One of the reasons that practitioners become interested in natural medicine is that in many situations it is considerably safer than conventional medicine. The risks associated with conventional medical care were highlighted by two recent studies published in the New England Journal of Medicine.
The first study concluded that, for every 100 hospital admissions, there are 25 episodes of patients' being harmed as a result of their medical care. Adverse events resulted most frequently from medical procedures, medications, and hospital-acquired infections. One in 12 adverse events was life-threatening, and 2.4% of the events caused or contributed to a patient's death.
The second study concluded that, in the US between the years 2007 and 2009, there were approximately 100,000 emergency hospitalizations per year for adverse drug events, among people aged 65 or older. In about two-thirds of those hospitalizations, the drug or drug class responsible for the event was warfarin, an antiplatelet agent, insulin, or an oral hypoglycemic agent, and the adverse reaction was either bleeding or hypoglycemia.
Of course, many of the patients who were injured by their medical care were already quite ill, and from a population standpoint, the benefits of the therapies and procedures that they received may have outweighed the risks. However, to the extent that natural alternatives are available, their appropriate use would presumably improve the risk/benefit ratio in these patients.
It is not particularly comforting that many of the adverse events described in the two new studies were considered preventable. Both patients and practitioners are only human, and we all sometimes make mistakes, particularly when a patient has multiple health conditions and is on multiple medications. Despite extensive efforts over the past decade to improve in-hospital patient safety, there has been little change in the frequency with which hospitalized patients are being harmed. And despite ongoing measures to improve outpatient education, fully two-thirds of emergency hospitalizations for adverse drug reactions are due to unintentional overdoses. Thus, while we should always try to do better, errors are going to be made, and it would preferable to make those errors with interventions such as diet, nutritional supplements, and herbs (the consequences of which are usually not serious) than with potentially toxic medications (the consequences of which can bg catastrophic).
Nor should we be comforted by the claim that a significant minority of the adverse events that occur in and out of the hospital are not preventable," and are therefore "not our fault." While even some of the best-managed patients will suffer a serious hemorrhage from taking warfarin or antiplatelet drugs, the risk of a major bleeding episode from nutritional anticoagulants such as garlic, fish oil, vitamin E, vitamin B6, and nattokinase appears to be remote. Likewise, severe hypoglycemia would not be expected to occur in a diabetic patient who is being managed successfully on an exercise regimen, a high-fiber diet, and supplements such as chromium, biotin, and cinnamon. Thus, adverse drug reactions that are considered "not preventable" are in reality preventable, if one is able to substitute a different, and safer, treatment.
There is no question that type 2 diabetes can frequently be controlled without drugs, provided that the patient takes an active role in his or her care. The situation regarding natural anticoagulants is more complex. Various natural substances have been shown to prevent excessive blood clotting through a number of different mechanisms, including inhibiting platelet aggregation, blocking the fibrin cascade, and increasing fibrinolytic activity. Because different anticoagulant mechanisms are involved with different natural compounds, it is conceivable that taking these substances in combination would produce a powerful anticoagulant effect. Moreover, clinical observations suggest that taking various combinations of natural anticoagular does not put patients at risk of excessive bleeding.
The problem is that there has been no clinical trials to investigate whether taking a cocktail of natural anticoagulants would be as effective as warfarin or antiplatelet drugs for preventing strokes and heart attacks. In fact, we don't have any firm evidence that such an alternative approach is effective at all.
A clinical trial that compares conventional and natural anticoagulation regimens is therefore urgently needed. Considering that an estimated $500 million is spent by Medicare each year on hospitalizations necessitated by drug-induced bleeding, it would be in the federal government's interest to fund a study that would determine whether these hospitalizations can be prevented.
Alan R Gaby, MD
27 April 2012