The Numbers No One Owns: Who Gets Hurt—Plants or Pills?

Prologue: An Uncomfortable Question

Step into any modern pharmacy, and you enter a paradox in plain sight. On one side, neat shelves of prescription drugs — brightly colored boxes, barcoded and blister-packed, their inserts crowded with black-box warnings, dosage charts, and legal disclaimers. These are the crown jewels of pharmaceutical science: products of billion-dollar trials, decades of regulatory oversight, and the complex dance of insurance billing codes.

Turn your head a few degrees, and you see another world. Here, on quieter shelves, sit bottles of valerian, turmeric, milk thistle, chamomile, and St. John’s wort. Their labels speak softly: “supports relaxation,” “promotes immune health,” “may aid digestion.” Instead of black-box warnings, they carry disclaimers: “This product is not intended to diagnose, treat, cure, or prevent any disease.”

Both shelves claim to heal. Both have long lineages — one in clinical science, the other in cultural traditions stretching back millennia. But which shelf harms more people?

The answer should be straightforward. In reality, it’s a maze of incomplete data, conflicting narratives, and political interests. Governments maintain extensive surveillance systems for adverse drug events (ADEs), logging them in hospitals, poison centers, and pharmacovigilance databases. By contrast, herbal medicine is tracked haphazardly: small poison control registries here, a handful of case reports there, and scattered analyses in academic journals.

Yet a pattern emerges when we line up the evidence:

• Pharmaceuticals generate a massive, well-documented burden of injury, hospitalization, and death each year.¹–³

• Herbal medicines cause far fewer serious events per user, but their harms are not mythical. They cluster around specific pitfalls: misidentified plants, adulterated products spiked with drugs, heavy-metal contamination, ultra-concentrated extracts, and dangerous herb–drug interactions.⁴–¹²

Below is a reckoning with the numbers — the ones governments track, the ones they don’t, and the ones that reveal uncomfortable truths about how we heal, how we suffer, and how we count the costs.

1. How Many People Are “Made Sick” Each Year?

1A. Pharmaceuticals: The Heavyweight

The scale of pharmaceutical harm is not speculation; it is measured in millions.

• United States: The Centers for Disease Control and Prevention estimates over 1.5 million emergency-department visits each year are linked to adverse drug events. Of these, roughly 500,000 require hospitalization.⁶ ¹⁷ The patients are disproportionately older adults, often on multiple prescriptions. Polypharmacy — the simultaneous use of five, ten, or even more drugs — is a silent driver of risk.

• European Union: A major EU analysis concluded that ~197,000 deaths per year are attributable to adverse drug reactions (ADRs), with an estimated €79 billion in societal costs including hospital stays, tests, and lost productivity.⁷ ¹³ ²¹

• Global trend: Studies drawing on the Global Burden of Disease (GBD) dataset show that adverse effects of medical treatment (AEMT) are a persistent global problem. Mortality rates have declined somewhat over the decades thanks to better monitoring, but incidence remains stubbornly high, fueled by aging populations and chronic disease requiring multiple medications.¹–³ ¹⁶

Mini-story: In 2019, an 82-year-old woman in Ohio collapsed at her kitchen table. Her warfarin dose — intended to prevent clotting — had tipped into over-anticoagulation. She arrived at the ER with internal bleeding. She survived after transfusions, but her life changed forever: from that day, she needed round-the-clock monitoring. She was one of over a million Americans who visit the ER every year for drug side effects. Her story is ordinary — and that is what makes it so chilling.

Takeaway: For modern, regulated pharmaceuticals, the signal is loud: millions harmed globally every year, with hundreds of thousands of deaths in high-income regions alone — despite robust safety systems.¹–³ ⁶–⁸

1B. Plants/Herbals: Smaller Signals, Gaps in the Map

By comparison, the herbal medicine signal is faint — though not invisible.

• WHO pharmacovigilance: VigiBase, the world’s largest adverse-event database, holds tens of millions of reports. Herbal medicine reports account for just ~0.5% of identifiable safety “signals.”¹⁰ This is not proof that herbs are harmless; it reflects both lower risk and underreporting.

