WARNINGS (from Mosby’s Drug Consult)

Peptic ulceration and gastrointestinal bleeding have been reported in patients receiving diclofenac. Physicians and patients should therefore remain alert for ulceration and bleeding in patients treated chronically with diclofenac even in the absence of previous GI tract symtoms. It is recommended that patients be maintained on the lowest dose of diclofenac possible, consistent with achieving a satifactory therapeutic response.

Well right now my mother is in hospital in London following emergency surgical repair to two perforated ulcers induced by diclofenac. She was not given any idea by her prescribing physician that there may be a problem with these drugs, and was not monitored for any adverse symptoms. In fact she had frank melena, a sure sign of proximal GI bleeed, as well as nausea and loss of appetite and hypotension. Only after she passed out and fell over 4 times in one day was she regarded as symptomatic enough to merit hospitalization.

NSAIDs cause GI bleeds. They are the BIGGEST single cause of serious drug ADR event in the UK affecting literally thousands per year yet PCP docs prescribe NSAIDS as though they were candy without any pecautionary advice.

Diclofenac sucks. Drugs suck.

In a Herbal Hypothesis entitled MEDLINE and the Mainsteam Manufacture of Misinformation, we documented, as an aside, how mainstream medical journals in MEDLINE regularly mispell the scientific names of herbs. Not the best way really to lend credibility to your point - imagine an article on the “Dangers of Warfaring”, or “Reversing the effects of Digital Toxicity”. Uncool ? One would think - and hopefully articles with such stupid mistakes submitted for publication would be denied even a cursory glance…on their way to the trash rather than “peer review” status in MEDLINE. But wait….

In the mainstream journal departments of anti-herb propaganda and related wisdom there is an ongoing attempt to raise the bar of utter ignorance to new new heights - here the Plastic Surgery Nurses editorial guru takes the prize of the month for dyslexic biomedical buffoonery with the following gem:

Dinman, S. (2006). “Black cohash: a contraindication in general anesthesia.” Plast Surg Nurs 26(1): 42-3.

WHAT are they smoking? Black cohash?

Comment: Its about time we got away from the mainstream biomedical model of describing herbs as anti-inflammatory. Immunomodulators have pro-inflammatory influences as evidenced by this study on Ganoderma (mycelium). THIS TOTALLY RELATES TO THE ACTIVATION OF TOLL-LIKE RECEPTORS BY ECHINACEA. Modulation of NF–Kappa B by natural compounds is completely different from blockade of NF– Kappa B by pharmaceuticals. I love it.

Kuo, M. C., C. Y. Weng, et al. (2006). “Ganoderma lucidum mycelia enhance innate immunity by activating NF-kappaB.” J Ethnopharmacol 103(2): 217-22.

Ganoderma lucidum is a popular medicinal mushroom in China and Japan for its immunomodulatory and antitumor effects. The goal of this research is to investigate the effect of dried mycelia of Ganoderma lucidum produced by submerged cultivation on the enhancement of innate immune response. We found that Ganoderma lucidum mycelia (0.2-1.6 mg/ml) stimulated TNF-alpha and IL-6 production after 8h treatment in human whole blood. IFN-gamma release from human whole blood was also enhanced after 3 day-culture with Ganoderma lucidum mycelia (0.2-1.0mg/ml). However, Ganoderma lucidum mycelia did not potentiate nitric oxide production in RAW264.7 cells. To better understand the possible immuno-enhancement mechanisms involved, we focused on nuclear factor (NF)-kappaB activation. Electrophoretic mobility shift assay revealed that the Ganoderma lucidum mycelia (1.6 mg/ml) activated kappaB DNA binding activity in RAW264.7 cells. These results provide supporting evidences for the immunomodulatory effect of Ganoderma lucidum mycelia.

What is it about pharmacists? How stupid can you get? One of the self-styled “authoritative reference sources” for physicians on matters relating to nutrients and botanicals is the execrable “Natural Database” - nowadays published on line and in print by Elsevier. This massive tome of completely uncritical citation dredgings is maintained by pharm Ds - who - despite their new found apparent expertise in botanicals - are absolutely incapable of making a sensible comment about anything herbal whatsoever, but despite all, they continue to the point of complete surreality. I suppose the print version at least could be used as a doorstop, the on line version is devoid of any utility at all.

