SPEAKER_00 0:16

So having accumulated this resource of 28,000 pounds and all of the different names that the botanists might use, but also all of the names that the pharmacists are using and expose the ambiguity, we can begin to address the problem of how they might be regulated verbally.

Federica Santoro 0:32

Welcome to Drug Safety Matters, a podcast by Uppsala Monitoring Centre, where we explore current issues in pharmacovigilance and patient safety. In this episode, we trek through the jungle of medicinal plant names. With herbal substances found in anything from food supplements to cosmetics to pharmaceutical drugs, it should come as no surprise that calling plants with the wrong name can have serious health consequences. Take what happened in Belgium in 1998, when a slimming clinic mixed up two very different herbal remedies, both known as Plan G, and as a consequence, over a hundred people suffered from renal failure. But why is there so much confusion around medicinal plan names and what can we do about it? My name is Federica Santoro, and my guest today is Bob Alkin, program manager at Royal Botanic Gardens Kew in the UK. Bob is an expert in the thorny nomenclature of herbal medicines and manages Kew's Medicinal Plan Name Services, a catalogue of medicinal plan names that helps make sense of the chaos. Before embracing this challenge, he spent several years in northeastern Brazil helping rural communities make good use of medicinal plants. So the interview that follows is dotted with colorful stories from that time, and I hope you enjoy it. Welcome to our podcast.

SPEAKER_00 2:06

Thank you.

Federica Santoro 2:06

So we are here with you today to talk about medicinal plants and nomenclature confusion, right? How many people nowadays use herbal remedies around the world? How widespread are they?

SPEAKER_00 2:20

It's an important question, a valid question, but also one that's very difficult to answer. So WHO have produced various publications suggesting the number of millions of people that depend on herbal medicines. I think that if you look in rural parts of the less well-developed countries in the world, then the majority of the population depend upon traditional remedies. And plants are the primary source of those medicines. They often do not have the money to buy the bus ticket to take them to the town where there is a pharmacy that they could buy aspirin, but of course they can't buy the aspirin anyway. So the only option they have is to use medicinal plants in their reality. So that is a very, very important constituent use of herbal medicine. And my view is that health professionals in the West are doing them a disservice by not actually treating herbal medicines as important as pharmaceutical drugs. However, in the West, in the world that we all live in and habit, there is a increasing use of natural products. There is a a perception that something or other, something that will be natural, taken from a plant, will be good for them as opposed to some manufactured chemical.

Federica Santoro 3:32

And is that true? Would you say that natural equates safe all the time?

SPEAKER_00 3:37

No, absolutely categorically not. There are many plants which are poisonous. And often plants which may have an impact, whether it's measurable or not, but nevertheless they have been used for hundreds of years, and the evidence in China or India or even here in Europe is that the plant has some health benefit. They may be substituted one for another. And the regulatory framework is such that there is little control over what is actually being sold under a particular name. And so there is far less control over the quality of the products that are being sold to the man on the street. But in countries such as Germany, I think is the case which is typically consulted where maybe 95% of the population have used herbal products. So it's nearly everybody is using some natural herbal product. The other confusion is that herbal medicines are controlled to some extent through the pharmacopoeia and through medical regulation. But exactly the same products. It is the same plant or the same part of the plant treated in a similar sort of a process may be also marketed as a food supplement. There's a great confusion over what is a food supplement, what is a and it is often just down to the marketing or the the strength of the material rather than what's actually in that product. And then of course plants are used as parts of cosmetics. Again, with this sense of well-being, you know, they all be packaged with green leaves on them, and everyone feels good about what they're doing to themselves. So I think there are opportunities. I believe that Western medicine has neglected these products and dismissed them on the grounds that the evidence does not exist, the scientific evidence does not exist for the use of these products. And to some degree they are right, but the clinical trials for these products are very, very few and far between. It is, however, an inherently complicated thing to do. If you are trusting a single molecule that appears in a pharmaceutical drug, then you know what is the target system in the body that it is intended to impact upon. And you can therefore it is a controlled experiment, but the clinical trial becomes more straightforward to measure the impact because it is one molecule, which is intended to measure one target within the body. It may in fact two or three, but it is measurable, it is a manageable problem. A plant is a wonderful mix of all sorts of different chemicals that are bombarding the body simultaneously, different parts of it. Indeed, some of those chemicals may interact one with another, so the fact that there is a poisonous chemical in there may be filtered out by the presence of a of another. And then if you look at the TCM, the traditional Chinese medicine and the Ayurvedic medicine, they're often using mixtures of minerals with a plant or several plants, or in some cases, literally scores of plants uh brought together to create some particular remedy. And so that poses enormous challenges for science. And my perception is that science is not yet capable of sharing that evidence. And therefore it is, if you like, not the fault of the herbalists or the traditional remedies that they haven't got to gather the evidence, is the fact that science has not yet actually progressed to the point at which you can gather that evidence sufficiently. And so it does offer challenges to formal health regulation. But nevertheless, that doesn't say that there aren't some actually some useful properties and lessons to learn.

