economic

Media portrayal of herbal remedies versus pharmaceutical clinical trials: impacts on decision.: Med Law. 2007 Jun; 26(2): 363-73 Bubela T, Koper M, Boon H, Caulfield T

The use of Complementary and Alternative Medicines (CAM) in Europe and North America is increasing significantly with a concomitant growth in business interest. Users are educated and self-empowered and rely on information sources beyond mainstream medical practitioners. Not surprisingly, media coverage, much of dubious quality, has increased to meet demand for information. Here we present data from a study that explores how knowledge is translated in the socioeconomic-political context of CAM as compared to conventional pharmaceuticals. Specifically, we are interested in the nature of the information provided by clinical trials and the media and how this might impact decision-making regarding the use of CAM versus conventional pharmaceuticals and the reporting of conflicts of interest and industry funding of research. Our results suggest that, in the media, there were significant errors of omission in describing clinical trial quality and a serious under-reporting of risks of herbal remedies. Consumers, who often self-administer CAM are not being provided with information sufficient to make informed choices about treatment alternatives. The next step in the research is to determine whether these reporting dynamics in describing CAM clinical trials differ from those of reporting on pharmaceutical clinical trials.

Herb and supplement use in the US adult population.: Clin Ther. 2005 Nov; 27(11): 1847-58 Kennedy J

Abstract BACKGROUND:: Research on the scope of use and factors associated with herbal medicine use is limited. OBJECTIVES:: The aims of this work were to assess nationalusage patterns, reasons for use, and the perceived efficacy of herbal products and dietary supplements. METHODS:: This was a secondary analysis of the complementaryand alternative medicine (CAM) supplement to the 2002 National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics (NCHS). Participants were asked whether they had used natural herbs for their own health and treatment. Those who responded yes were compared with those who responded no. Supplement users were asked whether they had used any of 36 specific herbs or nonherbal dietary supplements (eg, glucosamine, fish oil, bee pollen), how important the use of CAM treatment was to them, whether they had seen a CAM provider, and whether they had informed a conventional medical provider about their use. NCHS weights, derived from Decennial Census data, were used to calculate national prevalence estimates. Group comparisons of herbal use were conducted with the Wald x(2) test. RESULTS:: A total of 31,044 adults participated in the2002 NHIS CAM survey; 632 were omitted from analyses due to incomplete information. In all, 5787 adults said they had used herbs or supplements during the previous 12 months, of whom 57.3% said they used these products to treat specific conditions. Based on these responses, an estimated approximately 38.2 million adults in the United States used herbs and supplements in 2002. More than half of all users said that herbs and natural products were important to their health and well-being. Use rates were higher for women than men (21.0% vs 16.7%; P < 0.001); adults aged 45 to 64 years (P < 0.001 vs other age groups); those of multiple races (32.2%), Asians (24.6%), or American Indians or Alaskan natives (21.9%) rather than whites (19.1%) or blacks (14.3%) (effect of race, P < 0.001); residents of the western United States (effect of region, P < 0.001), and college graduates (25.3% vs 10.4% among those who did not graduate high school; effect of education, P < 0.001). Only 33.4% told a convenentional health care provider about their herb or supplement use use. CONCLUSION:: Herb and natural supplement use waswidespread in the US adult population in 2002, according to data from the NHIS CAM survey, despite the fact that few participants informed their conventional health care providers about such use.

Safety assurances for dietary supplements policy issues and new research paradigms.: J Herb Pharmacother. 2005;5(1):3-15 Authors: Basch EM, Servoss JC, Tedrow UB

Herbal therapies are used by more than 12% of the U.S. population each year, resulting in annual out-of-pocket expenses above $5 billion. Utilization rates are particularly high among patients with chronic diseases, and in patients frequently seen in clinic by physicians and nurse practitioners. Most physicians do not receive formal education regarding the safety of these therapies, and there is growing concern in the medical community about the potential risks to patients and the paucity of reliable information. Numerous adverse effects and interactions have been attributed to dietary supplements, based on variable levels of evidence ranging from historical use or anecdotes to pre-clinical research or high-quality clinical trials. Significant potential morbidity and costs have been indirectly associated with herb/supplement-drug interactions, including increased emergency room visits, outpatient clinic visits, and perioperative complications. However, most research has focused on efficacy rather than safety. Post-market surveillance is complicated by the uneven standardization of products between manufacturers, and in some cases between batches produced by the same manufacturer. To assure public safety around the use of dietary supplements within the framework of existing legislation and market realities, schema must evolve to more systematically monitor the safety of agents in the post-market environment; identify potentially dangerous supplements (and/or constituents); study the mechanism and potential hazards of these identified products; and clarify the process by which products may be considered for removal from the market. We discuss research and educational paradigms within this context which make use of existing surveillance mechanisms to more efficiently identify agents of particular concern. Specific examples are given.

