Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Monday, April 14, 2014

To Exercise The Cautionary Principle

"For far too long, disciplines have worked in isolation without communication and our patients have often felt caught between different therapeutic philosophies, often to their detriment."
Dr. Shailendra Verma, medical oncologist, The Ottawa Hospital; scientific adviser, Ottawa Integrative Cancer Centre

"In light of how many Canadians mix natural products and prescription medications, we do not have enough information on which of those combinations are safe -- and which should be avoided."
Dr. Sunita Vohra, paediatrician, patient-safety expert, University of Alberta researcher

"It's really difficult to draw firm conclusions from this study.The sample size was really small ... so it's impossible to generalize the findings to the average Canadian."
Helen Long, president, Canadian Health Food Association

"A lot of patients ... don't perceive the importance of it. [But] my recommendation is that people treat natural health products just like any other medication."
Dr. Ran Goldman, co-head, clinic pharmacology, B.C. Children's Hospital

Dr. Goldman has studied the impact of alternative-health products and it is his belief that a recently concluded research study whose conclusions were just published in the journal BMJ Open -- indicating that doctors and patients should monitor closely interaction between pharmaceutical medicines and natural medicines, the combination of which many Canadians use -- confirms the conclusions of previous studies.

Natural health products in combination with prescription drugs, they concur, are six times as likely to produce unwanted side effects, in comparison to the use of prescription drugs alone for some patients. Dr. Goldman recalls an instance where a nine-year-old patient prescribed anti-convulsive drugs for a seizure disorder simply kept experiencing epilepsy-like seizures, despite the medication.

And then it was discovered the child was also receiving St. John's Wort, a medicinal herb whose properties affect how drugs are metabolized. The use of the herb was withdrawn, and the seizures also withdrew.

St. John's Wort, it appears, has the capacity to help relieve moderate depression, while at the same time has the potential to interfere with drug potency; from birth-control pills to blood thinners, according to the U.S. National Center for Complementary and Alternative Medicine. If it is used alongside drugs like Zoloft or other SSRI anti-depressants, potentially dangerous over-production of the brain chemical serotonin can occur.

In Dr. Vohra's opinion there is a distinct lack of reliable scientific research relating to such interactions, to guide doctors and patients in their search for best-treatment options, despite that doctors, reliant on feed-back from their patients, have warned for years that troublesome results from interactions occur. She does not advocate that people avoid natural products completely, since most people in her research group experienced no serious side effects from using prescribed pharmaceuticals alongside natural products.

And there is also the very real prospect of patients experiencing mild-to-serious side effects from the use of prescribed pharmaceuticals, in any event. There are consequences of taking drugs; they do mediate certain health problems and they do provide benefits to patients whose health is variously compromised, but they also have the potential to complicate the body's functions in ways both large and small. They are judged by the nature of their efficacy; whether they do more good than possible harm.

Dr. Vohra and her research colleagues began an "active surveillance" study in Ontario, then expanded it to British Columbia and Alberta where pharmacists monitored patients who had their prescriptions filled at their pharmacies, with a follow-up enquiry whether those patients had experienced any adverse events that could have been related to the use of the prescribed drug. A third of the 1,100 patients enrolled in the study used only prescription drugs, while 3% used only natural health products and 59% used both natural and pharmaceutical treatments.

Over 7% of those patients using both therapies experienced adverse effects, compared to 1.2% of the drug-only users, and 2.9% of people who used just natural products. One of the "adverse events" probed resulted in the cardiac arrest of an eight-year-old girl who had taken both types of medicines. No causal link could be proven through the study, but evidence does suggest that some natural remedies can impact on the biological impact of drugs, interfering with their potency.

In Ottawa, a clinic is in operation, supported by the Ottawa Regional Cancer Foundation, which seeks to break down barriers between conventional and complementary cancer therapies. The clinic is supported by doctors, including a medical oncologist at The Ottawa Hospital. Dr. Verma cautions that naturopathy and other complementary treatments not be seen as replacements or alternatives, taking the place of conventional medical treatment but rather as supports of conventional treatment.

The Ottawa Integrative Cancer Centre conducts research into the role of diet or supplements -- like Vitamin C -- as a form of useful therapy for cancer patients. The reason is to establish what should be viewed as safe, effective treatment, not interacting with conventional cancer treatments, as some supplements are believed to do. Turmeric tablets for cancer patients may be prescribed, and used as a complementary treatment; the natural healing attributes of Turmeric exploited for better health outcomes.

And advice is given to cancer patients that just makes common sense, such as diet adjustment with the elimination of most red meat, pork and cheese. Consuming greater amounts of cruciferous vegetables, as well. Sometimes acupuncture treatment is used to aid patients find relief from chemotherapy-related pain. On staff at the clinic is the individual who is director of research and clinical epidemiology at the Canadian College of Naturopathic Medicine.

Other naturopathic doctors, family physicians, nurses, physiotherapists, nutritionists and allied health workers are included in the clinic for their expertise in health management techniques. Additional treatments offered to patients include massage therapy, exercise and counselling. "Trying to provide whole-person care to people living with cancer", is how Dugald Seely, executive director of the centre puts it.

"We are not about providing a cure." The idea is to aid patients to increase their tolerance levels of conventional treatments. Integrative therapies is seen by health experts as a method by which conventional treatment can be usefully complemented with naturopathic treatments for optimum health-outcome results

And obviously all avenues should be pursued, albeit with caution, to arrive at protocols most useful and helpful to those people whose health has been compromised, and whom medical science does its utmost to medically intervene to usher people back to good health and/or learn to live as best they can with chronic conditions that can be managed to return them to the view that they can themselves can take a certain amount of responsibility in their own health-care management.

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