Federica Santoro 6:55

You raise a lot of important points there. So herbal remedies are used worldwide and they are useful, but there's also risks they pose. So we need to investigate them more and we need to understand that the regulatory framework has to catch up, right, compared to conventional um products, yes.

SPEAKER_01 7:14

Yes.

Federica Santoro 7:15

So in 2017, Q Gardens, which is the botanical research institute you work for, published a report called State of the World's Plants. And in this report, they showed that although herbal remedies are very popular, only 16%, I think, of medicinal plant species are under regulatory control. So my question is, why is there such a gap in regulation?

SPEAKER_00 7:41

It's because of the lack of scientific evidence. So I think that you're right to have said that the regulatory framework needs to catch up, but I think that that is itself a reflection of the lack of scientific evidence and of science to deal with this. So the example I would use, uh, we actually quoted it in that article, is that the Brazilian Pharmacopoeia, for example, in 1910, that edition of the Brazilian Pharmacopoeia had in excess of 80 different herbal products based upon Brazilian plants. And over the decades, down towards 1980, that reduced to just five. And the reason those products were removed from the National Pharmacopoeia was that the level of evidence required for them to feel safe about putting these products into the pharmacopoeia and promoting their use became higher and higher. They became more cautious, and the evidence was not there for them from a scientific perspective. The evidence was insufficient for them to justify their inclusion. And so the natural remedies that were used in Brazil actually covered by formal pharmacovigilance became reduced to a handful of just five, which were actually primarily European plants introduced into Brazil. Over the years since then, the number of plants in the Brazilian pharmacopoeia has increased year by year. But the plants, ironically, the plants and the products that are being included are traditional Chinese medicines, not Brazilian plants. And so the pharmacovigilance profession in Brazil are concerning themselves with TCM products that are being sold to the well-off population in Sao Paulo, but they're not concerning themselves with the herbal medicines that are used by 90% of the population in Brazil. And that story, I don't intend to criticize Brazil particularly. The same story is true for the British pharmacopeia. And I believe that pharmacovigilance professionals from Morocco through to Peru have a similar focus because of their training, uh, the background. They're not encouraged to look at actually the the medicines that the population are largely using in their countries.

Federica Santoro 9:45

Now you've your professional focus is plant names and the chaos around them. In uh April 2018, you published a feature article for our quarterly magazine, Uppsala Reports. And that article, we called it Navigating the Plant Names Jungle, which really sums it all up. So tell me about this chaos in plant names. Why is it so chaotic?

