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Monday April 2 10:26 AM ET

Docs Must Educate Themselves on Herbals

 

By Emma Patten-Hitt, PhD

 

ATLANTA (Reuters Health) - Doctors can no longer ignore their

patients' use of herbal medicines, according to Dr. Isadore Rosenfeld

of Cornell University's New York Presbyterian Hospital.

 

Rosenfeld spoke at the American College of Physicians-American Society

of Internal Medicine's scientific program in Atlanta, Georgia. He

discussed some more commonly used herbal medicines, describing their

benefits and their risks.

 

Regarding echinacea for colds, Rosenfeld said reports are mixed.

``Some studies show that echinacea may prevent colds,'' he said. But

he pointed out that, as with other herbal medicines, the problem with

evaluating its use is that preparations come from so many different

parts of the plant, such as the root and the flower.

 

Evidence is better for using saw palmetto to treat enlarged prostate,

he added. ``It is widely used in Europe and there are studies that

indicate that saw palmetto is as effective as the prescription drug

Proscar,'' he said. ``This is a drug that can and should be used in

patients with (an enlarged prostate),'' he said.

 

Ephedra, he noted, is widely sold as an appetite suppressant and can

aggravate high blood pressure and heart problems. Some studies have

shown that Ginkgo biloba may be useful in the treatment of early

Alzheimer's disease (news - web sites), he added. ''Because there is

nothing else, I sometimes use it in patients with the early

Alzheimer's disease,'' Rosenfeld said.

 

``St. Johns wort has been very popular for the treatment of mild

depression,'' he said, ``but it interacts with almost every drug, so

it should only be used if the patient is taking nothing else.''

 

Some herbs, he added, should be avoided at all costs. These include

comfrey and sassafras, which may cause cancer; chaparral and

germander, which are toxic to the liver; and pokeroot, which can be fatal.

 

He also noted that some herbal medicines can interact with

prescription drugs. Black cohosh decreases iron absorption; Capsaicin

worsens a cough from taking a class of prescription drugs called ACE

inhibitors; and several other herbs, including chamomile, Dong Quai,

feverfew and Ginkgo biloba should not be taken with the prescription

blood-thinning drug warfarin, because they increase the risk of bleeding.

 

``It is important for patients to understand that because herbal

medicines are classified as dietary supplements, the US Food and Drug

Administration (news - web sites) does not regulate these drugs,'' he

said. He also warned that there is no guarantee of the purity of these

products. ``You have got to be very careful,'' he noted. ''What I tell

my patients is that they should buy products made in the United

States, from companies that have been in business for a while and have

some kind of reputation,'' Rosenfeld added.

 

``Some people talk about the toxicity of herbal drugs, but

prescription medications have side effects too, so we have to be

careful with anything we use,'' Rosenfeld told Reuters Health. ``The

main point is that patients are using these drugs, so it is important

for doctors understand them,'' he said.

 

Rosenfeld is a best-selling author of books on herbal medicines who

denies any financial ties with manufacturers of these medicines. He

began studying herbal remedies because he felt he was being

intellectually dishonest when he dismissed his patients' use of them

simply because he did not know much about the subject. So, Rosenfeld

said, he delved into studying the topic for 2 years.