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Alternative Medicine in Medicine

Posted May 14 2010 2:03am
I spend a fair amount of time researching alternative treatments and supplements, mostly for my son but occasionally for myself or the rest of my family as well. I am always quick to point out to doctors that I have added some supplements to Brayden's diet, and found it quite shocking that they generally don't ask more about it or even note it in his records. One doctor, upon my disclosure to the fact that Brayden takes Fish Oil/DHA (among other things) daily, asked me if I knew that it was for improving cognitive function. Apparently, since his diagnosis with hydranencephaly gives the textbook advice that he should not be alive, I am not supposed to do anything to increase the use of what part of brain he does indeed have intact?! Not to mention that it has also been shown to improve function of joints and muscles as well as maintain a healthy heart...


Anyways, the following article sums things up and makes it all make sense. I knew we, we being us parents of extra special little ones and even just every day informed patients, knew more than the medical professionals. Point proven:


Alternative medicine isn’t taught to doctors in medical school
by Crystal Phend

Physicians don’t know much more about complementary and alternative medicine than their patients do, according to a new survey.

Most healthcare professionals who answered an online survey ofDrug and Therapeutic Bulletin subscribers said their profession was just as poorly informed about herbal medicines (75.5%) as the general public (86.3%).
And almost half of respondents rated their own knowledge about herbal medicines as “quite” or “very” poor (36.2% and 10.4%, respectively).
Even more worrying, journal editor Ike Iheanacho, MBBS, said in a podcast released in conjunction with the survey, was that medical professionals exhibited a lack of interest in even asking whether patients were taking herbal compounds.
More than half of respondents said they never or only occasionally (8.6% and 46.6%, respectively) ask when reviewing patients’ medications whether they are taking herbal medicines.
This was surprising, commented Linda Anderson, BPharm, PhD, principal pharmaceutical assessor at the British Medicines and Healthcare products Regulatory Agency.
Her agency’s survey of the general population suggested that “most patients were quite willing to tell doctors they were taking herbal medicines and, in fact, expected their doctor to ask,” she explained in the podcast.
Anderson’s interpretation was that physicians don’t ask because they don’t know enough to respond.

Indeed, 89% of those surveyed said their knowledge of herbal medicines was “much poorer” than their knowledge of prescribed medicines.

However, 21.3% of respondents said that if they were faced with a patient taking an herbal medicine they were unfamiliar with, they wouldn’t seek further information about it.

The primary reason cited for this was being unsure where to find such information (60%), followed by being unsure how to assess or use such information even if they were able to find it (42.9%).

This sets up a worrying conflict with patient expectations, Anderson noted.

“Our survey showed that patients thought doctors would be a good source of information,” she said in the journal’s podcast.

Notable, too, was that the largest proportion of medical professionals surveyed — 50% — said they would turn to general searches of the Internet, such as using Google, for reliable information on herbal medicines.

“I would suggest that that’s a terrible source of information where herbal medicine is concerned,” Michael McIntyre, chair of the European Herbal Practitioners Association, commented in the podcast.

“Unless you know what site you’re on, you could get terrible information, wrong information,” added McIntyre, who also serves as a member of the U.K. Department of Health Herbal Medicine Regulatory Working Group.

Patients would likely be horrified to know that physicians were relying on information on the Internet that wasn’t qualified, Anderson agreed.

One reason for healthcare professionals’ lack of information on herbal medicines may be that they feel it’s a step backward, McIntyre said.

Doctors “don’t want to get pulled back into the swamp,” McIntyre suggested in the podcast. “There’s the feeling that we got away from that because we found out what the active constituents are . . . this is science.”

In the Drug and Therapeutic Bulletin survey, 75.3% of physicians thought herbal medicines were helpful in some circumstances, but an equally high proportion said that the general public has misplaced faith in these compounds (71.8%).

The survey garnered response from 164 individuals among a random sample of 1,157 journal subscribers — primarily physicians and pharmacists — representing a response rate of 14%. Among them, 87.8% practiced in Britain.

Crystal Phend is a MedPage Today Senior Staff Writer.

If that isn't worrisome to you, read the next article. Please be aware that if your doctor is not going to show concern for what herbal/natural supplements you have elected to add to your diet; you definitely need to stay informed and ask specific questions. Talk to your pharmacist before taking prescriptions or even over the counter medications to ensure you do not suffer any adverse side effects, irreversible damage to your body, or even death. Stay informed for your own sake, don't put your life in the hands of your likely to be uninformed physician:

How alternative and herbal medications can have dangerous side effects
Originally published in MedPage Today
by John Gever, MedPage Today Senior Editor

Herbal medicines are not always the harmless nostrums that manypatients and even some physicians think, but may actually contribute to cardiovascular morbidity and mortality, researchers warned in a review covering 44 years of research into the subject.

