THE POLITICS AND ECONOMICS OF ST JOHN’S WORT
As I have mentioned, in Germany St John’s Wort vastly outsells Prozac, which is the number-one selling prescription drug in the US. In recent years German doctors have written about seven prescriptions for St John’s Wort for every Prozac prescription – and this does not take into account the millions of St John’s Wort tablets sold over the counter. There is every reason to believe that St John’s Wort can become as popular an anti-depressant in Britain and the US as it is in Germany, and if that occurs the sales of the herbal anti-depressant will take over a major fraction of the antidepressant market. The over-the-counter availability of St John’s Wort gives the herb the additional market advantage of easier accessibility as compared with prescription anti-depressants. Many patients may seek to treat their own depressions as opposed to seeking help from the medical establishment. Whatever the wisdom of such a decision on the part of the patient, this change in behaviour will mean more money in the pockets of producers of herbal compounds, owners of health food shops and, most important, patients themselves.
Private insurance companies and even the NHS are in a position to influence the relative cost of St John’s Wort versus conventional anti-depressants. Should private insurers choose to reimburse patients for synthetic anti-depressants but not for St John’s Wort, they would make the herbal anti-depressant more expensive than synthetic ones for some patients. The current situation in Germany is that St John’s Wort is reimbursed by insurers if it is prescribed by a doctor but not if it is purchased over the counter. This seems like a reasonable guideline to follow in other countries as well.
The questions raised in this chapter, such as ‘Should people be encouraged to treat their own depressions?’ or ‘Should active antidepressants be available over the counter?’ are worth debating in their own right and will no doubt be discussed in the years to come. Given the economic and political stakes involved in these issues, however, it is important for the consumer to be aware of the potential biases of those who are most likely to be engaged in the debate even though these biases do not invalidate the content of their arguments. With this in mind, let us examine some of the controversies that have been raised in relation to St John’s Wort.
*40\75\2*
