Herbs and Supplements

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Let’s talk about Complementary and Alternative Medicine, CAM for short. Some say this term makes us think that these treatments are inferior to the FDA approved medicine, so they feel Integrative Medicine is a more appropriate term. Around 75% of those surveyed in the U.S. have used CAM at least once including prayer, magnets, herbs, meditation, massage, manipulation, supplements, and others. I have used Aloe Vera on my cuts at times, and I pray.

For this article I am using the textbook: Rakel: Integrative Medicine, 2nd ed. Copyright © 2007 Saunders, An Imprint of Elsevier.

Of course CAMs that are not chemicals can be thought of as safe, so what is the harm in using them? The harm may be in delaying effective therapy. There have been news reports of children dying since their parents had more faith in CAM than proven treatments. FDA approved medications must go through a rigorous process to prove they help more than harm. CAMS, if ingested are thought of as food and are not tested as much, so you can’t have the same confidence about harm and help with CAM unless you take the steps listed below.

We must be wise in our choice regarding our health. There are important questions to ask before using CAM:

Does the therapy result in symptom resolution or symptom suppression?
That is, does it work as it is advertised to do in a majority of subjects? Of course the symptom may be a sign of a deeper problem, e.g. stomach ulcers may be a sign of excess stress. Palpitations may be a sign of too much caffeine or tobacco. Poor sleep can be caused by depression or anxiety. Treating just the symptom and ignoring its cause doesn’t promote health. A trained professional is helpful here.

What is the evidence?
It is not fair to insist that a treatment that worked on your barber’s sister’s mechanic’s banker will work for you. Seeing smiling faces on the package or “Doctor Recommended,” or “As Seen on TV” is not enough to convince the logical person. You would like to know if there have been clinical trials that show enough evidence to take a chance it may help you. There are many theories out there. The ideas usually start with Basic Science, move to the lab with small animals, and then finally to human testing. There are many products that have been shown to be worthless in humans when they were thought to be possibly helpful at the earlier stages. It is hard for the general public to understand that many things that make sense to us, are proven wrong when the undergo clinical trials. Many times this is because the human body and mind are quite different from mice or monkeys. For example, dogs cannot eat much chocolate or they may have liver failure. On the other hand, many times the animal trials are quite predictive of what will happen in the human.
Please realize that the vast majority of researchers are honest, but there are some who hide results unfavorable to sales. Also, there are some side effects that are so uncommon, that they cannot be discovered until a larger number of people have taken that medication after it comes to market. This is why some physicians wait a year or two before prescribing newly approved medications.

What is the potential harm?

The FDA first wants the food item or medication to be safe before proceeding with any further research. For instance, it made sense to try to suppress bad heart rhythms after a heart attack since those rhythms can kill. The FDA approved a drug, flecanide, which proved to suppress these dangerous rhythms. But after years on the market, it was shown that those who took the medication actually had a higher risk of early death compared to those who did not take it. We find out years later that taking large amounts of garlic or grapefruit products or taking St. John’s Wort can have bad interactions with HIV medications. We must study the list of side effects and the chance we may get them. If the side effects are mild and happen in 15% then we may agree to try it. If they are fatal in 1% we may decide to not take it unless we have a severe disease.

What is the cost?
CAM therapy is usually cheaper than FDA approved medicine IF it provides relief and has less chance of side effects.

Does the therapy match the patient’s culture and belief system?
This is important for at least two reasons. The patient will not take the medicine correctly if they don’t believe there is a good chance it will help them more than harm them. The placebo effect, based on belief, is very powerful. In a minority of patients, placebo pills (sugar) have been shown to cure diseases, treat symptoms, and in others cause many side effects. The only explanation is that the patient belief caused the good or bad effect. In the same way, if a patient feels the medication will not work or will cause side effects, this belief can sabotage the beneficial effects of the medication. The patient must trust the health care provider and the medication.

In conclusion, be wise about your health. Investigate treatments. Use trusted internet sources such as http://www.kaiserpermanente.org and WebMD. Anyone can put anything on the web.

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