Wednesday, 27 August 2008

Heavy metals in "safe", natural, alternative medicines...why we need evidence based medicine

I saw this in today's Guardian. A team led by Robert Saper of the Boston Medical Centre ordered 230 different ayurvedic medicines from websites, and analysed the 193 they actually received for metal content [interesting that they never received 37 of them...]. For those interested, the paper is in JAMA 300 (8): 915-923, but it's behind a paywall...

What is Ayurvedic medicine? It's not something I know a lot about, but it's a traditional form of Indian medicine. Medicines are made up of herbs or mixtures of herbs, which can be combined with metals, minerals or animal products. The medicines that include metals, minerals or gems are known as rasa shastra medicines. As is typical for any form of alternative medicine, Ayurveda is described as being safe and natural by the various people who sell it: try a simple Google search to see what I mean. But how safe are they really?

Well, according to Saper and colleagues, a good proportion of them are stuffed full of heavy metals. Of the 193 medicines they analysed, 20.7% contained detectable levels of lead, mercury or arsenic. Unsurprisingly, metals were more prevalent in the rasa shastra medicines, of which 40.6% had detectable levels of nasty metals. The authors then took the recommended doses for each of the metal-containing medicines, and calculated what the daily intake of heavy metals would be for someone taking the medicine according to the stated dose. They found that for ALL of the medicines that contained detectable metal levels, a person taking the recommended dose would exceed standards for the ingestion of heavy metals. For some of the medicines manufactured in India, ingestion of heavy metals exceeded the limits by up to 10,000 times.

Pretty scary, eh? There are some caveats here. Firstly, these medicines were bought online: the authors concede that the results may not be similar for medicines given in consultation with an Ayurveda practitioner, or over the counter in western pharmacies. Even so, a previous study of medicines sold in Boston by Saper and colleagues showed that 20% contained lead, mercury or arsenic. So be careful: it is clear that while Ayurveda may be a 'natural' alternative to conventional medicine, it is not necessarily 'safe', as these case reports also testify. This is why conventional medicines are tested for safety before they can be sold. While there is no doubt that the evidence-based process of efficacy and safety testing can sometimes go wrong, it should be supported; the alternative is taking medicine of no proven benefit and with no understanding of the risks. This is too often what happens with inadequately regulated alternative treatments.

8 comments:

jdc325 said...

Ah yes, gotta love those natural remedies. Arsenic is natural isn't it? As are snake venom, anthrax and poisonous mushrooms. Typhoid? Cholera?

HolfordWatch said...

This looks like an update of a similar JAMA study in 2004 that was written up with some startling revelations about other ingredients in Ayurvedic remedies such as ground human skulls and bones. The article mentioned (like the current JAMA) a 20% contamination rate in US but 64% in India.

"THE SUBJECT OF gold bhasams brings us to the next issue of concern, namely, heavy metals. The 2004 study published in the Journal of American Medical Association found significant levels of toxic heavy metals such as mercury, lead, and arsenic in 20 percent of Ayurvedic preparations that were made in India for sale in America (see figure 1). The situation is far worse in India where 64 percent of sample collected were found to contain significant amounts of mercury, arsenic and cadmium."

It's an interesting article for the clash of cultures involved.

Paul Wilson said...

holfordwatch:

Cheers for that link: illuminating.

The 2004 study you mention is this one, I think. In that study, Saper and colleagues looked at 'medicines' they could buy in Boston ('20 miles or less from Boston City Hall', in fact). In this study, they looked at what they could get over the internet. Neither study is particularly re-assuring.

Paul Wilson said...

Another thing to note here is that out of 230 medicines they ordered, they only actually got 193. So not only do you have a 20% chance of getting safe, natural poison in exchange for your hard-earned dollars, you also stand a 16% chance of being ripped off.

HolfordWatch said...

Meh - you order any medications on the internet and you are in trouble. More than half of drugs sold online are fake or substandard. 62% in fact.

"Their analysis showed that 62% of the drugs bought online were substandard or counterfeit and that only 38% were genuine branded drugs. Moreover, 16% of the branded drugs were illegal imports from outside the European Union, and 33% had no information leaflet in the pack delivered to the purchaser. All were bought without a prescription, which meant they were supplied illegally."

Joann L said...
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dyangelo said...
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Angela Navejas said...

Nice Info! There many people who are in the treatment of Ayurveda so they have to take Ayurvedic medicine but they want to buy it online and every online pharmacies do not have it.

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