Tag: medicine

  • The danger of overdoing over-the-counter medicine

    The danger of overdoing over-the-counter medicine

    In 2023, David Mitchener, 89, was admitted to a hospital in Surrey, England where he died. His death was attributed, in part, to high levels of Vitamin D, which he had been taking for nine months before his death.

    It turns out that using herbal remedies and nutritional supplements could put your health at risk.

    In a 2020 study at a Canadian naturopathic clinic, 42% of participants said they did not discuss their use of natural health products, including herbal remedies and vitamins, with their doctor. It turns out there are risks associated with not disclosing that you’re taking herbal remedies and supplements.

    Some people are aware of the risks and are careful when using these products, but some people aren’t, said Frances Atcheson, a community pharmacist based in Northern Ireland. “There is a danger with people thinking that they’re always safe to take, just because they’re natural.”

    Lezley-Anne Hanna, chair of pharmacy education at Queen’s University Belfast, said that the products could interfere with a patient getting a correct diagnosis. “If you didn’t disclose that you were on an herbal medicine, well, that could actually be causing your symptoms in the first place,” Hanna said.

    Drug interactions

    A major risk, Atcheson said, is that the natural medicines will interact negatively with with conventional medicine. Increased bleeding risk, for example, is associated with using herbal remedies such as ginkgo biloba, cranberry juice and ginger at the same time as blood-thinning medication, such as warfarin and aspirin.

    In 2014, the Medicines and Healthcare products Regulatory Agency (MHRA), which regulates medicines in the United Kingdom, warned about the interaction between hormonal contraceptives and St. John’s wort, a herbal supplement that is used to alleviate mild depression and anxiety.

    Such interaction has been blamed for unplanned pregnancies. St. John’s wort can also cause serotonin syndrome when used with other antidepressants. This can show up as high blood pressure, shivering and mania.

    Ayurvedic medicine, which originated in India, uses many herbal remedies. The products can also include metals. However, in December 2025, the U.S. Food and Drug Administration issued a warning about the possibility of heavy metal poisoning, such as lead and mercury, when using Ayurvedic products.

    This could lead to infertility, kidney and brain damage and convulsions.Taking herbal remedies and supplements when there aren’t specific symptoms or illnesses has risks too.

    Side effects of natural remedies

    While taking Vitamin D supplements is recommended for everyone in the United Kingdom by the Department of Health and Social Care, too much Vitamin D can lead to bone pain, loss of appetite and abdominal pain in otherwise healthy patients.

    Liver injury caused by herbal remedies and supplements has been reported in Australia, the United States and Spain, in some cases so serious that it led to the need of a liver transplant.

    Seema Haribhai, a 37-year-old woman from North London, became concerned about the potential side effects of conventional medication and turned to herbal remedies to treat psoriatic arthritis — a type of arthritis that causes pain and swelling in joints. A coroner’s report attributed her death to liver failure that might have been aggravated by herbal remedies recommended by an Ayurvedic medicine practitioner. “All medicines can cause harm, even those that are herbal based,” the report said.

    Eva Delaney, 24, of Belfast takes the herbal supplement ginkgo biloba to improve brain function and Kalms tablets, which contain the herb valerian root, to reduce stress. She says she found out about the supplements in the pharmacy where she worked and consulted a pharmacist at her work before buying the products. “It probably should be the thing where you should always go to your pharmacist first,” she said.

    Hanna said that pharmacists should be able to discuss these products in the context of patient safety. “Pharmacists are the expert in the safe and effective use of medicine,” she said.

    Discussing herbal medicine with doctors

    What form the herbal remedies and supplements take, Delaney said, play a role in whether people tell a healthcare professional they’re taking them. “I think if it’s a tablet, you’d be more inclined to tell someone, ‘Oh, I’m taking this’,” Delaney said. “But if it was anything else, like a syrup … I think it would be harder to consider that as a medicine.”

    In a 2021 study, more than 90% of pregnant women in Ethiopia using herbal remedies throughout their pregnancies did not discuss this with their health-care professionals. The most common reason they gave was that the healthcare professional did not ask.

