Turn over a new leaf

Herbal medicine is booming as patients lose faith in modern drugs. And finding the right cure will soon be a whole lot easier. By Jerome Burne

Nearly 40 years ago, Margaret Weesz, who had arrived in England from Hungary at the end of the Second World War, was being plagued by arthritis. It ran in the family. Her mother had it, her sister had it and now it was beginning to trouble her. Since her husband was a GP and kept up with the latest medical developments, she had a series of gold injections. "We would read the British Medical Journal and it said that gold injections had been tested," she says in her charming Zsa Zsa Gabor accent. "They were the latest and best thing for arthritis. But a few years later, the journal said they were very dangerous and left deposits on the joints. I had to find something else that worked, so I took a tip from a friend and went to Italy."

Weesz is talking in her light, airy shop just off King's Road, Chelsea, lined with attractive green and white packages of herbs that come from the Italian connection she made on that 1970s trip. Going in search of an alternative cure in 1970 was a distinctly odd thing to do. Thirty-five years later, it's something most arthritis sufferers do, especially after the latest medical volt-face on a recommended treatment - the Cox-2 inhibitor, Vioxx - which turned out to double the risk of heart attacks.

Despite official warnings that herbal and other natural cures are untested, and may not be as safe as people think, those risks are minuscule compared with the damaging side-effects of aspirin-like drugs (NSAIDS), the medical standby for arthritis. These drugs have been estimated to cause 2,600 deaths a year in the UK from gastrointestinal bleeding.

For Weesz, at least, the herbal option has been remarkably effective and side-effect free. At the age of 86, her only muscle and joint problem is that she's not quite as good at digging her garden as she used to be. What's more, places like her shop - Cornucopia, founded in the 1970s - were supposed to have withered away before the onward march of modern scientific medicine. But now she finds herself in one of the major growth areas in health care.

Earlier this year, the Archives of Internal Medicine reported that the use of alternative medicines, "particularly herbal products", has increased considerably in the past decade. Rather than replacing herbs, the damaging side-effects of modern drugs for chronic conditions, such as arthritis, HRT and depression, have driven millions to try them as a gentler, safer alternative.

Weesz is now the best possible recommendation for them; energetic and humorous, she could pass as 20 years younger. "Such a dear boy," she says gesturing after the young man from the nearby pizza restaurant, who has just brought us a cup of coffee. "I am the queen of this road, you know," she declares, embarking on a story about how she raised £6,000 pounds from various rich, local friends to pay for Christmas lights on the street.

At a time when registration, testing and proper controls are seen as the way forward for herbal medicine, Weesz is a throwback to an earlier, more charming age. While the Italian imported herbs she sells are grown organically and pass stringent inspections, the language of "controlled trials", "placebos", "double blinding" and all the other tools of modern scientific herbalism don't feature in her vocabulary. How does she know her remedies work? "Of course they do," she says. "Only the other day a man who lives just off the Embankment came in. He is very rich, but very sad. I give him my remedy for depression and three days later he puts his head through the door. 'I'm happy,' he shouts." And there are many more tales along the same lines.

Ironically, she won't sell the one herb that has more evidence for its effectiveness than any other - St John's wort for depression. "I don't do it," she says, "because it doesn't suit everybody; some have a wrong reaction. I don't like to harm anybody, so I removed it." The mixture she sells - £7 for a month's supply - contains, among others, fenugreek, rosemary and garden rue.

She also spurns the phytoestrogens (chemicals in plants which act like oestrogen), which have recently been the mainstay of herbal approaches to the menopause, preferring instead a mix of eight traditional herbs including sage, mistletoe, parsley and eucalyptus. "If you use my combination, you will start making the oestrogen," she claims. Although she has built up a lot of experience over the years, Weesz makes it clear that she isn't a trained medical herbalist. What she sells are packages made up by experts in Italy.

Weesz's highly individualistic approach would be an anathema to the likes of Professor Edward Ernst of Exeter University, who regularly warns about the potential dangers of herbs and the need for proper testing. Only recently, in response to a booklet on complementary and alternative medicine put out by the Prince of Wales Foundation for Integrated Health, he allowed that there was evidence that some herbs were effective, but warned: "Whether the UK traditional herbalist approach of prescribing individualised herbal mixtures to patients is effective is far less certain."

It is, of course, worth testing herbs for efficacy - and research on a small scale is going on - and putting the issue of harm into perspective. The Medicines and Healthcare products Regulatory Agency (MHRA) - the government group responsible for regulating UK medicines, including herbs - says "between 2000 and August 2004, there were 451 reports of suspected adverse reactions involving herbal preparations, of which 152 were serious."

