Natural Medicines

What is a natural medication?  These are usually herbal remedies used instead of pharmaceutical medications.  Pharmaceutical medications have to pass a process of evaluation by the FDA to ensure that the medication is safe and effective for the purpose the manufacturer says it is designed to be used.  Herbal or natural medications are allowed to be sold unless they are found to be unsafe.  That usually happens after they have been on the market for awhile.  There have been several "natural" products which have been pulled off the market due to injury, illness, or death.  The same is also true pharmaceutical problems but far less common than for natural medication.  Pharmaceutical medications get pulled off the market because they don't work as effectively as predicted or because when combined with other medications there may be an unusual side effect.

The biggest problem I see with people using herbs is that they do not know how they are supposed to be used.  People take herbs or even foods used as medications without a lot of medical supervision.  I met a woman who was dating someone who owned a health food store and was taking 14 different herbal remedies.  So I looked at the list and realized the herbs were in conflict with one another.  The Physicians Desk Reference company makes an Herbal Supplement.  I opened my copy and started showing her how to research the herbal preparations she was using.  Taking an herb to cause constipation along with an herbal laxative isn't a good idea.  The fact that the bottle of both medications says it is good for stomach prblems doesn't help people decide what to take.

Some pharmacists have a background in herbal medicine some don't.  But a pharmacist would be a place to start with questions.  The library may have books on herbs also known as "herbals."  Many of thee contain folk use of plant medicines.  There are research papers on herbs including parts of the plants, dose and preparation methods.  Any prescribing physician should be aware of any herbs, over the counter medicines, or foods used as medicine, prior to prescribing pharmaceutical preparations.

Use of medications

I often talk with people about their medications, use of herbs, supplements, foods used as medications, use of other people's prescribed medications and use of over the counter medications.  Physicians use prescribed medications for two main reasons.  First because medications have a therapeutic effect, and secondly because medications have side effects.  Sometimes physicians prescribe medications specifically for side effects.

The general public has a different idea about medications.  Some people believe that medications are somehow against the "natural order" of things and disturb how the body is supposed to function.  They are fine with herbs, supplements, and foods used as medications.  But they have a problem with pharmaceutical preparations standardized, refined, and produced under governmental supervision, to strict standards.  Some people believe that prescribed medication is needed in order to recover from any illness.  Some people treat medication as magical.  Lots of people use medications in a haphazard fashion neither knowing what the medication is for nor how it works.  They take medications not prescribed for them and combine them with other medications.  They take medications when they remember to do so or when they have what they think are a symptom the medication will fix.

I grew up in a rather unique environment.  My adoptive father was a pharmacist trained in plant medication and compounding or making prescription medications from plants.  I worked in his pharmacy for many years.  I have a medicinal herb garden in my yard.  So I'm certainly not opposed to medicines from herbs or plants.

I think when people know about prescribed medications they have a better understanding about what the medication is for, how it is used and how they are supposed to take it.  I don't think plant medicine or herbal remedies are intrinsically better than pharmaceutical medicines, and in some cases because of the lack of oversight in preparation and inconsistency in potency they can be much worse.  I had a physician mention echinacea as a treatment once.  So I asked what part of the plant was he recommending.  Roots or flower?  Did he suggest E. Purpurea or some other variant of the plant like E. Angustifolia or E. Pallida?  All of these are Echinacea.  All of them I have grown.  Pretty plants.  Very poor research on their impact on the immune system.  There are multiple ways to prepare them.  He didn't know.  He also couldn't advise on dosage.  I suggested he stick to pharmaceuticals or commercially prepared herbal products.  I gave him an E. Purpurea and an E. Angustifolia flower.

A man recently asked me about a medication he had "borrowed" from his wife which helped with some symptom he was having.  "Borrowing" medication from someone else is a very poor practice.  The medication is prescribed to a specific person for a specific symptom or for a property of the medication.  In this case the reason the medication was effective was because of an unusual side effect of the medication.  Trying to get the medication prescribed by his doctor meant that the medication wasn't being used for it's general purpose but instead for a side effect it has.  Unless the physician combed medical research journals to find the side effect and the fact that the medication has been linked to treatment for this condition the physician wouldn't be likely to think it should be used.  There are 4 or 5 classes of medications that can be used to treat the condition.  One is available over the counter very inexpensively.  The pharmaceuticals can be very expensive, and their use is based on side effect properties.