SPEAKER_00 10:09

First of all, I'd say it goes beyond the plant, the names of the plants, to also include the names of the herbal drugs. In the area of medicinal plants and herbal drugs, there is an additional level of complexity. As far as the plants are concerned, it is inevitable that plants have common names. For centuries, people have communicated with one another about the plants. My grandmother knew all the names of the plants locally, and I learnt many of them from her. But those are regional by nature. The names will change over time, like any other element of language. They are nothing more than that. So the words will change over time with use. And so, be it a name written in Chinese script or a name in Italian or English, these are used differently in different parts of countries from country to country. And so returning again to northeastern Brazil as the example, I could cite a case where nuns had decided they wanted to help some of the poor communities that they were working with, and recognized and they used medicinal plants. And so they began handing out medicinal plants in pots growing to those communities and encouraged them to use them to make tea or to make soap or whatever. And they used as their reference source a book published by one of my Brazilian colleagues, a chemist, who lived in a neighbouring state in Northeastern Brazil, and he had produced a very, very nice book called Farmacias Vivas, Living Pharmacies. And it encouraged people to take the plants and how to grow them and how to make a tea or a soap from them, and it was a limited number of plants for which he felt there was evidence of safety and evidence of some efficacy. Rather than just promoting lots and lots of plants, he wanted to try and improve the safety and value of these plants. So these nuns were, in some senses, on the right track. They were using a reference source. The tragedy was that some of the plants that they were giving out were poisonous plants. And the reason was that the common name for the plant in Sierra, where Professor Matos had worked, was the same common name for a poisonous plant in the state of Bahia, where they lived. And so it was a common name shared between two states, but employed for completely different plants, one medicinal, one poisonous, and serious consequences. So common names are not controlled. Plant scientists, because of Linnaeus, who worked, lived here in Uppsala, he established a formal mechanism, the binomial system, of naming plants and animals. And this is via a formal procedure about how you would establish a new name, and the procedures are reviewed every six years. But basically, what is required is that a a specimen, botanical specimen in the case of plants, is deposited in a major herbarium or one or more herbaria around the world as evidence of what this scientific name means. And so it pins that string of Latin characters down to a physical entity. And that physical entity has certain characteristics, be it the chemistry of them, whether the sorts of hairs it has, the colour of the petals, all of that is established and fixed for all time. So that name does not change, unlike common names. And so we have, gratefully, a formal system in botany for fixing these names, and therefore they uniquely refer to a plant species. The challenges come because people study plants in different places, so that the same plant may have been described more than once with alternative scientific names, only you only discover that decades later. It may be that which is the right name for a plant will depend really upon the evidence base that you're working with, the chemistry, the morphology, maybe the DNA. And that evidence base improves and grows over time. And so these these decisions about whether a four species or five species in this particular genus, or whether or not this other species which is currently sitting in another genus, should actually be included here or not, those decisions are being taken all the time by taxonomists in Herbert, in Europe, all around the world. And those are being published. So 10,000 changes to names are published every year. And one of Q's roles is to keep abreast of that rate of change and record them. And so there are many names, scientific names for the plants. There's 1.6 million scientific names in total, and only 360,000 plants. So on average, four scientific names for every plant. Medicinal plants, it's much worse because they're so well studied. So we've got 16 different scientific names for every medicinal plant on average. And then, of course, you have the additional complexity of pharmacists becoming involved and wanting to define with great precision how you produce a particular herbal drug. And so they will state from this plant you will take so many grams of this leaf, you will dissolve it in this strength of alcohol, and then you will do the description of the herbal drug will go for pages and it's very, very detailed. And what is striking from my perspective, not a botanist, is how imprecise they can be about actually which plant you're actually working with to start with. So I think that they will put a scientific name in there, but they don't necessarily know how to use them. And that's because botanists have done a poor job of making that sort of information available, in my view, and that's that's really where our work is focused. But equally, it is common in the Chinese pharmacopoeia, but equally in some European pharmacopoeia as well, for other substance to be established based upon one or more species. So there is a hint that actually either of these species would be good enough. And it may be that once it's gone through all that processing, the end result is something very, very similar. But nevertheless, as a scientist, I can't help but question surely the chemistry of these two plants are going to be different in some form or other, and therefore are they not actually different substances. But so there's a layer of complexity around the naming of these drugs on top of the complexity of the plant names themselves.

Federica Santoro 15:55

That's fascinating. And I think any pharmacovigilance professional will agree that naming things properly is so important. You run a clinical trial and you need to know exactly what drug you're using, right? And when you report adverse reactions, you also need to know exactly what active substance you're talking about. And yet it's interesting what you say that so many people in the field will happily underestimate the complexity of the plant world and overlook the plethora of names that the same plant can be referred to with. How do you even begin to tease out this complexity and make some order in this mess of names?

