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A Word About Herbs by Ihor Magun, M.D., F.A.C.P. Complementary and alternative medicines are becoming increasingly more popular in this country, and one manifestation of this is that one- fifth of all adults in the United States report that they have used some herbal therapy. By definition, herbal therapy refers to products other than vitamins or minerals, which are taken orally as a dietary supplement. This is not, as some may believe, a new idea. In fact, medications from flowers and plants date back to antiquity. In more recent times, scien tists found that digoxin, which comes from a purified extract from the foxglove flower, can be used as a treatment for cardiac arrhythmias. This example attests to the many excellent benefits to be derived from herbal sources, but it is important to remember that there are two sides to a coin. The same foxglove flower that gave us digoxin also yields a potent and dangerous poison. Most physicians in Europe, are enthusia stically embracing herbal therapy as a routine part of healing and are trained to use herbal medications whose quality has been tested and which are properly manufactured. In fact, patients from the United States travel to Europe specifically to seek out these physicians to obtain advice about herbal treatment for specific ailments or health concerns. Compared to Europe, the United States is still in its infancy with respect to herbal treatments. Despite the massive public interest, the U.S. medical community has reservations regarding the quality of medicinal herbs for treatment purposes. One of the main reservations about herbal products, sometimes referred to as "natural products," is that they are not always standardized. Products vary in quality and government testing is not specifically required and is therefore not conducted as it is for all prescription medications on the market. Yet despite all the controversy in the medical com munity itself, the use of herbal products is explod ing. Many in the medical community wonder if this tendency to self-medicate stems from patients’ doubts about conventional therapies or simply a trend to seek a more “natural approach” to medi cine. No matter what we think or do about it, herbal medications are here to stay; eventually, they will quite likely become a natural part of the American physician’s arsenal to promote and sustain patients’ health and well-being. In the meantime, the purpose of this article is to touch on three herbs and supplements that are the most commonly purchased and utilized in this country: St. John’s Wort, Ginko biloba, and Black co hosh. Unfortunately, the focus of my message is on their adverse effects. My reason for this is that the efficacy of each of the three supplements is questionable; current research on their benefits is incomplete or inconclusive. St. John's Wart is used to treat mild depression, but it blocks an enzyme in the liver, resulting in decreasing blood levels of certain medications—especially medications taken for elevated cholesterol. Another common side-effect is sexual dysfunction. In addition, people with severe depression are strongly discouraged from using it. Ginko biloba is modestly effective in patients with dementia. It can, however, cause bleeding when taken with common medications such as aspirin or warfarin (a blood thinner also called coumadin). Patients should inform their physicians if they are taking this medications and should discontinue its use at least seven days prior to any elective surgery. Black cohosh a phytoestrogen, a natural occurring estrogen. Used to treat hot flashes, it has become increasingly popular with menopausal women. Short-term use is safe, but prolonged use can cause breast cancer. As a physician, my principal concern is the welfare of my patients, and this certainly includes a willingness to prescribe and recommended medica tion and therapy that is beneficial to those patients, whether it be pharmacological or herbal. Like all physicians, I adhere to the implications of the Hippocratic oath, which states, “First, do no harm,” and my choices must be guided by this principal. Until sound medical research confirms that what I recommend or dispense to patients will “do no harm,” I will tend to err on the side of caution. Видання C оюзу Українок A мерики - перевидано в електронному форматі в 2012 році . A рхів C У A - Ню Йорк , Н . Й . C Ш A.
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