Is there a role for botanical medicines in the twenty-first century?: Promotion of untested traditional therapies by the World Health Organization and China endangers global public health.

China and the WHO's promotion of herbal and traditional medicines, most of which were not tested for safety and efficacy, have raised public health concerns.

Dietary supplements: What's in a name? What's in the bottle?

The Dietary Supplement Health and Education Act of 1994 (DSHEA), which arbitrarily classified herbals and other medicinal products as dietary supplements, obscured fundamental differences between two classes of products. Authentic supplements to the diet, such as multivitamins or calcium, have nutritional value and are safe. Herbals are used worldwide as medicines, they do not supplement the diet, they may cause severe adverse events, and they should be regulated as medicines. DSHEA also prevented the Food and Drug Administration (FDA) from effectively regulating herbal supplements as medicines. One consequence of weak FDA regulatory oversight is the poor quality of herbals. FDA inspections of manufacturing facilities have revealed violations of good manufacturing practices in over half of facilities inspected, including unsanitary conditions and lack of product specifications. Moreover, many "all natural" herbals marketed for weight loss, enhancement of sexual health and improving sports performance are adulterated with prescription and over-the-counter medications that have caused adverse cardiovascular events. New procedures to authenticate the identity of plants used in herbals will neither detect adulteration by medications nor provide assurance of appropriate pharmacological activity or safety. Nonvitamin, nonmineral "supplements" should be regulated as medicines, but revision or repeal of DSHEA faces strong opposition in Congress. The marketing of botanical supplements is based on unfounded claims that they are safe and effective. Health professionals need to inform patients and the public that there is no reason to take herbal medicines whose composition and benefits are unknown, and whose risks are evident.

IgG4 related cardiac disease.

IgG4-related systemic disease is an inflammatory disorder that can affect many organs. This case report describes a patient who in 2004 was found to have an inflammatory pseudotumor with IgG4 pathology. Over the next 3 years, visual symptoms responded well to recurrent courses of prednisone. In 2009, the patient developed chest pain and bradycardia with subsequent third-degree heart block, necessitating placement of a pacemaker. A subsequent PET scan showed extensive involvement of multiple organs as described in IgG4 disease as well as involvement of the myocardium and SA node. Pseudotumors involving the heart have been reported but have not been shown to be related to IgG4 disease. Although there was no pathology confirmation of heart involvement, the nature and extent of the organ involvement led us to conclude that it was due to IgG4-related disease. The use of the PET scan may help identify involvement of the myocardium.

My career as an immunoglycobiologist.

The research program of my laboratory included three major topics: the structures and immunology of human carbohydrate blood group and glycosphingolipid antigens; the tissue distribution, subcellular localization and biosynthesis of glycosphingolipids; and the structural basis of the binding of carbohydrates by antibodies and lectins.

A randomized controlled trial of acupuncture for osteoarthritis of the knee: effects of patient-provider communication.

OBJECTIVE: There is conflicting evidence on the efficacy of traditional Chinese acupuncture (TCA), and the role of placebo effects elicited by acupuncturists' behavior has not been elucidated. We conducted a 3-month randomized clinical trial in patients with knee osteoarthritis to compare the efficacy of TCA with sham acupuncture and to examine the effects of acupuncturists' communication styles. METHODS: Acupuncturists were trained to interact in 1 of 2 communication styles: high or neutral expectations. Patients were randomized to 1 of 3 style groups, waiting list, high, or neutral, and nested within style, TCA or sham acupuncture twice a week over 6 weeks. Sham acupuncture was performed in nonmeridian points with shallow needles and minimal stimulation. Primary outcome measures were Joint-Specific Multidimensional Assessment of Pain (J-MAP), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction scores. RESULTS: Patients (n = 455) received treatment (TCA or sham) and 72 controls were included. No statistically significant differences were observed between TCA or sham acupuncture, but both groups had significant reductions in J-MAP (-1.1, -1.0, and -0.1, respectively; P < 0.001) and WOMAC pain (-13.7, -14, and -1.7, respectively; P < 0.001) compared with the waiting group. Statistically significant differences were observed in J-MAP pain reduction and satisfaction, favoring the high expectations group. In the TCA and sham groups, 52% and 43%, respectively, thought they had received TCA (κ = 0.05), suggesting successful blinding. CONCLUSION: TCA was not superior to sham acupuncture. However, acupuncturists' styles had significant effects on pain reduction and satisfaction, suggesting that the analgesic benefits of acupuncture can be partially mediated through placebo effects related to the acupuncturist's behavior.

An evaluation of the evidence in "evidence-based" integrative medicine programs.

Alternative therapies are popular, and information about them should be included in the curricula of health profession schools. During 2000 to 2003, the National Institutes of Health National Center for Complementary and Alternative Medicine awarded five-year education grants to 14 health professions schools in the United States and to the American Medical Students Association Foundation. The purpose of the grants was to integrate evidence-based information about complementary and alternative medicine (CAM) into the curriculum. The authors reviewed the educational material concerning four popular CAM therapies-herbal remedies, chiropractic, acupuncture, and homeopathy-posted on the integrative medicine Web sites of the grant recipients and compared it with the best evidence available. The curricula on the integrative medicine sites were strongly biased in favor of CAM, many of the references were to poor-quality clinical trials, and they were five to six years out of date. These "evidence-based CAM" curricula, which are used all over the country, fail to meet the generally accepted standards of evidence-based medicine. By tolerating this situation, health professions schools are not meeting their educational and ethical obligations to learners, patients, or society. Because integrative medicine programs have failed to uphold educational standards, medical and nursing schools need to assume responsibility for their oversight. The authors suggest (1) appointing faculty committees to review the educational materials and therapies provided by integrative medicine programs, (2) holding integrative medicine programs' education about CAM to the same standard of evidence used for conventional treatments, and (3) providing ongoing oversight of integrative medicine education programs.

Therapy: Herbals and supplements for rheumatic diseases.

Many people with chronic rheumatic diseases choose to use complementary and alternative therapies on the basis of information from unreliable sources. Does a report from a UK-based arthritis charity meet the need for rigorous, evidence-based recommendations for the public and for health-care providers?