Surgery? Time to Ditch the St. John's Wort

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Two great myths haunt the annals of alternative medicine. One: Herbal remedies are just as effective as synthetic medicines. Two: Herbal remedies are just as safe as sugar pills. Neither of these statements is true, but thatís been no deterrent to the herbal faithful, some of whom continue to portray alternative medicines as infinitely effective yet virtually devoid of side effects. And in response to the rising popularity of herbal remedies, which in general are not regulated by the Food and Drug Administration, the medical establishment is beginning to take note of the kava-kava and St. Johnís wort circulating through so many of their patientsí bloodstreams.

At a conference in Dallas last week, Dr. Charles McLesky told the American Society of Anesthesiologists that at least 17 percent of 979 patients he surveyed took one or more herbal products, many of which were shown to interact with general anesthesia, prolonging or changing the effect of the anesthesia. St. Johnís wort, which is marketed as a natural antidepressant, and the relaxant kava-kava tended to extend the duration of sedation, while ginger, garlic, gingko biloba and ginseng slow the formation of blood clots, exacerbating the threat of excessive blood loss in surgery.

While this isnít exactly breaking news ó even before the release of this study, the ASA urged patients about to undergo surgery to stop taking any herbal regimen at least two weeks before surgery, and to inform doctors of any herbal concoctions in their diets ó this is a far more definitive warning. According to TIME medical correspondent Dr. Ian Smith, it will "absolutely" surprise many patients who take herbs. "These herbs are marketed to people as 'all-natural, without side effects,íĒ says Dr. Smith. "The ASA is saying, look, these herbs may be natural, but they do have an effect on the body, and their presence may hinder or change the influence of other drugs." It all boils down to good and bad news for the makers of herbal remedies: Yes, herbs do indeed have some physiological effects ó and that could mean that herbal remedies won't be treated by the federal government as "food supplements" forever.