Herbal Weight Loss Supplement Review

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Herbal Weight Loss Supplement Review

  1. 1. Herbal Medicine Introduced Into the Basic Science Curriculum for 2 nd Year Medical Students DJ Smith, Ph.D. WVU-HSC Coordinator Medical Pharmacology
  2. 2. Does instruction in herbal medicine have a place in a US medical school?
  3. 3. The Need for Instruction in Herbal Medicine <ul><li>Herbal Remedies and Dietary Supplements are used extensively </li></ul><ul><li>Herbal products have medicinal value & toxicities & interactions with other herbs and drugs </li></ul><ul><li>Physicians need to be prepared to interact with patients using or requesting herbals </li></ul>
  4. 4. Introduction of Herbal Instruction at WVU-HSC <ul><li>Early in the Medical Pharmacology lecture series </li></ul><ul><ul><li>Final 8 weeks of the Basic Science curriculum </li></ul></ul><ul><li>Began in 2000 </li></ul><ul><li>Students’ first formal exposure to herbal products </li></ul>
  5. 5. Objectives of the Learning Experience <ul><li>Learn indications, side effects and contraindications for herbal remedies </li></ul><ul><li>Appreciate herb-herb and herb-drug interactions </li></ul><ul><li>Understand the regulatory climate for dietary supplements and herbal remedies </li></ul><ul><li>Begin to understand unique barriers to effective physician-patient interaction </li></ul>
  6. 6. Instructional Method <ul><li>75 minutes of lecture </li></ul><ul><ul><li>delivered non-judgmentally, but factually </li></ul></ul><ul><li>Small group discussion (2hrs) </li></ul><ul><ul><li>faculty facilitator & 8 students </li></ul></ul><ul><li>Students prepared in advance of group discussions </li></ul><ul><ul><li>reviewing clinical cases </li></ul></ul><ul><ul><li>using on-line and hard copy resources </li></ul></ul><ul><ul><li>visiting herbal retail store </li></ul></ul>
  7. 7. Evaluation of the Impact of the Instruction <ul><li>Questionnaire given before and repeated after the instruction </li></ul><ul><li>Instrument was designed to evaluate students’ awareness, attitudes and content knowledge of herbal remedies </li></ul><ul><li>Also asked the extent to which they recommend future students be exposed to the material </li></ul>
  8. 8. The Case For Herbal Medicine <ul><li>Tradition: used throughout history </li></ul><ul><li>Natural: perceived as gentler and safer </li></ul><ul><li>Cost: often less expensive than prescription medicine </li></ul><ul><li>Access: patient maintains control & no prescription necessary </li></ul><ul><li>Synergism: a view that multiple ingredients working together yield better results </li></ul>
  9. 9. The Case Against Herbal Medicine <ul><li>Lack of FDA Regulation and Oversight </li></ul><ul><ul><li>Lack of Dosage Standardization </li></ul></ul><ul><ul><li>Potential for adulteration </li></ul></ul><ul><li>Potential for toxicity and drug interactions: natural is not always safer </li></ul><ul><li>More effective therapy may be delayed </li></ul><ul><li>Many herbs are not superior to prescription medicines </li></ul>
  10. 10. Regulatory Issues <ul><li>Dietary Supplement Health Education Act (DSHEA) of 1994 </li></ul><ul><ul><li>Herbal products are legally food supplements </li></ul></ul><ul><ul><li>Manufacturer may state usage and safety, but not make curative claims </li></ul></ul><ul><ul><li>Manufacturer alone is responsible for product safety </li></ul></ul><ul><ul><li>FDA must prove product unsafe to remove it from the market </li></ul></ul><ul><li>Europe: Herbs regulated as pharmaceuticals </li></ul>
  11. 11. Saw Palmetto ( Serenoa repens ) <ul><li>Used for prostatic obstructive symptoms </li></ul><ul><li>Dose: lipidosterolic extract 100mg (bid) or 1 g dried berries (tid) with food </li></ul><ul><li>Side effects: include nausea, diarrhea, headache impotence </li></ul><ul><li>Cautions: include false negative PSA </li></ul><ul><li>Effectiveness: equal to finasteride, but alpha-1 antagonists appear better </li></ul>
  12. 12. Introduction to Case Discussion (edited for brevity) <ul><li>Athlete presents with SVT. Reluctantly admits drinking flavored beverage containing Ma Huang ( Ephedra sinica ) to enhance weight-lifting performance. Used two scoops for good measure. Observed till tachycardia resolved. </li></ul><ul><li>Initial Questions </li></ul><ul><ul><li>What may account for his reluctance to admit using the product? </li></ul></ul><ul><ul><li>How do health care providers perpetuate the propensity to withhold this information? & How do we change? </li></ul></ul>
