By Sol E Solomon
Singapore Health Sep-Oct 2014
Singapore Health Sep-Oct 2014
Doctors worried about the herbal medicines their patients take with the Western medical drugs they prescribe are turning to a traditional medicine information service for help.
Many patients regularly take traditional or herbal medicines without realising that such remedies can have harmful effects or interact with the conventional Western drugs prescribed by their doctors.
Yet, the use of such medicines is on the rise.
While doctors and other medical professionals can and should play a role in ensuring that folk or complementary remedies are used safely, high-quality evidence about the efficacy, effects and other pharmaceutical information of these products must also be readily available, said Ms Lim Ching Hui, Senior Principal Pharmacist, Singapore General Hospital (SGH). “There is a gap in current medical practice,” said Ms Lim. “We know through our daily contact with patients that many of them take complementary and alternative medicines, but the reality is that many don’t or won’t tell their doctors they are using such products. Doctors, on the other hand, may not know how to advise their patients because they don’t know enough about these products.”
Much of the distrust that Western medical professionals have about traditional medicines stems from the differences in practice. Cold, hard evidence following years – sometimes decades – of documented clinical observations and tests is the cornerstone of conventional Western medical practice. With traditional and herbal medicines, however, the proof is in centuries’ worth of practice and experience, and less in the way of
documented trials. “So it’s hard to draw a conclusion about whether a herb works, or whether a result is due to something else,” said Ms Lim. To address this shortcoming, Ms Lim and a group of like-minded SGH colleagues set up a traditional medicine information service in october 2011 to provide doctors, pharmacists and other health care professionals with evidence-based information about traditional and alternative medicines.
Yet, the use of such medicines is on the rise.
While doctors and other medical professionals can and should play a role in ensuring that folk or complementary remedies are used safely, high-quality evidence about the efficacy, effects and other pharmaceutical information of these products must also be readily available, said Ms Lim Ching Hui, Senior Principal Pharmacist, Singapore General Hospital (SGH). “There is a gap in current medical practice,” said Ms Lim. “We know through our daily contact with patients that many of them take complementary and alternative medicines, but the reality is that many don’t or won’t tell their doctors they are using such products. Doctors, on the other hand, may not know how to advise their patients because they don’t know enough about these products.”
Much of the distrust that Western medical professionals have about traditional medicines stems from the differences in practice. Cold, hard evidence following years – sometimes decades – of documented clinical observations and tests is the cornerstone of conventional Western medical practice. With traditional and herbal medicines, however, the proof is in centuries’ worth of practice and experience, and less in the way of
documented trials. “So it’s hard to draw a conclusion about whether a herb works, or whether a result is due to something else,” said Ms Lim. To address this shortcoming, Ms Lim and a group of like-minded SGH colleagues set up a traditional medicine information service in october 2011 to provide doctors, pharmacists and other health care professionals with evidence-based information about traditional and alternative medicines.
Because we Believe that traditional medicines do have their Benefits, we want patients to Benefit from Both traditional medicine and western medicine (within safety limits).
The others in her team are Dr Linn Yeh Ching, Senior Consultant, Department of Haematology, SGH; Mr Ricky Ang Seng Kok, Principal Pharmacist, Department of oncology Pharmacy, National Cancer Centre Singapore; Ms Shyamala Narayanaswamy, Pharmacy Practice Manager, SGH; and Ms Fung Foon Yin, Traditional Medicine Resource Executive, Pharmacy Department, SGH. Ms Fung answers queries and does the literature searches.
Funded by the Ministry of Health, the service covers all traditional remedies including traditional Chinese, Ayurvedic and Malay/indonesian Jamu medicines, as well as health supplements.
“Because we believe that traditional medicines do have their benefits, we want patients to benefit from both traditional medicine and Western medicine (within safety limits),” said Ms Lim. For instance, ginger, a traditional herbal cure for nausea and vomiting, can help alleviate the side effects that a patient undergoing chemotherapy may get. Acupuncture can also help with such symptoms, said Ms Lim, noting that patients have stopped treatment when the side effects of chemotherapy became too severe to bear. “Reducing the side effects of the chemotherapy helped them to continue with their treatment,” she said.
The traditional medicine information service receives two to three queries a week. Ms Fung trawls through medical reference books, medical journals, case reports, and Chinese medical databases to find the information needed. The process can take anywhere from one to two hours to several days.