SPEAKER_00 16:31

Well, what we have done, which is, if you like, a first step, I would regard it as a first step rather than the solution, but it's a necessary first step. What we have done is to scour all of the pharmacopoeia that we can find from Japan, China, Korea, Vietnam, Europe, South America, wherever, all of the pharmacopoeia that we are aware of have been scanned and we have recorded the scientific names that they use for the plants, for each the drug names which they associate with that scientific name. If they suggest that the drug name can be associated with two or more species, we will record that, what part of the plant they recommend being used, and the form that the herbal substance is used in. And so we have slowly built up a record of what pharmacists and regulators are employing, the terminology that they're using in their world, both in the formal reference works, the pharmacopia, but also in regulation. And it covers something like 6,000 plant species. But we've gone beyond that and we've included other reference works which indicate what plants are being traded internationally, and that adds a few hundred more species, possibly a thousand additional species. And we've been looking at the natural products chemistry literature and pulling in the plant names that are employed there and what evidence there is for chemical activity and efficacy for those plants. And increasingly we've been looking at the ethno-botanical literature. So this is where people are recording what an indigenous group of people in southern Mexico or in a particular rural community in a part of Italy would be using, for example. So these are botanical but also sociological, archaeological, anthropological sort of studies of what plants are being in use. And we increasingly include that sort of information. These are medicinal plants, they are being used for a medicinal purpose traditionally. And so as a result, thus far, we have generated a catalogue of 28,000 different species of plants that have are recorded somewhere in one of those different sorts of literature, and we can tell you which of them are under regulation and which are not, which are being traded and not regulated, which are only being studied in the laboratory. But we are very well aware that we've we've got a long way to go, and it's the ethnobotanical literature that we largely lack and would love to increase slowly. So we don't know how many medicinal plants are in the world. We suspect estimates published in the past by other authors have suggested 70,000. My gut is that it's not that high, but it's very likely to be over in excess of 50,000. In other words, we're just about halfway there, really, in capturing that all that diversity. But if you do that, then you've got a solid base on which to start asking questions and on which to begin thinking about regulation, actually. And so having accumulated this resource of 28,000 plants and all of the different names that the botanists might use, but also all of the names that the pharmacists are using and expose their ambiguity, we could begin to address the problem of how they might be regulated globally. And our work with the IDMP, this new ISO drugs standard, is important, I think, in that regard.

Federica Santoro 19:41

The identification of medicinal products or IDMP is an ISO standard that harmonizes terminologies for medicinal products, so that different regulatory agencies can speak to each other using a common set of terms. Bob's team at Q helps out whenever plant names are involved, and they even help medicine regulators like the US FDA validate plant names in their databases. For the last few years, his team has also been collaborating with our staff here at Uppsala Monitoring Center. They helped us tidy up plant names in our drug dictionary Who Drug Global and InVigiBase, the global database of adverse drug reactions that we manage on behalf of the World Health Organization. But you don't have to work at a medicines regulatory agency or an organization like ours to see the value of Q's work. The Medicinal Plant Name Services portal is public and free to access online. Type in the name of any medicinal plant of interest and you'll get back the scientific name currently in use, all its synonyms, plus all the data that's ever been published about that plant. A great help for anyone who needs to communicate accurately and unambiguously about herbal remedies. Just out of curiosity, how do you go about condensing different names? So you've got one plant that's known around the world with different names, and you have to settle for one. But probably these names have been in use for years, right? And people want to refer to those plants with those names. So which one do you choose? Do you settle for a different name entirely? What's the approach generally?

SPEAKER_00 21:21

So the first thing to say is that we in our project wouldn't make that choice. We defer to professional botanists and we look to them to make those choices. And so we in the Medicinal Plant Name Services database we simply pull the most recent taxonomy and nomenclature and synonymy and so forth from Q's botanical resources, and those are being worked on and curated constantly. We choose to version it so that regulators have something fixed that they can refer to that has a legal standing rather than a resource which is being changing from day to day, which is what is the case for the s for the scientists, it matters for them that they've got the most up to date information. So we choose to version our window upon that information. But to come back to a question, how do they decide which is the right name? First and foremost, it is which names are equivalent to one another will be partly decided upon looking at those specimens that are referred to. So the the scientific names themselves, each of them is tied to a physical specimen stored in one or more herb area. And by comparing the chemistry, comparing the morphology, comparing the DNA of those different specimens, we'll say whether or not it is the same plant or not. And so that is the work of taxonomists, systematists, not only at Q but around the world. Q has a particularly large, important collection just because we've a large organization, we've been going for a very long time. But the literature is genuinely global. And so there are taxonomists working in every country in the world. Brazil is a good example where there is a fabulously young, energetic group of taxonomists that are doing very, very good innovative work and understanding their flora much better than other countries. And so they would be producing more scientific publications, changing the names of plants, or deciding that these two names are in synonymous one with another, more often than anyone in Britain is doing. So Q's role is actually just keeping on top of that scientific publications and who is saying what and looking to bring a consensus to it. And so the compilers will go through that literature and they decide are these two names synonyms? And then the secondary question is, if they are synonyms, then which of them should we use as its current name? And that is more subjective. It really establishes whether or not this plant is more closely related to those three species which are in genus one, or more closely related to another couple of species that are in a separate genus. Where are its alliances? Evolutionary is it best sit? And so effectively the taxonomy is trying to recreate and demonstrate the evolutionary relationships with these plants. And that matters for pharmacovigilants and for pharmacists in general, because where sh plants share an evolutionary past, they are likely to share chemical pathways. And so you will be able to find molecules that are very similar to one another but slightly different, and that can have importance in drug discovery or understanding how to create drugs in the laboratory.