• Korea (KAERS): An analysis of the Korean Adverse Event Reporting System identified 1,054 individual case safety reports linked to herbal products. About 4.6% were serious — a small number in absolute terms, but a reminder that herbal risks exist.¹¹

• The Netherlands: Hundreds of herbal reports were logged in the Dutch pharmacovigilance database; roughly 15% were serious. Many were linked not to the herbs themselves but to adulteration — supplements laced with undeclared pharmaceuticals.¹²

• United States (Poison Centers): In 2022, U.S. poison centers recorded 2.06 million human exposures across all substances. Among children under five, dietary supplements/herbals/homeopathics accounted for 6.65% of exposures. Of 3,255 deaths, the vast majority traced to pharmaceuticals or illicit drugs, not herbs.¹³

• Liver injury perspective: A 2021 global review documented about 12,000 cases of herb-induced liver injury (HILI) in the medical literature.¹⁴ ¹⁵ This is rare compared with drug-induced liver injury (DILI), but significant for certain concentrated extracts, such as green tea catechins or turmeric enhanced with piperine.

Mini-story: In Kerala, India, a grandmother applies a turmeric paste to her grandson’s scraped knee. He heals without incident. Half a world away in California, a middle-aged man develops jaundice after months of taking high-dose turmeric capsules fortified with piperine. His liver enzymes spike, and he is hospitalized. The plant is the same; the preparation and dosage are not. One child plays cricket the next day; one man spends weeks recovering. This contrast captures the paradox of plant medicine safety.

Takeaway: Herbal medicine harms are far rarer than pharmaceutical ones, but not zero. The risks cluster around quality problems (contamination, mislabeling, adulterants) rather than the plants themselves.¹⁰–¹⁵

2. Deaths: Where the Body Count Really Sits

When it comes to mortality, the gap between pills and plants yawns wide.

• Pharmaceuticals: ADRs are among the world’s leading causes of death, ranked between fourth and sixth globally depending on methodology.⁷ ⁸ In the EU alone, ~197,000 people die each year from drug reactions.²¹

• Herbals: Deaths are vanishingly rare in comparison. But where they occur, they trace to well-documented culprits:

• Aristolochia: Its aristolochic acids cause irreversible nephropathy and urinary cancers. A scandal in Belgium in the 1990s — where a weight-loss clinic mistakenly used Aristolochia in place of Stephania tetrandra — led to dozens of women developing kidney failure and cancer.¹⁶–¹⁸

• Ephedra: Once popular in weight-loss supplements in the U.S., ephedra triggered cardiovascular events. It was banned by the FDA in 2004 after being linked to deaths.¹⁹

• Kava: A South Pacific ceremonial beverage consumed safely for centuries; in Europe in the early 2000s, a small cluster of liver injury cases tied to concentrated kava extracts led to temporary bans. Later reviews concluded that traditional kava use is overwhelmingly safe.

• Concentrated extracts: Modern high-dose green tea catechins and turmeric + piperine formulations have caused rare but notable liver injuries.¹⁴–¹⁵ ¹⁹–²⁰

Mini-story: In Brussels, 1992, a young woman visits a slimming clinic. She takes herbal capsules said to contain Chinese herbs for weight loss. Months later, she is on dialysis: her kidneys have failed. The capsules contained Aristolochia, not the intended plant. The scandal eventually led to international recognition of “Aristolochic acid nephropathy.” The tragedy was not the herb itself but the deadly consequences of misidentification and poor regulation.

Bottom line: The overwhelming share of medicine-related deaths sits with pharmaceuticals, not herbs. Herbal fatalities cluster in a short, well-known blacklist.⁷–⁸ ¹⁴–²⁰

3. “Made Sick” ≠ “Died”: The Side-Effect Landscape

Pharmaceuticals crowd emergency rooms with predictable culprits: anticoagulants leading to bleeding, diabetes medications causing hypoglycemia, sedatives triggering falls and delirium, antibiotics provoking rashes and arrhythmias. In the U.S. alone, more than 1.5 million ER visits each year stem from such adverse events.⁶ ¹⁷

Plant medicines, by contrast, usually cause mild and reversible events: nausea, diarrhea, rashes, headaches. In Korea’s KAERS database, ~6% were serious; Dutch data showed ~15%.¹¹–¹² Still tiny numbers compared to pharmaceuticals.

