(2004; 109 pages)
1.2 The risks involved in the use of TM/CAM
TM/CAM medication therapies are commonly used as self-care treatments. However, TM/CAM products are unregulated in many countries, and therefore many of the concerns about the risks for consumers relate to the safety and quality of TM/CAM medicinal products. Reported problems include sales of incorrect plant species and the contamination and adulteration of TM/CAM medication therapies. Heavy metals, fumigation agents, microbial toxins and pharmaceutical substances have been found in toxic concentrations in TM/CAM medication therapies (17-19). Problems involving the use of incorrect plant species and contamination can be prevented by the development and enforcement of herbal medicine regulations and by following good agricultural and collection practices (GACP) for medicinal plants and good manufacturing practices (GMP) respectively.
Uppsala Monitoring Centre, a WHO Collaborating Centre that monitors adverse reactions to medicines, has received reports from all over the world on adverse events following the use of TM/CAM medication therapies (20, 21). The risks also include adverse events following sub-standard practices or the misuse of TM/CAM by unqualified practitioners. It is important to note that while TM/CAM procedure-based therapies are relatively safe, accidents do occasionally occur, for example when TM/CAM practitioners are not fully trained (3); when practitioners do not follow the professional code of ethics; or when the treatment is not adjusted or modified according to the condition or constitution of the patient. For example, although serious adverse events following acupuncture (e.g. pneumothorax) are rare, well-documented cases have occurred, including fatalities (17).
Incorrect use of TM/CAM medication therapies can have fatal outcomes. For example, the Chinese herb ma huang (Ephedra sinica), which contains ephedrine and is used for breathing problems, has caused heart attacks and strokes among some Americans using it as a dietary supplement (22); long-term use of kava kava (Piper Methysticum) can cause serious liver damage (23); and the use of ginkgo (gingko biloba), which stimulates peripheral circulation can result in bleeding during surgery (22).
In addition to adverse events, interactions have been described in the scientific literature (17, 24) as well as in WHO Monographs (25, 26). Interactions may pose a risk to patients who use TM/CAM medication therapies in conjunction with conventional drugs. Studies show that many patients use TM/CAM therapies concurrently with conventional medicine, often without informing their health care provider (27). Efforts are needed to improve communication between patients and health care providers and, in the case of self-care treatments, to ensure that consumers are better informed.
In summary, TM/CAM is unregulated in most countries, communication between patients and health care providers is generally poor, and there is an urgent need to develop consumer information in order to minimize the risks and maximize the benefits of TM/CAM use.