Ethical Challenges for Humans Using Traditional and Complementary Medicines

  • Kate ChatfieldEmail author
Part of the SpringerBriefs in Philosophy book series (BRIEFSPHILOSOPH)


Critics of traditional and complementary medicine assert that people are putting their trust in the hands of incompetent and poorly regulated practitioners who are deliberately misleading patients about benefits leading to risks to health, and even lives. Injury or infection from acupuncture needles, severe injuries from osteopathy or chiropractic manipulation, or rejection of effective conventional medicine, are just some of the threats described for humans who use traditional and complementary medicine. The two most commonly cited safety concerns are examined: adverse drug reactions from herbal medicine and the potential for harm from delayed access to conventional care when using homeopathy. Through examination of real world scenarios and data, discrepancy between the rhetoric and the reality of these contentious issues is revealed.


Adverse drug reactions Adverse events Herbal medicine Homeopathy Patient safety Pharmacovigilance 


  1. Abdualmjid RJ, Sergi C (2013) Hepatotoxic botanicals—an evidence-based systematic review. J Pharm Pharm Sci 16(3):376–404CrossRefGoogle Scholar
  2. Bhagavathula AS, Elnour AA, Shehab A (2016) Pharmacovigilance on sexual enhancing herbal supplements. Saudi Pharm J 24(1):115–118CrossRefGoogle Scholar
  3. Bruce NW, Robyn AR (2008) Informed consent: good medicine, dangerous side effects. Camb Q Healthc Ethics 17(1):66–74Google Scholar
  4. Carnes D, Mars TS, Mullinger B, Froud R, Underwood M (2010) Adverse events and manual therapy: a systematic review. Man Ther 15(4):355–363CrossRefGoogle Scholar
  5. Cawte J (1985) Psychoactive substances of the South Seas: Betel, Kava and Pituri. Aust NZ J Psychiatry 19(1):83–87CrossRefGoogle Scholar
  6. Chancellor A (2007) I’m becoming a less confident driver—especially in a country where the Vatican write the highway code. The Guardian. Accessed 4 May 2018
  7. Chatfield K, Duxbury J (2010) Practical and ethical implications for homeopaths in mental healthcare. In: Johannes CK, van der Zees H (eds) Homeopathy and mental healthcare: integrative practice, principles and research. Homeolinks, HollandGoogle Scholar
  8. Chen S, Pang X, Song J, Shi L, Yao H, Han J, Leon C (2014) A renaissance in herbal medicine identification: from morphology to DNA. Biotechnol Adv 32(7):1237–1244CrossRefGoogle Scholar
  9. Connor KM, Payne V, Davidson JR (2006) Kava in generalized anxiety disorder: three placebo-controlled trials. Int Clin Psychopharmacol 21(5):249–253CrossRefGoogle Scholar
  10. Curtis P, Gaylord S (2005) Safety issues in the interaction of conventional, complementary, and alternative health care. Complement Health Pract Rev 10(3):31CrossRefGoogle Scholar
  11. Editorial (2005) The end of homeopathy. Lancet 366:690Google Scholar
  12. Elliott R, Camacho E, Campbell F, Jankovic D, Martyn St James M, Kaltenthaler E, Wong R, Sculpher M, Faria R (2018) Prevalence and economic burden of medication errors in the NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK. Policy Research Unit in Economic Evaluation of Health & Care Interventions. Accessed 5 May 2018
  13. Ernst E (2003) Herbal medicines put into context: their use entails risks, but probably fewer than with synthetic drugs. BMJ 327(7420):881CrossRefGoogle Scholar
  14. Ernst E (2008) How the public is being misled about complementary/alternative medicine. J R Soc Med 101(11):528–530CrossRefGoogle Scholar
  15. Ernst E (2009) Harmless homeopathy? Int J Clin Rheumatol 4(1):7–10CrossRefGoogle Scholar
