Transcript: Alternative Medicine: What Works, What Doesn't | Sep 24, 2003

(music plays)

Against a blurry background of blue and pink pills, a video reel displays pictures of medical gear such as a needle, a scan of a human body, heartrate monitors, and a microscope.
The title of the show slides in: “Mini-Med School.”

Then, Heather Boon stands on a stage in a university auditorium giving a lecture. She’s in her mid-thirties with curly blond hair tied-up. She’s wearing glasses, a blue shirt, a black blazer and a matching skirt. Behind her, a computer screen is projected on a tall white wall.

Heather says SO, FIRST OF
ALL WHO USES HERBAL MEDICINE?
HOW MANY PEOPLE IN THIS ROOM
HAVE USED HERBAL MEDICINE AT
SOME POINT IN THEIR LIVES?
ALMOST, EVERY HAND.

A caption appears on screen. It reads “Heather Boon. University of Toronto.”

Heather laughs and continues YOU KNOW,
THESE DAYS IT DOESN'T MATTER
WHETHER I'M TALKING TO A ROOM
FULL OF PHARMACISTS, A ROOM
FULL OF PHYSICIANS, A ROOM FULL
OF NURSES, A ROOM NURSES, A
ROOM FULL OF THE PUBLIC, I GET
AT LEAST HALF THE HANDS GOING
UP.

The caption changes to “Alternative Treatments: What works-what doesn’t.”

Heather says PEOPLE ADMITTING THEY'VE TRIED
HERBAL MEDICINE.
AND I THINK THAT, THAT REALLY
REFLECTS THE UM, THE CHANGING
OVER THE LAST FIVE OR TEN YEARS
OF HOW COMMONLY AVAILABLE THESE
PRODUCTS ARE.
THEY USED TO BE HARD TO GET,
CAUSE NO ONE KNEW MUCH ABOUT
THEM.
NOW, THEY'RE AVAILABLE IN MANY,
MANY DIFFERENT PLACES.
PHARMACIES, DRUGSTORES, UM,
HEALTH FOOD STORES, YOU CAN GET
THEM AT YOUR LOCAL GROCERY
STORE.
YOU GET INFORMATION ABOUT THEM
ON THE INTERNET.
IN FACT YOU GET FLYERS IN YOUR
MAILBOX, AND YOU DON'T WANT TO
KNOW ABOUT THEM.
SO, I THINK THAT WHAT WE'RE
SEEING HERE IS A HUGE CHANGE
OVER THE LAST FEW YEARS.
WE KNOW THAT UP TO 50 percent OF
CANADIANS USE HERBAL MEDICINE
EVERY YEAR FOR SOMETHING.

She runs a PowerPoint presentation. A slide under the title “Who uses herbs?” appears.

She continues WE KNOW THAT USE IS MORE COMMON
AMONG WOMEN, BUT WE ACCESS THE
HEALTHCARE SYSTEM MORE OFTEN
ANYWAY, SO THAT'S NOT TERRIBLY
SURPRISING.
WE ALSO KNOW THAT IN CANADA
IT'S PEOPLE WITH THE HIGHER
LEVELS OF EDUCATION AND INCOME
THAT TEND TO USE HERBAL
MEDICINE.
YOU HAVE TO HAVE SOME LEVEL OF
DISPOSABLE INCOME, CAUSE YOU
HAVE TO PAY FOR THESE THINGS.
SO, ONE OF THE THINGS THAT WE
NEED TO LOOK AT IS, DO THESE
THINGS REALLY WORK, AND IF SO,
FOR WHAT?
AND IF THEY REALLY DO WORK, ARE
THEY BETTER THAN CONVENTIONAL
MEDICINE, AND IF SO, SHOULD WE
BE PAYING FOR THEM AS A
SOCIETY?
AND IF NOT, THEN WE DEFINITELY
SHOULDN'T.
BUT THESE ARE SOME RESEARCH
QUESTIONS THAT WE NEED TO SORT
OUT.
WE ALSO KNOW THAT PEOPLE THAT
HAVE BEEN DIAGNOSED WITH ANY
KIND OF CHRONIC DISEASE ARE
MORE LIKELY TO USE HERBAL
MEDICINE.
WELL, IT'S CHRONIC BECAUSE BY
DEFINITION A CHRONIC DISEASE IS
SOMETHING CONVENTIONAL MEDICINE
CAN'T CURE.
SO OF COURSE YOU'RE LOOKING FOR
OTHER OPTIONS, AND THAT MAKES
SENSE AS WELL.
SO, ONE OF THE QUESTIONS THAT I
ASK AS A SOCIOLOGIST, IS WHY IS
HERBAL MEDICINE SO POPULAR
THESE DAYS?
WHY ARE SO MANY PEOPLE TRYING
IT?
I SPENT A LOT OF MY LIFE
INTERVIEWING PATIENTS AND
ASKING THAT VERY QUESTION.
WHY DID YOU TRY HERBAL
MEDICINE?
AND AS A SOCIOLOGIST I LIKE TO
CATEGORIZE THINGS, SO I
CATEGORIZED THEM INTO PUSHES
AND PULLS.

The slide changes to “Why do patients seek herbs? Pushes: Adverse effects of conventional treatments. Lack of efficacy of conventional treatments. Perceived poor doctor-patient interactions.”

She continues SO, THE PUSHES ARE THINGS THAT
PUSH PEOPLE TOWARDS TRYING
SOMETHING ELSE, TRYING HERBAL
MEDICINE.
THESE ARE THINGS LIKE, THEY
EXPERIENCE ADVERSE EFFECTS WITH
CONVENTIONAL MEDICATIONS.
THEY WANTED TO TRY SOMETHING
DIFFERENT.
THEY FELT THAT CONVENTIONAL
MEDICATIONS WEREN'T WORKING FOR
THEM.
WANTED TO TRY SOMETHING
DIFFERENT.
THEY DIDN'T LIKE THEIR
INTERACTION WITH THEIR DOCTOR,
OR THEIR PHARMACIST OR OTHER
CONVENTIONAL HEALTHCARE
PROVIDER, SO THEY WENT TO SEE
SOMEONE ELSE AND THAT PERSON
RECOMMENDED HERBAL MEDICINE.
THE PULLS ARE THOSE THINGS THAT
ARE INHERENT IN THE HERBS THAT
PULL PEOPLE TOWARDS TRYING
THEM.

The slide changes to “Pulls: Perception that ‘natural’ is better. Perception that herbs are safe. Congruence with beliefs about the nature of health and illness.”

She continues AND THAT'S THE PERCEPTION THAT
NATURAL IS BETTER.
THE PERCEPTION THAT HERBS ARE
ALL SAFE, AND IF YOU TAKE ONE
THING AWAY FROM MY TALK TODAY,
PLEASE BE IT THAT NOT ALL, ALL
HERBS ARE SAFE FOR ALL PEOPLE.
THE EXAMPLE THAT I USE IS NOT
EVEN AN HERB, IN FACT IT'S A
FOOD, MUSHROOMS.
SOME MUSHROOMS ARE PERFECTLY
SAFE TO GO PICK IN THE FOREST
AND PUT IN YOUR SPAGHETTI
SAUCE.
SOME MUSHROOMS HAVE ADVERSE
EFFECTS WHICH ARE ILLEGAL, BUT
TEENAGERS BUY THEM ANYWAY.

