Herbal medicines: predictors of recommendation by physicians

Isolation of flavonoids from Anemopaegma arvense (Vell) Stellf. ex de Souza and their antifungal activity against Trichophyton rubrum

Anemopaegma arvense (Vell) Stellf. ex de Souza belongs to the family Bignoniaceae, and is popularly known as catuaba. To evaluate the cytotoxic and antimicrobial activity of A. arvense, fraction F3 and flavonoids 1 (quercetin 3-O-α-L-rhamnopyranosyl-(1→6)-β-D-glucopyranoside) (rutin) and flavonoid 2 (quercetin 3-O-α-L-rhamnopyranosyl-(1→6)-β-D-galactopyranoside) were isolated from the leaves of this plant. Fraction F3 and flavonoids 1 and 2 exhibited no antibacterial activity. Furthermore, no cytotoxic activity of fraction 3 or flavonoids 1 and 2 was observed against the tumor cells tested. However, analysis of the antifungal activity of flavonoids 1 and 2 revealed minimum inhibitory concentrations of 0.5 and 0.25 mg/mL, respectively, against the Trichophyton rubrum strains tested (wild type and mutant). This study demonstrates for the first time the antifungal activity of isolated flavonoids, validating the same activity for A. arvense.

Responding to GPs' information resource needs: implementation and evaluation of a complementary medicines information resource in Queensland general practice

BACKGROUND

Australian General Practitioners (GPs) are in the forefront of primary health care and in an excellent position to communicate with their patients and educate them about Complementary Medicines (CMs) use. However previous studies have demonstrated that GPs lack the knowledge required about CMs to effectively communicate with patients about their CMs use and they perceive a need for information resources on CMs to use in their clinical practice. This study aimed to develop, implement, and evaluate a CMs information resource in Queensland (Qld) general practice.

METHODS

The results of the needs assessment survey of Qld general practitioners (GPs) informed the development of a CMs information resource which was then put through an implementation and evaluation cycle in Qld general practice. The CMs information resource was a set of evidence-based herbal medicine fact sheets. This resource was utilised by 100 Qld GPs in their clinical practice for four weeks and was then evaluated. The evaluation assessed GPs' (1) utilisation of the resource (2) perceived quality, usefulness and satisfaction with the resource and (3) perceived impact of the resource on their knowledge, attitudes, and practice of CMs.

RESULTS

Ninety two out of the 100 GPs completed the four week evaluation of the fact sheets and returned the post-intervention survey. The herbal medicine fact sheets produced by this study were well accepted and utilised by Qld GPs. The majority of GPs perceived that the fact sheets were a useful resource for their clinical practice. The fact sheets improved GPs' attitudes towards CMs, increased their knowledge of those herbal medicines and improved their communication with their patients about those specific herbs. Eighty-six percent of GPs agreed that if they had adequate resources on CMs, like the herbal medicine fact sheets, then they would communicate more to their patients about their use of CMs.

CONCLUSION

Further educational interventions on CMs need to be provided to GPs to increase their knowledge of CMs and to improve their communication with patients about their CMs use.

Canadian family physicians and complementary/alternative medicine: the role of practice setting, medical training, and province of practice

The present study sheds some light on how and why Canadian family physicians offer complementary and alternative medicine (CAM) services to their patients. Our results suggest that organizational settings discourage physicians from offering CAM, while solo clinics are most conducive. Physicians trained in French-language medical schools are less likely than their English-language trained colleagues to offer CAM services, and those in British Columbia are the most likely to do so. Provincial differences do not appear to be related to the presence or absence of "negative proof" legislation that is considered to facilitate CAM provision by physicians.

Herbal medicines: prevalence and predictors of use among Malaysian adults

OBJECTIVE

The aim of this study was to examine the prevalence and identify factors, which predict the use of herbal medicines among Malaysian adults.

METHODS

Using a cross-sectional design, data were collected via face-to-face interview using structured questionnaire from convenience sample of adults from four towns in Malaysia. Multivariate logistic regression analysis was used to identify the significant predictors of herbal medicines use.

RESULTS

From a total of 1601 respondents, 542 (33.9%) reported use of herbal medicines in the previous 12 months. Multivariate logistic regression analysis revealed the following variables to be predictive of herbal medicines use: female gender [odds ratio (OR) 1.80, confidence interval (CI) 1.40-2.31], being married [OR 1.97, CI 1.44-2.71], having health problems [OR 2.31, CI 1.74-3.07] and having high-income levels [OR 4.21, CI 1.72-10.30]. The odds of someone using herbal medicines also increases though slightly if someone has favorable opinions about herbal medicines on the aspects examined. On the other hand, being Chinese [OR 0.74, CI 0.57-0.96] and Indians [OR 0.17, CI 0.11-0.27] were associated with decreased odds of using herbal medicines compared to Malays.

