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CDS Member News and ArticlesProfessional News Articles : : ON PRACTICE MANAGEMENT by Janyce Hamilton : Dentists don't know what to tell patients about herbs: Herbal medicine Web resource begins posting data on dental indications Dentists don't know what to tell patients about herbs: Herbal medicine Web resource begins posting data on dental indicationsNovember 03, 2006 Jackie Wootton, MEd, president, Alternative Medicine Foundation, Inc., and director of HerbMed in Potomac, MD, remembers in the late 1990s herbs were becoming increasingly popular. “Scientists and medical professionals bemoaned that there was very little data on the efficacy and uses of herbs,” Ms. Wootton recalled. “I was astonished as I knew there was a great deal of scientific evidence on all forms of complementary and alternative medicine. Of course, I realized there was a great deal of promotional misinformation too.” This was the inspiration behind the database—to present clear, neutral, categorized data on medicinal herbs for the use of professionals and public. “This model has endured the test of time and a number of pharmacologists and pharmacognosists have worked with me to develop and refine the categories and subcategories.” (These can be viewed on the public web site at www.herbmed.org, and the categories are explained at www.herbmed.org/help.asp#Categories.) I interviewed Ms. Wootton to learn more about the database and how it can help practicing dentists find answers for themselves and their patients. The InterviewJanyce Hamilton (JH): How did www.herbmed.org come into existence? Jackie Wootton (JW): Our original purpose was to make the database fully available as a public resource but, like many nonprofit organizations, the drop in funding after 9/11 forced us to create a business model. Approximately 40 herbs are still fully available on the public site (including the most popular herbs) but only the professional version, HerbMedPro, provides access to the entire database and a sophisticated search engine, through subscription or licensing. Individual subscriptions start at $45 per year and there are a range of options for library subscriptions and organizational licenses. JH: How long have you been at the helm? JW: HerbMed is my baby. Although I am not myself a scientist, I was the originator of the concept and design; I have found and inducted the expert staff into the philosophy of an impartial and comprehensive database. I do all the publishing and take responsibility for quality control. JH: Was there ever a time you were skeptical about herbs used medicinally? How did you come around? JW: There was really no epiphany for me, having spent most of my life in Europe, primarily in England but also in France and German-speaking Switzerland. Herbal traditions were part of everyday life so that, as a child, I was taught to pick and use herbs for medicinal and culinary use. On the other hand, there was also a healthy realism as to what extent they could replace or complement biomedical treatments. I did not develop HerbMed in order to advocate the use of medicinal herbs but to demonstrate that there is a wealth of scientific data from contemporary research, as well as long-standing empirically based traditions including Native American practices and the Eclectics tradition here in the USA. JH: What sets www.herbmed.org apart from other web- or paper-based herbal therapeutic evidence databases? JW: I'm so glad you ask this question. I feel very strongly that the database format and impartial, categorized approach is unique and crucial. Most herbal resources are collections of monographs and are usually compiled and the data selected and summarized from a specific viewpoint. This can range from strongly advocating the use of herbs to extremely cautious advice from medical professionals (who often know little about herbal traditions and use). In compiling HerbMed, we do not attempt to filter, review, and select but let each data set speak for itself. There are so many ways to interpret data that we prefer to present it “as is”, with clear guidelines on different types or levels of evidence base. This is highly appreciated by such bodies as the Food and Drug Administration, the Library of Congress, and the U.S. Patents and Trademarks Office who license the database because it provides clear, categorized data that is essential as the basis for making their own judgments and policy, based on their own priorities and goals. Many paper and electronic herbal monographs are loosely called databases but strictly speaking they are not. Monographs are essentially static (until updated). In contrast, a true database, like HerbMed is built incrementally and contains multiple fields of much more comprehensive underlying data providing endless flexibility of use and searchability. Basically, what you see on the Web is not the database—pages are generated afresh each time from queries. Certain features are only possible with a genuine database format: Live Updates that provide automatic updating of information; generating the database on another site through licensed access; and adding new sub-categories of information. JH: Who are your board, consultants and/advisors? JW: We have a prestigious advisory board, listed at www.herbmed.org/about.asp. This includes Mark Blumenthal, director of the American Botanical Council, several herbalists from different traditions, including Tieraona Low Dog, MD, and Native American herbalist. We have pharmacists, botanists, and pharmacognosists. JH: Do you know if the NIH's National Center for Complementary and Alternative Research has accessed your database or use it? JW: Individual researchers at NCCAM use the database but the office does not license the database. JH: Can a dentist or dental school professor use your site to research herbs for his/her patients or students, and print out what is found, or must it be paraphrased? JW: Absolutely, HerbMed can be used to research herbs for dental use. Any medical professional, researcher or patient/consumer can