This was really highlighted for me when I was myself approached by Natural Database a while ago to see if I would be able to review monograph contributions: I sent the boss a piece I wrote about St John’s Wort and received the reply that she did not want opinions - just facts.” Now admittedly most science education is generally pretty lacking in foundation philosophical studies, but why is it that you can get a Pharm D (equivalent to a PhD) and still believe there is some ex corporeal entity called a FACT independent of any reality other than its connection to absolute truth revealed by its being published in MEDLINE. So you can get all you need to know about a botanical or herbal medicine by compiling lists of references trawled from MEDLINE? I mean - its actually quite psychopathological when you think about it. How about actually reading the papers, never mind critically or even analytically, with some effort to understand their context and provenance. And heaven forbid, howabout checking with someone who uses high dose green tea extracts every day - like me for example. Well? Its like a magical spell - it works only if those who are spellbound act as though its real, and through their beliefs and actions they reinforce that reality - even though it is entirely fictive.

Natural Database released an email update this week drawing attention of its subscribers to the toxicity of 2 herbs. Black cohosh and Green Tea extracts. Apparently there are now 7 documented reports of hepatotoxicity arising from GTE consumption. Now never mind that this is the number one beverage in the world, consumed at a level of millions of gallons by billions of people every day. There are a couple of completely unsubstantiated reports in MEDLINE alleging that GTE caused hepatotoxicity. Never mind that toxicological studies completely failed to induce an adverse reaction by injecting rats with enormous amounts of GTE - and no toxicology has ever showed a problem with the stuff - MEDLINE sez hepatotoxic so that’s it. Tea really is hepatotoxic - it has to be. If MEDLINE reported masturbating was associated with blindness these people would issue a wanking warning.

Intelligent and useful review article here by Fan et al. E-pub ahead of print so no page/volume details yet, but access full text available online (not free). Interesting that the University of Cambridge Pharmacy School has an entire laboratory devoted to angiogenesis and Chinese herbs. The authors point out that botanicals are used in complex combinations - “fufang” in TCM, with the implication that trials on single agents are misleading (duh). The ever increasing “therapeutic gap” between promising basic science research on anticancer herbs in academia and any kind of recognition let alone therapeutic use of botanicals in the world of clinical oncology is a testament to the extent that the big pharma companies are the dominant “pimps of progress” in cancer treatment (more…)

Second part of a lecture at the AHG Symposium in Portland, Oregon, 2005, on Food Medicine and Poison. This is a general but practical discussion of the theory and philosphy of herbal practice, based on the author’s clinical experience with cancer: intended for practitioners and students of clinical herbalism. iTunes subscribers will get the podcast automatically when updating subscriptions. Newsreader subscribers and direct web browsing - download MP3 file from link below. 43.26 minutes duration, 9.9 megabytes.
Food, Medicine, Poison Part Two

The latest issue ( #70) of Herbal Gram ( the American Botanical Council magazine) is really embarrassing. Or at least it should be. The extent of the self-congratulatory, expense paid partying (industry sponsored) mutual “award” giving marketing/promo extravangansas is exceeded only by the”branding” of founder and executive director of ABC Mark Blumenthal as an “industry icon”. Oprah set the style - and Blumenthal, with his picture repeated serially throughout the rag, follows. There is even an “article” about articles in other magazines that have featured Blumenthal, together with pictures of their covers bearing pictures of Blumenthal. Oh mercy.
There would be nothing wrong with this exercise in unrestrained egotistical masturbation per se, if it were not for the fact that HerbalGram and the ABC are using their undoubtedly well-developed marketing and journalistic skills to position a version of botanicals that purports to advocate HERBAL MEDICINE but which in reality merely promotes an entirely reductionist and mainstream view of HERBAL MEDICINES.
Take for example the much heralded new members of the ABC “advisory board”. They are introduced in this issue as “herbal medicine experts and clinicians” . Now, no disrespect intended to any of those folk, but there is not a single person there with any training or qualification in herbal medicine at all. Like if you wanted to refer your nearest or dearest for herbal medicine care to a practitioner who knew what they they were doing with herbs - well you never even consider any of these people. Not to say they are not proficient in their own field(s) but the issue is that they are represented by ABC as representing the field of clinical herbal medicine -which is patently untrue. …. they are largely industry folk, academic scientists, or mainstream medics and a smattering of fellow travellors like who actually have zip, zero, diddely squat training or clinical experience with clinical herbal medicine whatsoever…