By way of comparison, consider this from a report in the British Medical Journal last year: "In England alone, reactions to drugs that led to hospitalisation followed by death are estimated at 5,700 a year and could actually be closer to 10,000." Herbs may not be completely safe, as critics like to point out, but they are a lot safer than drugs. Herbs can also interact with drugs, such as those between St John's wort and the cancer drug Gleevec, or Echinacea and treatments for leukaemia, and, again, interactions between herbs and drugs are rarely as damaging as drug-drug interactions.

The use of herbal medicine is still regularly attacked for being unscientific, but its rise in popularity during the past decade - the American market is currently estimated to be worth more than $4bn (£2.16bn) - has not been driven by some hysterical collective flight from reason, but by a perfectly rational concern about the dangers of modern drugs and their irresponsible marketing.

In fact, several of the remedies on Weesz's shelves stand as a silent reproach to the over-hyped claims for the safety and effectiveness of drugs to treat certain chronic disorders. Research shows that many patients feel anxious about taking drugs for years, and if they do need long-term medication, they prefer one that may be milder but has fewer side-effects.

Just as the hazards of Vioxx and NSAIDS have prompted people to seek alternative ways to treat arthritis, so recent revelations about the potential dangers of SSRIs, which include suicide, have led to renewed interest in gentler treatments for depression. Similar concerns about drug treatments for the menopause (increase risk of cancer, heart disease and strokes), insomnia (addiction to barbiturates) and Alzheimer's (little or no benefit from drugs, plus significant side-effects) have also steered customers through Weesz's doors.

As a result of these popular concerns, the traditional world of herbal medicine is currently undergoing a huge upheaval. "In five years' time, the whole herbal scene will look quite different," says Dick Middleton, the chairman of the British Herbal Medicine Association. "Shops will be carrying an even bigger range of single herb treatments for "self-limiting clinical conditions" like headaches or allergies - but with the big difference that the wording on the packaging, instead of being deliberately vague, will make specific claims about what they are intended to treat." In parallel, licensed medical herbalists will still be allowed to make up combinations of herbs that their training informs them will help an individual patient. "I think we will see a lot more medical herbalists working closely with GP's practices," Middleton says.

All of this is the result of the new EU directive on traditional herbal medicinal products, which came into force last April. It will allow traditional herbs - in use for more than 30 years - to be sold without extensive testing, but it will require the suppliers to be licensed to ensure quality and safety. A new Herbal Medicines Advisory Committee is being set up to advise the MHRA.

Some of the finer details of the new system have yet to be ironed out, but Weesz is not worried. "The legislation does not apply to me," she says. "I am traditional. I will be the only one left, because I am the answer for the NHS. But I tell you too many jokes."

Pelargonium sidoides

* A root from a species of geranium, this is a traditional South African treatment for respiratory-tract infections (coughs, colds, sore throats). Placebo-controlled trials found it to be effective against a form of tonsillitis and to shorten the duration of the illness in children and adults.

Ginkgo biloba

* Studies have shown that the leaves can help with Alzheimer's. Last month, a small, placebo-controlled study of 20 patients at the Oregon Health and Science University School of Medicine showed that it helped multiple sclerosis patients with "cognitive impairment".

Curry leaf tree

* Scientists working at King's College London have discovered that the curry leaf tree, which is used in traditional Indian medicine, can affect the action of the digestive enzymes that break down dietary starch into glucose.

Black cohosh

* Widely taken as a treatment for the menopause, recent research has found that this herb works not by mimicking the effects of oestrogen (as had been assumed) but by boosting levels of the feel-good chemical serotonin in the brain.

Garlic and devil's claw

* These treat rheumatoid arthritis. A study expressed concern about herbal remedies that could interact harmfully with treatments like NSAids (aspirin-type drugs), leading to increased gastrointestinal bleeding. But the herbs don't cause the bleeding, it's adding the aspirin.

Sage

* Researchers at Newcastle have shown that this herb, traditionally given for memory problems, can inhibit the enzyme responsible for breaking down the brain chemical acetylcholine, which is deficient in Alzheimer's. Drug treatments also target this enzyme.

St John's Wort

* This is not only more effective in the treatment of moderate to severe depression than the SSRI Seroxat, according to the British Medical Journal, but it also has fewer side-effects. Trials have found it also to be effective for mild to moderate depression.