By: Fidel O. Garcia EMT-PEMS Education CoordinatorEMS Outreach OfficeSt. Mary’s Hospital fidel.garcia@stmarygj.org

Contemporary Alternative Medicine

What is it?

Aroma Therapy

Accupuncture

Vitamins and Minerals

Massage Therapy

Chiropractic Medicine

Herbal Therapy

Homeopathic Medicine

Dr. Samuel Hahnemann

What is it?

Stated to have minimal side effects

Stated to have fewer drug interactions

Current study for

asthma

rheumatoid arthritis

auto-immune diseases

Herbal remedies

herbs and supplements are drugs!

>30% of “conventional drugs”

Herbs and supplements have:

therapeutic effects

sub -therapeutic effects

side effects

toxic effects

How does it work?

Law of Similars

Law of Succussion

Law of Infintesimals

“No Medicine - Medicine” ?

6X , 30X

12C , 200C

LM

Why all the popularity?

Disappointment with modern medicine

Personal involvement with their own care

Easy to purchase and take

Perception that all herbal are healthier

Limited time with healthcare provider

***NOTE: Approx. 40% tell their healthcare providers they are taking supplements!!!!!!!

Due to lack of control, it is possible that:

herbs may be sub-potent

they do not contain what is in the label

they misrepresent what it can be used for

Regulation

The DSHEA passed by congress in the 1994

“The Dietary Supplement Health Education ACT”

- Categorized as dietary supplements

- No FDA approval as long as NO “therapeutic claims” were made

-Manufacture can still make general health claims

-This must be on all labels: “This product is not intended to diagnose, treat, cure, or prevent any disease”

-NO REQUIREMENTS FOR QUALITY ASSURANCE, SAFETY, OR EFFICACY

How big is this whole thing?

Billions of users (estimate by WHO)

Thousands of dealers

600 million visits annually

Thousands of “Homeopathic Experts”

Insurance companies assist or pay for

>$ 5.7 billion / yr industry

Approx. $20 billion / yr with all CAM

Top 10 selling products in the US(2002) in millions!

Garlic – 34.5

Ginkgo Biloba – 33.0

Echinacea – 32.4

Isoflavones – 28.2

Saw Palmetto – 23.0

St. John’s Wort – 15.0

Black Cohosh – 12.3

Valerian – 8.1

Milk Thistle – 7.8

Kava – 4.4

What is the responsibility of the patient?

What do they want to achieve !

Stop if not working !!

Document what and why they are taking herbs !

What is the responsibility of the healthcare provider?

Educate our patients

Be patient advocates

Class 1 – Can only be safely consumed when used appropriately

Class 2 – Restrictions, unless directed by an expert

2a – external use only

2b – not to be used in pregnancy

2c – not to be used while nursing

2d – other specific restrictions as noted

Class 3 – Herbs for which significant data exists to recommend the following label:

“To be used only under supervision of an expert qualified in the appropriate use of this substance”

Labeling must include:

dose; contraindications; adverse effects; and drug interactions

Class 4 – Herbs for which insignificant data exists to recommend

NIHNational Center for Complementary &

Alternative Therapy Clearinghousewww.nccam.nih.gov

Office of Dietary Supplementswww.ods.od.nih.gov

U.S. Food & Drug Administrationwww.cfsan.fda.govwww.fda.gov/medwatch

Otherhttp://naturaldatabase.com

Name: GarlicClass: 2c (bulb)Possible uses: Digestive aid ; lowers

cholesterol and BP; antiplatelet activity; stimulation of the immune system; protection from cancer

Side effects: GI distress; bleeding; sweating; hypoglycemia; hypotension

Cautions: pts with active bleeds or bleeding disorders; diabetic patients

Drug interactions:Anticoagulants; antiplatelets; antihypertensives; hypoglycemics

Name: Gingko BilobaClass: 1 (leaf)Possible uses: Improves cerebral and

peripheral blood flow; improved cognitive function in alzheimers pts; treatment of impotence; depression; and asthma

Side effects: GI distress; HA; palpitations; bleeding

Cautions: bleeding disordersDrug interactions: ASA; antiplatelets;

anticoagulants

Name: Echinacea

Class:Class: 1 (root / seed)1 (root / seed)

Possible uses: Stimulate immune system; prevent colds – flu – allergies – upper respiratory infections; topically for eczema – mild burns – canker sores – herpes and minor wounds

Side effects: Immunosuppression with prolonged use; allergic reactions

Cautions: should not take for > 8 wks or >10 days with acute infection; NOT

TO be used by individuals with autoimmune diseases:ie – HIV. Leukemia, MS, TB, Lupous, Rheumatiod arthritis

Drug interactions: immunosuppressants

Name: Saw Palmetto

Class: No class noted

Possible uses: benign prostatic hypertrophy; mild diuretic; cystitis

Side effects: HA and nausea – rarely; abd. Pain; dysuria

Cautions: prostatic cancer should be ruled out

Drug interactions:May INCREASE

anticoagulants; alpha adrenergic blockers; aspirin

Name: IsoflavonesIsoflavonesClass: No class notedPossible uses: Replenish estrogen; relieve Replenish estrogen; relieve

menopausal symptoms; menopausal symptoms; decrease risk of heart decrease risk of heart

disease disease and osteoporosisand osteoporosis

Side effects: Unsure of safety or efficacy Unsure of safety or efficacy since most trials have been since most trials have been done on animals or in test done on animals or in test tubestubes