    Atcheson said that she wouldn’t normally ask about herbal remedies specifically. But she will ask patients: “Are you on any other prescribed medication or do you take anything over the counter? And sometimes they will volunteer information if they’re taking herbal remedies or supplements.”

    Hanna said that healthcare professionals need to ask specific questions in order to learn about patients’ use of herbal remedies and supplements. “If you want to know if somebody’s on a herbal medicine,” she said, “you need to ask.”

    It is also important for healthcare professionals to know their own limitations, and to know how to find the information they lack. “It’s about accepting that you may not know that particular product or you may not know that name,” Hanna said. “But where can you go and find out reliable information? Where could you advise the person to go?”

    Finding reliable resources

    Atcheson said that she uses the online Cochrane Library as a resource when presented with a patient question she can’t answer. The Cochrane Library provides evidence-based information on herbal remedies and supplements and their effectiveness in different medical conditions. Unfortunately, she said, there aren’t many other readily available resources. “Apart from the Cochrane Library, I’m just going onto Google Scholar looking for reviews,” she said.

    Atcheson recalls telling a patient not to take collagen supplements because the patient had chronic kidney disease. “There’s something about collagen where it can actually interfere with the kidneys when you take it orally,” she said.

    Many young people find misinformation on the internet, she said. “I’ve heard about people buying supplements and herbal remedies for weight loss,” Atcheson said. “It’s especially risky when you’re buying things on the internet. Then there’s no point of contact at all.”

    In the UK, people can look for a  Traditional Herbal Registration symbol on product packaging when deciding whether to buy a herbal remedy. This symbol means the product has met the safety and quality standards set by the MHRA.

    Hanna said that discussing over-the-counter products with a health-care professional can help patients feel empowered about their own health and provide them with unbiased information.

    “It really would be a missed opportunity to not use a healthcare professional,” she said, “and to help you whenever you’re thinking about a herbal medicine.”

    Questions to consider:

    1. Why don’t many people discuss herbal medicines with their medical doctors?

    2. What are some things you need to consider before taking vitamins or herbal remedies?

    3. If you or someone you know takes vitamins, how did you or they decide to do that?

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  • Podiatric Medicine: An In-Demand Surgical Field

    Podiatric Medicine: An In-Demand Surgical Field

    Podiatric medicine is a highly rewarding health career with a variety of specialty areas to serve patients with diverse needs that rely upon highly trained skills.

    A professional basketball player who tore their achilles tendon during a game, a diabetic patient at risk of losing their foot, and an older woman with a painful bunion who wants to get back to her daily walks. These are all patients served by Doctors of Podiatric Medicine (D.P.M.) who can not only get them back on their feet but also help prevent future medical issues. 

    By going directly into a specialty at the time they begin podiatric medical school, D.P.M.s are qualified by their education and training to diagnose and treat conditions affecting the foot, ankle, and related structures of the leg. 

    “From sports medicine, to reconstruction and trauma, to diabetic limb salvage patients or geriatrics, it’s a profession that really encompasses all of the aspects of medicine in one unique profession,” said Dr. John Steinberg, system chief for the MedStar Health Division of Podiatric Surgery and the program director of the MedStar Health Georgetown University Podiatric Surgery Residency program. “It’s just such a unique profession that blends the capabilities of medicine and surgery into a skill set for a practitioner that can really make a big difference in a patient’s life.”

    However, it’s not just about surgery. Steinberg says the operating room is just one of the tools podiatric physicians can use to help patients. He said one of the reasons podiatric medicine is so unique is the range of focuses that D.P.M.s can specialize in and the connection between the podiatric physician and their patients. 

    “You can get to know your patient. You can get to know their family. You can follow them for a lengthy course of treatment and be their go-to source,” Steinberg said.  “I couldn’t ask for a more fulfilling and purposeful profession.”

    Day-one specialization

    Steinberg is an expert in limb salvage and diabetic wound care. With an increase in diabetic patients, podiatric physicians are filling a demand for wound care experts who are able to use their knowledge of biomechanics to prevent patients with foot ulcers from losing their limbs. 

