A well-designed and conducted multicenter study" on the treatment of BPH was published in 1996. The 1098-patient study was conducted in nine European countries with the participation of an American biostastistician. In the study the subjects were given 320 mg Permixon (a preparation of saw palmetto berry extracts)/day or 5 mg finasteride/day for 6 months, under double-blind randomly assigned conditions. Both Permixon and finasteride caused substantial decrease in the International Prostate Symptom Score (-37% and -39%, respectively), improved quality of life (38% and 41%, respectively), and increased peak urinary flow rate (25% and 30%, , respectively). The researchers stated that "Permixon fared better than finasteride in a sexual function questionnaire and gave rise to less complaints of decreased libido and impotence" than fmasteride. However, finasteride differ from Permixon in that Permixon did not decrease prostate volume and serum prostate-specific antigen. Those conclusions are correct. These difference are important in that there is no possibility for saw palmetto berry or its extract to interfere with prostate cancer detection by lowering serum PSA level. The lack of effect on prostate volume does not necessarily indicate that saw palmetto berry or its extract is ineffective on treating LUTS.
Two meta-analyses on the treatment of BPH with a preparation of saw palmetto berry extract were published in 1998. Wilt et al.6 reviewed 18 randomized controlled trials involving 2939 men, including the study mentioned above. The mean study duration was 9 weeks (range: 4 to 48 weeks). As compared with men receiving placebo, treatment with the saw palmetto berry extract caused a decrease in urinary tract symptom scores of 1.41 points (scale range: 0 to 19) and nocturia of 0.76 times, an increase in peak urine flow of 1.93 mL/second, and improvements in subjective self-rating of urinary tract symptoms. In many important aspects, Permixon yielded benefits that are practically not different from the benefits of finasteride, e.g., in International Prostate Symptom Score (the different being 0.37 out of 0 to 35 scale range). As compared to placebo, patients taking saw palmetto had decreased nocturia (weighted mean difference {WMD) -1.41 points {scale 0.76 times per evening) and increased peak urine flow (WMD, 1.93 ml/s). When compared to finasteride, men treated with saw palmetto had similar improvements in peak urine flow (WMD, 0.74 ml/s) and improvements in urinary tract symptom s cores (WMD 0.37 International Prostate Symptom Score points {scale range, 0-25}). These meta-analysts concluded that "the evidence suggests that S repens improves urological symptoms and flow measures. Compared with finasteride, S repens produces similar improvement in urinary tract symptoms and urinary flow and was associated with fewer adverse treatment events." This conclusion should be accepted with the following reservations: stating that the saw palmetto berry/its preparation is comparably as effective as fmasteride in treating BPH/LUTS may be an understatement (see, Bach, Schmitt and Ebeling'a (1996) a 3-year, 309 patient trial, saw palmetto was shown to improve objective urinary flow rate and subjective symptoms substantially, and a 50% in postvoid volume, whereas finasteride improved the flow rate only slightly and did not improved the post void volume. Wilt, et al., also stated that "further research is needed.. .to determine its long-term effectiveness and ability to prevent BPH complications." That statement is in error because one of the reviewed studies, Carraro et al.'s", was 6 months long, involving 87 urological centers in 9 European countries with 1098 patients. The patient base is greater than one-third of the total number of patients reviewed by the authors. In all senses, a study that lasted 6 months is a long term study. If a drug or nutrient does not show its effects in 6 months, it must be considered ineffective. On the other hand if efficacy is properly demonstrated within this period, as is the case of Carraro et al.'s study, (IPPS scores -37% and -39%, respectively; improved quality of life (by 38 and 41%, respectively); and increased urinary peak flow (+25% and +30%, p =0,035)) the efficacy must be accepted. . In Bach's 3-year study the patients enrolled in that multicenter study experienced increased urinary flow rate to 6.1 ml/s with a 50% decrease in residual urine volume (from 64 +2.3 ml to 32 + 2.0 ml; mean + SEM) while taking saw palmetto versus only a slight improvement in urine flow and no change in residual volume while taking finasteride.
Furthermore, the results of Bach's study demonstrate a sustained effect of saw palmetto which is posited for initial treatment of BPH with milder symptoms without complications. Saw palmetto is advised for mild to moderate BPH. In accordance with the United States Department of Health and Human Services Guidelines for Benign Prostatic Hyperplasia: Diagnosis and Treatment, patients with BPH complications (e.g., recurrent infection, urinary retention, renal failure, gross hematuria, bladder stones and bladder diverticuli) should always seed surgical consults (McConnell JD. Benign prostatic hyperplasia: treatment guidelines and patient classification. Br J Urol 1995;76 (Suppl) 29-46).
In clinical trials with therapeutic agents, the requirement of a trial duration greater than 6 months has hardly been required. Fitzpactrick and Lynch14 believe that in clinical trials it took 3 to 6 months to develop placebo effects. Carrarro's study demonstrated that a preparation of saw palmetto berry extracts (Permixon) is practically as effective as a "proven" and "approved" drug finasteride in treating BPH. If finasteride is acceptable as safe and effective, then this saw palmetto berry extract preparation must be accepted as safe and effective, even though a placebo group was not used in the study.
Published in the same year is the report of the Committee on Other Medical Therapies of the Fourth International Consultation.15 The 7 studies reviewed by this committee were also a part of the database that was reviewed by Wilt et al. The Committee stated that "the placebo-controlled studies are the ones being examined in this paper... Seven placebo-controlled studies with Permixon have been published, with the longest duration being 3 months... Only four of these included more than 50 patients in each study; in three of these trials, Permixon was statistically significant better than placebo in terms of effects on urinary frequency (nocturia and daytime) as well as peak flow rate. Peak flow rate improved by 26-50% in the Permixon patients, but only 2-35 % in the placebo-treated patients. The over-all symptom improvement demonstrated in the placebo-controlled trials was a reduction of baseline nocturia by 33-74% with Permixon compared to 13-39% with placebo."
The Committee drew heavily on Descotes' study16 and stated: "In the study of Descotes ... there was statistically significant improvement in frequency, nocturia, and flow rate. However, the same study showed that 'despite this evidence of symptomatic improvement, there was little difference between either the patients' or the physicians' global assessments of the efficacy of Permixon and placebo.' Patients satisfaction was 71% for Permixon and 68% for placebo (P> 0.05, NS), while the physicians' assessments were 57% for Permixon and 47% for placebo (P> 0.05, NS). Thus, the symptomatic improvement seen with Permixon after I month of treatment, although statistically significant, was felt to be of limited overall clinical significance by the patients with BPH in this study. Clearly, no definitive conclusions can be drawn from these aforementioned studies concerning Permixon since they were all short-term with a maximum duration of 3 months...." Those conclusions are not justified and the Committee have apparently overlooked some unique experimental procedures that might have contributed to the large improvements in the subjective scores of the placebo group. The extremely large placebo effects (68% and 47%) observed in the Descotes' study require careful examination of the study procedures to ascertain whether these data are acceptable. In most clinical trials, placebo effects range between 0% to 35 %. The Descotes et al.'s study is unique in that the researchers wanted to minimize placebo effect by having the patients to go through a base-line, placebo run-in period of 30 days. Only patients showing <30% improvement from base-line in peak urinary flow rate ("the nonresponding patient") were selected for the placebo-controlled study. Dr. Lin's experience as research scientist indicates that this type placebo run-in base-line period can cause exaggerated placebo effects in the subsequent actual study. This is probably due to the fact that patients in both treated and placebo groups somehow realized that they were entering a more important or more serious study period, and their mind subconsciously worked on the matter. Thus, the large placebo effect of the subjective assessment of the placebo group and treated group should be both discounted.
The more objective measurements of daytime and nocturnal urinary frequency and peak flow rate should be depended upon to make conclusions. In these cases, both objective parameters improved significantly with the saw palmetto berry preparation in comparison with the placebo group. (Although one can counter argue that frequency of urination and the urine flow rate are subject to the control of the mind to certain degrees and are thus not objective parameters, this argument cannot prevail because these functions, like most other bodily functions, are primarily physiologically controlled and not psychologically controlled. If one stretches psychosomatic interactions to the extreme, then all objective physiological measurements could be called subjective measurements. But such extremism is not the standard practice in biomedical sciences.) Thus, a definitive conclusion can be made that the saw palmetto berry preparation was at least effective for short term (30 days) treatment of BPH.
Critics of phytotherapy of BPH have relied heavily on the placebo effect to argue that the efficacy observed in open-label studies, which are often short term, should be discounted. Meta-analysts, including Fitzpactrick and Lynch12, and Schulze et al.'' are of the opinion that placebo effects of drug trials on BPH could occur as early as 3 to 6 months and last for at least 2 years. Such an argument has tow problems. Firstly, before the 4th month, placebo effects would be assumed to be nonexistence or small. The Descotes' data clearly do not support this contention. Secondly, had placebo effect be so long lasting and so powerful, then many placebos would be potent and long lasting drugs for BPH and patients of BPH would benefit from various placebos, This is certainly not the experience of patients of BPH and urologists. In reality, the placebo effect has sometimes been unscientifically used as a weapon to attack the results that are not consistent with the critics opinions.
Many other studies on the mitigating effects of saw palmetto berries or its preparations were not blinded and placebo-controlled and were not reviewed by these authors. Nevertheless, these studies can provide highly valuable information on the efficacy and safety of these substances and are discussed below.
Study |
Type of Study |
Duration of |
Saw |
Nocturnal |
Chance in |
Change in |
Bach 1996 |
Multicenter, |
3 years |
320 |
73.3% response; |
6.1 |
32 |
Braeckman |
Prospective, open- |
3 months |
320 |
NA |
2.4 |
7.2 |
Gerber 1998 |
Controlled clinical |
6 months |
320 |
NA |
-0.7 |
-9.3 |
Redecker |
Prospective, open- |
3 months |
320 |
2.15 baseline |
3.4 |
11 |
Romics 1993 |
Prospective, open- |
12 months |
320 |
37.8% response; |
2.5 |
50.5 |
Ziegler 1998 |
Prospective, open- |
3 months |
320mg/day |
NA |
2.44 |
36.9 |
Gerber et al.'s open-label without placebo control study's was published after these reviews and meta-analyses. The authors studied the efficacy of a commercial saw palmetto berry extract, 320 mg daily, on 46 BPH/LUTS patients for 6 months. They concluded that: " The mean IPSS (International Prostate Symptom Score, ± standard deviation) improved from 19.5 ± 5.5 to 12.5 ± 7.0 (P<0.001). Significant improvements in the symptom score were noted after treatment for 2 months. An improvement in IPSS of 50% or greater after treatment for 2, 4, 6 months was noted in 21%, 30%, and 46% of the patients, respectively." They observed no significant change in peak urinary flow rate, postvoid residual urine volume, detrusor pressure at peak flow, and serum prostate specific antigen (PSA) level. The researchers used an 8F transurethral catheter to measure urodynamic parameters, and a 14F transrectal catheter to measure abdominal pressure. The testing procedures were described as the "bladder was filled with room temperature water at a rate of 50 mL/min. Bladder pressure, volume infused, and rectal pressure were recorded. Patients were then asked to void in a standing position. Urinary flow rate, bladder pressure, rectal pressure, volume voided, and subtracted detrusor pressure were simultaneously recorded." These testing conditions were very unnatural/unphysiological. For example, the infusion water should be of body temperature instead of room temperature. Otherwise, the temperature change can cause contractions of the bladder and/or the urethra. The lack of improvement in flow rate and residual volume could be artifacts of the highly unnatural measurement procedures.
