Safety and Effectiveness of Herbs and Pharmaceuticals

Hey rockondon.

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However, one herb that has shown to be effective is St. John's Wort.

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Indeed, but I think you're representing a rosier picture of SJW than is supported by credible sources. Ignoring Wiki for the moment, according to NIH's NCCAM Study: To be fair, although the study also compared SJW to sertraline (Zoloft), the differences between the two as to effectiveness according to DSM-IV criteria were not statistically significant (lest you think I'm rah-rahing Big Pharma).

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It has a side effect profile similar to placebo.

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This is also a mischaracterization. Most medications (rx or otc) will list possible side effects observed in controlled clinical studies, but most will also be shown to occur in less than 5% of people. This is usually clinically and statistically indistinguishable from placebo, but do they occur? You bet they do; whether by actual processes or psychosomatic processes, they will occur. To write off the possible side effects of any drug based on the fact that, clinically they are infrequent, is to shoot myself in my pharmacist-foot (esp. when considering little studied "supplements" like SJW). And that doesn't even begin to touch upon the fact interactions that SJW has with other medications. It potentiates an important enzyme responsible for breakdown of other meds you may be using, thus possibly contributing to toxicity of those medications. Not a good thing, especially for the depressed grandma who is also taking heart medications such as digoxin.

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...its about as harmful to you as drinking water

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Possibly true for most people, but a dangerous blanket statement for the above reasons.

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Why are people taking these drugs and suffering all these side effects when St John's Wort seems just as good and with virtually no side effects?

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Setting aside the falsity of the "virtually no side effects" part, to answer your question, perhaps it's because 9 out of 10 times a pharmacist will steer a patient toward a product which has the weight of years and years of clinical trials vs. a product which "has not been evaluated." Don't get me wrong: I'm not a supplements-basher. Many herbals are marginally effective, and actually don't have much of a side-effect profile. But in my daily practice, I need to weigh the risk/benefit profile of each and every product I recommend. Since I have a better idea of the effects of most of the mainstream antidepressants (more studies), and also have at my disposal the rest of the patient's medication profile when considering whether those antidepressants are appropriate, is more than enough to move SJW to the bottom of my list of treatment options.Hope this helps.Have a good one.

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"My own suspicion is that the Universe is not only queerer than we suppose, but queerer than we can suppose. J.B.S Haldane 1892-1964

Hey Coragyps. I deal with this myth almost every day. Someone will walk up to the counter (after nosing around the "Natural Foods" section for awhile) with a jug of echinceablackcohosheveningprimroseredriceyeast and say, "Is this good for my [insert any malady here]?" Well, I think to myself, "Oh, great! A question about an herbal that I can actually answer since I read about this in my latest pharmaceutical journal." Then I come to realize that waaaait ... that "study" referenced the "standardized" extract, not the "standardized" flower parts like this bottle says it contains. So I attempt to consult the literature I have at my disposal about the flower parts type of product, and lo and behold, there is none. Anywhere. Nor can I find a product which actually contains extract of the above ingredient. Nor is there any literature describing the conversion factor to determine how much of one = how much of the other. So I attempt to tell the patient this, and also that I cannot say either way if this product is "good"; at this point the patient sniffs, looks at me, then back at the bottle -- and I can feel a form of "IDIOT" stigmata pop out on my forehead for only this patient to see. The patient turns on her heel, and walks off, presumably to treat/toxify herself. This, in regard to herbal supplements, is what "The FDA has not evaluated these statements" means to someone in my profession. By and large, most products have few side effects (indeed, most have few "effects" at all) and I have no problem recommending one. But many times the liability I face is too great, and I punt it away...whether this makes me look like I know next to nothing, I don't know. But it's not a tough call to make, in any case... This is interesting. I'd never thought of it this way before, but it makes sense to me. Most folks equate OTC/herbals as "safe" vs prescription products, though they may be quite the opposite. I try to get this across to people with this misconception, but the minute I start in on it, the glaze-over begins and you can tell the battle's lost before it began since I didn't start by telling them what they wanted to hear.

