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Natural remedies ‘potentially harmful’


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#1 doug123

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Posted 25 July 2007 - 03:00 AM


The National Post ran a story yesterday called: Natural remedies ‘potentially harmful’ that reported on findings of a recent Annals of Pharmacotherapy study called: Community Identification of Natural Health Product-Drug Interactions.

Let me please provide some introductory information regarding the primary source of evidence:

What is The Annals of Pharmacotherapy?
The Annals of Pharmacotherapy is a monthly medical journal for pharmacists, physicians, and other healthcare providers. It publishes articles promoting the safe, effective, and economical use of medications. The Annals has been published for over 40 years and is a trusted source of the newest medication-related information. The journal is independent of any society or organization that could bias its content.


Here is the abstract:

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Published Online, 19 June 2007, www.theannals.com, DOI 10.1345/aph.1H463.
The Annals of Pharmacotherapy: Vol. 41, No. 7, pp. 1124-1129. DOI 10.1345/aph.1H463
© 2007 Harvey Whitney Books Company.

COMPLEMENTARY AND ALTERNATIVE MEDICINE
Community Identification of Natural Health Product-Drug Interactions
Theresa L Charrois, BScPharm MSc
Research Associate, CARE Program, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada

Richard L Hill, MB BS

Deputy Director, Adverse Drug Reactions Unit, Therapeutic Goods Administration, Woden, Australia

Duc Vu, MSc PhD

Director, Bureau of Cardiology, Allergy and Neurological Sciences, Therapeutic Products Directorate, Health Canada, Ottawa, Canada

Brian C Foster, PhD

Senior Science Advisor, Therapeutic Products Directorate, Health Canada

Heather S Boon, BScPharm PhD

Associate Professor, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada

Kristie Cramer, MSc

Research Associate, CARE Program, Department of Pediatrics, University of Alberta

Sunita Vohra, MD MSc

Director, CARE Program; Associate Professor, Department of Pediatrics, University of Alberta

Reprints: Dr. Vohra, University of Alberta, 8213 Aberhart Centre #1, 11402 University Ave., Edmonton, AB T6G2J3, Canada, fax 780/492-2105, svohra@ualberta.ca

BACKGROUND: The majority of Canadians use natural health products (NHPs), most of which are purchased in pharmacies. Community pharmacists regularly field inquiries regarding NHPs. As such, pharmacists are ideally placed to answer questions about NHP use and interactions with other medications.

OBJECTIVE: To identify community pharmacists' familiarity with NHPs and NHP-related adverse events (AEs) and their knowledge and ability to counsel on potential and known NHP-drug interactions.

METHODS: Survey questions were derived from a literature review of previous surveys, data collected from Health Canada, and in consultation with clinicians, pharmacists, policy-makers, and researchers. A convenience sample of 321 community pharmacists in Alberta and British Columbia were asked to participate.

RESULTS: We received responses from 132 pharmacists, resulting in a response rate of 41% (132/321). A total of 19% of the sample had previously reported an adverse event to Health Canada. When asked specifically about NHP-drug interactions/AEs, 47% of pharmacists stated that they had identified a potential interaction; however, only 2 of these reported it to Health Canada. Pharmacists were most familiar (76% of respondents) with the interaction between sertraline and St. John's wort and were least familiar with interactions between NHPs and anti-retrovirals.

CONCLUSIONS: This survey provides evidence to suggest that pharmacists encounter reportable NHP-drug interactions, yet rarely choose to report these events. The current lack of available data on NHP AEs makes it difficult to provide patients and healthcare providers with useful strategies for managing AEs and drug interactions. Changes to the current system of monitoring AEs due to NHPs and further education of healthcare professionals regarding NHP-drug interactions is required.

Key Words: community pharmacy services, herbal-drug interactions

Published Online, June 19, 2007. www.theannals.com, DOI 10.1345/aph.1H463

Copyright © 2007 by Harvey Whitney Books Company.