Furthermore, even minor changes in the flow rate and residual volume can cause substantial changes in the subjective symptoms. In other words, the changes in flow rate and residual volume are not sensitive indexes for estimating the symptom changes. Thus, Gerber et al.'s results do not necessarily mean that there was a lack of improvements in flow rate and residual volume that were sufficient to cause some degree of symptom improvements. PSA is not a factor directly related to the symptom of LUTS. The absence of an effect on PSA is an advantage of using saw palmetto berry or its extracts for treating BPH and LUTS.
Common to the situations in many other medical fields, some "meta-analysts" and reviewers are articulate but not properly qualified. Sometimes these less qualified meta-analysts and reviewers made mistakes or misleading statements that caused controversies, perhaps due to their lack of knowledge on the clinical details. For example, Plosker and Broaden stated: "Serenoa repens (Permixon) has been available for several years for the treatment of men with benign prostatic hyperplasia (BPH). The drug is the n-hexane lipdosterolic extract of the dwarf American palm...." Similarly, Lowe et al.15 stated that: "Serenoa repens (saw palmetto berry) is the most widely used phytotherapeutic preparation for the treatment of BPH/LUTS." Fitzpatrick and Lynch''- reviewed some studies on the use of phytotherapeutic agents for BPH, including saw palmetto berry. They stated: "Serenoa repens , which is an extract of the dwarf palm tree, has been used in the treatment of BPH and has a purported androgenic effect.. .the rationale for an extract of a dwarf palm tree to be used in BPH was not demonstrated." (underline added). Serenoa repens is the scientific name of the species or the entire plant, not saw palmetto berry. The whole plant is not used as an herbal medicine. Rather the berry is used as a medicine for BPH/LUTS. These statements reveal that these authors were perhaps ignorant about the difference between the berry (or the drug made from the berry) and the plant. Or they were simply careless. Such sloppiness and/or a lack of expertise does not lend credence to their arguments. These were the authors who were more inclined to argue against the use of saw palmetto berry for treating BPH and LUTS. In the case of Plosker and Brogden's paper, many other mistakes and/or omissions, have indeed rendered their point of view less valuable.
In the 12-week, double-blind, placebo-controlled study on 70 BPH patients, Reece Smith et al.9 concluded that: "whilst the regime of Permixon (a saw palmetto preparation) used in this trial was... associated with considerable symptomatic improvement, we have no evidence that this improvement was due to anything more than the psychosocial value of being involved in the trial and meeting a number of sufferers from a similar condition. In particular, a significant proportion of patients came to a greater understanding of their disease and no longer required surgical treatment. Thus it may be that if more time were spent counselling patients with symptoms of benign prostatic hypertrophy, the operative workload would be reduced." The parameters that they measured included subjective assessments by the investigators (difficulty in micturition, impairment of stream, urinary urgency, hesitancy, intermittency, terminal dribbling, incomplete voiding, average daytime micturitions, and average nocturnal micturitions), by the patients (difficulty in passing urine, difficulty in starting urination, intermittency, terminal dribbling, sensation of incomplete voiding, poor stream, urgency, average daytime micturitions, average nocturnal micturitions), and objective measurements (urinary flow rate and bladder residual volume).
As mentioned above, Reece-Smith's report lacks critical elements of a quality study. The report of the study fails to provide any statistical analysis on bladder residual volume measurement and the standard deviations of the flow rate measurements, two of the most important objective measurements. Measuring urinary flow rate usually has large standard deviations. For example, in a similar study with more than twice as many patients (n=205), the standard deviation for flow rate measurements are ca. 35% of the means, and that for the residual volume (using the same echogram method) are ca. 68% of the means. As for the subjective evaluations, the data become even more unreliable, particularly the measurements used in this study is hard to quantify and not related to a scale of symptoms, which would be more quantifiable even though they are still subjective. Of special concern, the patients apparently socialize among themselves. A well conducted double-blind, placebo-controlled study would discourage participants from socializing among themselves, which may cause them to compare the treatment and to break the blind code. For these reasons, the conclusions are questionable.
The strongest negative comments came from Fitzpatrick and Lynch12, who in 1995 concluded that "It is unthinkable, therefore, that plant extracts should be considered as legitimate therapy for symptomatic BPH without undergoing the same strict control... it is preferable that they should be respected scientifically because of proven efficacy in multicenter placebo-controlled trials." However, these comments should now be ignored. After the publication of this article, high quality scientific multicenter, double-blind and placebo-controlled studies have proven that an extract of saw palmetto berry is effective in treating BPI-I, as discussed above. They also stated that: "It has never been proved, although it has been suggested, that plant extracts will decrease outflow resistance and also reduce the size of the prostate." The first part of this 1995 comment is no more valid because it has been conclusively demonstrated that treatment with a saw palmetto berry preparation can indeed improve urinary flow, as discussed above. Regarding reduction of the size of prostate, there is still a lack of evidence presently. But as discussed above, prostate size may or may not be a factor in determining the symptoms and severity of LUTS.
Fitzpatrick and Lynch further assert: "To date, no absolute rationale for the use of plant extracts in symptomatic BPH has been demonstrated. It is absolutely necessary, given the widespread use of these agents (saw palmetto berry extracts and other plant materials), that other studies be performed in this regard." It should be noted that a "rationale" or mechanistic explanation is desirable but not absolutely required for many special nutritionals and drugs. Many nutrients and drugs that are now in use do not have a "rationale" or mechanistic explanations on how they work or have explanations that appear to be wrong. The scientific interpretations of the relation between pellagra and niacin are typical examples. Most herbs have many active principles. At the current state of knowledge, it would be very difficult or impossible to explain their modes of action, because the interactions among the multiple active principles and between these active principles and the body is often beyond the comprehension of scientists. In any case, one should not give Fitzpatrick and Lynch's opinion much weight because the mistakes and/or carelessness in writing this article, as stated above.
TABLE 4. EFFICACY OF SAW PALMETTO EXTRACT FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA AND/OR LOWER URINARY TRACT SYMPTOMS
Author(s), |
Key Features of the |
Author(s)' |
Remarks |
Miller, |
Not applicable (NA); |
"the most common use for saw palmetto is for benign prostatic hypertrophy... both objective (eg, |
The conclusion is valid and supports the efficacy of saw palmetto for treating BPH/LUTS.. |
Gerber et al., 1998, ref. 18 |
prospective, open- label, 50 patients, 6 months, 320 mg/d. |
The International Prostate Symptom Score improved 19.5±5.5 to 12.5+7.0 (P<0.001). |
See text for comments. |
Lowe et al. |
NA. (A review article). |
"No definitive conclusion can be drawn." |
See text for comments. |
Wilt et al. |
meta-analysis. |
"evidence suggests that S repens |
See text for comments. |
Braeckman et al. |
double-blind, randomized, placebo-controlled, 205 patients, 3 |
reductions in pollakiuria (P <0.05), nocturia (P <0.05), dysuria (P<0.01), urgency (P<0.01), and hesitancy. |
This study strongly support the efficacy of saw palmetto extract for use in |
Plosker and Brogden |
NA. (A review article). |
"oral administration of Serenoa repens ...was generally superior to placebo." |
See text on the detailed remarks on this work. |
Lowe & Ku |
meta-analysis. |
"the studies evaluating the efficacy of SPB (saw palmetto berry) extract are inconclusive... For example, the 3-month trial by Reece Smith et al. demonstrated a significant increase in flow rate and decrease in |
These conclusions are not |
20
|
|
symptoms with both placebo and |
|
Carraro et al. |
Double-blind, randomized, 1098 |
"Both (saw palmetto extract and finasteride) treatments relieve the |
See discussions on Carraro |
Fitzpatrick & |
NA. (A review article.) |
"It would seem that plant extracts
|
These conclusions are not
|
Descotes et al. |
Double-blind, |
"Permixon (a saw palmetto extract preparation) appears to be significantly more effective than |
See discussions in on their |
Romics, |
open study, 32 |
The following improvements in |
Although these long term |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Schmitz, & |
patients, 12 months |
symptoms were observed: number |
observations are consistent |
Frang |
320 mg/d. |
of daily urinations 29%, number of |
with the observations of |
1993 |
|
night urinations 39%, hesitancy |
many other researchers and |
ref. 26 |
|
73%, interrupted stream 75%, |
lend support to the efficacy |
|
|
residue feeling 77%, terminal |
of saw palmetto, the study |
|
- |
dribbling 67 %, weak stream 76%. |
was not blinded. Thus, |
|
|
Significant to substantial |
how much placebo effect |
|
|
improvements were also observed |
contributing the observed |
|
|
in: duration of urination, duration |
improvements is not |
|
|
until maximum flow, maximum |
known, |
|
|
flow, average flow, uroflow index, |
|
|
|
residue, bladder capacity, AP |
|
|
|
diameter of prostate volume, and |
|
|
|
transverse diameter of rostate. |
|
Carbin, |
double-blind, |
"Urinary flow, micturition time, |
Although these observations |
Larsson, and |
placebo-controlled, |
residual urine, frequency of |
are consistent with the |
Lindahl |
randomized, 53 |
micturition and a subjective |
observations of many other |
1990 |
patients, 3 months, |
assessment of the effect of treatment |
researchers and lend |
ref. 27 |
480 mE/d saw |
were all significantly improved in |
support to the efficacy of |
|
palmetto extract and |
the treatment group." |
saw palmetto, the study was |
|
480 mg/d pumpkin |
|
not blinded. The presence |
|
seed extract. |
|
of pumpkin extract |
|
|
|
complicates the |
21
|
|
|
interpretation. |
Reece Smith |
double-blind, |
"There was no significant difference |
See text on detailed |
et al. |
placebo-controlled, |
between the results of treatment in |
discussions on this study, |
1986 |
randomized, 70 |
either group (saw palmetto and |
|
ref. 9 |
patients, 12 weeks |
placebo)." |
|
|
320 mg/d, with a |
|
|
|
follow up at the end |
|
|
|
of the 6th month |
|
|
|
after the treatment. |
|
|
Tasca et.al. |
double-blind, |
"Clearly positive results were |
The conclusion is valid and |
1985 |
placebo-controlled, |
obtained in 42.9% of the patients |
supports the efficacy of saw |
ref. 23 |
randomized, 27 |
treated with the active substance |
