Mary Hardy

Analysis of the interactions of botanical extract combinations against the viability of prostate cancer cell lines.

Herbal medicines are often combinations of botanical extracts that are assumed to have additive or synergistic effects. The purpose of this investigation was to compare the effect of individual botanical extracts with combinations of extracts on prostate cell viability. We then modeled the interactions between botanical extracts in combination isobolographically. Scutellaria baicalensis, Rabdosia rubescens, Panax-pseudo ginseng, Dendranthema morifolium, Glycyrrhiza uralensis and Serenoa repens were collected, taxonomically identified and extracts prepared. Effects of the extracts on cell viability were quantitated in prostate cell lines using a luminescent ATP cell viability assay. Combinations of two botanical extracts of the four most active extracts were tested in the 22Rv1 cell line and their interactions assessed using isobolographic analysis. Each extract significantly inhibited the proliferation of prostate cell lines in a time- and dose-dependent manner except S. repens. The most active extracts, S. baicalensis, D. morifolium, G. uralensis and R. rubescens were tested as two-extract combinations. S. baicalensis and D. morifolium when combined were additive with a trend toward synergy, whereas D. morifolium and R. rubescens together were additive. The remaining two-extract combinations showed antagonism. The four extracts together were significantly more effective than the two-by-two combinations and the individual extracts alone. Combining the four herbal extracts significantly enhanced their activity in the cell lines tested compared with extracts alone. The less predictable nature of the two-way combinations suggests a need for careful characterization of the effects of each individual herb based on their intended use.

Integrating Dietary Supplements Into Cancer Care

Many studies confirm that a majority of patients undergoing cancer therapy use self-selected forms of complementary therapies, mainly dietary supplements. Unfortunately, patients often do not report their use of supplements to their providers. The failure of physicians to communicate effectively with patients on this use may result in a loss of trust within the therapeutic relationship and in the selection by patients of harmful, useless, or ineffective and costly nonconventional therapies when effective integrative interventions may exist. Poor communication may also lead to diminishment of patient autonomy and self-efficacy and thereby interfere with the healing response. To be open to the patient’s perspective, and sensitive to his or her need for autonomy and empowerment, physicians may need a shift in their own perspectives. Perhaps the optimal approach is to discuss both the facts and the uncertainty with the patient, in order to reach a mutually informed decision. Today’s informed patients truly value physicians who appreciate them as equal participants in making their own health care choices. To reach a mutually informed decision about the use of these supplements, the Clinical Practice Committee of The Society of Integrative Oncology undertook the challenge of providing basic information to physicians who wish to discuss these issues with their patients. A list of leading supplements that have the best suggestions of benefit was constructed by leading researchers and clinicians who have experience in using these supplements. This list includes curcumin, glutamine, vitamin D, Maitake mushrooms, fish oil, green tea, milk thistle, Astragalus, melatonin, and probiotics. The list includes basic information on each supplement, such as evidence on effectiveness and clinical trials, adverse effects, and interactions with medications. The information was constructed to provide an up-to-date base of knowledge, so that physicians and other health care providers would be aware of the supplements and be able to discuss realistic expectations and potential benefits and risks.

Divining integrative medicine.