The audience laughs.

Heather continues SOME MUSHROOMS
ARE VERY, VERY POISONOUS AND
YOU CAN'T ALWAYS TELL BY
LOOKING AT THEM.
SO, JUST BECAUSE SOMETHING'S
NATURAL, JUST BECAUSE SOMETHING
GROWS DOES NOT MEAN THAT MEN
AND WOMEN ARE MEANT TO EAT IT.
SO, LET'S JUST THINK A LITTLE
BIT FIRST ABOUT WHO PRACTICES
HERBAL MEDICINE AND WHAT THEIR
BACKGROUNDS ARE.
SO THAT WHEN PEOPLE GIVE YOU
ADVICE ABOUT HERBS YOU HAVE A
SENSE OF WHO YOU CAN TRUST.
SO THE FIRST THING YOU NEED TO
KNOW IS THAT CONVENTIONAL
HEALTHCARE PROVIDERS CAN
RECOMMEND HERBAL MEDICINE.
AND SOMEONE OUT THERE SAID, HE
TOOK HERBS BECAUSE HIS DOCTOR
RECOMMENDED IT.
SO, DOCTORS AND PHARMACISTS AND
DIETICIANS, AND THAT SORT OF
PEOPLE, WE CAN RECOMMEND HERBAL
MEDICINE.
WE DON'T REALLY VERY OFTEN, AND
THAT'S BECAUSE WE DON'T HAVE
ANY FORMAL TRAINING IN IT, IN
MOST CASES.
BUT THAT'S CHANGING OVER TIME.
I SPEND LOTS OF MY LIFE DOING
CONTINUING EDUCATION FOR
PHARMACISTS AND FOR DOCTORS ON
THIS TOPIC, AND YOU'LL FIND
THAT MORE AND MORE PHYSICIANS
AND PHARMACISTS ARE ABLE TO
ANSWER YOUR QUESTIONS.
SO, I DO ENCOURAGE YOU TO TALK
TO THEM ABOUT THESE PRODUCTS.
THEY CAN ONLY MAKE
RECOMMENDATIONS BASED ON THEIR
OWN SCOPE OF PRACTICE AS A
HEALTHCARE PROVIDER.
CHIROPRACTORS WHO ARE REGULATED
IN ALL PROVINCES AND ONTARIO,
MAY ALSO RECOMMEND HERBS TO
YOU.
THEY HOWEVER DON'T HAVE, LIKE
PHARMACISTS AND DOCTORS, DON'T
HAVE FORMAL TRAINING IN HERBAL
MEDICINE IN THEIR BASIC
CURRICULUM.
SO, UNLESS THEY TAKE AN
ADDITIONAL TRAINING THEY DON'T
HAVE A LOT OF FORMAL TRAINING
IN BOTANICAL MEDICINE, BUT THEY
MAY HAVE TAKEN ADDITIONAL
COURSES.
NATUROPATHIC PRACTITIONERS ARE
REGULATED IN ONTARIO, BRITISH
COLUMBIA, SASKATCHEWAN AND
MANITOBA.
SO, THEY DO ACTUALLY HAVE
FORMAL TRAINING IN HERBAL
MEDICINE.
IT'S NOT ALWAYS BASED ON
SCIENTIFIC EVIDENCE AND
SCIENTIFIC TRAINING, BUT SOME
OF IT IS AND SOME OF ITS BASED
ON HISTORICAL USE OF THE
PRODUCTS.
BUT THE THING TO KEEP IN MIND
HERE IS THAT BOTANICAL MEDICINE
OR HERBAL MEDICINE OR
HERBALISTS OR BOTANIC,
BOTANICAL MEDICAL PRACTITIONERS
ARE NOT REGULATED.
AND WHY THAT'S IMPORTANT FOR
YOU TO UNDERSTAND IS THAT
ANYONE CAN CALL THEMSELVES AN
HERBALIST.
SO, WHEN YOU GO TO AN HERBALIST
AND YOU TAKE THEIR ADVICE, YOU
NEED TO KEEP IN MIND THEY'RE
NOT REGULATED.
SO IT'S NOT, SOMETIMES NOT MUCH
BETTER THAN TAKING ADVICE FROM
YOUR NEIGHBOUR.
THEY MIGHT KNOW SOMETHING, BUT
THEY MIGHT NOT.
THE OTHER PEOPLE THAT ARE NOT
REGULATED IN ONTARIO ARE
TRADITIONAL MEDICINE,
TRADITIONAL CHINESE MEDICINE
PRACTITIONERS WHO ALSO
RECOMMEND A LOT OF HERBAL
MEDICINE.

The slide changes to “Practising Herbal Medicine. Conventional healthcare practitioners (based on provincial scope of practice. Chiropractors (licensed in all Provinces). Naturopathic practitioners (licensed in BC, SK, MA, ON). Herbal or Botanical Medicine practitioners (no regulation).Traditional Chinese Medicine practitioners (regulated only in BC).”

She continues UM, AND AGAIN WITH THESE GROUP
OF PRACTITIONERS, THEY'RE NOT
REGULATED SO ANYONE CAN CALL
THEMSELVES A TRADITIONAL
CHINESE MEDICINE PRACTITIONER.
SOME PEOPLE DO HAVE FORMAL,
FABULOUS TRAINING, BUT YOU NEED
TO ASK ABOUT IT, BECAUSE SOME
PEOPLE DON'T, AND IT'S REALLY
VERY, VERY MUCH A BUYER BEWARE
SITUATION.
SO WHAT DO YOU WANT TO LOOK FOR
WHEN YOU'RE LOOKING FOR
SOMEONE, A PRACTITIONER, IF
YOU'RE ASKING ABOUT HERBAL
MEDICINE?

The caption changes to “Guidelines for Choosing a Practitioner.”

She continues WHEN POSSIBLE GET A REFERRAL
FROM SOMEONE YOU TRUST.
ASK ABOUT THEIR TRAINING.
BEWARE OF CURE-ALLS.
I'M NOT AWARE OF ANY HERB THAT
CAN CURE THINGS THAT
CONVENTIONAL MEDICINE CAN'T.
CONVENTIONAL MEDICINE CAN'T
CURE A LOT OF THINGS EITHER,
BUT.
BEWARE OF SOMEONE THAT CLAIMS
THEY CAN CURE EVERYTHING.
UM, IT'S VERY, VERY UNLIKELY.
ASK FOR INFORMATION ABOUT HOW
LONG THE THERAPY'S GONNA LAST,
ABOUT WHAT IT'S GONNA COST, IF
THE PRACTITIONER HAS
MALPRACTICE INSURANCE IF
ANYTHING GOES WRONG?
BE VERY WARY OF UNCONVENTIONAL
DIAGNOSTIC TESTS.
A LOT OF PRACTITIONERS ASK YOU
TO PAY FOR A LOT OF TESTING,
WHICH IS NOT NECESSARILY PROVEN
TO TELL THEM ANYTHING, AS FAR
AS I CAN TELL.
UM, AND YOU SHOULDN'T BE
PRESSURED TO BUY THE HERBS OR
NATURAL PRODUCTS FROM THE
PERSON THAT'S RECOMMENDING THEM
TO YOU.
ANYONE KNOW WHAT THIS IS?

The picture of a pink flower with an orange bulb appears on a large screen.

A female member of the audience says ECHINACEA.

