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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
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