AHP Internship

For the Summer 2018 Trimester I conducted a 0.5 credit hour with American Herbal Pharmacopoeia Under the supervision of the AHP Executive Director Roy Upton I contributed to the upcoming monograph on Anemopsis Californica.  This monograph will serve a complete and critical review of the traditional and scientific literature regarding the efficacy and safety of yerba mansa.   I feel especially lucky to be working on a monograph with AHP because I feel that it is an organization conducting vitally important work for the field of herbal medicine.  My perspective is that there is a direct association between the work that Lloyd, Felter, Scudder and King etc were doing a century ago and the work that AHP is doing now.

Aside from the deliverables, the metrics associated with a quality internship program necessarily center around the opportunities it provides for students to develop the soft skills that will facilitate their transition to professional life.   This internship experience challenged me to continue developing competency in many of the soft skills articulated in as learning goals for the internship.   Four skills that I was able to identify significant self progress in are: Written communication skills, the MUIH value of discernment, critical thinking skills, and professionalism.

While the monograph is ultimately the intellectual property of AHP a small sample of the work I conducted for the internship can be exemplified by this chart of the ethnobotanical use of Anemopsis.

Communities

Reference

Internal Use

Colds

Tübatulabal ,
 Maricopa, Pima,
Diné, Luiseño and
  Chumash Pericú
   Chumash and
 southern Paiute
Larsen 1992; Wheeler-
Voegelin 1938; Wyman
and Harris 1979;
Dimayuga et al.;
Russell 1908; Stoffle
and Dobyns 1982;
1983; Timbrook 2007;
Train etal 1974

Dysentery

Yaqui and
 Tarumari

Boido 1894

Diuretic

Diné

Wyman and Harris 1979
Tuberculosis

Diné, Pima

Wyman and Harris
1979; Russell 1908

Gangrene

Yaqui and
 Tarumari

Boido 1894

General pain

Chumash and
southern Paiute,
    Kumeyaay
Russell 1908; Stoffle
and Dobyns 1982,
1983; Timbrook 2007;
Train et al. 1974;
(Wilken, 2012)
menstrual
   cramps
Costanoan, Ohlone

Bocek 1984

Blood purifier
Luiseño and
  Chumash
Gardner 1965; Jepson
1909; Kroeber et al.
1908; Sparkman 1908;
Train et al. 1974

Asthma

Luiseño and
Chumash Paiute
Gardner 1965; Jepson
1909; Kroeber et al.
1908; Sparkman 1908;
Train et al. 1974;
Rhode 2002

Indigestion

Chumash and
southern Paiute,
    Kumeyaay
Russell 1908; Stoffle
and Dobyns, 1982,
1983; Timbrook 2007;
Train et al 1974;
(Wilken, 2012)
Venereal
 disease
Tübatulabal ,
 Maricopa, Pima
   Chumash and
southern Paiute,
      Hopi
Larsen 1992; Wheeler-
Voegelin 1938;
(Sánchez, 1999)

Emetic

Papago, Pima

Castetter and
Underhill 1935;
Russell 1908

Diabetes

Tübatulabal ,
Maricopa, Pima
Larsen 1992; Wheeler-
Voegelin 1938

Malaria

Yaqui and
 Tarumari

Boido 1894

Topical Use

Wounds Bruises
and Sores
Luiseño and
Chumash Yaqui and
 Tarumari Pericú
 Costanoan Zuni,
 Pueblo, Navajo,
  Kumeyaay, Hopi
Gardner 1965; Jepson
1909; Kroeber et al.
1908; Sparkman 1908;
Train et al. 1974
Dimayuga et al.;
Bocek 1984; Curtin
1997; (Wilken, 2012);
(Sánchez, 1999)

Rheumatism

Paiute

Train et al., 1974;
Larsen 1992

Gargle

Zuni, Pueblo,
    Navajo

Curtin 1997

 

Anemopsis californica flickr photo by wallygrom shared under a Creative Commons (BY-SA) license

Collaborative Product Development Assignment

One of our many brainstorming sessions

This collaborative assignment with Andrea Miller is an exposition and outline of the typical factors that modern western herbalists account for when formulating according to an evidence based perspective that is informed by traditional use.

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Product Development Collaboration

Reflections on Scientific Writing ISCI610B

Final papers are a recurrent element within academics.  But there are few classes where the final product has external relevance.   In many cases demonstrating competence is the main utility involved in writing papers and any relevance to external parties is secondary.  Of course, from a metacognitive standpoint, all of the artifacts produced as coursework can serve as external indicators of internal development.  But this utility is still within the context of the writing reflecting something about the student as opposed to the student contributing and original discussion that is useful for peers.

This class was different in that the main learning goals were focused on becoming an effective communicator to external stakeholders, specifically in the context of scientific writing.   I think the class was effective at facilitating development in this area.

