Herbal centres/clinics and manufacturers of various forms of herbal medicines, rely heavily on advertisements to keep their facilities and products running in Ghana.

This approach is necessitated by the inability to achieve full integration of herbal medicine practice into the health system to ensure the required acceptance of practice and patronage is achieved, despite all efforts made by successive governments in the past.

Full integration of science-based herbal medicine practice will ensure that the herbal clinic by law becomes part of the departments of all health institutions, with the necessary structure in place to ensure professional relations with existing members of the healthcare delivery system nationwide, and thus accepted by all with no stigmatizations, misconceptions and sabotage.

Attainment of full integration will also establish formidable standards of practice and standards for manufacture, marketing, and regulation of herbal medicines prescribed and sold over-the-counter.

It will ensure that practitioners of herbal medicine are trained in aspects of health sciences, and also all existing health professionals receive training in aspects of herbal medicines as part of their education, to understand how the herbal medicines work in order to foster good working relation.

Full integration is also needed for establishment and smooth running of private herbal hospitals and clinics to complement the services of anticipated herbal clinics existence as departments within Medical centres, without heavy reliance on advertisements whose components most of the time, contradicts the Public Health Act, 2012(Act 851) with regards to advertisements of health conditions or diseases.

Advertisements of herbal clinics or facilities indirectly advertises the  herbal medicines used as most herbal clinics or facilities produce their medicines unlike in orthodox practice that employs the use of generic medicines available under different brands depending on the pharmaceutical industries that manufactures the medicines.

Advertisements is usually achieved through radio, television stations, print media, community information centres, sales vans/cars, inter and intra city buses, social media, bill boards, among others.

Herbal medicine practice currently thrives in areas of management or treatment of chronic medical conditions and conditions that the orthodox medical system have not been able to manage or treat effectively, although the World Health Organization (W.H.O) recognizes that about 70% of people in developing countries rely on Herbal medicine for their primary healthcare needs.

The Public Health Act, 2012(Act 851) provisions forbids advertisements of cure or management of disease such as; epilepsy, paralysis, asthma, leprosy, cancer, hernia, kidney defects, tuberculosis, diseases of the heart, diabetes mellitus, infertility, mental disorders and impotency among others.

It has however been difficult enforcing this provision of the Public health Act, with the practice of herbal medicine mainly due to the inability to achieve full integration of clinical herbal medicine practice into the main health care delivery system in Ghana.

Herbal medicine practitioners continue to advertise cure for the above mentioned medical conditions and diagnostic equipment mainly on radio stations although a system exist that directs the Food and Drugs Authority (FDA) to vet all drug related adverts, jingles, or announcements before registration to ensure the content conforms to the already mentioned provisions prior to airplay.

It appears the FDA has turned “deaf ears” to such advertisements of herbal clinics and their product but rather enforces such provisions strictly with pharmaceuticals or orthodox medicines.

Such advertisements have serious effects directly and indirectly on state of health of individuals, especially the chronically ill ones.

Orthodox medicines employed in the management of the already mentioned disease conditions are prescription based implying that there is a management or treatment plan in place to monitor such patients by health professionals like medical Doctors, Nurses and Pharmacists, over a period of time with scheduled review times because of the unpleasant effects associated with such medicines and the critical nature of such illnesses.

This arrangement is also made by some practitioners of herbal medicine although the medicines have very reduced unpleasant effects.

Here, chronically ill patients are admitted into medical wards and extemporaneous preparations (fresh herbal preparations like concoctions) administered.

Success stories have been achieved by some herbal practitioners this way whiles others continue to take advantage of the challenge with enforcement of strict regulation of practice by extorting monies from chronically ill people( who perhaps are on prescribed orthodox medications) hoping to get well at all cost, through misleading advertisements.

The danger associated with advertisements of herbal treatment for management of chronic diseases and other disease conditions contained in the Public health Act (Act 851) is the fact that there is often no collaboration with orthodox counterparts when patients already on prescribed orthodox medicines are involved and vice versa, before usage.

There isn’t better understanding of practice and good referral system between practitioners of both practices, in the benefit of patients, especially the chronically ill ones. Such people who mostly are on prescribed orthodox medicines, upon exposure to advertisements of herbal treatment for their conditions patronize products and services of herbal centres without the knowledge and supervision from their orthodox practitioners.

