The Department of Health, and its boss, Minister Cowan, have recently become embroiled in a controversy which threatens to render them the laughing stock of the EU. By introducing legislation supported by the Irish Medicines Board, which renders the common herbal remedy, St. John's Wort available on prescription only, he has not only raised the hackles of a sizeable portion of the public who regularly use herbal remedies, but has pre-empted a more considered EU directive on herbal remedies due for publication in February 2000.
The Irish Medicines Board sought to have St. John's Wort confined to prescription due to its use in the treatment of depression. According to the IMB, no treatment for depression should be available across the counter.
Trevor Sargent, Green Party TD, sees this particular spin as something of a red herring, detracting, as it does, from the wider implications of restricting the public's access to the widely used herb.
"This problem goes right back to the Department of Health," he asserts, "which has shown a blatant disregard for herbal remedies. When the Alliance of Herbal Practitioners alerted the Department of Health to the claims being made for St. John's Wort (which they didn't feel they could support), the Department failed to respond or to take any action.
On December 1st, Trevor Sargent, Nuala Ahern, MEP, and Mick Lally were just three of a number of petitioners who presented a 65,000-signature protest to the Dáil, objecting to the proposed legislation. Trevor Sargent is clearly frustrated by the Government's pre-emptive strike in introducing this piece of legislation (which will come into effect in January), particularly in light of the fact that the EU Commission is itself working on a more practical directive concerning the availability of herbal remedies, and promises to publish one next February.
"The Irish Medicines Board has gone out on a limb internationally in this matter," he avers. "They've shown themselves to be over-zealous in wanting to protect the public from the misuse of medicines. They have clearly over-stepped their brief in moving to restrict the availability of St. John's Wort (as well as a number of other remedies including Tribulus Terrestis and Blue Cohosh) when no serious side effects have ever been reported.
John Bourke, President of The Pharmaceutical Society of Ireland has been quick to defend the IMB's action, stating that "for too long many so-called alternative medicines have been legally supplied without the requisite research and data to support their efficacy, their safety, and their quality".
However, Sargent has been vocal in his response to such claims, as have the collective body of European Herbal Practitioners.
"The fact is that herbal remedies are not appropriate to the conventional pharmacy setting," Sargent claims, "in that they have no identifiable active ingredient. A great deal rests on the history of the product, on documenting and recording each individual's reaction to the herb. It's been used for over 2,000 years, and for over 30 years in its current form, and has been shown to have no serious side effects."
The concerns expressed by the Irish Practitioners' Association of Chinese Herbal Medicine, among others, are that by making St. John's Wort available only on prescription, it will no longer be available for use as a preventative health care measure, and so it effectively removes it from a sizeable portion of the public who are anxious to take management of their health into their own hands.
"I think this public reaction we are witnessing is symbolic of the attention people give to preventative health care," Sargent continues. "Unbeknownst to the Department of Health, people take vitamin supplements, herbal remedies and take other measures, such as getting enough sleep, in order to maintain a decent standard of health. St. John's Wort is part of this process, and here we have the Government legislating to remove it from the public's access."
Treatment of depression is a subject of much debate, particularly in Ireland, where our spiralling suicide rates are a cause for major concern, and where conventional medicine has witnessed a sea change in the public's reliance on its word as the very last in health care.
Sargent finds it ironic that the Irish Medicines Board should seek such a drastic measure in its perceived battle against depression.
"The IMB takes a very extreme view that anyone with depression should have all sharp implements and shoelaces taken away from them, as though they can't be responsible for their own well-being," he observes dryly. "But people want to take an active role in managing their own health, and in mild depression certainly, people are very aware of how to avoid sinking into a trough of despair.
Sargent also feels that removing St. John's Wort from sale in alternative health care shops, and consigning it to the realms of prescription only, effectively bans it from the public.
"Doctors aren't going to be able to prescribe it," he suggests, "because they don't know enough about it, they haven't been trained in herbal medicine. So what this is doing is working against public health, and ensuring that more people get sick. Preventative health care has always been the poor relation in the Department of Health's view.
There is a ready solution to the problem, Sargent believes, and it's one that will be acceptable to both sides of this heated debate.
"The Minister has the opportunity to modify the statutory instrument so that any dose over 3 grams would be subject to prescription," he proposes. "Anything below that dosage could then continue to be sold over the counter. That is the system operating in Germany at present."
Meanwhile, if the proposed regulations are adopted, we're likely to see people furtively importing St. John's Wort from Northern Ireland, where it continues to be freely available, as it is in most other countries worldwide. In the '60s they had the glamour and excitement of the condom trains. As we enter the new millennium it's looking likely that we'll be seeing condoms replaced by St. John's Wort in illicit merchandise being smuggled over the border. These are indeed, progressive times we live in. n