CONCLUSION

The prevalence of herbal medicines use is high. Respondents' personal attributes and opinions influence their likelihood of using herbal medicines. These findings are important because knowledge of the predictors of herbal medicines use may help health care providers to identify patients at increased risk who would be candidates for receiving guidance on safe use of herbal medicines.

Evaluation of knowledge base of hospital pharmacists and physicians on herbal medicines in Southwestern Nigeria

The use of herbal medicines among Nigerian patients and the tendency to combine this class of medicines with allopathic drugs while on hospital admission have been on the increase. Earlier studies show that community pharmacists from Nigeria believe that they need more training to counsel patients on their use of herbal medications.

Objective

To evaluate knowledge base, use, acceptability, attitudes and beliefs of hospital pharmacists and physicians in South-western Nigeria on herbal products / phytopharmaceuticals /dietary supplements (HP/PP/DS).

Methods

A 20-odd questionnaire including an 8- item herbal medicine question was used to assess the knowledge of the physicians and pharmacists in the area of pharmacology of HP/PP/DS. Effects of demographic information such as age, sex, year post graduation, years of experience and area of specialization on the scores obtained were evaluated using Fisher’s exact tests. Level of significance was set at p<0.05.

Results

Pharmacists (51.4%) believed that the training they had was not adequate while physicians (44.6%) believed HP/PP/DS are not safe and 18.5% believed they are not effective. Pharmacovigilance centres were not significantly used for adverse reactions reported by patients. Pharmacists (67.6%) and physicians (29.3%) believed phytopharmaceuticals interact with other drugs. Year of graduation had a significant effect on the perception of the possibilities of interaction for pharmacists. 5.6% of the physicians and 62.4% of the pharmacists scored ≥50% with the questions on use and interaction potentials of HP/PP/DS, with cadre and years of practice having significant effects.

Conclusions

There is a deficiency in the knowledge base of physicians, especially on the pharmacology and potential interaction of herbal medicines. There is an urgent need for the inclusion of pharmacology of common herbal medicines in the curriculum of Nigerian medical degree and an improvement in the pharmacy curriculum in this area.

A gap between acceptance and knowledge of herbal remedies by physicians: the need for educational intervention

Background

The unprecedented global increase in the use of herbal remedies is set to continue apace well into the foreseeable future. This raises important public health concerns, especially as it relates to safety issues including adverse effects and herb-drug interactions. Most Western-trained physicians are ignorant of the risks and benefits of this healthcare modality and assessment of acceptance and knowledge would identify appropriate intervention strategies to improve physician-patient communication in this area.

Methods

A cross-sectional survey was done using an interviewer-administered pilot tested de novo questionnaire at six public hospitals in Trinidad between May–July 2004. The questionnaire utilized weighed questions to quantify acceptance (maximum score = 14 points) and knowledge (maximum score = 52 points). Acceptance and knowledge scores were analyzed using the ANOVA and Tukey's tests.

Results

Of 192 physicians interviewed, most (60.4%) believed that herbal remedies were beneficial to health. Respondents had relatively high acceptance levels (mean = 5.69 ± 0.29 points or 40% of total possible score) and poor knowledge (mean = 7.77 ± 0.56 points or 15% of total possible score). Seventy-eight physicians (40.6%) admitted having used herbs in the past, and 60 of these (76.9%) were satisfied with the outcome. Although 52 physicians (27.1%) recommended the use of herbs to their patients only 29 (15.1%) were able to identify at least one known herb-drug interaction.

Conclusion

The use of herbal remedies is relatively high in Trinidad, as throughout the world, and most patients self-medicate with or without the knowledge of their attending physician. Surprisingly, we demonstrated relatively high acceptance levels and use of herbs among physicians in Trinidad. This interesting scenario of high acceptance levels and poor knowledge creates a situation that demands urgent intervention. We recommend educational intervention to narrow the gap between acceptance and knowledge so that physicians would be adequately equipped to communicate with their patients on this modality. The integration of herbal medicine into the curriculum of medical schools, continuing education programs and the availability of reputable pharmacopoeias for referencing at public health institutions are useful instruments that can be used to close this gap and promote improved physician-patient communication.

The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products

The purpose of this paper is to explore the possibility that adverse reactions and drug interactions arising from the use of homeopathic and herbal medicines could lead to confusion when adverse reactions to conventional medicines are reported. An extensive literature review was conducted on the occurrence of adverse reactions and drug interactions following the use of homeopathic or herbal remedies, and the potential for these to confound adverse event reporting to conventional medicines considered. The survey demonstrates the potential for herbal remedies and homeopathic products, to produce adverse drug reactions or drug interactions, and shows the scope for potential for confusion with those arising from conventional medicines. There is a need for greater awareness that adverse reactions apparently due to a conventional medicine, might in reality be due to a herbal medicine or a drug interaction between a herbal medicine and a conventional drug, particularly when a health professional is unaware of the extent of a patient's self-medication with alternative therapies.