The present survey highlights the potential risk of confidence with the 'natural world', the lack of discussion on this argument among health care providers and patients on warfarin therapy and the need to monitor strictly the INR value.To this I would add (especially in the wake of recent experience): increased levels of physician education on the effects of the 'natural world' might help increase their confidence (heresy, I know). Many botanicals are perfectly safe to use in conjunction with anticoagulant therapy; others are not. A clear understanding of the underlying pharmacology and physiology is the best place to start.
I just couldn't get over how the first conclusion of this study, which rightly identifies poor communication between docs and patients and highlights the dangers that result, was to lay the blame at the feet of the 'natural world'. Fortunately, I think this kind of attitude is waning (eternal optimist).