palmetto for treating |
|
patients, 1-3? months |
(saw palmetto extract) and in 15.4% |
BPH/LUTS. |
|
320 me/d. |
of those treated with the placebo," |
|
Champult G, |
double-blind, |
Significant to substantial |
These results strongly |
Patel IC, & |
placebo-controlled, |
improvements (PC 0.001) were |
support the efficacy of the |
Bonnard AM. |
randomized, 94 |
observed in nocturia, flow rate, |
saw palmetto extract. |
1984 |
patients, I month |
postvoid residue, dysuria and other |
|
ref. 28 |
320 mg/d. |
subjective indexes. |
|
Boccafoschi & |
double-blind, |
Significant to substantial |
This is a well conducted |
Annoscia |
placebo-controlled, |
improvements (P <0.05 or smaller) |
and written study. These |
1983 |
randomized, 22 |
were observed in volume of |
results strongly support the |
ref. 29 |
patients, 60 days |
urination, maximum and average |
efficacy of the saw |
|
320 mg/d. |
flow rate, clinical scores of dysuria |
palmetto extract. |
|
|
and nocmria. |
|
Emili, Cigno, |
double-blind, |
"The hexane extract of Serenoa |
These results is consistent |
& Petrone |
placebo-controlled, |
repens B was shown in our study to |
with other studies and |
1983 |
randomized, 30 - |
be useful improving the clinical and |
support the efficacy of the |
ref. 30 |
patients, 30 days |
instrumental parameters |
saw palmetto extract. |
|
320 mg/d. |
|
|
Mandressi et |
double-blind, |
"there was a clearly greater |
These results is consistent |
al. |
placebo-controlled, |
reduction in the points (symptoms) |
with other studies and |
1983 |
randomized, 34 |
for the subjects treated with Serenoa |
support the efficacy of the |
ref. 31 |
patients, 30 days |
repens (sic) (Permixon) compared |
saw palmetto extract. |
|
320 mg/d. |
to those treated with a placebo. |
|
|
|
Especially relative to nocturia., .the |
|
|
|
group treated with a placebo |
|
|
|
actually showed a slight increase in |
|
|
|
symptoms, almost to the point of |
|
|
|
indicating a progression of the |
|
|
|
disease, while the subject treated |
|
|
|
with Serena repens (sic) |
|
|
|
(Permixon) showed a considerable |
|
|
|
reduction of the phenomenon." |
|
22
Importantly, no reviewer or meta-analysts has denied that saw palmetto berry preparations can provide certain benefits to BPH/LUTS patients. Critics often attribute these benefits to placebo effects. If saw palmetto berry provided only placebo benefit in the treatment of BPH/LUTS, then why numerous other plants that were more available to Native Americans for centuries were not used? There must be something unique that links these berries to BPH and/or related LUTS. The unique factor most likely is the efficacy of saw palmetto berries in the treatment of BPH and/or related LUTS. The most recent discovery19 that a saw palmetto berry extract, not extracts of some other plants, potently and non-competitively inhibited human ct-adrenoceptors is consistent with the uniqueness of saw palmetto berry in the
treatment of BPH and/or LUTS.
With regard to the lack of effects on prostate volume and serum PSA level, these two indexes may or may not have material effects on the symptoms of BPH/LUTS, which include difficulty in passing urine and in starting urination, intermittency, terminal dribbling, sensation of incomplete voiding, poor stream, urgency, frequent daytime and nocturnal micturition with a smaller quantity of urine for each urination. The lack of effect of saw palmetto berry on prostate volume and PSA does not necessarily compel us to conclude that the observed benefits are placebo benefits. The lack of effect on serum PSA level is actually an advantage, as discussed above.
The Stability of Saw Palmetto Berries and Preparations of Saw palmetto berry
Little scientific information is available about the stability of saw palmetto berries, except that the dried berries and powder that have been stored for years are still effective for many of the intended medicinal purposes. Thus, the dried berries of saw palmetto and their active principles, like many other herbs and their active principles, are stable for at least several years. The stability of preparations of saw palmetto berry extracts are not known to me.
Since the active principles are reported to be acylglycerides2° and phytosterols, we can expect a stability of at least several months to a few years, this range of stability is adequate for dietary supplement, whose requirement for stability ranges from a few weeks (as for acidophilus products) to a few years (as for vitamins). For comparison, most over the counter drugs have shelf-life of 1 to 3 years.
Active Principles and Physiological and/or Pharmacological Modes of Action
Saw palmetto preparations are made from the n-hexane lipidosterolic extract of the pulp and seed (fruit) of the dwarf American palm, Seronoa repens. The extract is a combination of free fatty acids and their esters, small quantities of phytosterols, tannins, and various other polyprenic compounds. Our knowledge concerning saw palmetto's pharmacological mode of action in this area is limited. Nevertheless, most researchers agree that the active principles are
23
fatty acids/fat extractable substances, and phytosterols. evertheless, many researchers believe that the active principles are fatty acids/fat extractable substances, and phytosterols. The proposed mechanisms of saw palmetto include: antiandrogenic effects (inhibition by competition with dihydrotestosterone for binding to the androgenic receptors, inhibition of 3, H-methyl-trielenone binding to the receptor, inhibition of 5,a-reductase, which converts testosterone into dihydrotestosterone, and inhibition of 3,a-oxireductase), antiestrogenic effects'-', modulation of the function of eicosanoids, and inhibition of prostate dell proliferation. Most recently, Goepel et al.19 reported that a saw palmetto berry extract potently and non-competitively inhibited human a-adrenoceptors in vitro. Such an inhibition is unique to saw palmetto berry extract; extract of other commonly used phytotherapies for BPH, pumpkin seed, a beta-sitosterol preparation, and stringing nettles were not effective. (See Elghamry MI, Hansel R. Activity and isolate phytoestrogen of shrub palmetto fruits (Serenoa repens Small), a new estrogenic plant. Experentia 1969;25:828-9)(DiSilverio F, D'Eramo G, Lubrano C et. al., Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Eur Urol 1992;21:309-14 and Sultan C. Inhibition of androgen metabolism and binding by a liposterolic extract of Serenoa repens B in human foreskin fibroblasts. J Sterol Biochem Mol Biol 1984;20:515-19).
Because saw palmetto is a complex mixture of several compounds, pharmacokinetic data is difficult to obtain. Plasma concentrations of one of the components (unspecified; referred to as "component two") were measured in 12 fasting healthy young men volunteers (mean age: 24 years) after administration of 320 mg of saw palmetto. Peak plasma concentrations of 2.6 mg/dl was obtained with 1.5 hours with an area under the curve (AUC) of 8.2mg/1/h and elimination half-life of 1.9 hours (DeBernardi di Valserra M, Tripodi AS, Contos Set. al., Serenoa repens capsules: a bioequivalence study. Acta Toxicol Ther 1994;15:21-39.) Oral administration to rats of 14C-labelled oleic or lauric acid or beta-sitosterol with saw palmetto demonstrates preferential uptake with higher concentrations found in the prostate gland than the liver, seminal vesicles or other genitourinary tissues (Plosker GL, Brogden RN. Serenoa repens (PermixonR): a review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia. Drugs Aging 1996;9:379-95).
Legal and Regulatory Point of View
Three main issues, safety, efficacy, and stability, must be addressed when considering a health claim that saw palmetto berry or its extracts are beneficial for reducing the risk of or to be capable of mitigating BPH and/or LUTS. Regarding safety, statements about the use of phytochemicals in food fortification, such as "A phytochemical must be tested for safety more rigorously than a drug would be, before the pure compound can be used for food fortification. A reason for a more stringent test is that the consumers' exposure to phytochemicals is expected to be greater than their exposure to drugs. Another reason is that the benefit of a
24
phytochemical is expected to be lower than that of a drug, at least in the short term. Therefore, the use of a phytochemical must have a very low safety risk in order to achieve an acceptable benefit/risk ratio"s applies.
"A more difficult and serious problem related to functional foods is that a plant/phytochemical may reduce the risk of certain diseases in some individuals, but may increase the risk of other diseases in some other individuals, or even in the same individuals.., many foods (phytochemicals) have an effect of counterbalancing certain imbalanced physiological states, sc that the risk of certain diseases associated with the imbalance may be mitigated. A phytochemical may enhance the balance in some, but may cause excess in others. Typical examples: anti-occlusive phytochemicals can reduce the risk of occlusive cardiovascular diseases in the majority of people, but they may also increase the risk of hemorrhages in a certain segment of the population... In my opinion, the substantiation of the safety of phytochemicals must be more stringent than that of drugs, and the substantiation of the efficacy of phytochemicals must be more relaxed than that of drugs. "5 Since saw palmetto berries have been consumed for a long time for medicinal purposes, including benign prostate hyperplasia and/or lower urinary tract symptoms, without known adverse or toxic effects and since a preparation of its extracts has been studied extensively in clinical trials without any statistically significant adverse effects when taken with meals, the safety of saw palmetto berry and proper extracts of the berry for use in benign prostate hyperplasia and/or lower urinary tract symptoms has been confirmed and is sufficient for approving them as a dietary supplement for such purposes.
Regarding the efficacy issue, as stated in Functional Foods: "Proving efficacy is perhaps the most difficult aspect of the phytochemical matter. In many cases, the required degree of proof for drugs is not obtainable with phytochemicals, simply because the risk/reward ratio is too great to justify subjecting seemingly healthy humans to the testing conditions of a drug test. In drug clinical trials, the expected relief from the suffering and/or the expected reduction of the risk of death from a disease may justify the risk of trying an unproven drug; but in the case of phytochemicals and/or functional foods there is a lack of strong justifications for risk taking." Thus, when consider a health claim for saw palmetto berry and/or its extracts the government must lower the standard that is required for drug approval. The above discussions clearly demonstrate that a preparation of saw palmetto berry extract is effective in mitigating benign prostate hyperplasia and/or lower urinary tract symptoms, though not as potent as many dwgs used in treating other diseases. (However, the commonly used drug for BPH/LUTS, finasteride is only as effective as saw palmetto berry.) Considering that saw palmetto berries have been used for similar purposes for a long period of time, it is appropriate to generalize the efficacy to other properly prepared saw palmetto berry preparations. The combined evidence of efficacy of saw palmetto berry and proper extracts of the berry for use in benign prostate hyperplasia and/or lower urinary tract symptoms is adequate for approving them as a dietary supplement for such purposes.
