When I see mainstream reports that unfairly attack the use of
complementary and alternative healthcare methods, normally I get peeved. Or angry. Or sometimes very angry. But not this time. This time it's just too laughable to get angry. We'll start with the rational and then move on to the ridiculous. The May 2005 issue of the Annals of the Rheumatic Diseases carries a study from a UK team of researchers who examined herbal treatment use among arthritis patients. Their goal was to determine if potentially harmful interactions might be risked by combining herbs with conventional rheumatological drugs. And so far I'm with them 100 percent. I'm all for research that will add to our knowledge of the parameters of alternative therapies. - More than 230 rheumatology outpatients completed questionnaires about their use of conventional drugs, over-the-counter (OTC) medications and herbal treatments during the prior six months. The subjects were also asked if they were aware of potential adverse interactions and if they had sought advice from a healthcare professional before using the herbal and OTC remedies.
The results: - Nearly 45 percent reported using herbal and/or OTC treatments.
- Eleven percent reported taking remedies that might interact with conventional drugs.
- Of 120 subjects who were taking disease-modifying anti- rheumatic drugs (DMARDs), five were also taking Echinacea. (According to the researchers, this combination increases the risk of hepatotoxicity; toxicity to the liver.)
- Of 238 patients who were taking non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, 24 were also taking ginkgo biloba, garlic or devil's claw. (According to the researchers, this combination increases the risk of bleeding disorders.)
- A total of 26 patients were determined to be at risk of harmful interactions. All but two of them were unaware of the risks, and only 10 had sought advice from doctors or healthcare professionals before starting an herbal treatment.
In their conclusions the researchers write: "Healthcare workers should remember to be particularly vigilant to ask about herbal remedies when taking a drug history." I agree with that and would add that patients who use herbal products should be just as vigilant when it comes to alerting their doctors about herbal use. But this is where I part ways with the UK team. Let's start with the researchers' concern that taking ginkgo biloba,
garlic or devil's claw with NSAIDs increases the risk of bleeding
disorders. The likelihood that any of those three herbals taken alone in appropriate doses would cause bleeding disorders is very small. But NSAIDs? They're notorious for prompting gastrointestinal problems, including bleeding. Take the NSAIDs out of the picture and you're probably fine. And yet the researchers make the herbals sound like culprits that will trigger all the problems. Echinacea gets singled out for this special mention: "Echinacea may be hepatotoxic and exacerbate this adverse effect of disease modifying anti-rheumatic drugs (DMARDs)." A little research reveals other warnings about the danger of liver
toxicity with Echinacea. And yet an American Botanical Council report published in March 2005 states, "There is no credible evidence that Echinacea preparations cause hepatotoxicity." DMARDs, however, CAN prompt hepatotoxicity and quite a bit more. Here are a few quotes from the warning flyer for methotrexate, the generic name for a common DMARD: - "Patients should be closely monitored for bone marrow, liver, lung and kidney toxicities."
- "Deaths have been reported with the use of methotrexate in the treatment of malignancy, psoriasis, and rheumatoid arthritis."
- "Methotrexate-induced lung disease is a potentially dangerous lesion, which may occur acutely at any time during therapy and which has been reported at doses as low as 7.5 mg/week. It is not always fully
reversible." - "Severe, occasionally fatal, skin reactions have been reported following single or multiple doses of methotrexate."
- "Non-Hodgkin's lymphoma and other tumors have been reported in patients receiving low-dose oral methotrexate."
One word: Yikes! Given these warnings, the idea that the addition of Echinacea might be responsible for prompting a serious adverse side effect is laughable. If you happen to be taking Echinacea and add some methotrexate, THEN you've got problems. The UK study was sent to me by a colleague who noticed that in spite of the study's frequent references to elevated risks when herbs are combined with drugs, apparently none of the subjects actually experienced any adverse interactions over a period of six months. You would think that would be noted in the study, but it's not. Meanwhile, here's how Reuters Health headlined a report about this study: "Herbal Remedies for Arthritis Can Be Risky." Did I say I wasn't angry? Well, I'm laughing at the absurdity of it all,
but that headline…yep, that makes me angry. To Your Good Health, Jenny Thompson
Health Sciences Institute Sources: "Use of Herbal Remedies and Potential Drug Interactions in Rheumatology Outpatients" Annals of the Rheumatic Diseases, Vol. 64, No. 5, May 2005, ard.bmjjournals.com "Herbal Remedies for Arthritis Can Be Risky" Reuters Health, 4/14/05, abcnews.com "Warnings" Rheumatrex (Methotrexate Sodium Tablets), rheumatrex.info | 
