Monday, February 10, 2020

It's only natural

I cannot count the times a patient told me they were taking a supplement or over-the-counter medication that “must be safe” because it was “natural.” This is a widespread belief; a large majority of people surveyed believe that a “natural” product is superior to a man-made or synthetic one, even though arsenic and poisonous mushrooms are “natural,” as well as being deadly poisons. There is no formal definition of “natural,” so manufacturers and dealers can tout their products as being natural at whim.

When a remedy has been used for hundreds of years (or in the case of Chinese medicines for thousands), there presumably must be something to it. Many natural products, mostly plant-based have been used for such common ills as toothache, colds and upset stomachs. A study done ten years ago found that some 40% of Americans had used some form of alternative remedy in the preceding year. Because the FDA considers most of these to be food rather than medication, they are not required to do the efficacy and safety studies required of new drugs.

Do they work? It is hard to answer that without considering the placebo effect. The mind is a powerful force, and we produce many chemicals in our bodies that have measurable effects. Numerous studies of treatments for pain and psychiatric disorders find that when used in a “double blind” fashion (i.e., neither patient nor doctor know whether getting the active treatment or the sugar pill), placebos work almost as well as active medications. Moreover, about 20% of people getting a placebo report side-effects! So…if a remedy works, it may simply be the placebo effect in action.

Let us look at some specifics. Cranberry juice is widely touted to prevent or treat urinary tract infections, but large studies have found it of no benefit over simply drinking more water. Cinnamon has been touted to help control blood sugar, but careful studies have found no effect. Clove oil is often used for toothaches, but again has no consistent benefit and large amounts can be toxic when swallowed. Primrose oil is suggested for eczema, but its benefits over placebo cream are minimal, and better alternatives exist.

Perhaps most worrisome is when patients turn to “natural remedies” in place of proven treatments. A study looked at cancer patients who used “complementary medicine” and found that many of these patients refused conventional treatments and those who did had a higher death rate and shorter average survival.

Chinese and other imported herbal products have periodically been linked to serious outbreaks of illness and death, and the association is often hard to find until many people have been affected.

What does this mean for you? If you are treating a nuisance but not serious illness, and you have found an herbal product that works for you, it is probably harmless. Be sure to get any products from a legitimate source. Be wary of buying these products on-line from an uncertain source. If you have something more than a cold, please consult your doctor!

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