Herbal therapy Herbal therapy is defined as products

Herbal therapy �Herbal therapy is defined as: products other than vitamins and minerals taken by mouth and containing dietary ingredients intended to supplement the diet.

Evidence of Efficacy, Safety of Selected Herbs & Supplements Herb or supplement Most studied indication Efficacy Adverse effects Drug interactions Comments Glucosamine Osteoarthritis chondroitin pain relief, hyperglycemia None possibly for in diabetic slowing disease effect is additive is unknown St. John's wort Depression mild depression Numerous, severe consequences Should not be used in major depression Ginkgo biloba very modest may cause efficacy bleeding aspirin or warfarin Should be stopped 7 days before surgery Dementia Sexual dysfunction

Other herb Other type of herbs Herb or supplement Most studied indication Efficacy Adverse effects Drug interactions Comments Phytoestrogens Menopausal Data unknown symptoms incomplete; None Avoid in those with a history of breast cancer Saw palmetto Benign Good prostatic evidence hyperplasia None May be better tolerated than conventional therapies Echinacea Upper Study results None respiratory have been tract mixed infection None wide variation in species

4 th lecture : Safety of CAM Not all CAM therapies are safe; Some are toxic in their own right (e. g. dietary supplements containing ephedrine alkaloids, now banned in USA) ii. Others are harmful if used in combination with conventional treatment (e. g. garlic supplements that interfere with the action of anti-HIV chemotherapy) iii. Others have been associated with rare but serious sideeffects, which can be life-threatening (e. g. bowel perforation from coffee enemas, hyponatraemia from noni juice). i.

potential for harm Potential for harm when CAM is used to treat serious or life -threatening medical conditions, if the resultant delay in seeking conventional treatment compromises clinical outcome. On balance, however, the relative safety of most CAM therapies can be regarded as a positive feature; homeopathy is an example.

The popularity of CAM may reflect the: � lack of confidence in conventional medicine, particularly a belief that it will not help the condition or may cause harm � often used by cancer patients who have disease which is unresponsive to conventional medicines. � increasing ease of access to information &therapies via the Internet. � CAM is often seeming to be completely safe; patients may therefore be willing to experiment with it as a ‘no-lose’ measure. � inherently pleasurable, Many forms of CAM regardless of any therapeutic benefit

Evidence Based Medicine EBM � practitioners and advocates of CAM are increasingly challenged to justify these treatments through independent, well-conducted, controlled clinical trials. � In some cases, this may be difficult (e. g. the placebo arm of a double- blind trial of acupuncture) � In addition, it can be argued ( ﺍﻟﺒﺮﻫﻨﺔ )ﻣﺤﺎﻭﻟﺔ different types & evidence, focusing on patient satisfaction & subjective benefit rather than measurable clinical outcomes, may be more appropriate for CAM.

NEW literature � only a minority of CAM therapies are supported by any evidence that would be acceptable for conventional medicine. These are primarily the ‘big five’ CAM therapies: � osteopathy ( ﺑﺎﻟﺘﻘﻮﻳﻢ )ﺍﻟﻤﻌﺎﻟﺠﺔ � chiropractic � acupuncture � homeopathy & � herbal medicine Moreover, where such positive evidence does exist, it is: often outweighed by negative studies limited to a small subset of the clinical conditions for which the treatment is used.

Integrated health care � There is a considerable stimulus behind moves to integrate CAM with conventional medicine and health care at the level of: resource allocation, service design, clinical practice, education & research. � Almost 50% of general practices in the UK & an increasing number of hospitals offer some form of access to CAM. � In many parts of Asia in particular, this kind of medical multiplicity is the norm, and patients do not necessarily make a distinction between different systems of health care. ( ﺍﻟﺘﻌﺪﺩﻳﺔ )

Historically in Western societies, patients using both types of therapy have often experienced: �Conflicting advice &value judgments, �poor or absent communication between practitioners & �even hostility (lack of sympathy). � They often revert to secrecy ( ﺍﻟﺴﺮﻳﺔ ) , an inherently undesirable and potentially dangerous outcome.

Integrated health ( IH ) �IH care aims: to understand remove the barriers that create dilemmas for patients. � let them exercise their choice of treatment in an open environment by: good communication respect due consideration of autonomy efficacy & risk

Websites � www. dh. gov. uk UK Department of Health guidance and policy on confidentiality and consent. � www. evidence. nhs. uk A UK National Health Service resource providing a searchable library of clinical guidelines from all sources. � www. gmc-uk. org UK General Medical Council. Includes access to guidance on professional conduct (Duties of a Doctor, Good Medical Practice) and guidance on medical education, such as ‘Tomorrow’s Doctors’. � www. nice. org. uk National Institute for Health and Clinical Excellence. Includes recommendations for evidence-based treatments. � www. rcplondon. ac. uk Royal College of Physicians. Includes access to a working party report: Doctors in Society: Medical Professionalism in a Changing World. � www. sign. ac. uk Scottish Intercollegiate Guidelines Network. Includes evidence-based guidelines for clinical practice. � www. who. int World Health Organization. Includes information relevant to global health and differences in medical practice.