Dr DIMITRIOS – JAMES MANOS
1 January 2012

Medications, herbs and dietary supplements have specific indications, contraindications, interactions with other drugs and side effects.

Today it is important to check if a medicine, a herb or a dietary supplement really helps a patient and there is a specific way of checking it: Evidence Based Medicine. Also several trials and research is published at database such as the Medline.

Many published studies have bias (one example is a medication that is studied by a manufactory company). They may are poor designed. They may have a small sample (e.g. it is different to involve 5 subjects and different to involve 5 000 subjects) and they may have logistic problems and inadequate publication of the statistic methods and results. They may also have published insufficient data. They may not be placebo controlled or double – blind and also may not be randomized controlled. Also many meta-analysis involve just a few RCTs (randomized controlled trials), for example they investigate just 3 – 4 studies or even 1 – 2 studies, so it is impossible to lead to a safe conclusion. Also a study may have short duration and this may influence the results. So the duration of a study is important.  In conclusion many studies are poor designed, so we need to check first if the quality of a study is good or poor. Cochrane meta-analysis are based on good designed studies that fulfil the inclusion criteria.

Evidence Based Medicine analyzes several trials (meta-analysis) and ends up to a safe conclusion about if a dietary supplement or a medication really helps a disease. A guideline is published to guide the doctors and the scientists in all over the word about its safe use (1), (2), (3), (4).

We should not accept any article – trial without References at the end of the publication. Of course many investigations are biased (e.g. if conducted from a drug company), and that’s why today scientists seek and analyze several trials (meta-analysis). Also trials are better if are randomized controlled and also double blind and placebo – controlled. These trials are analyzed by ‘Evidence Based Medicine’ and also the ‘Cochrane’ Library. The Cochrane Library has meta-analysis that are more important than a single study e.g. on pubMed. However, many meta-analysis involve just a few RCTs (randomized controlled trials), for example they investigate just 3 – 4 studies or even 1 – 2 studies, so it is impossible to lead to a safe conclusion.

So, we all need to search on the web about Evidence Based Guidelines.

Evidence Based Medicine (EBM) aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments (including lack of treatment) and diagnostic tests. Evidence quality can range from meta-analyses and systematic reviews of double blind, placebo controlled clinical trials. EBM recognizes that many aspects of health care depend on individual factors such as quality and value of life judgments, which are only partially subject to scientific methods. EBP seeks to clarify those parts of medical practice that are in principle subject to scientific methods and to apply these methods to ensure the best prediction of outcomes in medical treatment, even as debate continues about which outcomes are desirable (1).

Evidence based Medicine recommendations, according to the US Preventive Service Task Force, can be categorized to the following categories:

• Level A: there is good scientific evidence suggesting that the benefits of the clinical service substantially outweigh the potential risks. Clinicians should discuss the service with eligible patients.
• Level B: there is at least fair scientific evidence suggesting that the benefits of the clinical service outweigh the potential risks. Clinicians should discuss the service with eligible patients.
• Level C: there is at least fair scientific evidence suggesting that there are benefits provided by the clinical service, however the balance between benefits and risks are very close for making general recommendations. Clinicians need not offer it, unless there are individual considerations.
• Level D: there is at least fair scientific evidence suggesting that the risks of the clinical service outweigh the potential benefits. Clinicians should not routinely offer the service to asymptomatic patients.
• Level I: scientific evidence is lacking, has poor quality, or is conflicting, so that the risk against benefit balance can’t be assessed. Clinicians should help patients understand the uncertainty of surrounding the clinical service (1).

Always someone should make his/her own research and check a drug, a herb or a dietary supplement (by writing its name at the ‘search’ box) at the following sites:

1. Sites for Evidence Based Medicine are many e.g. http://ebm.bmj.com and http://www.dmoz.org/Health/Medicine/Evidence_Based_Medicine

2. Sites for Cochrane (it has matanalysis) are http://www.cochrane.org and http://www.thecochranelibrary.com   

3. Site for medline – PubMed is http://www.ncbi.nlm.nih.gov/pubmed

and for MedlinePlus

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

For quick search write on a search engine such as ‘google’ the keyword with the name of the supplement and next the phrase ‘PubMed’.

For a classic encyclopaedia go e.g. to Britannica at http://www.britannica.com  

Also for encyclopaedia you may go to http://en.wikipedia.org/wiki/Main_Page

OTHER SITES:   

Clinical evidence:

• www.clinicalevidence.com

• http://highwire.stanford.edu

• www.eguidelines.co.uk

• www.medicine.ucsf.edu/recourses/guidelines

• www.guidelines.gov

• http://www.nature.com/

• For drugs (medications, medicines)

·        www.bnf.org  

·         www.medicines.org.uk

·          www.ukmi.nhs.uk  

·         www.fda.gov

·        http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm

·        http://www.drugs.com

Further information on internet about herbs, dietary supplements and complementary medicine you can find at the sites:

?        http://www.sciencedirect.com

?        http://ods.od.nih.gov/  

?        http://www.ars.usda.gov

?        http://www.herbmed.org  

?        http://www.nimh.org.uk

?        http://www.herbnet.com  

?        http://www.usda.gov/wps/portal/usda/usdahome

?        http://www.fda.gov.tw/files/publish_periodical/8-4-1.PDF

?        http://dietarysupplements.nlm.nih.gov/dietary/index.jsp

?        http://nccam.nih.gov/health/

?        http://www.umm.edu/

For a good dictionary (that follows the ‘corpus’) go to http://dictionary.cambridge.org

About buying medicine on the internet please read the FDA’s article:

http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/BuyingMedicinesOvertheInternet/default.htm

It is strongly suggested to never stop a medication that a doctor prescribed or suggested in order to replace it with a herb or a dietary supplement. This is important especially for severe diseases such as cancer in which the medication therapy should not be stopped in order to be replaced by a herb/ dietary supplement in any way.

Instead, guided by a specialist, therapy with herbs or dietary supplements may be combined with prescribed drugs. Of course this combination may occur only if there aren’t any interactions between the dietary supplement and the medication. Before someone takes a herb or a dietary supplement, he/she needs to consult a health care provider.  

REFERENCE (LINKS)

1. http://en.wikipedia.org/wiki/Evidence_based_medicine

2. Simon C., Everitt H., Kendrick T., Oxford Handbook of General Practice, Oxford Medical Publications, 2^nd edition, 2005.

3. Evidence Based Medicine, p. 668 – 669, Longmore M., Wilkinson I.B, Davidson E.D., Foulkes A., Mafi A.R., Oxford Handbook of Clinical Medicine, Oxford Medical Publications, 8^th edition, 2010.

4. Evidence Based Medicine, p. 489, Collier J., Longmore M., Brinsden M., Oxford Handbook of Clinical Specialties, Oxford Medical Publications, 7^th edition, 2006.