Without angering the publishers too much (I hope!) -- please enjoy an additional excerpt from the full text:

Finally, with regard to suspected NHP-drug interactions, pharmacists were not asked to provide details about the specific events. We therefore do not know the severity of the events, nor do we have sufficient data to confirm a potential causal link. It is difficult to determine causality of an AE if potential drug interactions, adulterants/contaminants, and ingredients are not investigated simultaneously. Despite this, our concern stands: we feel these events should be reported so that they can be assessed in greater detail. In particular, suspected NHP AEs should be accompanied by product analysis to verify that the AEs were not attributable to an adulterant or contaminant.


Thoughts or comments?

Take care.

#2 spaceistheplace

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Posted 25 July 2007 - 03:55 AM

of course natural remedies can have interactions with other drugs. this doesn't make them inherently harmful.

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#3 doug123

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Posted 25 July 2007 - 06:05 AM

of course natural remedies can have interactions with other drugs. this doesn't make them inherently harmful.


Dear spaceistheplace,

Cool nickname. ;)

Yes, it seems natural remedies may have interactions with drugs; similarly, natural remedies may have interactions with natural remedies, and drugs may have interactions with drugs -- and so on.

There is an online drug interaction checker available here -- but your Doctor is the probably best person to ask; considering you probably are not going to reveal your entire medical history to an online device. :)

That's not all this study seems to be reporting on, however.

Dietary supplements in the United States are regulated like foods; which -- if you've been paying attention to recent news, doesn't appear to be good enough.

It is best to make your Doctor fully aware of any drugs and supplements you may be taking. Even some foods can alter your body's metabolism enough to possibly lead to cancer!

Here's one recent example:

First, some information regarding the primary source of evidence, The British Journal of Cancer, a publication of Cancer Research UK:

This following information from Wikipedia found July 16, 2007 seems to be accurate:

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British Journal of Cancer
From Wikipedia, the free encyclopedia
Jump to: navigation, search

The British Journal of Cancer a twice-monthly professional medical journal of Cancer Research UK (a registered charity in the United Kingdom), published on their behalf by the Nature Publishing Group (a division of Macmillan Publishers Ltd).

The British Journal of Cancer (BJC) provides a forum for clinicians and scientists to communicate original research findings that have relevance to understanding the etiology of cancer and to improving patient treatment and survival. BJC works with a team of international experts to ensure high standards of selection and review. Once accepted, papers are published in print and online.

Full research papers and short communications are published under five broad headings:

o clinical studies
o translational therapeutics
o molecular diagnostics
o genetics and genomics
o epidemiology


Here's information regarding Cancer Research UK, also from Wikipedia, which seems to have accurate data as of July 16, 2007:

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Cancer Research UK
From Wikipedia, the free encyclopedia

Cancer Research UK is a cancer research and awareness-promotion group in the United Kingdom, formed on 4 February 2002 by the merger of the Cancer Research Campaign and the Imperial Cancer Research Fund. It is the foremost cancer charity (charity number 1089464) in the United Kingdom, and the biggest cancer research organisation outside the USA. It is accredited by the UK's National Health Service as a health information provider.

As of 2006, the charity spends approximately £213 million per year on cancer research, supporting the work of more than 3,000 researchers, physicians, nurses and other medical professionals.
The vast majority of its funds come from private and corporate donations. It also conducts fundraising events[1] including the women-only Race for Life 5k series, has a network of volunteers, and operates over 600 "high street" charity shops, which stock both new and donated items.[2]] In recent years a number of Relay For Life events have been held in the UK (the idea having been imported from the American Cancer Society); their numbers, and the amount of money they bring in, are increasing year on year. The charity has recently moved into the area of public campaigning, lobbying the Government on issues such as smokefree workplaces legislation and long-term strategies for cancer services.

Cancer Research UK is supported by a number of celebrities, including Nicole Kidman, Madonna, Kara Tointon, Nell McAndrew, Kirstie Allsopp, All Saints, Mica Paris, Gloria Hunniford, Lemar, Cilla Black and Cate Blanchett.