Health psychologists can provide information to both physicians and patients about why something is working.  We have a background in research.  We can provide extensive information to patients about medications and how they work, how to take them, and systems to improve medication compliance.  We can provide information on interactions with foods, over the counter preparations, the impact of taking someone's medication and use of complementary and alternative treatments.

Diagnostic Ambiguity

For most people a trip to a physician means that a doctor will tell them what is wrong and will tell them how to get better.  For some people it may take a couple of visits or a couple different types of medications.  But for some the diagnosis may take months, years or maybe never.

These people, the ones waiting to be diagnosed, go through an agonizing process which changes how they relate to the medical community, to themselves, to their support system and to information about health care.  In as few as six visits to a physician with no clear diagnosis a couple of things start to happen.  First, the physician is likely to blame the patient for the lack of a diagnosis.  "Maybe you aren't telling me everything."  "Maybe it's psychological."  "Maybe it's stress."  "Maybe you should be seen by a specialist."  Second, the social support system of the patient no longer wants to hear about the illness or the lack of diagnosis.  Third, people will provide information on alternative care techniques which may not help with symptoms and may complicate diagnosis and or treatment.  Over time, patients will avoid medical care and become stuck and focused on information about symptoms.  They will have a phobic, reaction to physicians, diagnoses and treatment attempts.  They will have outright refusal of care and avoidance reactions or become clingy and desperate.  Some will develop specific ideas about what makes them better and worse.  Some of those ideas will have no actual basis in reality.  All of these reactions from the phobic or avoiding, to the clingy, to the superstitious, are all normal variants in dealing with diagnostic ambiguity.  Physicians will become rejecting, hostile, irritated, or overly concerned, intrusive and paternalistic. 

Anyone who has not been diagnosed in 6 to 10 office visits should be appropriately referred to a health psychologist.  What can be expected is specific assistance in managing the symptoms, developing strategies in managing the complex relationship with physicians, significant friends and family and concerned other people, and help in coping with the ambiguity.  A health psychologist can assist with tracking symptom data, setting up symptom recording systems, and looking at all the health care options available including traditional, non-traditional, alternative and complementary, as well as other treatments which may be exploitative for a patient with diagnostic ambiguity.  A health psychologist can provide information to the treating physician on how to provide information to the patient in a manner that best matches how they use medical information.  They can assist the relationship and lessen malpractice risks.

Failure to seek Medical Care

There was a study a few years ago in San Francisco that found 49% of people with mental illness failed to seek medical care for a condition they had.  The study cited concerns about coercive treatment, costs to obtain care, and worries about the process of seeking evaluation and care.  The study concluded that regular contact with a physician helped reduce medical costs and improved health care outcomes.

I think the percentage amongst the non-mentally ill failing to seek needed medical care is about equal.  Most people simply aren't sure if their medical condition requires a medical evaluation or not so they wait.  While they wait to improve or worsen to some vaguely determined threshold, they talk to people.  The checker at the market commenting on my yogurt that her frequent heartburn means she can no longer eat food like that.  My sister-in-law telling me about her failed attempts to lose weight and her painful joints.  My husband's cousin asking about substance abuse treatment for someone he knows who lives in Orange County.  The clerk at the office complaining she couldn't stop vomiting.  None of these people are talking to a doctor.  None of them are talking to a health psychologist.  Some of these people will talk online.  Some will call friends.  Some will check websites. 

Health psychology can help with all this.  Some people have been severely traumatized when seeking medical care.  Some medical doctors are abrasive and time pressured.  Some are simply perfunctory.  Some don't explain what they are doing or why.  Health psychology can provide a physician with information on how to treat a patient in a manner that matches their psychological make-up.  If you have an anxious patient worried about procedures then going through what to expect, how to remain feeling positive in light of ambiguity, and helping get questions answered can ensure the patient leaves knowing their questions were addressed.  For people who want a lot of information and require a lot of independence, then clarifying available options, providing research, and support assists that patient.  Some people just get overwhelmed and need to be helped step-by-step through each part of evaluation, diagnosis and treatment with information kept to a minimum.

If you have been thinking about seeking a physician for an initial consultation or second opinion about a condition or simply haven't sought treatment but have symptoms you are concerned about, feel free to contact me at DonohueMA1@me.com.