The team analysed the 216 queries the service received between october 2011 and April 2013, and found that 77 percent related to the safety of traditional or herbal medical products. Published information was available for 82 per cent of these queries. And of these, 115 enquirers provided feedback about whether they encouraged or discouraged the use of the product in question.
Out of 15 cases for which no risk was indicated, eight (53 per cent) of the health care professionals allowed the use of the product in question. The remaining 47 per cent took a cautious stance and discouraged their use, said Ms Lim, who was the lead investigator of the survey.
Ms Lim added that those who gave the go-ahead to their patients did so because they continued monitoring their patients’ conditions, or the drug had already been used for a while by the patient with no reported problems.
The queries came from pharmacists (77 per cent) and doctors (20 per cent). Not surprisingly, safety issues predominated, such as concerns with drug interactions (56 per cent) and adverse reactions (22 per cent). The findings were summarised in a poster and presented at last year’s SGH Annual Scientific Meeting, Annual Singapore Pharmacy Congress (where it was the 2nd runner-up in the Competitive Poster category), and other overseas conferences.
Ms Lim said that her team is working on another project to build up a database of treatments on cancer, diabetes and hypertension with Thong Chai Medical Institution. The effects – both positive and negative – of using both Western and traditional Chinese treatments for cancer, diabetes or hypertension will be studied carefully and documented. “Hopefully, we will be able to develop a database of findings to share with both
Western and traditional Chinese doctors,” said Ms Lim.
If the group is able to secure a grant for the project, the study will begin at the end of this year. The team is also looking to set up a database on warfarin, a common blood-thinning drug, and its interactions. When that is completed, they will continue and set up databases of other medications.
Funded by the Ministry of Health, the service covers all traditional remedies including traditional Chinese, Ayurvedic and Malay/indonesian Jamu medicines, as well as health supplements.
“Because we believe that traditional medicines do have their benefits, we want patients to benefit from both traditional medicine and Western medicine (within safety limits),” said Ms Lim. For instance, ginger, a traditional herbal cure for nausea and vomiting, can help alleviate the side effects that a patient undergoing chemotherapy may get. Acupuncture can also help with such symptoms, said Ms Lim, noting that patients have stopped treatment when the side effects of chemotherapy became too severe to bear. “Reducing the side effects of the chemotherapy helped them to continue with their treatment,” she said.
The traditional medicine information service receives two to three queries a week. Ms Fung trawls through medical reference books, medical journals, case reports, and Chinese medical databases to find the information needed. The process can take anywhere from one to two hours to several days.
The team analysed the 216 queries the service received between october 2011 and April 2013, and found that 77 percent related to the safety of traditional or herbal medical products. Published information was available for 82 per cent of these queries. And of these, 115 enquirers provided feedback about whether they encouraged or discouraged the use of the product in question.
Out of 15 cases for which no risk was indicated, eight (53 per cent) of the health care professionals allowed the use of the product in question. The remaining 47 per cent took a cautious stance and discouraged their use, said Ms Lim, who was the lead investigator of the survey.
Ms Lim added that those who gave the go-ahead to their patients did so because they continued monitoring their patients’ conditions, or the drug had already been used for a while by the patient with no reported problems.
The queries came from pharmacists (77 per cent) and doctors (20 per cent). Not surprisingly, safety issues predominated, such as concerns with drug interactions (56 per cent) and adverse reactions (22 per cent). The findings were summarised in a poster and presented at last year’s SGH Annual Scientific Meeting, Annual Singapore Pharmacy Congress (where it was the 2nd runner-up in the Competitive Poster category), and other overseas conferences.
Ms Lim said that her team is working on another project to build up a database of treatments on cancer, diabetes and hypertension with Thong Chai Medical Institution. The effects – both positive and negative – of using both Western and traditional Chinese treatments for cancer, diabetes or hypertension will be studied carefully and documented. “Hopefully, we will be able to develop a database of findings to share with both
Western and traditional Chinese doctors,” said Ms Lim.
If the group is able to secure a grant for the project, the study will begin at the end of this year. The team is also looking to set up a database on warfarin, a common blood-thinning drug, and its interactions. When that is completed, they will continue and set up databases of other medications.