Federica Santoro 24:17

And understanding how those drugs work, right, and what what processes in the body they affect. That makes total sense.

SPEAKER_00 24:23

What evidence there is for the activity, medical activity.

Federica Santoro 24:27

So you mentioned a few different criteria that people use to identify plants, not only medicinal plants, morphology, chemistry, and DNA analysis. And I imagine that these three developed historically just in that order. So perhaps in the past, people were only identifying plants via their physical features, and then they could look at the chemistry, and then DNA analysis has been the most recent entry. So how do you see these three interact with each other, these three techniques, these three methodologies interact with each other? And how much do they weigh nowadays in the identification of a plant?

SPEAKER_00 25:06

Yeah, your description is absolutely correct. Linnaeus would not have had access to the chemistry, uh the chemical information that we have access to today, or nor even less the molecular of the DNA mapping. That level of data has slowly been increasing over the centuries. It is the systematist's job to use all knowledge, all data which is available to decide about relationships. And so plants may look very like one another physically, and yet not share an evolutionary past. And it will be because maybe they grow in the desert and therefore they have adapted to take on certain physical characteristics that enables them to survive in the desert, but they will have a very, very different evolutionary past. And so it is the job of taxonomy to unravel that. And so there are two tasks actually. One is the identification, is this plant X or is it Y? And then the second is where does X, species X, fit into the relationships, which plants is it most closely related to? And so again I'll come back to Northeastern Brazil because it gives nice solid examples, I hope, for you. Um we were interested in promoting the use of medicinal plants and we wanted people to be employing plants for which there was evidence of efficacy and safety. We wanted people to be creating teas and soaps that were well made and appropriate, and we wanted these information to be available to less professional people, I would say. And so it was important for us that if we had a description of a fault for a leaflet about how you displant, it was important for us that the individuals would be using the correct plant. So photographs are good, but not necessarily actually one of those line drawings with little arrows indicating the particular specific characteristic of the leaf shape that you need to be looking for, which was the key to knowing whether it is that or not. So there was various experiences about how you how you provide information to identify. But the other is what are the universe of potential confusions? And so we asked ourselves the question, what plants might this thing be confused with? And that is something which science hasn't done terribly well, actually, in the past. So the confusion may be because they look remarkably similar, despite the fact they're in very different plant families. The confusion may come about because they just have the same common name. So there's all sorts of different ways why those plants might be confused. So our concern was how do you differentiate between the species we're describing, the one that we want people to be using, and each of these different potential candidates. And so we would provide a what we called a diagnostic description, but in hopefully in simple, intelligible language for our target audience about separating them. So that's one problem, and in their context, they wouldn't have access to chemical data. They wouldn't have access to DNA analysis or techniques, and so it has to be based upon the morphology. The decision about whether or not this plant is in this genus or that genus and is closely related to this or this, or actually whether or not this group of specimens laying on your table is one species or two different species. That is a question which is for the systematist, and they then will be looking at using the full range of evidence available to them. And it is one of the causes, of course, of name changes, why they keep on changing, is because the taxonomists of slowly evolving or improving their classification. Plants will move from one genus to another to better reflect the greater understanding that we now have of their evolutionary relationship. There is a tendency, I think, with any new technology for everyone to assume that it's going to solve the problem. I know that this was the case with phytochemistry, and that chemistry was somehow or other magically more closely related to the genes and therefore was going to solve the problems. And it didn't. It added further evidence.

Federica Santoro 28:45

Can I interrupt you just there? I was just wondering, when we talk about a plant's chemistry, what do we mean? So the compounds that are present in there? Do you look at specific kinds of compounds?

