Your Health: Just because it's herbal doesn't mean it's safe

By CLAIRE TREVETT

In 1996, Charles Weinberg entered the annals of New Zealand medical history.

The 81-year-old Cambridge man's death from viral hepatitis was mentioned by health professionals in the same sentence as a herbal remedy touted as a cure-all for prostate problems.

About 13 others of the 600 who bought the natural Indian remedy K4 suffered serious side-effects such as liver damage. One other man - a New Zealander in Australia, died.

Although there have been recordings of fatalities from reactions to alternative remedies overseas, in New Zealand the K4 case was the first and, thus far, only documented fatality linked in any way with herbal supplements. Even that link has never been proven beyond doubt.

That low death rate is something alternative medicine advocates have held up as proof the industry is safe.

In New Zealand, alternative medicines are blamed for just 214 reports of about 50,000 registered with the Centre for Adverse Reactions Monitoring at the University of Otago.

The 214 reports involved 401 different reactions to 246 different substances.

Globally the WHO Programme for Drug Monitoring at Sweden's Uppsala Monitoring Centre has recorded adverse reaction reports to herbal medicines for 20 years.

In 1997 it had 8986 on its books. That figure has since risen to 11,716 cases.

In comparison, WHO's reports of reactions to conventional medicine drugs number about three million cases, with an extra 200,000 added each year.

The National Nutritional Foods Association, the Charter of Health Practitioners and researcher, business lecturer and consultant to the industry, Ron Law, argue the numbers tell a tale of a safe industry.

But the adverse reaction centre's medical assessor, Dr Michael Tatley, believes using the statistics is like shooting a blank - all bang and no direct hits. The data is too patchy to be used fairly by the alternatives industry as proof of safety.

"I'm not sure they reflect anything other than the fact people do have adverse effects."

But Tatley said the findings highlighted the potential for adverse events from alternative medicines.

"There's an adage out there that if it's complementary or herbal it is natural and safe. That's not necessarily true."

He said people might fail to mention alternative remedies to their doctor, either out of embarrassment or because they didn't view vitamin pills or diet supplements as medical.

Others did not realise the seemingly safe herbal product might be causing the reaction.

"I've heard people say they were feeling unwell but were told it was a good thing, because it proved the product was getting rid of the toxins in their body. How do we counter that? If people truly have that view then they will never report the adverse effects."

Law says the reason the statistics do not tell horror stories is because there are no horror stories.

"They haven't discovered weapons of mass destruction in Iraq. Why? It's the same thing."

Dr Patrick Fahy, chief executive of the Charter of Health Practitioners, said alternatives were often unfairly blamed for side-effects caused by conventional medicines.

But senior Ministry of Health medical adviser Dr Stewart Jessamine said if anything, the reactions were under-reported, rather than overstated. There was no recognised reporting system for complementary medicines and the people who sold and marketed them did not often have internal systems for collecting data of side-effects.

The reporting of conventional medicine side-effects was also voluntary, but the reporting system was well-known.

A 1998 survey of herbal remedy users by Exeter University's department of complementary medicine found people were less likely to go to their GP for reactions to herbal supplements than for reactions to conventional medicines.

Of 515 herbal remedy users, 43 per cent said they would not go to their GP if they suffered serious adverse effects from either conventional over-the-counter drugs, or herbal remedies.

A further 26 per cent said they would visit the doctor if the serious reactions were caused by the conventional medicines, but not from the herbal.

The chairman of the Medical Association's GP Council, Dr Peter Foley, said he did not know of any research but anecdotal evidence showed serious reactions were often prevented from turning into death by the intervention of orthodox medicine.

"When there's an adverse event, particularly an allergic or more serious anaphylactic reaction, then we have to use orthodox medicine to treat that."

The Medical Association, concerned at the increasing number of reports of interactions with other drugs, was strident in calls for alternative remedies to be subject to the same tests as pharmaceuticals.

Law points out: "There are side-effects for everything. If you eat green plums you get diarrhoea. No one's regulating green plums."

He said the rules on manufacturing could be tightened to eliminate a "few cowboys" but, by and large, alternative therapists were peddling their trade safely.

"Why should there be a more rigorous system when they are the ones killing people? When they've sorted that out, they can start to look at us. You don't start at the safest end of the spectrum."

Reports of adverse reactions from complementary and herbal remedies to the Centre for Adverse Reaction Monitoring:

1992 - 1

1993 - 5

1994 - 10

1995 - 2

1996 - 35

1997 - 23

1998 - 21

1999 - 24

2000 - 32

2001 - 17

2002 - 35

Top five:

K4 - 15 reports in 1996 (since withdrawn from New Zealand)

Royal Jelly, Creatine and Echinacea - 5 each

St John's Wort - 19

Bee Pollen - 9

Evening Primrose Oil - 7