25
Looking at it from another angle, EPH and LUTS are not life threatening diseases. The treatment of these conditions does not require drugs of high potency and of very precisely quantified and certainly do not warrant use of drugs with known serious adverse effects. The required level of certainty for saw palmetto and mild BPH is in contrast with the treatment of many other diseases, e.g., treating Type I diabetes with insulin, for which precisely metered doses must be dispensed timely. The primary concern here is safety, including that the treatment does not affect the detection of much more serious and may be deadly prostate cancer (e.g., not affecting serum PSA level). Saw palmetto berry and its extracts are very safe and do not affect PSA level. Thus, saw palmetto berry and its extracts can be valuable dietary supplement for use in the mitigation and/or risk reduction of benign prostatic hyperplasia and lower urinary tract Symptoms. Even though the efficacy of the berry and its extracts is not as precisely substantiated.
Summary
Meeting with rigid adherence to industry standards for the manufacture of saw palmetto, a uniform amount of the extract will be delivered. Commensurate with this standardization, desired effects of decreased nocturia, increased urinary flow volume and decreased post-void residual volume will be attained. Minimal side effects will be encountered and will be less than that noted with finasteride. Importantly, public health issues will be addressed under the rubric of lack of interference with PSA levels with saw palmetto use, a claim finasteride cannot make in regard to monitoring for prostate cancer. The available information supports the safety, efficacy, and stability of saw palmetto berry and properly prepared saw palmetto berry extracts for use in mitigating and/or reducing the risk of benign prostatic hyperplasia and/or lower urinary tract symptoms. There is substantial scientific agreement among experts on this matter. Approval of a health claim that such a product may mitigate and/or reduce the risk of benign prostatic hyperplasia and lower urinary track symptoms is of substantial public interest and is of great economic importance.
FM
References
1. Kawachi I, Barry MJ, Giovarmucci E, Rimm EB, Colditz GA, Stampfer MJ, and Willett WC. 1996. The impact of different therapies on symptoms of benign prostatic hyperplasia: a prospective study. Clin. Therap. 18:1118-27.
2. Berry SJ, Coffey, Walsh PC et al. 1984. The development of human benign prostatic hyperplasia with age. J Urology 132:474-9.
3. Murray M and Pizzorno J. 1994. Encyclopedia of Natural Medicine. John Bastyr University Publishing. Seattle.
4. J. Kloss, author, Back To Eden Books, publisher. Loma Linda, California.
5. Lin RIS. 1994. "Phytochemicals and Antioxidants" in Functional Foods (Goldberg I. ed., Chapman & Hall publ., New York).
6. Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, and Mulrow C. 1998. Saw palmetto extracts for treatment of benign prostatic hyperplasia. J. Am. Med. Assoc. 280: 1604-9.
7. See the FDA appoved brochure accompanying the drug PROSCAR.
8. Plosker GL and RN Brogden. 1996. Serenoa repens (Permixon) A review of its pharmacology and therapeutic efficacy in benign prostate hyperplasia. Drugs and Aging 9:379-95.
9. Reece Smith H, Amemon, CJ Smart, and K Dewbury. 1986. The value of Permixon in benign prostatic hypertrophy. Br. J. Urology. 58:36-40.
10. Stenger A, Tarayre J-P, Carilla E et al. 1982. Pharmacologic and biochemical study of the hexane extract of Serenoa repens B(PA109). La Gazette Medicale de France 89:20418.
11. Rhodes L, Primka RL, Berman C et al. 1993. Comparison of finasteride (Proscar), a 5-a reductase inhibitor, and various commercial plant extracts in in vitro and in vivo 5-a reductase inhibition. Prostate 22:43-51.
12. Fitzpatrick JM and Lynch TH. 1995. Phytotherapeutic agents in the management of symptomatic benign prostatic hyperplasia. Adv. Benign Prostatic Hyperplasia 22:407-12.
27
13. Carraro JC, JP Raynaud, G Koch, GD Chishom, F Di Silverio, P Teillac, FC Da Salva, J Cauquil, DK Chopin, FC Hamdy, M Hanus, D Hauri, A Kalinteris, J Marencak, A Perier, and P Perrin. 1996. Comparison of phytotherapy (Permixon) with Finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate 29:231-40.
14. Bach D, Schmitt M, Ebeling L. 1997. Phytopharmaceutical and synthetic agents in the treatment of benign prostatic hyperplasia (BPH). Phytomed. 3-4:209-13.
15. Lowe FC, Dreikorn K, Borkowski A, Braeckman J., Denis L, Ferrari P, Gerber G, Levine R, Perrin P, and Senge T. 1998. Review of recent Placebo-controlled trials utilizing phytotherapeutic agents for treatment of BPH. Prostate 37:187-93.
16. Descotes JL, Rambeaud JJ, Deschaseaux P, and Faure G. 1995. Placebo-controlled evaluation of the efficacy and tolerability of Permixon in benign prostatic hperplasia after exclusion of placebo responders. Clin. Drug Invest. 9:291-7.
17. Schulze H, Berges H, Paschold K, et al. 1982. Neue konservative Therapieausaetze bei der benignen Prostahyperplasiie. Urologe A 31:8-13.
18. Gerber GS, Zagaja GP, Bales GT, Chodak GW, and Contreras BA. 1998. Saw palmetto (Serenoa repens ) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms. Urology 51:1003-7.
19. Goepel M, Hecker U, Krege S, Rubben 1-I, Michel MS. 1999. Prostate 38:208-15.
20. Shimada H, Tyler VE, and Mclaughlin JL. 1997. Biologically active acylglycerides from the berries of saw-palmetto. J.Nat. Prod. 60:417-8.
21. Elghamry MI, Hansel R. 1969. Activity and isolated pgytoestrogen of shrub palmetto fruits (Serenoa repens Small): an estrogenic plant. Experientia 24:828-9.
22. Miller L. 1998. Herbal Medicinals: Selected clinical considerations focusing on known or unknown drug-herb interactions. Arch. Intern. Med. 158:2200-2211.
23. Tasca A. 1985. Treatment of Obstruction in prostatic adenoma using an extract of Serenoa repens : double-blind clinical test vs placebo. Minerva Urol. Nefrol. 37:887-91.
24. Braeckman J, Denis L, de Leval J, Keuppens F, Cornet A, De Bruyne R, De Smedt E, Pacco J, Timmermans L, Van Vliet P, Bruhwyler J, Kaufman L, Derde MP. 1997. A double-blind, placebo-controlled study of the plant extract Serenoa repens in the treatment
28
of benign hyperplasia of the prostate. Europ. J. Clinical Res. 9:247-59.
25. Lowe FC and Ku JC. 1996. Phytotherapy in treatment of benign prostatic hyperplasia: a critical review. Urology 48:12-20.
26. Romics I, Schmitz H, Frang D. 1993. Experience in treating benign prostatic hypertrophy with Serena serrulata for one year. Intern. Urol. Nephrol. 25:565-9.
27. Carbin BE, Larsson B, and Lindahl 0. 1990. Treatment of benign prostatic hyperplasia with phytosterols. Brit. J Urolo. 66:639-41.
28. Champult G, Patel JC, & Bonnard AM. 1984. Adouble-blind trial of an extract of the plant Serenoa reps in b ni n prostatic hyperplasia. Br. J Clin. Pharmac. 18:461-2.
29. Boccafoschi C and Annoscia. 1983. CONFRANTO FRA ESTRATTO DI SERENOA REPENS E PLACEBO MEDIANTE PROVA CLINICA CONTROLLATA IN PAZEINT CON ADENOMATOSI PROSTATICA. Urology 50:1257-68.
30. Emili E, Cigno ML, & Petrone U. 1983. RISULTATI CLINICI SU UN NOUVO FARMACO NELLA TERAPIA DELL'IPERTROFIA DELLA PROSTATA (PERMIXON). (Terapia Medica) Urologia 50:1042-8.
31. Mandressi A, Tarallo U, Maggioni A, Tombolini P, Rocco F, Quadraccia S. 1983. TERAPIA MEDICA DELL'ADENOMA PROSTATICO: CONFRONTO DELLA EFFICACIA DELL'ESTRATTO DI SERENOA REPENS (PERMIXON) VERSUS L'ESTRATTO DI PIGEUM AFRICANUM E PLACEBO. (Terapia Medica) Urologia 50:752-7.
29
Dr. Robert I-San Lin, Ph.D., CNS, FICN
Box 50632, Irvine, CA 92619-0632, USA
Fax 714-8546170, tel 714-8544855, e-mail: drlin@juno.com
Education: Ph.D. UCLA. 1968. Biophysic & Nuclear Medicine. Studied under Nobel Laureate, Willard Libby. Conducted research on mechanisms, treatment, and prevention of injuries caused by nuclear radiations; physiological mechanisms of steroid hormones; synthesis of subcellular organells; and regulation of gene expression.
M.S. UCLA. 1968. Plant biochemistry.
B.Sc. National Taiwan University. Premedical Science.
Postdoctoral training: California Institute of Tchnology. 1968-70. Conducted research on mmoleuclar biology and biotechnology in Norman Davidson's team, which includes Philip Sharp (postdoctoral trainee then and later Nobel Laureate) and Louis Chow (a graduate student then and later one the hihest honor awardee, American Chemical Society)
UCLA Medical Center. 1970-71. nutrition and metabolic
diseases.
Massachusettes Institute of Technology. 1971-72. Nutrition.
Executive training: Harvard University. 1973.
Leadership training: University of Maryland/Center for Creative Leadership. 1982.
Employment Histroy: Nutrition International Co. 1990-present. Executive Vice President in charge of matters related science and technology in the biomedical field, including: research in biomedical field (vitamins, minerals, herbs, phytochemicals, hormones, intermediate metabolites), regulatory affairs, and product development.
Weider Health & Fitness Co. 1988-90. Senior Vice President in charge of matters related science and technology related to sport physiology, sport medicine, and sport nutrition.
Makers of Kal Co. 1986-88. Senior Vice President in charge of
1. Editorial boards:
a) EmergindexR Editorial Board, After Care, Micromedex, Denver: 1989 to 1993.
b) Geriatric Medicine Today, Adjunct Editorial Advisor Board, 1990 to 1993.
c) Journal of the American Pharmaceutical Assocation, Editorial Advisory Board, March 1999- February 2002
2. Grant Award Referee; reviewer for joint American Academy of Family Physicians/F-AAFP Grant Award Committee; 1990, 1991, 1993, 1994, 1996.