Heather says ECHINACEA.
HOW MANY PEOPLE HAVE ECHINACEA
GROWING IN THEIR GARDEN?
A FEW OF YOU, GOOD.
UM, ECHINACEA'S ACTUALLY NATIVE
TO NORTH AMERICA AND IT GROWS
WILD.
IT USED TO GROW WILD ANYWAY IN
THIS AREA.
UM, IT IS THE MOST COMMONLY
USED HERBAL PRODUCT IN CANADA.
SO, WE'RE GONNA TALK A LITTLE
BIT ABOUT ECHINACEA AND WHETHER
IT WORKS OR NOT.
ECHINACEA'S THE PURPLE CONE
FLOWER, AND THERE ARE ACTUALLY
THREE DIFFERENT SPECIES OF
ECHINACEA THAT IS AVAILABLE ON
THE CANADIAN MARKET.

The caption changes to “Echinacea.”

She continues ECHINACEA PURPUREA, ECHINACEA
ANGUSTIFOLIA, AND ECHINACEA
PALLIDA.
SO, WHEN I WAS WORKING AS A
PHARMACIST IN THE DRUGSTORE,
ONE OF THE MOST COMMON
QUESTIONS I USED TO GET FROM
PATIENTS WAS, WHICH TYPE OF
ECHINACEA SHOULD I TAKE?
WHICH ONE'S THE BEST?
THERE'S NO CLEAR EVIDENCE THAT
ONE SPECIES IS BETTER THAN
ANOTHER.
NOW, HAVING SAID THAT,
ECHINACEA ANGUSTIFOLIA IS THE
SPECIES THAT'S NATIVE TO NORTH
AMERICA.
AND IT HAS A VERY, LONG,
HISTORIC, TRADITION WITH NATIVE
PEOPLES HERE IN CANADA.
AND SO IF AN HERBALIST IS
TRAINED IN NORTH AMERICA,
THEY'RE MORE LIKELY TO
RECOMMEND THAT PARTICULAR
SPECIES.
ECHINACEA PURPUREA IS THE ONE
THAT'S MORE COMMONLY
RECOMMENDED UM, IN EUROPE,
ESPECIALLY IN GERMANY.
AND ECHINACEA PALLIDA DOESN'T
SEEM TO BE ANYBODY'S FAVOURITE,
BUT THERE ARE SOME GOOD STUDIES
TO SHOW THAT IT WORKS TOO.
AND OFTEN YOU'LL SEE PRODUCTS
THAT ARE COMBINED.
SO, THERE'S NO DEFINITIVE
EVIDENCE THAT ONE WORKS BETTER
THAN THE OTHER.
SO, HOW DOES ECHINACEA WORK?
WELL, THE EASY ANSWER TO THAT
IS WE DON'T REALLY KNOW.

The slide changes to “Most commonly used herb in Canada. How does it work? Stimulates the immune system in a non-specific way. Little or no direct antimicrobial action (i.e, it doesn’t kill anything!).”

She laughs and continues
WE DON'T EVEN
REALLY KNOW WHAT THE ACTIVE
INGREDIENTS IN ECHINACEA ARE.
ECHIN, HERBS ARE SO DIFFERENT
FROM DRUGS.
WITH A DRUG WE HAVE A CHEMICAL
STRUCTURE, AND AS A PHARMACIST
I HAD TO MEMORIZE FAR TOO MANY
OF THEM AND KNOW HOW ALL THE
MOLECULES WORK TOGETHER.
WITH AN HERB, THERE ARE ALL
KINDS OF DIFFERENT COMPOUNDS IN
THE HERB ITSELF AND WE HAVE TO
SORT OUT WHICH ONES ARE ACTIVE
AND AT WHAT QUANTITIES, AND
WHETHER THEY WORK TOGETHER
SYNERGISTICALLY AND ALL THOSE
KINDS OF THINGS.
THEY'RE VERY COMPLICATED.
SO, WITH ECHINACEA WE'RE NOT
SURE EXACTLY WHAT THE ACTIVE
INGREDIENTS ARE.
WE HAVE SOME IDEAS.
BUT IT'S PROBABLY NOT JUST ONE.
IT'S PROBABLY A WHOLE BUNCH.
WE KNOW THAT IT DOES SEEM TO
OVERALL THE IMMUNE SYSTEM.
AND BY THAT WHAT I MEAN IS IT
INCREASES THE NUMBERS OF CELLS
IN YOUR IMMUNE SYSTEM, AND IT
ALSO INCREASES THEIR ACTIVITY A
LITTLE BIT.
SO, FOR THOSE YOU THAT LIKE
SPECIFICS, IT INCREASES THE
SECRETION OF TUMINACHROSIS
FACTOR, IT INCREASES INTERLUKEN
ONE, IT INCREASES INTERLUKEN
SIX.
THESE KINDS OF THINGS, THAT ARE
VERY WELL, DOCUMENTED.
BUT THAT DOESN'T REALLY TELL US
VERY MUCH ABOUT OVERALL.
SO WHAT?
THERE'S A FEW MORE CELLS
RUNNING AROUND.
DOES THAT REALLY HAVE A
CLINICAL EFFECT IN THE HUMAN
BODY?
AND THAT'S THE QUESTION WE ALL
WANT ANSWERED.
ONE THING WE DO KNOW IS THAT
ECHINACEA DOES NOT DIRECTLY
KILL ANYTHING.
I'VE HEARD IT CALLED LIKE A
NATURAL ANTIBIOTIC.
IT'S NOT.
IT DOESN'T DIRECTLY KILL
ANYTHING ITSELF.
WHAT WE DO KNOW IS THAT ITS
EFFECTS DO SEEM TO BE MEDIATED
BY ITS EFFECT ON THE IMMUNE
SYSTEM, WHICH WE'RE STILL
LEARNING ABOUT.
WE DON'T REALLY UNDERSTAND VERY
WELL.
SO, THE MAIN THINGS THAT
ECHINACEA ARE USED FOR IS THE
TREATMENT OF COLDS AND FLUS AND
THE PREVENTION OF COLDS AND
FLUS.
SO, IF WE LOOK AT THE VIEW OF
THE SCIENTIFIC EVIDENCE.
AND RCT ON MY SIDE STANDS FOR
RANDOMIZED CONTROL TRIAL, AND,
AND, AND IN ALL MY SLIDES THESE
ARE RANDOMIZED PLACEBO CONTROL
TRIALS.

A new slide appears. It reads “Treatment of Colds/Flus. Review of evidence: 8 RCTs: 6 positive findings. Problems with quality of trials/different extracts/use of combination products.”

