herbal

Herbal Medicine: real drugs with real side-effects

by Barry Bittman, MD

While it is widely recognized that prescription drugs can have serious side effects, have you ever considered that the choices you make in your local health food store can be hazardous to your health?

If not, think again.

On September 17^th1998, the lead article in the New England Journal of Medicine (NEJM), shed some new light on what is rapidly evolving into an important debate.

The article entitled, Clinical and Biologic Activity of an Estrogenic Herbal Combination (PC-SPES) in Prostate Cancer presented a series of eye-opening facts about a remedy called “PC-SPES,” a commercially available collection of 8 herbs. It wasn’t readily apparent when I read the original article that the compound’s name suggested its intended use, since the FDA does not allow such open labeling for unapproved compounds.

Yet in a NEJM editorial by Drs. Marcia Angell and Jerome Kassirer, it was disclosed that “PC” refers to prostate cancer, and SPES is Latin for “hope.” This type of labeling for dietary supplements appears to be a legal work-around for a wide-open loophole.

You’re probably saying to yourself that as a physician, I’m about to bash herbal medicine. Actually, that’s not the case. What I am about to do, however, is present some of the pros and cons about the use of herbs that could potentially save your life.

Robert S. DiPaola and colleagues of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School revealed that PC-SPES did have clear-cut, measurable estrogenic qualities with considerable potency. It decreased serum testosterone concentrations and lowered PSA or prostate specific antigen, a fairly reliable gauge of this type of cancer.

Frankly, it’s not surprising that combinations of herbs have potent effects and medicinal qualities. After all, many of the drugs that doctors prescribe had their origins in natural occurring substances. Examples include digitalis, morphine, quinine and penicillin.

Yet, what may be surprising is the fact that as a substance’s potency increases, so does the likelihood of adverse effects. As a case in point, the NEJM article noted side effects such as breast tenderness and loss of libido. One individual suffered venous thrombosis, a medical term for blood clots in veins.

There’s more to this story than just dangerous side effects. Another serious problem surfaced when the authors discovered that individuals were taking PC-SPES without the knowledge of their physicians. Again, this is not surprising. In 1993, Dr. David Eisenberg wrote about the widespread use of herbal remedies in the Journal of the American Medical Association (JAMA). He noted that 70 percent of individuals using alternative medical strategies did not mention them to their personal physicians.

This issue becomes highly relevant when one realizes that some patients had already been taking prescription estrogens as a conventional treatment for cancer. As a result, the combination of the prescribed drug and PC-SPES resulted in an overdose with serious consequences. Retrospectively, however, I am convinced that even if their doctors were told, the problem would not have been averted since the majority of physicians have not received training regarding the indications or side-effects of herbal preparations.

As a physician and an advocate of “whole person” care, I agree with the authors’ statement, “The use of this unregulated mixture of herbs may confound the results of standard or experimental therapies, and may produce clinically significant adverse effects.”

However, I am also convinced that it is the medical profession’s responsibility to step up to the plate and champion the scientific testing of naturally-occurring substances that may be of benefit to mankind. We should work together to promote an integration of medical approaches that can best serve our patients.

While individuals opposed to exposing alternative strategies to the rigors of scientific testing cite numerous examples of conventional medical treatments that are not backed by exemplary scientific research, it is this author’s contention that two wrongs do not make a right¾ Mind Over Matter!