e-Phytovigilance: Internet and natural product pharmacovigilance

Despite the use of phytotherapy is constantly increasing, consumers and health professionals often ignore important issues regarding possible interactions between herbs and drugs, their adverse effects or, simply, the ineffectiveness of many products. On the contrary, just because the use of natural health products is not well regulated, many herbal products are not adequately tested for their pharmacology and toxicology, especially when used during pregnancy and breastfeeding. Nowadays, with the Internet playing such an important role in the dissemination of scientific information, often mixed with pseudo-scientific misinformation, the issue is further complicated by self-diagnosis and self-medication which follow hurried web information and by the prompt availability of these products through e-commerce.
Unfortunately, websites that publish incorrect information on natural products are in sharp increase, sometimes even recommending uses that have been already demonstrated harmful for health.
In general, the majority of information on phytotherapy products and supplements published on the Internet does not undergo any check, with consequent scarce scientific reliability. Besides, this lack of regulation often allows the promotion of some “alternative therapies” without any communication about their toxic potential.
It is not rare that the online information provide therapeutic indications that can harm patients, for example promoting worrying medical statements or the use of toxic products. A survey on 522 Italian websites including information about the use of Germander (Teucrium chamaedris) showed for example that only 63% of the websites reported correct information about the serious potential hepatotoxicity of this herb, that can be easily purchased online and whose use is forbidden by health authorities.
This is the case for many other products too, for example borage (excluding its oil) which is sold according to its traditional use as depurative, anti-inflammatory and diaphoretic or coltsfoot (Tussilago farfara), traditionally used as mucolytic and cough sedative, which are both banned among the vegetal supplements for their high level of pyrrolizidine alkaloids with hepatotoxic and carcinogenic activity. For this reasons Google should improve its filters and not visualize sponsored links in the search results of medical words or products. We would like to report, for example, the case of a Google search with the term “Aloe arborescens”, which resulted in pages and pages describing this plant as a cure for many types of cancer, clearly without any reliable scientific data behind. Therefore, since the web is not yet well regulated, once again the members of the medical community have the task of monitoring the situation and, in this contest, natural products must be included in the pharmacovigilance systems.
In Italy, like in many other countries, the pharmacovigilance system collects only spontaneous reports for registered drugs, but the increasing awareness about the need of surveillance for natural product safety led to set up a reporting system for suspect reactions specific to natural products, managed by the National Health Institute (www.epicentro.iss.it).
What are the future prospects for online Phytovigilance? With no doubts the report sheet for adverse reactions should be much improved, in particular including information found on the Internet; besides, it would be desirable to implement a task force of online health observers able to search for and verify information present on the Internet, accurately and critically reviewing it and reporting to citizens and health professionals on official websites any inaccuracy, false information, risk and clinical and toxicological problems that may harm consumers’ health and safety.