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Author Topic:   Safety and Effectiveness of Herbs and Pharmaceuticals
Apothecus
Member (Idle past 792 days)
Posts: 275
From: CA USA
Joined: 01-05-2010


Message 76 of 209 (554353)
04-07-2010 7:00 PM
Reply to: Message 74 by rockondon
04-06-2010 9:46 PM


Hey rockondon.

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

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:

An extract of the herb St. John's wort was no more effective for treating major depression of moderate severity than placebo, according to research published in the April 10 issue of the Journal of the American Medical Association.

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).

quote:
It has a side effect profile similar to placebo.

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.

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

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

quote:
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?

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.


"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

This message is a reply to:
 Message 74 by rockondon, posted 04-06-2010 9:46 PM rockondon has responded

Replies to this message:
 Message 81 by rockondon, posted 04-08-2010 1:54 PM Apothecus has responded

  
Apothecus
Member (Idle past 792 days)
Posts: 275
From: CA USA
Joined: 01-05-2010


Message 79 of 209 (554485)
04-08-2010 1:36 PM
Reply to: Message 78 by Coragyps
04-07-2010 10:36 PM


Re: Side Effects
Hey Coragyps.

...it irritates the crap out of me that herbal fans go on about how their wares "contain no chemicals."

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...

At the base, it's another piece of anti-science similar to creationism. Based on different superstitions, but still on anti-facts.

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.


"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

This message is a reply to:
 Message 78 by Coragyps, posted 04-07-2010 10:36 PM Coragyps has not yet responded

  
Apothecus
Member (Idle past 792 days)
Posts: 275
From: CA USA
Joined: 01-05-2010


Message 83 of 209 (554559)
04-08-2010 10:52 PM
Reply to: Message 81 by rockondon
04-08-2010 1:54 PM


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):

Apo writes:

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).

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.

What I do contend is that it is effective for some types of depression in some circumstances. If you disagree with that, I'd love to hear it.

I've got no qualms with this, as I said in my reply to your initial post.

I even did an APA style reference and everything. Hope you enjoyed it

It really did make my day, thanks.

I presume you will agree that SSRI's are effective based on the "years of clinical trials," if you don't then please correct me.

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?

Incidentally, the other point I'm making is that the side-effect profile of SJW is lower than other antidepressants. If you disagree with that, I'd love to hear more about that too.

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.


"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

This message is a reply to:
 Message 81 by rockondon, posted 04-08-2010 1:54 PM rockondon has not yet responded

  
Apothecus
Member (Idle past 792 days)
Posts: 275
From: CA USA
Joined: 01-05-2010


Message 99 of 209 (554655)
04-09-2010 12:54 PM
Reply to: Message 84 by Granny Magda
04-09-2010 9:12 AM


Hey Granny.

If people are going to use herbal medicines, they need to be aware of the risks. Experience tells us that most will not make themselves aware of the risk, nor will the snake oil salesmen of the alt-med industry tell them of the risks. That is why I support legal controls on herbal medicine.

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.


"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

This message is a reply to:
 Message 84 by Granny Magda, posted 04-09-2010 9:12 AM Granny Magda has acknowledged this reply

  
Apothecus
Member (Idle past 792 days)
Posts: 275
From: CA USA
Joined: 01-05-2010


Message 100 of 209 (554657)
04-09-2010 1:06 PM
Reply to: Message 96 by Percy
04-09-2010 12:17 PM


Re: Thimerosal does not cause autism
Hey Percy.

... thimerosal was removed from vaccines in the US beginning around 2000 and autism rates have continued to climb.

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 ...


This message is a reply to:
 Message 96 by Percy, posted 04-09-2010 12:17 PM Percy has acknowledged this reply

Replies to this message:
 Message 102 by nwr, posted 04-09-2010 1:09 PM Apothecus has responded

  
Apothecus
Member (Idle past 792 days)
Posts: 275
From: CA USA
Joined: 01-05-2010


Message 104 of 209 (554666)
04-09-2010 1:45 PM
Reply to: Message 102 by nwr
04-09-2010 1:09 PM


Re: Thimerosal does not cause autism
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.


"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

This message is a reply to:
 Message 102 by nwr, posted 04-09-2010 1:09 PM nwr has responded

Replies to this message:
 Message 105 by nwr, posted 04-09-2010 2:04 PM Apothecus has acknowledged this reply

  
Apothecus
Member (Idle past 792 days)
Posts: 275
From: CA USA
Joined: 01-05-2010


Message 106 of 209 (554702)
04-09-2010 3:41 PM
Reply to: Message 87 by Hyroglyphx
04-09-2010 9:33 AM


Hey Hyro.

The problem is that there is also a false sense of pharamceuticals too which often have side effects worse than the actual condition you want to treat. How many drugs are being pulled off the shelves and how many lawsuits are in effect because the product is dangerous? A lot.

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).

As soon as she was off those meds, she had made marked improvements. How ironic?! She took the meds to sedate her anxiousness and it made the condition ten times worse!

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.


"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

This message is a reply to:
 Message 87 by Hyroglyphx, posted 04-09-2010 9:33 AM Hyroglyphx has not yet responded

  
Apothecus
Member (Idle past 792 days)
Posts: 275
From: CA USA
Joined: 01-05-2010


Message 167 of 209 (555577)
04-14-2010 9:27 AM
Reply to: Message 164 by Buzsaw
04-14-2010 8:49 AM


Re: Not the Question
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


"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

This message is a reply to:
 Message 164 by Buzsaw, posted 04-14-2010 8:49 AM Buzsaw has responded

Replies to this message:
 Message 174 by Buzsaw, posted 04-14-2010 10:53 AM Apothecus has responded

  
Apothecus
Member (Idle past 792 days)
Posts: 275
From: CA USA
Joined: 01-05-2010


Message 178 of 209 (555616)
04-14-2010 2:12 PM
Reply to: Message 174 by Buzsaw
04-14-2010 10:53 AM


Re: Not the Question
Hey Buz.

You're oversimplifying, Apothecus, without citing the nutritional elements of the Scripts regimes.

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:

Buz writes:

No alternative suppliments are a silver bullet for cancer. Going at it naturally would require a very stringent and well guided regimen. Also, it depends on how advanced the cancer was before beginning any program. There comes a point where nothing outside of a miracle will be able to bring remission or cure.

... 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.


This message is a reply to:
 Message 174 by Buzsaw, posted 04-14-2010 10:53 AM Buzsaw has responded

Replies to this message:
 Message 185 by Buzsaw, posted 04-18-2010 12:29 PM Apothecus has not yet responded

  
Apothecus
Member (Idle past 792 days)
Posts: 275
From: CA USA
Joined: 01-05-2010


Message 187 of 209 (556278)
04-18-2010 6:52 PM
Reply to: Message 186 by onifre
04-18-2010 6:12 PM


Re: Not the Question

Thanks anyway, Buz. Seriously, I appreciate the thoughtfulness.

Perhaps for you, once the chemo is completed, then is the time to rebuild your impaired immune systems via a vigorous wholeistic health regime, applying the necessary nutrients the body's systems need to keep the cancer cells at bay.

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?

Certainly, regardless of what you do, the more knowledge you acqure relative to all aspects of health, the less you will be in the dark as to what where to go from here.

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.


This message is a reply to:
 Message 186 by onifre, posted 04-18-2010 6:12 PM onifre has not yet responded

Replies to this message:
 Message 189 by Buzsaw, posted 04-19-2010 8:26 AM Apothecus has acknowledged this reply

  
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