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"My own suspicion is that the Universe is not only queerer than we suppose, but queerer than we can suppose. J.B.S Haldane 1892-1964

Thanks for the reply rockondon...I think you're misunderstanding my position. At no point (other than citing the study) did I comment on the effectiveness of SJW, except to say this (which supports your contention as to effectiveness): What I was getting at was your blatant use of rose-colored glasses pertaining to safety. I see this all the time with people who misinterpret studies and conclude that an herb being freely available OTC translates to it being "about as harmful as drinking water." That's a fallacious comparison, one which could prove deadly. I've got no qualms with this, as I said in my reply to your initial post. It really did make my day, thanks. Again, I wasn't arguing for effectiveness of SSRI's vs SJW, I was arguing against your characterization of SJW as "safe as drinking water." When speaking of safety, in the case of SSRIs, which have been around for years, the side effect profiles and interaction profiles have been pretty much fleshed out. It seems they're finding new interactions and side effects for SJW every month, which is what you'd expect when you need to rely on anecdotal reporting with herbal products, as opposed to scientific trials with prescription meds (notwithstanding the limited trials with SJW). Now that's not saying SSRIs don't have interactions of their own (please don't ignore this part and reply with 600 drugs interacting with Prozac), but the fact that a patient needs to see a doctor and get Prozac at the pharmacy seriously diminishes the likelihood of toxicity. We do employ software which catches these interactions (as well as the one in my brain) but who's going to catch the potential problem when SJW walks out the door of GNC? I'd agree with you that for mild cases of depression, there are many people who could benefit from SJW. I never said otherwise -- you seemed to put those words in my mouth. There are indeed people with severe depression who need prescription medications, but a case could be made that SSRIs would not be first choices in those cases.But I digress. My point (if you haven't ascertained it already) is that for most patients, I'd recommend seeking the advice (and Rx, if warranted) of a physician and subsequent Rx antidepressant obtained from a pharmacy. This way, safety can be more adequately assured and treatment (however you may feel about Rx medications) can proceed without excessive concerns about overdosage, toxicity, or drug interactions.Unfettered access to dangerous substances is the crux here, rockondon. Not supposed effectiveness.Have a good one.

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"My own suspicion is that the Universe is not only queerer than we suppose, but queerer than we can suppose. J.B.S Haldane 1892-1964

Hey Granny. Good points, all. It seems as if, every once in a while, we'll get a whiff of the FDA possibly regulating an herbal which has shown to have this-or-that active metabolite of a legitimate prescription med (making the herb a de facto version of the original, albeit most of the time, a weaker version). But then of course the activists and industry lobbyists (yes, they exist) get their backs all up about it, and the interest seems to magically fade away. There have been some legitimate efforts to regulate supplements, however. Pseudoephedrine can only be bought behind the pharmacy counter, although this was for reasons associated with meth-manufacture vs. actual run of the mill patient safety. Ephedrine has been "banned", but can be obtained as Ma Huang; yohimbine isn't too far removed from either of these, and is easily available as well.Unfortunately, the only types of situations which will result in more regulation of OTCs include the above type of abuses or multiple high profile deaths following legitimate usage. Like so many other things, hindsight rules. But I agree -- supplements should be regulated.Have a good one.

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"My own suspicion is that the Universe is not only queerer than we suppose, but queerer than we can suppose. J.B.S Haldane 1892-1964

Hey Percy. Just thought I'd comment that thimerosal was removed from vaccines routinely given to children under age 6. It is still commonly found in vaccines for older kids and adults, but I fully agree that the hysteria surrounding thimerosal and autism was and always has been unjustified. Once again, the FDA has kowtowed to the anti-science fervor of the wing-nut crowd ...

Hey NWR.Good point. There will always be those who are on the fence about vaccines who, after an allegedly harmful agent is withdrawn from a product, will then decide it's OK to use.But the thing is, these aren't normally the people who are the most vocal about vaccines. Those screaming the loudest are the nutters who accuse the gov't of a vast vaccine conspiracy in which children are test subjects for some deeper purpose. Travesties such as Tuskegee, of course, give these folks ample ammunition (in their mind) to decry any government involvement in public health. They'd throw the proverbial baby out with the bathwater in a NY minute, even as their actual child suffers life-threatening mumps-related swelling which could have been avoided otherwise...I know quite a few families like this, as I'm sure all here do. When all is said and done, many of them would consider vaccines the equivalent of injecting sulferic acid into the jugular of their 2 year old, thimerosal or not, and regardless of the risks of non-treatment.I still contend the FDA kowtowed; now whether it was to increase credibility, as you contend (and I'm not saying it's not -- it actually seems like a good reason) or just to appease the wingnuts, I still believe thimerosal (a good preservative) containing vaccines would be available for children to this day if not for the anti-vaccine crowd.

