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Published Date: 2009-10-14 22:02:51
Subject: PRO/MBDS> Chemical contamination, herbal medicine - Viet Nam: Hanoi
Archive Number: 20091014.3546

CHEMICAL CONTAMINATION, HERBAL MEDICINE - VIET NAM: HANOI
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Date: Tue 13 Oct 2009
Source: Viet Nam News (VNS) [edited]
<http://vietnamnews.vnagency.com.vn/showarticle.php?num=01HEA131009>

Herbal medicines threaten health, pocket
----------------------------------------
People who take traditional herbal medicines without professional
supervision are in danger of suffering long-term health problems and
costly treatments.

The warning comes from the Bach Mai Hospital's Detoxification Centre
director Pham Due following the admission of up to 8 patients a month
with complications from traditional herbal treatments.

One of the patients, 35, was prescribed a herbal medicine to help her
conceive a baby. What she did not tell the practitioner was that she
was a hepatitis patient.

After 10 days of taking the herbal medicine she fell ill and was
rushed to the Bach Mai centre in serious condition.

Due also related the case of a 4-year-old child who was brought to
the centre unconscious after having been given a herbal medicine for
his epilepsy. Tests showed he had been poisoned with high levels of
arsenic, mercury, and lead. The child would be in hospital for a year
but his brain was permanently damaged, she said. "He will never be
normal again," Due said. "He has less memory, his speech is affected,
and he can never go to school again."

Due said traditional medicines were not necessarily safe, as many
contained toxins. They should only be taken on prescription from a
qualified and experienced practitioner.

Dr Due warned that treating someone who had been poisoned by
so-called traditional medicines was not only difficult, it was also costly.

A patient with acute hepatitis could have to pay hundreds of millions
of dong for treatment and end up suffering symptoms for the rest of
his or her life, she said.

Due urged people to think carefully before taking such medicines or
giving them to others.

National Traditional Medicine Institute doctor Le Ngoc Diep said
arsenic was extremely toxic but it was an ingredient in some
traditional medicines. Diep said only experienced doctors could make
a safe prescription containing arsenic without poisoning the patient.

In fact, there were good herbal prescriptions to treat deadly
diseases, handed down from traditional healers, she said.

"It's important to have a detailed diagnosis of the problem for the
prescription."

However, she said, instead of visiting a qualified practitioner with
a good reputation or a registered clinic or hospital for their
traditional treatment, they went by word-of-mouth and chose other ways.

"The poisoning cases resulted when practitioners were inexperienced
and unqualified to prescribe or the patients themselves bought herbal
medicines without advice or prescription," Diep said.

Viet Nam Association for Traditional Medicine member Vu Quoc Trung
said herbal medicines were rarely used in isolation, except for ginseng.

"But combining medicines was fraught and inexperienced practitioners
could put their patients' lives in danger," Trung said.

They could choose a deadly poisonous leaf to cure a disease, he said.
Even a qualified practitioner was liable to make that mistake because
there were similarities between some curative and toxic herbs.

Diep said another problem was the overuse of fertiliser. Residues
could poison patients.

Also, she said, herbal medicines were preserved using sulphur which,
if added in larger quantities than necessary by people not certified
for the job, could be rendered poisonous.

Ha Noi Health Department deputy director Nguyen Van Yen said the
herbal medicine sector was out of control.

Under regulations, a herbal medicine practitioner must have a licence
from the Department of Health before opening a traditional clinic.

Their "handed-down" medicines must also be registered with the
department and used only in the clinic, he said, and all the medicine
sources or origins had to be recorded.

However, it was proving difficult to police the situation because
there were only 3 inspectors to deal with many traditional medicine
shops in the city.

Ly Duy Khuong, deputy chairman of Ninh Hiep Village, the biggest
source of herbal medicines for Ha Noi, said there were more than 200
households trading and prescribing traditional medicines, but only 30
were registered.

The licensing of traders and practitioners in the traditional village
was problematic as they were born into the field.

"We used to open a class to train them and give them information
about the medicines, then provide them with operator certificates,
but most of them ignored the class," Khuong said.