3. Official consultant, American Medical Association Drug Evaluations; 1991.
4. Review Panel: American College of Clinical Pharmacy, M J Family Medicine Research Award, 1992, 1994.
5. Review Panels: |
|
Journal |
Years(s) |
American Family Physician |
1989 to present |
Journal of Clinical Psychopharmacology |
1987 to present |
Southern Medical Journal |
1989 to present |
Movement Disorders |
1989 to present |
Journal of the American Board of Family Practice |
1989 to present |
Clinical Pharmacy |
1984 to 1993 |
American Journal of Hospital Pharmacy |
1984 to present |
American Hospital Formulary Service, Drug Information |
1984 to present |
Journal of Nervous and Mental Diseases |
1990 to present |
Biopharmaceutics and Drug Disposition |
1991 to present |
Journal of Family Practice |
1991 to present |
American Journal of Medical Sciences |
1991 to present |
Archives of Family Medicine |
1992 to present |
Pharmacotherapy |
1994 to present |
Clinical Therapeutics |
1995 to present |
PharmacoEconomics |
1996 to present |
Journal of the American Pharmaceutical Assocation |
1998 |
6. Conn's Current Therapy; W. B. Saunders Company, Pharmacotherapy editorial consultant for annual review of drug therapy. 1988-1993.
7. Pharmacotherapy Self-Assessment Program (PSAP) II, neurology referee, 1994.
8. Actigraphy consultant, NIH National Institute of Nursing Research,
regarding the use of actigraphy in COPD and CAD research studies, 1994.
Advisory Board, National Library of Medicine, Midwest Region, two-year appointment, 1994-96; appointed to second term 1996-2001 (moved out of region in 1997).
10. Actigraphy consultant, Ambulatory Monitoring Inc., regarding use of actigraph in children with Attention Deficit Hyperactivity Disorder, 1995.
11. Board Certification Affairs Committee, American College of Clinical Pharmacy, 1995-1996 and 1996-97.
12. Pharmaceutical care consultant, Merck & Company, Inc. , 1996-1997
13. ADHD and pharmacotherapy consultant, Alpha School, School for Behaviorally Disturbed Children, 1615 6th St., Omaha, NE 68108-3714, 1996-present.
14. Advisor Board, Warner-Lambert Pharmaceutical Company, 1998-present
15. Professional Affiliations
1977-80 |
Student American Pharmaceutical Association |
|
|
1979-1997 |
American Society of Hospital Pharmacists |
|
|
1981-82 |
Kansas Pharmacists Association |
|
|
1982-1993 |
Houston-Galveston Area Society of Hospital Pharmacists |
|
|
1983-1989, |
Texas Society of Hospital Pharmacists |
|
|
1998-present |
|
|
|
1983-85 |
Recording Secretary, Houston-Galveston Area of Society of |
|
|
|
Hospital Pharmacists |
|
|
1984-1987 |
American Society of Hospital Pharmacists: SIG on |
|
|
|
Drug and Poison Information Practice |
|
|
1984-1986 |
Drug Information Association |
|
|
1987-1997 |
American Society of Hospital Pharmacists: SIG on Ambulatory |
|
|
|
Practice |
|
|
1987-1993 |
Movement Disorder Society |
||
1987-1994 |
Society of Teachers of Family Medicine |
||
1988-Present |
American College of Clinical Pharmacy |
||
1994-Present |
Ambulatory Care SIG: American College of Clinical Pharmacy |
||
1991-1994 |
International Society of Chronobiology |
||
1992-Present |
Sigma Xi Scientific Research Society |
||
1992-1993 |
Association of Women Faculty, Baylor College of Medicine |
||
1993-present |
Rho Chi Honorary Society |
||
1994-present |
American Association Colleges of Pharmacy |
||
1994-1997 |
Nebraska Society of Hospital Pharmacists |
||
1995 Legislative Subcommittee on Pharmacist Prescribing Authority,
Nebraska Society of Hospital Pharmacists
16. Invited Presentations
National
"Selecting Among the Non-Steroidal Anti-Inflammatory Agents", 12th Annual Review Course in Family Medicine, Houston, TX, May 16, 1988.
"Selecting a NSAID: Patient and Medication Considerations", Ventura County Medical Center, Ventura, CA, August 11, 1988.
"Generic Substitutions: Are They Therapeutic?" 13th Annual Review Course in Family Medicine, Houston, TX, May 26, 1989.
"Selecting Among the Nonsteroidal Anti-Inflammatory Drugs: Adverse Effects Profile Considerations." 15th Annual Review Course in Family Medicine, Houston, Texas, April 29, 1991.
"Anxiolytics: Use and Abuse." 15th Annual Review Course in Family Medicine, Houston, Texas, May 2, 1991.
"Pharmacologic management of obesity: fad and fiction", Advances in Family Medicine CE Seminar, League City, TX, January 24, 1992.
"Management of the child with attention deficit hyperactivity disorder (ADHD): diagnostic and treatment considerations", 16th Annual Review Course in Family Medicine, Houston, TX, May 19, 1992.
"Childhood and adolescent psychopharmacology: focus on attention deficit hyperactivity disorder (ADHD), Fourth Regional Psychopharmacy Update, University of Texas Psychiatric Pharmacy Program, Austin, TX, November 14, 1992.
"Medical Informatics for the Pharmacist", 3rd Annual National Medical Information Networking Conference, Omaha, NE, July 18, 1994.
State
"Substance Abuse," guest speaker, Louisiana State Society of Radiologic Technologists, Annual Seminar, Lake Charles, LA, August 12, 1983.
"Methods of Contraception: A Review, "West Texas Pharmaceutical Association, Continuing Education Seminar, September 8, 1984, sponsored by Syntex Laboratories, Inc., Lubbock, TX.
"New Drugs and Indications," Lucinda Miller and Cathy Mullins, Texas Society of Hospital Pharmacists Annual Seminar, Galveston, TX, April 21, 1986.
"Generic Substitution of Amitriptyline: Impact on Effectiveness, Quality of Life and Patient Satisfaction." Interprofessional Task Force on Pharmacotherapy of Texas, Texas Medical Association, Austin, Texas, November 17, 1989.
"Herbal medicinals: an overview for clinicians", West Texas Pharmaceutical Association, Continuing Education Seminar, April 26, 1998, Amarillo, TX.
"Herbal medicinals: potential drug interactions", Pharmacology for Advanced Practice Nurses, Amarillo College Center for Continuing Healthcare Education, October 3, 1998, Keynote Speaker.
Regional
"Epilepsy and Anti-Epileptic Medications," Critical Care Nursing Certification Program, Park Plaza Hospital, Spring 1982 Module, Houston TX.
"Substance Abuse," Texas Southern University Health Center Seminar, Houston, TX, October 4, 1983.
"The Turner Drug Information Center: What It Can Do For you," Texas Department of Health, Houston, TX, October 24, 1983.
"Adverse Drug Reaction Reporting: A Brief Report with an Emphasis on Antibiotics," Infectious Disease Nursing Monthly Conference, The Methodist Hospital, Houston, TX, May 15, 1986 and Annex Dialysis Unit, August 21, 1986.
"New Drugs," Lucinda Miller and Cathy Mullins, Houston-Galveston Area Society of Hospital Pharmacists monthly conference, Houston, TX, June 19, 1986.
"Metoclopramide-Induced Movement Disorders", Baylor/Univ. of Texas Neurology Monthly Seminar, March 3, 1988, Houston TX.
"Drug-Induced Movement Disorders", Ventura County Medical Center, Ventura, CA, August 12, 1988 and Department of Family Medicine, Baylor College of Medicine, Houston, TX, January 31, 1989.
"Post-Partum Seizures", Fred Bakht, MD, Lucinda Miller, PharmD, and Tahirih Baker, MD, Grand Rounds, Department of Family Medicine, Baylor College of Medicine, Houston, TX, January 31, 1989.
"Management of Breast Cancer in an Elderly Diabetic: Pharmacologic and Psychosocial Issues." Christine C. Matson, MD, Lucinda Miller, PharmD, and Phil Bohnert, MD, Grand Rounds, Department of Family Medicine, Baylor College of Medicine, Houston, TX, September 26, 1989.
"Drug Therapy in the HIV population: drug interactions and side effects." Susan Miller, MD, and Lucinda Miller, PharmD, Baylor/University of Texas Infectious Disease Conference, January 29, 1991.
"Psychopharmacologic drug use in children and adolescents." Irvin A. Kraft, MD, and Lucinda Miller, PharmD, Grand Rounds, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, January 3, 1992.
17. Presented Papers (peer-reviewed)
International
"Assessment of Body Activity of Attention Deficit Hyperactivity Disorder (ADHD) Children by Actigraphy: A Case Series", Lucinda Miller, PharmD, Stewart West, PhD, Michael Smolensky, PhD, Irvin Kraft, MD, 5th International Conference of Chronopharmacology, Amelia Island, FL, July 14, 1992.
National
"Stability and Sterility Data for Unit-Dose Packaging of Medications for Inhalation Therapy," Lucinda Miller, PharmD, and S Neal Gardner, BS, American Society of Hospital Pharmacists, Annual Meeting, Denver, CO, June 1986.
"Staff Development Through Involvement in a JCAH Compliance Team: The First Year," Diane Ginsburg, B.S., Lucinda Miller, PharmD, and Darrell Newcomer, MS, American Society of Hospital Pharmacists, Midyear Meeting, Las Vegas, NV, December 1986.
"Comparison of the Astra Century and Abboject Syringe Systems in a Cardiovascular Intensive Care Unit," Garman T. Ho, B.S., Lucinda G. Miller, PharmD, W. Gerald Quandt, BS, Darrell R Newcomer, MS., Barbara Dovidas, BS, American Society of Hospital Pharmacists, Annual Meeting, Washington, DC, June 1987.
"Variable Expression of Neuroleptic-induced Movement Disorders: A Study of 125 Patients", Lucinda Miller, PharmD, and Joseph Jankovic, MD. Drug-Induced Movement Disorder Symposium, American Neurological Association, Philadelphia, PA, October 2, 1988.
State
"Metoclopramide-Induced Movement Disorders: A Decade Later", Lucinda Miller, PharmD, and Joseph Jankovic, MD. Drug-Induced Movement Disorder Symposium, American Neurological Association, Philadelphia, PA, October 2, 1988.
"A Naturalistic Evaluation of Motor Activity in Non-ADHD Children with the Use of Actigraphy", Lucinda Miller, PharmD, and Irvin Kraft, MD, Southwestern Society for Research in Human Development, Biennial Meeting, Tempe, AZ, March 19, 1992.