Science writing is both similar and distinct from other types of narratives.  It is similar in that it relies on competency in the same basic skills associated with any narrative form such as proper grammar.  It is also similar in that scientific writing must be coherent and facilitate reader comprehension.  But scientific writing is distinct because it requires that additional layers of rigor and synthesis be applied to the narrative.  Hyperbole and rhetoric, which are powerful tools for persuasion in other areas of narrative become potential sources for the introduction of bias.   Scientific writing also relies heavily on the passive voice and when done well, directly addresses any limits of research or inconsistencies in research even if they constitute an uncomfortable presence to a clean and tidy discussion.   In this way, scientific writing is more cautious than other types of persuasive writing, but it is also ultimately more honest.

Another way that this course shaped my perspective on writing is the new awareness that elegant writing can be simple writing.  Effective scientific writing needs to actively synthesize complex information and then leverage the reader’s anticipated concept of how information “should” flow to enhance comprehension.  This is distinct from other forms of writing where the emphasis is placed more on producing a comprehensive narrative and expecting the reader to synthesize their own meaning from the text.  Many examples of profoundly important professional writing are, by design, open to many interpretations.  Effective science writing avoids this level of ambiguity and it should be capable of this specificity irrespective of the intended audience.

Despite it’s continued flaws and amateur provenance, I think the small literature review that I completed over the course of this class is an effective example of original science writing.   I think in hindsight, this project served as an important moment in the transition from “writing as student to relay information about myself” to “writing as professional contributing to the global body of science.”   There is a rubicon like element to this transition too.  I have noticed that in the other classes I am taking the way that I write and the way that I use citations has transitioned from one that reinforces my existing bias to one that strives to eliminate it.

I do want to continue building skills related to writing scientifically.  I have decided to participate in the poster symposium and look for other methods of writing scientifically while at MUIH. 

Research Summary: Plant based interventions for drug resistant infections.

Growing antimicrobial drug resistance is a significant global health problem (Weber, 2005).   There is a need for both novel antimicrobial interventions as well as methods for preserving the efficacy of existing interventions to address this issue.  Clinically, this rise in bacterial resistance has prompted recommendations that allopathic doctors prescribe fewer antibiotics. This in turn, has led to a search for alternatives (MacKay, 2003).  Research using current drug discovery technologies has provided evidence to support the traditional claims for many plant based interventions (Graziose, Lila, & Raskin, 2010).   Garlic (Allium sativum L.) has been used in traditional medicine to treat infections for millennia (Koch & Lawson, 1996).

A recent literature search of controlled clinical trials provided scant and conflicting results on garlic’s efficacy as an antimicrobial. Some trials provide preliminary evidence that garlic is effective against salivary Streptococcus mutans (Chavan, Shetty, & Kanuri, 2010) and chronic oral candidiasis (Bakhshi, Taheri, Basir Shabestari, Tanik, & Pahlevan, 2012).  Yet, an earlier systematic review of controlled clinical trials found that garlic provided no significant effect against Helicobacter Pylori (Martin & Ernst, 2003).   Furthermore, no human trials looking for a synergistic effect between garlic and the existing complement of pharmaceutical antibiotics were found in the literature.  This gap in the literature was unexpected primarily due to an increasing body of basic science on the efficacy of garlic as an antimicrobial both independently and in synergy with existing antimicrobial interventions.

In disk diffusion tests of Candida albicans, the antimicrobials fluconazole and itraconazole combined with Fresh Garlic Extract (FGE) showed greater inhibition zones against multi drug resistant C. albicans than the drugs alone (P<0.01) (Li et al., 2015).   Disk diffusion tests with methicillin-resistant Staphylococcus aureus and the drugs cefoxitin, oxacillin, and piperacillin showed larger inhibition zones (P <0.01) but the factorial analysis showed no positive interaction effects (P>0.05) (Li et al., 2015).   Applying the same test methodology to Pseudomonas aeruginosa resulted in a strong positive interaction between FGE and the anti-microbials cefotaxime & ceftriaxone (P < 0.01) (Li et al., 2015).   Despite larger inhibition zones, the anti-microbials levofloxacin, cefazolin and ampicillin did not show positive interaction effects with FGE on P. Aeruginosa (P>0.05) (Li et al., 2015).

An in-vitro disk/well diffusion study focused on Staphylococcus aureus isolates resistant to ampicillin with a mean minimum inhibitory concentration (MIC) of 24 μg/ml.  In all samples S. aureus showed statistically significant dose dependent increase in the zone of inhibition at FGE concentration 12.5 mg/ml and higher compared with the control (P>0.05).  The addition of 30-60 mg/ml of FGE reduced the MIC of ampicillin to 0.6-1.2 μg/ml (Pillai, Trivedi, & Bhatt, 2013).   Other well diffusion tests with the species Escherichia coli, Klebsiellosis pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and Staphylococcus aureus all showed dose-dependent increases (P <0.05) in the zone of inhibition at FGJ concentration of 10% and higher compared to control (Yadav, Trivedi, & Bhatt, 2015).

