Coming Clean About Herbals

Tim Tracy knows how much patients really use natural supplements. So why don’t their doctors?

By Jeanne Mettner

 A surprising number of people take herbal supplements, says Tim Tracy, yet they often do not tell their health care providers.

To find out the truth from one group, Tracy and colleagues had to dig with a three-stage interview process. After a woman’s gynecological appointment, she met a pharmacy student who first asked three open-ended questions about what medications she was using, specifically mentioning over-the-counter drugs and herbal supplements. Then, the student did a “review of systems,” asking her what she used to treat a headache, back pain, menstrual cramps, and other ailments. As a final step, the student and patient reviewed a specific list of drugs, including 20 or 30 herbal medications, to determine which ones the patient was using.

“Invariably, in every stage, we would get a little bit more information,” says Tracy, professor and chair of the department of experimental and clinical pharmacology in the University’s College of Pharmacy. The recently published study of rural West Virginia women took more than three years.

In the end, Tracy and his colleagues found that 92 percent of participants were taking prescription medications, 96.5 percent were taking over-the-counter drugs, and 59.1 percent were using herbal supplements. The most striking finding: the lack of communication. “When we’d show the aggregate data to the physician, he said, ‘I had no idea my patients were taking this medication, or this one.’ It was really quite enlightening,” Tracy says.

Tracy’s research revealed that sometimes patients feel they will be chastised by their physicians if they admit to using herbals.

Yet patient-physician communication about medications is critical, Tracy says, primarily because of potential interactions that can occur between over-the-counter drugs or herbal supplements and prescription medications. Several women in the study, for example, were taking St. John’s wort, which potentially can adversely interact with prescription antidepressants or reduce the effectiveness of birth control pills.

Potential is the key word in regard to herbal medicines, says Dennis McKenna, research associate with the University’s Center for Spirituality and Healing. “There is a great deal of discussion regarding herbal supplements’ potential to interact with prescription and over-the-counter drugs, but how much of that translates into dangerous or even actual interactions is a gray area at present.”

St. John’s wort is often mentioned, says McKenna. “That doesn’t necessarily mean that there will be an interaction, but there can be one, so the patient has to go into it with eyes wide open.”

Health care providers also must open their eyes, ears, and their minds. “We need to be more specific in our questioning about herbals,” says Tracy. “And we need to create an environment where the patient feels comfortable sharing the information with you. The ‘What do you think you’re doing?’ and the ‘I didn’t prescribe that’ are not going to get us very far…. In the end, we would rather have more information than less.”

Providers also need to know what to do with the information from patients. “In order for physicians to serve as reliable sources of information for patients, they must become educated themselves,” says McKenna. “I think things are changing for the better, so that consumers are starting to get more professional guidance in the area of herbal supplements and natural medicines. Increasing provider education is obviously going to help a lot in the long run.”

Tracy’s results are serving as a segue to other research involving patient’s use of herbal medications. His next focus, for example, will be on those with chronic conditions, such as cancer and epilepsy. No matter what the disorder, he says, “with all medications—herbals, OTCs and prescription drugs—patients should be monitored for drug interactions and adverse effects.”