She continues SO, ESSENTIALLY WHAT THAT MEANS
IS TWO GROUPS OF PEOPLE.
IT WAS TOTALLY RANDOM WHICH
GROUP YOU ENDED UP IN.
HALF THE PEOPLE GOT THE PRODUCT
I'M TALKING ABOUT HALF THE
PEOPLE GOT AN INACTIVE PRODUCT.
NOBODY KNEW WHICH WAS WHICH.
WE DID A BUNCH OF TESTS AT THE
END AND WE GOT OUR RESULTS.
SO, THAT'S WHAT A RANDOMIZED
CONTROLLED TRIAL IS.
SO, SIX OF THE EIGHT TRIALS
WERE POSITIVE.
AND BY POSITIVE WHAT I MEAN IS
THAT THE PEOPLE SEEMED TAKING
ECHINACEA SEEMED TO HAVE
SHORTER DURATION OF THEIR COLD
OR THEIR FLU, AND THE SYMPTOMS
DIDN'T SEEM TO BE SO SEVERE.
HOWEVER, THE PEOPLE THAT DID
THIS REVIEW, WHICH IS THE, THE
COCHRANE COLLABORATION SAID
THAT THE QUALITY OF THE TRIALS
WASN'T VERY GOOD.
THERE WEREN'T VERY MANY PEOPLE
IN THESE TRIALS.
THEY DIDN'T RECORD WHAT THEY
DID VERY WELL, SO THE QUALITY
OF THE TRIALS WASN'T GREAT.
AND THEY ALL USED DIFFERENT
EXTRACTS OF ECHINACEA.
NOW I JUST FINISHED TELLING YOU
THAT WE DON'T KNOW FOR SURE
WHAT THE ACTIVE COMPONENTS OF
ECHINACEA ARE.
SO IF EVERYBODY USES A
DIFFERENT BRAND, IT'S LIKELY
THAT SOME BRANDS ARE GONNA BE
ACTIVE AND SOME AREN'T,
DEPENDING ON HOW THEY MAKE
THEM.
AND SO A STUDY THAT SHOWS
ECHINACEA WORKS DOESN'T MEAN
THAT ALL ECHINACEA PRODUCTS
WORK.
IT JUST MEANS THAT, THAT BRAND
WORKS.
WELL, THAT BATCH WORKS.
AND SAME AS THE STUDY THAT
SHOWS--

She air quotes and says ECHINACEA DOESN'T WORK.
SO, THAT'S A CHALLENGE WHEN
WE'RE LOOKING AT THIS RESEARCH.
AND SOME OF THESE STUDIES USE
COMBINATION PRODUCTS.
THEY HAD ECHINACEA IN THEM BUT
THEY HAD SOMETHING ELSE.
SO, THE CONCLUSION FROM THE
COCHRANE COLLABORATION IS THAT
PREPARATIONS CONTAINING
EXTRACTS OF ECHINACEA PROBABLY
CAN BE EFFECTIVE IN THE
TREATMENT OF COMMON COLDS.
BUT WITH THE PREVENTION OF
COLDS AND FLUS I HAVE A MORE
DEFINITIVE ANSWER FOR YOU.
SO, FIVE RANDOMIZED CONTROLLED
TRIALS WERE REVIEWED BY THE
COCHRANE COLLABORATION, AND
THEY FOUND FOUR OF THOSE TRIALS
THAT THERE WAS NO SIGNIFICANT
DIFFERENCE BETWEEN PEOPLE THAT
TOOK ECHINACEA AND PEOPLE THAT
TOOK PLACEBO.
NOW THESE ARE, WHEN I SAY
PREVENTION THESE ARE THE PEOPLE
THAT TAKE ECHINACEA ALL YEAR
ROUND AND CLAIM THAT SINCE
THEY'VE BEEN DOING THAT THEY
HAVEN'T HAD A COLD OR FLU.
WELL, I'M REALLY GLAD THEY
HAVEN'T HAD A COLD OR FLU.
IT'S PROBABLY NOT THE ECHINACEA
THAT THEY'RE TAKING.
SINCE THAT REVIEW WAS DONE
THERE WERE TWO MORE NEGATIVE
STUDIES, WHICH ALSO SHOWED THAT
ECHINACEA DOESN'T SEEM TO
PREVENT COLDS AND FLUS.

The slate changes to “Prevention of Colds/Flus. Current evidence from clinical trials suggests that prophylactic ingestion of Echinacea is unlikely to result in a clinically significant reduction of the incidence, severity or duration of the common cold. However, larger clinical trials are necessary to confirm these findings (www.CAMline.org).”

She continues SO, RIGHT NOW MY RECOMMENDATION
TO A PATIENT IS OKAY, IF YOU
FEEL A COLD OR FLU COMING ON
AND YOU WANT TO TRY ECHINACEA,
IT MIGHT BE WORTH A TRY.
BUT THERE'S NO REASON TO TAKE
ECHINACEA FOR LONG PERIODS OF
TIME TO PREVENT COLDS AND FLUS.
WE HAVE PRETTY GOOD EVIDENCE
THAT THAT'S A WASTE OF MONEY.
IT DOESN'T WORK FOR THAT.
NOW, ECHINACEA IS ACTUALLY A
REALLY, SAFE HERB.
THERE ARE VERY FEW CAUTIONS
ASSOCIATED WITH IT.
THE ONE THING THAT WE'RE A
LITTLE BIT CONCERNED ABOUT ARE
PEOPLE THAT HAVE AUTO IMMUNE
CONDITIONS OR IMMUNE
DYSFUNCTION.

The slide changes to “Echinacea: cautions. Should be used with caution by people with chronic immune dysfunction and autoimmune conditions.”

She continues REMEMBER HOW I TOLD YOU HOW WE
THINK IT WORKS?
IT AFFECTS THE IMMUNE SYSTEM.
IT INCREASES THE NUMBER OF
CELLS.
SOME OF THE IMMUNE CELLS AND IT
INCREASES SOME OF THEIR
ACTIVITY.
IF YOUR IMMUNE SYSTEM IS
ALREADY NOT WORKING PROPERLY,
WE'RE A BIT WORRIED THAT
ECHINACEA MIGHT CAUSE IT TO,
YOUR SYMPTOMS TO WORSEN.
NOW HAVING SAID THAT, THERE ARE
NO CASES IN THE LITERATURE
WHERE WE KNOW FOR SURE THIS HAS
HAPPENED.
IF YOU ARE A PERSON THAT HAS
ONE OF THESE CONDITIONS LIKE
LUPUS OR RHEUMATOID ARTHRITIS,
I RECOMMEND AT THIS POINT THAT
YOU DEFINITELY DON'T TAKE
ECHINACEA FOR LONG PERIODS OF
TIME.
IT'S NOT COMPLETELY CONTRA
INDICATED TO TAKE IT FOR SHORT
PERIODS OF TIME, TEN TO
FOURTEEN DAYS MAXIMUM TO TREAT
A COLD OR FLU.
BUT IF YOU FEEL YOUR SYMPTOMS
GETTING WORSE, PLEASE LET YOUR
PHARMACIST AND OR YOUR DOCTOR
KNOW, BECAUSE IT'S REALLY
IMPORTANT FOR US TO, TO FIND
OUT WHETHER THIS IS SOMETHING
THAT'S A REAL CONCERN FOR
PEOPLE, OR JUST A THEORETICAL
CONCERN THAT WE TELL PEOPLE
ABOUT, BUT WE DON'T REALLY HAVE
TO WORRY.
ADVERSE REACTIONS OR ADVERSE
EFFECTS WITH ECHINACEA ARE
UNCOMMON, BUT IT'S POSSIBLE TO
BE ALLERGIC TO ECHINACEA.
ECHINACEA'S IN THE RAGWEED
FAMILY.
NOW THOSE OF YOU THAT HAVE
RAGWEED ALLERGIES, YOU'RE
USUALLY ALLERGIC TO THE POLLEN
WHEN YOU INHALE IT.
MOST ECHINACEA, ECHINACEA
PRODUCTS DON'T HAVE ANY POLLEN
IN THEM, AND WHEN YOU INGEST IT
YOU DON'T USUALLY HAVE A
REACTION EVEN IF YOU ARE
ALLERGIC TO UM, THE POLLEN.
NOW, HAVING SAID THAT, IF YOU
HAVE A SEVERE, RAGWEED ALLERGY,
I WOULD THINK IT'S MORE LIKELY
THAT YOU'RE ALLERGIC TO
ECHINACEA.
AND THERE'S A COUPLE OF PEOPLE
THAT HAVE HAD ANAPHYLACTIC
SHOCK REACTION TO TAKING
ECHINACEA.
SO, SOME OF THEM ACTUALLY HAD
TROUBLE BREATHING THEY'RE SO
ALLERGIC TO IT.
SO, REMEMBER ALL OF THESE
HERBS, IT'S POSSIBLE TO BE
ALLERGIC TO THEM.
JUST LIKE IT'S POSSIBLE TO BE
ALLERGIC TO DUST AND ALL KINDS
OF OTHER NATURAL, THINGS.
SO, JUST KEEP THAT IN MIND.
HOW MUCH DO YOU NEED TO TAKE?
WELL, IF YOU'RE TAKING IT FOR
TREATMENT TAKE AT LEAST ONE
GRAM A DAY AND MOST PEOPLE TAKE
IT IN DIVIDED DOSES.
SO, THEY TAKE IT UM, TWO OR
THREE TIMES A DAY TO A TOTAL OF
AT LEAST A GRAM.
ANYONE KNOW WHAT THIS ONE IS?