Based on the increasing body of evidence for garlic’s bactericidal effects, a call for further research is justified.  Research is needed that more fully explores the phytochemical mechanisms that contribute to the possible synergistic effects of garlic with our existing antimicrobial arsenal.  Further clinical trial research is also needed to discover if there are replicable and generalizable garlic interventions that could be relevant to current clinical practice.

    

References:

Bakhshi, M., Taheri, J.-B., Basir Shabestari, S., Tanik, A., & Pahlevan, R. (2012). Comparison of therapeutic effect of aqueous extract of garlic and nystatin mouthwash in denture stomatitis. Gerodontology, 29(2), e680–e684. https://doi.org/10.1111/j.1741-2358.2011.00544.x

Chavan, S. D., Shetty, N. L., & Kanuri, M. (2010). Comparative evaluation of garlic extract mouthwash and chlorhexidine mouthwash on salivary Streptococcus mutans count – an in vitro study. Oral Health & Preventive Dentistry, 8(4), 369–374.

Graziose, R., Lila, M. A., & Raskin, I. (2010). Merging traditional Chinese medicine with modern drug discovery technologies to find novel drugs and functional foods. Current Drug Discovery Technologies, 7(1), 2–12.

Koch, H. P., & Lawson, L. D. (1996). Garlic: the science and therapeutic application of Allium sativum L. and related species (2nd ed). Baltimore: Williams & Wilkins.

MacKay, D. (2003). Can CAM therapies help reduce antibiotic resistance? Alternative Medicine Review: A Journal of Clinical Therapeutic, 8(1), 28–42.

Martin, K. W., & Ernst, E. (2003). Herbal medicines for treatment of bacterial infections: a review of controlled clinical trials. Journal of Antimicrobial Chemotherapy, 51(2), 241–246. https://doi.org/10.1093/jac/dkg087

Pillai, R., Trivedi, N. A., & Bhatt, J. D. (2013). Studies on in vitro interaction of ampicillin and fresh garlic extract against Staphylococcus aureus by checkerboard method. Ancient Science of Life, 33(2), 114–118. https://doi.org/10.4103/0257-7941.139053

Li, G., Ma, X., Deng, L., Zhao, X., Wei, Y., Gao, Z., … Sun, C. (2015). Fresh Garlic Extract Enhances the Antimicrobial Activities of Antibiotics on Resistant Strains in Vitro. Jundishapur Journal of Microbiology, 8(5). https://doi.org/10.5812/jjm.14814

Yadav, S., Trivedi, N. A., & Bhatt, J. D. (2015). Antimicrobial activity of fresh garlic juice: An in vitro study. AYU: An International Quarterly Journal of Research in Ayurveda, 36(2), 203–207. https://doi.org/10.4103/0974-8520.175548

Weber, C. J. (2005). Update on Antimicrobial Resistance. Urologic Nursing, 25(1), 55–57.

Sample Health Policy Statement for women’s health/OB/GYN practitioners in a hospital setting

Health Policy Statement for women’s health/OB/GYN practitioners of Hospital “X”

A significant number of women use herbal products both during pregnancy and while nursing, there are indications that the use of herbal products is increasing globally (Kennedy, Lupattelli, Koren, & Nordeng, 2016).    

A central component of a patient centered approach to wellness is patient preference.  The hospital also acknowledges that in many cases botanical interventions are a compelling choice compared with pharmaceutical interventions.

When assessing the appropriateness of phytotherapeutic interventions for pregnant or lactating patients the following guidelines are recommended:

  • Patients are advised to fully disclose any supplements or herbs they are taking, and consult with staff member before beginning any new course of herbs during all trimesters of pregnancy as well as during the period the patient is nursing.
  • The quality and provenance of herbs or supplements is a central component of ensuring a comprehensive safety assessment so it is advised that clients disclose the specific products and brands they are using or considering using.  This extends to homeopathic remedies and flower essences.   
  • As a general guideline herb or supplement use during the first trimester is discouraged.
  • There are many routes in which herbs can affect fetuses, newborns, and nursing infants so it is advised that patients fully disclose botanical products and supplements that are taken internally or topically throughout the course of their pregnancy and/or nursing period
  • The hospital is in the process of drawing up a list of common botanical products  that are generally considered safe based on a polity of primary and secondary sources for the following conditions:
    • Nausea
    • UTIs
    • Reflux
    • Iron deficiency anemia
    • Constipation
    • Insomnia
    • Varicosities
    • Hypertension / Preeclampsia
    • Uterine irritability
    • Preterm labor
    • Lactation promotion
  • This list is intended to serve as a tool for Doctors and is not intended to supersede or replace expert medical opinion.

References:

Kennedy, D. A., Lupattelli, A., Koren, G., & Nordeng, H. (2016). Safety classification of herbal medicines used in pregnancy in a multinational study. BMC Complementary and Alternative Medicine, 16. https://doi.org/10.1186/s12906-016-1079-z