Green Tinted Glasses

Social media’s impact on the popularity of “natural” products has been significant – and CBD is far from the exception to the rule. The increased demand in sales and supply of herbal remedies over the past few years is an example of how people are starting to reconsider natural products. I like to think that they are “coming back into fashion.”

I recently published a paper surveying public perception of CBD globally. A wide range of responses were recorded, including some in favor and others sceptical of the use of CBD. Some participants reported a willingness to try CBD products because they were seeking a more holistic lifestyle or because of promotions they had seen on social media; others shared concerns about the lack of regulation of CBD products, especially as they were often sold as food supplements and not medicines. The need for more research and evidence to demonstrate the safety and efficacy of CBD was highlighted (1).

Naturally, we asked an important question: is lack of clinical evidence on safety and efficacy actually deterring use? For some people, the answer was yes. If there was more information to facilitate the safe use of CBD based products it would be well received. Improved clinical evidence is not only required for users/the public, but also healthcare professionals, who do not have sufficient knowledge of how herbals interact with conventional medicines so often advise against their use. On the other hand, those who are interested in natural products – based on traditional use – will not be affected by the lack of clinical evidence. 

It is important to remember that natural products were being used long before conventional medicines were developed. Certainly, many talented and inventive people are responsible for the advances that make up modern medicine. But, as a society, I feel we have become so driven by evidence-based medicine, guidelines, and accountability that our freedom to explore natural products has been restricted. Where once nature provided well-known remedies, we now rely entirely on pharmaceutical intervention.

There are three reasons behind this almost complete shift away from natural products. The first is access; those products that are native to some countries are not always easy to find in others – tulsi (also known as holy basil, Ocimum tenuiflorum L.) is an example of this. Closely related to basil, tulsi has been used for various ailments, including asthma, eczema, and diabetes, in Southeast Asia. Here in the UK, tulsi is less common, but seeds are now exchanged within communities who have found ways of successfully growing this native Indian plant (2).

The second reason is cost. It is only with the introduction of the National Health Service (NHS) and free access to healthcare for all that people began seeking medical advice and with it, a prescription, as opposed to seeking a natural solution. With standardized dosing, formulations and prescribing guidelines, we have seen a transition away from nature’s pharmacy and instead, a reliance upon cheaper (or free) mass-produced medicines. The third reason is knowledge – or lack thereof. Often, healthcare professions disregard the use of natural products – even going as far as to advise patients against their use, because of unknown herb-drug interactions (3). If we don’t fully understand the pharmacological effects of natural products – and if the evidence base and clinical guidelines are lacking – it’s a clear problem.

As a healthcare professional, I had very limited training on natural products during my undergraduate training. Now, as an academic training the next generation of healthcare professionals, I can see the problem still exists. The answer is simple in theory, but difficult in practice. We need better education for healthcare professionals and the public, more clinical evidence, and better regulation surrounding natural products. Only by addressing all three areas will we see traditional and conventional medicines used in a safe and effective manner.