Doc's concern about supplements centers on safety, outcomes

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Earlier this month, a letter to the editor took issue with a column I wrote in November about supplements.

Prior to discussing the issues raised in that letter I have to admit I failed to adhere to the journalistic standard I have set for myself.

In focusing on the many problems associated with the use of supplements I did not, as I should have, acknowledge problems relating to use of drugs.

Now to the issues raised in the letter. She was entirely correct in mentioning the April 1998 issue of JAMA -- Journal of the American Medical Association -- that described the large number of serious and fatal adverse drug reactions in hospitalized patients.

That article was written by two Canadian physicians who looked at the those reactions from 1966 to 1996 in U.S. hospitals. Their work was considered a meta-analysis which means that they looked at a number of studies to draw their conclusions.

What the letter writer apparently did not know was that in the April 2000 MedGenMed journal was a report by seven American researchers who reviewed all the data used for the 1998 JAMA article.

They concluded the prior meta-analysis was invalid. The methods used were seriously flawed and no conclusions about the adverse drug reactions in hospitalized patients in the U.S. should be made on the basis of that meta-analysis, the new study found. It was felt that the incorrect work could dramatically overestimate the death rate.

Having said that, there are serious and fatal adverse drug reactions in hospitals, but no one seems to know for sure how many. Even one death is one too many, but it should be kept in mind that wherever you have humans at work mistakes can be made. One of the good things that has emerged from this is that there has been a significantly increased effort to prevent those errors.

The letter writer is correct in stating a large percentage of the costs of developing new drugs is borne by the U.S. government, in other words, us taxpayers, and that drugs are much cheaper in other countries.

She ascribes some of that cost to perks of one kind or another given to doctors. I am glad to say this is largely a thing of the past.

Forty years ago while I was in a private practice group in Brewster, Wash., I accepted a gift of a briefcase covered with alligator hide from a drug company. At that time it was common practice to accept things from drug representatives and I did not even question the ethics.

Since that time, in part due to the Institute of Medicine, the American Medical Association and other organizations, the practice of accepting gifts from drug companies has greatly diminished.

It is also true that not too many years ago there were instances in which drug studies funded by drug companies were found to have negative results and those same companies would not allow the studies to be published. It is my understanding this practice has largely been eliminated.

As far as the Poison Control Centers not reporting one death from the use of vitamins, herbs or supplements, one needs to understand the role of the centers.

In my practice I used them a number of times but it was only in case of a deliberate overdose such as in a suicide attempt or accidental ingestion or exposure to a harmful substance.

Those centers would not know if a person had been using kava root or comfrey leaves or roots that can be toxic to the liver. In fact a patient with that kind of problem would not turn to a Poison Control Center for care.

In the April 2001 Journal of Ethnopharmacology there is a report from Washington University, "Should we be concerned about herbal remedies?"

The report points out that there is no regulatory agency that insures plant remedies do what they claim to do, are actually what they say and more importantly, are safe.

In the July 2002 Journal of Urology is a report regarding supplements that have been given to people with prostate disease. Multiple brand samples of vitamin E, vitamin D, seleniuim, lycopene and saw palmetto were sent to an independent laboratory blinded to the specific dose and brand names.

Of the seven brands of Vitamin E only three were within 15 percent of the stated dose, and three were above or below by 40 percent. Of five brands of selenium, two were within 15 percent of the stated dose. Of the six brands of saw palmetto there was a variation of -97 to +140 percent of the stated dose with three of the samples containing less than 20 percent of the stated dose. There were similar problems with lycopene. Vitamin D fared better. Also when Vitamin E, selenium and saw palmetto tablets were tested from the same manufacturer there were variations of greater than 20 percent.

Folks who are really interested in the question about the use of herbal supplements may want to buy the excellent book by National Geographic, "Guide to Medicinal Herbs -- The World's Most Effective Healing Plants." I have this book and find it very helpful.

As far as this statement by the letter writer, "this was a result of members of the review board having a financial investment in the drug company," it would help if the source for that statement was given.

It is not true that I do not want people to take supplements. I simply want people to know that they are not always safe, or pure or effective. And at times, especially in interactions with prescribed medications a person may already be taking, there can be adverse reactions including death.

Another letter writer in the U-B offered a quote from the president of Bionutritionals claiming supplements have "an unrivaled safety record. Statistics show that they are safer than drugs ... and even safer than food."

In the first place this is not true. Secondly, he represents a company that sells these products so he could not be considered unbiased.

That writer also stated the FDA is going to put a ban on all supplements beginning in 2012. Although I try to keep up with current developments in the field of medicine I have seen nothing to that effect in my sources.

She also mentioned that "experts estimate this ban would cost tens of billions of dollars and result in the loss of tens of thousands of job." It would have been nice if she could have told who these experts are and how we could access their reports.

Actually the FDA will not ban any supplements that have been shown to be safe, effective and unadulterated. There is however one other problem with supplements. I have known of people who have died from cancer because they were encouraged to use supplements instead of conventional medical treatment.

In view of what I have written in this article and prior articles some folks may wonder if am opposed to natural methods to cure cancer. Far be it from me to oppose natural methods if they have been shown to work.

In truth I would be very pleased if natural methods including the use of raw foods did work because hopefully they would avoid some of the disturbing side effects of radiation, chemotherapy and surgery.

What the folks who are espousing natural methods need to do is to be sure the cancer has been proven either by biopsy or, as in the case with some leukemias, by a blood test.

Then they need to keep track of those patients for a minimum of five years to be sure the cancer has been cured. If there are valid statistics showing natural methods work there would no doubt be many people who would opt for a natural cure.

Every respectable hospital or clinic that treats cancer with conventional methods has, of course, taken the proper steps to be sure it is a cancer. Then after treatment they keep track of those patients for at least five years unless they lose contact.

From my nearly 54 years of the practice of medicine I know there are folks who feel there should be a pill for every ill. Some are not interested or willing to use proven prevention techniques nor what could be considered natural methods.

Although on my part I feel drugs are much more effective in the treatment of disease than nearly all supplements, I consider drugs to be necessary evils. In previous articles it has been mentioned that 70 percent of disease is due to lifestyle issues.

That being the case if seems safe to say that we could cut the drug bill in half if people would get serious about prevention.

Here is a list of things I would class as natural methods that I know can help cure some diseases without the use of drugs: Physiotherapy, hydrotherapy, massage, hot and cold applications, charcoal, which can be very effective for problems besides poisoning, and honey for treatment of chronic wounds.

I think now would be a good place to speak to the psychological aspect of having good health. I happen to believe that this phrase, "A merry heart does good, like medicine, but a broken spirit dries the bones," hits the nail on the head when it comes to the question of the role thinking plays in having optimum health.

It would be helpful to know if either of the letter writers is involved in the production, distribution or sale of supplements. Or if someone who promotes their use has urged them to write.

Nowadays folks who write for medical journals that promote the use of drugs in any way are expected to tell if they are receiving remuneration from any of the drug companies.

As for myself, I have never had stock in any drug company nor do I ever plan to do so. No one is paying me to write the articles in the Union-Bulletin.

As a final note, due in large part to the serious illness of my wife, I will not be able to continue regularly writing for the newspaper. I have considered it a privilege to be able to advance the cause of preventive medicine via the U-B.

Dr. Don Casebolt of College Place is a retired physician who is passionate about preventive medicine. He spent four years as a medical officer in the U.S. Navy, the last 2 1/2 years as a flight surgeon. He also worked on the Navajo Reservation for 22 years.

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