Best Advice is Buyer Beware of Over-the-Counter Remedies

Originally published in The Ottawa Citizen January 29, 2002

Herbal supplements should be regulated, like prescription drugs, so people know exactly what they’re getting.

A new study in a recent edition of Journal of the American Medical Association found that “in any given week, most U.S. adults take at least one medication, and many take multiple agents. The substantial over-lap between use of prescription medications and herbals/supplements raises concern about unintended interactions.”

It went on further to say that more than 80 per cent took at least one medication in any given week. These include herbal supplements, over-the-counter medications (OTC) and prescription drugs.

In Canada, usage patterns are similar to those of the U.S. The excellent report in the Citizen this past week about prescription drug use seems to corroborate this.

Are we overmedicated? For some the answer is clearly no. Many people suffering from chronic heart, lung, kidney, and blood diseases require specific treatment regimens, which can include a combination of medications to provide effective control.

What about the “worried well”? These people are generally in good health. They exercise and try to maintain a healthy diet. They rightly wish to have more control over their health. They ask good questions and want to know what they can do to prevent disease.

Some will take herbal supplements and vitamins. Some will mix them with prescription medications or OTC preparations. The problem is not only from the interactions of standard regulated OTC medications like Advil/Motrin (Ibuprofen), Tylenol (acetaminophen plain or with codeine) and Aspirin (ASA – acetylsalicylic acid) but from unregulated non-standardized herbal supplements.

I do not have a problem with herbal supplement use per se. Many of our prescription medications are derived from plant sources. Some prescription drugs are a purified form of the active ingredient(s) found in the plant that provides the wanted therapeutic effect. Herbal supplements contain chemicals akin to those found in our prescription medications.

Some have the potential to cause ad-verse effects in combination with other herbal remedies and prescription drugs. This month, Health Canada re-leased advisories about Kava Kava, which claims to treat anxiety, insomnia, pain and muscle tension and Ephedra (Ma Huang), which claims to promote weight loss, suppress appetite, increase metabolism and exercise tolerance, euphoria, increased energy and wakefulness.

Recent adverse events implicate Kava Kava with liver toxicity and some products containing Ephedra with “stroke, heart attacks, heart rate irregularities, seizures, psychoses and death.”

At the Indiana University School of Medicine, scientists warn that certain herbal preparations can interfere with oral contraceptives. Early findings suggest that Chasteberry (for premenstrual syndrome), red clover (for coughs, indigestion and rashes), echinacea, and St. John’s wort can reduce the efficacyand increase side effects of the pill.

Garlic, when used in combination with blood thinners (anti-coagulants) like ASA or Comedian can cause bleeding. Natural does not equate to safety.

Jared Diamond in his Pulitzer Prize-winning book Guns, Germs, and Steel comments on the development of agrarian societies and their crops. He notes that some foods taken for granted today were toxic in their original form.

An experienced hiker will not eat almonds off a wild almond tree because they contain cyanide. Eat too many and your hike will come to an abrupt end. Almond trees cultivated over thousands of years produce the almonds we eat today.

Foxglove, a common self-seeding perennial herb found in meadows of the Western United States, contains digitalis, which can cause heart beat irregularities (arrhythmias).

The Madagascar periwinkle plant contains vincristine, a potent chemotherapeutic agent used to treat some forms of cancer.

By all means, let’s look at the benefits of herbals. All medications, prescription or herbal, contain chemicals that have the potential to either help or harm us. The Compendium of Pharmaceuticals and Specialties (CPS) provide product monographs for all Drug Identification Number (DIN) prescription and OTC medications. It provides a list of side effects and drug interactions for most agents. There is no such compendium for herbals.

An excellent reference from the Canadian Medical Association, Herbs: Everyday Reference for Health Professionals provides a review of Go herbals with their latest clinical trials and evidence of efficacy.

To be consistent, herbals should be subjected to the same rigorous standards as all other licensed medications. Some approved drugs are shown over time to have adverse effects. The system is not perfect. But it is better than releasing a product into the market without any safeguards.

The same clinical trials and testing procedures should apply to all sub-stances regardless of their source. If the pre-market clinical trials satisfy Health Canada’s Health Protection Branch criteria for approval and licensure, by all means let us use it.

The federal government has pro-posed the Natural Health Products Regulations. They define Natural Health Products as substances whose physiologic actions are akin to synthetic drugs. However, they will not be regulated or tested as synthetic drugs.

The goal is public safety, not political correctness. People deserve to have the best possible testing and evaluation of any substance. It is the only way to make an informed choice.

© Dr. Barry Dworkin 2002

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