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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

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

DJ Smith, Ph.D.


Coordinator Medical Pharmacology

the need for instruction in herbal medicine
The Need for Instruction in Herbal Medicine
  • 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
introduction of herbal instruction at wvu hsc
Introduction of Herbal Instructionat 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
objectives of the learning experience
Objectives of the Learning Experience
  • 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
instructional method
Instructional Method
  • 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
evaluation of the impact of the instruction
Evaluation of the Impact of the Instruction
  • 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
the case for herbal medicine
The Case For Herbal Medicine
  • 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
the case against herbal medicine
The Case Against Herbal Medicine
  • 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
regulatory issues
Regulatory Issues
  • 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
saw palmetto serenoa repens
Saw Palmetto (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
introduction to case discussion edited for brevity
Introduction to Case Discussion(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?
facts and assignment discussion continues
Facts and Assignment(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?
additional questions
Additional Questions
  • 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?
further consideration
Further Consideration
  • 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?
awareness of herbal remedies
Awareness of Herbal Remedies
  • 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
awareness of herbal remedies1
Awareness of Herbal Remedies
  • Students significantly improved their recognition of herbal medicine
    • Q. The contemporary definition of herbal medicine is?
awareness of herbal remedies2
Awareness of Herbal Remedies
  • 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
attitudes toward herbal remedies
Attitudes Toward Herbal Remedies

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
attitudes toward herbal remedies1
Attitudes Toward Herbal Remedies
  • 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”
attitudes toward herbal remedies2
Attitudes Toward Herbal Remedies
  • 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
knowledge of herbal remedies
Knowledge of Herbal Remedies
  • 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
knowledge of herbal remedies1
Knowledge of Herbal Remedies
  • Q. FDA regulates the manufacture, sale and therapeutic claims of herbal medicine as they do for prescription and non-prescription drugs
knowledge of herbal remedies2
Knowledge of Herbal Remedies
  • Q. The herbal product used most frequently to treat migraine headache is:
general observations and conclusions
General Observations and Conclusions
  • 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