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LIBR534 – Module 1/Part III: Health information questions

  Drug information sources; complementary and alternative medicine (CAM) ANSWER drug/CAM related questions

DISCUSS issues in providing drug-related information DISCUSS print resources &/or electronic equivalents ANSWER questions AND DEVELOP search strategies

ACTIVITIES THIS EVENING:• Sources of information in health and medicine (17 sources)

• Discuss reading: Yanicke J. A suggested book list for hospital libraries. J Hosp

Librarianship. 2013;13(3).

• Discuss wiki articles:http://hlwiki.slais.ubc.ca/index.php/Complementary_%26_alternative_medicine_%28CAM%29

http://hlwiki.slais.ubc.ca/index.php/Drug_Information_-_print_%26_online_sources

NEWS, ANNOUNCEMENTS & BREAKS

Complementary & alternative medicine AND drug information for health librarians

“…[drug] spending in Canada is estimated to reach $35 billion dollars in 2014. Cross-Canada per capita costs average $355 per person (private spending = ~$410 per person). Non-prescribed drug costs includes OTC drugs, personal health supplies & complementary &

alternative medicine products…” ~ Canadian Institute for Health Information (CIHI)

LIBR534 Health information sources and services

Caduceus, based on the spire of Aesclapius

Bowl of Hygeia, symbol of pharmacy

Rx is the symbol in Latin “to take”

Goals tonight

• Discuss complementary, alternative & integrative health & drug questions

• Identify some major sources of credible, evidence-based information

• Discuss the drug approval process in Canada

• Select appropriate sources of scientific evidence

• Begin to understand how to approach questions

Complementary & alternative medicine• What is complementary and alternative medicine?

• Name two types of CAM therapies • What do health librarians need to answer these questions?

https://www.youtube.com/watch?v=zPgUiBPp9mY

https://www.nlm.nih.gov/medlineplus/

https://nccih.nih.gov/research

National Center for Complementary and Integrative Health (NCCIH)

• Challenges with information & advertising

• Prescription drugs and herbal remedies… adverse reactions

• Regulation of CAM products in Canada is strict(er)

• Is quackery a problem? http://quackwatch.com

CAM informational issues

Health Fraud Scams (US FDA) http://youtu.be/KsPlwKbGxE8?list=PLVaOpweBregW3JGZ81r3StdH1eyjA4cpN

https://www.youtube.com/watch?v=4pXsm3qaFIk

What is integrative medicine?

"...Imagine a world in which medicine was oriented towards healing rather than

disease; where doctors emphasized prevention above treatment."

— Andrew Weil, MD

Complementary and alternative medicine (CAM)• Any medical system, practice, or product not considered standard care

Complementary medicine• Used WITH standard medicine

Alternative medicine• Used IN PLACE of standard treatment

Integrative medicine• Combines treatments from conventional medicine and CAM, and for

which there is high-quality evidence of safety and effectiveness

CAM Definitions

Sources of information in CAM

Herbs at a Glance via NCCIH

BC Cancer Agency - Complementary and Alternative Cancer 

Therapies 

CAM in PubMed

http://resources.library.ubc.ca/1284

• Echinacea• Colds, flu

• Gingko biloba• Memory, cerebral

blood flow• Ephedra

• Stimulates heart • St. John’s Wort

• Depression

• Chamomile• Relaxant, anti-anxiety

Some popular herbal supplements

Do you have a favourite?

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• British Columbia Naturopathic Associationhttp://www.bcna.ca/

• Boucher Institute Of Naturopathic Medicine http://www.binm.org

• BC Government – Naturopathy Regulationshttp://www.healthplanning.gov.bc.ca/leg/notice/naturopathy.html

• Health Canada – Natural Health Branchhttp://www.hc-sc.gc.ca/dhp-mps/prodnatur/index_e.html

CAM in BC and Canada

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• The doctor says I have chronic fatigue syndrome. • Is there a dietary supplement I can take to improve my energy?

• I have a 16 year old athlete son who is taking ephedrine.• What are the risks associated with taking ephedrine?

• My mother has started a prayer circle to help me in grad school.• Is there any evidence that shows prayer is helpful?

• Can I take Valerian at the same time I am taking Ativan?

• What are the health benefits of regularly drinking chamomile tea?

UBC Library Subject guide on Complementary medicinehttp://guides.library.ubc.ca/complementary_medicine

CAM reference question examples

The use of & evaluation process for pharmaceuticals (drugs)

• Each country has regulatory body for drug approval• Each drug must be proven safe & effective • Pre-clinical testing (laboratory & animals) • Clinical testing (clinical trials in humans) • Drug approval can take ~10-15 yrs

Clinical trials process

• Administer new drug to subjects & assess outcome (uncontrolled)

• Administer new drug to one group & a control to second group (controlled clinical trial) • What happens to the drug in the body? • What happens to the body when given the drug? • Is the drug clinically-effective? • Is drug clinically-safe / tolerable? • How should the new drug be taken?

http://www.merck.com/clinical-trials/about-clinical-trials.html

Reference interview re: drugs / herbals

• Let the user state the research question (or information need)

• What are they looking for? Ask appropriate questions

• Determine urgency & format needed; is Canadian content needed?

• Use high quality sources of information, pointing out their value

• Provide a range of evidence-based information

General drug questions

• Background information

• Dosing

• Side effects, drug interactions

• Contraindications & precautions

• Pharmacokinetics & pharmacology

• How medications are supplied (tablet, injection, etc.)

• How medications are taken

• How medications should be stored Basic & Clinical Pharmacology

on AccessMedicine

Sources of drug information are tertiary sources

• Drug monograph, handbook, textbook• Background and basic knowledge, definitions, prescriptions• OTC, herbal, foreign, cosmetics, household product, and so on

• Organization: how is source organized?• Is it alphabetical, classified, faceted, by side effect …..?• By generic drugs, trade names, chemical, investigational,

formula, therapeutic class, pharmacological class

• Authority: is it referenced?• Is it regularly updated?• What is unique about source?• What types of questions might the source answer?

General drug information sources

Martindale : the complete drug referencePrint ONLY

via MedicinesComplete

American Hospital Formulary Service (AHFS) Drug Information

PDR Physicians Desk Reference

http://resources.library.ubc.ca/1147

…also via MedicinesComplete

Drug interactions – sources of information

Martindale : the complete drug referencePrint ONLY

via MedicinesComplete

Stockley’s Drug Interactions via MedicinesComplete

PDR Physicians Desk ReferencePrint ONLY

Adverse Reaction Reportinghttp://www.hc-sc.gc.ca/dhp-mps/medeff/report-declaration/index-eng.php

http://www.hc-sc.gc.ca/dhp-mps/medeff/bulletin/index_e.html

Drug portals – sources of information

Licensed Natural Health Products Database Health Canada

Canadian Agency for Drugs & Technologies in Health http://www.cadth.ca

National Library of Medicine Drug Information Portal http://druginfo.nlm.nih.gov/drugportal/drugportal.jsp

Drug & poison information sources

Olson’s Poisoning & Drug Overdose

Goldfrank’s Toxicologic emergencies

http://www.grupopamilt.com/cassarett.pdf

Casarett and Doull's toxicology: the basic science of poisons