• P-ISSN 0973-7200 E-ISSN 2454-8405
  • Follow us

Journal of Pharmaceutical Research

Article

Scope and Bottlenecks in Clinical Trials of Herbal Drugs - Present Scenario
  • VIEWS 916
  • PDF 262

Journal of Pharmaceutical Research

Year: 2015, Volume: 14, Issue: 1, Pages: 26-32

Original Article

Scope and Bottlenecks in Clinical Trials of Herbal Drugs - Present Scenario

Abstract

Purpose: This communication highlights the scope of clinical trials in herbal drugs and various problems being faced by herbal drug scientists, herbal drug industry in development of new herbal products that have to undergo clinical trials in all the countries to enhance global acceptance.Social Implications: Herbal drugs have been used since ancient times as medicines for the treatment of different diseases. It is the oldest and most popular form of healthcare practice known to humanity for maintenance of health that has been practiced by the people of all the societies throughout the history of evolution. Herbal medicines are also known as "the people's medicines" because of their easy accessibility, safety, ease of availability and self medication. Particularly in countries like India, many of herbal drugs and formulations are used in different practices of treatment like Ayurveda, Siddha and Unani.Research Implications: It is expected that more than 25% of all modern medicines are directly or indirectly derived from plants sources yet the contribution of developing countries in global herbal business is very poor due to lack of quality control and standardization measures. There is lack of common standards and appropriate methods for evaluating Traditional Medicine to ensure safety, ef?cacy and quality control. This indicates the importance and requirement to develop a standard operational procedure for the standardization of herbal drugs and formulations.Original value: Quality control, quality assurance, safety and ef?cacy of herbal drugs are the bench mark in the evaluation protocols and that would play a major role in providing highly reliable and effective herbal drugs to attract international trade, thus generating returns.Approach: For this study internet search engines and various documents available for drug regulatory affairs were screened. Problems faced by different scientist groups were analyzed and compiled from internet sources.Findings: The study highlights a very good scope of clinical trials in herbal drugs. It also highlights stringent guidelines for conduct of clinical trials in herbal drugs that needs little bit relaxation by regulatory agencies.Conclusion: The conclusion drawn from this review is that presently developing countries lack the necessary guidelines for clinical trials on Ayurvedic/natural/herbal medicines. If the WHO guidelines can be adopted in developing countries to approve clinical studies without the need for stringent safety data, clinical trials on Ayurvedic medicine can be encouraged to be at par with pharmaceutical products.