Cautions: Need to use soy products Need to use soy products not not capsules or pills;capsules or pills; may alter may alter

thyroid functionthyroid function

Drug interactions:

Name: St. John’s WartClass: 2d (flowering tops)Possible uses: depression and anxiety; topically for

burns and infections; contusions; sprains

Side effects: drowsiness; GI distress; fatigue; restlessness; hypertension

Cautions: Do not use in pregnancy; hypertension; suicidal; psychotic

or severely depressedDrug interactions: May INCREASE MAOI’s & paxil;

ADDITIVE effects with tricyclic antidepressants; amphetamines: “Serotonin Syndrome” –

autonomic NS instability, muscle rigidity, hyperreflexia, vital sign instability, COMA & DEATH; may DECREASE effectiveness of HIV drugs

Name: Black Cohosh

Class: 2b / 2c

Possible uses: Smooth muscle relaxant; antispasmodic; diuretic; dysmenorrhea; antidiarrheal

Side effects: Bradycardia; hypotension; N/V; anorexia; possible spontaneous abortion

Cautions: Should not be used in pregnancy Should not be used in pregnancy or or during lactation, although it may during lactation, although it may be be used in first trimester to decrease used in first trimester to decrease

uterine spasmsuterine spasms

Drug interactions: Antihypertensives; oral contraceptives; sedatives / hypnotics

Name: Valerian

Class: 1 (root)

Possible uses: anxiety; restlessness; insomnia

Side effects: HA; restlessness; insomnia; hepatotoxic (OD); poss. Palpitations;

Cautions: Pregnancy; lactation

Drug interactions: CNS depressants, MAOI’s; phenytoin; warfarin

Name: Milk ThistleClass: 1 (seed)Possible uses: Hepatotoxicity caused by

poisonous mushrooms; cirrhosis; HCV; exposure to toxic chemicals

Side effects: Diarrhea; menstrual irregularities; rash; N/V; anorexia

Cautions: Should not use in pregnancy; lactation; or for children

Drug interactions:those metabolized by P-450 enzyme

Name: Kava KavaClass:Class: 2b/2c/2d (root / rhizome)Possible uses: Anxiety; insomnia; skeletal muscle

relaxation; ADD/ADHD; antidepressant; antiepileptic

Possible side effects: rash; drowsiness; hallucinations; increased reflexes; blurred

visions; anorexia; N/V; decreased platelets; hematuria; pulmonary hypertension; liver damage

Cautions: pregnancy; lactation; use while driving or operating machinery

Drug interactions: May INCREASE digoxin; barbiturates; benzodiazepines (tends to increase depression);

CNS depressants

Name: BilberryClass: 4Possible uses: Treatment of eye disorders;

myopia; night blindness; diabetic retinopathy;

cataracts; varicose veins; phlebitisPoss side effects: bleeding; impaired

glucose controlling diabeticsCautions: pregnancy and lactation;

diabetics; DC 14 days prior to surgical procedures

Drug interactions:Insulin; oral hypoglycemics

Name: Cranberry

Class: No class noted

Possible uses: Prevention of kidney stones, treatment of UTI

Poss side effects: May develop GI symptoms with large doses

Cautions: None noted

Drug interactions:Drugs that increase uric acid levels

Name: ArnicaClass:Class: No class notedNo class notedPossible uses: Anti – inflammatory;

analgesic; cholesterol lowering (under supervision only), shock; jet lag; bleeding

Poss side effects: Considered poisonous iftaken internally; BP; anxiety; liver failure; bleeding; dyspnea; muscle weakness; COMA, CARDIAC ARREST and DEATH

Cautions: should not take for > 8 wks or >10 days with acute infection

Drug interactions:May decrease effectiveness of antihypertensives if taken orally

Name: Evening primrose oilClass: No class noted

Possible uses: Digestive aid with irritable bowel; eczema; dermatitis; PMS; menopausal symptoms; diabetic neuropathy; rheumatoid arthritis; MS

Poss side effects: Seizures; bleedingCautions: do not use with seizure do not use with seizure

pts; pts;

Name: GinsengClass:Class: 2d (root)2d (root)Possible uses: enhances mental and physical

performance; decreases stress; improves immune function

Possible side effects: nervousness; depression; tachycardia and hypotension at

high doses; bleeding; diarrheaCautions: do not use in renal failure – acute

infection – pregnancy – lactation and active bleeding; use

cautiously in pts with hypertension or high risk for hypotension

Drug interactions: anticoagulants; antiplatelets; Asa; antihypertensives; CNS

stimulants; may INCREASE effects of insulin and hyperglycemic agents

Name: Goldenseal

Class: 2b (rhizome / root)

Possible uses: Gastritis; PUD, bladder infections; anti-hemorrhagic; anti-hemorrhoidal; anti-infective; anti-cancer

Possible side effects: Hallucinations; seizures; N/V/D; abdominal cramps; rashes; bradycardia, heart blocks; COMA; ASYSTOLE; DEATH

Cautions: NO DATA to support for most uses unless the pure form of berberine was used

Drug interactions: May INCREASE ETOH; anti-May INCREASE ETOH; anti-arrhythmics; beta blockers and CNS arrhythmics; beta blockers and CNS depressants; May DECREASE anti-depressants; May DECREASE anti-coagulants; calcium channel coagulants; calcium channel blockers and cardiac glycosidesblockers and cardiac glycosides