access the public site and print herb data in full. Likewise, subscribers or licensees of HerbMedPro can search at will and print in full. JH: How does a first-time dental visitor to your site know how to search, sort and peruse the data? JW: A dental visitor, like any other visitor, will find HerbMed provides information on how to use the search engine, how to interpret the categories of information, and how to use the Live Updates feature. Some of the more general uses of herbs, for infection, wound healing and pain, are applicable for dental problems even though not specified for dental use. The difference may be in how they are used—as gargle or mouthwash, or as poultice versus liniment. However, let's take a specific dental example such as periodontal disease. If you enter that into the search engine search screen as periodontal AND disease you will elicit seven records, including research summaries from such herbs as Calendula and Tea Tree Oil. Now if you omit search term disease (that narrows your search) and just punch in periodontal, that will produce 20 hits, including four references to Sanguinaria Canadensis (bloodroot). Search term periodont* increases the search result yet further, producing 32 hits. If a patient or student asks whether a specific herb can be useful for a particular dental problem, for example, the claim that cloves relieve toothache, that can be tested either by using the search screens or by pulling up the herb and skim reading the summaries. This is an interesting example because the search engine will not find a specific reference to use of cloves for toothache, however by clicking on Eugenia caryophyllus, then on View Entire Herb, you can quickly scan for dental references and find, for instance, that cloves are effective for the relief of pain from dry socket. Incidentally, if you do not know the scientific name for a particular herb, just search on the common name by toggling from Scientific to Common Name at the top of the alphabetized list of herbs. JH: Tell me about your funding source and how the ethics of that situation keep your reported data pure? JW: HerbMed relies on funding from sponsors and grants, and fees from licensing and subscriptions. Most of our funding is from non-commercial sources and we reject funding from commercial sources unless it is totally unconditional. The public site has Google ads as a source of revenue but these are third party ads generated by the Google system entirely separate from our compilation process. We can guarantee that our data is totally independently compiled and free from bias. JH: List all your dental/oral health indications available on www.herbmed.org. JW: As well as such general terms as pain or antibacterial, there are a number of specific indications relevant to dentistry and oral health:
We are, incidentally, open to further suggestions which can be added to the database. JH: Explain the difference between HerbMed.org and HerbMedPro. JW: HerbMed is the database and HerbMedPro is the professional interface for accessing the entire database, through subscription or licensing, and all views are generated directly from the underlying database. For historical reasons the publicly available, original site, is known as HerbMed (www.herbmed.org) even though now only a small proportion of the herbs is available on this site and the herbal records are precomputed html pages rather than data generated from the databases. JH: Tell me how MDs have told you that they are using the site. JW: HerbMed has between 20,000 and 25,000 hits per day! So we do not have specific information on particular groups, such as MDs. However, we do receive unsolicited expressions of gratitude and testimony from a range of professionals and researchers about their use of the resource. JH: Do you think herbs will see their golden age any time soon in OTC or prescription products and in-office treatments of medical and dental conditions, or is that 10-20 years away still (if ever)? JW: There is currently a move towards providing label information on medicinal uses for herbs so that they will eventually be recognized as OTC or drug products rather than foods. This is a complex development and I cannot predict when or exactly how the marketing of herbs will make this transition. JH: Is HerbMed.org the end-all, be-all source for medical and health professionals on herbs, or do you prefer they rely on a complementary handful of resources/references in making their decisions. If the latter, can you give some sources for them to go to? JW: No, I cannot make such a huge claim. The full herb picture has many facets. As part of the HerbMed and Alternative Medicine Foundation projects we do aim to inform and educate so we provide a listing of other herbal reference resources in the Links section of the web site: www.herbmed.org/links.asp. JH: What will HerbMed.org look like in five years—much like it is, but more herbs added or will it be the Amazon.com of herbs or what is the vision of the leadership? JW: In five years, HerbMed will be many times bigger, encompassing a great many more herbs. I do not have ambitions for becoming the Amazon.com of herbs as we aim to avoid any commercialization or any link to the sale of herbs. However, we have plans to add special collections of information such as:
JH: How about the future for herbs for dentistry on your site? JW: We would welcome sponsorship for such a project from a suitable nonprofit or professional organization. Conclusion Stay tuned over the next decade as “synthetic” medicines may be rejected by some segments of patients, and a resurgence in an interest in “natural” care emerges. In the U.S., herbs will likely become increasingly tested, regulated and slowly added more and more in healthcare and in dental products with assurances of safety (if not efficacy). Janyce Hamilton is a Chicagoland freelance dental writer and editor. Send suggestions for topics to be covered, or any comments on this column, to review@cds.org. Copyright 2006, Chicago Dental Society |
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