Drug abuse in Slovak Republic.: Przegl Lek. 2005;62(6):357-60 Authors: Kresanek J, Plackova S, Caganova B, Klobusicka Z

The drug abusing structure has dramatically changed since 1989. While in 1989 the sniffing of the fluid drugs represented 98% of the global drug abuse, the most abused drugs were: heroin, marijuana, cocaine, amphetamine and its derivatives. During last 10 years situation with drug abuse has changed. Currently the most abused drugs: cannabinoides, amphetamines. The plant drugs (Datura stramonium, hallucinogenic mushrooms Psilocybe semilanceata, nutmeg--the seed of Myristica fragrans) combined with the alcohol are popular among the young abusers. According to an analysis of the phone consultations in our Toxicological Information Centre (TIC) we found out, that the number of intoxications with the plant drugs has increased five times during the last year (comparing with the year 2000), because of their easy availability, low price and quick spreading of information.

Herb and supplement use in the US adult population.: Clin Ther. 2005 Nov;27(11):1847-58 Authors: Kennedy J

Abstract BACKGROUND:: Research on the scope of use and factors associated with herbal medicine use is limited. OBJECTIVES:: The aims of this work were to assess nationalusage patterns, reasons for use, and the perceived efficacy of herbal products and dietary supplements. METHODS:: This was a secondary analysis of the complementaryand alternative medicine (CAM) supplement to the 2002 National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics (NCHS). Participants were asked whether they had used natural herbs for their own health and treatment. Those who responded yes were compared with those who responded no. Supplement users were asked whether they had used any of 36 specific herbs or nonherbal dietary supplements (eg, glucosamine, fish oil, bee pollen), how important the use of CAM treatment was to them, whether they had seen a CAM provider, and whether they had informed a conventional medical provider about their use. NCHS weights, derived from Decennial Census data, were used to calculate national prevalence estimates. Group comparisons of herbal use were conducted with the Wald x(2) test. RESULTS:: A total of 31,044 adults participated in the2002 NHIS CAM survey; 632 were omitted from analyses due to incomplete information. In all, 5787 adults said they had used herbs or supplements during the previous 12 months, of whom 57.3% said they used these products to treat specific conditions. Based on these responses, an estimated approximately 38.2 million adults in the United States used herbs and supplements in 2002. More than half of all users said that herbs and natural products were important to their health and well-being. Use rates were higher for women than men (21.0% vs 16.7%; P < 0.001); adults aged 45 to 64 years (P < 0.001 vs other age groups); those of multiple races (32.2%), Asians (24.6%), or American Indians or Alaskan natives (21.9%) rather than whites (19.1%) or blacks (14.3%) (effect of race, P < 0.001); residents of the western United States (effect of region, P < 0.001), and college graduates (25.3% vs 10.4% among those who did not graduate high school; effect of education, P < 0.001). Only 33.4% told a convenentional health care provider about their herb or supplement use use. CONCLUSION:: Herb and natural supplement use waswidespread in the US adult population in 2002, according to data from the NHIS CAM survey, despite the fact that few participants informed their conventional health care providers about such use.

Uncommon trajectories: steroid hormones, Mexican peasants, and the search for a wild yam.: Stud Hist Philos Biol Biomed Sci. 2005 Dec;36(4):743-760 Authors: Soto Laveaga G

This article analyzes how evolving pharmaceutical technology, chemical advances, and world politics created the need for an abundant and cheap supply of steroids, and how decisions made in faraway laboratories ultimately determined that a Mexican yam, barbasco, was the best possible raw material. Following this discovery, this article explores how barbasco's exploitation impacted on the Mexican countryside and specifically the men and women hired to gather wild yams. In analyzing, for example, the peasant organizations that emerged, the use of chemical terms by barely literate peasants, and the Mexican government's political strategy to control rural unrest by controlling barbasco production one begins to understand the unexpected consequences of the global search for medicinal plants. In this particular case, the merging of science and peasant life reshuffled social hierarchies in the countryside, granted monetary value to an erstwhile 'weed', and gave a novel reinterpretation to laboratory knowledge and its (social) uses.