Friday, 20 August 2010

Self help or self harm – do we know?

Whether we live a “healthy” lifestyle or not many of us think about it even if we don’t always succeed. Herbal and other complementary therapies have always been around and while there may be a lack of evidence to how effective they are (no I am not going to enter into the evidence-based discussion here) most of them are not harmful.

I am for the healthy lifestyle and I believe that if you eat a balanced diet you shouldn’t need supplements but have to admit to swallowing vitamin C if I think I am getting a cold and sometimes the cold develops and sometimes it doesn’t...

Just as there are interactions between licensed medicines (and your doctor and/or pharmacist should always make a careful note of what you are already taking before prescribing/dispensing something new), there are interactions between the medicines and the complementary therapies or indeed some foods.

In 2004, a colleague and I went to the American Society of Clinical Oncology (ASCO) conference and there was a very scary presentation from a group including someone from the Memorial Sloan Kettering Cancer Centre – one of the top cancer hospitals in the USA. What was so alarming is that they said that over 70 per cent of cancer patients receiving medical treatment are also using complementary therapies and some of these were actually counteracting the effect of their cancer treatments. What is really worrying is that the vast majority of these patients did not tell their doctor because they thought they would be laughed at or stopped from taking something which they thought “was doing them good”.

Sloan-Kettering has a database About Herbs, Botanicals & Other Products where you can look up the various products and also see if there are known interactions.

This was brought to my attention this week by an article in the Irish Times by Muiris Houston The mixing of treatments can be lethal. This drew from an article in Cancer World by Anna Wagstaff, Grapefruit juice and St Johns Wort are just the tip of the iceberg (July-August 2010 No 37). We know that many cancer drugs are “toxic” which means that as well as killing the cancer cells they have unpleasant or even quite serious side-effects and the two have to be balanced. What happens if some other substance is either preventing the drug from working – or even causing the drug to stay in the body longer than it should, resulting in an overdose.

When treatments fail patients or when the side-effects are so bad the treatment is stopped – is the impact of possible other therapies that the patient is taking explored? As Anna Wagstaff says, “Drug interactions cannot always be avoided but so long as they are identified, they can at least be managed. The danger lies in interactions that are not being identified and by their very nature it is difficult to know how widely this is happening”.

I am neither for nor against complementary therapies – I am for the evidence - and article like this should provoke an acceptance the evidence is needed and a spirit of cooperation between clinician and patient is essential. Sloan Kettering has made a good start.

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