  16. Ernst E, Smith K (2018) More harm than good?: the moral maze of complementary and alternative medicine. Springer, BaselCrossRefGoogle Scholar
  17. European Committee for Homeopathy (2018) Regulatory status. European Council for Homeopathy. Accessed 15 Mar 2018
  18. Farah M (2011) Classification and monitoring safety in herbal medicine. WHO-UMC, SwedenGoogle Scholar
  19. Farah MH, Edwards R, Lindquist M, Leon C, Shaw D (2000) International monitoring of adverse health effects associated with herbal medicines. Pharmacoepidemiol Drug Saf 9(2):105–112CrossRefGoogle Scholar
  20. Fisher P (2006) Homeopathy and the Lancet. Evid-Based Complement Altern Med 3(1):145CrossRefGoogle Scholar
  21. Freckelton I (2012) Death by homeopathy: issues for civil, criminal and coronial law and for health service policy. J Law Med 19(3):454–478Google Scholar
  22. Future Market Insights (2017) Herbal medicines product market. Accessed 3 Mar 2018
  23. Gale NK, McHale JV (2015) Routledge handbook of complementary and alternative medicine: perspectives from social science and law. Routledge, New YorkCrossRefGoogle Scholar
  24. Gallo E, Pugi A, Lucenteforte E, Maggini V, Gori L, Mugelli A, Firenzuoli F, Vannacci A (2014) Pharmacovigilance of herb-drug interactions among preoperative patients. Altern Ther Health Med 20(2):13–17Google Scholar
  25. Garrouste-Orgeas M, Philippart F, Bruel C, Max A, Lau N, Misset B (2012) Overview of medical errors and adverse events. Ann Intensive Care 2(1):2CrossRefGoogle Scholar
  26. Gilard V, Balayssac S, Tinaugus A, Martins N, Martino R, Malet-Martino M (2015) Detection, identification and quantification by 1H NMR of adulterants in 150 herbal dietary supplements marketed for improving sexual performance. J Pharm Biomed Anal 102:476–493CrossRefGoogle Scholar
  27. Gilmour J, Harrison C, Asadi L, Cohen MH, Vohra S (2011a) Complementary and alternative medicine practitioners’ standard of care: responsibilities to patients and parents. Pediatrics 128(4):S200–S205CrossRefGoogle Scholar
  28. Gilmour J, Harrison C, Asadi L, Cohen MH, Vohra S (2011b) Informed consent: advising patients and parents about complementary and alternative medicine therapies. Pediatrics 128(4):S187–S192CrossRefGoogle Scholar
  29. (2014) Enabling integrated care in the NHS. UK Government. Accessed 2 May 2018
  30. Grollman AP, Shibutani S, Moriya M, Miller F, Wu L, Moll U, Suzuki N, Fernandes A, Rosenquist T, Medverec Z (2007) Aristolochic acid and the etiology of endemic (Balkan) nephropathy. Proc Natl Acad Sci 104(29):12129–12134CrossRefGoogle Scholar
  31. Heaton CA (1994) The chemical industry. Springer Science & Business Media, BerlinCrossRefGoogle Scholar
  32. Herbal Medicines Advisory Committee (2017) Annual Report 2016. Accessed 5 Mar 2018
  33. Hope A (2010) Coroner’s report: inquest into the death of Penelope Dingle. Accessed 5 Apr 2018
  34. Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, Leonard B, Lorig K, Loureiro MI, van der Meer JWM, Schnabel P, Smith R, van Weel C, Smid H (2011) How should we define health? British Med J 343:d4163CrossRefGoogle Scholar
  35. Hunt KJ, Ernst E (2010) No obligation to report adverse effects in British complementary and alternative medicine: evidence for double standards. Qual Saf Health Care 19(1):79CrossRefGoogle Scholar
  36. Kim H, Hughes PJ, Hawes EM (2014) Adverse events associated with metal contamination of traditional chinese medicines in Korea: a clinical review. Yonsei Med J 55(5):1177–1186CrossRefGoogle Scholar
  37. Kohn LT, Corrigan JM, Donaldson MS (2000) To err is human: building a safer health system. National Academies Press, WashingtonGoogle Scholar
  38. Le J (2014) BCPS-ID “Pharmacokinetics”. Merck Manual for Healthcare Professionals. Accessed 16 Apr 2018
