This summary of an article from "Drug and Therapeutic Medicine" is not a surprise. Its message is that most doctors do not ask their patients about herbal/complementary/eastern medicines they are using and wouldn't know much about them if patients offered the information. This unfortunate fact, however, is not a reason or an excuse not to speak with your doctor about other treatments or medicines or supplements you are using. Generally speaking, there are no concerns about "external treatments" (acupuncture, massage, visualization, etc) but there are worries about anything that you swallow. Since the studies have not been done to examine the possible interactions of various herbs and supplements with chemotherapy, there is worry that there could be negative consequences. Although not quite the same thing, the negative combination of tamoxifen and some SSRIs (see yesterday's entry) is an example of how two independently good treatments may be bad for each other--and therefore you you. Here is the summary:
A Herbal Medicines a Mystery to Most Doctors
By Crystal Phend, Senior Staff Writer, MedPage Today
Physicians don't know much more about complementary and alternative medicine than their patients do, according to a new survey. Most healthcare professionals who answered an online survey of Drug and Therapeutic Bulletin subscribers said their profession was just as poorly informed about herbal medicines (75.5%) as the general public (86.3%). And almost half of respondents rated their own knowledge about herbal medicines as "quite" or "very" poor (36.2% and 10.4%, respectively). Even more worrying, journal editor Ike Iheanacho, MBBS, said in a podcast released in conjunction with the survey, was that medical professionals exhibited a lack of interest in even asking whether patients were taking herbal compounds. More than half of respondents said they never or only occasionally (8.6% and 46.6%, respectively) ask when reviewing patients' medications whether they are taking herbal medicines. This was surprising, commented Linda Anderson, BPharm, PhD, principal pharmaceutical assessor at the British Medicines and Healthcare products Regulatory Agency. Her agency's survey of the general population suggested that "most patients were quite willing to tell doctors they were taking herbal medicines and, in fact, expected their doctor to ask," she explained in the podcast. Anderson's interpretation was that physicians don't ask because they don't know enough to respond. Indeed, 89% of those surveyed said their knowledge of herbal medicines was "much poorer" than their knowledge of prescribed medicines. However, 21.3% of respondents said that if they were faced with a patient taking an herbal medicine they were unfamiliar with, they wouldn't seek further information about it. The primary reason cited for this was being unsure where to find such information (60%), followed by being unsure how to assess or use such information even if they were able to find it (42.9%). This sets up a worrying conflict with patient expectations, Anderson noted. "Our survey showed that patients thought doctors would be a good source of information," she said in the journal's podcast. Notable, too, was that the largest proportion of medical professionals surveyed -- 50% -- said they would turn to general searches of the Internet, such as using Google, for reliable information on herbal medicines. "I would suggest that that's a terrible source of information where herbal medicine is concerned," Michael McIntyre, chair of the European Herbal Practitioners Association, commented in the podcast. "Unless you know what site you're on, you could get terrible information, wrong information," added McIntyre, who also serves as a member of the U.K. Department of Health Herbal Medicine Regulatory Working Group. No information on conflicts of interest was provided. Patients would likely be horrified to know that physicians were relying on information on the Internet that wasn't qualified, Anderson agreed. One reason for healthcare professionals' lack of information on herbal medicines may be that they feel it's a step backward, McIntyre said. Doctors "don't want to get pulled back into the swamp," McIntyre suggested in the podcast. "There's the feeling that we got away from that because we found out what the active constituents are . . . this is science." In the Drug and Therapeutic Bulletin survey, 75.3% of physicians thought herbal medicines were helpful in some circumstances, but an equally high proportion said that the general public has misplaced faith in these compounds (71.8%). The survey garnered response from 164 individuals among a random sample of 1,157 journal subscribers -- primarily physicians and pharmacists -- representing a response rate of 14%. Among them, 87.8% practiced in Britain. Primary source: Drug and Therapeutics Bulletin Source reference: "DTB survey on herbal medicines" Drug Ther Bull 2010. Disclaimer The information presented in this activity is that of the authors and does not necessarily represent the views of the University of Pennsylvania School of Medicine, MedPage Today, and the commercial supporter. Specific medicines discussed in this activity may not yet be approved by the FDA for the use as indicated by the writer or reviewer. Before prescribing any medication, we advise you to review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse effects. Specific patient care decisions are the responsibility of the healthcare professional caring for the patient.
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