An increasing number of Americans are using various forms of what has been termed "alternative medicine." Alternative medical approaches can include seeking care from nontraditional practitioners such as naturopaths, homeopaths, or even music therapists. One of the largest impacts in this area is the manufacturing and sales of alternative medicines including herbs and dietary supplements. Long thought of as simply a fringe movement within health care, alternative medicine is quickly becoming widely used among the general population. However, unlike traditional medical care, where there is increasing emphasis on using evidence-based practice approaches, alternative care and medicinal substances are only beginning to be studied using controlled, clinical studies.
Questioning Supplement Safety
One problem concerning the use of alternative medicines is the fact that there is little regulatory oversight over many of the products. For example, under the Dietary Supplement Health and Education Act of 1994, safety does not have to be demonstrated prior to marketing. Considering that there are more than 1,500 herbal products such as Ginkgo, St. John's Wart and Echinacea sold in drug stores, nutritional outlets and through mail order sources, a sizable effort would have to be undertaken to just to determine safety. The Food and Drug Administration (FDA) only has the burden of proof once these products are marketed to prove that they are unsafe. Recently, more attention is being focused on this potential concern. Such concern is evidenced by publicized case incidents. For example, in 1999, power forward Tom Gugliotta of the NBA's Phoenix Suns reportedly had a severe reaction to a medicinal herb which reportedly produced a potentially, life-threatening consequence.
The National Toxicology Program (NTP) best known as the U.S. government agency which performs testing and makes determinations of carcinogenicity on various chemicals, announced that it will design and initiate studies to identify and characterize possible adverse health effects that may be associated with prolonged use or higher doses of certain alternative medicines including Ginkgo biloba and Echinacea. Such testing will depend on the specific herb but potentially include studies of reproductive, developmental and immune system toxicity as well as carcinogenicity.
The potential impact on workers and occupational health professionals is also drawing concern. Individuals taking these medicines frequently do not tell their personal physicians or their employers, including occupational health practitioners. A recent study reported that women diagnosed and undergoing treatment for breast cancer, overwhelmingly also took some form of alternative medicines, yet frequently did not tell their treating physicians. Workers who may be exposed to various chemicals at the workplace may also take alternative medicines. The potential interactions between these substances, workplace exposures and traditional over-the-counter and prescription drugs is only now being studied to any extent. However, a quick review of the compendium, Natural Medicines, Comprehensive Database notes many potential adverse interactions.
There is also little oversight on the manufacturing of these products. For example, the ingredients in these preparations varies from manufacturer to manufacturer. Additionally, certain of what has been termed natural, medicines and supplements may have known hazards. Several years ago, an individual who worked on foreign assignment in the Far East for a company for which I consulted received a snake bite. After receiving traditional medical care, some of his native co-workers recommended a herbal tea made in a neighboring country. On return to this country he reported increasing neurologic difficulty which initially was felt to be psychiatric or malingering in nature. Heavy metal screening showed toxic levels of a potent neurotoxin. It was initially assumed that his work at a waste site was responsible but subsequent questioning surfaced the herbal tea as the culprit. Several published studies confirmed the presence of high levels of lead, mercury and other toxic heavy metals in some of these products.
Cost and Worker Health
Another potential workplace impact is on healthcare costs and worker health. There is little scientific data confirming the effectiveness of most natural medicines and supplements. I have listened to radio commercials for several of these products and product lines. Numerous Internet sites promote these products as well. The promises ranged from cancer prevention to assistance in sexual performance and effective relief from depression.
Not only are some of these compounds very expensive, but their claims relief may prevent workers with treatable diseases from seeking proven, effective care. For example, over the years taking Dill Seed has been claimed to help asthma, bronchitis, loss of appetite, fever and chills, liver and gallbladder complaints and other problems. To date little clinically-derived evidence shows substantive utility for any health problems.
Until much-needed data and necessary regulation is provided, it will in many cases fall to the occupational health provider to help disseminate appropriate information about alternative medical care. Likewise occupational health providers may need to determine its safety as well as illicit historical information from workers.
Various newsletters and other sources of unbiased information are available from sources like the American Health Consultants' newsletter.
Another source, Alternative Medicine Alert, provides a referenced analysis of alternative therapies including pertinent history, clinical studies, adverse effects, and recommendations.
Contributing Editor Howard M. Sandler, M.D., has more than 25 years in occupational and environmental health. He has served as a medical officer for NIOSH. He has consulted extensively with EPA, OSHA, NIOSH and the Consumer Products Safety Commission. He can be reached via e-mail at [email protected]