SPEAKER_00 28:55

Yes, it's what by what compounds are there. But associated with that is, of course, how how are they manufactured. And increasingly, plants are becoming models for the drug industry, not so much as actually what are the new molecules, but rather how are they manufacturing these and it's a very, very sophisticated pathway, chemical pathway, that is used to go from really quite simple molecules up to something with this extraordinarily complex. And so unraveling how that happens within a plant is enormously valuable information for thinking about how they might be manufactured in in the laboratory. So increasingly, I would say it is as much about how these molecules arrive as it is as to what is in there. But the key is what is there. And of course, these chemicals are generally produced by the plant, not just for our use. They were there because they have a biological function. They're attracting pollinators or they're dissuading herbivores from eating them. So there's a variety of different classes of compound, of course. But they those chemicals themselves, those chemical pathways, have of course evolved over time, over the thousands of years, often in interaction with the insects that are pollinating them or eating them, and they're very, very complicated, fascinating stories to tell. The result is we're just looking at a picture now, trying to understand what happened in in the past, I guess, and that's what the systematist's task is.

Federica Santoro 30:13

Thanks for clarifying that. But you were making a point about modern technologies and how people think that they'll just solve the problem, and that's not the case then?

SPEAKER_00 30:23

So the DNA information, this is the this is the current trend, and of course it's very exciting that we can start looking at the genes themselves and the sequences and start comparing them. And therefore, it is, I think, quite understandable that people would think, okay, this is going to enable us to identify this plant. And it may also give us insights as to whether these two plants are closely related one with another or not. People talk about barcoding globally, but I think there is a even amongst regulators and pharmacists and so forth, I think there is a poor understanding generally of what barcoding is. But in the case of plants, there have been one or two different barcodes defined, each of which actually only looks at two or three genes. And so it is a very, very limited bit of the DNA of that plant that is being used to make any judgments. Colleagues of mine at Q at the moment are embarked upon a very ambitious project called the Plant and Fungal Tree of Life. And what they are looking to achieve is to have a genealogical tree with one plant or one fungi from every genus. So it's a classification from the genus level upwards. And they were doing it by looking at the 350 genes. So it's a whole scale of greater precision, more information than has been possible with the barcodes up until now. It's becoming possible because improvements in the technology. And because you're looking at 350 genes rather than just two or three, it means that you are beginning to be able to compare plants in really quite different families. It also enables it has a better chance of being able to differentiate between two species in the same genus that are actually very closely related. But it's not a guarantee, and there will be places where even 350 genes is not sufficient to differentiate between two species. And that's partly because, of course, the genome varies from individual to individual. You and I don't look alike, we don't sound alike. And that's because we have a different, you know, there are variability in the human genome, and any plant or species has exactly that level of variability from individual to individual. So which individual would you take as being the pattern? And how different need you be before you decided actually it's a different species rather than just a bit of variation. So those are the challenges that are are faced. In terms of which individual you would look at, then of course I would say you go to the type specimen, that one that that Latin name is associated with. And that is your starting point. That is the reference material to which you can compare anything else. So there was a case of a company wished to have plant material authenticated by the Robotanic Garden's Q. They were being sold this product for their use in manufacturing a ginseng, which they were going to sell. And their question was quite simple. Are we being sold ginseng? Or are we being sold something else? So the Q laboratories began to look at the chemistry and did it have the appropriate chemical analysis profile? Did it have peaks in the right place on those chromatograms and so forth? And the answer was yes, it looked good. And the DNA, well, it was a bit iffy, but it wasn't sufficient evidence to say this was something else. And so the conclusion of the laboratory scientists was that yes, the company are buying the right product. But it was fortuitous for Q at that point that the botanist, the traditional anatomist, botanist that knows TCM products very well, walked through the laboratory and was shown the sample and said, no way, that is not ginseng proper. She could dissect it simply by looking at it, simply with a morphology. And further research provided that actually what the company they're doing that was selling this product for a manufacturer had dipped it into a liquid which contained the necessary components to fall any pharmacological laboratory tests. And so I like that story just because it gives you evidence that actually that all morphology actually has its has its place. These are all bits of evidence which need to be weighed equally, I would say, in the balance of making a decision about what a plant is and particularly is, how they relate one to another.

Federica Santoro 34:29

Such a cautionary tale, that's fascinating. So trust your eyes and complement it, I guess, with more detailed molecular analysis, but don't dismiss um observation. Yes.

