Herbal medicine introduced into the basic science curriculum for 2 nd year medical students
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Herbal Medicine Introduced Into the Basic Science Curriculum for 2 nd Year Medical Students. DJ Smith, Ph.D. WVU-HSC Coordinator Medical Pharmacology. Does instruction in herbal medicine have a place in a US medical school?. The Need for Instruction in Herbal Medicine.

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Herbal medicine introduced into the basic science curriculum for 2 nd year medical students l.jpg

Herbal Medicine Introduced Into the Basic Science Curriculum for 2nd Year Medical Students

DJ Smith, Ph.D.

WVU-HSC

Coordinator Medical Pharmacology



The need for instruction in herbal medicine l.jpg
The Need for Instruction in Herbal Medicine medical school?

  • Herbal Remedies and Dietary Supplements are used extensively

  • Herbal products have medicinal value & toxicities & interactions with other herbs and drugs

  • Physicians need to be prepared to interact with patients using or requesting herbals


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Introduction of Herbal Instruction medical school?at WVU-HSC

  • Early in the Medical Pharmacology lecture series

    • Final 8 weeks of the Basic Science curriculum

  • Began in 2000

  • Students’ first formal exposure to herbal products


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Objectives of the Learning Experience medical school?

  • Learn indications, side effects and contraindications for herbal remedies

  • Appreciate herb-herb and herb-drug interactions

  • Understand the regulatory climate for dietary supplements and herbal remedies

  • Begin to understand unique barriers to effective physician-patient interaction


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Instructional Method medical school?

  • 75 minutes of lecture

    • delivered non-judgmentally, but factually

  • Small group discussion (2hrs)

    • faculty facilitator & 8 students

  • Students prepared in advance of group discussions

    • reviewing clinical cases

    • using on-line and hard copy resources

    • visiting herbal retail store


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Evaluation of the Impact of the Instruction medical school?

  • Questionnaire given before and repeated after the instruction

  • Instrument was designed to evaluate students’ awareness, attitudes and content knowledge of herbal remedies

  • Also asked the extent to which they recommend future students be exposed to the material


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The Case For Herbal Medicine medical school?

  • Tradition: used throughout history

  • Natural: perceived as gentler and safer

  • Cost: often less expensive than prescription medicine

  • Access: patient maintains control & no prescription necessary

  • Synergism: a view that multiple ingredients working together yield better results


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The Case Against Herbal Medicine medical school?

  • Lack of FDA Regulation and Oversight

    • Lack of Dosage Standardization

    • Potential for adulteration

  • Potential for toxicity and drug interactions: natural is not always safer

  • More effective therapy may be delayed

  • Many herbs are not superior to prescription medicines


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Regulatory Issues medical school?

  • Dietary Supplement Health Education Act (DSHEA) of 1994

    • Herbal products are legally food supplements

    • Manufacturer may state usage and safety, but not make curative claims

    • Manufacturer alone is responsible for product safety

    • FDA must prove product unsafe to remove it from the market

  • Europe: Herbs regulated as pharmaceuticals


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Saw Palmetto ( medical school?Serenoa repens)

  • Used for prostatic obstructive symptoms

  • Dose: lipidosterolic extract 100mg (bid) or 1 g dried berries (tid) with food

  • Side effects: include nausea, diarrhea, headache impotence

  • Cautions: include false negative PSA

  • Effectiveness: equal to finasteride, but alpha-1 antagonists appear better


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Introduction to Case Discussion medical school?(edited for brevity)

  • 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.

  • Initial Questions

    • What may account for his reluctance to admit using the product?

    • How do health care providers perpetuate the propensity to withhold this information? & How do we change?


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Facts and Assignment medical school?(discussion continues)

  • 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

  • At a local herb store see what products contain ephedra, and evaluate the label information

  • Questions:

    • Is the label information adequate?

    • What medical conditions preclude ephedra use?

    • What herb-herb-drug interactions concern you?


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Additional Questions medical school?

  • 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.

  • Questions:

    • Are US physicians prejudiced, and if so why?

    • Are US physicians competent to make judgments about herbals and to guide their patients, and if not how do we improve?


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Further Consideration medical school?

  • 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

  • Questions

    • Advantages and disadvantages of US approach?

    • Would you change the regulatory environment, how?

    • How can patients be encouraged to share their use of herbals with physicians?


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Awareness of Herbal Remedies medical school?

  • 60% did not have personal exposure

  • Gained knowledge of the extent of herb use in the US

    • Q. What % of the US population uses herbal remedies


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Awareness of Herbal Remedies medical school?

  • Students significantly improved their recognition of herbal medicine

    • Q. The contemporary definition of herbal medicine is?


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Awareness of Herbal Remedies medical school?

  • Students discovered that there are credible sources for information on herbal medicine which are available in print form and on-line.

    • Professional’s Handbook of Complementary and Alternative Medicine, Fetro and Avila, Springhouse, 1999.

    • Herbal Research Foundation: www.herbs.org

    • Herb Med www.herbmed.org

    • Medline Plus http://www.nlm.nih.gov/medlineplus/herbalmedicine.html

    • ConsumerLab.com: http://www.ConsumerLab.com


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Attitudes Toward Herbal Remedies medical school?

Students had strong opinions that changed very little with the learning experience

  • 70% were skeptical of the reliance on herbals to the exclusion of Rx meds

  • Overwhelmingly, herbals are to be used with caution

  • Nearly all students accepted that their responsibility is to counsel patients regarding herbals


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Attitudes Toward Herbal Remedies medical school?

  • Physicians should take a non-judgmental approach when counseling patients

    • Q. I believe that it is _____ to take the position that herbal remedies are “bad medicine”


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Attitudes Toward Herbal Remedies medical school?

  • Physicians should take a non-judgmental approach when counseling patients

    • Q. If a patient mentions the decision to take St John’s Wort for depression, the physician should


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Knowledge of Herbal Remedies medical school?

  • 8 Content questions dealing with the regulatory climate, and therapeutic effects of specific herbals were asked.

  • Examined knowledge in a low impact manner, since performance on the questionnaire did not influence grade, nor were the students “asked” to study

  • Students gained appreciably


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Knowledge of Herbal Remedies medical school?

  • Q. FDA regulates the manufacture, sale and therapeutic claims of herbal medicine as they do for prescription and non-prescription drugs


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Knowledge of Herbal Remedies medical school?

  • Q. The herbal product used most frequently to treat migraine headache is:


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General Observations and Conclusions medical school?

  • Our students have a high tolerance of the use of herbals, and are willing to counsel patients in a non-judgmental manner

  • They express a cautious view, but accept that there may be medical value when patients use some products appropriately

  • They report that exposure to this material is important and should be in the Medical Curriculum


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