Sir, - Ruaidhri Kirwan (November 1st) says there is a "considerable lack of articles in the respected medical journals" supporting the efficiency of St John's Wort. That is incorrect. There is in fact a wealth of published material strongly supporting the efficiency and safety of hypericum. I refer him to the British Medical Journal of August 3rd, 1996, page 253/258. This is a meta-analysis of randomised clinical trials all clearly showing the benefits of St John's Wort.
Mr Kirwan's second incorrect argument is that hypericum acts primarily as a monoamine oxidase inhibitor (MAOI) and that this justifies the IMB restricting it to doctors' prescriptions. The actions of St John's Wort on the human brain are complex and not yet fully understood. No single component accounts for all of its antidepressant action. Instead, several synergistic effects are produced, some Prozac-like, some MAOI-like, though the latter are thought to be the weaker.
Underlying this whole debate are profoundly serious implications for citizens who value some freedom of choice in matters affecting their own health. I think the following points deserve careful consideration:
1. St John's Wort is just the first naturally occurring product that the Irish Medicines Board has singled out to become prescription only. All other herbal, homeopathic and nutritional supplements are vulnerable to the same restrictions since they are, by the IMB's definition, "medicinal products". So where is this all going to end?
2. The IMB receives its funds not from the State but from product authorisation and licence maintenance collected from the international pharmaceutical industry. Thus it is not wholly independent. Clearing the pitch of unlicensed contenders is very much in its own interest.
3. Placing herbal remedies on a doctors' prescriptions to be later subject to a pharmacist's dispensing fee adds at least £25 to a product with an over-the-counter value of about £10. Since most doctors know little or nothing about herbal medicine or homeopathy, this additional fee adds nothing to the value of their therapy.
4. Ireland is the only country in the world where St John's Wort is to be the subject of a doctor's prescription alone.
5. It is estimated that some 20,000 people die each year in the United States alone from the side-effects of single molecular licensed allopathic pharmaceutical products. There is no reported mortality from homeopathic or herbal remedies, used properly. Licensing authorities such as the IMB have a poor track record when it comes to guarding our health.
6. Forcing natural products like St John's Wort on to prescriptions will drive them "underground". This law will be unworkable and unpoliceable. People who choose not to go to their GP for hypericum can always concoct a version of it in their own kitchen, garnered from their own shrubbery. Is this really what we want to happen? - Yours, etc.,
Dr Andrew Rynne, Downings House, Prosperous, Co Kildare.