Cancer Research UK supports and undertakes cancer research in hospitals, universities and medical schools throughout the United Kingdom, and disseminates information to the general public and the scientific community through its various websites, as well as its twice-monthly scientific publication, the British Journal of Cancer. It also makes information about current clinical trials accessible via its website; as at January 2006, there were 211 such trials open to UK cancer patients.[3]


And it appears that Cancer Research UK's work is published on their behalf by The Nature Publishing Group.

Here is some information regarding the Nature Publishing Group, which is in fact a division of Macmillan Publishers Ltd:

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Nature Publishing Group: scientific and medical excellence in print and online

Nature Publishing Group (NPG) is a division of Macmillan Publishers Ltd, dedicated to serving the academic and professional scientific and medical communities. The flagship title, Nature, is the world's most highly-cited weekly multidisciplinary journal and was first published in 1869. NPG is a global company, with headquarters in London and offices in New York, San Francisco, Washington DC, Boston, Tokyo, Paris, Munich and Basingstoke.

The mission of the Nature Publishing Group is to become the premier scientific and medical publisher, focusing always on the quality of the information we publish. NPG strives to serve scientific, technical and medical communities by delivering dynamic and audience-focused web services. Our goal is to become the first choice of scientists in search of (1) ground-breaking original research that has been rigorously and rapidly peer-reviewed; (2) superior review, filtering and navigating material; (3) the most relevant career information; and (4) timely and essential breaking news.

NPG Journals
Nature, our flagship journal, has been an influential force in scientific publishing for more than 130 years. Today it is still fresh, arresting and innovative and aims to communicate the latest ground-breaking and original scientific discoveries across all disciplines of science. It is published weekly: www.nature.com.

Nature research journals – The Nature research journals are published monthly, covering extensively the breadth of life sciences as well as material science, chemistry and the physical sciences. The aim of the Nature research journals is to be the most prestigious journals in their respective fields, publishing primary research papers of high scientific quality and of exceptional interest and significance in their disciplines. Many of the journals are the most highly cited in their disciplines. By publishing news, reviews and other secondary material, the Nature research journals aim to be the voice of their respective communities.

Nature Methods is a cutting edge methodology journal for life scientists and chemists. Publishing both novel methods and significant advances to tried and tested techniques. Nature Methods presents and discusses methods of immediate practical relevance, helping researchers perform faster, better and more efficient experimental research.

Nature Reviews – The acclaimed Nature Reviews series has revolutionized review journal publishing, providing authoritative coverage of the breadth and depth of their science discipline. Published monthly, their mission is to be the premier source of reviews, commentary and associated current-awareness in their communities. Nature Reviews makes full use of innovative advances in print and online technology and design principles to produce engaging, informative and accessible journals of the highest quality: a one-stop shop for cutting-edge information, analysis and opinion in each field.

Nature Clinical Practice journals deliver timely, authoritative interpretations of key research developments, translating the latest findings into clinical practice. Content includes editorial and opinion pieces, highlights from the current literature, commentaries on the application of recent research to practical patient care, thorough reviews, and in-depth case studies. The distinguished Editors-in-Chief and international advisory boards ensure comprehensive coverage throughout the year, with discussion of topical issues included as soon as possible after publication of the original research.

NPG academic journals publish a wide range of high quality scientific and medical journals, many in partnership with eminent national and international societies. NPG's aim is to be the publisher of choice for authors, readers and scientific societies in our chosen specialist subject areas. The aim is to publish high-quality scientific papers quickly; to provide the best support to editors and partner societies; to ensure the widest possible readership of all our published material; to understand and fulfill the needs of all our customers; to offer excellent service to authors, editors, readers, librarians and subscription agents; and to have a strong business profile within the publishing industry. NPG academic journals are editorially independent of the Nature journals, but have the same core publishing values.

www.nature.com. hosts the online edition of all NPG publications plus additional electronic resources and community portals. With over 20 million hits a month, nature.com is one of the most important online scientific resources in the world and serves over 1.8 million registered users. The online format offers users many additional benefits such as personalized electronic delivery including RSS feeds, Advance Online Publication (AOP), valuable search and browse functionalities, links to related resources from NPG and beyond, and integration with all major abstracting services. Access is provided to all published content, plus supplementary information and extended digitized archives. Online access is available on a personal and institutional level.


