This Month's Features

Spotlight On Alternative Medicines

Quick Poll — Are your patients taking more herbals?

From The Medical Editors

New Association Partnerships

Epocrates In The News

Question of the Month — Why was the Elavil monograph removed?

Advocate Of The Month

This Month In Medical History

Advocate Of The Month

Dan Lessner, M.D., FAAFP, San Miguel de Allende, GTO, México

When I was a busy solo practitioner in family medicine on Long Island, NY, I remember thinking that I couldn't imagine practicing medicine without my PDA, and especially without the Epocrates program. With my trusty PDA, I was able to look up drug-to-drug interactions, pregnancy contraindications, dosage forms, etc., in seconds! So instead of "winging it" or paging through huge reference books, I could easily look up necessary data with just a few clicks. I was even more amazed by how much time Epocrates could save me when working with HMOs; the program included information on which products were covered by the health plan — incredible!

I also found myself having to comment on the many herbal products my patients had decided to take. Having had no real training in herbal medicine during med school, I wondered how I should counsel my patients about products such as hawthorn or St. John's wort, and more importantly, how they might interact with the drug I had prescribed? Then I found all my questions quickly and succinctly answered in the Epocrates databases. Bravo!

In time, I realized it was time for a change of life and opted for "early retirement" in Central México. Being only in my late 40s, I couldn't just play golf all day — or could I? I soon started doing volunteer work to serve my new community. I found my niche as "medical advisor" in a charity home for seniors and also became the medical director for a children's organization that provides healthcare for the poor. I have rediscovered exactly why I went into medicine to begin with and finally have the time to spend with my patients and their families. Now that I am seeing patients again, I find myself looking to Epocrates for the latest and greatest medication information. I still love the drug interaction features and the ease with which I can access any and all medication data. Living in México, the infectious disease databases have been invaluable, as well as the tables and MedTools. My PDA now holds kilos of medical texts! Epocrates is a great reference on the road or at meetings, as well as in the little clinic that I work in now. Honestly, I don’t think I could practice as efficiently or effectively without it!

This Month In Medical History

Thanks to users like you, Epocrates has played a role in the evolution of medicine. To honor accomplishments in medicine over time we bring you this milestone in medical history:

July 1st, 1911 - The term "vitamine" was coined by Casimir Funk, a 37-year-old Polish biochemist.

He named the substance "vitamine" because he believed it was a chemical amine necessary to life (a "vital amine"). The "e" at the end was later removed when it was recognized that vitamins need not be amines. Funk lived in the United States from 1937 until his death in 1967.

Spotlight On Alternative Medicines

Complements Or Complications?

This month we celebrate Herbal/Prescription Awareness Month with a spotlight on alternative medicines. According to a recent Harvard Medical School report, the use of herbal supplements has increased by 50% in the last 5 years. Last year, the National Center for Complementary and Alternative Medicine and National Center for Health Statistics jointly published a report on the use of complementary and alternative medicine (CAM) in the U.S.. Some of their conclusions might surprise you:

• 19% of U.S. adults are using "natural products"



• In 1997, $5 billion was spent out-of-pocket on herbal products



• The primary reason that people are using CAM is that they believe it "would improve health when used in combination with conventional medical treatments"



• CAM use is greater among:
  • women than men
  • people with higher education levels
  • former smokers


• Americans are most likely to use CAM for back, neck, head, or joint aches, or other painful conditions; colds; anxiety or depression; gastrointestinal disorders; or sleeping problems

Organizations Calling For Changes To Legislation

In the past year, a number of organizations have issued statements expressing concern about how herbal medications are evaluated and regulated.

In 2004, both the AMA¹ and the American Society of Health-System Pharmacists² called on Congress for legislation requiring the FDA to develop a regulatory scheme that ensures that dietary supplements are safe and effective.

This last March, the American Society for Clinical Pharmacology and Therapeutics made five recommendations, including enhanced FDA oversight of dietary supplements, particularly their adverse effects; implementation of the FDA’s planned current good manufacturing practices; improving labeling of dietary supplements in line with other non-prescription agents; increasing educational opportunities for consumers and professionals; and increasing research on potential adverse effects, as well as efficacy of herbal supplements.³

What Can You Do?

Studies reveal that patients may only admit to the use of alternative medications if they are asked about it specifically^4,5. Having such information at the point of care can be useful in spurring discussion about the use of such remedies with patients, which may not only result in delivering better patient care, but can also enhance the clinician-patient relationship.

Clinicians can use the alternative and herbal medication information in the Epocrates Rx Pro premium mobile drug reference, Epocrates Essentials all-in-one mobile reference, and Epocrates Rx Online web-based drug reference to educate themselves and their patients about the potential adverse effects and drug interactions that can occur with use of those agents and prescribed medications.

How?