A slide shows a tree and a few leaves.

She continues GINKGO.
YOU GUYS ARE GOOD.
MOST OF MY AUDIENCES CAN'T TELL
IF THEY DON'T GET THIS ONE.
IT'S THE LEAVES OF THE GINKGO
TREE, WHICH ARE USED
MEDICINALLY.
AND WITH GINKGO, GINKGO IS
ACTUALLY ONE OF THE OLDEST
DECIDUOUS TREES STILL AROUND ON
THE EARTH TODAY.
INDIVIDUAL GINKGO TREES CAN
LIVE UP TO 1,000 YEARS OR
LONGER.
AND SO OF COURSE THAT'S WHY
THERE ARE ALL KINDS OF CLAIMS
THAT IF YOU TAKE GINKGO YOU'RE
GONNA LIVE, MAYBE NOT A
THOUSAND YEARS, BUT LONGER THAN
IF YOU DIDN'T TAKE GINKGO.
AND I MUST SAY THERE'S NO
SCIENTIFIC EVIDENCE TO SUPPORT
THAT ONE.
SO, UM, UNLIKE ECHINACEA, WITH
GINKGO WE DO IN FACT KNOW WHAT
THE ACTIVE INGREDIENTS ARE.
IS THERE THE GINKGOFLAVONE
GLYCOSIDES AND THE TERPENOIDS.
SO, WITH GINKGO I ONLY
RECOMMEND YOU PURCHASE A
STANDARDIZED EXTRACT.
WHAT I MEAN BY STANDARDIZED
EXTRACT IS IF A COMPANY HAS
GONE TO THE TROUBLE OF
MEASURING HOW MUCH OF THESE
ACTIVE COMPONENTS ARE IN THE
BOTTLE, IN, IN THE PRODUCT.

The slide changes to “Ginkgo (Ginkgo biloba. Active constituents: ginkoflavone glycosiders and terpenoids.”

She continues SO, YOU WANT SOMETHING THAT'S
24 TO 26 percent GINKGOFLAVONE
GLYCOSIDES AND SIX OR SEVEN
PERCENT TERPENOIDS.
ALL THE SCIENTIFIC STUDIES I'M
GOING TO TELL YOU ABOUT WERE
DONE ON THESE STANDARDIZED
EXTRACTS, AND THERE ARE VARIOUS
DIFFERENT BRANDS THAT MAKE THE
STANDARDIZED EXTRACT.
AH, THE KEY IS IT HAS TO BE
STANDARDIZED TO WHAT WE KNOW IS
THE ACTIVE INGREDIENT IN THIS
PRODUCT.
SO, HOW DOES THIS ONE WORK?
WELL, WE KNOW IT INCREASES
CIRCULATION, QUITE DRAMATICALLY
ACTUALLY.
IT INCREASES BLOOD FLOW TO YOUR
BRAIN AND TO YOUR EXTREMITIES,
TO YOUR FINGERS AND YOUR TOES,
AND IT DOES THAT QUITE QUICKLY.
WITHIN AN HOUR OF TAKING GINKGO
WE CAN MEASURE INCREASED BLOOD
FLOW UNDER YOUR NAIL BEDS.
IT ALSO IS AN ANTIOXIDANT AND
WE DON'T KNOW EXACTLY HOW THAT
PLAYS INTO HOW IT WORKS IN THE
BODY, BUT IT IS AN ANTIOXIDANT.
THAT'S THOUGHT TO BE A GOOD
THING.
IT ALSO INHIBITS PLATELET
ACTIVE OR AGGREGATING FACTOR,
AND THE REASON THAT'S IMPORTANT
IS THAT IT AFFECTS YOUR BLOOD'S
ABILITY TO CLOT.
SO, WHEN WE TALK ABOUT CAUTIONS
WITH GINKGO I'M GONNA COME BACK
TO THIS.
SO, WHAT'S IT USED FOR?

A slide appears under the title “Vascular Dementia (e.g., Alzheimer’s Disease.”