"They think their own technique is good and has been handed down, so
they don't need training."

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[Herbal medicine is a traditional or folk medicine practice based on
the use of plants and plant extracts. Herbal medicine includes the
use of fungal and bee products, minerals, shells, and some animal
parts. Many plants synthesize useful substances for maintenance of
health in humans and other animals. Herbs are commonly used to treat
disease in non-industrialized societies.

The World Health Organization (WHO) estimates that 80 percent of the
world's population presently uses herbal medicine for primary health
care. Herbal medicines currently used as pharmaceuticals include
opium, aspirin, digitalis, and quinine. However, self-usage of herbal
medicine is not safe due to lack of standardization on purity and
dosage. In addition, some herbal medicines are contaminated with
chemicals such as arsenic, mercury, lead, and sulphur, used as
preservative and to improve efficacy.

Arsenic is a naturally occurring and widely distributed element. It
is odorless and tasteless. Arsenic and its compounds are used as
pesticides, herbicides, insecticides, and in various alloys. Symptoms
of exposure to lower levels of arsenic include nausea and vomiting,
decreased production of red and white blood cells, abnormal heart
rhythm, damage to blood vessels, and a sensation of pins and needles
in hands and feet. Breathing high levels of inorganic arsenic can
cause sore throat or irritated lungs. Death can occur by ingesting
very high levels of arsenic (see
<http://www.atsdr.cdc.gov/tfacts2.html#bookmark02>).

Mercury is a naturally occurring shiny, silver-white, metal that is a
liquid at room temperature. Metallic mercury is used in chlorine gas,
caustic soda, thermometers, dental fillings, and batteries. Mercury
salts are sometimes used in skin lightening creams, and as antiseptic
creams and ointments. Symptoms of poisoning are peripheral
neuropathy, skin discoloration, muscle weakness, tremor, dermatitis,
and mental disturbances. Death may occur with high exposure to
metallic mercury (see
<http://www.atsdr.cdc.gov/toxprofiles/tp46.html#bookmark06>).

Lead is a naturally occurring bluish-gray metal found in small
amounts in the earth. Lead is used in batteries, ammunition, metal
products, and devices to shield X-rays. Lead poisoning can cause high
blood pressure, anemia, learning disabilities, mental retardation,
seizures, coma, miscarriage, reduced sperm production, and even death
(see <http://www.atsdr.cdc.gov/toxprofiles/phs13.html>).

Selected references
-------------------
1. Smolinske SC. Herbal Product Contamination and Toxicity. Journal
of Pharmacy Practice, Jun 2005; 18: 188-208 (abstract available at
<http://jpp.sagepub.com/cgi/content/abstract/18/3/188>).
2. Ernst E. Toxic heavy metals and undeclared drugs in Asian herbal
medicines. Trends Pharmacol Sci, Mar 2002; 23(3): 136-9 (abstract
available at <http://www.ncbi.nlm.nih.gov/pubmed/11879681>).
3. Dasgupta A. Review of Abnormal Laboratory Test Results and Toxic
Effects Due to Use of Herbal Medicines. Am J Clin Pathol, Jul 2003;
120: 127-37 (full article available at
<http://ajcp.ascpjournals.org/content/120/1/127.full.pdf+html>).
4. Ernst E. Serious psychiatric and neurological adverse effects of
herbal medicines -- a systematic review. Acta Psychiatr Scand, Aug
2003; 108(2): 83-91 (abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/12823164>).
5. Poppenga RH. Herbal medicine: potential for intoxication and
interactions with conventional drugs. Clin Tech Small Anim Pract, Feb
2002; 17(1): 6-18 (abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/11890130>).

For a map of Viet Nam with provinces, see
<http://en.wikipedia.org/wiki/File:VietnameseProvincesMap.png>. The
interactive HealthMap/ProMED-mail map with direct links to other
outbreaks in Viet Nam and surrounding countries reported on
ProMED-mail and PRO/MBDS can be accessed at
<http://healthmap.org/r/00a9>. - Mod.YMA]

See Also