Mini-story: A 52-year-old man in Amsterdam buys “herbal potency capsules” online. Hours later, his blood pressure spikes dangerously. Doctors discover the capsules were laced with sildenafil (Viagra) and tadalafil (Cialis), undeclared on the label. He nearly dies, not from herbs — but from hidden pharmaceuticals passed off as plants.

4. Costs: The Silent Metric

Numbers tell another truth: the financial weight of harm.

• European Union: ADRs cost ~€79 billion each year, draining hospitals and productivity.⁷ ²¹

• United States: Estimates range from $30 billion to $137 billion annually, depending on methodology.⁹ ²² ²³

By comparison, herbal harms generate no comparable global bill. Why?

1. Serious herbal injuries are rare.

2. Many people self-treat at home; even if they get sick, they don’t enter formal billing systems.

3. Herbal adverse events are vastly underreported.¹⁰ ²⁵

Mini-story: In France, an elderly man spends weeks in intensive care after a prescription drug interaction. The hospital bill exceeds €40,000. In a small village in Peru, a family treats diarrhea with chamomile tea — with no costs at all. The world records the hospital bill; the tea disappears into the silence of uncounted care.

5. Why the Gap? Exposure, Dose, and the Nature of Harm

Why do pharmaceuticals dominate harm statistics while herbs fade into the background?

1. Dose and potency: Drugs are designed for high potency and narrow therapeutic windows. This is their strength — and their danger. Herbs, especially in traditional culinary doses, are gentler. Exceptions exist: aconite, ephedra, aristolochia.¹⁶–¹⁸ ²⁶

2. Quality systems: Pharma is tightly standardized. Herbs vary widely in quality. The worst herbal injuries trace to misidentification, adulteration, or hyper-concentrated extracts.¹¹–¹⁵ ²⁶–²⁷

3. Underreporting: Less than 10% of all ADRs are reported in any system.²⁵ Herbal events are even less visible, since patients often don’t tell doctors they’re using them.

Mini-story: A retired schoolteacher in London takes St. John’s wort for mild depression — but doesn’t tell her doctor. She’s also prescribed an SSRI. The combination leads to serotonin syndrome: confusion, sweating, tremors. She recovers, but her case never enters official databases. The event is real — the numbers never catch it.

6. What the Best Data Say — Put Simply

Pharmaceuticals: A clear, large, well-quantified burden — millions of injuries, hundreds of thousands of deaths annually, and tens of billions of dollars in costs.¹–⁹ ¹³

Plant medicines: Far fewer serious events per user; fatalities are rare, clustering in a short blacklist of known dangerous plants or adulterated products.¹⁰–¹⁶ ¹⁹–²⁰

Practical comparative risk: Traditional-dose, quality-assured herbal use = low risk. Danger arises with the wrong plant, wrong dose, adulteration, or drug–herb interactions.¹¹–¹⁵ ²⁶–²⁷

Mini-story: Consider aspirin. A single 325 mg pill can relieve pain — but also trigger internal bleeding in vulnerable patients. Its parent, willow bark tea, delivers salicin in far smaller doses. Both can heal, both can harm. The difference is potency, concentration, and how the body is pushed to the edge of its tolerances. In risk terms, pharmaceuticals dance closer to the cliff.

7. How to Keep People Safe (and Honest)

1. Blacklist the killers: Aristolochia, raw aconite, ephedra, hyper-concentrated extracts.¹⁴–²⁰

2. Stop adulteration: Require identity testing and adulterant screens.¹² ²⁶–²⁷

3. Document interactions: Especially with anticoagulants, chemo drugs, sedatives.³⁵

4. Report cases: Herbs need full integration into pharmacovigilance.¹ ² ²⁸–³¹

Mini-story: In New York, inspectors found “herbal slimming pills” spiked with sibutramine — a banned weight-loss drug pulled from markets for cardiovascular risks. The product wasn’t dangerous because of herbs; it was dangerous because of hidden pharmaceuticals.

