Education
Botanical, herbal, and other natural products
We are improving our understanding or the mechanism of action of natural products and evaluating their safety and efficacy.
The herbal market grew from $1.6 billion in 1994 to $2-3 billion in 1996, and the dietary supplement industry in 2000 was in excess of $14 billion. The majority of consumers who buy botanical products or dietary supplements have the same degree of confidence in these compounds that they have in pharmaceutical products, and assume that product safety is assured. Most people are unaware that such products are regulated under an entirely different set of rules than those that cover prescription and over-the-counter drugs and conventional foods.
Under the 1994 Dietary Supplements Health and Education Act, "the manufacturer is responsible for insuring that a dietary supplement is safe before it is marketed; the FDA is responsible for taking action against any unsafe dietary supplement after it reaches the market." (
Click for dietary supplement link) To date, only dietary supplements containing ephedra have been prohibited.
While most pharmaceutical agents have only one active ingredient whose presence and potency can be measured and tested and used to create a standard dose, herbal or botanical products almost always have more than one active ingredients. ( Click for dietary supplement safety link) For many natural products, the most important ingredient or the specific combination of compounds that produce a clinical impact are often unknown. As a result, standardizing natural products is very complex.
There is an urgent need to assess the efficacy and effectiveness of natural products currently in use. It is essential to establish what herbals, botanicals and supplements work for what conditions and to ascertain their mechanisms of action, their active ingredients and when interactions with other drugs may be harmful.
Mind-body interventions
Mind-body approaches to healing have gained enormous popularity in the U.S. They range from the more traditional practices such as support groups, mindfulness-based stress reduction, and cognitive-behavioral therapy, to relaxation, meditation, biofeedback, hypnosis and guided imagery. T'ai Chi, Qi Gong and yoga are approaches that combine movement and meditation.
Despite tremendous strides by scientists in understanding the mechanisms of disease, many patients with chronic illnesses find conventional therapies do not completely alleviate their symptoms. The prognosis of patients with chronic illnesses such as coronary artery disease and cancer is influenced by psychosocial factors, including social support, stress, anxiety and depression. From heart disease to cancer, many chronic illnesses leave patients reaching for alternative therapies to reduce pain and disability or improve outcomes. Mind-body approaches have been advocated for many conditions but there are few randomized trials.
We know that physiological predisposition, stress and individual behaviors alter the risk of developing chronic illness. Patient empowerment and participation is likely a major component in most successful treatments. Techniques such as motivational interviewing, mindfulness-based stress reduction and self-efficacy enhancement may provide other strategies that will allow patient-specific healing. Approaches like yoga, exercise, social support, meditation, and guided imagery may provide important strategies to improve patient outcomes and quality of life.
