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Doctors Want Tests of Herbal Remedies

September 21, 1998

Citing the hazards of poorly tested herbal remedies, a leading medical journal says alternative medicines should be subjected to the same rigorous standards as mainstream treatments.

In an editorial in Thursday's New England Journal of Medicine, Drs. Marcia Angell and Jerome P. Kassirer argued that testimonials and speculation are no substitute for precise medical evidence that treatments are safe and effective.

"There cannot be two kinds of medicine--conventional and alternative," they wrote. "There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work."

The same issue of the journal carried these reports on alternative medicine:

* Doctors from Alberta Children's Hospital in Canada reported two cases in which parents opted to treat their children's cancer with shark cartilage or the herb astragalus instead of standard medicines. In both cases, the cancers progressed, and one child died.

* The California Department of Health Services tested 260 traditional Chinese medicines and found one-third were contaminated with heavy metals, such as lead and arsenic, or pharmaceuticals not listed on the labels.

* Doctors from Robert Wood Johnson Medical School in New Jersey tested a mixture of eight herbs, sold as PC-SPES, on men with prostate cancer. They found it worked like estrogen, decreasing testosterone and cutting sex drive. While not proving whether it relieves cancer, the study shows that the herb blend has potent hormonal effects.

* The FDA described an episode, publicized last year, in which the herb plantain was contaminated with a naturally occurring form of digitalis, a heart stimulant that can cause cardiac arrest.

* A group of doctors from Arizona reported the case of a man found driving erratically after taking a supplement promoted as a way to increase growth hormone.

Gene Differences May Explain Salt Reactions

Utah researchers have identified a gene that may explain why people respond differently to a low-salt diet. Some people have a significant reduction in blood pressure when salt intake is minimized, while others show little or no effect.

Geneticist Steven C. Hunt and his colleagues at the University of Utah School of Medicine found that the gene for the enzyme angiotensinogen exists in three forms. Increased concentrations of this enzyme in the blood have previously been linked to higher blood pressures. Hunt and his colleagues report in the September Hypertension: Journal of the American Heart Assn. that people with one form of the gene show a greater reduction in blood pressure on a low-salt diet.

Undressing for Exam Doesn't Speed Process

Undressing and putting on a flimsy gown before the physician enters the examining room does not speed up the exam, according to a study in the July Journal of General Internal Medicine. Researchers found it took doctors just as long to examine patients in gowns as it did those who chose to stay dressed. Moreover, people in both groups received the same number of tests, suggesting that staying dressed did not impair medical efficiency. Similar results were reported in the November 1977 Journal of Family Practice. The researchers conclude that patients should not hesitate to stay dressed before meeting the doctor if it makes them feel more comfortable.

Ibuprofen May Cause Hepatitis C Flare-Ups

Hepatitis C patients who take the over-the-counter medication ibuprofen, sold under brand names such as Motrin and Advil, to combat joint pain risk serious liver damage, physicians from the Milton S. Hershey Medical Center in Pennsylvania report in the September issue of the American Journal of Gastroenterology. Dr. Thomas Riley III and his colleagues reported on three such patients who had flare-ups in their disease after taking the drug.

The correct recommendation for such patients, Riley said, is about 2 grams of Tylenol per day--one extra-strength Tylenol every six hours or two every 12 hours.

Lorazepam Tops Study of Four Seizure Drugs

A comparison of four types of drug treatments for seizures associated with epilepsy found that lorazepam worked better than the others, Thursday's New England Journal of Medicine reports. The seizures, known as status epilepticus, can be fatal if not treated promptly. Several drugs are available, but there had never been a head-to-head comparison until the current study.

A team led by Dr. David M. Treiman, which looked at 384 patients at 22 Veterans Affairs medical centers and affiliated hospitals, found lorazepam stopped the seizures within 20 minutes in 65% of the patients, compared with phenobarbital, which worked 58% of the time. A combination of diazepam and phenytoin was effective in 56% of the cases, while phenytoin alone had a success rate of 44%.

Vampire Tale May Stem From Rabies Epidemic

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