How do biomedicine and herbal medicine currently coexist and how could we develop an integrated alternative that mitigates cost to the individual?
The integration of herbal medicine and biomedicine in the United Kingdom (UK) presents a valuable opportunity to improve patient care by combining the benefits of both treatment modalities (1). Both herbal medicine and biomedicine have their own unique strengths in the management of acute conditions, chronic diseases and complex health issues.
Herbal medicine is widely used in the UK, with an estimated 9 million people regularly using herbal remedies. The UK’s interest in complementary and alternative medicine (CAM) has grown in recent years, with herbal medicine playing a significant role in this trend (2,3). Sometimes patients will visit a qualified medical herbalist, who will prescribe and dispense individually tailored herbal medicines, and other times people will be taking over the counter herbal remedies, such as echinacea for colds, valerian for sleep, and ginger for digestive issues, alongside or instead of mainstream treatments.
A significant number of patients in the UK express a preference for natural and holistic approaches to healthcare (1,4). Integrating herbal medicine into mainstream medicine allows healthcare practitioners to respect patient preferences, improve patient satisfaction, and potentially enhance adherence to treatment plans (5). Equally, many cultural communities in the UK have long traditions of using herbal medicine, such as Ayurveda, Traditional Chinese Medicine (TCM), and Western herbal medicine. Integration could help bridge cultural gaps in healthcare delivery and promote inclusivity (5).
Biomedicine and herbal medicine have been successfully integrated in other healthcare systems in countries such as Ghana, China, Japan and South Korea (6,7,8,9). The UK’s National Health Service (NHS) is a publicly funded healthcare system that offers free or low-cost medical services and treatment to all UK residents. While the NHS does provide some complementary therapies, such as acupuncture and osteopathy in some Trusts, the inclusion of herbal medicine remains limited (10). Herbal remedies and access to herbalist care is not funded by the NHS, contributing to a big expenditure for those who want to use it.
The cost of herbal medicine and pharmaceutical drugs
NHS prescriptions are free in Scotland and Wales, while in England, most people are required to pay a charge of £9.90 per item, with exemptions available for certain groups, such as those over 60, under 16, or with certain medical conditions (11). Herbal medicines are not subsidised by the NHS, and the cost of herbs can vary significantly depending on the preparation and quality of the product, whether bought over the counter, bought from a qualified herbalist or harvested and prepared at home.
Prescription pharmaceuticals can range from a few pounds to hundreds per month depending on the condition they treat and on the type of drug, the manufacturer, and the required dosage. For example, generic drugs, which are chemically identical to brand-name drugs, are typically cheaper. In the UK, generic drugs can cost anywhere from £1 to £10 for a month’s supply. The cost of over-the-counter pharmaceuticals can range from a few pounds to around £20, depending on the product. For example, a box of ibuprofen may cost around £1–3, while medications like antihistamines or nasal sprays might cost between £5–10.
Herbal supplements and products can vary widely in cost, from a few pounds to over £50, depending on the herb, brand, form (e.g., capsules, teas, tinctures), and quality standards. For example, 100 grams of dried herb to make a tea can cost £6–8 pounds, while 100 ml of a herbal tincture could range from £8-£20 for a week’s supply.
Consultations with qualified herbalists in the UK are not subsided by the NHS, and can range from £35 to £100 or more per session (with the initial consult typically lasting an hour or more, with subsequent sessions of 30 minutes), depending on the practitioner’s experience and location. There are herbalists that will offer consultations for cheaper, on a sliding scale or even for free.
The cost of consulting a herbalist and using herbal medicine in the UK is significantly higher than NHS-funded pharmaceuticals and medical care, making herbal medicine inaccessible for many. It is important to note that while foraging and homemade herbal preparations for self-care would cost very little, the knowledge required for plant identification and to process herbs at home is not always within the reach of everyone.
