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Natalie Lane is production editor, journals, with
the Pharmaceutical Press, the
publishing arm of the Royal Pharmaceutical Society
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What is FACT?
Focus on Alternative and Complementary Therapies (FACT), edited
by Edzard Ernst (Laing Chair in Complementary Medicine, Peninsula
Medical School, Universities of Exeter and Plymouth) is an evidence-based
journal that is a single point of reference for current information
on complementary and alternative medicine (CAM) from around the
world. Current literature is summarised and commented on by members
of the FACT international editorial board, reviewing topics as
diverse as herbal medicines, vitamins, minerals and supplements,
homoeopathy, acupuncture and manipulative therapies, and giving
readers a concise and objective view of the value of such therapies
currently available. FACT also contains news, short reports, focus
articles and debates on CAM.
The full text of FACT is available by
subscription and is now available online |
Heather Boon, assistant professor at the Leslie Dan Faculty of Pharmacy,
University of Toronto, discusses the increased use of complementary and
alternative medicine (CAM) in a guest editorial. She also wonders whether
CAM products provide an opportunity or a challenge for pharmacists. With
the increased use of CAM, pharmacists “appear to be in a good position
to provide patients with evidence-based information”, particularly
regarding the potential interactions with conventional medicine. Pharmacists
are also potentially able to help patients make a safe choice about CAM
products, although many pharmacists have limited ability when it comes
to achieving this. A varying level of content and discussion about CAM
in pharmacy schools has resulted in pharmacists practising with different
degrees of knowledge and competency.
The responsibility of pharmacists to detect and prevent interactions
between CAM products and conventional medicine is consistently recognised
as important. The editorial highlights several calls for pharmacists
to have more knowledge about CAM products, with one document suggesting “that
providing care to patients (many of whom are considering the use of CAM
products) means that the pharmacist must assume an active role in this
area of practice”. These reports assume a level of agreement by
pharmacists regarding CAM and pharmacy; yet evidence is also shown that
pharmacists do not accept herbal medicines. One Canadian study reported
that only 2 per cent of pharmacists believed that they had adequate information
about complementary and alternative health care.
The editorial concludes that the pharmacy profession can no longer ignore
the widespread use of CAM products by patients, and if pharmacies sell
CAM products, pharmacists must have sufficient knowledge to ensure they
help consumers and patients. Undergraduate pharmacy students need to
be actively educated, and practising pharmacists should be provided with
additional training.
Supplementary diabetes treatment
To evaluate the supplementation of pycnogenol, a Pinus pinaster (French
maritime pine) bark extract, to the usual treatment for type II diabetes,
77 participants in China received 100mg of pycnogenol, or a placebo
for 12 weeks. Significant improvement was found in plasma glucose levels
on multiple occasions, and positive effects noted in several metabolic
parameters. The authors concluded that the supplementation of pycnogenol “lowers
glucose levels and improves endothelial function”.
FACT suggests that the clinical trial and accompanying article were
produced quickly so as to confirm a set of beliefs rather than test
a hypothesis.
There are several details that the commentary suggests are missing from
the clinical trial such as: “How did the authors decide on the
number of subjects to enrol?” and “How did they prepare the
placebo and how did it compare to the pycnogenol?”. The authors
have replied to such details. They also note that this was the first
study to test lowering blood glucose in diabetic patients and, therefore,
there were no data to assist them.
FACT comments that pycnogenol is a fascinating substance and has the
potential to improve the health of type II diabetes patients. However,
it is difficult to draw conclusions from the data provided. AGE and coronary heart disease
In a pilot randomised controlled trial, participants with known coronary
artery disease or at high risk from such disease in Los Angeles, were
on stable courses of a statin drug and aspirin. The participants took
4ml of aged garlic extract (AGE) or a placebo daily for one year. The
results of absolute changes and percentage change per year were measured
by electron beam tomography using two different calculations: the Agatson
calcium score and a volumetric calcium score. The results showed less
progression of the volumetric calcium score per year for the AGE group
than for the placebo group, thus indicating the potential of AGE to
inhibit the rate of progression of coronary calcification. The authors
noted the incremental benefit of the garlic over the statin drugs,
and larger studies should be conducted to confirm this finding.
FACT discusses how this trial is well designed, executed and reported.
Participants were educated about a low cholesterol diet, were on a stable
regimen of statin drug plus aspirin, and were warned against consuming
garlic products. Participants were also tested quarterly for S-allylcysteine,
an active compound of AGE, which provided confirmation of compliance
with the trial. All these measures increased the reliability of the results.
The commentary notes a minor criticism concerning the lack of a power
calculation. This is relevant where the calculation of the volumetric
calcium score showed a difference between groups while the Agatson score
did not. FACT also highlights the need for all trials of herbs to document
the constituents of the products, and this trial makes a first step by
reporting the method of extraction.
In summary, however, FACT praises the authors for identifying the incremental
benefit of AGE in relation to statin therapy, and for showing the “positive
results that AGE slows progression of atherosclerosis without overstating
the findings from their study”. |
The
Pharmaceutical Journal