PHARMACY PRACTICE AND HERBAL MEDICINES
What's the latest in pharmacists' perceptions and role regarding herbal medicines
and their safety?
STATINS MOBILIZE ENDOTHELIAL PROGENITOR CELLS, POSSIBLY PROMOTING VASCULOGENESIS
While statins are widely used to lower blood cholesterol levels, two reports indicate
that they may also promote new blood vessel formation by augmenting the population
of circulating endothelial progenitor cells.
Pharmacy Practice and Herbal Medicines
White Paper on Herbal Products. American College of Clinical Pharmacy
Miller LG, Hume A, Harris IM, et al Pharmacotherapy. 2000;20:877-91
Individuals increasingly are taking a more active role in their health care, and
herbal products have emerged as a common choice among self-care therapies. Pharmacists
are active participants in the care of patients who are taking herbal products.
Currently, most pharmacists are not educated adequately about herbal products
and other types of alternative medicine. Furthermore, good information about many
of these products is not available. These combined factors present a challenge
for pharmacists as they seek to provide optimal care and counseling to patients
who use herbs or supplements. We recommend the following actions to place pharmacists
in better positions as effective agents protecting public safety: Regulations
should be implemented at a federal level to require basic levels of standardization
and quality control in the manufacture of herbal products. Indexing terms in medical
bibliographic systems should be expanded to target herbal products. Funding should
be increased for scientific research evaluating herbal products. Pharmacy schools
should include a competency statement in their curricula regarding herbal medicines.
Continuing education in herbal products should be available and encouraged for
all pharmacists. Pharmacists should approach the use of all therapeutic interventions
with scientific rigor, whether they are traditional or complementary in nature.
Patients will benefit as more information is known and widely disseminated. By
actively embracing the responsibility for counseling individuals on the appropriate
use of herbal products, pharmacists will become a recognized source of expert
information in this rapidly growing area, yielding important improvements in the
quality of care.
Pharmacists' Knowledge and Attitudes Toward Herbal Medicine
Chang ZG, Kennedy DT, Holdford DA, et al Ann Pharmacother. 2000;34:710-5
Objective: The use and sales of herbal medications have increased
dramatically over the past several years. Pharmacists are in an ideal position
to educate patients about herbal medicines. This study was intended to determine
the knowledge and attitudes of pharmacists regarding herbal medications. Methods: A survey was distributed to pharmacists at several state
and regional meetings in Virginia and North Carolina between August and October
1998. The survey evaluated demographic data, attitudinal scales, and a 15-item
herbal medicine knowledge test. Pharmacists immediately returned the surveys to
the distributor on completion. Results: Of the 217 surveys distributed, 164 met the inclusion
criteria for further evaluation. Of the pharmacists surveyed, 68.0% practiced
in a community pharmacy, 45.1% had previous continuing education on herbal medications,
and 73.6% sold herbal medications in their practice settings. The average score
on the herbal knowledge test was 6.3 (maximum score of 15). Pharmacists with previous
continuing education scored significantly higher than those without prior continuing
education (p < 0.001). Of the 15 questions, the five that pharmacists were
most likely to answer correctly assessed the uses of herbal medications. Additionally,
pharmacists with prior continuing education or with access to herbal medication
information at their practice site were more likely to agree that providing information
about herbal medication is a pharmacist's professional responsibility (p = 0.02
and p = 0.01, respectively). Conclusions: The findings from this study demonstrate that pharmacists
were more likely to answer correctly about the uses of herbal medications than
about drug interactions, adverse drug effects, and precautions of herbal medications.
Additionally, pharmacists with previous continuing education on herbal medications
were more knowledgeable about these products. With the increasing use of herbal
medications, there is a greater need for pharmacy training programs in this area.
Pharmacy and Herbal Medicine in the US
Bouldin AS, Smith MC, Garner DD, et al Soc Sci Med. 1999;49:279-89
Herbal medicine is increasing in popularity in the United States. The market continues
to grow, with a presence being established for commercially-prepared herbal products
in community pharmacies throughout the nation. This survey was conducted to describe
that presence in pharmacies and to describe pharmacists' perceptions of this product
class. A response rate of 26.3% (n = 512) was achieved for a five-page mail survey
sent to a geographically stratified random sample of community pharmacies in the
United States. Approximately 73% of pharmacists responding indicated that their
pharmacy carried commercially-prepared herbal products. Attitudinal items were
included to measure pharmacists' perceptions toward these products, as those perceptions
have the potential to influence attitudes and subsequently behavior (such as clinical
involvement with patients wishing to integrate herbal products into an existing
regimen). Pharmacists, on average, did not believe that herbal products are well
standardized, or that the products are well accepted by the Food and Drug Administration
or the National Association of Boards of Pharmacy. Much potential exists for pharmacists
to fill a role as information provider to patients who self-medicate with herbal
medicines; must their perceptions of the product class be changed first?
