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Orthopedic Docs Boost Complementary Medicine Awareness

Web site warns of potential interactions with conventional drugs

SATURDAY, April 20, 2002 (HealthDayNews) -- With more people turning to alternative therapies to treat everything from aching joints to the common cold, doctors are finding they need to educate themselves on potential interactions with conventional drugs.

In one such effort to increase awareness, the American Academy of Orthopaedic Surgeons recently created a Complementary and Alternative Medicine section on its Web site.

Among information found on the site is a listing of popular alternative remedies that could have adverse reactions when used with common conventional drugs.

For instance, St. John's Wort, commonly taken as treatment for mild depression, can have potentially harmful interactions with anti-coagulants, and can enhance bleeding and hasten the metabolic breakdown of drugs. The therapy is particularly discouraged for organ transplant patients.

Other alternative treatments that pose a risk of increasing bleeding include everything from ginkgo biloba and ginseng to ginger and garlic.

The herbal supplement kava kava may have adverse reactions with anesthetics and golden seal, which eases cold symptoms, and it can mix badly with diuretics and hypertensive drugs.

The primary goal of the site is not to encourage or discourage the use of any particular remedy, but to increase dialogue between doctors and patients, says Dr. Harris Gellman, a professor of orthopedics at the University of Miami and a member of the committee that put the site together.

"The purpose of the site is to try to give information, and say to both doctors and patients that this is what's available and these are the risks and complications," he says.

"In addition, it's to inform doctors of the specific reasons why it's so important to ask their patients if they are taking any of these things, especially when scheduling for surgery," Gellman says.

Otherwise, he says, there's a good chance patients won't volunteer the information: "Many patients may think of herbal therapies along the same lines as food supplements, and don't realize that it's nevertheless important to tell their doctor they're taking something."

The U.S. Food and Drug Administration reports that sales of herbal and botanical products alone increased a full 20 percent from 1995 to 1999, with the products representing a $3 billion industry by the year 1999.

In proper doses and when not in conflict with other medications, many alternative remedies are not only endorsed, but even recommended by some orthopedic surgeons.

The dietary supplement glucosamine, for instance, is widely regarded by conventional doctors as an effective treatment for osteoarthritis.

"Glucosamine actually looks like something that is very healthy for cartilage, and may be an alternative medicine remedy that could become mainstream," explains Dr. Julie Dodds, an orthopedic surgeon at Michigan State University.

But even with that, she adds, relaying the information to one's doctor is important: "People hear the word natural and they think that translates to safe, so they don't mention it and physicians don't think to ask about it."

"But surgeons in particular need to be aware that a large percentage of their patients may be taking some of these supplements and that, especially with anesthetic medications, there are some potentially serious interactions," she says.

Joseph Betz, vice president for scientific and technical affairs for the American Herbal Products Association, argues that research on potential problems from products such as garlic is sketchy, but he agrees a cautionary approach is always wise when mixing any kinds of drugs or alternative supplements.

"Some have published warnings on potential risks based on very weak reviews of the literature and the recommendations are unjustified," he says. "But it's clear that physicians have to be conservative, and anesthesiologists generally recommend discontinuing all herbal therapies two weeks before your surgery. That's probably justified, based on the lack of knowledge we have on some herbs."

"The bottom line is that physicians need to know what herbs patients are taking so they can have a good working knowledge of what's going on," Betz says.

What To Do

For more on alternative medicine, visit the American Academy of Orthopaedic Surgeons.

The National Institute of Health's National Center for Complementary and Alternative Medicine offers information on alternative therapies and safety issues.

The U.S. Food and Drug Administration offers extensive information on dietary supplements.

SOURCES: Harris Gellman, M.D., professor, orthopedics, University of Miami; Julie Dodds, M.D., orthopedic surgeon, Michigan State University, East Lansing, Mich.; Joseph Betz, Ph.D., vice president, scientific and technical affairs, American Herbal Products Association, Silver Spring, Md.; American Academy of Orthopaedic Surgeons press release
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