One of my two partners doesn't take anything unless the doctor insists. The other takes whatever he’s told and then adds all manner of what he calls "herbals” to his regimen. I fall somewhere in the middle.
Its taken awhile, but I have finally managed to get the one of us who will try most any herbal to provide the doctor with a list of his herbals — which run from Valerian Root for his problems sleeping to Cat s Claw which he says helps fight off the effects of a case of Lyme Disease he got from tick bites some years ago.
Do they work? Maybe, according to the experts. And does the doctor need to know if you or I or my partner takes these herbals? A definite yes to that because those herbals can affect your body and other prescriptions you might have to take. Some of them can even be deadly with the wrong combination of prescription and even over- the-counter drugs.
The truth is, however, that very few healthcare professionals in the United States like answering questions about natural medicine products — the proper name for what my partner calls "herbals". Chances are if you've asked your doctor about herbal products, they probably resisted answering the question and told you to ask your pharmacist. Afterall, pharmacists are supposed to be the experts about medicines, right? Problem is that most pharmacists don’t like answering questions about herbal products any more than the doctors do. Why is that? How could it be?
First off, herbal products are not regulated by the Food and Drug Administration (FDA). That means anyone can market, package and distribute these “medicines” and sell them to you and me supposedly to "fix" or "cure” most any ailment we have.
But wait! There's a notice on the bottles and it says right there that the FDA calls these dietary supplements, not drugs, so it’s the law, right?
Well The Dietary Supplement Health and Education Act of 1994 (DSHEA) classified herbs as "dietary supplements” and not “drugs," but all that means is that the FDA is not required to regulate them. [So then why are some naturally occurring plants, like marijuana, regulated by the government? The answer is that marijuana is currently classified as an "illicit drug" and not a "dietary supplement" or a "medicinal ding,” so it is over-seen by a division of the government called the Drug Enforcement Agency (DEA) though even that is currently changing with several states "legalizing” pot for "medicinal use,” and others for "recreational purposes, though that’s a story for another day.].
But back to those other roots, oils and herbs... Manufacturers of herbal products can make claims about their product’s supposed safety and efficacy, but the claims don’t have to have any scientific evidence to support them (unlike claims made about drugs). The only stipulation is that manufacturers cannot claim that their herbal products diagnose, treat, cure or prevent any diseases. For example, a company can say that their product "improves your mood” but they cannot say that it "treats depression.” Just look on most any bottle and there’s a politely worded FDA-required statement which says exactly that — that the FDA had not guaranteed or tested the product. In other words: it's the maker's word against yours and your doctor's if that herbal will treat, help or do anything positive. And it's your responsibility not to let it harm or kill you with an interaction to something your doctor did prescribe.
In addition, that herbal may (or may not) do you any good at all aside from taking bucks out of your wallet. Get all that?
So back to your drugstore. Pharmacists primarily learn about FDA-approved drugs during their time at pharmacy school. The reason for this is because the efficacy and safety of these drugs has been critically evaluated. If drugs are ineffective and /or unsafe for human use, they are not introduced to the market. If they are found to be both effective and safe, they’re evaluated on whether or not their use requires the supervision of a physician. If they can be used safely without the supervision of a physician, they are sold over-the-counter. If they require a physician's supervision, they are deemed "prescription-only” drugs. The lack of studies to support the use of herbal products for certain conditions makes a lot of healthcare professionals leery of recommending them to patients and I’d fib were I not to say it also makes a lot of us patients scared to try them because not only is data scarce about their efficacy and safety, but even less data is available to you and me about how herbal products interact with other herbals, over-the-counter meds and prescriptions — not to mention if they really work.
Need an example? Gingko, which is frequently marketed bv companies as a "memory booster,” can cause serious bleeding problems if taken with aspirin. St. John's Wort, a popular herbal for depression, can diminish the effectiveness of both oral contraceptives and a group of medications used to treat HIV called protease inhibitors. Many consumers believe that herbals are neutral when it comes to interactions with their medications since they are so readily available at their local pharmacies, but that simply is not the case.
Where do druggists and doctors stand on the use of natural products? The answers from the ones we have spoken with are as diverse as asking someone at the local nightspot what their favorite drink is: all over the map. One physician we spoke with says she approves of the herbals, uses several herself and so long as you inform your primary care doc what you are using (to avoid any interactions with other herbals or prescriptions) she has no problem with their use — though certainly not in every case.
A local pharmacist who wrote about the topic in these pages a few years ago said,
"I tend to agree with the crowd that says IF there is evidenced-based data for the effectiveness and safety of the product, AND there are no suitable FDA-approved products for you to treat the condition diagnosed by your physician, AND there are no known drug interactions with any of the ‘traditional’ medications you are taking, AND you firmly believe that the product is helping to alleviate the condition you’re using it for, what's the harm? There are a lot of ifs and ands in that sentence, but each one is equally important."
So what should you think or do? Well there are three folks at our house and as I said at the outset, one swears by his herbals, one won't touch them and the 3rd of us takes fish oil and one other and says they seem to work fine.
Remember that it's crucial that your doctor(s) and pharmacist(s) know if you’re taking any herbal products in addition to the medications that you receive by prescription or purchase over-the-counter. It is also good to tell them why you are taking that herbal product and how long you have been taking it. Also, be certain to include all of the over-the-counter and herbal products you take routinely and as needed on your list of medications that you carry with you at all times and hand over annually to your doctors. As we are approaching the first of the year, and since the new health law requires those forms be reviewed and updated every year under the guidelines, now would be a good time to look at what you are taking, why you are taking it and include it on your updated list. It’s also a great way to remind your doctor what pills you take and let her or him have a vote in whether the mix is right for you.
Finally, as mentioned previously, data about herbal products is hard to come by and while I’d recommend you start by asking for some with your local doc or pharmacist, there are a few consumer-friendly websites you can try. They may not offer the answer to your questions (for that you will have to talk to the doc or pharmacist) but these are a few resources you can use to find an answer (if it's out there) to your unanswered questions. Good luck, stay healthy and have a great holiday!