She continues THE NUMBER ONE THING THAT
GINKGO IS USED FOR IS DIFFERENT
TYPES OF VASCULAR DEMENTIAS.
SO A DEMENTIA IS WHERE YOU
START TO LOSE YOUR MEMORY OR
YOUR COGNITIVE ABILITIES.
AND ONE OF THE MOST COMMON
TYPES OF VASCULAR DEMENTIAS
THAT YOU'VE PROBABLY ALL HEARD
OF, IS ALZHEIMER'S DISEASE.
SO, EZRA ERNST AND MAX PITTLER
FROM THE UNITED KINGDOM DID A
REVIEW OF ALL THE STUDIES THAT
TRIED TO FIND OUT IF GINKGO
WOULD BE HELPFUL FOR PEOPLE
WITH THIS TYPE OF CONDITION.
THEY FOUND NINE RANDOMIZED
CONTROLLED TRIALS, AND THEIR
CONCLUSION WAS THAT OVERALL
GINKGO SEEMS TO BE MORE
EFFECTIVE THAN PLACEBO IN
DELAYING THE CLINICAL COURSE OF
THESE CONDITIONS.
SO, THAT'S A GOOD THING.
IT, IT, BUT THE THING TO KEEP
IN MIND HERE IS THAT IT'S NOT A
CURE.
IT DOESN'T STOP THE
PROGRESSION.
THE DISEASE IS EVENTUALLY GOING
TO GET WORSE.
BUT IT MAY SLOW THE PROGRESSION
OF THE CONDITION.
AND THE OTHER THING TO KEEP IN
MIND IS THAT IT IS NOT
SOMETHING, WHICH BRINGS THE
PERSON BACK TO NORMAL.
ALTHOUGH WE CAN MEASURE CHANGES
IN THEIR MEMORY AND THEIR
COGNITIVE ABILITY WHEN THEY
START TAKING GINKGO, IT'S NOT A
DRAMATIC CHANGE.
UM, WE DO THIS TEST, CALLED THE
ALZHEIMER'S DISEASE ASSESSMENT
SCALE.
AND IT'S ONLY A THREE PERCENT
CHANGE.
SO, IT'S MEASURABLE, BUT IT'S
NOT A HUGE CHANGE.
SO YOU NEED TO BE REALISTIC
ABOUT THIS.
THE OTHER THING THAT THIS IS
USED FOR IS PERIPHERAL ARTERIAL
OCCLUSIVE DISEASES.
SO THESE ARE UM, CIRCULATORY
CONDITIONS AND THERE'S SEVERAL
DIFFERENT KINDS.
THE ONE THAT'S BEEN MOST
STUDIED IS CALLED INTERMITTENT
CLAUDICATION.
IT HAS TO DO WITH YOUR BLOOD
FLOW, USUALLY IN YOUR LEGS.
AND PEOPLE THAT HAVE THIS
CONDITION HAVE TROUBLE WALKING.
IT ACTUALLY IS PAINFUL.
SO, WHAT WE MEASURE WHEN WE DO
STUDIES, IS IF WE GIVE PEOPLE
GINKGO OR WE GIVE PEOPLE
PLACEBO AND WE MEASURE PAIN
FREE WALKING DISTANCE.
HOW FAR CAN THEY WALK WHEN
THEY'RE ON A PLACEBO, AND HOW
FAR CAN THEY WALK WHEN THEY'RE
ON GINKGO WITHOUT ANY PAIN.
SO, WHEN WE LOOK AT THIS, WE
FOUND EIGHT RANDOMIZED
CONTROLLED TRIALS, AND AGAIN
GINKGO IS BETTER THAN PLACEBO.
IN FACT IN THIS CASE, GINKGO IS
PRETTY DARN GOOD.
IT MAKES A HUGE DIFFERENCE.
AND IT'S ACTUALLY BECOME THE
MOST, COMMON, FIRST LINE
THERAPY FOR INTERMITTENT
CLAUDICATION IN EUROPE, IN MANY
EUROPEAN COUNTRIES.
IT'S MUCH BETTER AS FAR AS SIDE
EFFECT PROFILE THAN
CONVENTIONAL MEDICATIONS THAT
ARE OFTEN USED TO TREAT THIS
PARTICULAR CONDITION.
SO, GINKGO DOES WORK FOR SOME
THINGS.
WHAT ABOUT ITS' CAUTIONS?
WELL, ADVERSE EFFECTS ARE RARE.
THE MOST COMMON THING YOU SEE
WITH GINKGO IS HEADACHE OR
DIGESTIVE UPSET.

A slide shows the points she describes.

She continues HEADACHES BECAUSE IT'S A
VASCULAR HEADACHE.
YOU'RE ACTUALLY INCREASING
BLOOD FLOW TO THE BRAIN AND
THAT CAN CAUSE A HEADACHE.
SO, WHAT YOU DO IN THAT CASE IS
YOU START WITH A LOW DOSE OF
GINKGO AND YOU SLOWLY TRY TO
GET UP TO THE RECOMMENDED DOSE.
OR IF YOU'VE ALREADY GOT THE
HEADACHE, YOU DROP YOUR DOSE
AND THEN SLOWLY BRING IT BACK
UP AGAIN.
ONE OF THE THINGS I SHOULD HAVE
MENTIONED WHEN I WAS TALKING
ABOUT MEMORY, LOTS OF PEOPLE
ASK ME WILL GINKGO ENHANCE MY
MEMORY IF I DON'T ALREADY HAVE
MEMORY IMPAIRMENTS?
THERE HAVEN'T BEEN A LOT OF
STUDIES, BUT GENERALLY IT SEEMS
TO SHOW NOT MUCH EFFECT.
SO UM, IF YOU DON'T ALREADY
HAVE MODERATE TO SEVERE MEMORY
IMPAIRMENT, YOU PROBABLY WON'T
SEE ANY DIFFERENCE IF YOU TAKE
GINKGO.
FORGETTING WHERE YOUR KEYS ARE
IN THE MORNING DOESN'T COUNT AS
MODERATE MEMORY IMPAIRMENT.
ONE THING YOU NEED TO WORRY A
LITTLE BIT ABOUT WITH GINKGO IS
OTHER ANY MEDICATIONS THAT YOU
MIGHT BE TAKING, THAT MAKE YOUR
BLOOD UM, LESS LIKELY TO CLOT,
OR THINNER, AS SOME PEOPLE USE
THE TERM.
SO THAT WOULD BE THINGS LIKE
ASA OR WARFARIN.
GINKGO DOES THE SAME THING AND
SO YOU'RE LIKELY TO HAVE AN
ADDITIVE EFFECT, AND SO WE DO
ASK THAT YOU USE CAUTION AND IF
YOU'RE TAKING ANY OF THESE
THINGS YOU DON'T TAKE GINKGO
UNLESS YOU TALK TO YOUR DOCTOR.
HOW MUCH GINKGO SHOULD YOU
TAKE?
IT DEPENDS.
ANYWHERE BETWEEN 40 AND 60
MILLIGRAMS OF GINKGO BILOBA
EXTRACT.

A slide reads “Dosing regimen: 60 mg of GBE 2 to 4 times daily. (GBE= Ginkgo biloba extract standardized to 24 percent flavones glycosides and 6 percent terpenoids.”

She continues REMEMBER I TALKED IN THE
BEGINNING THAT YOU WANTED TO
BUY THE STANDARDIZED EXTRACT?
SO, YOU NEED TO TAKE THAT TWO
TO FOUR TIMES A DAY, AND YOU
TAKE IT REGULARLY.
THIS ONE IS?

A yellow flower appears on a slide.

A member of the audience says SAINT JOHN'S WORT.

Heather says OH, THE, THE
NAME'S RIGHT ON THE PICTURE,
SAINT JOHN'S WORT.
SAINT JOHN'S WORT HAS BEEN
RESEARCHED A LOT, BEEN IN THE
PRESS A LOT.
HOW DOES THIS ONE WORK?
WELL, THIS ONE'S PRIMARILY USED
AS AN ANTIDEPRESSANT AND IT,
WHAT IT DOES WE THINK IS THAT
IT INFLUENCES THE LEVELS OF
SEROTONIN IN YOUR, IN YOUR
BRAIN.
AND IT ALSO AFFECTS THE
SEROTONIN RECEPTORS IN YOUR
BRAIN.
IT PROBABLY DOES OTHER THINGS
AS WELL.
IT DOESN'T JUST DO THIS, AND
THERE'S LOTS OF RESEARCH GOING
ON ABOUT SAINT JOHN'S WORT,
BECAUSE DRUG COMPANIES WANT TO
FIND OUT HOW IT WORKS, CAUSE
THEY THINK IF THEY CAN FIND OUT
IF IT WORKS BY A WHOLE
DIFFERENT MECHANISM OF ACTION
THAN OUR CONVENTIONAL
ANTIDEPRESSANTS, THEY CAN
SYNTHESIZE NEW MOLECULES THAT
WILL DO THE SAME SORT OF THING.
UM, THE DOSE DEPENDS ON WHAT
KIND OF EXTRACT YOU GET.
SO, SAINT JOHN'S WORT IS ANOTHER
THING THAT I RECOMMEND ONLY
BUYING STANDARDIZED EXTRACTS.
LOTS OF RESEARCH ON ST. JOHN'S
WORT, ALL WITH THE STANDARDIZED
EXTRACTS.
BUT IN THE CASE OF SAINT JOHN'S
WORT THERE'S CONTROVERSY OVER
WHAT ARE THE ACTIVE COMPONENTS,
AND IT LOOKS LIKE THERE'S
SEVERAL DIFFERENT ONES.
SO, HYPERICUM IS AN ACTIVE
COMPONENT, AND SO YOU WILL SEE
PRODUCTS STANDARDIZED TO
USUALLY ABOUT .3 PERCENT HYPERICUM,
AND THOSE HAVE BEEN PROVEN TO
BE ACTIVE, AS HAVE ONES THAT
ARE STANDARDIZED TO HYPERFORIN
CONTENT.
AND USUALLY IT'S ABOUT TWO TO
FIVE PERCENT HYPERFORIN
CONTENT.

