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Docs
Must Educate Themselves on Herbals
ATLANTA
(Reuters Health) - Doctors can no longer ignore their patients'
use of herbal medicines, according to Dr. Isadore Rosenfeld of
Cornell University's New York Presbyterian Hospital.
Rosenfeld
spoke at the American College of Physicians-American Society of
Internal Medicine's scientific program in Atlanta, Georgia. He
discussed some more commonly used herbal medicines, describing
their benefits and their risks.
Regarding
echinacea for colds, Rosenfeld said reports are mixed. ``Some
studies show that echinacea may prevent colds,'' he said. But
he pointed out that, as with other herbal medicines, the problem
with evaluating its use is that preparations come from so many
different parts of the plant, such as the root and the flower.
Evidence is
better for using saw palmetto to treat enlarged prostate, he added.
``It is widely used in Europe and there are studies that indicate
that saw palmetto is as effective as the prescription drug Proscar,''
he said. ``This is a drug that can and should be used in patients
with (an enlarged prostate),'' he said.
Ephedra, he
noted, is widely sold as an appetite suppressant and can aggravate
high blood pressure and heart problems. Some studies have shown
that Ginkgo biloba may be useful in the treatment of early Alzheimer's
disease, he added. ''Because there is nothing else, I sometimes
use it in patients with the early Alzheimer's disease,'' Rosenfeld
said.
``St. Johns
wort has been very popular for the treatment of mild depression,''
he said, ``but it interacts with almost every drug, so it should
only be used if the patient is taking nothing else.''
Some herbs,
he added, should be avoided at all costs. These include comfrey
and sassafras, which may cause cancer; chaparral and germander,
which are toxic to the liver; and pokeroot, which can be fatal.
He also noted
that some herbal medicines can interact with prescription drugs.
Black cohosh decreases iron absorption; Capsaicin worsens a cough
from taking a class of prescription drugs called ACE inhibitors;
and several other herbs, including chamomile, Dong Quai, feverfew
and Ginkgo biloba should not be taken with the prescription blood-thinning
drug warfarin, because they increase the risk of bleeding.
``It is important
for patients to understand that because herbal medicines are classified
as dietary supplements, the US Food and Drug Administration does
not regulate these drugs,'' he said. He also warned that there
is no guarantee of the purity of these products. ``You have got
to be very careful,'' he noted. ''What I tell my patients is that
they should buy products made in the United States, from companies
that have been in business for a while and have some kind of reputation,''
Rosenfeld added.
``Some people
talk about the toxicity of herbal drugs, but prescription medications
have side effects too, so we have to be careful with anything
we use,'' Rosenfeld told Reuters Health. ``The main point is that
patients are using these drugs, so it is important for doctors
understand them,'' he said.
Rosenfeld
is a best-selling author of books on herbal medicines who denies
any financial ties with manufacturers of these medicines. He began
studying herbal remedies because he felt he was being intellectually
dishonest when he dismissed his patients' use of them simply because
he did not know much about the subject. So, Rosenfeld said, he
delved into studying the topic for 2 years.
Reference
Source 89
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