The case for integrating herbal medicine with biomedicine
Herbal medicine offers potential benefits for managing chronic conditions, such as arthritis, anxiety, digestive disorders, and mild depression. For example, turmeric has been shown to be effective to reduce inflammation and pain, and St John’s wort can be beneficial to treat mild to moderate depression (12,13,14). Integrating such herbs could provide additional options for patients seeking alternatives to long-term pharmaceutical use, which can have undesirable side effects. A holistic approach that combines conventional and herbal medicine can offer more comprehensive care, especially for conditions where conventional treatments have limited effectiveness or undesirable side effects (14).
Herbal medicine emphasises preventative care by supporting overall health and wellness. For instance, herbs like echinacea and elderberry are used to support immune function. The NHS is increasingly focussing on prevention as a strategy to reduce long-term healthcare costs, making herbal medicine a potentially valuable addition (15).
Many pharmaceutical drugs come with a range of side effects. For example, long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastrointestinal bleeding and perforation, cardiovascular problems, and kidney damage (16,17). Similarly, antidepressants can lead to side effects such as weight gain, sexual dysfunction, and increased risk of withdrawal symptoms (18). Herbal medicines, when used appropriately, often have fewer, milder or no side effects (14). For instance, ginger can help with nausea without the gastrointestinal risks associated with some antiemetics.
Some pharmaceutical drugs, particularly painkillers like opioids and certain anxiolytics (such as benzodiazepines), have a high potential for dependency and abuse. Over-prescription of these drugs has led to significant public health challenges, including the opioid crisis (19). Herbal alternatives under the supervision of a herbalist, such as turmeric for inflammation and pain, valerian for anxiety, or St John’s wort for depression, can offer safer options for managing symptoms without the risk of dependency (13,14).
The rising costs of pharmaceuticals is also of concern. The cost of developing, producing, and distributing pharmaceutical drugs can be very high, leading to increased healthcare costs for the NHS and patients (20). Herbal medicines are often less expensive to produce and can provide cost-effective alternatives for managing certain conditions, reducing the overall financial burden on the healthcare system. Yet we do not know how much it would cost to mass produce plant-based or mushroom-based products to supply to millions. For example, the most prescribed pharmaceutical in England in 2023–2024 was atorvastatin, a drug used to lower cholesterol levels (20). One of the effective alternatives used by herbalists is red yeast rice, a product of rice fermented with a yeast called Monascus purpureus (21). This contains monacolin K, which has been shown to significantly reduce LDL cholesterol levels (22). Atorvastatin was dispensed 65 million times last year, and we do not know what the planetary, environmental and financial costs of producing red yeast rice at this scale would be. However, there is potential for the NHS to reduce spending by lowering the need for expensive pharmaceuticals, reducing hospital admissions, and minimising the management of drug side effects if integrating herbal medicine into the system. Furthermore, the pharmaceutical industry is known to have prolific detrimental effects on the environment. Read our article on The quiet ecocide of pharmaceutical pollution.
Strategies for integration
Given these potential benefits, several strategies could facilitate integration into the NHS. NHS Trusts could integrate herbal medicine in a wide range of services, from outpatient specialist clinics to general practice including mental health and palliative care. A good example of this is the herbal medicine clinic at the Whipps Cross University Hospital dermatology outpatient department (23). This service has been running since 2000 and welcomes student medical herbalists to sit in the consultations. Funding and resourcing for the clinic comes from universities or schools offering herbal medicine courses, which pay the herbalists’ clinic fee for the student placements, and Whipps Cross University Hospital Dermatology Department, which provides the clinic space within the hospital, reception cover and some administrative support. These clinics are run by an experienced medical herbalist, Alex Laird. Patients can access the clinic by referral from dermatologists within the hospital department, local general practitioners or nurse specialists. A review conducted in 2008 showed that the main reasons for referring were when conventional treatment was not working or was not suitable, followed by patients requesting alternative treatment, and when other patients reported improvement and consequently recommended the service to others (23). This review showed that the herbal medicine service had statistically significant improvements in self-reported patient health.