"Evaluation of Medication Effectiveness in Children with Attention Deficit Hyperactivity Disorder (ADHD): Actigraphical Assessments", Lucinda Miller, PharmD, Michael Smolensky, PhD, Irvin Kraft, MD, American College of Clinical Pharmacy, Toronto, Canada, August 12, 1992.
Pharmaceutical care in rural community pharmacies: emphasis on developing computer skills to enhance patient education. Lucinda Miller, PharmD, Paul Jungnickel, PhD, Dave Scott, PhD, American Association of Colleges of Pharmacy, Reno, NV, July 17. 1996.
The Nebraska Drug Information Network: Computer Technology Supporting Delivery of Rural Pharmaceutical Care, Lucinda Miller, PharmD, Warren Narducci, PharmD, American College of Clinical Pharmacy, Nashville, TN, August 6, 1996.
Assessment of pharmaceutical care training by Nebraska pharmacists in urban and rural areas. David Scott, PhD, Lucinda Miller PharmD, Lori Letcher, PharmD candidate; American Pharmaceutical Assocation, Los Angeles, CA, March, 1997.
Herbal medications: development of a case-based course. Wallace J Murray, PhD and Lucinda G. Miller, PharmD, American Association of Colleges of Pharmacy, Indianapolis, IN, July 1997.
"Progression of a Developing Drug Information Center: What A Difference a Year Makes," Lucinda Miller, PharmD, and John Loomis, Jr, PharmD, poster session, Texas Society of Hospital Pharmacists, 35th Annual Seminar, Houston, TX, April 7, 1983.
"Pharmacist Involvement in a JCAH Compliance Team: A Descriptive Report," Diane B. Ginsburg, BS, Lucinda G. Miller, PharmD, Darrell R. Newcomer, MS, Texas Society of Hospital Pharmacists, 38th Annual Seminar, Galveston, TX, April 21, 1986.
Herbal medications: interface with allopathic medicine, Lucinda Miller, PharmD, Wallace Murray, PhD, Choices in the Healing Arts, Omaha, NE, September 21, 1996.
C.
Publications
1. Refereed Journals
a. Full papers
1) Miller LG, Loomis JH. Advice of manufacturers about effects of temperature on biologicals. Amer J Hosp Pharm 1985;42:843-8. (original research)
2) Miller LG, Raatz S. Development of a drug-food
interaction discharge counselling program. Nutrition
International 1987;3:47-9. (original research)
3) Youngkin EQ, Miller LG. The triphasics: insights for effective clinical use. Nurse Practitioner 1987;12:17-28. (critical review)
4) Miller LG. Phenylpropanolamine: a controversy
unresolved. J Clin Psychopharmacol 1989;9:1-3. (critical review)
5) Miller LG, Bowman RC, Bakht FR. Sparing effect of sulindac on lithium levels. J Fam Practice 1989: 28:592-3. (case report with literature review)
6) Burke RE, Kang UJ, Jankovic J, Miller LG, Fahn S. Tardive akathisia: an analysis of clinical features and response to open therapeutic trials. Movement Disorders 1989:4:157-75. (original research)
7) Miller LG. Recent developments in the study of the effects of cigarette smoking on clinical pharmacokinetics and clinical pharmacodynamics. Clin Pharmacokinet 1989:17:90-108. (critical review)
8) Miller LG, Prichard JG. Selecting nonsteroidal anti-inflammatory drugs: pharmacologic and clinical considerations. J Am Board Fam Practice 1989;2:257-71.
(critical review)
9) Miller LG, Rogers JC, Swee DE. Indomethacinassociated sexual dysfunction: a case report. J Fam Practice 1989:29:210-11. (case report with literature review)
10) Miller LG, Jankovic J. Metoclopramide-induced movement disorders: Clinical findings with a review of the literature. Arch Intern Med 1989;149:2486-92. (case report cohort with literature review)
11) Miller LG, Bowman RC, Mann D, Tripathy A. Fluoxetine-induced serum sickness-like reaction. Am J Psychiatry 1989;146:1616-17. (case report with literature review)
12) Miller LG, Bakht F, Baker T, Kirshon B. Possible cocaine predisposition to adverse cerebrovascular and cardiovascular sequelae of bromocriptine administered post-partum. J Clin Pharmacol 1989; 24:781-5. (case report with literature review)
13) Miller LG, Jankovic J. Sulpiride-induced tardive dystonia. Movement Disorders 1990;5:83-84. (case report)
14) Miller LG, Prichard JG, White CA, Vytla B, Feldman S, Bowman RC. Effect of concurrent sucralfate administration on the absorption of erythromycin. J Clin Pharmacol 1990;30:39-44. (original research)
15) Miller LG. Cigarettes and drug therapy: pharmacokinetic and pharmacodynamic considerations. Clin Pharm 1990;9:125-135. (critical review)
16) Miller LG, Jankovic J. Neurologic assessment of drug-induced movement disorders in 125 patients. South Med J 1990;83:525-32. (original research)
17) Miller LG, Bowman RC. Selective effect of diclofenac in the treatment of osteoarthritis versus dysmenorrhea. J Clin Pharmacol 1990;30:378-9. (case report)
18) Miller LG, Miller SM. Dysgeusia secondary to
acetazolamide therapy. J Fam Pract 1990;31:199-200. (case report)
19) Miller LG. Phenylpropanolamine; the saga
continues. J Clin Psychopharmaccol 1991;11:82. (critical review)
20) Miller LG, Kraft IA. Quinacrine-induced
psychosis in a pediatric patient. J Fam Practice
1991;32:526-28. (case report)
21) Bakht FR, Miller LG. Association of naproxen with nightmares. South Med J 1991;84:1271-73. (case
report)
22) Miller LG, Jankovic J. Persistent dystonia possibly induced by flecainide. Movement Disorders 1992;7:62-63. (case report)
23) Miller LG. Oxaprozin: a once daily nonsteroidal anti-inflammatory drug. Clin Pharm 1992;11:591-603.
(critical review)
24) Miller LG, Rogers JC, Brown EB, Perkins G. Medical management of persistent anal fissure with associated internal sphincter spasm with dicyclomine. Texas Medicine, 1992:11:65-66. (case report)
25) Miller LG, Matson CC, Rogers JC. Improving prescription documentation in the ambulatory setting. Fam Pract Res J 1992:12:421-29. (original research)
26) Miller LG, Kraft IA. Sleep disturbances and epileptiform activity in a subpopulation of children with attention deficit disorder-hyperactivity (ADDH): a literature review generating an hypothesis with implications for drug therapy. Behav Neurol 1992;5:149154. (critical review)
27) Miller LG, Smolenslcy MH, Kraft IA, Malseed L. Sleep disturbances and epileptiform activity in four
children with attention deficit hyperactivity disorder
(ADHD). Houston Medicine 1992;8:95-100. (original research)
28) Miller LG, Blum AM. Physician awareness of prescription drug costs: a missing element of drug advertising and promotion. J Fam Pract 1993;36:33-36.
(original research)
29) Kazal LA, Hall D, Miller LG, Noel ML. Fluoxetine and SiADH: A geriatric occurrence. J Fam Pract 1993;36:341-43. (case report)
30) Miller LG, Hopkinson J, Motil K, Corboy J, Andersson S. Secretion of olsalazine into breast milk. J Clin Pharmacol 1993: 33:703-6. (original research)
31) Miller LG, Kraft IA. Evaluation of medication effectiveness in children with attention deficit hyperactivity disorder (ADHD): actigraphical
assessments. Pharmacotherapy 1994: 14:219-223.
(original research)
32) Miller LG. Reimbursement for pharmacy cognitive .services and health care reform: are they compatible? Pharmacotherapy 1994: 14: 506-7.
(commentary)
33) Miller LG. Applied medical informatics for the pharmacist. J Med Systems 1994: 18: 299-303. (critical review)
34) Miller LG. Research guidelines for the pharmacy practitioner. Pharmacotherapy: 1994: 14: 740-42.
(commentary)
35) Miller LG. Pharmacy cognitive services and mail-order pharmacies. Nebraska Med J 1994: 12: 388.
(commentary)
36) Miller LG. A comparative evaluation of oral contraceptive use and associated compliance issues in a
rural population. Clin Ther 1995: 17: 541-51. (original research)
37) Miller LG, Kraft IA. Psychopharmacologic drug use by 222 patients in the outpatient setting: side effects in the context of MMPI data. J Pharmacoepidemiol 1995: 4: 41-58. (original research)
38) Miller LG. Pharmaceutical care and health care
reform:: the public can afford no less. J
Pharmacoepidemiology. 1995; 4 (2):3-6. (commentary)
39) Miller LG, Narducci WA. The Nebraska Drug Information Network: A educational model for community sites. Am J Pharm Ethic 1996; 60:131-35. (original work)
40) Miller LG, Jungnickel PW, Scott DM. Pharmaceutical care in rural community pharmacy clerkships: emphasis on developing computer skills to enhance patient education. Am J Pharm Education 1996; 60:249-56. (original research)
41) Miller LG, Scott DM. Documenting indicators of pharmaceutical care in rural community pharmacies. J Manag Care Pharm 1996: 2:659-666. (original research)
42) Miller LG. Usage of patient education and monitoring software in community pharmacies. J Am Pharm Assoc. 1997: N37:517-21. (original research)
43) Scott DM, Miller LG. Reimbursement for
pharmacy cognitive services: Insurance company
assessment. J Manag Care Pharm. 1997:3:46-48, 50-51. (original research)
44) Miller LG, Murray WJ. Herbal instruction in United States pharmacy schools. Am J Pharm Educ 1997:61:160-62. (original research)
45) Miller LG. Exploring the potential impact of the electronic revolution on pharmacy education. J Pharm Teaching. 1998;6:3-7. (commentary)
46) Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998. 158:2200-11. (review).
47) Scott DM, Miller LG, Letcher LA. Needs assessment of pharmaceutical care training in Nebraska. Am J Pharm Educ; 1998:62:243-52. (original research)
48) Scott DM, Miller LG. Reimbursement for pharmacy cognitive services: pharmacist assessment. J Manag Care Pharm 1998. In press, (original research)
49) Miller LG, Tan G. Drug-induced pancreatitis (Lisinopril). J Am Board Fam Pract 1998: In press. (case
report with literature review).
50) Miller LG, Hill JH, Esser T. Psychopharmacologic drug use in a pediatric outpatient setting: ethnic and financial considerations. Submitted. (original research)
51) Miller LG, Freeman B. Subdural hematoma associated with ginkgo biloba use. Submitted (case report with literature review).
