Transcript Alternative Therapies - Vanderbilt University Medical Center

Alternative and
Complementary Therapies
Thomas L. Davis, MD.
Department of Neurology
Vanderbilt University
Western Medicine
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Pathologically based - “We have no cure”
Limited practioners
“Expensive”
May be painful
Negative testimonials despite positive
studies
Alternative Medicine
• Symptomatically based- Treatment for
everything
• Unlimited practioners - Do it yourself
• “Inexpensive”
• Nonpainful
• Positive testimonials
Other Terms
• Evidence based medicine
• Good medicine / Bad medicine
The majority of health care
delivered is “alternative”?
1. True
2. False
The Adkins diet is alternative
medicine?
1. True
2. False
Alternative Medicine
• WHO reports 65-80% of the world
population relies on traditional medicine
• 30 billion dollar industry in USA
• > 1000 homeopathic meds sold OTC
Legislation - Alternative
Medicine
• Dietary Supplement Health and Education Act of 1994 ingested products that are intended to supplement the
diet are considered foods and are exempt from federal
drug laws.
• Labeling Addendum 1997 - “ This statement has not been
evaluated by the FDA. This product is not intended to
diagnose, treat, cure, or prevent any disease”
• Acupuncture - not recognized in Tennessee. Several
states allow licenser of nonphysician practioners.
What is CAM?
Complementary and alternative medicine, as defined
by the National Center for Complementary and
Alternative Medicine (NCCAM), is a group of
diverse medical and health care systems, practices,
and products that are not presently considered to
be part of conventional medicine. The list of
practices that are considered CAM changes
continually, as those therapies that are proven to
be safe and effective become adopted into
conventional health care and as new approaches to
health care emerge.
Complimentary v. Alternative
• Complementary medicine is used together
with conventional medicine.
• Alternative medicine is used in place of
conventional medicine.
• Integrative medicine combines mainstream
medical therapies and CAM therapies for
which there is some high-quality scientific
evidence of safety and effectiveness.
Dietary Supplement Health and Education
Act of 1994 • Product (other than tobacco) intended to supplement the
diet, which contains one or more of the following: vitamins;
minerals; herbs or other botanicals; amino acids; or any
combination of the above ingredients.
• Intended to be taken in tablet, capsule, powder, softgel,
gelcap, or liquid form.
• Not represented for use as a conventional food or as a sole
item of a meal or the diet.
• It is labeled as being a dietary supplement.
Herbal Products
• A US survey of adults who regularly take
prescription medication, 18% reported the
concurrent use of at least one herbal
product or high-dose vitamin.
• 61.5% of those who used unconventional
therapies did not disclose such use to
their physicians.
Fugh-Berman A, Lancet, 355:134, 2000
Most patients volunteer the use of
alternative therapies with their
physicians?
1. True
2. False
Herbal Therapies
• 40% prescription drugs sold in US contain
ingredients derived from nature
• 25% of drugs contain at least 1 component
derived directly, or from chemical
modeling of flowering plants
Herbal Treatments of PD
Mucuna puriens
Vitex agnis castors
Banisteria caapi
Vicia faba
Atropa belladonna
Cannibus sativa
L-DOPA (Indian Legume)
Dopamine agonist
MAO inhibitor
L-DOPA
Anticholinergic
Anticholinergic (Indian hemp)
Ginkgo
Ginkgo biloba
• Memory loss,
claudication, stroke,
tinnitus
• Ginkgolides, Bilbobalides
• Free radical scavenger,
anticoagulant
• AE’s: hemorrhage
Valerian
Valeriana officinalis
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Anxiety, insomnia
? Valerenic acid
Sedative
AE’s: oversedation, no
evidence of dependence
St. John’s-Wort
Hypericum perforatum
• Depression
• Hypericin,
psuedohypericin
• MAO inhibitor
• AE’s: light sensitivity,
tyramine effect
Indinavir and St John’s Wort
Before St John’s wort
After St John’s wort
300 mg TID x 14 days
Piscitelli, SC et al, Lancet, 355:547, 2000
Herbal Products: St John’s Wort
• Patients on serotonin-reuptake inhibitors,
cyclosporin, digoxin, warfarin, HIV
protease inhibitors, oral contraceptives
and other drug substrates of CYP3A/P-gp
are advised to avoid St John's wort.
Herbal Products
Fugh-Berman A, Lancet, 355:134, 2000
Metabolife has pointed to several animal studies
and two human studies to support its claims of
safety and effectiveness: one at Vanderbilt
University and the other at Columbia University.
When contacted by Newsweek in August of 1999,
"researchers from both studies said that neither
was comprehensive enough to support any
conclusions about long-term usage of the product .
. . Vanderbilt insisted that its name be removed
from Metabolife's promotional materials."
Herbal Medications
• Potentially potent
• Polypharmacy - may contain other
ingredients
• Unregulated
• Not standardized
• “Natural” not necessarily good
• Can’t have it both ways
What Should You Do ?
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Learn about it
Talk about it
Use it
Encourage patients to think of them as
medicines
• Encourage patients to grow their own
• Encourage well designed trials