8. The Narrative Under the Numbers

Pharmaceutical harms are counted meticulously, filling hospital registries and economic analyses. Herbal harms are faint — not because they don’t exist, but because they occur more rarely and because underreporting leaves them hidden.

The lesson is not to romanticize plants or demonize drugs. It is to be precise:

• Most of the world’s medicine-related sickness and death comes from pharmaceuticals.

• Plant harms are real but sporadic, preventable, and concentrated.¹–⁸ ¹⁰–²⁰ ²⁵–³¹

Mini-story: In 2004, the arthritis drug Vioxx was pulled from the market after an estimated 60,000 deaths from cardiovascular complications. Contrast that with kava: banned across Europe for a handful of hepatotoxicity cases, yet consumed safely by Pacific Islanders for centuries. The scales of risk are not equal, but regulation often pretends they are.

9. A Practical Comparison

Pharmaceuticals: Millions of ADEs each year; hundreds of thousands of deaths; huge costs.⁶–⁷

Plant medicines: Rare fatalities; low absolute burden; mild side effects most common.¹¹–¹³

10. Final Word: How to Read Risk Like a Professional

If you’re asking “plants vs. pills?” the honest answer is: dose, product quality, and context.

If you’re asking “who hurts more people per year?” the answer is clear: pharmaceuticals, by orders of magnitude.

If you’re asking “how to stay safe with herbs?” the answer is practical: buy tested products, avoid red-flag plants, screen interactions, and report adverse events.

Who Owns the Numbers?

Plants do not write reports. Drugs do not speak their harms aloud. The counting — and the narrative — belongs to institutions: regulators, pharmaceutical companies, hospitals, and sometimes, herbalists.

Pharmaceutical harms are counted and published. Herbal harms are often invisible — too rare, too dispersed, too informal. This asymmetry shapes perception: we fear herbs we cannot quantify and accept pharmaceuticals whose harms we can.

But the truth hiding in the numbers is this: nature’s pharmacy, when respected and used in context, is gentler than the industrial one. Pharmaceuticals save lives but exact staggering collateral damage. Herbs save lives too, and when they harm, it is mostly in ways we already know and can avoid.

The uncomfortable question — who gets hurt, plants or pills? — finds its answer not in myth, but in the math: pills hurt vastly more.

Afterward

Many of the world’s most important drugs are still tied to plants, even if their final pharmaceutical form is standardized or synthesized. Morphine from the opium poppy, quinine from cinchona bark, and digoxin from foxglove are examples of natural products (NP) that remain in direct use. Others, like docetaxel from yew tree precursors or irinotecan from the “happy tree,” are semi-synthetic (SS)—their molecular scaffolds come from plants but are chemically modified to improve safety, potency, or delivery. Still others, such as aspirin and high-dose capsaicin, are synthetic analogues (SA): entirely lab-made, yet unmistakably modeled on plant chemistry. In all three cases, the fingerprints of plants are embedded in the very structure of modern drugs.

What this means is that modern pharmacology, whether in the United States or globally, continues to rely on plant intelligence even while patents and manufacturing emphasize chemistry and delivery systems. Plants are the silent partners in countless therapies, seeding entire drug families in oncology, cardiology, neurology, infectious disease, and pain control. Although the final pill or vial may contain no raw bark, leaf, or flower, its blueprint was written by a living plant. In this sense, our pharmacopeia remains deeply ecological: rooted in ancient relationships with plants that continue to shape medicine for billions of people worldwide.

Endnotes

1. X. Kong et al., “Global Trends and Partial Forecast of Adverse Effects of Medical Treatment (GBD 2019),” Frontiers in Public Health (2024).

2. L. Lin, “Global, Regional and National Time Trends in Incidence of Adverse Effects of Medical Treatment, 1990–2019,” BMJ Quality & Safety (2024).

3. J.E. Sunshine et al., “Association of Adverse Effects of Medical Treatment with Mortality in the United States,” JAMA Network Open (2019).

