Has your doctor or dentist ever asked you what medicines you’re taking? If so, have you told them the whole truth? I’m guessing you think you have – after all, drug interactions can be dangerous, and you’d be mad to put yourself at risk. But what if you didn’t realise you weren’t giving them all the facts? All too often, I discover people are taking herbal remedies or supplements – but they have no idea that they ‘count’ as medicines.
In fact, while millions of people across the world take herbal remedies and supplements every day, many have no idea they can cause side effects. When I explain to my patients that St John’s wort can interact with up to 70% of all prescription drugs; or ginseng can cause dangerous fluctuations in blood-thinning if you’re taking warfarin; or green tea supplements can interact with pseudoephedrine, taken for colds; or ginkgo biloba can interact with aspirin and warfarin; they’re usually stunned.
Now the Journal of the American Medical Association has just issued a patient guide to herbal medicines. They highlight both possible side effects and interactions with prescribed and non-prescribed medications. I’m amazed how many of my patients believe that just because something is ‘natural’, it must be safe. Deadly nightshade is natural.
Any buying from a ‘reputable’ chain doesn’t guarantee quality. Last year, Walmart, Target, Walgreens and GNC in the USA were all forced to remove herbal supplements from their shelves .
A report last year from the New York Attorney General’s office showed many supplements didn’t contain any of the herb they advertised. In fact, nearly 4 in 5 of the supplements they tested didn’t have any trace of DNA from the substance on the label . This claim has since been disputed on the basis of whether the right tests were run – but the fact that there could be such a major problem speaks volumes.
Licensed drugs can’t be given to the public without reams of evidence, including:
- Whether the drug has a real effect on the condition it’s used for (it’s important to point out that no medicine works for everyone, but the manufacturers have to jump through lots of hoops relating to ‘placebo-controlled’ trials – do more people respond to their drug than an inactive pretend tablet – or ‘active comparator’ trials - does their drug have advantages over current medicines on the market)
- Whether the benefits outweigh the risks
- How much of the drug is needed for best effect
- How the drug is manufactured
- The precise amount of the drug in the tablet
- How this is monitored and quality controlled.
In the USA, there’s no regulation with herbal supplements about whether the ‘active ingredient’ is in the tablet in the first place; if it is there, there are no checks on how much is in it; or how much is needed to get the benefit it claims; or whether the claims are even true. On the whole in the USA, the only investigation comes if customers run into health problems as a result.
In the UK, the MHRA (which regulates our medicines) has introduced a ‘Traditional Herbal Registration (THR) scheme’ which does answer some of these questions. It came into effect in 2011 and by the end of 2012 about 200 licences had been granted. All herbal remedies sold in the UK should carry a THR marking on the packet. To get a THR licence, you have to prove that you:
- Only make claims for your product that are agreed by the MHRA
- Include patient information explaining when it’s not appropriate to use the remedy
- Doesn’t make fanciful claims about ‘curing’ serious diseases
- Is manufactured to agreed standards
- Has regular safety monitoring.
This scheme has got around some of the US problems – but there are still lots of gaping holes. Firstly, if you order herbal remedies over the internet, they may come from outside the UK, where the same regulations don’t apply.
And more obvious still, you don’t actually have to prove your product works. You only have to show your product has been ‘traditionally used’ for at least 30 years to treat the condition you want to advertise it for. Of course, there are some herbal remedies with good evidence – but not all, and the current regulations don’t distinguish. Call me cynical, but bloodletting was ‘traditionally’ used to treat every conceivable malady (including blood loss from stab wounds) for well over 30 years back in the mists of time. Anyone for leeches?
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