George A. Sprecace M.D., J.D., F.A.C.P. and Allergy Associates of New London, P.C.

Alternative (and Herbal) Medicine

Despite substantial effort on my part to access available reliable information,  the state of knowledge  on this subject does not, in my opinion, allow me to act as a “learned intermediary” for my patients or for the public at large.  Therefore, this is strictly a case of “caveat emptor - let the buyer beware.”.

The two main issues, as usual in the case of medical treatments, are effectiveness and safety.  The agent must be substantially more effective at what it purports to do than the 40% placebo effect of any medical intervention.   And it must not harm
(“primum non nocere - first, do no harm”).  The state of information regarding  most alternative and herbal medical treatments does not allow us  reliably to address  either of these issues at this time.  Of particular concern is the problem of  harmful drug interactions  between these “alternatives” and  prescribed and “over the counter” medicines.  Our fearless leaders in Washington have compounded the problem  through passage of the Health Education Act of 1994, which classified  the entire area of Alternative and Herbal Medicines as “Dietary Supplements” rather than medicines or food stuffs - which would come under the oversight of the “Federal Food and Drug Act”.   As a result, there is no federal inspection or quality control  over manufacturers;  and there is no requirement to prove efficacy and safety.   This is producing “the wild, wild West” in your medicine cabinets.  Could corporate opportunities and profits - and campaign contributions - be involved here???

I do not recommend any alternative or  herbal medicines at this time; and I await further reliable information from the National Institutes of Health  section on Alternative Medicine to guide all of us.    Meanwhile,  if you insist on playing  with your medical care,  the CVS chain of pharmacies offers a system  that claims to check for drug interactions.  As purveyors of these agents,  they and soon probably other  pharmacies  have evidentally decided that they  must act as “learned intermediaries”  in this field.

The above statement can now only be modified with regard to Glucosamine (500 mg)  and Chondroitin Sulfate (400 mg), taken 2-3d times daily for improvement of osteoarthritis and other degenerative (eg.traumatic) arthridities.  Benefit appears to be noted after 2-3 months of daily use.


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