4. European Medicines Agency / EudraVigilance, “Electronic Reporting and Pharmacovigilance Guidance” (accessed 2025).

5. WHO, “Pharmacovigilance—Regulation & Safety,” and WHO Guidelines on Safety Monitoring of Herbal Medicines (Geneva, 2004; updated).

6. CDC, “Medication Safety: FastStats—Facts & Stats” (2024).

7. European Commission, “Strengthening Pharmacovigilance… (ADR burden: 197,000 deaths; €79B cost)” (2012 press memo).

8. H. Le Louët, “Twenty-First Century Global ADR Management,” Drug Safety (2022).

9. J. Sultana et al., “Clinical and Economic Burden of Adverse Drug Reactions,” Drug Safety (2013); S.F. Abu et al., “Cost Estimations…,” Drug Safety & Health Policy (2023).

10. D. Sartori et al., “Signals of Adverse Reactions to Herbal Medicines: Scoping Review,” Frontiers in Pharmacology (2025).

11. Y. Choi et al., “Adverse Events Associated with Herbal Medicine Products from KAERS,” Frontiers in Pharmacology (2024).

12. F.P.A.M. van Hunsel et al., “Analysis of Reports on Adverse Drug Reactions Related to Herbal Products in the Dutch Database” (2022).

13. America’s Poison Centers, “2022 NPDS Annual Report,” Clinical Toxicology 61(10):717–939 (2023).

14. R. Teschke, “HILI with 12,068 Worldwide Cases—RUCAM-Based Review,” Translational Gastroenterology and Hepatology (2021).

15. V.R. Ballotin et al., “Herb-Induced Liver Injury: Systematic Review and Meta-Analysis,” World Journal of Hepatology (2021).

16. WHO/IARC, “Aristolochic Acid–Associated Cancers: Public Health Risk” (2022).

17. NTP/NCI, Aristolochic Acids—Report on Carcinogens (2021).

18. F.D. Debelle et al., “Aristolochic Acid Nephropathy: A Worldwide Problem,” Kidney International (2008).

19. D. Halegoua-DeMarzio et al., “Liver Injury Associated with Turmeric—A Growing Problem,” American Journal of Medicine (2023).

20. A. Likhitsup et al., “Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in the U.S.,” JAMA Network Open (2024).

21. J.C. Bouvy et al., “Epidemiology of ADRs in Europe,” Drug Safety (2015).

22. M. Durand et al., “Evaluating the Costs of Adverse Drug Events in Hospitalized Patients,” Health Economics Review (2024).

23. U.S. cost overviews compiled in Abu et al., 2023 (see note 9).

24. CDC/NCHS, “Emergency Department Visits—FastStats” (2023).

25. R. Walji et al., “Adverse Event Reporting for Herbal Medicines: Underreporting <10%,” BMC Complementary and Alternative Medicine (2009).

26. D. Shaw, “Pharmacovigilance of Herbal Medicine,” Journal of Ethnopharmacology (2012).

27. H.H. Chang et al., “A System for Reporting and Evaluating ADRs of Herbal Products,” Scientific Reports (2021).

28. EMA, “EudraVigilance Annual Reporting” (2024).

29. UMC/WHO, “About VigiBase” (accessed 2025).

30. VigiAccess, WHO public portal for suspected adverse drug reactions (accessed 2025).

31. F.P.A.M. van Hunsel et al., “Reports for Herbal Medicines in VigiBase,” in Herbal Pharmacovigilance: Global Perspectives (2022).

32. L. Pochet et al., “Herb–Anticancer Drug Interactions in Real Life Based on VigiBase,” Scientific Reports (2022).

33. AHRQ PSNet, “Safety Commentary on Lin (2024), BMJ Quality & Safety” (2024).

34. IHME, “Global Burden of Disease Study: Methodological Portal” (University of Washington, 2024).

35. P. Barvaliya et al., “Cutaneous Adverse Drug Reactions Linked with Traditional Medicines via VigiBase,” Frontiers in Pharmacology (2023).