1. Unit VI – Herbal / Pharmacological Readings for Unit V: Systems II: Text 8 (166-176) & 11 Links on Easing Cancer Pain & Reflex Unit VI: Herbal / Pharmacological & ‘Unconventional’ (drugs, vaccines) Approaches

2. Readings for Unit VI Links re Pharmacological/Herbal: Herbal Minefield by Barrett Herbal Remedies: Adverse Effects and Drug Interactions Herbal 'Health' Products: What Family Physicians Need to Know Text: 5 – Botanical Medicine 6 – Safety of Herbs & Phytochemicals 7 – Integrative Approach to Nutrition

3. Text chapters 8 & 11 Straightforward ? 8 re Osteopathy fits nicely with Taylor session [ all of his slides are posted ] 11 is re body centered therapies – focus on the use, evidence, practice for therapies discussed

4. Easing Cancer Pain & Anxiety What does dealing with pain demand? Pain prevalence with cancer? How good is the empirical evidence for pain relief with holistic therapies ? What does Reflexology do for pain & anxiety ? For pain / anxiety from lung and/or breast cancer, what does the study by N.C. research team show ?

5. Reflexology Any different theories behind Reflexology mentioned here ? Instruments used ? Techniques can be learned and self administered, any flag here ? What evidence is offered re “scientists” studying health problems like IBS or MS? Do you believe the findings of this article, why or why not ?

6. Drugs are THE answer What drugs do you (your “friends”?) use, OCD’s, herbal, legal, illegal ? ~ make a list Why do you / they use them ? What do you know about them ?

7. Herbal Gardens

9. At Issue… $3.8 billion self-care health products industry in Canada

14. Too available ?

15. Chemicals in plants ? chemical constituents of plants vary depending on: ~ species; variety; part of the plant ~ conditions of growth (soil, water, & temp) ~ age of the plant These complexities and variations of chemical content make standardization essential some cases standardization is attempted, but it is difficult and seldom accomplished [ compare to Barrett, Herbal Minefield reading re drug companies going for potency, predictability, & few side effects ]

16. Herbal / Pharmacological Are they safe just because they come from plants ? Fully 1/3 of North American population uses herbs for health purposes Chamomile, Flavonoids, Garlic, Gingko biloba …

17. Usage Patterns in Canada Largest user group: women 36 – 55 ( almost 40% ) Women use more than men B.C. region clearly has the most users Longevity of users -- 5 years or less 41.5% (2003) of users said they take herbal or homeopathic remedies on a daily basis

18. Usage Patterns in Canada Most frequent reasons for use : to alleviate symptoms of a specific illness or disease, and / or to prevent illness or disease Family / friend main influence on decision to use Drugstores are main point of sale

19. Grow, Grow… Stall Taken from: Waiting for the Sheriff: From growth to uncertainty in the NHP market, NDMAC Issue Seminar -- March 22, 2000 Between 1996 and 1998, usage of “herbal” remedies more than doubled, but there has been a levelling-off.

20. Herbal / Pharmacological High blood pressure Diabetes Thyroid problems Heart disease Psychiatric problems Epilepsy Parkinson's disease Glaucoma Enlarged prostate gland Stroke at some time in the past Blood clotting problems Are they safe just because they come from plants ? Maybe no, IF you have

21. ephedra

23. Ephedra º Clinical Summary º Scientific Name º Also Known As º Brand Name º Purported Uses º Constituents º Mechanism of Action Clinical SummaryScientific NameAlso Known AsBrand NamePurported UsesConstituentsMechanism of Action ºPharmacokinetics º Warnings ºContraindications º Adverse Reactions º Drug Interactions º Lab Interactions º Literature Summary and Critique PharmacokineticsWarningsContraindicationsAdverse ReactionsDrug InteractionsLab InteractionsLiterature Summary and Critique

24. Effectiveness of Herbal Medicines To establish the effectiveness of herbs as medicines, they must be tested in prospective, double blind, randomized, placebo-controlled clinical trials (RCTs) Relatively few herbs have been tested in this manner

25. Non-prescription drug makers association of Canada

31. Natural Health Products - Mission Statement To ensure that all Canadians have ready access to Natural Health Products that are safe, effective, and of high quality, while respecting freedom of choice and philosophical and cultural diversity

34. Your job for 1 Week Today Text p 116 has 10 clinically researched botanicals Using web sites, our text, what you know about nature of evidence, data bases, NHP data, & any other original sources of evidence, find out everything you can about the botanical assigned to you Groups

35. Botanical Groups Cohosh: Abu-Romeh to Blanchette – 1 Chamomile: Blommers to Connor – 2 Chaste tree: Crowther to Eastwood – 3 Echinacea: Fabian to Geddis – 4 Garlic: Girvan to Hudders – 5 Ginkgo: Jagielnik to Korczynski – 6 Ginseng: Kusmider to Mazur – 7 Saw Palmetto: McDonagh to Persico – 8 Milk Thistle: Pone to Sklazeski – 9 St John’s Wort: Snider to Zettler – 10

36. What are you to find out ? What is it ? Where is it found ? How prevalent ? What is it used for and by whom ? What does Barrett (Quackwatch) say about it ? Evidence – what kinds, be critical Would you take it ?