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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.

WVU-HSC

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