SPEAKER_00 34:42

And who knows, maybe there will be some future technique which will come will add to our knowledge about those plants and provide us further insights.

Federica Santoro 34:49

So to conclude, if you had to give advice to pharmacovigilance professionals who are dealing with herbal medicines, what would you tell them to look out for?

SPEAKER_00 35:01

Well, there's a challenge. I think the first thing is that you can't rely on pharmaceutical or pharmacological names for a drug to be unambiguous. They are likely to be ambiguous. The only way that you can provide precision is establishing which plant you are referring to and rather which plant you require the scientific name. You need to recognise that different people will use different scientific names for that same plant and so there are a plethora. And so if you're trying to find everything out that's been published about that plant, then you are well advised to find out what are the synonyms, minor functions of our website, will give you that list of synonyms, and then you can go and search in PubMed to discover what has been published about that plant. If you search PubMed for information about a plant, a medicinal plant, using a single scientific name, then you will retrieve simply 15% of the information that PubMed holds about that plant on average. And to retrieve 100% of the information, you need to know those 25 or those 40 different scientific synonyms and then search one by one. So what we do with our website is that we just enable people to push a button and it does that for you. Because PubMed is so critical to our target audience, we specifically provide a link into PubMed. Most botanists wouldn't necessarily be interested in that, so the Q's other websites don't point that way. I would also If you're going to be publishing research or the results of clinical trials and so forth, then you need to be very, very precise about, again, which plant is actually involved, and that involves using plant names, scientific plant names, and it implies using scientific names correctly. And there's a lot of poor a lot of examples in the literature where these names have been used inappropriately, and thus the validity of the scientific research published is is reduced. So there is best practice. We have published some best practice guidelines as to try and advise authors how to do that. So I'd recommend that you refer to those. But certainly be cautious and certainly assume just because it's written in Latin doesn't mean to say that it's meaningful or not ambiguous. And if I had to say one thing, it would be make the scientific plant name does include the author. Just simply putting the genus and the species is insufficient because there in about five percent of cases there will be other binomials, identical binomial, which refer to completely different plants. The classic example is where the European Commission banned the import of Styronese into Europe when their intention was to ban the import of a Japanese poisonous plant, and they did so simply because they were unaware that there were two scientific names which were homonyms of one another, but the same binomial published by different people meaning two different plants, and so it does have a significance. I think the more general problem, and I'm not sure I have easy solutions to this, but I am aware that the challenge of pharmacoviligence is when individuals will walk into their GP's surgery in in Bogota or wherever and report that their child has eaten these leaves or these berries, and then those adverse reactions get recorded and what information should actually be recorded and so forth. And clearly a common name, the local common name, is as a starting point, but very often insufficient for you to know what plant that was. So the very, very best practice would be that you got some leaves and you press them and you got some specimens and you berries and you put them into alcohol and you got a local botanist to actually identify that material. Photographs can help, uh, but again, you need to know what you're looking at often to take a good photograph, because it may be critical pieces of information about the I don't know, the shape of the root or something, you've not got the photograph, so nothing can be done per se event. So but being aware of that ambiguity is the key and gathering all the evidence you possibly can and not assume that if I write down Bluebell, someone else in another country is going to know exactly what that plan was, because they won't, they will probably make the wrong conclusion.

Federica Santoro 38:43

And on that note, I would thank you for your time. I would encourage then our listeners to check out Q Garden's Medicinal Plant Names services. Being aware of the issue is already an excellent starting point, even if there is no easy solution, as you say, but knowing that there is this complexity is already a good starting point. Thanks again.

SPEAKER_00 39:03

Thank you very much.

Federica Santoro 39:05

That's all for now. We'll be back soon with more conversations on medicine safety. If you'd like to know more about Q's medicinal plan name services, check out the episode show notes for more information. If you like drug safety matters, make sure to subscribe to it via your favorite podcast directory. And don't forget to check out our series of Uppsala Reports long reads, the best stories from our pharmacovigilance magazine brought to you in audio format. If you have any comments or suggestions for the show, get in touch with us on social media. We love to hear from our listeners. You'll find Oopsala Monitoring Center on Facebook, LinkedIn, and Twitter, and you can join the conversation there with the hashtag Drug SafetyMatters. Thanks for listening.