ContextWidespread use of herbal medications among the presurgical population
may have a negative impact on perioperative patient care.ObjectivesTo review the literature on commonly used herbal medications in the
context of the perioperative period and provide rational strategies for managing
their preoperative use.Data SourcesThe MEDLINE and Cochrane Collaboration databases were searched for articles
published between January 1966 and December 2000 using the search terms herbal medicine, phytotherapy,
and alternative medicine and the names of the 16
most commonly used herbal medications. Additional data sources were obtained
from manual searches of recent journal articles and textbooks.Study SelectionWe selected studies, case reports, and reviews addressing the safety
and pharmacology of 8 commonly used herbal medications for which safety information
pertinent to the perioperative period was available.Data ExtractionWe extracted safety, pharmacodynamic, and pharmacokinetic information
from the selected literature and reached consensus about any discrepancies.Data SynthesisEchinacea, ephedra, garlic, ginkgo, ginseng, kava, St John's wort, and
valerian are commonly used herbal medications that may pose a concern during
the perioperative period. Complications can arise from these herbs' direct
and pharmacodynamic or pharmacokinetic effects. Direct effects include bleeding
from garlic, ginkgo, and ginseng; cardiovascular instability from ephedra;
and hypoglycemia from ginseng. Pharmacodynamic herb-drug interactions include
potentiation of the sedative effect of anesthetics by kava and valerian. Pharmacokinetic
herb-drug interactions include increased metabolism of many drugs used in
the perioperative period by St John's wort.ConclusionsDuring the preoperative evaluation, physicians should explicitly elicit
and document a history of herbal medication use. Physicians should be familiar
with the potential perioperative effects of the commonly used herbal medications
to prevent, recognize, and treat potentially serious problems associated with
their use and discontinuation.

https://jamanetwork.com/journals/jama/articlepdf/194003/JRV10013.pdf

Herbal Medicines and Perioperative Care

Some aspects of toxic contaminants in herbal medicines

Background: The interest in complementary and alternative medicine (CAM) has increased during the past decade and the attitude of the general public is mainly positive, but the debate about the clinical effectiveness of these therapies remains controversial among many medical professionals. Methods: We conducted a systematic search of the existing literature utilizing different databases, including PubMed/Medline, PSYNDEX, and PsycLit, to research the use and acceptance of CAM among the general population and medical personnel. A special focus on CAM-referring literature was set by limiting the PubMed search to ‘‘Complementary Medicine’’ and adding two other search engines: CAMbase (www.cambase.de) and CAMRESEARCH (www.camresearch.net). These engines were used to reveal publications that at the time of the review were not indexed in PubMed. Results: A total of 16 papers met the scope criteria. Prevalence rates of CAM in each of the included studies were between 5% and 74.8%. We found a higher utilization of homeopathy and acupuncture in German-speaking countries. Excluding any form of spiritual prayer, the data demonstrate that chiropractic manipulation, herbal medicine, massage, and homeopathy were the therapies most commonly used by the general population. We identified sex, age, and education as predictors of CAM utilization: More users were women, middle aged, and more educated. The ailments most often associated with CAM utilization included back pain or pathology, depression, insomnia, severe headache or migraine, and stomach or intestinal illnesses. Medical students were the most critical toward CAM. Compared to students of other professions (ie, nursing students: 44.7%, pharmacy students: 18.2%), medical students reported the least consultation with a CAM practitioner (10%). Conclusions: The present data demonstrate an increase of CAM usage from 1990 through 2006 in all countries investigated. We found geographical differences, as well as differences between the general population and medical personnel.

Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review.

Do medical devices have enhanced placebo effects

Background: Interest in alternative therapies is growing rapidly in the United States. We studied the types and prevalence of conventional and alternative therapies used by women in four ethnic groups (Latino, white, black, and Chinese) diagnosed with breast cancer from 1990 through 1992 in San Francisco, CA, and explored factors influencing the choices of their therapies. Methods: Subjects (n = 379) completed a 30-minute telephone interview in their preferred language. Logistic regression models assessed factors associated with the use of alternative therapies after a diagnosis of breast cancer. Results: About one half of the women used at least one type of alternative therapy, and about one third used two types; most therapies were used for a duration of less than 6 months. Both the alternative therapies used and factors influencing the choice of therapy varied by ethnicity. Blacks most often used spiritual healing (36%), Chinese most often used herbal remedies (22%), and Latino women most often used dietary therapies (30%) and spiritual healing (26%). Among whites, 35% used dietary methods and 21% used physical methods, such as massage and acupuncture. In general, women who had a higher educational level or income, were of younger age, had private insurance, and exercised or attended support groups were more likely to use alternative therapies. About half of the women using alternative therapies reported discussing this use with their physicians. More than 90% of the subjects found the therapies helpful and would r ecommend t hem t o t heir friends. Conclusions: Given the high prevalence of alternative therapies used in San Francisco by the four ethnic groups and the relatively poor communication between patients and doctors, physicians who treat patients with breast cancer should initiate dialogues on this topic to better understand patients’ choices with regard to treatment options. [J Natl Cancer Inst 2000;92: 42‐7] In the United States, interest in alternative therapies is growing steadily (1‐8). Three recent surveys (9‐11)showed that 42%‐50% of adults used some type of alternative care in the past year. Although few studies have examined patterns of alternative therapy use in the United States, no studies have investigated its use among breast cancer patients of different ethnicities. This study presents the prevalence and patterns of use of conventional and alternative therapies chosen by black, Chinese, Latino, and white women in San Francisco, CA, who were diagnosed with breast cancer from 1990 through 1992. It further examines factors associated with the use of different therapies.

Sophie Smiley

Papers

Complementary Medicine