ABSTRACT
Title
An investigation on the perception of the risk on the use of medicinal plants commonly used and sold by herbalists in Tuscany
Authors
1E. Gallo, 1E. Lucenteforte, 1S. Harrison, 1M. Di Pirro, 1M. Moschini, 1,2L. Gori, 1,2V. Mascherini, 1,2F. Firenzuoli,1,2A. Mugelli, 1,2A. Vannacci
1 University of Florence, Department of Pharmacology, CIMMBA, Florence
2 Centre for Integrative Medicine, Careggi General Hospital, University of Florence
1 University of Florence, Department of Pharmacology, CIMMBA, Florence
2 Centre for Integrative Medicine, Careggi General Hospital, University of Florence
Abstract
BACKGROUND: The herbalist represents a professional figure that is responsible for educating and making sure that the patient uses correctly medicinal plantsThe objective of the present study was to evaluate the perception of the risk from the herbalists on the use of plants generally used and sold in the herbalist's shops.
METHOD: The investigation was conducted “de visu” by means of a questionnaire. For each product/plant (Allium, Aloe gel, citrus aurantium, Cimicifuga, Escolzia., antraquinones laxatives, propolis, echinacea, Harpagophytum and Ginseng) and for some specific effects on intestinal disturbances, hepatic damage, gastritis, cardiac damage, drowsiness, neurological damage and allergy. The herbalist was asked to indicate the exact proportion of risk across a simple Visual Analogic Scale, reproduced graphically along 10 cm. In this study 159 in 185 herbalists assisted in the inquiry. A group formed by 10 experts in this area was used as a control group. The values on the VAS scale were then categorized into 3 levels of risk: low, middle and high (low: <3, 3; middle: ≥3.3-<6.6; High: ≥ 6.6). The category variables were presented as numerosity and percentage. A p-value of <0.05 was considered statistically significant. The data was evaluated by the differences of the perception of the risk as part of the herbalist in respect to the control group, and the data was subsequently divided into groups of herbalists based on their title of study and the number of years at work in this area.
RESULTS: The herbalists in this study considered plants and natural products more secure in respect to other experts, in exception to plants containing antraquinones. Nevertheless, such differences were not statistically significant. The final analysis which was carried out confronts the response of the herbalists based on their title of study and years of experience in this area, emphasizing the perception of risk against the graduated herbalist against herbalists with less years of work experience, and these differences resulted statistical significant relative to Ginseng and to plants that contained antraquinones. For how much it is worth Garlic, the herbalists showed a perception of the general (middle) risk but much lower in respect to the experts (Median: 2,1 and 4,6, respectively) and, even those there are the known unfavorable effects (gastritis and allergy). However, garlic remained as a low risk of onset of these symptoms. Furthermore, it emerged that the graduated herbalists and the herbalists with exception of 10-year-old of working experience had a perception of risk similar to that of the experts. For the Citrus aurantium the herbalists were perfectly in line with the experts, considering the general risk being middle of the plants (4.0 and 5.6, respectively) and recognized that the possibility that such plants could give unfavorable reaction to the load on the heart. Besides the perception of the risk of damage to the heart the graduated herbalists was identical to that of the experts, while that of the herbalists without a degree was inferior. There were differences between the herbalists who resulted with more than 10 years of working experience or less than 10 years. Finally, half of the herbalists interviewed reported to having had unfavorable reports of adverse reactions from actual customers.
DISCUSSION AND CONCLUSION: From the investigation it has emerged that the herbalists demonstrated a good knowledge of medicinal plants/natural products and associated risks. The herbalists demonstrated an inferior perception of risk to that of the Experts. Considering that from April 2002 to June 2010 only about 500 reports were obtained from the National Phytovigilance System, the discrete number of adverse reactions reported by the herbalist’s in this study demonstrates that a majority of the signals were generally omitted by herbalists.
METHOD: The investigation was conducted “de visu” by means of a questionnaire. For each product/plant (Allium, Aloe gel, citrus aurantium, Cimicifuga, Escolzia., antraquinones laxatives, propolis, echinacea, Harpagophytum and Ginseng) and for some specific effects on intestinal disturbances, hepatic damage, gastritis, cardiac damage, drowsiness, neurological damage and allergy. The herbalist was asked to indicate the exact proportion of risk across a simple Visual Analogic Scale, reproduced graphically along 10 cm. In this study 159 in 185 herbalists assisted in the inquiry. A group formed by 10 experts in this area was used as a control group. The values on the VAS scale were then categorized into 3 levels of risk: low, middle and high (low: <3, 3; middle: ≥3.3-<6.6; High: ≥ 6.6). The category variables were presented as numerosity and percentage. A p-value of <0.05 was considered statistically significant. The data was evaluated by the differences of the perception of the risk as part of the herbalist in respect to the control group, and the data was subsequently divided into groups of herbalists based on their title of study and the number of years at work in this area.
RESULTS: The herbalists in this study considered plants and natural products more secure in respect to other experts, in exception to plants containing antraquinones. Nevertheless, such differences were not statistically significant. The final analysis which was carried out confronts the response of the herbalists based on their title of study and years of experience in this area, emphasizing the perception of risk against the graduated herbalist against herbalists with less years of work experience, and these differences resulted statistical significant relative to Ginseng and to plants that contained antraquinones. For how much it is worth Garlic, the herbalists showed a perception of the general (middle) risk but much lower in respect to the experts (Median: 2,1 and 4,6, respectively) and, even those there are the known unfavorable effects (gastritis and allergy). However, garlic remained as a low risk of onset of these symptoms. Furthermore, it emerged that the graduated herbalists and the herbalists with exception of 10-year-old of working experience had a perception of risk similar to that of the experts. For the Citrus aurantium the herbalists were perfectly in line with the experts, considering the general risk being middle of the plants (4.0 and 5.6, respectively) and recognized that the possibility that such plants could give unfavorable reaction to the load on the heart. Besides the perception of the risk of damage to the heart the graduated herbalists was identical to that of the experts, while that of the herbalists without a degree was inferior. There were differences between the herbalists who resulted with more than 10 years of working experience or less than 10 years. Finally, half of the herbalists interviewed reported to having had unfavorable reports of adverse reactions from actual customers.
DISCUSSION AND CONCLUSION: From the investigation it has emerged that the herbalists demonstrated a good knowledge of medicinal plants/natural products and associated risks. The herbalists demonstrated an inferior perception of risk to that of the Experts. Considering that from April 2002 to June 2010 only about 500 reports were obtained from the National Phytovigilance System, the discrete number of adverse reactions reported by the herbalist’s in this study demonstrates that a majority of the signals were generally omitted by herbalists.