Many such products, including aloe vera, ginkgo biloba, ginseng, and green tea, can interact with conventional cardiovascular drugs and lead to serious adverse reactions, according to Arshad Jahangir, MD, of the Mayo Clinic in Scottsdale, Ariz., and two other Mayo physicians.

“There is a clear need for better public and physician understanding of herbal products through health education, early detection and management of herbal toxicities, scientific scrutiny of their use, and research on their safety and effectiveness,” they wrote in the Feb. 9 Journal of the American College of Cardiology.

Jahangir and colleagues also called for increased regulation of such products, at least requiring manufacturers of herbal medicines to register with the FDA and provide evidence of good manufacturing practices.

“Some of these adverse drug reactions are preventable,” Jahangir told MedPage Today in a telephone interview. “Simple things like taking a good history or giving that history and discussing these issues, probably we can avoid [such reactions].”

Other physicians contacted by MedPage Today and ABC News agreed that the growth in popularity of herbal medicines poses problems for physicians and patients.

“Because these remedies are ‘natural,’ their potential dangers are not considered the same way they would be if they were medication,” commented Suzanne Steinbaum, MD, a cardiologist at Lenox HillHospital in New York City, in an e-mail.

“For many reasons, patients tend not to disclose to their doctors if they are taking herbal remedies, including fear that their doctors won’t approve or they will be told to stop them,” Steinbaum added. “This lack of knowledge and full-disclosure, for some, might be a fatal omission.”

Jahangir and colleagues reviewed nearly 90 publications that have addressed herbal or complementary therapies and cardiovascular effects since 1966.

Their JACC article listed 15 common herbal medicines known to interact adversely with conventional cardiovascular drugs.

In many cases, the herbal products compete with the regular medicines for the same drug-metabolizing cytochrome P450 enzymes, potentiating the latter’s effects. In other cases, the herbal products have their own cardiovascular effects.

Many physicians already know that grapefruit juice occupies the CYP3A4 enzyme, leading to slower-than-expected metabolism and, therefore, higher blood levels of a host of pharmaceuticals.

These include the statins, calcium channel antagonists, several common anti-arrhythmic drugs, and the angiotensin receptor blocker irbesartan (Avapro), Jahangir and colleagues noted.

Garlic is one of several common herbal remedies with specific cardiovascular effects in its own right (others include ginkgo biloba, ginseng, and saw palmetto). Garlic inhibits platelet aggregation and thus can lead to increased bleeding risks when combined with aspirin, clopidogrel (Plavix), or warfarin (Coumadin), the researchers noted.

The Mayo group identified 10 herbal products that increase bleeding risks with anticoagulant and antiplatelet drugs, as well as 14 that can induce arrhythmias.

In all, Jahangir and colleagues listed 27 herbal products that patients with cardiovascular diseases would do well to avoid. These include such common and harmless-seeming products as green tea, capsicum pepper, licorice, and kelp, as well as grapefruit juice and garlic.

“We need to check with our patients what type of products they are using, to identify these potential interactions,” Jahangir toldMedPage Today.

He cited the previously reported figure of 100,000 deaths annually from drug interactions, adding, “We don’t even know how many of these are due to use of compounds that we are not aware that our patients are taking.”

Jahangir said he was surprised, in preparing the review, at the scale of hebal medicine use in the U.S.

He and his colleagues found data from the 1990s suggesting that more patients consult complementary and alternative medicine providers than regular physicians.

The total annual out-of-pocket expenditure on complementary and alternative medicine services and products also was greater than for conventional physician services.

“The surprise for me was . . . how much people are willing to spend on a type of therapy which has not shown, in any scientific way, to be effective or safe,” Jahangir said.

He added that the trend may reflect shortcomings of the conventional medical system.

“What is the reason people are going there? Is it because there is some unmet type of need that we are not recognizing as practitioners of conventional medicine?”

Jahangir said it may be that physicians aren’t spending enough time with patients to understand their true needs. He said it appears that, “despite the advancement in our technology and new medicines, there is a demand for alternative therapies that is increasing.”

He recommended that, in addition to asking patients in detail about herbal and other alternative therapies they may be using, physicians should educate themselves on what these therapies purport to do and what is known about their real biological effects.

The National Center for Complementary and Alternative Medicine at the National Institutes of Health is a good starting point for such information, both for physicians and for patients, Jahangir said.

