Monday 21 October 2019

Dear Dr Nina: Are alternative treatments safe during chemotherapy?

Cost ratio of any alternative treatment should also be considered
Cost ratio of any alternative treatment should also be considered

Nina Byrnes

Q I am very worried about my wife. She is undergoing chemotherapy for breast cancer and has been visiting an expensive acupuncturist. I am sure the treatment itself is harmless, but the acupuncturist is also suggesting supplements and vitamins for her to take to complement her treatment. I can see that she is coming under this man's spell and I am worried that this is going to interfere with her medical treatment. She tells me that she has told her oncologist about anything she is taking but I am not so sure. Can over-the-counter supplements interfere with chemotherapy?

Dr Nina replies: There is a public perception that 'herbal' or 'alternative' when coupled with the word 'medicine' means 'harmless'. However, this is not necessarily the case. I believe anyone taking a remedy should know exactly what they are taking, why, and the possible side effects of same. So how can doctors and patients get reliable information about alternative remedies?

The National Institute of Health (NIH) in the United States contains a National Centre for Complementary and Alternative Medicine. Each common herbal remedy is listed here, and a summary is provided of the evidence behind its use, and any interactions or adverse effects. This is a good independent and reliable source of information.

It is essential that any patient undergoing medical treatment discusses with their doctor any other remedies or treatments they are considering, before undertaking any alternative care. There may be individual concerns for patients and their treating doctor is best poised to advise as regards this.

In order to try and ensure safety and efficacy of herbal or alternative remedies, the American Food and Drug Administration has undertaken to subject some of the more popular herbal medicines to the same kinds of trials to which western medicine is subjected. Results have been mixed to date. When it comes to chemotherapy, concerns have been expressed about the concurrent use of St John's Wort, Echinacea, Valerian root, Aloe Vera juice and certain types of green tea. Over-the-counter medicines such as paracetamol, ibuprofen and antacid or reflux medicines should never be taken without medical advice.

The cost/benefit ratio of any alternative treatment should also be considered. These treatments can be expensive and in many cases little health return is guaranteed. Financial stress could have a detrimental effect on physical and mental health. As doctors we are told "primum non nocere" but equally important is 'caveat emptor' or 'buyer beware'. 

The truth is that there is a place for complementary treatment but this should never replace conventional medicine and you should always keep your treating team informed.

A Short History of Medicine:

* 2000 BC - "Here, eat this root.

* 1000 BC - "That root is heathen, say this prayer."

* 1850 AD - "That prayer is superstition, drink this potion."

* 1940 AD - "That potion is snake oil, swallow this pill."

*1985 AD - "That pill is ineffective, take this antibiotic."

* 2000 AD - "That antibiotic is artificial. Here, eat this root."

- Author Unknown

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