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Holistic Healing and its Interaction with Western Medicine – COSIPA – June 2016
Holistic Healing and its Interaction with Western Medicine
Ted C. Hanf JD, MPH
Kegel, Tobin & Truce APC
Southern California
[email protected]
Population of California by Origin
• 10 Million Immigrants
• 27% Foreign Born
• ½ the children in Calif. have 1 foreign born parent
• 53% Latin American
• 37% Asian
Source: ppic.org
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Council of Self-Insured Public Agencies
(c) Ted C. Hanf 2016 (c) Ted C. Hanf 2016 What Are We Talking About?
Complementary and Alternative Medicine
• Herbal Remedies
• Homeopathic Remedies
• Spiritual Remedies
• Traditional “cures”
How Prevalent is This ?
• Mainstream usage among all groups
• Geographic / Regional Variances
• Cross Pollination by proximity and exposure
• Social Networking and Media influences
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Council of Self-Insured Public Agencies
(c) Ted C. Hanf 2016 (c) Ted C. Hanf 2016 How Prevalent is This ?
How Prevalent is This ?
Gender
Education
College
No College
Men
Women
0
20
40
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60
(c) Ted C. Hanf 2016 © Ted C. Hanf ‐ 2016
80
100
0
20
40
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60
80
100
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Holistic Healing and its Interaction with Western Medicine – COSIPA – June 2016
How Prevalent is This ?
How Prevalent is This ?
Mexican Amer
Native Amer
Chinese
Income
Use CAM
>50 K
< 50K
Dominican
African Amer
0
0
20
40
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60
80
20
40
60
80
100
100
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(c) Ted C. Hanf 2016 (c) Ted C. Hanf 2016 Why Use CAM ?
Why Use CAM ?
• Pain /Back Problems
• Menopause / Gynecological Problems
• Rheumatology Related • Gastrointestinal
• Sinus
• Cognitive / Attention / Hyperactivity
• Psychiatric / Neurological
• Cancer
• HIV
• Asthma
source: Institute of Medicine
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Council of Self-Insured Public Agencies
(c) Ted C. Hanf 2016 (c) Ted C. Hanf 2016 Most Commonly Prescribed Drugs
Most Commonly Used OTC
• Hydrocodone
• Zocor
• Lisiniopril
• Synthroid
• Norvasc
• Prilosec
• Azithromycin
• Cough/Cold
• Analgesics
• Antacids
• Laxatives
• Antidiarrheal
source: Daily Rx News 4‐17‐14
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Holistic Healing and its Interaction with Western Medicine – COSIPA – June 2016
Why Does This Concern Us?
Why Does This Concern Us?
• High Percentage of CAM users do not report self‐
treatment to their primary treating physician
• “Herbal” and “Natural” products are not regulated
•
•
•
•
•
•
61% 60%
31%
20%
15%
2%
Not important
Dr. never asked
None of Dr’s business
Dr. wouldn’t understand
Dr. wouldn’t approve
Dr. might refuse to treat
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• Dosages and quality of ingredients varies widely
• Teas, energy drinks, vitamins, soft drinks, dietary and food supplements from gym or “As Seen on TV”
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(c) Ted C. Hanf 2016 (c) Ted C. Hanf 2016 Echinacea
• Has life threatening interactions with:
•
•
•
•
•
•
Acetaminophen
Acyclovir
Many statin drugs
Cipro and other floxacin ABX Colchicine
and close to 100 other commonly prescribed drugs
Council of Self-Insured Public Agencies
Source: National Center for Health Statistics, 2004
(c) Ted C. Hanf 2016 Echinacea
(c) Ted C. Hanf 2016 Echinacea
• Often used to strengthen the immune system, boost resistance to colds, flu, infections
• May depress CD+4 levels and increase HIV replication • Affects hepatotoxicity used with drugs that raise liver enzyme levels
• Affects drug levels of Anti‐Retroviral drugs taken for HIV and Hepatitis C
• May depress CD+4 levels and increase HIV replication • May decrease activity of immunosuppressant drugs used in transplant and auto immune diseases
Source: Drug‐Herb Interactions, Lippencott Williams & Wilkins 2003 Council of Self-Insured Public Agencies
(c) Ted C. Hanf 2016 © Ted C. Hanf ‐ 2016
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Holistic Healing and its Interaction with Western Medicine – COSIPA – June 2016
Ginseng Ginseng • Affects the action of many drugs
• Also an ingredient in many “energy” drinks
• Digoxin – causes false level readings on testing
• Furosemide, HCTZ – decreases effectiveness of diuretics used for high blood pressure
• Haldol (haloperidol) increases CNS stimulation
Source: Drug‐Herb Interactions
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(c) Ted C. Hanf 2016 Gingko ( Gingko biloba)
• Contains a substance that interferes with blood platelet activity and amplifies the effects of blood thinners
•
•
•
•
•
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(c) Ted C. Hanf 2016 Gingko ( Gingko biloba)
• Affects the action of many drugs
• Wellbutrin ‐ lowers seizure threshold
Warfarin
Coumadin
Heparin
Aspirin
Fish‐Oil
• Flagyl ‐ lowers seizure threshold, increases the risk of seizure
• NSAIDS ‐ increases bleeding risk
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(c) Ted C. Hanf 2016 Council of Self-Insured Public Agencies
(c) Ted C. Hanf 2016 Garlic
St. John’s Wort • Used to prevent infection
• Touted for having cancer prevention properties
• Increases risk of bleeding
• Used for mild to moderate depression
• Inhibits effect of Warfarin, Digoxin in CVD
• Significant Effect on SSRI psychotherapeutic drugs
• Augments effect of MAOI psychotherapeutic drugs
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Holistic Healing and its Interaction with Western Medicine – COSIPA – June 2016
St. John’s Wort
St. John’s Wort
• Affects the action of many drugs:
• Must not be taken with MAOI antidepressants
• If taking SSRI, must wait 4‐5 weeks before starting MAOI to avoid side effects
• Furoxone, Marplan, Nardil
• May cause extreme fever ( 104+F)
• Has same properties as SSRI antidepressants
• Celexa, Lexapro, Prozac, Paxil, Zoloft
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• Seizure or death if taken with MAOI
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(c) Ted C. Hanf 2016 Kava ( Kava Kava)
(c) Ted C. Hanf 2016 Kava
• Serious Drug Interactions:
• Prevalent use among Pacific Islanders
• Mood elevator, enhances wellbeing and contentment
• Elavil – coma
• Lipitor – liver damage
• Wellbutrin – seizure and coma
• Taken for anxiety and insomnia
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(c) Ted C. Hanf 2016 Kava
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(c) Ted C. Hanf 2016 YAWN !!!