Others choose to discontinue use of prescribed drugs and prepare concoctions of medicinal plants they are informed are good for their conditions by peddlers of herbal medicines in buses (in attempt to sell their medicines), and other people.

These persons in some cases, end up declining in their state of health drastically to an extent that they are rushed back to orthodox hospitals/referral centres with complications.

Complications diagnosed or uncovered may result from long time intake of the wrong herbal medicines for a disease condition, consumption of poorly produced herbal medicines (usually self- made decoctions and concoctions contaminated with heavy metals, and pathogens).

In other cases usage of unregistered products, usage of registered products without monitoring/review by Medical Herbalists or qualified practitioners, and combination of herbal medicines with prescribed drugs.

In other words, complications occurs in sick people (with history of herbal medicine usage) mainly from persistence of the underlining cause(s) of the disease from the already mentioned causes, and not usage of herbal medicines in general as being portrayed in orthodox medical practice.

Other complications are a result of the Combination of herbal medicines with prescribed drugs, a phenomenon known as Drug-herb interactions.

Drug-Herb interactions most of the time result from irrational advertisements of various dosage forms of herbal medicines as natural products with no side effects (even when taken with drugs).

It also occurs from usage of herbal products adulterated with drugs or pharmaceuticals. Herbal medicines and pharmaceuticals or drugs may both be used in a treatment plan when their pharmacokinetic profile (Absorption, Distribution, Metabolism, and Excretion) is known and well understood.

Knowledge of drug excretion from systemic circulation/body for instance is vital as it helps space out the herbal and orthodox medicines used together (in a treatment plan for a chronic disease) to avoid Drug-herb interactions.

This is currently being done by Herbal Medical Officers/Medical Herbalists at herbal medicine units/clinics in selected government health institutions nationwide on pilot basis since 2012.

Drug-herb interactions often result in loss of therapeutic effect or drug activity (Antagonism), toxicity, unexpected increase in pharmacological activity(Additive effect), an increase or decrease in the side effect, and new side effect(s) not previously known.

For example, the stimulant laxative Cascara bitter bark (Rhamnus purshiana, Cascara sagrada) interact with thiazide diuretics, resulting in imbalance of body electrolytes (which may potentiate drug toxicity), Garlic preparations (Allium sativum) interacts with warfarin when taken together by people with cardiovascular problems (stroke, hypertension, etc).

Both medicines are blood thinners therefore there is a risk of bleeding to death in case of the slightest injury/bleeding, as formation of blood clots are inhibited by the medicines.

Advertisements of herbal medicines should be restricted to conditions that fall under primary health care, with a caution to see an Herbal Medical Officer/Medical Herbalist or any licensed experienced herbal practitioner in clinical Herbal setting/ Herbal clinics, if symptoms of suspected illness still persists after a given short period.

To effectively prevent advertisement of chronic diseases and those that falls outside primary healthcare, clinical herbal medicine practice should be fully integrated into the healthcare delivery system in Ghana with establishment of a good referral system.

Drug Regulatory bodies in Ghana should be empowered to “weed out” charlatans/drug peddlers and prosecute media houses that air advertisements whose contents violates provisions of the Public Health Act (Act 851).

There is a need for passage of an advertisement law to regulate advertisement of goods and services through every available platform.

Collaboration between the Bureau of National Investigations (BNI), the Police, the Ghana Private Road Transport Union (G.P.R.T.U), and State Transport Corporation, is necessary to curb the menace of drug peddling in buses especially inter-city buses.

The FDA should collaborate with all the 216 Metropolitan, Municipal and District Assemblies (MMDAs) in Ghana, to   establish special tasks force to help “arrest” situations of misleading herbal medicine advertisements at various market/community information centres, sale vans to curb the menace of drug peddling at the grass root level.

Finally there should be consistent public education on proper access to herbal medicine practice, with a system in place to enable citizens’ report incidence of drug peddling and inappropriate advertisement contents directly to appropriate authorities.

REFERENCES

Public Health Act 2012(Act 851) of the republic of Ghana.
FDA Guidelines on advertisements of medicines and food supplements. Republic of Ghana.
Elizabeth W.(ed), Samuel D.(ed), and Karen B.(ed), 2009. Stockley’s Herbal Medicines Interactions. Pharmaceutical Press. London, U.K.
Selected Herb-Drug Interactions (1999).University of Michigan Health System Drug Information Service. Michigan, U.S.A.

By Emmanuel Bentil Asare Adusei (BSC Herbal Medicine,KNUST)