    “We can get into the tendon lengthening procedures and bone remodeling procedures and the reconstructive work so that, yes, we healed the wound, but we also reconstructed the foot and the leg so they can actually walk on it,” he said. 

    There are nine accredited colleges and schools of podiatric medicine in the United States offering the four-year D.P.M. program. Graduates are then placed into a three-year, hospital-based, comprehensive medical and surgical residency with a nearly 100% residency match rate. Podiatric medicine is the quickest pathway to becoming a surgeon, as D.P.M.s specialize from day one.

    The modern podiatrist

    For Steinberg, it was an easy decision to go into podiatric medicine, as he was exposed to the field at a young age. His son is now applying to podiatric medical schools, and when he finishes school, he will be the fourth generation of podiatric physicians in the Steinberg family. 

    “My son sees what I do, and he sees how content I am, and he sees how much fulfillment I get from my work, and he says, ‘Why would I want to do anything different?’” Steinberg said. 

    Podiatric medicine offers a faster entry to start a career as a physician than traditional medical school or osteopathic medical school programs, which means earlier access to ancillary sources of income. 

    Podiatric medicine also offers autonomy and the ability to choose an ideal practice setting. D.P.M.s can work in hospitals, outpatient settings, athletic departments, in private practice, or in an academic or research setting.  

    “This is not your father’s podiatrist, this is not your grandfather’s podiatrist. In 2025, it is a whole different ballgame,” Steinberg said.

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  • Diversifying medicine by widening participation

    Diversifying medicine by widening participation

    Medicine is an elite profession, traditionally dominated by white, male, middle- or upper-class people, frequently from medical families.

    In 2014, the Medical Schools Council (MSC) created a Selection Alliance (SA), and published Selecting for Excellence (SfE), to address inequities in access to medical degrees in the UK for those from “widening participation” backgrounds.

    Fostering Potential: 10 years on from Selecting for Excellence , published in December of 2024, reports on progress made, with welcome achievements that are testament to the commitment of the community. The report rightly notes that focus on widening access has meant support for diverse students once they commence studies has been neglected.

    Recently, medical student activism – #LiveableNHSBursary , and #FixOurFunding – have highlighted the peculiar funding situation medical students find themselves in , and the financial pressures they experience during their studies.

    Fostering Potential asserts that WP needs to be reconceptualised away from a deficit framing of individuals as lacking ambition or aptitude to excel, to understanding lack of participation as the product of systemic and institutional failures around inclusion. For me, one of the main barriers to success for students from a disadvantaged socio-economic background studying medicine is the degree was designed and developed for a financially comfortable student. Its current structure excludes students from diverse backgrounds, and part of this is financial.

    The earnings gap

    One might argue that the financial hardship experienced by student medics is the temporary cost of what will become a lucrative career. However, once qualified, doctors from a lower socio-economic background will experience an average class pay gap of £3,640. This means their degree is both harder won and less remunerative.

    Current research and initiatives on financial barriers to success mostly treat money as a discernible object that can be quantified. It is a thing we either have enough of, or not; something we earn for ourselves as individuals. Hence proposed solutions tend to focus on maximising individual students’ abilities to earn alongside studies, while recognising that lack of time due to part-time work or caring responsibilities means some students cannot take advantage of extracurricular career development opportunities.

    I find this contradictory and suggest it misses a key point – money is also a relationship; it shapes our experiences of the world far beyond how much we have. It is a condition of success, not a result of it. Developing support for a student from a financially disadvantaged background should be informed by research that explicates how poverty impacts students’ opportunities to learn and exploit the advantages higher education allegedly offers.

    A student’s-eye-view

    I lead a project at Lancaster Medical School called Medicine Success, providing funds to mitigate the hidden costs of a medical degree for students from diverse backgrounds – purchasing a stethoscope, professional attire and funding the compulsory elective.

