Do you prescribe herbal remedies in your clinical practice?

The interesting thing is that in Canada, there are no regulations. There is no prescription for these [compounds], and anybody can pick them up anyplace. This is a major problem. Based on evidence, I cannot ethically prescribe or suggest the use of a botanical or herbal treatment because the evidence [that they work] is not there. But if a patient is interested, I will then work with the patient and make suggestions based on the best available evidence of which ones they should be on.

The problem I have is that there are literally thousands of these botanicals available on the Canadian market either via the health food store, the pharmacy or the Internet. Many of these compounds are not legitimate. They do not contain what they say they contain, or the product is not durable and stable. So it's sometimes "buyer beware." I do suggest to my patients that they obtain their supply from a reputable source and investigate the source. We've done that as well, and many times have come up with a product lacking in many of the attributes we'd like to see in a good product.

But there are some very good companies in Canada and North America who produce herbal preparations that do contain what they're supposed to contain, and if they do what they're supposed to do, then they'll be very helpful to the patient. But until the evidence is actually there, it's really unethical for a physician to suggest taking something just based on anecdotal information and case reports.

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