Letters to the Editor
Potentially Fatal Natural Remedies
Am Fam Physician. 1999 Mar 1;59(5):1114-1120.
TABLE 1 Organ Systems Affected by Potentially Fatal Natural Remedies
Organ Systems Affected by Potentially Fatal Natural Remedies
Herbs contaminated with lead
Thornapple or Jimson weed
Ephedrine containing Herbal products
South American “mutis”
Chan-su aphrodisiac (also known as “rock hard,” “stone,” “love stone” and “black stone”)
Mail-order diet pills
Chinese herbal remedies
South African traditional remedies containing Liliiflorae sona
Cantharidin beetle powders
Jequirity seeds or rosary peas
Royal Jelly (anaphylaxis)
Tanning tablets [beta- carotene and canthaxanthin] (aplastic anemia)
Hemlock water dropwort
Apple seed (cyanide poisoning)
Apricot kernels (cyanide poisoning)
Were it not for liver transplantation,2–4 renal transplantation,3 dialysis5–8 and other heroic medical measures,9 many more people might have died as a result of using natural remedies and green plants. Because natural remedies pose as dietary supplements, these products currently escape systematic study by the U.S. Food and Drug Administration. In South Africa, 51.7 percent of fatal poisonings result from the use of traditional herbal preparations.10 Recently in the United States, the proportion of deaths from outpatient medication errors and “undetermined poisonings” has more than doubled.11
Like the flourishing sales of botanicals, there is increasing recognition that herbs can be toxic. Ellenhorn's Medical Toxicology, for example, lists 86 references published prior to 1980, 164 articles between 1980 and 1989, and 248 papers between 1990 and 1995. Clearly, plants can kill as well as cure. Patients who choose to self-medicate with natural remedies should not be told that “it probably can't hurt you” (Table 2).1,12 The facts must be checked first.
TABLE 2 Advice for Patients Who Self-Medicate with Herbs
Advice for Patients Who Self-Medicate with Herbs
Look at the label on the medication for scientific names of ingredients, quantity of active ingredients, name and address of producer, batch and lot numbers, date of manufacture and date of expiration.
Learn about the efficacy and toxicity of the product and the reliability of the producer. Distrust information from those who gain from its sales. Seek out objective, credible information.
Avoid use in infants and young children, avoid use if pregnant, lactating or trying to conceive, and avoid abuse or overdosage.
Be wary of variations from batch to batch and of other ways (misidentification, substitution, contamination, adulteration) that commonly cause a mismatch between what the label claims and what the product actually contains.
Inform your doctor about all of your self-medications.
Stop taking the medication if an adverse reaction occurs.
References may be obtained by writing to Alan Marty, M.D., in care of the Deaconess Resource Center for Healthy Living, 600 Mary St., Evansville, IN 47747, and will also be available on the AAFP Web site: www.aafp.org/afp.
1. Huxtable RJ. The myth of beneficent nature: the risks of herbal preparations [Editorial]. Ann Intern Med. 1992;117:165–6.
2. Sheikh NM, Philen RM, Love LA. Chaparral-associated hepatotoxicity. Arch Intern Med. 1997;157:913–9.
3. Gordon DW, Rosenthal G, Hart J, Sirota R, Baker AL. Chaparral ingestion. The broadening spectrum of liver injury caused by herbal medications. JAMA. 1995;273:489–90.
4. Mattei A, Rucay P, Samuel D, Feray C, Reynes M, Bismuth H. Liver transplantation for severe acute liver failure after herbal medicine (Teucrium polium) administration [Letter]. J Hepatol. 1995;22:597.
5. Vanherweghem JL, Depierreux M, Tielemans C, Abramowicz D, Dratwa M, Jadoul M, et al. Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs. Lancet. 1993;341:387–91.
6. Abt AB, Oh JY, Huntington RA, Burkhart KK. Chinese herbal medicine induced acute renal failure. Arch Intern Med. 1995;155:211–2.
7. Vanhaelen M, Vanhaelen-Fastre R, But P, Vanherweghem JL. Identification of aristolochic acid in Chinese herbs [Letter]. Lancet. 1994;343:174.
8. van Ypersele de Strihou C, Vanherweghem JL. The tragic paradigm of Chinese herbs nephropathy [Editorial]. Nephrol Dial Transplant. 1995;10:157–60.
9. Oliver MR, Van Voorhis WC, Boeckh M, Mattson D, Bowden RA. Hepatic mucormycosis in a bone marrow transplant recipient who ingested naturopathic medicine. Clin Infect Dis. 1996;22:521–4.
10. Joubert PH. Poisoning admissions of black South Africans. J Toxicol Clin Toxicol. 1990;28:85–94.
11. Phillips DP, Christenfeld N, Glynn LM. Increase in US medication-error deaths between 1983 and 1993 [Letter]. Lancet. 1998;351:643–4.
12. Drew AK, Myers SP. Safety issues in herbal medicine: implications for the health professions. Med J Aust. 1997;166:538–41.
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