Lenox Hill’s Steinbaum said it was important that conventional physicians “become more open-minded and accepting” of alternative medicine, if only because so many of their patients are already practicing it.

David Meyerson, MD, JD, a Johns Hopkins University cardiologist, told MedPage Today and ABC News in an e-mail that he advises patients to limit their use of “unstudied and unproven and FDA-unregulated herbal medications.”

“It’s unfortunately very big business, and potential drug interactions and potential harmful effects abound,” he wrote.

But another physician criticized the Mayo physicians’ emphasis on adverse effects in their review.

“For many of products listed, evidence for side effects seems to be minimal,” Scott Grundy, MD, of the University of Texas Southwestern Medical Center in Dallas, argued in an e-mail.

He agreed that the efficacy and safety of such drugs remains largely unproven, but added, “It is mainly for these reasons that they cannot be recommended for use.”

Creating alarm about side effects “may not be the appropriate way to discourage their use,” Grundy said.

Here is the link to the National Center for Complementary and Alternative Medicine:  http://nccam.nih.gov/ . It is a National Institutes of Health Web site and you can find information on the supplements you are taking, drug/herbal interactions, alternative and complementary treatments you have not previously heard of, etc. It also explains the terminology involved with alternative/integrated/complementary treatments and meds:

Introduction
There are many terms used to describe approaches to health care that are outside the realm of conventional medicine as practiced in the United States. This fact sheet explains how the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health, defines some of the key terms used in the field of complementary and alternative medicine (CAM). Terms that are underlined in the text are defined at the end of this fact sheet.

What is CAM?
CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered to be part of conventional medicine. While scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies—questions such as whether these therapies are safe and whether they work for the purposes for which they are used.

Are complementary medicine and alternative medicine different from each other?
Yes, they are different.
Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient's discomfort following surgery.
Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor.

What is integrative medicine?
Integrative medicine combines treatments from conventional medicine and CAM for which there is evidence of safety and effectiveness. It is also called integrated medicine.

What are the major types of complementary and alternative medicine?
NCCAM groups CAM practices into four domains, recognizing there can be some overlap. In addition, NCCAM studies CAM whole medical systems, which cut across all domains.

~Whole Medical Systems
Whole medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of whole medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include traditional traditional Chinese medicine and Ayurveda.
~Mind-Body Medicine
Mind-body medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some techniques that were considered CAM in the past have become mainstream (for example, patient support groups and cognitive-behavioral therapy). Other mind-body techniques are still considered CAM, including meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.
~Biologically Based Practices
Biologically based practices in CAM use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements, herbal products, and the use of other so-called natural but as yet scientifically unproven therapies (for example, using shark cartilage to treat cancer).
~Manipulative and Body-Based Practices
Manipulative and body-based practices in CAM are based on manipulation and/or movement of one or more parts of the body. Some examples include chiropractic or osteopathic manipulation, and massage.
~Energy Medicine
Energy therapies involve the use of energy fields. They are of two typesBiofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include qi gong, Reiki, and Therapeutic Touch.
Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.

What is NCCAM's role in the field of CAM?
NCCAM is the Federal Government's lead agency for scientific research on CAM. . NCCAM's mission is to explore complementary and alternative healing practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals.
For More Information
Sources of NCCAM Information
NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. Examples of publications include "Selecting a CAM Practitioner" and "Are You Considering Using CAM?" The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: nccam.nih.gov
E-mail: info@nccam.nih.gov
Sources of Information on Dietary Supplements
Office of Dietary Supplements (ODS), NIH

ODS seeks to strengthen knowledge and understanding of dietary supplements by evaluating scientific information, supporting research, sharing research results, and educating the public. Its resources include publications and the International Bibliographic Information on Dietary Supplements database.

Web site: ods.od.nih.gov
E-mail: ods@nih.gov
U.S. Food and Drug Administration (FDA)

Center for Food Safety and Applied Nutrition
Web site: www.fda.gov/AboutFDA/CentersOffices/CFSAN/
Toll-free in the U.S.: 1-888-723-3366

Information includes "Tips for the Savvy Supplement User: Making Informed Decisions and Evaluating Information" ( www.fda.gov/Food/DietarySupplements/ConsumerInformation/ucm110567.htm ) and updated safety information on supplements ( www.fda.gov/Food/DietarySupplements/Alerts/ ). If you have experienced an adverse effect from a supplement, you can report it to the FDA's MedWatch program, which collects and monitors such information (1-800-FDA-1088 or www.fda.gov/Safety/MedWatch/ )


Again, please just be safe and stay informed.... 
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