52) Scott DM, Jungnickel PW, Miller LG, Ranno AE, Maloley PA. Pharmaceutical care preceptor training and assessment in community pharmacy clerkship sites. Submitted. (original research)
53) Miller LG, Caulfield J, Chin T, Hume AL, Jackson E, Mehra-Harris I, Kanmaz T, Knell M. Position statement on alternative and complementary medicine.
Submitted (white paper from ACCP Ambulatory Care Practice and Research Network)
54.) Cantral KA, Narducci WA, Jungnickel PW, Ranno AE, Maloley PA, Windle ML, Miller LG. Conversion of community pharmacy externship sites to clinical clerkship sites: development of pharmaceutical care education/practice settings. Am J Pharm Education. Submitted. (original research)
b. Letters-to-the-editor
1) Glantz LA. Nicotine chewing gum not for all smokers. Clin Pharm 1984;3:236.
2) Miller LG. Update on the new triphasic oral contraceptives. Clin Pharm 1985;4:24-25.
3) Baharloo M, Miller LG. Metronidazole in antibiotic-associated pseudomembranous colitis. Hosp Pharm 1986;21:468,472.
4) Miller LG, Gardner SN. Use of sodium bicarbonate vials or syringes to buffer cardioplegic solutions. Amer J Hosp Pharm 1986;43:1416, 20.
5) Miller LG. Choice of beta-blockers in
hypertensive patients who smoke. Clin Pharm
1987;6:924-25.
6) Miller LG. Ibuprofen and antihypertensive drugs. Ann Intern Med 1988;108:485.
7) Miller LG, Miller SM. Drug selection for rheumatic manifestations of AIDS. Am J Medicine: 1988;85:894-6.
8) Prichard JG, Miller LG. Monitoring of hepatotoxicity secondary to NSAID therapy. J Am Board Earn Pract 1990;3:142.
9) Burke RE, Kang UJ, Fahn S, Jankovic J, Miller
LG. Tardive akathisia. Movement Disorders
1990;5:181-82.
10) Miller LG. Physician assistants and nurse practitioners (PharmD's as mid-level practitioners). Ann Intern Med 1995;123:237-238.
c. Book reviews
1) Miller LG. Cocaine, a symposium. Amer J Hosp Pharm 1986;43:1838.
2) Miller LG. The diagnosis and treatment of drug and alcohol abuse. Clinc Pharm 1987;6:335, 39.
3) Miller LG. USPDI, Ninth Edition. Drug Information for the Health Care Professional, Advice for the Patient: Drug Information in Lay Language, Approved Drug Products and Legal Requirements. Am J Hosp Pharm 1989;46:2400,02.
4) Miller LG. The family practice drug handbook. J Fam Practice 1991:33:417.
2. Non-refereed Publications
1) Glantz LA. Aspirin: pervasive, popular, but is it dangerous? TMC (Texas Medical Center) News, 1983 (March);5:2,11.
2) Glantz LA. Side effects, benefits of drug must be weighed before taking two aspirin. TMC News, 1983 (April);5:3.
3) Glantz LA. Ask before swallowing (article regarding the use of OTC drugs during pregnancy). Houston Chronicle, 1984 April 10) Section 4:7.
4) Miller LG. Contamination potential of three-in-one TPN noted. ASHP Signal 1984;8(6):44.
5) Miller LG. Expired drugs. Consultant 1988;28:17.
6) Miller LG, Miller SM. HIV transmission-information for the general public. After Care® Instructions Computer Database (Micromedex) 1989.
7) Miller LG, Miller SM. Safe sex guidelines. After Care® Instructions Computer Database (Micromedex) 1989.
8) Miller LG, Miller SM. HIV antibody testing: meaning of a positive test and recommendations. After Care® Instructions Computer Database (Micromedex) 1989.
9) Miller LG, Miller SM. Pneumocystis carinii pneumonia
prophylaxis. After Care® Instructions Database (Micromedex) 1989.
10) Miller LG, Miller SM. Zidovudine Therapy. After Care® Instructions Database (Micromedex) 1989.
11) Helling D, Miller LG, Sax M, Sperer M. Doing your part to lower drugs costs. Patient Care 1994 (May30): 55-65.
12) Dickey NW, Karig A, Miller LG, Trubo RT. Are your patients using OTC's wisely? Patient Care 1997 (March 15): 63-72.
13) Miller LG. Selected drug-herb interactions: clinical implications. Panhandle Health 1999: In press.
3. Book
Miller LG, Murray WJ, eds., Herbal Medicinals: A Clinician's Guide, Pharmaceutical Products Press, Binghamton, NY, 1998.
4. Book Chapters (peer-reviewed)
1) Miller LG, Jankovic J. Drug-induced dyskinesia. In: Appel SH ed. Current Neurology, Volume 10. Chicago: Yearbook Medical Publishers, Inc. 1990, pp. 292-325.
2) Miller LG, Prichard JG. Current issues in NSAID therapy. In: Carter BL ed. Primary Care Clinics. Philadelphia. Saunders Publishing Co. 1990; 17:589-601.
3) Miller LG, Jankovic J. Drug-induced dyskinesias: an overview. In: Joseph AS, Young R, eds. Movement Disorders in Neurology and Neuropsychiatry Boston: Blackwell Scientific Publishers 1992:5-32.
4) Miller LG, Jankovic J. Drug-induced dyskinesias: an
- overview. In: Joseph AS, Young R, eds. Movement Disorders in Neurology and Neuropsychiatry. 2nd ed Boston: Blackwell Scientific Publishers 1999:
5) Miller LG. Issues in the use of herbal medicinals and nutritional supplements concomitantly with conventional medicines. In: Miller LG, Murray WJ, eds., Herbal Medicinals: A Clinician's Guide, Pharmaceutical Products Press, Binghamton, NY 1998: 1-15.
6) Miller LG. Diabetes and herbal products. In: Miller LG,Murray WJ, eds., Herbal Medicinals: A Clinician's Guide, Pharmaceutical Products Press, Binghamton, NY 1998: 117-136.
7) Miller LG, Kazal LA. Hypertension and herbal products. In: Miller LG, Murray WJ, eds., Herbal Medicinals: A
Clinician's Guide, Pharmaceutical Products Press, Binghamton, NY 1998: 137-164.
8) Miller LG, Murray WJ. Specific toxicologic considerations of selected herbal products. In: Miller LG, Murray WJ, eds., Herbal Medicinals: A Clinician's Guide, Pharmaceutical Products Press, Binghamton, NY, 1998:315-39.
9) Prichard JG, Miller LG, Asthma: A review of diagnostic, pharmacotherapeutic and herbal issues. . In: Miller LG, Murray WJ, eds., Herbal Medicinals: A Clinician's Guide, Pharmaceutical Products Press, Binghamton, NY, 1998: 191-232.
5. Journals
I am the founding editor of Journal of Herbal Pharmacotherapy. First issue is anticipated in late 1999.
III TEACHING INFORMATION
A. Didactic Course Work
1. Texas Tech University Health Sciences Center REOUIRED:
PHPR2302 Pharmaceutical Care II
Written documentation of medical history, medication history and physical examination September 10, 1997
PHPR2302 Pharmaceutical Care II
Oral presentation of history interviews using written documentation guidelines September 15, 1997, October 1998
PHPR2302 Pharmaceutical Care II
Patient information: drug/disease profiles: strength and weakness analysis Case: diabetes mellitus
September 16, 1997
PHPR2302 Pharmaceutical Care II
Database: behavioral, lifestyle, medical and drug therapy Case: depression
September 22, 1997
PHPR2302 Pharmaceutical Care II
Drug therapy problems: categories Cases: depression and diabetes mellitus September 24, 1997; October 1998
PHPR2302 Pharmaceutical Care II
Drug therapy problem list creation: how to September 24, 1997, October 1998
PHPR 2203 Pharmaceutical Care II Laboratory
Introduction and overview; policies, lab/general safety, professionalism, confidentiality August 18 and 19, 1997
PHPR 2203 Pharmaceutical Care II Laboratory What does the pharmacist need to know? August 20 and 21, 1997, September 1998
PHPR 2203 Pharmaceutical Care II Laboratory
Patient interview basics: medical history, medication history interview (OP) September 2 and 4, 1997; September 1998
PHPR 2203 Pharmaceutical Care II Laboratory
Generating a pharmacist's database: institutional practice process inpatient prescription admitting orders
September 29 and 30, 1997, September 1998
PHPR2302 Pharmaceutical Care II
Adverse drug events, drug interactions, failure to receive therapy October 8, 1997 -
PHPR2302 Pharmaceutical Care II Financial impact of care plans October 9, 1997, November 1998
PHPR2302 Pharmaceutical Care II Identifying drug therapy goals October 14, 1997, October 1998
PHPR2302 Pharmaceutical Care II
Narrative notes: PWDT notes, FARM notes October 21, 1997
PHPR2302 Pharmaceutical Care II Modifying pharmacist's care plans October 22, 1997, October 1998
PHPR2302 Pharmaceutical Care II Lab medicine: hepatic, renal focus November 3, 1997
PHPR2302 Pharmaceutical Care II Lab medicine: integrated case studies November 5, 1997
PHPR2302 Pharmaceutical Care II
Drug midadventures: general overview and principles November 19, 1997, October 1998
PHPR2302 Pharmaceutical Care II
Drug midsdverntures: case reports and application November 24, 1997, October 1998
PHPR2302 Pharmaceutical Care II
Medication administration basics: otics and ophthalmics: therapeutic principles December 2, 1997
PHPR 2203 Pharmaceutical Care II Laboratory Pharmacist interventions: inpatient prescription orders Case: asthma
October 15 and 16, 1997
PHPR 2203 Pharmaceutical Care II Laboratory Pharmacist interventions: inpatient prescription orders Case: diabetes
PHPR 2203 Pharmaceutical Care II Laboratory Cost-benefit analysis of therapy
October 24 and 25, 1997
PHPR 2203 Pharmaceutical Care II Laboratory
Drug therapy problem list: drug theapy assessment worksheet October 30, 1997
PHPR 2203 Pharmaceutical Care II Laboratory Discharge prescriptions: Inpatient becomes outpatient discharge counseling
November 3 and 4, 1997
PHPR 2203 Pharmaceutical Care II Laboratory Designing care plans III
multidisease, inpatient November 17 and 18, 1997
PHPR 2203 Pharmaceutical Care II Laboratory Designing care plans IV
multidisease, outpatient
November 19 and 20, 1997
PHAR 2153 Therapeutics: Blood and Reticuloendothelial Anemias: An Overview
December 3, 1997, August 1998
PHAR 2153 Therapeutics: Blood and Reticuloendothelial Iron-deficiency anemia
December 3, 1997, August 1998
PHAR 2153 Therapeutics: Blood and Reticuloendothelial Megaloblastic anemia
December 3, 1997, August 1998
PHAR 2153 Therapeutics: Blood and Reticuloendothelial Sickle cell anema
December 4, 1997, August 1998
PHAR 2153 Therapeutics: Blood and Reticuloendothelial Anemia of chronic disease
December 4, 1997, August 1998 -
PHAR 2153 Therapeutics: Blood and Reticuloendothelial Heparin
December 11, 1997, August 1998
PHAR 1501 Pharmaceutical Care I
Herbal Medicinals: Clinical Considerations for Pharmacists April 1, 1998
PHAR 1501 Pharmaceutical Care I Laboratory Herbal Medicinals: dissecting case scenarios April 6,7,8 1998
PHAR Basic Clinical Skills Clerkship
Team Leader: development of syllabus and course content Spring 1998
PHAR 1500 "Boot Camp"
Professionalism: for pharmacists and pharmacy students August 4, 1998
University of Nebraska Medical Center (UNMC)
College of Pharmacy Professional Course Instruction (Didactic):
REOUIRED:
PHPR 622 Drug Information and Literature Evaluation, Course Coordinator, 1995-1997
PHPR 622 Drug Information and Literature Evaluation, 1995-1997
Statistics lectures: How to evaluate the medical literature: cases,
1) descriptive statistics, null and alternate hypotheses
2) Type I vs Type II errors, data types, dissecting a study
3) Chi square, Fishers Exact, Wilcoxon, t tests
4) ANOVA, correlations (Pearson, Spearman), coefficient of determination
PHPR 622 Drug Information and Literature Evaluation, 1995-1997
Drug information computer software for the public: a vehicle for pharmacist-delivered patient education, February 1995, February 1, 1996, January 30, 1997.
