therapeutic effect. Homeopathic medicines are
available with and without prescriptions. Homeo-
pathic prescribing resembles orthodox, if histori-
cal, prescribing. Homeopathic drugs are identified
using the Latin terms for the (usually alkaloid)
starting materials, and a set of apothecaries’ sym-
bols for dose size, dose frequency and the number
of dilutions required before dispensing. In the
United Kingdom, homeopaths are regulated by
law, and there is aFaculty of Homeopathywithin
the Royal Colleges in an analogous manner to the
Faculty for Pharmaceutical Medicine. Associate
members of the Faculty of Homeopathy may
include any clinician with statutorily registered
qualifications; theLicenceof the Faculty is avail-
able by examination, again to all clinicians, usually
after study at any of five nationally recognized
homeopathic colleges.Membershipof the Faculty
is by examination and restricted to medical practi-
tioners, and dental and veterinary surgeons;Fel-
lowsare selected from among the more prominent
members. The Royal Household includes one or
more homeopathic practitioners.
30.2 Common complementary
medicinesThe nine most commonly used complementary
medicines that are in use in most of Europe and
North America are derived from St. John’s Wort,
Saw palmetto,Gingko biloba, Black cohosh, glu-
cosamine/chondroitin, SAM-e, Ephedra, Ginseng
and Kava. Although there is a certain amount of
contemporary fashion that seems to govern which
products sell best, all have a long tradition in
complementary therapy.
The popularity of these preparations has caused a
serious blight to the natural populations of some of
the plant species in which they are found (espe-
ciallyPanax ginseng, Cimicifuga racemosa and
Kava kava). The World Health Organization
(WHO) has issued guidelines on good agricultural
and collection practices for many of these species.
Cultivationofthese speciesonnonnative continents
can seriously harm the tenuous economies of the
original suppliers, who usually live in underdeve-
loped countries. For example, Harpagophytum
procumbens(or Devil’s Claw, used for arthritis)
was originally sourced from Namibia in quantities
of about 200 tonnes per annum; foreign competi-
tion has driven down the price paid to its African
growers by about 85% in the last 10 years, accord-
ing to the WHO (Anonymous, 2004).
These complementary medicines are not with-
out adverse effects (Tomlinsonet al., 2000 and see
below).
Extracts of St. John’s Wort(Hypericum perfora-
tum) are used for the prevention of migraine,
depression and anxiety. The clustering of indica-
tions for neurological purposes suggests that it
contains an active alkaloid or alkaloid mixture.
The remittent, relapsing nature of these diseases
make assessment of the limited reports of its effi-
cacy difficult, but there are one or two fairly sound
papers concerning migraine and depression. Most
formulations of St. John’s Wort can reduce rates of
absorption of antiviral drugs. Serotoninergic drugs
(antimigraine agents, antidepressants, whether
serotonin-specific uptake blockers or not) ought
to be most likely to interact with St. John’s Wort,
while, on its own, St. John’s Wort can cause photo-
sensitivity. Pharmaceutical physicians should
investigate herbal drug use whenever this unusual
adverse event arises (see also kava, below).
Saw palmetto(Palmito caroliniensis)is the State
tree of South Carolina, being the only palm indi-
genous to the east coast of North America. Its seeds
(which are used to derive the pharmaceutical) are
rich in fatty acids, their esters and sterols. The
extract of these seeds is recommended for mild
symptoms referable to the prostate, without any
pharmacological rationale. A recent clinical trial
has confirmed the uselessness of Saw palmetto for
this indication (Bentet al., 2006), and, further-
more, the danger is that patients will use the pro-
duct to temporize for symptoms that could lead to
an earlier diagnosis of malignancy. The doses
administered are usually insufficient to reduce the
absorption of oral fat-soluble drugs, but it would
seem wise to separate the administration of vitamin
D, warfarin and so on, and this lipophilic comple-
mentary therapy.
Ginko extract:The robust treeGingko bilobahas
remained essentially unevolved for far longer than
almost all other tree species. For this reason it is30.2 COMMON COMPLEMENTARY MEDICINES 389