• Cannot combine with
• Many statin drugs ‐ Lipitor, Pravachol, Crestor, Zocor
• TCA, MAOI, SSRI, Benzodiazapine Antidepressants • Valerian Root tea ( contains benzodiazapines)
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Holistic Healing and its Interaction with Western Medicine – COSIPA – June 2016
Yohimbe
SEX
• Sexual enhancer sales are soaring
(now that I have your attention !!)
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Council of Self-Insured Public Agencies
(c) Ted C. Hanf 2016 Sexual Enhancement Supplements
(c) Ted C. Hanf 2016 Sexual Enhancement Supplements
Sales are soaring
$ Million
• Sexual enhancer supplements are everywhere
400
100
2001
2006
Source: Nat Bus Journal October 2007
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(c) Ted C. Hanf 2016 Council of Self-Insured Public Agencies
(c) Ted C. Hanf 2016 Sexual Enhancement Supplements
Sexual Enhancement Supplements
• Sexual enhancer supplements are everywhere
• You pay your money and you take your chances
www.youtube.com/watch?v=q1eR7LXKEV0 accessed 5/14/16
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(c) Ted C. Hanf 2016 © Ted C. Hanf ‐ 2016
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Holistic Healing and its Interaction with Western Medicine – COSIPA – June 2016
Sexual Enhancement Supplements
Yohimbe
• FDA lab tests found that nearly 300 products contain undisclosed drug ingredients
Active ingredient in Viagra, Cialis and Levitra. • Ingredient in many “herbal sex enhancers”
• Samples also contained combinations of undisclosed ingredients or excessively high doses
Source: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm465024.htm
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• Traditionally used in Africa as aphrodisiac
source: NCCAM – nccam.nih.gov/health/supplement‐safety
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(c) Ted C. Hanf 2016 (c) Ted C. Hanf 2016 Yohimbe
Sexual Enhancement Supplements
• High Blood Pressure +
Increased Heart Rate
• Anxiety + Sleeplessness
• Dangerous combined with tricyclics and phenothiazines
Source: NCCAM – nccam.nih.gov/health/supplement‐safety
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• Captopril
• Naproxen
• Furosemide
• Dexamethasone
• Folic Acid
• Loratadine
• No prescription needed
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(c) Ted C. Hanf 2016 (c) Ted C. Hanf 2016 Food and Beverages
Food and Beverages
• Grapefruit
Energy Drinks
• Blocks enzyme to metabolize Medication. Drug levels too high
• Blocks absorption in intestine. Drug levels too low
• Affects therapeutic effect of :
Benzodiazepines
Anti‐migraine drugs Statins
Codeine Council of Self-Insured Public Agencies
(c) Ted C. Hanf 2016 © Ted C. Hanf ‐ 2016
Opioids
Antiretrovirals
• ER visits due to use
• Deaths linked to use
• Sales continue to rise
• Popular with Millenials
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Holistic Healing and its Interaction with Western Medicine – COSIPA – June 2016
Food and Beverages
Take Away Message
• Drs., Lawyers, and Examiners shouldn’t just ask:
“Are you taking any prescription or over the counter medicine?”
• That is a totally meaningless question
• Ask specifically about teas, herbs, food supplements, additives, over the counter, healing practices, traditional remedies
Council of Self-Insured Public Agencies
Council of Self-Insured Public Agencies
(c) Ted C. Hanf 2016 (c) Ted C. Hanf 2016 Take Away Message
Take Away Message
• Ask about remedies or drugs acquired by travelers or sent by relatives from other countries
• Understand how therapeutic agents are perceived and how and where they are obtained.
• Know the different forms that “treatment” can take.
• Speak in terms of “remedies” not drugs or prescription medicines
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Council of Self-Insured Public Agencies
(c) Ted C. Hanf 2016 (c) Ted C. Hanf 2016 Resources
Resources
National Center for Complementary and Alternative Medicine
You
NCCAM.NIH.GOV
Your Friends
Your Relatives
Food and Drug Administration
Your colleagues
FDA.GOV
Your instincts
Centers for Disease Control and Prevention
PROBE RELENTLESSLY UNTIL YOU HAVE AN ANSWER
CDC.gov
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Holistic Healing and its Interaction with Western Medicine – COSIPA – June 2016
The world is full of
obvious things
which nobody by
any chance ever
observes
THANK YOU FOR YOUR ATTENTION
Ted C. Hanf J.D., M.P.H.
Kegel, Tobin & Truce APC
Tel: 213‐380‐3880
Fax: 213‐383‐8346
E‐mail: [email protected]
Sherlock Holmes
A. Conan Doyle , Hound of the
Baskervilles
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(c) Ted C. Hanf 2016 © Ted C. Hanf ‐ 2016
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