A new slide appears. It reads “Saint John’s Wort (Hypericum perforatum). Extensively researched. How does it work? Influences serotonin levels and receptors in the brain. Dose: 300mg 3 times a day or 250mg 2 times a day. Products standardized to hypericin or hyperforin.”

She continues SO IF YOU'RE GETTING A
HYPERICUM BASED PRODUCT,
USUALLY ITS DOSED 300
MILLIGRAMS THREE TIMES A DAY.
AND IF YOU'RE GETTING A
HYPERFORIN STANDARDIZED
PRODUCT, USUALLY ITS 250
MILLIGRAMS TWO TIMES A DAY BUT
IT VARIES.
AND SOME COMPANIES NOW ARE
STANDARDIZED TO BOTH, SO READ
THE LABELS AND FOLLOW THEM.
BUT DO GET A STANDARDIZED
PRODUCT.
THE THING WITH ST. JOHN'S WORT
LIKE MANY HERBS IS THAT BOTH OF
THESE THINGS ARE ACTIVE.
IT'S NOT JUST ONE.
AND IN FACT, IN ONE CITY WHERE
THEY JUST GAVE PEOPLE PURE
HYPERICUM THEY SAID IT DIDN'T
WORK.
SO OBVIOUSLY THERE ARE LOTS OF
DIFFERENT COMPOUNDS WITHIN THE
PLANT, WHICH IS WHY WE NEED TO
USE THESE EXTRACTS.
SO DOES IT WORK?
WELL, A REVIEW OF 27 RANDOMIZED
CONTROLLED TRIALS, THIS WAS
DONE IN 1998.
SO THERE WERE 27 IN 98, THERE'S
PROBABLY ALMOST 50 BY NOW,
FOUND THAT SAINT JOHN'S WORT
OVERALL HAS BEEN DETERMINED TO
BE MORE EFFECTIVE THAN PLACEBO
FOR THE SHORT TERM TREATMENT OF
MILD TO MODERATE DEPRESSION.
AND THAT'S ACTUALLY REALLY
IMPORTANT.
MOST OF THESE TRIALS WEREN'T
VERY LONG.
MANY OF THEM WERE SIX TO EIGHT
WEEKS ONLY.
ANYONE THAT KNOWS ANYONE THAT'S
BEEN DIAGNOSED WITH DEPRESSION,
KNOW THAT USUALLY YOU'RE ON
MEDICATION FOR A LOT LONGER
THAN THAT.
UM, SO WE NEED TO KEEP THAT IN
MIND.
THE OTHER THING WE NEED TO KEEP
IS THAT THIS IS WITH PEOPLE
THAT HAVE MODERATE OR MILD
DEPRESSION.
PEOPLE THAT HAVE MORE SEVERE
DEPRESSION, THE EVIDENCE IS NOT
SO GOOD.
SO THIS IS FOR MILD TO MODERATE
DEPRESSION.
IT HAS BEEN COMPARED WITH
CONVENTIONAL ANTIDEPRESSANTS.
SO, THIS IS AN EXAMPLE OF A
STUDY WHERE SAINT JOHN'S WORT WAS
COMPARED WITH IMIPRAMINE, WHICH
IS A CONVENTIONAL TRICYCLIC
ANTIDEPRESSANT.
AND THEY FOUND THAT SAINT JOHN'S
WORT WAS AS EFFECTIVE AS THE
CONVENTIONAL ANTIDEPRESSANTS,
AND THAT PATIENTS GENERALLY
LIKED SAINT JOHN'S WORT BETTER
BECAUSE IT DIDN'T HAVE AS MANY
ADVERSE EFFECTS.

The caption changes to “Saint John’s Wort: Efficacy. Review of the evidence (27 trails in 1998) SJW is more effective than placebo for the short-term treatment of mild to moderately severe depressive disorders (Cochrane Collaboration). Woek, BMJ 321 (2): 536-539,2000. SJW (250mg 2 times a day) versus imipramine (75mg 2 times a day). SJW appears to be as effective as imipramine; patients tolerate SJW better.”

She continues THERE'S ALSO STUDIES COMPARING
IT TO SELECTIVE SEROTONIN
UPTAKE INHIBITORS, UM, WHICH
ARE ANOTHER CLASS OF
CONVENTIONAL ANTIDEPRESSANTS.
THIS ONE'S COMPARED TO
FLUOXETINE.
SIX WEEKS OF TREATMENT, NO
SIGNIFICANT DIFFERENCE BETWEEN
THE TWO GROUPS ON THE HAMILTON
DEPRESSION SCALES, SCORES,
WHICH IS WHAT WE USE A LOT WHEN
WE'RE DOING THESE TYPES OF
TRIALS.
AND AGAIN, FEWER ADVERSE
AFFECTS WITH SAINT JOHN'S WORT.
HOWEVER, AS I SAID EARLIER,
THERE HAVE BEEN TWO RECENT,
VERY LARGE TRIALS ACTUALLY THAT
LOOKED AT SAINT JOHN'S WORT AND
FOUND THAT IT WAS NOT EFFECTIVE
IN THE TREATMENT OF SEVERE
DEPRESSION.
SO, IT'S VERY, VERY IMPORTANT
TO NOTE UM, AND TO TALK THIS
OVER WITH YOUR DOCTOR IF YOU'RE
INTERESTED IN THINKING ABOUT
SAINT JOHN'S WORT.
SO, CURRENTLY WE ONLY RECOMMEND
SAINT JOHN'S WORT FOR INDIVIDUALS
THAT HAVE BEEN DIAGNOSED WITH
MILD TO MODERATE DEPRESSION.
SO, I SAID THAT MANY PEOPLE
LIKE ST. JOHN'S WORT BECAUSE IT
DIDN'T HAVE AS MANY SIDE
EFFECTS AS CONVENTIONAL
ANTIDEPRESSANTS.
DOES THAT MEAN SAINT JOHN'S WORT
DOESN'T HAVE ANY SIDE EFFECTS?
UNFORTUNATELY, NO.
IT HAS LOTS OF SIDE EFFECTS.
MANY OF THESE ADVERSE EFFECTS
ARE SIMILAR TO THE KINDS OF
ADVERSE EFFECTS YOU GET FROM
OTHER ANTIDEPRESSANTS.