References

  • Sharma AK, Kumar R, Mishra A, Gupta R. Problems associated with clinical trials of ayurvedic medicines. Rev Bras Farmacogn. 2010; 20(2): 276-81.
  • Bansal D, Hota D, Chakrabarti A. Research methodological issues in evaluating herbal inventions. J Clin Trials. 2010; 2: 15-21.
  • Brevoort P. The U.S. botanical market.An overview. Herbal Gram 1995; 36: 49-59.
  • Calixto JB. Ef?cacy, safety, quality control, marketing and regulatory guidelines for herbal medicines (phytotherapeutic agents). Braz J Med Biol Res. 2000; 33: 179-89.
  • Wagner H. Phytomedicine Research in Germany.Environ Health Perspect. 1999; 107: 779-81.
  • WHO Traditional Medicine Strategy 2002�2005.Geneva: World Health Organization; 2002.
  • Mills S. Herbal medicine. In: Lewith GT, Jonas WB, Walach H, editors. Clinical Research in Complementary Therapies: Principles, Problems and Solutions. Elsevier Science: 2003; p. 211�27.
  • Shiapush M. Postmodern values, dissatisfaction with conventional medicine and popularity of alternative therapies. J Sociol. 1998; 34: 58-70.
  • MacLennan AH, Wilson DH, Taylor AW.Prevalence and cost of alternative medicine in Australia. Lancet. 1996; 347: 569-73.
  • Robbers JE, Tyler VE. Tyler's Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York: The Haworth Herbal Press; 1999, p. 124-58.
  • Tapsell LC, Hemphill I, Cobiac L, Patch CS, Sullivan DR, Fenech M et al. Health bene?ts of herbs and the past, the present, the future. Med J Aust. 2006; 185 (4): S4-24.
  • Fisher P, Ward A. Complementary medicine in Europe. Brit Med J. 1994; 309: 107-11.
  • Straus S. Herbal medicines - What's in the bottle?New Engl J Med. 2002; 347: 1997�8.
  • WHO Operational guidance: Information needed to support clinical trials of herbal products.Geneva: World Health Organization; 2005.
  • Vaidya RA, Vaidya ADB, Patwardhan B, Tillu G, Rao Y. Ayurvedic pharmacoepidemiology: a proposed new discipline. J Assoc Physicians India. 2003; 51:528-9.
  • Thatte UM, Rege NN, Phatak S, Dahanukar SA.The ?ip side of Ayurveda. J Postgrad Med. 1993; 39: 179-82.
  • Eisenburg DM, Davis RB, Ettner SL, Appeal S, Wilkey S, VanRompay M et al. Trends in alternative medicine use in the United States, Results of a follow-up national survey. JAMA.1998; 280: 1569�75.
  • Robert BS, Stefanos K, Janet P, Michael JB, David ME, Roger BD et al. Heavy Metal Content of Ayurvedic Herbal Medicine Products. JAMA.2004; 292: 2868-73.
  • Bhattaram VA, Graefe U, Kohlert C, Veit M, Derendorf H. Pharmacokineticsand bioavailability of herbal medicinal products.Phytomedicine. 2002; 3: 1-33.
  • Chaudhary R, Chandrashekharan M, Mishra S.Embryotoxicity and teratogenicity studies of an ayurvedic contraceptives-pippalyadi vati. J Ethnopharmacol. 2001; 74: 189-93.
  • Chan K. Some aspects of toxic contaminants in herbal medicines. Chemosphere. 2003; 52: 1361-71.
  • Fugh-Berman A. Herb-drug interactions. Lancet.2000; 355: 134�8.
  • Bauer R, Tittel G. Quality assessment of herbal preparationsasapre condition of pharmacological and clinical studies. Phytomed.1996; 2: 193�8.
  • Thatte UM. Clinical resaerch with ayurvedic medicines. Pharma Times. 2005; 37: 9-10.
  • Shukla NK, Narang R, Nair NGK, Radhakrishna S, Satyavati G. Multicentric randomized controlled clinical trial of Kshaarasootra (Ayurvedic medicated thread) in the management of ?stula-in-ano. Indian J Med Res. 1991; 94: 177�85.
  • Armstrong NC, Ernst E. The treatment of eczema with Chinese herbs: A systematic review of randomized clinical trials. Brit J Clin Pharmacol.1999; 48: 262�4.
  • Leung PC. Complementary Medicine. In: Machin D, Day S, Green S, editors. Textbook of Clinical Trials. First edition. Chichester: John Wiley & Sons; 2004; 63�84.
  • Ernst E, Siev-Ner I, Gamus D. Complementary medicine: a critical review. Israel J Med Sci. 1997; 33: 808�15.
  • Zhang ZN, Liu EK, Zheng TL, Li DG. Treatment of chronic myelocytic leukemia (CML) by traditional Chinese medicine and western medicine alternately. J Tradit Chin Med. 1985; 5: 246�8.
  • Kirsch I. How Expectancies Shape Experience.1st ed. Washington DC: American Association; 1999.
  • Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978; 88: 251�8.
  • Moerman DE, Jonas WB. Toward a research agenda on placebo. Adv Mind Body Med. 2000; 16: 33�46.
  • Black N. Why we need observational studies to evaluate the effectiveness of health care. BMJ.1996; 312: 1215�8.
  • Bian ZX, Li YP, Moher D, Dagenais S, Liu L, Wu TX et al. Improving the quality of randomized controlled trials in Chinese herbal medicine, part i: clinical trial design and methodology. J Chin Integr Med. 2006; 4(2): 120�9.
  • Gagnier JJ, Boon H, Rochon P, Moher D, Barnes J, Bombardier C. Reporting randomized, controlled trials of herbal interventions: An elaborated CONSORT Statement. Ann Intern Med. 2006; 144(5): 364�7.
  • Schulz KF, Grimes DA. Sample size calculations in randomized trials: mandatory and mystical.Lancet. 2005; 365: 1348�53.
  • Rothman KJ, Michels KB. The continuing unethical use of placebo controls. N Engl J Med.1994; 331: 394-8.
  • Sheehan MP, Rustin MH, Atherton DJ, Buckley C, Harris DW, Brostoff J et al. Ef?cacy of Chinese herbal therapy in adult atopic dermatitis. Lancet. 1992; 340: 13�17.
  • Palevitch D, Earon G, Carasso R. Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: a double-blind placebocontrolled study. Phytother Res. 1997;11:508 -11.
  • Sheehan MP, Atherton DJ. One year follow up of children treated with Chinese medicinal herbs for atopic eczema. Br J Dermatol. 1994; 130: 488�93.
  • Howard KL, Orlinsky DE, Perilstein J. Contribution of therapist's to patient's experiences in psychotherapy: a components of variance model for analyzing process data. J Consult Clin Psychol. 1976; 44: 520�6.
  • Mason S, Tovey P, Long AF. Evaluating complementary medicine: methodological challenges of randomised controlled trials. BMJ. 2002; 325: 832�4.
  • Schnyer RN, Allen JJB. Bridging the gap in complementary and alternative medicine research: manualization as a means of promoting standardization and ?exibility of treatment in clinical trials of acupuncture. J Alternat Complement Med. 2002; 8: 623�34.
  • Sale JEM, Lohfeld LH, Brazil K. Revisiting the quantitative�qualitative debate: implications for mixed-methods research quality and quantity. Quality and Quantity. 2002; 36: 43�53.
  • Bower H. Double standards exist in judging traditional and alternative medicine. British Medical Journal. 1998; 316: 1694-5.
  • Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978; 88: 251�58.
  • Linde K, Berner M, Egger M, Mulrow C. St. John's wort for depression : meta - analysis of randomised controlled trials. Br J Psychiatry. 2005; 186: 99�107.
  • Jonas WB, Linde K. Conducting and Evaluating Clinical Research on Complementary and Alternative Medicine. In: Gallin JI, editor. Principles and Practice of Clinical Research. San Diego: Academic Press; 2002, p. S 401�26.
  • Spencer JW, Jacobs JJ. Complementary and Alternative Medicine: An Evidence-Based Approach. Elsevier Science; 2003.
  • Grunwald J. The European phytomedicines market: ?gures, trends, analysis. Herbal Gram. 1995; 34: 60-65.

DON'T MISS OUT!

Subscribe now for latest articles and news.