Lane P. Johnson, MD, MPH, clinical associate professor in family medicine and in public health at The University of Arizona Health Sciences Center, has been recognized for his pioneering work in producing educational materials that focus on commonly used commercial and Hispanic herbal remedies.
Dr. Johnson received a first-place Health Education Media Makers Yearly (HEMMY) award for excellence in health-education materials at the Arizona Public Health Association''s annual conference last month in Sedona.
The annual HEMMY awards are given at two levels: professional, recognizing materials designed and produced by an outside agency, and grassroots, for materials designed and created "in-house." Working with project director Hal Strich, MPH, an epidemiologist with the UA College of Medicine, and other colleagues at the College of Medicine, the UA College of Pharmacy, the UA Mel and Enid Zuckerman College of Public Health and community health centers, Dr. Johnson developed a PowerPoint presentation and collateral materials based on his study, "Hierbas y Diabetes." The collateral materials, including posters that describe commonly used commercial and Hispanic herbal remedies and an interactive, online compendium of Hispanic herbs, were awarded the top-prize HEMMY at the grassroots level. [M]
Designed to inform patients and health-care professionals about the benefits and risks associated with herbal remedies, the posters and Web-based resource materials represent the second phase of "Hierbas y Diabetes," a study undertaken by Dr. Johnson to evaluate the use, effects and interactions of herbal remedies used by Hispanic women being treated for type 2 diabetes at community health centers in the Southwest. The project was supported by a grant from the UA Center for Education & Research on Therapeutics (AZCERT) and Agency for Healthcare Research and Quality (AHRC) in the U.S. Department of Health and Human Services.
According to Dr. Johnson, millions of adults in the United States use self-prescribed herbal remedies or other supplements to treat conditions for which they are receiving standard medical therapy as well. Most do not volunteer their herb or supplement use to their health-care providers. In Dr. Johnson''s view, the majority of natural remedies commonly available in botanicas, health-food stores, backyard gardens and via the Internet probably are harmless, and some may be beneficial in treating certain conditions. However, herbs taken for their potential healing effects can be inappropriate for some people. Some can interact with traditional medications, and a few are downright dangerous.
A case in point is ephedra (aka ma huang, Mormon tea). Extensively promoted to aid weight loss, enhance sports performance and increase energy, ephedra was linked to thousands of adverse effects, including sudden death, heart attack and stroke, before it
was removed from the commercial market in 2004. Following a lawsuit filed by a supplement company challenging the Food and Drug Administration''s ban, ephedra is back on the shelves.
Citrus aurantium, or bitter orange, marketed as a replacement for ephedra, may have even greater negative effects on heart rate and blood pressure than ephedra was shown to have. Both substances can have deadly interactions with traditional medications.
Being aware of what their patients are taking and the potential consequences can help clinicians head off serious problems, says Dr. Johnson. A good time to ask about herb use is when taking a medication history, but a lack of information often steers the health-care professional away from the subject. "Many practitioners, especially in primary care, would like to discuss herbal remedies with their patients, but they find themselves overwhelmed with the hundreds of herbal products being marketed with no objective assessment of their effectiveness, side effects, contraindications or potential interactions."
However, he asserts, the vast majority of people who use herbal remedies make their selections from only 25 to 30 herbs. Therefore, a practitioner who is acquainted with these 25 to 30 herbs should be able to discuss almost any herbal remedy a patient may be using. To help facilitate this kind of discussion, Dr. Johnson designed simple, practical tools to make information about herbs readily accessible for clinicians.
Drawing in part on his book, Pocket Guide to Herbal Remedies, published in 2002, he developed two charts, one describing commonly used, commercially available herbs, the other a table of commonly used Hispanic herbs. Each herb is described by its scientific or botanical name, its common name(s), its uses, potential adverse effects and potential interactions with other medications. The evidence of usefulness for various herbs also is provided - i.e., whether the evidence is theoretical, anecdotal, based on animal and/or human studies. For commercial herbs, sales rankings in the United States are included.
The charts are designed in two formats: as large, colorful wall posters and as 8-1/2 inch by 5-1/2 inch laminated reference cards that can be kept at hand in an examining room or a practitioner''s office.
Supplementing these materials is an interactive Web page of Hispanic herbs that can be searched by typing in a keyword or by selecting a plant''s scientific, family or common names or symptoms for which it might be used. This resource provides the essential information about each plant that most clinicians want: how well does it work, and is it dangerous?
Noting that knowledge is only part of the solution to potential trouble with herbs, Dr. Johnson stresses the need for clinicians to talk with and document their discussions with their patients.
"Herbs can help, and herbs can hurt," he says. "The job of the medical professional is to help patients make the best decisions they can. Now we have a few more tools that clinicians can use to open up discussion."
To search Dr. Johnson''s database of herbs or to view and download the commercial and Hispanic herb charts, please visit the AZCERT Web site, www.arizonacert.org