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    Physicians Encouraged to Learn More About Herbal Medicines

    In 1993, the Federal Drug Administration (FDA) commissioner called for the elimination of herbal and nutritional supplements from the marketplace due to a lack of proof of their safety or efficacy -- and the public responded. Not since the Vietnam War did legislators receive more letters on a single issue than on this one, said Robert Lutz, M.D., professor and fellow in the Integrative Medicine Program at the University of Arizona, during a presentation on herbal medications at the American Diabetes Association's 60th Annual Scientific Sessions in San Antonio.

    With about 40 percent of Americans taking herbal and/or nutritional supplements, the medical community can no longer ignore their popularity, he said, noting that between 1994 and 1998, use of these products increased by 380 percent. Americans now spend $5.1 billion annually out-of-pocket on these products.

    Why are so many people turning to alternative medical practices? Interestingly, a 1998 study, which looked at this question, found that many people find alternative medicine appealing because it fits into their personal philosophy on life and health. "What people find in alternative medicine is a greater appreciation, greater similarity to their own world views about life, about health, about illness," said Dr. Lutz. "It is most applicable to their spiritual and religious beliefs, their ideas about wellness, health, and illness."

    "What I would suggest to you right now is the great interest in herbal medicine really reflects, if you will, a changing cultural shift, a changing cultural framework on how herbal medicine is being looked on," he said. "I would also like to suggest that herbal medicine exists not just as an 'alternative medicine', but really as an integral component of how medicine can, how it has, and how it should be practiced."

    Lutz pointed out, however, that there are a number of issues associated with this trend that must be addressed. Of major concern is that an estimated 15 million people are currently taking herbal medicines and supplements in combination with pharmaceuticals - there is great potential for adverse drug interactions in this population, he said. Lutz also noted that only about 40 percent of people taking dietary supplements discuss it with their doctors.

    Stressing that "natural" does not necessarily mean "harmless", Cynthia Payne, MS, RD, a certified diabetes educator from the University of Maryland, offered physicians a five-point approach to talking with patients about use of herbal remedies. She suggested: listen rather than talk, remain open-minded, invite disclosure, praise patients for taking an interest in self-care and partner with them in their complementary alternative medicine practices.

    Additionally, labeling rules established by the 1994 Dietary Supplement Health and Education Act has increased consumer confusion about health claims of various products. Labels on botanicals and supplements can't make direct reference to a disease but they can make structure and function claims such as 'improves general well being'. Lutz noted, for example, that a label on Gingko biloba can claim to improve absent-mindedness but not to treat Alzheimer's disease or dementia.

    Bernadette Marriott, Ph.D., who established the federal government's Office of Dietary Supplements, pointed out that dietary supplements are regulated differently than over-the-counter (OTC) drugs. She noted that the botanical supplement industry is doing a good job of self-policing so consumers can be pretty confident they are getting quality products. However, she says that there are post-manufacturing variables that aren't being addressed systematically or studied in depth. These include shipping, storage, shelf life, and stability of products.

    Dr. Marriott noted that currently the FDA is proposing that botanicals be permitted to undergo OTC drug review so labels could carry health claims, including information from foreign sources to support claims. Marriott said, however, that due to the lengthy review process for OTCs, most botanicals probably would continue to be marketed as dietary supplements.



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