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LIBR534 (Module 1: Health information questions Part III)

  Drug information sources; complementary and alternative medicine (CAM)

Introduce basic concepts in answering drug/CAM related questions Core issues; common issues in drug-related information

Using print resources &/or electronic equivalents Create opportunities to encounter questions, develop search strategies

Reading:

DISCUSS – REPORT BACK: Yanicke J. A suggested book list for hospital libraries. J Hosp Librarianship. 2013;13(3).

On the wiki:

COMPLEMENTARY & ALTERNATIVE MEDICINEhttp://hlwiki.slais.ubc.ca/index.php/Complementary_%26_alternative_medicine_%28CAM%29

LIBR534 Health information sources and services, Sept 2014Dean Giustini, UBC Biomedical Branch Librarian

Complementary & alternative medicine AND drug information for health librarians

“…[drug] spending in Canada is estimated to reach $35 billion dollars in 2014. Cross-Canada per capita costs average $355 per person (private spending = ~$410 per person). Non-prescribed drug costs includes OTC drugs, personal health supplies & complementary &

alternative medicine products…” ~ Canadian Institute for Health Information (CIHI)

LIBR534 Health information sources and services, 2014

Caduceus, based on the spire of Aesclapius

Bowl of Hygeia, symbol of pharmacy

Goals tonight

• Start to examine CAM & drug-related questions

• Identify main / major sources of credible information

• Assess each as a starting point

• Discuss the drug approval process in Canada

• Select appropriate sources of scientific evidence

• Begin to understand how to approach questions

LIBR534 Health information sources and services, 2014

Minerva, goddess of medicine

Complementary & alternative medicine

• Based on the wiki entry, what is complementary and alternative medicine?

• Name some types of CAM therapies?

• What do health librarians need to consider in providing info re: CAM?

https://www.youtube.com/watch?v=zPgUiBPp9mY

NCCAM YouTube Channel https://www.youtube.com/channel/UC3Y8xLrGG7Lh7smbkPZcCGQ

• In CAM, it can be difficult to distinguish between what is meant to be information & what is advertising

• Prescription drugs interact with herbal remedies; may cause adverse reactions

• Regulation of CAM products in Canada is strict(er)

• In 2014, is quackery a problem? http://quackwatch.com

Complementary (CAM) information

Health Fraud Scams (US FDA) http://youtu.be/KsPlwKbGxE8?list=PLVaOpweBregW3JGZ81r3StdH1eyjA4cpN

https://www.youtube.com/watch?v=4pXsm3qaFIk

Integrative medicine

"...Imagine a world in which medicine was oriented towards healing rather than disease; where doctors

emphasized prevention above treatment." — Andrew Weil, MD

Complementary and alternative medicine (CAM)• Any medical system, practice, or product that is not thought of as standard care

Complementary medicine• A CAM therapy used along with standard medicine

Alternative medicine• A CAM therapy used in place of standard treatments

Integrative medicine• An approach that combines treatments from conventional medicine and CAM, and for

which there is high-quality evidence of safety and effectiveness

CAM Definitions

Sources of information in CAM

Herbs at a Glance via NCCAM website

Natural Standard via naturalstandard.com

BC Cancer Agency - Complementary and Alternative Cancer Therapies (no image)

Tyler's honest herbal : a sensible guide to the use of herbs 

Rakel: Integrative Medicine via MD Consult

National Center for Complementary & Alternative MedicineNCCAM Health Topics

CAM in PubMed

• Echinacea• Colds, flu

• Gingko biloba• Memory, cerebral

blood flow• Ephedra

• Stimulates heart • St. John’s Wort

• Depression

• Chamomile• Relaxant, anti-anxiety

Most popular herbal supplements

Do you have your own favourite?

10

• British Columbia Naturopathic Associationhttp://www.bcna.ca/

• Boucher Institute Of Naturopathic Medicine http://www.binm.org

• BC Government – Naturopathy Regulationshttp://www.healthplanning.gov.bc.ca/leg/notice/naturopathy.html

• Health Canada – Natural Health Branchhttp://www.hc-sc.gc.ca/dhp-mps/prodnatur/index_e.html

CAM in BC and Canada

Drug use & evaluation process

• Each country has regulatory body to govern approval process

• Each drug must be safe & effective

• Pre-clinical testing (laboratory & animals)

• Clinical testing (clinical trials in humans)

• Drug approval can take ~10-15 yrs

Clinical trials process

• Administer new drug to subjects & assess outcome (uncontrolled)

• Administer new drug to one group & a control to second group (controlled clinical trial)

• What happens to the drug in the body? • What happens to the body when given the drug? • Is the drug clinically-effective? • Is drug clinically-safe / tolerable? • How should the new drug be taken?

http://www.merck.com/clinical-trials/about-clinical-trials.html

Reference interview re: drugs / herbals

• Background information

• Let user state the research question

• Classify it (“THE” question)

• Ask appropriate background questions

• Gather extra information to determine “true” question

• Determine urgency & format needed

Classify drug question• Availability of drug• Identification of drug• Drug interactions• Dosage • Adverse drug reactions• Side effects • IV administration / compatibility • Poisoning / toxicity• Pregnancy & lactation issues• Natural products • Patient-oriented information • Therapeutics

General drug questions

• Background information

• Dosing

• Side effects, drug interactions

• Contraindications & precautions

• Pharmacokinetics & pharmacology

• How medications are supplied (tablet, injection, etc.)

• How medications are taken

• How medications should be stored Basic & Clinical Pharmacology

on AccessMedicine

Sources of drug information are tertiary sources

• Drug monograph, handbook, textbook• Background or fundamental knowledge• By prescription, OTC, herbal, foreign, cosmetics, household

product, and so on

• Organization: how is source organized?• Alphabetical, classified, faceted, by side effect?• What kind of information does it present?

• Generic, trade, chemical, investigational, formula, therapeutic class, pharmacological class

• Authority: is it referenced?• Is it regularly updated?• What is unique about source?• What types of questions might the source answer?

General drug information sources

Martindale : the complete drug referencePrint ONLY

via MedicinesComplete

American Hospital Formulary Service (AHFS) Drug Information

PDR Physicians Desk Reference

http://resources.library.ubc.ca/1147

…also via MedicinesComplete

Drug interactions – sources of information

Martindale : the complete drug referencePrint ONLY

via MedicinesComplete

Stockley’s Drug Interactions via MedicinesComplete

PDR Physicians Desk ReferencePrint ONLY

Adverse Reaction Reportinghttp://www.hc-sc.gc.ca/dhp-mps/medeff/report-declaration/index-eng.php

http://www.hc-sc.gc.ca/dhp-mps/medeff/bulletin/index_e.html

Drug portals – sources of information

Licensed Natural Health Products Database Health Canada

Canadian Agency for Drugs & Technologies in Health http://www.cadth.ca

National Library of Medicine Drug Information Portal http://druginfo.nlm.nih.gov/drugportal/drugportal.jsp

Drug & poison information sources

Olson’s Poisoning & Drug Overdose

Goldfrank’s Toxicologic emergencies

http://www.grupopamilt.com/cassarett.pdf

Casarett and Doull's toxicology: the basic science of poisons

Drugs in pregnancy – sources of information

http://toxnet.nlm.nih.gov/help/lactmedapp.htmBrigg’s drugs in Pregnancy and Lactation on Books@Ovid

Disease control & immunization sources

Canadian Immunization Guide http://www.phac-aspc.gc.ca/publicat/cig-gci/

Public Health Agency of CanadaInfection Control Guidelines

http://www.bccdc.ca/default.htm

LIBR534 Health information sources and services, 2014