Archive for category Alternative medicine
In spite of being a user of calendula cream for many years and having an interest in the medically active ingredients in plants, I remain very sceptical when herbal products are promoted. Mostly they are used by practitioners of alternative medicine.
Herbal preparations are not well regulated and can sometimes do harm.
A paper is due to be published in “Internal and Emergency Medicine,” the official journal of the Italian Society of Internal Medicine warning of the dangers of damage to the liver by some products. As yet only the abstract is available. The full article will, when published require subscription to the journal.
COUNTRY : ITALY
Complementary and alternative therapies, including herbal products, have become increasingly popular in the general population and among patients and physicians. Regulations and pharmacovigilance regarding herbal drugs are still incomplete and need to be improved. In fact, herbals are commonly marketed on the Internet, and in many countries they are sold as food supplements, which are beyond the control of drug regulatory agencies. In Europe and the U.S., reports of hepatotoxicity from these products, including those advertised for liver diseases, are accumulating. Many herbal drugs are also commonly used in children, and in women during pregnancy and lactation, because they are believed to be “natural” and, therefore, “harmless.” One emerging problem is people preferring herbal-based slimming aids to conventional dietary and physical activity. In Italy, the use of non-conventional therapies has been reported for 13.6 % of the population, and 3.7 % freely use herbal drugs, unaware of the risks associated with a potential interaction with prescription drugs. In our review, we discuss the problem of the lack of standardization of herbal drugs, the lack of randomized clinical trials regarding the majority of these products, the unawareness of risks by the patients who buy and use them, and, further, the problem of underreporting. For the most commonly used herbal products and slimming aids, we describe their potential hepatotoxicity mechanisms, the causality assessment necessary for a correct diagnosis, and the clinical patterns for which these products seem to be responsible.”
Please read DISCLAIMER by clicking on LEGAL tab above
In the previous post, a link to brief information on the BBC site, I questioned the usefulness of acupuncture and ginger in helping morning sickness, so I have tried to find whether there is any evidence that these work. In summary, the evidence is not good.
Cochrane reviews are an attempt to put medicine on an evidence base and there is was a paper in 2010 discussing ginger, acupuncture and other alternative therapies that are often recommended for pregnancy sickness. This is a comprehensive article and is probably the most evidence based that there is around at the present.
COUNTRY : COLLABORATIVE – IRELAND, UK, USA
IMPLICATIONS FOR PRACTICE
Women will continue to seek treatments for the often distressing symptoms of nausea and vomiting in pregnancy. They may take over-the-counter and complementary therapies, based on anecdotal or peer advice. There are many sources of advice for women on the Internet, including peer fora. Wilkinson 2000 found a lack of consensus about safety of herbal treatments (including ginger) for nausea and vomiting in pregnancy in 300 non-medical sources identified in a literature review. This highlights the necessity of health professionals providing clear guidance to women, based on systematically reviewed evidence. On the basis of this review, high-quality consistent evidence is lacking to support the accuracy or appropriateness of that advice. Current guidelines and other reviews often offer incomplete evidence, without comment on the quality of evidence. Health professionals’ decisions about treatments should take account of the lack of clear and consistent evidence found in this review and acknowledge that it is not possible at present to identify, with confidence, safe and effective interventions for nausea and vomiting in early pregnancy.
IMPLICATIONS FOR RESEARCH
The difficulties in interpreting the results of the studies included in this review highlight the need for specific and clearly justified outcomes in research on interventions for nausea and vomiting in pregnancy. The range of instruments used to measure these symptoms (including those not developed for this patient group) also suggest the need for a consistent and appropriate approach to measurement, which may be addressed by the PUQE scale described above. There is also a need to systematically measure quality of life and adverse maternal and fetal and neonatal outcomes, to ensure that studies are of most usefulness to health professionals and women seeking safe and effective treatments. We did not identify any studies of dietary or behavioural interventions. Dietary and behavioural strategies (eating low fat, small, frequent meals) were often recommended to all participants (in both treatment and placebo groups) within the studies in this review. Only one study (Ozgoli 2009) measured adherence to dietary advice. The effectiveness of dietary and other behavioural strategies also needs to be evaluated in good quality trials.
It is interesting that this article seems at variance with NICE guidelines on the matter of acupressure and ginger. Furthermore, I am not at all sure what the last paragraph of the quotation of the guidelines below is supposed to mean. It seems to imply that patients should be given knowledge of all alternative therapies for morning sickness that are not evidence based? If so, why and how will this be done to ensure patients are not being led up the garden path by those health care professionals looking after them who themselves have a non-evidence based bee fluttering around in their bonnets about alternative medicine in pregnancy?
Nausea and vomiting in early pregnancy
Women should be informed that most cases of nausea and vomiting in pregnancy will resolve spontaneously within 16 to 20 weeks and that nausea and vomiting are not usually associated with a poor pregnancy outcome. If a woman requests or would like to consider treatment, the following interventions appear to be effective in reducing symptoms:
• non-pharmacological: − ginger
− P6(wrist)acupressure • pharmacological:
Information about all forms of self-help and non-pharmacological treatments should be made available for pregnant women who have nausea and vomiting.
Please read DISCLAIMER by clicking on LEGAL tab above