Taking the edge off - Why patients choose St. John's Wort

BACKGROUND. The number of visits to alternative medicine practitioners in t his country is estimated at 425 million, which is more than the number of v isits to allopathic primary care physicians in 1990. Patients' use of St. J ohn's Wort (SJW) has followed this sweeping trend. The purpose of our study was to examine the reasons people choose to self-medicate with SJW instead of seeking care from a conventional health care provider. METHODS. We used open-ended interviews with key questions to elicit informa tion. Twenty-two current users of SJW (21 women; 20 white; mean age = 45 ye ars) in a Southern city participated. All interviews were transcribed, and descriptive participant quotes were extracted by a research assistant. Quot es were reviewed for each key question for similarities and contextual them es; RESULTS. Four dominant decision-making themes were consistently noted. Thes e were: (1) Personal Health Care Values: subjects had a history of alternat ive medicine use and a belief in the need for personal control of health; ( 2) Mood: all SJW users reported a depressed mood and occasionally irritabil ity, cognitive difficulties, social isolation, and hormonal mood changes; ( 3) Perceptions of Seriousness of Disease and Risks of Treatment: SJW users reported the self-diagnosis of "minor" depression, high risks of prescripti on drugs, and a perception of safety with herbal remedies; and (4) Accessib ility Issues: subjects had barriers to and lack of knowledge of traditional health care providers and awareness of the ease of use and popularity of S JW. Also of note was the fact that some SJW users did not inform their prim ary care providers that they were taking the herb (6 of 22). Users reported moderate effectiveness and few side effects of SJW. CONCLUSIONS. SJW users report depression, ease of access to alternative med icines, and a history of exposure to and belief in the safety of herbal rem edies. Users saw little benefit to providing information about SJW to prima ry care physicians.