Unsafe and Potentially Safe Herbal Therapies
Klepser TB, Klepser ME
Am J Health Syst Pharm. 1999;56:125-38
Unsafe and potentially safe herbal therapies are discussed. The use of herbal
therapies is on the rise in the United States, but most pharmacists are not adequately
prepared educationally to meet patients' requests for information on herbal products.
Pharmacists must also cope with an environment in which there is relatively little
regulation of herbal therapies by FDA. Many herbs have been identified as unsafe,
including borage, calamus, coltsfoot, comfrey, life root, sassafras, chaparral,
germander, licorice, and ma huang. Potentially safe herbs include feverfew, garlic,
ginkgo, Asian ginseng, saw palmetto, St. John's wort, and valerian. Clinical trials
have been used to evaluate feverfew for migraine prevention and rheumatoid arthritis;
garlic for hypertension, hyperlipidemia, and infections; ginkgo for circulatory
disturbances and dementia; ginseng for fatigue and cancer prevention; and saw
palmetto for benign prostatic hyperplasia. Also studied in formal trials have
been St. John's wort for depression and valerian for insomnia. The clinical trial
results are suggestive of efficacy of some herbal therapies for some conditions.
German Commission E, a regulatory body that evaluates the safety and efficacy
of herbs on the basis of clinical trials, cases, and other scientific literature,
has established indications and dosage recommendations for many herbal therapies.
Pharmacists have a responsibility to educate themselves about herbal therapies
in order to help patients discern the facts from the fiction, avoid harm, and
gain what benefits may be available.
Assessment of Patients' Perceptions and Beliefs Regarding Herbal Therapies
Klepser TB, Doucette WR, Horton MR, et al Pharmacotherapy. 2000;20:83-7
We evaluated the demographics and beliefs regarding safety and efficacy of herbal
therapy among individuals in Iowa and assessed the willingness to discuss the
use of these products with health care providers. We distributed 1300 surveys
to two random samples: patients attending eight clinics, and residents of the
state (mailing). Data were categorized according to herb use and compared between
users and nonusers. The response rate was 61% (794 people), with 41.6% of respondents
reporting herb use. They were predominately white women and were likely to have
had education beyond high school (p<0.05). Their use of prescription drugs
was high (p<0.05). Although users rated safety and efficacy of herbs higher
than nonusers (p<0.05), both groups believed that health care providers should
be aware of use and would provide this information.
WESTPORT, CT (Reuters Health) Sept 14 - While statins are widely used to lower
blood cholesterol levels, two reports indicate that they may also promote new
blood vessel formation by augmenting the population of circulating endothelial
progenitor cells. If confirmed, statins could one day be used to treat ischemic
conditions such as stroke or coronary artery disease.
In one of the studies reported in the August issue of the Journal of Clinical
Investigation, Dr. Jeffrey M. Isner, from St. Elizabeth's Medical Center in
Boston, and colleagues analyzed simvastatin's effects on endothelial progenitor
cells (EPCs). Previous studies have shown these bone marrow-derived cells travel
to sites of neovascularization and differentiate into mature endothelial cells.
The researchers found that simvastatin mobilizes EPCs from the bone marrow and
thereby increases the circulating EPC pool. The enhanced response seemed to result
from simvastatin's ability to activate EPC's Akt protein kinase, an enzyme that
is known to augment the proliferation, migration, and survival of EPCs.
In the second paper, Dr. Stefanie Dimmeler, from the University of Frankfurt in
Germany, and colleagues describe a similar study in which they found that atorvastatin,
mevastatin or simvastatin can induce the differentiation of EPCs and increase
their numbers in vitro and in vivo.
These researchers also found that an intact PI 3-kinase/Akt pathway was needed
for statin-induced increases in EPC differentiation.
In a related editorial, Dr. Dario C. Altieri, from Yale University in New Haven,
Connecticut, comments on the current findings and the possible clinical implications.
"Targeted localized angiogenesis...is a very hot topic and one could envision
a number of clinical applications for diseases such as stroke or myocardial infarction,"
Dr. Altieri told Reuters Health. "It is somewhat surprising that cholesterol-lowering
drugs, which have been around for a long time, seem to mobilize precursors of
endothelial cells from the bone marrow," he stated.
Vascular endothelial growth factor is also a very potent stimulator of EPCs, but
it is contraindicated in cancer patients due to its ability to promote tumor angiogenesis,
Dr. Altieri said. "The current findings are important because they show that
statins, which are generally considered safe, also stimulate EPCs," he added.
"Still, further preclinical studies will probably be needed to convince many
investigators that statins do not facilitate cancer growth," he said.
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