By Scott Irwin and Mary Loftus, NYT Regional Newspapers
The first sign of a sniffle sends some people straight to the
medicine cabinet for a dose of echinacea. But they might want to
take a measure of caution along with it.
Herbal remedies -- ancient medicines that are still the norm for
80 percent of the world's population -- are continuing to grow in
popularity in the United States as natural alternatives to
conventional medicine.
A third of all Americans have tried such plant extracts to
combat depression, disease, memory loss, fatigue and stress. More
than $12 billion was spent on natural supplements in 1997, nearly
double what was spent in 1994. And medical research is supporting
claims that herbs such as St. John's wort and kava may indeed have
beneficial effects.
Celebrities including Mel Gibson, Ann Landers and Larry King
have recommended herbal elixirs. And on the Internet, scores of
companies hawk self-proclaimed natural remedies that offer cures
for everything from hot flashes to attention deficit disorder.
But increasingly, reports of unwanted side effects are
surfacing.
Recent studies have connected some of the most popular herbs --
St. John's wort, echinacea and ginko -- with infertility. St. John's
wort has also been linked to high blood pressure. And many herbal
remedies, including kava, are not recommended for pregnant or
nursing women.
Because herbal remedies are considered ''nutritional
supplements'' instead of medications, they are not regulated by the
Food and Drug Administration in the same way that prescription and
over-the-counter drugs are. The effectiveness of most herbal
remedies is often anecdotal, with little scientific research to
explain how they might work. Consistency can vary from brand to
brand, so that one product may be more potent than another.
The absence of regulation, along with a desire to have more
control over one's own health, has fostered a climate in which an
increasing number of people are comfortable treating themselves
with herbal remedies without consulting a doctor. The shelves of
the average health food store promise relief from depression, acne,
hot flashes and the common cold.
And while they may deliver good results for some people, they
require caution for others. A person who self-medicates with a
natural remedy runs the risk of triggering an allergic reaction or
misdiagnosing a serious ailment and delaying a more effective,
mainstream treatment. Some of the popular remedies shouldn't be
used at all when certain conditions exist.
Dr. Mary O'Brien, author of ''Complimentary Medicine: A
Practical Primer'' and a physician at Coastal Area Health Education
Center in Wilmington, N.C., says one example is the widespread use
of echinacea, the herb that has become so popular for fighting off
cold and flu symptoms.
''Certain people should not take echinacea under any
situation,'' O'Brien said. ''That's not on the bottle. But if they
have a disease that attacks the autoimmune system, such as lupus,
rheumatoid arthritis or multiple sclerosis, echinacea can actually
worsen that.''
In other cases, people take herbal remedies while they are
taking other over-the-counter or prescription medications. The
result can be disastrous.
For instance, when dextromethorphan, an ingredient in cough
syrup, combines with St. John's wort, a popular herbal treatment
for depression, it can cause serotonin syndrome, a condition
characterized by rapid pulse, high fever and convulsions that can
be fatal. Other herbs, such as ginkgo biloba, shouldn't be taken
with blood thinners.
Because of the complex and often combustible nature of human
chemistry, health practitioners urge people to consult their
physicians and pharmacists before beginning herbal treatments.
''The ideal situation is to have doctors and pharmacists who are
well-trained in herbal treatments,'' O'Brien said.
In some countries -- Germany, for example -- herbal remedies have
been used for years, and the government holds manufacturers to
strict standards for ingredients and manufacturing.
In this country, there are no such safeguards.
When you open a bottle of nutritional supplements, you can't be
sure of what's inside. The active ingredient might be present in
such small percentages that it is ineffective, some ingredients may
not be listed at all, and the claims of what the supplement can do
may not be accurate.
Anecdotal reports of people who developed serious side effects
from herbal supplements have shown up in medical journals and
national magazines:
--The New England Journal of Medicine carried reports of six
people who developed severe illnesses from herbal remedies,
including lead poisoning, impotence and abnormal heart rhythms.
--Another study found that a third of 260 traditional Chinese
medicines were contaminated with heavy metals such as lead or
arsenic. And four patients were hospitalized after drinking Chinese
kombucha tea as a remedy for cancer.
--A hospital reported a patient whose skin became hypersensitive
to the point that even a mild breeze was painful -- her reactions
were traced to the St. John's wort she was taking for depression.
Another elderly woman's sudden high blood pressure was linked to
St. John's wort.
--A new study by researchers at Loma Linda University in
California suggests that the side effects of some popular herbs,
including St. John's wort, echinacea and ginkgo, could include
blocking contraception. The study also uncovered suggestions of
genetic damage to sperm.
''Research on herbs has lagged in the United States because
companies have little incentive to spend $500 million on 10 to 15
years of tests -- as pharmaceutical firms typically do to check out
new medications,'' says journalist John Greenwald, in an article on
herbal healing in Time magazine. ''Unlike drugs, most herbal
preparations cannot be patented, so the testing company would not
be rewarded for its efforts.''
The FDA would have to prove that a supplement is unsafe before
they could take it off the shelves, but it has no authority to test
nutritional supplements.
Still, say advocates of herbal remedies, we shouldn't dismiss
all supplements because of a few bad reactions or ineffective
treatments.
Alice MacDonald, 57, of Savannah, Ga., says she hasn't had a
severe cold since discovering echinacea about seven years ago. ''I
start it immediately when I feel like I'm coming down with
something, and it never happens,'' says MacDonald.
O'Brien, the Wilmington physician, says herbal remedies are a
good option when used appropriately.
''What's lacking in this picture is a sense of balance or
perspective,'' says O'Brien. ''Conventional Western medicine is
unparalleled in its treatment of acute illness and injury. But when
it comes to degenerative conditions and illnesses, there is a role
for alternative medicine.''