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"My own suspicion is that the Universe is not only queerer than we suppose, but queerer than we can suppose. J.B.S Haldane 1892-1964

Hey Hyro. Your feeling like taking medications is a crap shoot is really not far off the mark. Many feel as if [insert drug here] will be the magic bullet to improve their [insert malady here], and are surprised when I tell them I can't say exactly how they'll respond to the medication until they've tried it. Some realize this, and, like yourself, refuse to take the chance. Many times, excessive side effects lead to switching medications to one which is more agreeable to a certain body type, and sometimes this can take months, involving multiple switches. The goal of therapy, of course, is to treat the condition as well as possible without resorting to treating side effects with additional medications.Despite all this, I do think your use of the word "often" in the above statement is an exaggeration of sorts. I can tell you that, although I agree this does occur in practice, I would consign these situations to "rarely" vs. "often", at least in my experience. No sane person would continue a med if side effects were worse than the original ailment, and most eventually find the treatment appropriate to them (at least if they're being followed adequately by their physician). Unfortunately, I've seen this happen, as well. It seems to happen most often in cases involving mental health vs a condition like, say, blood pressure. I think the problem results from the fact that psychiatric meds often are used to indirectly mimic or alter the levels of brain chemicals responsible for mental stability. Since everyone has a different body chemistry (and also due to the fact that most psychiatric medications' mechanism of action is unknown), it leads to the view that physicians are "shooting from the hip" in most cases, and that treatment of these conditions is inexact, at best. This is not all that inaccurate of a representation, but it's the reality nonetheless.If it seems at all that I waffle more than someone in my profession should in regard to prescription medications, I would counter that adopting a position of realism is superior to baldly advocating that rx meds are the end-all and be-all of treatment. This also (and especially) includes all OTC medications (and herbals, lest I'm accused of flailing off-topic ). My job is to present all the possible outcomes of a particular therapy, good and bad, which can result from a specific medication (or combination of medications). There are always going to exist those cases in which total discontinuation of therapy (as with your wife) will improve outcomes substantially. But by and large, I think most people will benefit from most medications (if with a little tinkering), and also that the positives of Rx medication treatment will invariably outweigh the negatives.

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"My own suspicion is that the Universe is not only queerer than we suppose, but queerer than we can suppose. J.B.S Haldane 1892-1964

Hey Buz.Aside from the fact that you attempted to answer the question with another question (I would say you dodged it again), do you really know what the Scripps Institute does? First and foremost, it employs cutting edge technology (science at its best) for a multitude of treatable conditions, from cardiac stents to sclerotic therapy. Second, the latest medically proven pharmaceuticals are used, complementing primary therapy to ensure long-term, successful outcomes. Adjunct to this (it almost seems it's added as a tiny postscript) are various "holistic" therapies, such as healing touch, stress therapy, massage, acupuncture, nutrition, and the like. I don't think anyone is claiming these types of therapies are useless, Buz. If they can provide a measure of mental or physical well being pursuant to some medically and scientifically proven procedure, then great!What folks here object to is your apparent assertion that holistic healing is as effective a medical therapy, as, say, a corneal transplant or cancer treatment.Edited by Apothecus, : Added "nutrition" for Buz

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"My own suspicion is that the Universe is not only queerer than we suppose, but queerer than we can suppose. J.B.S Haldane 1892-1964

Hey Buz. Fixed Message 167 for you. As they say, "it don't make no nevermind" to my position on the whole, Buz. My point is that all of these "alternative" therapies may, from either "mind over matter" effects on mental and/or emotional well being or possible actual physical effects, exert some benefit. I say this while openly describing some of them (I said some, Buz) as hoo-haw at best.It's great that you support integrated therapy, Buz. But when you make statements like this in response to Coragyp's post: ... it makes me think you would never support mainstream therapies for any situation as primary treatment. I'm talking chemotherapy, Buz. I know, it's probably anathema to you to consider this, but what if it were your wife and the physician stated it was either chemo or 3 months? Would you resort to prayer and woo? Or would you truthfully, as you state, support therapy integrated with mainstream and alternative therapies, as I'd support? I'm just wondering, because quite frankly, your statements are confusing and somewhat contradictory.Have a good one.

Thanks anyway, Buz. Seriously, I appreciate the thoughtfulness. It's good to know that (if I'm getting you correctly, here) you'd not throw the baby out with the bathwater, at least not totally anyway. I see the only difference between you and me as one of degree. I wouldn't be totally against alternative therapies adjunct to mainstream treatment, and you wouldn't be totaly against mainstream treatment adjunct to alternative therapies, no? Of course although I'd not be so arrogant as to suggest I don't learn new things daily, I think I have most of my bases covered here, Buz. Thanks, though. Have a good one, and thanks again for the prayers. Maybe god'll let me save them for a later unfortunate turn in life.