Sir, - Mr B. Kearon (October 22nd) complains about the Irish Medicines Board's plan to crack down on the alternative health care market and, in particular, St John's Wort. He claims that this plant exhibits "mild" antiviral activity and that it should be freely available to the self-medicating punter.
Of course, one could never be absolutely certain that all alternative practitioners and thereapies amount to a hoax. It's just that the considerable lack of articles in respected medical journals supporting their efficacy seems to reduce Mr Kearon's argument to little more than the quasi-science of an amateur enthusiast.
The essence of this on-going debate is that alternative medicine will not agree to the scrutiny of a controlled clinical trial as they know it would lead to an embarrassing and costly exposure. More importantly, that these alternative practitioners fail to display results of clinical trials which follow internationally accepted and agreed methods of data interpretation is at complete variance with the grandiose levels of confidence they have in their "remedies", which represent an obvious risk to poorly informed consumers who may mistakenly believe that their consumption in spurious quantities is in some way beneficial.
Another correspondent and advocate of alternative therapy, Mr J Philpott (October 25th), demands to know why the IMB has classified St John's Wort as a prescription only drug. I refer to Mr Philpott to The Irish Medical Times editorial (October 22nd) which explains that medical science now understands the active agent in St John's Wort to be an inhibitor of the enzyme monoamine oxidase. This property places it among a group of clinically proven antidepressant drugs called mono amine oxidase inhibitors (MAOIs) which alleviate depression by raising levels of the endogenous amines noradrenaline and serotonin.
Like all drugs, MAOIs have a number of side effects, but in particular the irreversible type may interact dangerously with certain cheeses and red wines. It is of utmost importance, therefore, that MAOIs or their analogues such as St John's Wort, don't fall in the hands of charlatans who waive all professional responsibility for their patients (unlike the orthodox medical profession) and are ignorant of the pharmacokinetics and therepeutics of the agents they are selling. The Irish Medicines Board is well aware of this dangerous situation and has taken prompt and commendable steps to prevent it continuing. - Yours, etc.,
Ruaidhri P. Kirwan, Final Medical Year, University College, Dublin.