Case report: Consequences of ephedra use in an athlete

Effects of botanical dietary supplements on cardiovascular, cognitive, and metabolic function in males and females

BACKGROUND

The onset of menopause marks a pivotal time in which the incidence of hypertension and of cardiovascular disease (CVD) begins to increase dramatically in women. Before menopause, the incidences of these diseases are significantly lower in women than in age-matched men. After menopause, the rates of these diseases in women eventually approximate those in men. The loss of endogenous estrogen at menopause has been traditionally believed to be the primary factor involved in these changes.

OBJECTIVE

This review summarizes recent findings regarding the effectiveness of botanicals in the treatment of some menopausal symptoms and other symptoms of aging (eg, rise in arterial pressure, cognitive decline, insulin resistance, and hyperlipidemia).

METHODS

Articles were selected for inclusion in this review based on the significance of the research and contribution to the current understanding of how each botanical elicits cardioprotective effects. To this end, PubMed and MEDLINE databases were searched, using terms that included the name of the specific botanical along with the relevant aspects of its action(s), such as blood pressure, glycemic control, and lipids. Most of the articles used were published within the past 5 years, although some older articles that were seminal in advancing the current understanding of botanicals were also included.

RESULTS

Soy has been found to lower plasma lipid concentrations and arterial pressure in postmenopausal women and age-matched men, and to have protective effects in heart disease and atherosclerosis of the carotid and coronary circulation. Soy was also found to lower fasting insulin concentrations and glycosylated hemoglobin concentrations. Grape seed extract, another frequently used botanical, contains polyphenols that have been found to reduce arterial pressure and salt-sensitive hypertension in estrogendepleted animal models.

CONCLUSION

Several botanical compounds have been found to have beneficial effects in the treatment of the symptoms of menopause and other symptoms of aging, including CVD, cognitive decline, and metabolic diseases.

Peer review and the process of publishing of adverse drug event reports

Most doctors finish their careers without ever having published a scientific paper. The small percent that do mostly end up writing "case reports". But, unless the report describes some truly extraordinary event, very little ever comes of it, and their publication may do more harm than good. The problem is particularly acute in cases of alleged drug toxicity. Case reports are incomplete, uncontrolled, retrospective, lack operational criteria for identifying when an adverse event has actually occurred, and resemble nothing so much as hearsay evidence, a type of evidence that is prohibited in all courts in all of industrialized societies. When a journal, even a highly respected one, decides to publish hearsay, readers are utterly reliant on the integrity of the journal, the author, and the peer review process; such reliance may not always be warranted. Some recent examples of process failure are provided, as well as some suggestions about possible remedies, including the use of pharmaco-vigilance algorithms.