Covering Up the Deadliness of Drug Interactions
Tempest in a Teapot
Covering Up the Deadliness
of Drug Interactions

ccording to The Wall Street Journal,1 “A wave of recent studies is sparking concern about the dangers of taking herbal supplements—including St. John’s wort, echinacea, and Ginkgo biloba—in combination with mainstream prescription drugs.” Sure sounds like a case for the possibility of a new administration (perhaps the Department of Herbal Security), but is it? What about the use of drugs in combination with other drugs? Surely the most regulated industry in the history of the planet shouldn’t have any problems of this sort.

Well, unless there has been an (unreported) revolution in hospital care, the data speak otherwise. Per a study published in the Journal of the American Medicine Association in 1997,2 adverse drug events (ADEs) resulted, back then, in more than 770,000 injuries, including up to 130,000 deaths each year!3

And where are the calls for more studies and more warnings on these deadly combinations, as the WSJ article advocates for herbs?

Cited by WSJ, there’s Brent A. Bauer, director of the Complementary and Integrative Medicine Program at the Mayo Clinic in Rochester, Minnesota: “Americans have this mythology that if it’s natural, it’s safe,” and that “… we barely know what one herb does on its own—let alone what happens when you mix in four or five prescription drugs.” But do we know the effect of five prescription drugs on one another? Surprise! There is not a single study on the interactions and risks between any five (heavily regulated) drugs, let alone four, or three, and dismally few for two.

Yet “Let’s gang up on herbs” is the implication of Bauer and his ilk. For what end? So that the costs of compliance are so high that only drug companies can afford to market them, and so they are regulated like, and are as expensive as, drugs?

Once again, per the WSJ, the FDA has only limited authority over herbs and (how did this slip in, without any evidence?) dietary supplements, so it is up to the drug makers to warn their patients. But why would they want to pick up the bill without any of the profit? But there is profit, or will be. Several drug companies, some of which already have herbal divisions, such as Bayer (with One-A-Day® Specialized Blends) and others, such as Bristol-Meyer Squibb (which would like to have one, but blew a big budget investigating their entry into the market*), have been busy adding warnings to their drug labels, but not without a lot of wailing—probably because they don’t have a bigger piece (or any piece) of the action.


*Yours truly was offered (but declined) a big consulting fee to contribute to their effort a few years ago.


So what impression does the WSJ leave us with? “The consequences of mixing medications can be grave.” To punctuate this, they cite a case study from the American Journal of Transplantation, presumably published earlier this year, wherein doctors hypothesized that an herb-drug interaction caused a woman who had lived with a transplanted kidney for 16 years to require another transplant after taking alfalfa for hot flashes and night sweats … in addition to her immunosuppressant drugs. I could find no such reference.

So there you have it: sloppy research, ignorance of risk assessment, and hugger-mugger, all colluding to make the world a safer place … for what? Protected markets, diversion from the truth, and more power to the regulatory profession. The WSJ should order a retraction.

References

  1. Spencer J. The risk of mixing drugs and herbs. The Wall Street Journal, June 22, 2004, p. D1.
  2. Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1997 Jan 22-29;277(4):301-6.
  3. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998 Apr 15;279(15):1200-5.

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