  13. 13. Facts and Assignment (discussion continues) <ul><li>Active ingredients of Ma Haung is ephedra… Used extensively in Chinese herbal medicine…. Alkaloids are used in FDA approved meds… Life threatening CVS complications occur </li></ul><ul><li>At a local herb store see what products contain ephedra, and evaluate the label information </li></ul><ul><li>Questions: </li></ul><ul><ul><li>Is the label information adequate? </li></ul></ul><ul><ul><li>What medical conditions preclude ephedra use? </li></ul></ul><ul><ul><li>What herb-herb-drug interactions concern you? </li></ul></ul>
  14. 14. Additional Questions <ul><li>Many herbalists and patients believe that medical establishment has a prejudiced view of herbals. This creates a rift between patient and physician that is a barrier to effective communication. </li></ul><ul><li>Questions: </li></ul><ul><ul><li>Are US physicians prejudiced, and if so why? </li></ul></ul><ul><ul><li>Are US physicians competent to make judgments about herbals and to guide their patients, and if not how do we improve? </li></ul></ul>
  15. 15. Further Consideration <ul><li>The regulatory climate in the US is described…. In Europe herbs are regulated as phytopharmaceuticals, and they are widely prescribed in Europe and Asia… About 1/3 of the US population regularly take herbals </li></ul><ul><li>Questions </li></ul><ul><ul><li>Advantages and disadvantages of US approach? </li></ul></ul><ul><ul><li>Would you change the regulatory environment, how? </li></ul></ul><ul><ul><li>How can patients be encouraged to share their use of herbals with physicians? </li></ul></ul>
  16. 16. Awareness of Herbal Remedies <ul><li>60% did not have personal exposure </li></ul><ul><li>Gained knowledge of the extent of herb use in the US </li></ul><ul><ul><li>Q. What % of the US population uses herbal remedies </li></ul></ul>
  17. 17. Awareness of Herbal Remedies <ul><li>Students significantly improved their recognition of herbal medicine </li></ul><ul><ul><li>Q. The contemporary definition of herbal medicine is? </li></ul></ul>
  18. 18. Awareness of Herbal Remedies <ul><li>Students discovered that there are credible sources for information on herbal medicine which are available in print form and on-line. </li></ul><ul><ul><li>Professional’s Handbook of Complementary and Alternative Medicine, Fetro and Avila, Springhouse, 1999. </li></ul></ul><ul><ul><li>Herbal Research Foundation: www.herbs.org </li></ul></ul><ul><ul><li>Herb Med www. herbmed .org </li></ul></ul><ul><ul><li>Medline Plus http://www.nlm.nih.gov/medlineplus/herbalmedicine.html </li></ul></ul><ul><ul><li>ConsumerLab.com: http://www. ConsumerLab .com </li></ul></ul>
  19. 19. Attitudes Toward Herbal Remedies <ul><li>Students had strong opinions that changed very little with the learning experience </li></ul><ul><li>70% were skeptical of the reliance on herbals to the exclusion of Rx meds </li></ul><ul><li>Overwhelmingly, herbals are to be used with caution </li></ul><ul><li>Nearly all students accepted that their responsibility is to counsel patients regarding herbals </li></ul>
  20. 20. Attitudes Toward Herbal Remedies <ul><li>Physicians should take a non-judgmental approach when counseling patients </li></ul><ul><ul><li>Q. I believe that it is _____ to take the position that herbal remedies are “bad medicine” </li></ul></ul>
  21. 21. Attitudes Toward Herbal Remedies <ul><li>Physicians should take a non-judgmental approach when counseling patients </li></ul><ul><ul><li>Q. If a patient mentions the decision to take St John’s Wort for depression, the physician should </li></ul></ul>
  22. 22. Knowledge of Herbal Remedies <ul><li>8 Content questions dealing with the regulatory climate, and therapeutic effects of specific herbals were asked. </li></ul><ul><li>Examined knowledge in a low impact manner, since performance on the questionnaire did not influence grade, nor were the students “asked” to study </li></ul><ul><li>Students gained appreciably </li></ul>
  23. 23. Knowledge of Herbal Remedies <ul><li>Q. FDA regulates the manufacture, sale and therapeutic claims of herbal medicine as they do for prescription and non-prescription drugs </li></ul>
  24. 24. Knowledge of Herbal Remedies <ul><li>Q. The herbal product used most frequently to treat migraine headache is: </li></ul>
  25. 25. General Observations and Conclusions <ul><li>Our students have a high tolerance of the use of herbals, and are willing to counsel patients in a non-judgmental manner </li></ul><ul><li>They express a cautious view, but accept that there may be medical value when patients use some products appropriately </li></ul><ul><li>They report that exposure to this material is important and should be in the Medical Curriculum </li></ul>

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