Abstract
By Dr Greg Sperber with Bob Flaws
Publisher: Blue Poppy Press
Boulder, CO 80301
Website: www.bluepoppy.com
First Edition, October 2007
ISBN: 1-891854-41-1; ISBN: 978-1-891845-41-3
LCCN: 2007937337
452 pages; $99.95
Reviewed by Eric S. Hsu, MD
Chapter 1: “Introduction” outlines the book and offers instructions on how to use it. Oriental Medicine students and practitioners are the target readers. This book is geared toward the US market and excludes any drugs unavailable in the United States. Any drugs given through injection and inhalation (except used in asthma) are not covered in this book. Over-the-counter drugs are also not included. Drug-herb interactions are a particularly rapidly changing field as more and more evidence is being accumulated. For the latest in drug-herb interactions, the authors do suggest the website at www.integrativepharm.com.
The authors chose standard evidence-based medicine levels from the Oxford Centre for Evidence-based Medicine to grade each drug-herb interaction paper for level of evidence for harm. These grades and what they mean are as follows: 1a: Systematic Review (SR) of Random, Controlled Trials (RCTs); 1b: Individual RCT with narrow Confidence Interval (CI); 2a: SR of cohort studies; 2b: Individual cohort study including low quality RCT; 2c: Outcomes research–study of a cohort of patients with the same diagnosis that correlates their clinical and health outcomes to the care that they received; 3a: SR of case-control studies; 3b: Individual case-control study; 4: Case-series, poor quality cohort and case-control studies; and 5: Expert opinion without explicit critical appraisal, or based on physiology bench research. Animal research falls under the category of bench research.
After an evidence level for each paper is determined, a letter grade for the overall interaction is assigned based on the level of evidence of the individual papers. For each interaction, the following criteria are employed. This assessment was listed in parenthesis behind each of the herbs:
Consistent level 1 studies Consistent level 2 or 3 studies or extrapolations from level 1 studies Level 4 studies or extrapolations from level 2 or 3 studies Level 5 evidence or troublingly inconsistent or inconclusive studies of any level.
Chapter 2: “Pharmacology Basics” navigates fundamental pharmacology through the pharmacokinetics, pharmacodynamics, and drug-drug interactions. It serves as a pleasant introduction for students, and refresher for experienced practitioners. The summary of variables commonly used in pharmacology is well implemented at the end of the chapter.
Chapter 3: “Drug-Herb Interactions” provides a superior synopsis of the ways in which herbs and pharmaceutical agents may interfere with each other. Section 6 of this chapter presents general guidelines and a brilliant stepwise approach in managing patients already taking Western medicine. It encourages Oriental Medicine practitioners to open lines of communication with patients' prescribing physician. The socioeconomic talking points emphasize available evidence that vigilant combination of Chinese herbs and Western drugs are feasible and beneficial.
Chapters 4 to 9: Cover the effects of Western drugs on the autonomic nervous system, central nervous system, cardiovascular system, endocrine system, respiratory system, and gastrointestinal system.
Chapter 10: “Chemotherapeutic Agents” deals with antimicrobial agents, anticancer drugs, and immunosuppressants. The adverse effects, red flags, and potential interactions with herbs are discussed under each section.
Chapter 11: “Anti-Inflammatory Drugs” concentrates on sections of non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and disease-modifying antirheumatic drugs (DMARDs), and drugs used to treat gout, migraines, and ulcerative colitis. Of note, there is a lengthy directory of herb interaction, especially with aspirin.
Chapter 12: “Miscellaneous Drugs” attends to agents used to treat erectile dysfunction, osteoporosis, obesity, aids for smoking cessation, and muscle relaxants. The Chinese medical explanations of the drug categories in these chapters are listed in chapter 13.
Chapter 13: Presents the provisional Chinese medical descriptions of Western drugs by each category. The authors emphasize the general Chinese medical classification of the drug and its apparent Chinese medical function. The drugs are listed by anticipated therapeutic effects and its potential side effects in terms of Chinese medical symptoms. Disease mechanisms accounting for these symptoms are then listed. The solitary Chinese medical mechanism is identified based on the proposed therapeutic effects and probable side effects of the drug. The word “provisional” was chosen because it has taken thousands of years to reach consensus on the Chinese medical descriptions of current Chinese medicines.
I was very impressed with the thoughtful page-by-page glossary of potentially intricate terms throughout the whole book. The design of this book is user-friendly and helps readers quickly search for specific information.
There are 3 appendices A, B, and C in the bibliography, abbreviations, and glossary. This is a unique book listing 6 indexes for general index, generic drug, brand name drug, drug group, conditions and procedures, and herb and supplement.
I applaud the authors for launching the inauguration of Integrated Pharmacology. This book could inspire and enhance the learning process of Oriental Medicine. Even seasoned practitioners may appreciate this book as a handy companion and reference. It could nurture promotion and joint venture of both Oriental and Western medicine. Future online versions with concurrent updates and versatility would be advantageous in such an evolving field as Integrated Pharmacology.
Footnotes
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