A PPENDIX B. P ATIENT R ESOURCES

A PPENDIX B. P ATIENT R ESOURCES

Overview

Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on herbal medicine can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources

The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to herbal medicine. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.

The National Institutes of Health

The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below.

Topic Pages: MEDLINEplus

The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to herbal medicine. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “herbal medicine”:

148 Herbal Medicine

• Guides on herbal medicine

Herbal Medicine

http://www.nlm.nih.gov/medlineplus/herbalmedicine.html

• Other guides

About Your Medicines

http://www.nlm.nih.gov/medlineplus/aboutyourmedicines.html

Cancer Alternative Therapy

http://www.nlm.nih.gov/medlineplus/canceralternativetherapy.html

Children's Health

http://www.nlm.nih.gov/medlineplus/childrenshealth.html

Within the health topic page dedicated to herbal medicine, the following was listed: • General/Overviews

About Herbs, Botanicals & Other Products

Source: Memorial Sloan-Kettering Cancer Center http://www.mskcc.org/mskcc/html/11570.cfm

Are Herbs for You?

Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=SA00043

Herbal Health Products: What You Should Know

Source: American Academy of Family Physicians http://familydoctor.org/handouts/364.html

HerbMed

Source: Alternative Medicine Foundation http://www.herbmed.org/

Using Herbal Supplements Wisely

Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=NU00205

• Specific Conditions/Aspects

Consumer Beware: Herbal Remedies and the Skin

Source: American Academy of Dermatology http://www.aad.org/PressReleases/herbal.html

Echinacea: What Should I Know about It?

Source: American Academy of Family Physicians http://familydoctor.org/handouts/744.html

Herb and Drug Interactions: 'Natural' Products Not Always Safe

Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=SA00039

Herbal Diet Pills

Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=SA00041

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Herb-Buying Tips

Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=SA00044

Kava-Containing Dietary Supplements May Be Associated with Severe Liver Injury

Source: Center for Food Safety and Applied Nutrition http://www.cfsan.fda.gov/%7Edms/addskava.html

Listing of Botanical Ingredients of Concern

Source: Food and Drug Administration http://vm.cfsan.fda.gov/%7Edms/ds-bot2.html

Questions and Answers about Valerian for Insomnia and Other Sleep Disorders

Source: National Institutes of Health, Office of Dietary Supplements http://ods.od.nih.gov/factsheets/valerian.html

Recall of PC SPES and SPES Dietary Supplements

Source: National Center for Complementary and Alternative Medicine http://nccam.nih.gov/health/alerts/spes/index.htm

St. John's Wort and the Treatment of Depression

Source: National Center for Complementary and Alternative Medicine http://nccam.nih.gov/health/stjohnswort/index.htm

Treatment of Colds with a Capsule Form of the Herb Echinacea

Source: American College of Physicians http://www.annals.org/cgi/content/full/137/12/I-18

What You Should Know about Herbal and Dietary Supplement Use and Anesthesia

Source: American Society of Anesthesiologists http://www.asahq.org/patientEducation/herbPatient.pdf

• From the National Institutes of Health

Botanical Dietary Supplements: Background Information

Source: National Institutes of Health, Office of Dietary Supplements http://ods.od.nih.gov/factsheets/botanicalbackground.html

Herbal Medicine

Source: National Toxicology Program http://ntp-server.niehs.nih.gov/htdocs/liason/factsheets/HerbMedFacts.pdf

Herbal Supplements: Consider Safety, Too

Source: National Center for Complementary and Alternative Medicine http://www.nccam.nih.gov/health/supplement-safety/

What Are Dietary Supplements?

Source: National Institutes of Health, Office of Dietary Supplements http://ods.od.nih.gov/showpage.aspx?pageid=46

What Is Complementary and Alternative Medicine (CAM)?

Source: National Center for Complementary and Alternative Medicine http://nccam.nih.gov/health/whatiscam/

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• Latest News

Green Tea Helps Against HIV

Source: 11/10/2003, United Press International http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14586 .html

Herbal Mix Shows Small Benefit for Mood, Vitality

Source: 11/10/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14603 .html

More News on Herbal Medicine

http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/alphanews_h.html#H erbalMedicine

Weight Loss Supplement May Raise Heart Risk

Source: 11/10/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14596 .html

• Law and Policy

Statement from FDA Deputy Commissioner Crawford Regarding Metabolife

Source: Food and Drug Administration http://www.fda.gov/bbs/topics/NEWS/2002/NEW00828.html

