Tobacco was once considered a medicinal herb. Now, a British Columbia physician, concerned that other medicinal herbs may not be as benign as they appear, has helped form a group to warn about their use.
Dr. Lloyd Oppel, a Vancouver emergency physician, and 3 colleagues formed Canadians for Rational Health Policy (CRHP) a year ago because of their concerns about the federal government's new Office of Natural Health Products. [1] Their aim is to "promote science in the service of the public." They are worried about the lack of scientific scrutiny in the office's transition team and the implications for patient safety. None of the 14 transition team members is a research scientist, and only 1 is a physician. Oppel maintains that the office's "standards of safety will be very much relaxed. That's unfortunate, because we've learned the hard way that this is dangerous."
"We're concerned about the financial abuse and risk to consumer's health," Oppel says of the new office. "People have an impression of safety because there has been no surveillance of side effects. We need long-term studies."
"It's legitimized quackery on a grand scale," agrees Winnipeg pharmacist Meera Thadani, a CRHP member who has written 2 books on natural products. "Natural describes the source, but it's not necessarily safe." She argues that these products can be regulated effectively by the Drugs Directorate as over-the-counter products. "If Benylin cough syrup can provide evidence for safety, quality and efficacy, then why should echinacea be exempt? There is no reason why these products should be excused because someone says they are 'natural.'"
Billing themselves as a "citizen's group," CRHP's 50 members include physicians like Thomas Handley, registrar of the College of Physicians and Surgeons of BC. The group's targets are health therapies of "questionable scientific merit" that are in wide use, including chelation therapy, herbalism, homeopathy and colonic irrigation.
The members' strategy is to influence public policy through the media and by lobbying; the group has already issued 2 press releases. The members have no shortage of things to say, says Oppel - just a shortage of time to say them because "we're all really busy." CRHP is currently looking for more members to promote its cause because it believes the federal government is under "intense pressure" from the herbal industry and alternative medicine practitioners to relax safety standards. Oppel says "the best unbiased assessment" of herbal remedies - he cites a study of the 50 most common herbal remedies by the BC Therapeutics Initiative Group (www.ti.ubc.ca/pages.letter25.htm) - indicates that there is "no compelling evidence of effectiveness." Of greater concern is the growing awareness of side effects and deaths related to the use of some of these remedies. Figure 1
The most dramatic incident thus far involved use of the herb Aristolochia in Belgium. According to Dr. Willem Betz of the University of Brussels, some 2000 women attending a "natural" slimming clinic in Belgium were advised to take a cocktail of medications that included 2 Chinese herbs. More than 100 women subsequently suffered renal damage, and 80 of them are currently receiving dialysis, states Betz.
Aristolochia is still available in Canada, says Oppel. It's also for sale via the Internet and is recommended for hypotension, anorexia, weakness, edema and to speed up deliveries. "There are lots of other examples being quietly reported in the literature," says Oppel. (A California health services study of 260 Asian patent medicines reported last year in the New England Journal of Medicine found that 83 [32%] contained undeclared pharmaceuticals or heavy metals.)
Oppel describes the situation as "shocking - there's no way the legitimate pharmaceutical industry would dream of getting [these types of products] approved for sale."
For more information about CRHP contact www3.bc.sympatico.ca/think or [email protected].
Barbara Sibbald is CMAJ's Associate Editor, News and Features.
References
- 1.↵