  39. Leape LL, Berwick DM (2005) Five years after To Err Is Human: What have we learned? J Am Med Assoc 293(19):2384–2390CrossRefGoogle Scholar
  40. Lim A, Cranswick N, South M (2011) Adverse events associated with the use of complementary and alternative medicine in children. Arch Dis Child 96(3):297–300CrossRefGoogle Scholar
  41. Linde K, Ramirez G, Mulrow CD, Pauls A, Weidenhammer W, Melchart D (1996) St John’s wort for depression—an overview and meta-analysis of randomised clinical trials. BMJ 313(7052):253–258CrossRefGoogle Scholar
  42. Luteijn JM, White BC, Gunnlaugsdóttir H, Holm F, Kalogeras N, Leino O, Magnússon SH, Odekerken G, Pohjola MV, Tijhuis MJ, Tuomisto JT, Ueland Ø, McCarron PA, Verhagen H (2012) State of the art in benefit–risk analysis: medicines. Food Chem Toxicol 50(1):26–32CrossRefGoogle Scholar
  43. MacPherson H, Thomas K, Walters S, Fitter M (2001) The York acupuncture safety study: prospective survey of 34,000 treatments by traditional acupuncturists. BMJ 323(7311):486CrossRefGoogle Scholar
  44. Medicine and Healthcare products Regulatory Agency (2014) Banned and restricted herbal ingredients. Accessed 1 Mar 2018
  45. Moncrieff J, Cohen D, Porter S (2013) The psychoactive effects of psychiatric medication: the elephant in the room. J Psychoactive Drugs 45(5):409–415CrossRefGoogle Scholar
  46. Nissen N, Weidenhammer W, Schunder-Tatzber S, Johannessen H (2013) Public health ethics for complementary and alternative medicine. Eur J Integr Med 5(1):62CrossRefGoogle Scholar
  47. Okoronkwo I, Onyia-Pat J-L, Okpala P, Agbo M-A, Ndu A (2014) Patterns of complementary and alternative medicine use, perceived benefits, and adverse effects among adult users in Enugu Urban. Evid-Based Complement Altern Med, Southeast Nigeria. Scholar
  48. Pirotta M, Willis K, Carter M, Forsdike K, Newton D, Gunn J (2014) ‘Less like a drug than a drug’: the use of St John’s wort among people who self-identify as having depression and/or anxiety symptoms. Complement Ther Med 22(5):870CrossRefGoogle Scholar
  49. Posadzki P, Watson L, Ernst E (2013a) Adverse effects of herbal medicines: an overview of systematic reviews. Clin Med 13(1):7–12CrossRefGoogle Scholar
  50. Posadzki P, Watson L, Ernst E (2013b) Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews. Eur J Clin Pharmacol 69(3):295–307CrossRefGoogle Scholar
  51. Posadzki P, Watson L, Ernst E (2013c) Herb-drug interactions: an overview of systematic reviews. Br J Clin Pharmacol 75(3):603–618CrossRefGoogle Scholar
  52. Rajendran D, Bright P, Bettles S, Carnes D, Mullinger B (2012) What puts the adverse in ‘adverse events’? Patients’ perceptions of post-treatment experiences in osteopathy—a qualitative study using focus groups. Manual Therapy 17(4):305–311CrossRefGoogle Scholar
  53. Schulze J, Raasch W, Siegers C-P (2003) Toxicity of kava pyrones, drug safety and precautions—a case study. Phytomedicine 10:68–73CrossRefGoogle Scholar
  54. Science and Technology Committee (2010) House of Commons Science and Technology Committee—Fourth Report. Evidence Check 2: Homeopathy. Accessed 10 Feb 2018
  55. Scott S, Thompson J (2014) Adverse drug reactions. Anaesth Intensiv Care Med 15(5):245–249CrossRefGoogle Scholar
  56. Sehon S, Stanley D (2010) Evidence and simplicity: Why we should reject homeopathy. J Eval Clin Pract 16(2):276–281CrossRefGoogle Scholar
  57. Shang A, Huwiler-Muntener K, Nartey L, Juni P, Dörig S, Sterne JAC, Pewsner D, Egger M (2005) Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 366(9487):726–732CrossRefGoogle Scholar
  58. Smith SD, Stephens AM, Werren JC, Fischer GO (2013) Treatment failure in atopic dermatitis as a result of parental health belief. Med J Aust 199(7):467–469CrossRefGoogle Scholar