Medicine, like scientific inquiry, is necessarily dynamic. As our understanding of health and disease continues to grow, medicine as we know it will change. Alternative therapies and perspectives that are coming to light will be illuminated by modern methods of inquiry applied to pre-modern healing systems. At the same time, patient demands and cultural concerns about health and healing influence the expansion of conventional medicine. The integrative medicine movement is a reflection of how these issues have tumbled together creating a medical field that is at once undefined and almost indescribable. Integrative medicine is growing in popularity among consumers and healthcare providers alike. An August 7, 2006 article in the Los Angeles Times (1) asserted under the heading Twice as Strong that ‘Western medicine team[ed] up with acupuncture, yoga and herbs to fight both disease and pain …[is] going mainstream’. Three regional clinical programs were described. Each was based in a conventional medical clinic; each identified as an integrative or multidisciplinary practice. Readers of the Twice as Strong article (Los Angles Times daily circulation is approximately 850 000 as of March 2006) (2) and viewers of The New Medicine television show broadcast March 29, 2006 (estimated audience between 4 and 9 million) (3, 4) learned that conventional biomedicine is undergoing a transformation from within. The popular message is that this movement is led by conventionally trained physicians who are opening their practices to include mind–body therapies as well as traditional techniques from other medical cultures such as acupuncture and oriental medicine (AOM). However, this is a narrow view. We hold a particular interest in the integration of AOM with conventional medicine where the breadth of this phenomenon can be readily comprehended. This emergence of integrative medicine in the public eye is full of irony, giving rise to our question: what comprises integrative medicine exactly? It is not complementary and alternative medicine (CAM). (5) It is a phenomenon that has defined itself, with requirements for membership self-determined by each practitioner who chooses to promote her practice as integrative medicine. Consider the following brief descriptions of integrative medicine providers. A physician who completed a 300 h acupuncture course for physicians prefers to refer out for needling to licensed acupuncturists. He identifies as an integrative practitioner relying on his strong research skills and belief in nutrition as medicine. He has a full practice. An acupuncturist teaches at many of the AOM colleges in Southern California. Born and trained in China she is widely recognized as an authority in orthopedic integrative medicine. She reads X-rays, tongue, pulse and inserts needles. She prescribes herbs. She treats side effects of chemotherapy. Her practice is full. A conventional physician witnessed Chinese medicine on the mainland in the early 1980s. When he became ill upon return to the United States he found a Chinese practitioner of AOM after exhausting conventional medical solutions. He is now an herbal expert in demand as a speaker. He knows herbs will be the last medicine to enter the integrative medicine circle. He fights to include the most basic herbal formulas in his multi-discipline integrative clinic. An American acupuncturist who became involved with Chinese medicine in the 1950s has been a witness to the history of AOM in the USA. He was among the first to earn an OMD degree (Oriental medicine doctorate), an early degree requiring ∼1000 h. The current masters degree requires nearly 3000 h. He believes physicians could learn enough about AOM in 1000 h, maybe less given their strong grounding in organ systems, basic anatomy and physiology. He believes traditional Chinese medicine and conventional Western medicine are very closely aligned; both allopathic with a central emphasis on the neurovascular system. He refers to his practice as One Medicine. Integrative medicine is as much a prototypical grass-roots populist movement as it is a medical approach that has sprinted ahead of any simple, fixed and lasting definition. As a descriptive term integrative medicine is multi-functional and prone to metamorphosis. It is full of nuances that correspond to various factors including the background of the author(s) attempting to describe it. Integrative medicine is bound by context and orientation, not fixed by any set of criteria at any level. It is worthwhile to ask the question how will we understand exactly what is integrative medicine?

Implementation of a Statewide Outcome Monitoring System: Lessons Learned From Substance Abuse Treatment Provider Staff

The authors analyze the pilot implementation of a statewide automated outcome monitoring system (OMS) in California, using the perspectives of substance abuse treatment providers responsible for its day-to-day operation. To gain a better understanding of changes experienced by staff and their perceptions of barriers and facilitators of implementation, they conducted 28 focus groups designed to inform midstream adjustments to the system prior to its possible roll-out. Qualitative analysis of the focus group data revealed five important factors influencing implementation: the treatment providers ethos, the time-consuming nature of the OMS, staff buy-in, resources, and counselor and program discretion. Lessons learned underscored the importance of taking into consideration aspects of organizational change and institutional resources and infrastructure when implementing a major change such as an automated OMS. Findings might be useful to those designing and implementing similar systems or other large organizational change initiatives.

Pharmacokinetics and Bioavailability of Plant Lignan 7-Hydroxymatairesinol and Effects on Serum Enterolactone and Clinical Symptoms in Postmenopausal Women: A Single-Blinded, Parallel, Dose-Comparison Study

Objective: 7-Hydroxymaitairesinol (7-HMR) is a naturally occurring plant lignan found in whole grains and the Norway spruce (Piciea abies). The purpose of this study was to evaluate the bioavailability of a proprietary 7-HMR product (HMRlignan, Linnea SA, Locarno, Switzerland) through measurement of lignan metabolites and metabolic precursors. Methods: A single-blind, parallel, pharmacokinetic and dose-comparison study was conducted on 22 postmenopausal females not receiving hormone replacement therapy. Subjects were enrolled in either a 36 mg/d (low-dose) or 72 mg/d dose (high-dose) regimen for 8 weeks. Primary measured outcomes included plasma levels of 7-HMR and enterolactone (ENL), and single-dose pharmacokinetic analysis was performed on a subset of subjects in the low-dose group. Safety data and adverse event reports were collected as well as data on hot flash frequency and severity. Results: Pharmacokinetic studies demonstrated 7-HMR C max = 757.08 ng/ml at 1 hour and ENL C max = 4.8 ng/ml at 24 hours. From baseline to week 8, plasma 7-HMR levels increased by 191% in the low-dose group (p < 0.01) and by 1238% in the high-dose group (p < 0.05). Plasma ENL levels consistently increased as much as 157% from baseline in the low-dose group and 137% in the high-dose group. Additionally, the mean number of weekly hot flashes decreased by 50%, from 28.0/week to 14.3/week (p < 0.05) in the high-dose group. No significant safety issues were identified in this study. Conclusion: The results demonstrate that HMRlignan is quickly absorbed into the plasma and is metabolized to ENL in healthy postmenopausal women. Clinically, the data demonstrate a statistically significant improvement in hot flash frequency. Doses up to 72 mg/d HMRlignan for 8 weeks were safe and well tolerated in this population.