    Five years of project evaluation data reveal much about the role money plays in students’ sense of belonging and success. A student’s-eye-view of the degree reveals how unexpected its hidden costs are, how difficult it is to cover the cost of living and studying without financial support, and how choices about career development are constrained by cost. Further, the data shows students with scarce resources are keenly aware of how wealth is a vector of exclusion and inequity shaping their experience of the degree differently to their wealthier peers:

    Receiving these funds made a massive difference as it took me by surprise how much of a financial burden studying at university was. It seems that every aspect of it requires you to spend money that you don’t have and I feel at times it’s not all inclusive (2nd year, 2024)

    Their evaluations of the funding show that money transforms our lived experience of the world, and in turn, shapes our thoughts and feelings. They explain how scarcity can impact mental health and mental bandwidth, and the funding alleviates financial anxiety and paid-work commitments so they may focus on their studies.

    But it means more than just being able to afford essentials, it means being able to participate equally and with pride in their degree in comparison to their wealthier peers. This directly impacts self-esteem and addresses feelings of unworthiness or lack of belonging.

    A good example of this is the professional attire fund:

    I know professional attire might not seem serious but not having the right attire when it’s necessary leads me to overthink about how I’m dressed and feeling insecure during sessions. It’s often to the point where instead of focusing on learning I can’t help but to think about my appearance. (1st year, 2020)

    It is well-established that class can be read through a multitude of symbols. Respondents describe how their “lower” social status feels revealed through clothing, making them feel insecure in the learning environment. Students relate having their cheap and tired-looking clothes pointed out to them by peers, others worried about wearing the same outfit every day and what that said about their finances, while some feel that their patients have less respect for their opinion when they don’t present well-dressed. Meanwhile, ill-fitting clothing and shoes also interfere with the ability to focus on studies, causing pain and making long shifts additionally exhausting.

    Widening participation initiatives that focus on belonging from a social, cultural or academic skills perspective miss this crucial element – money. One student articulates a point made repeatedly by many of their peers:

    Funds like these make students like myself feel more heard and seen and gives us the opportunity to come from a lower socio-economic background and not feel as if we don’t belong here simply due to lack of finance. It gives us the confidence and the ability to work hard for what we want as we know there is always support available for students like us. (1st year, 2022)

    Recipients of Medicine Success funding attest that financial support levels the playing field with their more privileged peers in numerous, significant, and yet, subtle ways. Providing financial support is essential to make the learning environment, social activities, and career development accessible to students from all backgrounds. Belonging is in part financial; you can’t participate fully without money.

    Wider Context

    Recent reports show that the government is making a loss on student loans due to higher interest rates . This means private lending institutions are making a profit from the scheme funded by tax-payers and graduate repayments. In Why We Can’t Afford the Rich, Andrew Sayer explains that our current political system “supports rentier interests, particularly by making the 99 per cent indebted to the 1 per cent” , in which wealthy people are less likely to earn money through paid work, but accrue wealth through financial activities. The student loans scheme is one example.

    Higher education is presented as a means of social mobility, while extracting wealth into a financial sector that shores up its and its investors power. It does so by making already poor people pay to access education but without the conditions to participate fully. The promise of breaking the cycle of poverty with a university degree is so powerful that it deflects attention from what is really happening, despite extensive evidence that education has yet to prove itself as a solution to class inequalities. For these reasons, even with WP policies, HE has financial injustice embedded within it, resulting in deleterious effects on students’ mental health, degree experiences and outcomes.

    I see this as an example of “financial trauma,” defined by Chloe McKenzie as “the cumulative effect of being required to experience economic violence, financial abuse, financial shaming, and/or (chronic) financial stress to attain or sustain material safety”.

    Social mobility is a problematic term; it requires individual people to increase their position in an established hierarchy that is itself integral to maintaining socioeconomic inequality. This is why I welcome the MSC’s push to reconceptualise improving participation as a systemic issue, not one focussed on changing individuals to fit into the status quo. At the same time, we must apply this thinking to financial barriers to success, by recognising that money is far from a private issue but a matter of justice.

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