• Men

Herbal Supplements: Their Safety, a Concern for Health Care Providers

Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/professionals/681_1815.asp

Phytoestrogens and Bone Health

Source: Osteoporosis and Related Bone Diseases-National Resource Center http://www.osteo.org/newfile.asp?doc=r618i&doctitle=Phytoestrogens%2Band%2 BBone%2BHealth&doctype=HTML%2BFact%2BSheet

• Organizations

Alternative Medicine Foundation

http://www.amfoundation.org/

National Center for Complementary and Alternative Medicine

http://nccam.nih.gov/

• Pictures/Diagrams

Medicinal Herb Garden - Images

Source: National Network of Libraries of Medicine, Pacific Northwest Region http://nnlm.gov/pnr/uwmhg/

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• Research

Echinacea Not Effective in Treating Children's Colds: New Study Results

Source: National Center for Complementary and Alternative Medicine http://nccam.nih.gov/health/alerts/echinacea/index.htm

Ephedra Is Associated with More Adverse Effects Than Other Herbs

Source: American College of Physicians http://www.annals.org/cgi/content/full/138/6/I-56

Liver Injury in 12 Patients Taking the Herbal Weight Loss Aids Chaso or Onshido

Source: American College of Physicians http://www.annals.org/cgi/content/full/139/6/I-47

NCCAM Consumer Advisory on Ephedra

Source: National Center for Complementary and Alternative Medicine http://nccam.nih.gov/health/alerts/ephedra/consumeradvisory.htm

• Women

Herbal Supplements: Their Safety, a Concern for Health Care Providers

Source: March of Dimes Birth Defects Foundation http://www.marchofdimes.com/professionals/681_1815.asp

Phytoestrogens and Bone Health

Source: Osteoporosis and Related Bone Diseases-National Resource Center http://www.osteo.org/newfile.asp?doc=r618i&doctitle=Phytoestrogens%2Band%2 BBone%2BHealth&doctype=HTML%2BFact%2BSheet

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.

The Combined Health Information Database (CHID)

CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on herbal medicine. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/.

To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive:

• Herbal Medicines

Source: Research Triangle Park, NC: National Toxicology Program, National Institute of Environmental Health. 2001. 3 p.

Contact: Available from National Toxicology Program. National Institute of Environmental Health, P.O. Box 12233, MD B3-10, Research Triangle Park, NC 27709. PRICE: Free.

152 Herbal Medicine

Summary: This fact sheet from the National Toxicology Program (NTP) at the National Institute of Environmental Health Sciences reviews the herbs currently under study by the NTP. The fact sheet discusses the 1998 workshop on herbal medicines, in which recommendations were made for more research. The fact sheet includes a table that provides information about the herbs and active or toxic ingredients under study by the NTP, including aloe vera gel, black walnut extract, comfrey, echinacea purpurea extract, ginkgo biloba extract, ginseng and ginsenosides, goldenseal, grape seed extract, kava kava, milk thistle extract, pulegone, and thujone.

Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database:

• Herbal Medicine Resource Guide Summary: These resources relate mainly to western traditions of herbal medicine (also

referred to as phytomedicine or botanical medicine) that rely primarily on the use of single herbs.

Source: Alternative Medicine Foundation, Inc. http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7613

• Medical Herbalism (Journal) Summary: The focus of this quarterly journal is to preserve and develop the science and

art of herbal medicine, and to promote communication and sharing of clinical methods and experiences.

Source: Commercial Entity--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3717

• NIEHS Research Initiatives: Herbal Medicines Summary: In response to the increased use of medicinal herbs by the U.S.

Source: National Institute of Environmental Health Sciences, National Institutes of Health

http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6484

The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to herbal medicine. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively

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rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

Additional Web Sources

A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample:

• AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats • Family Village: http://www.familyvillage.wisc.edu/specific.htm • Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/ • Med Help International: http://www.medhelp.org/HealthTopics/A.html • Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/ • Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/ • ® WebMD Health: http://my.webmd.com/health_topics

Finding Associations

There are several Internet directories that provide lists of medical associations with information on or resources relating to herbal medicine. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with herbal medicine.

The National Health Information Center (NHIC)

The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about herbal medicine. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

Directory of Health Organizations

The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines.

The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “herbal medicine” (or a synonym), and you will receive information on all relevant organizations listed in the database.

154 Herbal Medicine

Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information.

The Combined Health Information Database

Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “herbal medicine”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “herbal medicine” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

The National Organization for Rare Disorders, Inc.

The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “herbal medicine” (or a synonym) into the search box, and click “Submit Query.”