Mainstreaming Acupuncture: Barriers and Solutions

There is a place for the acupuncture profession within primary care. Nationwide, community clinics that serve the population of under- and uninsured persons are facing a tremendous shortage of primary care practitioners. Marginalized health care professions, that is, acupuncture, chiropractic, and naturopathy, are being drawn into a primary care role. An unanticipated workforce opportunity exists to fill the caregiver gap in community clinics. This transition can be quickly realized in states such as California where statutory code states that acupuncture is to be regulated and controlled as a primary care profession, but the requisite training has yet to be provided. Specific clinical experience in primary care settings would help overcome long-standing barriers that have resulted in the marginalization of the profession, high under- and unemployment among acupuncturists, and result in greater access to acupuncture treatment. A 1-year primary care training program for licensed acupuncturists (LAcs), which features clinical and didactic training, akin to what a physician assistant receives, would prepare acupuncturists to work in mainstream medicine. With appropriate training and biomedical collaboration skills, the participation of acupuncturists in mainstream medical settings can be accomplished with support from the acupuncture profession and mainstream medicine.

Unveiling the United States Acupuncture Workforce

Acupuncture was first legalized in Maryland in 1973. By the end of 2009, regulatory legislation had passed in all but six states. The growth of acupuncture is most commonly measured by its well-documented demand as a treatment modality and the rapid increase in the number of licensees. Much less documented is a puzzling stagnation in work opportunities and income. As many as half of all licensees, on graduation and licensure, may be unable to support themselves by working in their chosen profession. However, unlike other well-established complementary and alternative health professions, such as chiropractic and massage, acupuncture is conspicuously absent from the Bureau of Labor and Statistics occupations manual, with only a handful of secondary and incomplete studies available, which together provide an inexact picture of the workforce. In this article, the authors review seven reports that provide limited information including hours worked, income, and practice type. Although data from these published articles are not standard, it can be reasonably concluded from the available information that, over the past decade, 50% of the licensed acupuncture (LAc) workforce is working less than 30 hr weekly; 50% are earning less than

Acupuncture Practice Acts: A Profession’s Growing Pains

50,000 on average; and the number of LAcs working independently in practice, either in their own office or sharing one, has increased from approximately 75% to 90%. Suggestions are presented for conducting a much needed comprehensive analysis of the acupuncture workforce.

Multivitamin/multimineral supplements for cancer prevention: implications for primary care practice

State legislation that authorizes any healthcare profession is known as the Practice Act. In order for a profession to establish a recognizable national presence and be integrated into mainstream medicine, all the state Practice Acts must evidence consistency. The extent to which state Practice Acts fail to exhibit consistency can inhibit the ability of the profession to grow and become successful. We looked at the histories of other health professions, along with the 45 acupuncture Practice Acts in the USA, in order to understand the time worn paths that lead to integration in the mainstream and how the acupuncture profession might benefit.

OA12.01. Analysis of FDA mandated dietary supplement adverse event reports (AER) 2008-2009.

Abstract There is a popular belief that multivitamin and mineral (MVM) supplements can help prevent cancer and other chronic diseases. Studies evaluating the effects of MVM supplements on cancer risk have largely been observational, with considerable methodologic limitations, and with conflicting results. We review evidence from the few available randomized, controlled trials that assessed the effects of supplements containing individual vitamins, a combination of a few select vitamins, or complete MVM supplements, with a focus on the recent Physicians’ Health Study II (PHS II). PHS II is a landmark trial that followed generally healthy middle-aged and older men (mean age 64 years) who were randomized to daily MVM supplementation for a mean duration of 11 years. Men taking MVMs experienced a statistically significant 8% reduction in incidence of total cancer (hazard ratio [HR]: 0.92; 95% confidence interval [CI]: 0.86–0.998; p = 0.04). Men with a history of cancer derived an even greater benefit: cancer incidence was 27% lower with MVM supplementation versus placebo in this subgroup (HR: 0.73; 95% CI: 0.56–0.96; p = 0.02). Positive results of PHS II contrast with randomized studies of individual vitamins or small combinations of vitamins, which have largely shown a neutral effect, and in some cases, an adverse effect, on cancer risk. The results of PHS II may have a considerable public health impact, potentially translating to prevention of approximately 68 000 cancers per year if all men were to use similar supplements, and to an even greater benefit with regard to secondary prevention of cancer.