Guest guest Posted April 16, 2004 Report Share Posted April 16, 2004 " the hazards of bitter orange go beyond the ephedra-like stimulant effects " said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group. This fruit-a centuries-old component of traditional Chinese medicine known as zhi shi-also contains compounds that interfere with drug metabolism. Like grapefruit juice, bitter orange contains compounds that inhibit the cytochrome P450 system, through which many drugs are cleared. " This introduces a whole new set of problems aside from the stimulant effects " , Dr. Wolfe told this newspater. " We certainly would not recommend that anyone use this. " Sen. Charles E. Schumer (D-N.Y.) has sent a strongly worded letter to FDA Commissioner Mark B. McClellan requesting immediate action for the removal of these products from the mark, citing urgent safety concerns. This is a quote from the front page of the Internal Medicine News, March 01, 2004. The physicians who read this paper are an influential, cohesive, and organized group who lobby effectively, and donate to their political parties. The CHA needs to call for an URGENT meeting of the deans of our colleges, the presidents of our companies, the heads of our organizations, members of the Chinese government, our researchers, and of course our attorneys. It is time to put down old grudges and unite. The history of the homepathic physicians is that they were overwhelmed quickly and eliminated as an effective profession by the biomedical profession. The history of the Chiropracters is that they chose to fight and grapple tooth and nail. They pooled their money into a war chest and recruited their patients (known to politicians as voters), to call and write letters to their congresspersons and senators. They put on their best suits, and went out to defend their profession. Their success was hard fought and well deserved. This choice is ours now, but if we wait even a short time, we will be left with very little choice at all. you have hosted large groups before. I urge you to send out an invitation and gather everyone in the same room. I volunteer to help and I challenge every member of the Oriental Medical profession to do the same. The time for standing back is over. We must now stand up. To do less is to fail our patients, our profession, and ourselves. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 16, 2004 Report Share Posted April 16, 2004 Like grapefruit juice, bitter orange contains compounds that inhibit the cytochrome P450 system, >>>So do many pharmaceuticals. Are they going to ban them alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 16, 2004 Report Share Posted April 16, 2004 > Like grapefruit juice, bitter orange contains > compounds that inhibit the cytochrome P450 system, >>>>So do many pharmaceuticals. Are they going to ban them > alon Good thought. Evidence of P450 inhibition isn't grounds to ban a substance, but it opens the possibility for herb-drug interactions. I personally don't feel as well trained in this area as I should be, at least with certain patient populations. Is it me or the lack of supporting literature? The following question is more of an aside: I ran accross this Subhuti Dharmananda piece several years ago and was unsettled by the P450 induction/inhibition question. It is a theoretical drug-herb interaction, but in certain cases I want strong assurances - for example any HIV patient taking PIs. Is there anything in the literature about the use of zhi shi and any of the herbs below with HIV patients taking PIs? Here's a quote from the Subhuti piece (http://www.itmonline.org/arts/herbdrug.htm): ............ Furanocoumarins (also called furocoumarins and sometimes designated psoralens, after one of the best known furanocoumarins) and compounds of similar structure are found in several Chinese herbs (see Table 2). Therefore, the use of the herbs with the same drugs that interact with grapefruit juice could produce the same results, at least if the herb dosage yields a similar amount of the enzyme-inhibiting compounds as grapefruit juice. Further, other substances in herbs (as yet unidentified) could inhibit the same or other drug metabolizing systems, thereby causing the increase in drug absorption. Previously, it had been thought that flavonoids (e.g., naringin) in grapefruit juice were responsible for its action on drug levels; however, it was found that the flavonoids were not present in sufficient quantity to account for the effects noted. High levels of flavonoids are provided in some herbal remedies, and might, in such cases, account for significant inhibition of CYP. Table 2: Commonly Used Chinese Herbs with Furanocoumarins. Herbs >>Furanocoumarins citrus varieties, including citrus, blue citrus, chih-shih, chih-ko, citrus seed >>Bergapten Angelica species; including angelica, chiang-huo, tu-huo, tang-kuei >>psoralen, xanthotoxin, imperatorin, bergapten, angelin, marmesin, oxypeucedanin, isopimpinellin, phellopterin, byakangelicin cnidium fruit >>bergapten, isopimpinellin, columbianetin, cnidiadin psoralea >>Psoralens Some herbs can increase drug metabolism rather than decrease it, resulting in lower drug availability. This effect was recently discovered with the use of St. John’s wort by patients with HIV infection (8). It was found that the use of this herb resulted in much lower levels of the protease inhibitor drug Indinavir, with the possible consequence that the drug combination would not work and that resistant strains of HIV would emerge. A warning was issued by several agencies involved with AIDS treatment. St. John’s wort was also blamed for a sharp drop in cyclosporin availability (30); since this drug is used to prevent transplant rejection, a lowered blood level could lead to initiation of the rejection reaction, which may be difficult to reverse. On the other hand, the herb has also been reported to inhibit CYP3A4 (31), which could result in some drugs being made available to the blood at elevated levels. ............ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 17, 2004 Report Share Posted April 17, 2004 Can you provide a link to the article, the issue you refer to is available online at: http://www2.einternalmedicinenews.com/scripts/om.dll/serve?action=searchDB & s earchDBfor=iss & id=jqm0403705 & target= But I couldn't find the letter you referred to. Tim Sharpe LBH Friday, April 16, 2004 4:44 AM Next in line to be banned. " the hazards of bitter orange go beyond the ephedra-like stimulant effects " said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group. This fruit-a centuries-old component of traditional Chinese medicine known as zhi shi-also contains compounds that interfere with drug metabolism. Like grapefruit juice, bitter orange contains compounds that inhibit the cytochrome P450 system, through which many drugs are cleared. " This introduces a whole new set of problems aside from the stimulant effects " , Dr. Wolfe told this newspater. " We certainly would not recommend that anyone use this. " Sen. Charles E. Schumer (D-N.Y.) has sent a strongly worded letter to FDA Commissioner Mark B. McClellan requesting immediate action for the removal of these products from the mark, citing urgent safety concerns. This is a quote from the front page of the Internal Medicine News, March 01, 2004. The physicians who read this paper are an influential, cohesive, and organized group who lobby effectively, and donate to their political parties. The CHA needs to call for an URGENT meeting of the deans of our colleges, the presidents of our companies, the heads of our organizations, members of the Chinese government, our researchers, and of course our attorneys. It is time to put down old grudges and unite. The history of the homepathic physicians is that they were overwhelmed quickly and eliminated as an effective profession by the biomedical profession. The history of the Chiropracters is that they chose to fight and grapple tooth and nail. They pooled their money into a war chest and recruited their patients (known to politicians as voters), to call and write letters to their congresspersons and senators. They put on their best suits, and went out to defend their profession. Their success was hard fought and well deserved. This choice is ours now, but if we wait even a short time, we will be left with very little choice at all. you have hosted large groups before. I urge you to send out an invitation and gather everyone in the same room. I volunteer to help and I challenge every member of the Oriental Medical profession to do the same. The time for standing back is over. We must now stand up. To do less is to fail our patients, our profession, and ourselves. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 17, 2004 Report Share Posted April 17, 2004 From MSNBC article about new legistlation for California workers comp.... doesn't look good unless you are really hooked up with an MD and the insurance companies.... doug __________ The reform package would reduce disability payments from five years to two years and require workers who are accustomed to choosing their own doctors to pick from a pool of authorized physicians. Supporters say that will stop injured workers from " doctor-shopping " in search of a more favorable diagnosis. Also, employers would be liable only for the portion of an employee's injury that occurred at work. In addition, the legislation would require that treatment meet American Medical Association guidelines. And it says that employees cannot collect benefits unless their injuries are scientifically measurable using medical tests such as X-rays or MRIs. Critics warned the measure would be particularly harmful to California's farmworkers, who frequently complain of back pain because of the stooping and lifting required to pick crops. Back pain and similar injuries are not easily detected by X-rays or other diagnostic tools. The legislation does not regulate the amounts insurance companies can charge businesses for workers' comp insurance. Democrats initially insisted on regulating rates, but Schwarzenegger refused, saying the reforms will spur competition among insurers to lower rates. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 17, 2004 Report Share Posted April 17, 2004 Also, employers would be liable only for the portion of an employee's injury that occurred at work. >>>This is another huge deal. How are you going to prove that your back pain is only due to work. Those of us that see a lot of work comp will have very difficult time getting to see patients. Company Dr are often non-patient advocates and would probably not refer to us. It will be very difficult to become a company Dr as an LAc. On the positive side this will end the totally dysfunctional and abusive system in which many companies have 2 in 5 workers on WC compensation and those chiropractic mills that were just over treating and ripping all us Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 17, 2004 Report Share Posted April 17, 2004 The article that I am referring to is on the front page of the March 01, 2004 Internal Medicine News. Volume 37, No.5. It was written by Nancy Walsh of the New York Bureau. Blake Quote Link to comment Share on other sites More sharing options...
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