Here is some information regarding Nature that's found at Wikipedia and seems to be accurate as of today(July 16, 2007):

Posted Image

Nature Publishing Group (NPG) is an international publishing company that publishes scientific journals. It is a division of Macmillan Publishers Ltd, which in turn is owned by the Georg von Holtzbrinck Publishing Group. NPG's flagship title is Nature, a highly-cited weekly multidisciplinary journal first published in 1869. Other publications include Nature, the Nature research journals, the Nature Reviews series, the Nature Clinical Practice series, and a range of academic journals, including society-owned publications. Other services include Naturejobs, containing scientific career information, tools and jobs, the pre-print server Nature Precedings, Connotea, a free online reference management service for scientists, and Nature Network, the free social networking website for scientists. NPG's has offices in London, New York City, San Francisco, Washington, D.C., Boston, Tokyo, Paris, Munich, Hong Kong, Melbourne, Gurgaon, Mexico City and Basingstoke.


Okay, to the study; here's the abstract:

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British Journal of Cancer advance online publication 10 July 2007; doi:10.1038/sj.bjc.6603880 www.bjcancer.com

Prospective study of grapefruit intake and risk of breast cancer in postmenopausal women: the Multiethnic Cohort Study

K R Monroe1, S P Murphy2, L N Kolonel2 and M C Pike1

1Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089-9175, USA

2Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI 96813, USA

Correspondence to: Dr KR Monroe, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue (MS# 44), Los Angeles, CA 90089-9175, USA. E-mail: kmonroe@usc.edu

Received 30 April 2007; revised 11 June 2007; accepted 19 June 2007; published online 10 July 2007

In vitro and in vivo studies have shown that cytochrome P450 3A4 (CYP3A4) is involved in the metabolism of oestrogens. There is evidence that grapefruit, an inhibitor of CYP3A4, increases plasma oestrogen concentrations. Since it is well established that oestrogen is associated with breast cancer risk, it is plausible that regular intake of grapefruit would increase a woman's risk of breast cancer. We investigated the association of grapefruit intake with breast cancer risk in the Hawaii-Los Angeles Multiethnic Cohort Study, a prospective cohort that includes over 50 000 postmenopausal women from five racial/ethnic groups. A total of 1657 incident breast cancer cases were available for analysis. Grapefruit intake was significantly associated with an increased risk of breast cancer (relative risk=1.30, 95% confidence interval 1.06-1.58) for subjects in the highest category of intake, that is, one-quarter grapefruit or more per day, compared to non-consumers (Ptrend=0.015). An increased risk of similar magnitude was seen in users of oestrogen therapy, users of oestrogen+progestin therapy, and among never users of hormone therapy. Grapefruit intake may increase the risk of breast cancer among postmenopausal women.
Keywords: breast cancer; grapefruit intake; CYP3A4 metabolism


For a mainstream report on this matter, here is a link to BBC's story called: "Grapefruit link to breast cancer."

Thoughts or comments?

My comment? It seems this study's (and BBC's report) importance may be in helping advance understanding of the potential function of the P450 3A4 (CYP3A4) enzyme in the female hormone system. What might this imply for men?

Take care.


Take care.

P.S. Sorry if I overload folks with information regarding primary sources of evidence and such -- I just don't want to see the past repeat itself (i.e. it's best to know your source of evidence, don't trust online self-proclaimed [airquote] experts [/airquote] ! Don't believe anything you hear and only half of what you read! -- Mark Twain)

Edited by adam_kamil, 25 July 2007 - 06:34 AM.


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#4 nozza

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Posted 27 July 2007 - 01:22 PM

Any substance that you take to have an effect that actually has that effect is likely to produce other side-effects which have the potential to be harmful or at least unwanted.

Most natural remedies appear to have low intensity side effects but then they often have low primary effects too. They have not been tested to the same degree as pharmas. As more and more are tested in different ways I predict many unwanted effects will be found and yet again we will be left with the (probably) fact that just eating a healthy balanced diet of unrefined food is about as good as you can do in the long term.




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