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Natural therapies
Surprised at disdain for conventional medicines
From Mr C. Anton and Mr A. R. Cox, MRPharmS
Ian Jackson’s disdain for conventional medicine (PJ, 17 July, p83)
is surprising. All conventional medicines supplied in the UK have product
licences and the evidence base for their safety, efficacy and quality has
been checked, and is kept under review, by the Medicines and Healthcare
products Regulatory Agency (MHRA), together with its committees such as
the Committee on Safety of Medicines and Subcommittee on Pharmacovigilance.
This is not true of the majority of alternative or traditional products
available.
It is true that large numbers of patients are harmed by their conventional
medicines, with many cases remaining unreported. In a majority of instances
these events would have been avoidable with better medicines management
systems. 1 However, highlighting the known risks of conventional medicines
provides little insight into the efficacy and safety of herbal medicines;
we see many reports of such reactions or interactions in this centre.
Even the example of mistletoe Mr Jackson uses as evidence to support his
position, does little to back up his general point about herbal medication.
Systematic reviews of the efficacy of mistletoe extracts have found the
majority of trials to be of poor methodological quality; the one high quality
trial reported no difference between the treatment and control groups.2 Of course, standard chemotherapeutic agents are extremely toxic drugs,
but mistletoe is not without adverse effects. Hepatitis has been reported
in the literature2 and in reports of suspected adverse reactions to the
MHRA. Anaphylactic shock has also been reported.3 The latter reaction providing
mixed evidence for Mr Jackson’s assertion that mistletoe “works
with the body’s immune system rather than against it”.
We urge pharmacists to be vigilant in checking with patients whether they
are taking “natural” or “traditional” remedies,
to remind them that, just like other drugs, they are not always safe and
may cause harm. Pharmacists should complete a Yellow Card if they suspect
that any adverse reaction or interaction has occurred.
Christopher Anton
Anthony Cox
West Midlands Centre for Adverse Drug Reaction Reporting
References
1. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ et al.
Adverse drug reactions as cause of admission to hospital: prospective
analysis of 18,820 patients. BMJ 2004;329:15–9.
2. Barnes J, Anderson LA, Phillipson JD, editors. Herbal Medicines, 2nd
edition. London: Pharmaceutical Press; 2002.
3. Hutt N, Kopferschmitt-Kubler, M, Cabalion J, et al. Anaphylactic reactions
after therapeutic injection of mistletoe (Viscum Album L.). Allergologia
et Immunopathologia 2001;29:201–3. |
The
Pharmaceutical Journal