  59. Society of Homeopaths (2018) Code of Ethics. Society of Homeopaths. Accessed 1 May 18
  60. Spence DS, Thompson EA, Barron SJ (2005) Homeopathic treatment for chronic disease: a 6-year, university-hospital outpatient observational study. J Altern Complement Med 11(5):793–798CrossRefGoogle Scholar
  61. Stickel F, Shouval D (2015) Hepatotoxicity of herbal and dietary supplements: an update. Arch Toxicol 89(6):851–865CrossRefGoogle Scholar
  62. Stone J (2000) Ethical issues in complementary and alternative medicine. Complement Ther Med 8(3):207–213CrossRefGoogle Scholar
  63. Sultana J, Cutroneo P, Trifirò G (2013) Clinical and economic burden of adverse drug reactions. J Pharmacol Pharmacother 4(l1):S73CrossRefGoogle Scholar
  64. Supreme Court of India (1996) Poonam Verma vs. Ashwin Patel. Accessed 13 Nov 2017
  65. Teschke R, Schulze J, Schwarzenboeck A, Eickhoff A, Frenzel C (2013) Herbal hepatotoxicity: suspected cases assessed for alternative causes. Eur J Gastroenterol Hepatol 25(9):1093–1098CrossRefGoogle Scholar
  66. Thompson R, Ruch W, Hasenöhrl RU (2004) Enhanced cognitive performance and cheerful mood by standardized extracts of Piper methysticum (Kava-kava). Hum Psychopharmacol: Clin Exp 19(4):243–250CrossRefGoogle Scholar
  67. Tsang C, Bottle A, Majeed A, Aylin P (2013) Adverse events recorded in English primary care: observational study using the General Practice Research Database. British J General Pract 63(613): e534-e542CrossRefGoogle Scholar
  68. Tweed V (2015) Herb-drug interactions lack evidence. Better Nutr 77(6):12Google Scholar
  69. Uppsalla Monitoring Centre (2013) Glossary of Pharmacovigilance terms. Available at:
  70. Uppsala Monitoring Centre (2018) What is VigiBase? Accessed 27 Apr 18
  71. Vanherweghem J-L (1998) Misuse of herbal remedies: the case of an outbreak of terminal renal failure in Belgium. J Altern Complement Med 4(1):9–13CrossRefGoogle Scholar
  72. Vickers A, Zollman C, Lee R (2001) Herbal medicine. West J Med 175(2):125CrossRefGoogle Scholar
  73. Vithoulkas G (1980) The science of homeopathy. Grove Press, New YorkGoogle Scholar
  74. WebMD (2018) What is penicillin allergy? Accessed 03 Apr 2018
  75. Weich S, Brugha T, King M, McManus S, Bebbington P, Jenkins R, Cooper C, McBride O, Stewart-Brown S (2011) Mental well-being and mental illness: findings from the Adult Psychiatric Morbidity Survey for England 2007. Br J Psychiatry 199(1):23–28CrossRefGoogle Scholar
  76. Werner SM, Soghomonyan S (2014) Patient safety and the widespread use of herbs and supplements. Front Pharmacol 5:1–2CrossRefGoogle Scholar
  77. White A, Hayhoe S, Hart A, Ernst E (2001) Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ 323(7311):485–486CrossRefGoogle Scholar
  78. Wooltorton E (2002) Herbal kava: reports of liver toxicity. Can Med Assoc J 166(6):777Google Scholar
  79. World Health Organization (1972) International drug monitoring: the role of national centres. Report of a WHO meeting, Geneva: World Health OrganizationGoogle Scholar
  80. World Health Organization (2004) Pharmacovigilance: ensuring the safe use of medicines. World Health Organization, GenevaGoogle Scholar
  81. World Health Organization (2013) WHO traditional medicine strategy: 2014–2023. World Health Organization, Hong Kong SARGoogle Scholar
  82. World Health Organization (2014) 10 facts on patient safety. Accessed 10 Mar 2018
  83. World Health Organization (2018) Patient safety. Accessed 10 Mar 2018

Copyright information

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Centre for Professional EthicsUniversity of Central LancashirePrestonUK

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