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Re: Herbal References, was Re: ChoicesFrom: art fougner, md (evsono@pipeline.com)Tue Mar 23 09:16:11 2004
Group Rates Efficacy of Herbs Timothy F. Kirn Sacramento Bureau SAN DIEGO — A group based at Massachusetts General Hospital has begun to rate efficacy of herbal medicines according to the published evidence, the way that conventional clinical guidelines now grade the strength of the evidence behind their recommendations. “Our mission is to form a clearinghouse, central repository, or encyclopedia for these kind of data,” said Catherine Ulbricht, Pharm.D., a pharmacist at the hospital and a chief editor of the Natural Standard Research Collaboration in Cambridge, Mass. Like their mentors at the Cochrane Collaboration, the group provides reviews of the data, but on different herbal medicines and alternative practices. Currently, there is no other place to find such rigorously researched, quality evidence-based information, particularly on post-market surveillance, including safety and drug-herb interactions, Dr. Ulbricht said at a meeting on alternative medicine sponsored by the American Hospital Association. “We weren't educated about these things at school, and I like to think of myself as a pretty young clinician,” Dr. Ulbricht said. The German Commission E report, which many in the naturopathic community often cite as an authority on herbs, contains information on specific herbs and what they are used for, but it has no detailed safety information and contains no systemic analysis of the data or comparative efficacy, she said. The collaboration uses about 400 researchers and clinicians, and even has 45 translators, so that non-English publications can be incorporated. At the meeting, Dr. Ulbricht discussed the evidence and safety for the 10 most popular herbs, with the grade that the Natural Standard analysis had given that herb for each condition: Black cohosh. Black cohosh got a B grade for menopausal symptoms, but only a C for joint pain. A grade of B means that there is quality evidence of a beneficial effect, but not enough of it to be definitive, with positive animal data. A grade of C means the data are less than rigorous, such as those from small trials or case-cohort studies, or the data are conflicting, or there are only laboratory or animal data. Black cohosh has known interactions with hormonal medications and anticoagulants. Evening primrose oil. For atopic dermatitis, evening primrose oil gets a B grade. Though it is used for many other conditions, ranging from preeclampsia to asthma to Raynaud's disease, the evidence earns nothing but a C or D, where D is fair evidence that shows no effect. One active substance in evening primrose oil is thought to be an omega-6 essential fatty acid, gamma-linoleic acid, which in rats has been shown to cause central hypotension. It is to be avoided in seizure disorders and pregnancy. Saw palmetto. For benign prostatic hypertrophy, saw palmetto earns an A. But it only gets a C for male pattern baldness and underactive bladder. Saw palmetto has known drug and herb interactions. Valerian. Valerian earns a B for insomnia, a C for anxiety disorder, and a D for sedation. Because of its sedative properties, valerian is often taken recreationally, Dr. Ulbricht noted. Valerian should be avoided in liver disease, pregnancy, and breast-feeding, and does have drug interactions. St. John's wort. For severe depression, St. John's wort gets only a B or a C, though it was given an A for mild to moderate depressive disorder. It gets a C for anxiety disorder, obsessive-compulsive disorder, perimenopausal symptoms, and premenstrual syndrome. St. John's wort may interfere with oral contraceptives and should not be used by persons with a thyroid disorder because it can alter TSH levels. St. John's wort has a large number of drug interactions. Echinacea. Echinacea does show antimicrobial properties in vitro, and earns a B for the treatment of upper respiratory infections because it shortens duration. But it earns a C for prevention of upper respiratory tract infections, radiation-induced neutropenia, and cancer. It earns a D for genital herpes. Echinacea is known to interact with antibiotics, antifungals, and certain immunosuppressants, among other drugs. Bilberry. Bilberry contains flavonoids that may inhibit prostacyclin synthesis and impair coagulation and platelet aggregation. It is used for a number of vascular conditions and eye diseases, earning a C for all of them, except for improvement of night vision, for which it earns a D. Cranberry. Cranberry earns a B grade for prevention of urinary tract infection, and drinking cranberry juice can be considered safe, Dr. Ulbricht said. Large doses should be avoided in diabetes, pregnancy, and breast-feeding. It earns a C as an antiviral, an antioxidant, an antifungal, and for cancer prevention. It also earns a C for the treatment of urinary tract infections, kidney stones, and dental plaque. Wild yam. Wild yam may have hormonal and lipid-lowering properties, but it gets only a C for menopausal symptoms and hyperlipidemia. Wild yam can cause skin rash, uterine contractions, and hypoglycemia. Ginger. The effectiveness of ginger in treating nausea appears to depend on the cause. Ginger gets a B for chemotherapy-induced and pregnancy-associated nausea, but only a C for nausea after surgery and for motion sickness. It also gets a C for rheumatoid arthritis, osteoarthritis, arthralgias, and muscle pain. Further information is available from the Natural Standard Research Collaboration's Web site at http://www.naturalstandard.com.
At Tue, 23 Mar 2004, DoctorJoe@aol.com wrote:
>
-- art fougner, md ich bin ein New Yorker
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