Epocrates Rx Pro and Epocrates Essentials:

Your Epocrates premium mobile application includes hundreds of alternative medicine monographs. For example:

• Tap on the "Rx" tab.
• Look up "hawthorn"; if you have a color screen, you will see that it is identifiable as an alt med by its brown color.
• The hawthorn monograph menu includes information on Reported Doses, Reported Uses, Cautions, Drug Interactions, Adverse Reactions, and Synonyms.
• Tap on "Drug Interactions". As you can see, interactions are organized into clinically relevant categories. Tap on "ginger" to see the known interaction between hawthorn and ginger — "combo may incr. risk of cardiac adverse effects".
• Select "Synonyms" from the monograph menu and note that the Chinese name, "shanzha," is included.
• Select "Other Info" from the monograph menu to view Pregnancy, Lactation, and Reference information.
• Tap on the MultiCheck icon, , and tap on "hawthorn". Next, select 1-29 other drugs/alt meds from the Epocrates Rx database and tap "Drugs" to check for potential interactions.

Epocrates Rx Online:

The Alt Meds tab in the Epocrates Rx Online web-based reference includes hundreds of alternative medicine monographs. For example:

• Click on the "Alt Meds" tab.
• Look up "hawthorn."
• The hawthorn monograph sections includes information on Reported Doses, Reported Uses, Cautions, Drug Interactions, Adverse Reactions, and Synonyms.
• Click on "Drug Interactions." Click on "ginger" to see the known interaction between hawthorn and ginger — "combo may incr. risk of cardiac adverse effects."
• Select the "Synonyms" section and note that the Chinese name, "shanzha," is included.
• Select the "Other Info" section to view Pregnancy, Lactation, and Reference information.
• Tap on the MultiCheck tab, , click on "hawthorn" and "Add to list." Next, select 1-49 other drugs/alt meds from the Epocrates Rx database and click on "Run MultiCheck" to check for potential interactions.

References:

1. http://www.ama-assn.org/ama/pub/category/13945.html (accessed 6/18/05)
2. American Society of Health-System Pharmacists.  ASHP Statement on the Use of Dietary Supplements. Am J Health-Syst Pharm 2004; 61:1707-11.
3. Morrow JD, Edeki TI, El Mouelhi ME et al.  ASCPT Position Statement.  American Society for Clinical Pharmacology and Therapeutics Position Statements on Dietary Supplement Safety and Regulation.  Clin Pharm Ther 2005; 77:113-22.
4. Hensrud DD, Engle DD, Scheitel SM. Underreporting the use of dietary supplements and nonprescription medications among patients undergoing a periodic health examination. Mayo Clin Proc 1999; 74:443-7.
5. Adler SR, Fosket JR.  Disclosing complementary and alternative medicine use in the medical encounter: a qualitative study in women with breast cancer. J Fam Pract 1999; 48:453-8.

Quick Poll - Give Us Your Opinion!

This month's poll question is:
Are you seeing an increase in the number of patients using herbal medicines?

Please note that poll questions can only be answered via the HTML version of our newsletter email.

To find out how your colleagues answered, be sure to read the August newsletter from Epocrates!

Would you like to know what your peers are thinking on a particular topic? If so, email us your quick poll question (type "quick poll" in the subject line).

From The Epocrates Medical Editors

We added 17 new drug monographs and made 241 revisions to the Epocrates databases in June.

Drug monographs for the following recently FDA-approved drugs are now available:

• alprazolam (Niravam)
• ciprofloxacin (Proquin XR)
• clindamycin vaginal (ClindaMax Vaginal)
• dantrolene (generic)
• fenofibrate (Triglide)
• fenoldopam (generic)
• fluocinolone intravitreal insert (Retisert)
• fluocinonide topical (Vanos)
• hydrocodone/ibuprofen (Reprexain and generic)
• hylan B (Hylaform, Hylaform Plus)
• levalbuterol inhaled (Xopenex HFA)
• nystatin topical (Nyamyc)
• pramlintide (Symlin)
• verteporfin (Visudyne)

VIEW DETAILED UPDATES >

New Association Partnerships

This month Epocrates announces a partnership with the California Medical Association (CMA) to offer their members (including students and residents) discounts on all Epocrates products. If you are a California physician/medical student and want to learn more about this program, please visit http://www.calphys.org/html/bb909.asp  

The CMA  joins several other state associations and national specialty associations with discount partnerships currently in place, including the American Academy of Neurology, American Psychiatric Association, Illinois State Medical Society, Medical Society for the State of Alabama, Michigan State Medical Society and Minnesota Medical Association. If you are a member of one of these associations, please contact your association for more information.

Epocrates In The News

Who Has Been Talking About Epocrates Recently?

June 2005: Hand-held Takes Physician to School
Excerpt: "As a working mother, Catherine Carrigan, M.D., often found it difficult to squeeze in time for her required 50 hours of continuing medical education. So Carrigan, a solo bariatric care physician based in Finley, Ohio, jumped at the chance to take some courses through a new PDA-based application from Epocrates [— MobileCME]. Carrigan has completed most of the courses during her off hours, sometimes while attending her 10-year-old daughter's soccer games."

July 2005: Helping Doctors Go Digital
Excerpt: "'Most medical applications out there are garbage,' [says Dr. Choi]. 'Epocrates is one I can say I actually use."'