Complimentary and Alternative Medicines plus Tobacco Cessation

On Thursday, AphA-ASP sponsored an "OTC Herbal Medicines" Talk. This doctor who was trained in western medicine went to do a post-doc in china and then later taught Chinese medicine at UC Berkeley. She apparently received government funding to treat outbreaks of measles in the Chinese children and was active in promoting MMR vaccinations as well. She reviewed various herbs and medicines that could relieve common ills such as the cold, mild rashes, or pain. She stated that all of these remedies are available in Chinatowns throughout San Francisco and the Bay Area. Someone even asked how lay people can select effective Chinese medicines for their illnesses since these herbs are not FDA approved ( officially evaluated for their effectiveness, safety, or harmful interactions with pharmacologic agents). Her response was that people should consult knowledgeable Chinese herbalists who can give recommendations based on clinical trials that support the effectiveness and safety of the herbs.

But gathering from her talk, most of her recommendations come from her patients’ clinical outcomes, and not standardized clinical trials. But what was interesting was hearing the theories about imbalance of elements within a person that causes a disease to manifest. For example, too much heat or cold in the body could create an imbalance. Too much wind in a woman results in menstral cramps. It sounds like Feng Shui meets biology. The theories are too abstract for someone like me who has an empirical understanding rooted in the western medicine that is taught here at UCSF.

Even in our Clinical Pharmacy class, the herbal supplements section is mostly taught in a self-study format. We will only be covering 10 herbs this quarter, like Gingko Biloba and St. John’s Wort. And we do not even learn how to counsel someone how to use them, only know when to recommend to a patient to change dosages or not to use the herb concurrently with a drug due to an adverse drug reaction. St. John’s is well documented for inducing Cytochrome P450, which is an enzyme in the small intestines and the liver, that can decrease bioavailability of P450 substrates. It is daunting but interesting at the same time to realize the wealth of active ingredients that can be sequestered from natural sources. Optimistically, further research into uncovering new herbs can compliment or replace current accepted methods of treatment. It seems evident from her talk that we as future health professionals have a long way to go in terms of bridging these two systems of health care to call truly call it integrated medicine.

The pharmacies that are on the frontier of this movement is Pharmaca, a chain pharmacy that is growing at an exponential rate across the bay area which specializes in integrated medicine. I talked with their corporate recruiter a month ago about how they model their store after european pharmacies that provide herbs as well as pharmacological treatments. Their staff even includes acupuncturists, massage therapists, and other alternative medicine specialists.
The topic that we are delving into in clinical pharmacy class is Tobacco cessation. The program basically trains us about the importance of encouraging patients to quit, review of the physiological effect of nicotine and smoke on the body, how to counsel them about lifestyle changes that can improve rates of quitting, and pharmacologic treatments that can ease the withdrawal symptoms. I think this is the best series in the whole course since the instructors did a really thorough job on everything that we need to know about understanding how these treatments work, how to talk to a smoker, and the goals of how ending this behavior can decrease their chances of cardiovascular disease, stroke, asthma, COPD, and lung cancer.

They even did a shpeel on how the Tobacco industry has done everything they could to hook people on this drug for profit. For example, "Light" cigarrettes were marketed to be cleaner than regular cigarrettes. They were designed with ventilation holes to allow smoke to emit without entering the body, but they contain almost the same amount of nicotine and people inhale the same amount of smoke by covering the ventilation holes with their mouths when the take a puff. It is designed to be addictive since the nicotine reaches the brain to increase release of dopamine in the brainstem under 11 seconds, faster than most drug delivery systems developed today. Therefore this fast delivery of pleasure immediately after smoking a cigarrette reinforces the behavior of smoking.