Drug Interactions from Alternative Therapies

An important panel discussion was held at the recent American Society for Parenteral and Enteral Nutrition's 25th Clinical Congress in Chicago. In a symposium on complementary and alternative medicines (CAMs), speaker after speaker warned that the number of known nutrient-to-nutrient and nutrient-to-drug interactions is growing "exponentially." The culprit: The exploding number of herbs and dietary supplements being used by patients, usually without their doctor's knowledge or consent.

The panelists cautioned that even seemingly safe herbs and supplements could be dangerous when taken in excessive doses, or when mixed with other therapies, or especially if taken by patients with certain diseases. Furthermore, these therapies can sometimes mask patient symptoms or skew laboratory tests, thus affecting decisions about traditional medical treatments that might unnecessarily be abandoned.

And the situation will not get better any time soon, they warned, because there are no major definitive clinical trials evaluating many of these compounds. This is further complicated by the fact that many physicians themselves are not knowledgeable about the complementary and alternative therapies their patients may be taking.

Patient Confidence

This symposium comes on the heels of an important conference in Washington, D.C. that called for major improvements in the way the medical community is responding to this burgeoning patient trend in CAM therapies.

The White House Commission on Complementary and Alternative Medicine Policy recently came to two conclusions: patients are convinced that such therapies work; yet patients are also unhappy about their physicians' lack of knowledge about them. The commission was established by President Clinton in March 2000 to make policy recommendations for maximizing the general public's access to complementary and alternative medicines.

The commission also noted that the rising demand for herbal and dietary supplements, massage therapy, and even professionally-facilitated support groups is causing their costs to skyrocket. This is compounded by the fact that such treatments are usually not included in Medicare and Medicare reimbursement plans.

The biggest barrier to obtaining reimbursements, said Dr. James Gordon, the chairman of the commission, is "skepticism" on the part of traditional medicine providers. In the commission's final report, due to Congress in July 2001, he said they intend to recommend that complementary and alternative treatments be incorporated into medical school curricula. "More education about these therapies would reduce skepticism and allow physicians and others to provide their patients with more information on CAM," he said.

Communication Issues

Preliminary results from a five-year study presented at the International Congress on Women's Health Issues in San Francisco showed that over 70 percent of breast cancer patients are combining traditional medical treatments with alternative therapies such as acupuncture, herbs, prayer or nutritional supplements.

But the data also showed that only a third of the women discussed these alternative therapies with their doctors.

Another study, published in the Journal of Clinical Oncology, found that 99.3 percent of oncology patients had heard of complementary and alternative therapies, and 83.3 percent had used at least one CAM approach.

In that survey of 453 cancer patients at the University of Texas M.D. Anderson Cancer Center in Houston, Dr. Mary Ann Richardson and colleagues found that spiritual practices were the most popular CAM therapy (used by 80.5 percent of the patients), followed by vitamins and herbs (62.6 percent), and "movement and physical therapies" such as massage and touch (59.2 percent).

Given the number of patients combining vitamins and herbs with conventional treatments, the researchers concluded, "the oncology community must improve patient-provider communication, offer reliable information to patients, and initiate research to determine possible drug-herb-vitamin interactions."

Calling for Caution

Acknowledging the exploding use of complementary and alternative therapies among patients, The National Center for Complementary and Alternative Therapies recommends that patients take the following minimal steps when considering their use:

• Take the time to research the safety and effectiveness of the therapy.
• Ask different healthcare providers about the therapy, as well as patients who have already taken it.
• Consider the costs. Will you have to pay directly for the treatment? Will insurance cover a portion of the costs?
• Tell your doctor about the therapy you are considering! It may be perfectly safe-and even beneficial. But is may also have known interactions with other medicines you are taking, or side effects that could be harmful.

SOURCES:
American Society for Parental and Enteral Nutrition's 25th Clinical Congress, January 23, 2001, Chicago, Illinois
The National Center for Complementary and Alternative Medicine (http://nccam.nih.gov)
Journal of Clinical Oncology, July 2000; 18(13), 2505-2514

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