The caption changes to “Saint John’s Wort Adverse Effects. Adverse Effects: agitation, dizziness/confusion, fry mouth, gastrointestinal complaints, headache, nausea, sedation, anxiety, hypomania, photosensitivity, reversible liver enzyme elevations.”

She continues ONE OF THE THINGS I'VE
UNDERLINED THOUGH IS
PHOTOSENSITIVITIES.
SAINT JOHN'S WORT TENDS TO MAKE
YOU MORE SENSITIVE TO THE SUN.
OTHER ANTIDEPRESSANTS DON'T DO
THAT.
YOU KNOW THIS WAS ACTUALLY
DISCOVERED IN COWS.
COWS GRAZING ON ST. JOHN'S WORT
IN THE FIELD.
I'M NOT SURE WHAT A SUNBURNED
COW LOOKS LIKE.

Heather and the audience laugh.

Heather continues I DON'T WANT
TO KNOW PROBABLY.
BUT THERE WAS ALSO CASES IN
HUMANS.
UM, THE OTHER THING TO KEEP IN
MIND IS THAT ONE OF THE THINGS
THAT'S NOT ON THIS LIST, IS UM,
IMPOTENCE OR PROBLEMS WITH
SEXUAL FUNCTIONING.
MANY ANTIDEPRESSANTS DO CAUSE
THAT AS AN ADVERSE EFFECT, AND
SAINT JOHN'S WORT DOESN'T.
SO THAT'S WHY SOME PEOPLE ARE
INTERESTED IN TRYING THIS
PARTICULAR PRODUCT.
BUT I REALLY MUST STRESS, YOU
CAN'T JUST SWITCH FROM A
COMMERCIAL ANTIDEPRESSANT TO
SAINT JOHN'S WORT WITHOUT TALKING
TO YOUR DOCTOR, CAUSE IT HAS TO
BE, YOU HAVE TO STOP ONE SLOWLY
AND START THE OTHER ONE.
SO, DON'T JUST STOP AND START.
DEFINITELY TALK TO YOUR DOCTOR.
THE OTHER THING YOU NEED TO
KEEP IN MIND IS SAINT JOHN'S WORT
WE KNOW HAS A HOST OF DRUG
INTERACTIONS.
SO, THESE ARE DRUGS THAT SAINT
JOHN'S WORT HAS BEEN DOCUMENTED
TO INTERACT WITH.
DIGOXIN, WHICH IS A HEART
MEDICATION, AND IT DECREASES
DIGOXIN LEVELS SO THAT THE DRUG
IS NO LONGER EFFECTIVE.
HIV-1 PROTEASE INHIBITORS.
THESE ARE THE DRUGS THAT PEOPLE
THAT ARE HIV POSITIVE TAKE TO
HELP THEM, PREVENT THEM FROM
MOVING ONTO FULL BLOWN AIDS.
AND AGAIN IT DECREASES THE
LEVEL OF THE DRUG SO THAT IT'S
NOT EFFECTIVE.
IT INTERACTS WITH A VARIETY OF
ANTIDEPRESSANTS.
IT INTERACTS WITH CYCLOSPORIN,
WHICH IS A DRUG THAT PEOPLE
THAT HAVE HAD ORGAN
TRANSPLANTS, THEY TAKE SO THAT
THEIR BODY DOESN'T REJECT THE
ORGAN.
THERE ARE ALMOST 35 CASE
REPORTS IN THE LITERATURE,
WHICH FOUND THAT PEOPLE STARTED
TO REJECT THEIR ORGANS, THEIR
DONATED ORGANS, WHEN THEY
STARTED TAKING SAINT JOHN'S WORT
AT THE SAME TIME, SO, DRAMATIC.
UM, ORAL CONTRACEPTIVES.
SOME OF YOU MAY WANT TO KNOW
THAT SAINT JOHN'S WORT DECREASES
THE EFFECTIVENESS OF THE BIRTH
CONTROL PILL.
WE HAD SEVERAL CASES OF BREAK-
THROUGH BLEEDING AND TWO
PREGNANCIES IN TORONTO BECAUSE
OF THIS, SO KEEP THAT IN MIND.
THEOPHYLLINE IS A DRUG TO HELP
YOU BREATH AND AGAIN IT
DECREASES THE LEVELS, AND
WARFARIN, IT DECREASES THE, UM,
THE, THE EFFECTS OF WARFARIN AS
WELL.
IT DOES THIS BECAUSE WHAT IT
DOES IS SAINT JOHN'S WORT CAUSES
YOUR BODY TO METABOLIZE ALL
THESE DRUGS FASTER.
IT INDUCES A SET OF ENZYMES IN
THE LIVER CALLED THE CYTOCHROME
P450 SYSTEM.
AND SO, WHAT ANYTHING THAT ANY
DRUG THAT'S METABOLIZED THROUGH
THAT PATHWAY IT'S GONNA HAVE AN
INTERACTION WITH ST. JOHN'S
WORT.
WE THINK IT MIGHT ALSO INTERACT
WITH ANASTHETICS, OR ANY OTHER
DRUGS THAT CAUSE
PHOTOSENSITIZATION.

A slide shows the points mentioned.

She continues SO, BOTTOM LINE WITH SAINT JOHN'S
WORT IS YES, IT'S POTENTIALLY
EFFECTIVE IN MILD TO MODERATE
DEPRESSION.
IT DOESN'T MEAN THAT IT'S
PERFECTLY SAFE.
IT MAY BE AN OPTION FOR YOU,
BUT DEFINITELY IT'S SOMETHING
THAT YOU NEED TO TALK TO
SOMEONE ABOUT.
A DOCTOR OR PHARMACIST.
IT'S NOT SOMETHING YOU SHOULD
JUST START TAKING ON YOUR OWN.
SO, MY BOTTOM LINE TIPS FOR
PATIENTS.
PLEASE, ALWAYS TELL YOUR
DOCTORS, YOUR PHARMACISTS, ALL
YOUR HEALTHCARE PROVIDERS ABOUT
THE HERBS THAT YOU'RE TAKING.
AND I HOPE YOU UNDERSTAND THEY
CAN INTERACT WITH OTHER
MEDICATIONS THAT YOU MIGHT BE
TAKING.
OTHER THINGS THAT CAN HAPPEN IS
YOU MIGHT BE DOING FAR BETTER
THAN YOUR DOCTOR OR YOUR
PHARMACIST EXPECTS.
AND IT MIGHT BE BECAUSE OF THE
HERBS YOU'RE TAKING AND THEY
NEED TO KNOW THAT.
YOU MIGHT ALSO HAVE A WEIRD,
ADVERSE EFFECT THAT NO ONE
EXPECTED, AND THAT MIGHT BE
BECAUSE OF THE HERBS.
SO, IT JUST HELPS ALL OF US IF
EVERYONE KNOWS WHAT YOU'RE
TAKING.
UM, REMEMBER THAT HERBS
ALTHOUGH THEY CAN BE
BENEFICIAL, DO HAVE THE
POTENTIAL TO INTERACT WITH
DRUGS, NUTRIENTS AND OTHER
HERBS.

(music plays)

A slate pops up. It reads “For more information about Mini-Med School at the University of Toronto visit us on the web at: www.tvo.org.”

The end credits roll.

Mini-Med School Producer, Wodek Szemberg.

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Copyright The Ontario Educational Communications Authority 2003.

Watch: Alternative Medicine: What Works, What Doesn't