Times: Alert over fatal mix of herbal pills and medicines

From: Sufaud (sufaud_at_hotmail.com)
Date: 07/03/04 

Date: 2 Jul 2004 23:13:02 -0700

July 03, 2004
The Times (London)

Alert over fatal mix of herbal pills and medicines
By Sam Lister, Health Correspondent

Doctors warn that thousands are at risk

THOUSANDS of people are risking their lives by mixing herbal remedies
with common prescription drugs.

Of the 10,000 deaths caused by adverse reactions to prescription drugs
every year, a "significant number" were likely to have been caused by
patients mixing their treatments with complementary medicines,
doctors' leaders said yesterday.

Research has shown that more than 90 per cent of people prescribed
drugs such as warfarin, a powerful anti- coagulant taken to stop the
build-up of lethal blood clots, were not asked by their GPs if they
were taking any complementary medicines.

Popular substances such as St John's wort, a plant extract taken for
mild depression, have been found to react dangerously with warfarin
and other prescription drugs, preventing the treatments from working.

In the study, published in the British Journal of General Practice
(BJGP), one in five patients on warfarin was found to be taking
complementary medicines also.

Lindsay Smith, the lead author of the report, said that the findings
raised serious concerns about the lack of communication between
doctors and patients about herbal remedies. Current software used by
GPs to compile patient records does not include a facility to record
data on alternative medications.

"What was really striking was that one in five people is taking
something and nine out of ten are not discussing it with their
doctor," Dr Smith, a GP in Somerset, said.

"If complementary medicines were perfectly safe and had been
thoroughly tested, there wouldn't be a problem. But most of these
medications remain untested and unresearched. This is potentially very
dangerous."

In the research carried out by Dr Smith, 1,360 patients taking
warfarin from 35 different practices were surveyed about herbal remedy
use. Almost 300 were found to be taking a listed complementary
medicine, of which 25 were taking at least one reported to react with
warfarin, such as St John's wort, ginseng or gingko biloba, a tree
leaf extract believed to improve blood flow to the brain. A further
200 patients were on other unidentified alternative medicines. Dr
Smith said that problems arise from the lack of medical knowledge of
interactions between prescription and alternative medicines. His group
is to undertake further research into gingko and garlic pills.

It is estimated that at least 12 million Britons regularly use herbal
remedies, while more than 500,000 take warfarin. The overlap, which
remains undocumented, is likely to be high among the elderly, who
often rely on multiple medications for different ailments, health
experts said.

The report follows the publication yesterday of research from
scientists at the University of Liverpool which estimates that more
than 10,000 patients may be dying every year because of reactions to
common medications such as aspirin, anticoagulants and
antidepressants.

Researchers said that while most cases had been attributed to
conventional drug reactions — with patients and GPs asked about St
John's wort usage — other herbal remedies were likely to have
contributed to the high death rate.Concerns have been raised about the
effects of echinacea, a popular anti-viral supplement, on the liver
when combined with other drugs, and garlic supplements on some
anti-HIV treatments Jim Kennedy, the Royal College of General
Practitioners spokesman on prescribing, said that adverse reactions
triggered by herbal remedies would be high.

"It is going to be a factor in a significant number of those deaths —
certainly in the hundreds," he said.

Edzard Ernst, director of the Department of Complementary Medicine at
the University of Exeter and an adviser on the BJGP report, said that
many British GPs " know absolutely nothing about complementary
medicine".

"But they have a moral duty to advise patients responsibly on all
matters of healthcare. To exclude a whole strain of healthcare and say
it's got nothing to do with us because we didn't learn it at medical
school is not responsible."

He added: "With a drug like warfarin the therapeutic window is very
narrow. Underdosing you can have a blood clot, and overdosing can lead
to extensive bleeding and, in worst -case scenarios, brain
haemorrhages. You are dead as a church mouse. Any interference with
herbal medicines is potentially life-threatening."

http://www.timesonline.co.uk/article/0,,2-1166505,00.html

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