This model could be applied to other specialties such as rheumatology, with a particular focus on pain management, respiratory medicine or gastroenterology with a focus on functional digestive disorders. Herbal medicine can also have its place in general practice (24). GP practices could hire qualified medical herbalists to work within the practice. Patients could be referred to the herbalist based on patient’s choice, or GPs could refer when conventional treatment was insufficient or ineffective for a particular presentation (25). Herbalists within GP practices could also develop a role in preventative medicine, as there is evidence that some medicinal plants are effective in the prevention of some conditions. For example, cranberry preparations are effective in the prevention of recurrent urinary tract infections, and some preparations of echinacea can prevent upper respiratory infections (26,27).
In hospital settings the NHS could develop integrated care teams including herbalists, doctors, pharmacists, and other specialists. These teams could work together to create individualised care plans that incorporate both herbal and mainstream treatments, based on patient needs and preferences.
Further strategies for successful integration
Increased funding for clinical research
The UK government, research councils, and private stakeholders should fund more clinical trials to evaluate the safety and efficacy of herbal treatments. Collaborative research initiatives between herbalists, universities, and healthcare providers can build a robust evidence base that supports the integration of herbal medicine into mainstream practice.
Developing national guidelines
Organisations like the National Institute for Health and Care Excellence (NICE) together with herbalists, could develop guidelines for integrating herbal medicine into specific areas of patient care, such as chronic pain management, mental health, or supportive care in oncology.
Education and awareness
Most NHS practitioners have limited training in herbal medicine, which can lead to hesitation in recommending or integrating these treatments (28). Medical and nursing schools and postgraduate training programs should include modules on herbal medicine, focusing on its uses, potential interactions, and evidence-based benefits. This training would help doctors and nurses make informed decisions as well as enable them to communicate effectively with medical herbalists.
By taking a strategic approach, the UK can create a healthcare environment that respects patient preferences and enhances outcomes by offering a wider range of treatment options tailored to individual needs.
Government funding and NHS integration
Funding could be structured to support the integration of herbal medicine within the UK’s healthcare system in different ways. Funding would also need to be allocated to cover the costs of specific herbal preparations and the salaries of herbalists working within NHS settings.
The UK Department of Health and Social Care (DHSC) could fund NHS pilot programs to explore herbal medicine’s role in managing conditions like anxiety, mild depression, menopausal symptoms, and digestive disorders. These programs would generate essential data on safety, efficacy, and cost-effectiveness, supporting broader integration.
NHS funding could be allocated to support the training of GPs, nurses, and pharmacists in the basics of herbal medicine, as well as funding at least one trained medical herbalist to be part of the GP practice or specialist outpatient clinic. This funding could cover certification programs, workshops, or continuing professional development (CPD) modules focused on safe use, common indications, contraindications, and interactions of herbal treatments. This would empower healthcare professionals with the knowledge to advise patients safely and would enable them to communicate effectively with medical herbalists (28).
The government could also provide financial incentives for GP practices to participate in integrative medicine programs. This could be through the Quality and Outcomes Framework (QOF) or other NHS incentive schemes, where GPs could receive additional funding for including herbalists in their practice, as well as safe and evidence-based herbal options in their treatment plans when appropriate (29).
Another avenue could be establishing partnerships between the NHS, universities, and research councils (such as the Medical Research Council and the National Institute for Health and Care Research) to fund research into the efficacy, safety, and cost-effectiveness of herbal medicine. This collaboration could be targeted toward creating centres of excellence in integrative medicine research. Encouraging grants from organisations like the Wellcome Trust, British Herbal Medicine Association, and other charities interested in promoting holistic health could also be beneficial. These grants could fund studies that examine the integration of herbal medicine with conventional treatments, focusing on clinical outcomes, patient satisfaction, and cost savings.
Integrating herbal medicine with biomedicine in the UK offers an opportunity to create a more holistic, patient-centred healthcare system that leverages the strengths of both approaches. While challenges exist, these can be addressed through collaborative research, multidisciplinary care models, education and training, and regulatory frameworks.
References
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