SO what? Before anyone gets out of their stroller (or tries to sue me) …well this is the so what. ABC is, following the inexorable logic of its earlier production and promotion of the ridiculous and irrelevant Commission E monographs, attempting to stake an “authoritative’ claim to its version of botanical medicines. Of course these guys really believe they are doing a good job. But the entire magazine features reports of “clinical studies” on herbs which completely buy in to mainstream medical philosophy and presuppositions. We now get feature articles by Eddie Ernst for heavens sake…what? Evidence based herbal medicine? Give us a break. Or articles about echinacea trials by MD-PhD ( so credentialled) that suggest due to inconclusive trial results that we really cannot tell exactly whether echinacea is good for….lord help us.

There is nothing, not a single word in the entire magazine that remotely represents real clinical herbal medicine as it is practised today, here now in the USA, by western clinical herbalists, although you can sure sign up for tourist trips to the Amazon to see what “real herbal medicine” is all about. Then you can sign up again for free CEU’s by just reading the ABC Guide to clinical herbal medicine…or a weekend course that makes you a “certified” expert in botanicals…HerbalGram is arguably far closer to a 5th column of mainstream medicine than it is a progressive advocate of herbal medicine. The tragedy is that its staff, advisory board and above all its oprah clone director would not even remotely get it …

there now. well, someone had to say it.

This is HILARIOUS. Reuters newswire is today splashing a report from Canadian Medical Journal about a case of multiple hemorrhages caused by …wait for it - chamomile body lotion and a cup of chamomile tea. This deadly herb, applied to the feet and chest by the patient who was taking a perfectly normal safe prescription of amiodarone and warfarin caused her to experience a life threatening hemorrhagic episode: fortunately the eagle-eyed authors Segal and Pilote spotted the use of the killer body lotion and prevented her from certain death from further applications of the cream. Well done guys, primum non nocere heh? Don’chya just love the second line of this abstract ….. the “herb is thought to be a coumarin constituent”

Segal, R. and L. Pilote (2006). “Warfarin interaction with Matricaria chamomilla.” Cmaj 174(9): 1281-2.

No cases have been reported of Matricaria chamomilla potentiating the effects of warfarin. Nevertheless there is a theoretical risk for potentiation, since the herb is thought to be a coumarin constituent. We describe the case of a 70-year-old woman who, while being treated with warfarin, was admitted to hospital with multiple internal hemorrhages after having used chamomile products (tea and body lotion) to soothe upper respiratory tract symptoms. Patient education on the potential risk of taking chamomile products while being treated with warfarin is necessary to avoid such occurrences.

Following the high level of downloads of our paper on nettle seed and creatinine clearance , (see April webstats) HERBLOG readers may be interested in this review, focusing on Chinese herbs that are known renal tonics such as cordyceps and rhubarb root.

Wojcikowski, K., D. W. Johnson, et al. (2006). “Herbs or natural substances as complementary therapies for chronic kidney disease: ideas for future studies.” J Lab Clin Med 147(4): 160-6.
Chronic kidney disease (CKD) is an increasingly common condition with limited treatment options that is placing a major financial and emotional burden on the community. The use of complementary and alternative medicines (CAMS) has increased many-fold over the past decade. Although several compelling studies show renal toxicities and an adverse outcome from use of some CAMS, there is also emerging evidence in the literature that some may be renoprotective. Many nephrologists are unaware of these potential therapeutic benefits in treating CKD, or they are reluctant to consider them in research trials for fear of adverse effects (including nephrotoxicity) or deleterious interaction with co-prescribed, conventional medicines. The increased use of self-prescribed CAMS by their patients suggests that practitioners and researchers should keep abreast of the current information on these agents. A primary goal of this article was to review the available scientific evidence for the use of herbs or natural substances as a complementary treatment for patients with CKD. A further goal was to report the literature on herbs that have been reported to cause kidney failure.

Once again, daily vists to herbological.com increased in the month of April, with an average of 264 vists and 3214 hits per day. The top download once again was the paper on nettle seed, creatinine and renal treatment (690) followed by the facsimile of Weiss’s essay “What is herbal medicine”. We swapped over to Feedburner duringthe month, and its hard to know exactly how many people were subsribed before the change last month, but 40 new folk subscribed direct via XML feeds during the month. Feedburner is cool.