HERBAL AND ALTERNATIVE MEDICINE - 05/09/11
Résumé |
The use of “unconventional” or “alternative” medicine by the American public is now commonplace. In 1998, the alternative medicines industry accounted for $8.1 billion in economic impact. The prevalence of alternative medicine use in several US surveys ranges from 10% to 40% and is growing rapidly.18, 25, 46 In the most recent of these surveys, the use of alternative therapies increased through the 1990s, led especially by the growth of herbal medicines, megavitamins and folk remedies.18 This trend is expected to continue because some insurance providers and health systems are now advertising coverage of certain alternative regimens.48 Emergency physicians must be aware of alternative medicine and its various disciplines, because a significant proportion of ED patients report their use.25
Alternative medicine is a general term referring to a heterogenous set of therapies not taught in conventional medical schools in the United States; however, even this definition is outdated. In a 1998 study, 75 US medical schools described courses in alternative medicine.59 Alternative medical therapy includes the use of dietary supplements, vitamins, minerals, hormones, proteins, and botanicals such as herbals. Although herbs are defined botanically as a specific subgroup of plants, herbal supplements are loosely conceived of as any plant containing or plant-derived product. These are perceived to be more natural or “safer” than are conventional medications and appeal to many people, especially patients with chronic diseases. Unfortunately, few patients realize the lack of scrutiny or testing that these products undergo.
Because these products are considered neither food nor drug, they escape the jurisdiction of the Food and Drug Administration (FDA) and thus are held to minimal standards. In addition to potential endogenous toxicity of the product used, additional toxicity can result from drug interactions41 or by contamination of product with other botanicals26, 55 or heavy metals.20, 37 When critically reviewed, a small number of these therapies could have some efficacy,61 but some have been associated with distinct toxic syndromes and can be encountered in the ED patient. Although alternative medicine also includes a gamut of nonmedicinal-based ideologies such as yoga, therapeutic touch, and massage, this review focuses on ingested products such as herbals, minerals, and dietary supplements.
Multiple cases of toxicity highlight the need for regulation of these products; however, the economic lobby opposing FDA regulation led to the Dietary Supplement and Health Education Act of 1994. This law created a new category, including vitamins, minerals, herbs, and amino acids and is virtually free of FDA regulations. Fortunately, the Office of Alternative Medicine within the National Institute of Health (NIH) is funding more appropriate investigations of the possible efficacy or harm of these therapies, albeit on a limited budget.38 Emergency physicians could witness sentinel toxic events and should be reminded to report these events to Poison Centers and the FDA MedWatch program, to catalogue toxicity data from these products.
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| Address reprint requests to Lewis Nelson, MD, New York City Poison Control Center, 455 First Avenue, Room 123, New York, NY 10016, e-mail: nycpcc@hotmail.com |
Vol 18 - N° 4
P. 709-722 - novembre 2000 Retour au numéro
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