PHPR 622 Drug Information and Literature Evaluation, 1996-1997 Biomedical publication process, January 16, 1996, January 23, 1997.
PHPR 622 Drug Information and Literature Evaluation, 1996-1997
Establishing, developing and maintaining a drug information center: pharmaceutical care centers of the future, January 30,1996, January 28, 1997.
PHPR 622 Drug Information and Literature Evaluation, 1996-1997
Drug and health information for the professional: computerized databases, February 1, 1996
PHPR 622 Drug Information and Literature Evaluation, 1996-1997 Adverse drug events: monitoring and reporting, February 8, 1996
PHPR 622 Drug Information and Literature Evaluation, 1996-1997 Alternative sources of drug information, February 15, 1996
PHPR 622 Drug Information and Literature Evaluation, 1996-1997 Ethical and legal issues in drug information, February 20, 1996
PHPR 688 and 688 Applied Therapeutics I and II, 1993-1997,
"Attention Deficit Hyperactivity Disorder (ADHD): Diagnosis and Treatment", Applied Therapeutics Course, College of Pharmacy, UNMC, Omaha, NE, February 24, 1994, October 11, 1994, October 1995, October 10, 1996.
PHPR 686 and 688, Applied Therapeutics I and II, 1993-1997,
Case facilitator for Applied Therapeutics class, College of Pharmacy, UNMC, 1993 to present.
PHPR 560 Pharmacy and Health Care
"Nebraska Drug Information Network: Health Information Software in the Pharmacy", P-1 class, College of Pharmacy, UNMC, April 19, 1994.
PHPR 560 Pharmacy and Health Care
Research proposal mentor: instruction in research design and antidepressants, antipsychotics, benzodiazepines, extrapyramidal side effects and MMPI data for three PharmD candidates (Susie Wilke, Kim Gergen, Amy Nekuda), 1995.
PHPR 560 Pharmacy and Health Care
Research proposal mentor: Tobacco product sales in community pharmacies, Craig Hipsher, 1996.
PHPR 670 Nonprescription Products, 1995-1997
"Otic Preparations", College of Pharmacy, UNMC, Omaha, NE, October 12, 1995, November 19, 1996.
PHPR 670 Nonprescription Products, 1995-1997
"Ophthalmic Preparations", College of Pharmacy, UNMC, Omaha, NE, October 17, 1995, November 21, 1996. -
PHPR 658 Professional Practice II Insulin injection practicum, March 1996
ELECTIVES:
PHPR 651 Topics in Pharmacy Practice, 1995-1997
Pharmacy specialization and certification, January 1995, January 29, 1996, January 31, 1997,
PHSC 679 Developing a Personal Wellness Program, 1996-1997 Chronopharmacology: An Introduction, April 3, 1996
PHSC 657, Herbal medications: interface with allopathic medicine, Course developer and co-coordinator with Wallace Murray, PhD
PHSC 657 Herbal medicactions: Definitions, homeopathy vs. herbals, safety and efficacy issues, indication pluralism, January 1997
PHSC 657 Herbal medications: interface with allopathic medicine
OB/GYN concerns; herbs to avoid during pregnancy, herbs for nausea, January 1997
PHSC 657 Herbal medications: interface with allopathic medicine Diabetes, February 1997
PHSC 657 Herbal medications: interface with allopathic medicine Hypertension, February 1997
PHSC 657 Herbal medications: interface with allopathic medicine Asthma, March 1997
College of Pharmacy Professional Course Instruction (Clerkship):
PHPR 782, Rural Pharmacy Clerkship, August 1994-May 1997.
Rural clerkships two-day computer laboratory, focus on patient education and professional databases, review of 25 patient education programs plus technical databases to include Micromedex databases, Medline, Electronic Drug Reference, StatRef, Clinical Reference Library, Clinical Pharmacology as well as an introduction to the Internet. Also includes instruction in computer applications in blood pressure and blood glucose monitoring. Use of computer skills to support deliver of pharmaceutical care is discussed. Intervention documentation and available software (e.g., CliniTrendTM, Qj\J TM) to assist in this process were presented.
PHPR 784, Rural Community Pharmacy Clinical Clerkship, August 1994-May 1997.
Rural clerkships two-day computer laboratory, focus on patient education and professional databases, review of 25 patient education programs plus technical databases to include Micromedex databases, Medline, Electronic Drug Reference, StatRef, Clinical Reference Library, Clinical Pharmacology as well as an introduction to the Internet. Also includes instruction in computer applications in blood pressure and blood glucose monitoring. Use of computer skills to support deliver of pharmaceutical care is discussed. Intervention documentation and available software (e.g., CliniTrendTM, QARxTM) to assist in this process were presented.
PHPR 701, Drug Information Clerkships, 1996-1997
A continuation of PHPR 622 providing experiential training in the Drug Information Center at the University Hospital including the development of skills in providing drug information and other drug information services. Course materials were developed to assure students obtained standardized experience with various drug and medical information sources and skills. Pharmacy and Therapeutics Committee Formulary Review and an article for the Nebraska Mortar and Pestle were required elements of the rotation.
College of Pharmacy Continuing Education Instruction:
"Use of the Nebraska Drug Information Network", lecture to pharmaceutical care preceptors, College of Pharmacy, UNMC, February 17, 1994.
"Demonstration of the Nebraska Drug Information Network: Overview with Classroom Applications", UNMC COP Faculty Seminar August 30, 1994.
"Using computer technology to support pharmaceutical care initiatives", discussed computerized blood sugar and blood pressure monitoring, patient education software, health care professional databases, documentation and reimbursement issues, UNMC COP Preceptor Education Initiative, April 2 and 9, 1996.
Other UNMC Instruction:
"Nebraska Drug Information Network" to RHEN/RHOP pre-medical students, UNMC, Omaha, NE, January 6, 1994.
"An overview of the Nebraska Drug Information Network: implications for nurse practitioners", Pharmacology Course for Nurse Practitioners, UNMC, Omaha, NE (distance learning: NEB-SAT telecourse to Lincoln, Kearney and Scottsbluff, NE) January 28, 1994.
"Nebraska Drug Information Network as a resource for your community", Lied Leadership Development fellows (Knox County), D.O.E.R Program (Development, opportunity, enrichment, revitalization), UNMC, Omaha, NE, April 13, 1994 and Nebraska LEAD Program, Nebraska Agricultural Leadership Council, Inc. "World Affairs, Agribusiness, Advances in Health Care" Seminar, February 17, 1996.
"Demonstration of the Nebraska Drug Information Network", UNMC RHOP pre-pharmacy students, September 12, 1994, September 23, 1996.
"Multimedia health information for patient education", Patient Education Subcommittee for the Lied Transplant Center, University of Nebraska Hospital, June 20, 1995, June 27, 1995.
"Nebraska Drug Information Network: Scope of practice and cost implications", RHEN/RHOP allied health students, UNMC, Omaha, NE, September 18, 1995.
"Nebraska Drug Information Network: Supporting the Delivery of Pharmaceutical Care in Rural Nebraska", University of Nebraska Board of Regents, Chancellor, Vice-chancellor of Academic Affairs and President-University of Nebraska System, University of Nebraska Medical Center Omaha, NE, May 29, 1996.
"Nebraska Drug Information Network: Implications for Rural Nebraska", Board of Directors, Nebraska Farm Bureau, Omaha, NE, June 23, 1996.
"Providing state of the art health information to citizens in rural communities", South Platte United Chamber of Commerce, Omaha, NE, November 14, 1996.
"Rural pharmaceutical care: role of the Nebraska Drug Information Network", Rural Pharmacy
Student Association, University of Nebraska Medical Center, Omaha, NE, November 18, 1996.
"Pharmaceucial care: UNMC College of Pharmacy initiatives having national impact", University of Nebraska Medical Center Board of Counselors, Omaha, NE, January 30, 1997.
3. Baylor College of Medicine
"Treatment of Drug-Induced Tardive Dyskinesia," Department of Family Medicine, Baylor College of Medicine, Houston, TX, January 20, 1987.
"Generic Medications--Are They All Cost-Effective? Therapeutic Inadequacies" Department of Family Medicine, Baylor College of Medicine, Houston, TX, June 19, 1987, July 5, 1989, July 3, 1990, July 2, 1991, July 9, 1992.
"NSAIDS:Pharmacologic and Patient Considerations in Selecting Therapy", Department of Famiy Medicine, Baylor College of Medicine, Houston, TX, July 27, 1987, May 3, 1988, July 12, 1988, May 24, 1990, November 21, 1991.
"Smoking and Drug Therapy", Introduction to Clinical Specialties Course, Baylor College of Medicine, Houston, TX, September 11, 1987.
"Metoclopramide Uses and Adverse Effect Profile: Focus on Movement Disorders". Department of Family Medicine, Baylor College of Medicine, Houston, TX, March 31, 1988.
"Introduction to a Drug Information Source: Drugdex". Department of Family Medicine, Baylor College of Medicine, Houston, TX, January 9, 1989, July 5, 1989, July 3, 1990, July 2, 1991, July 9, 1992.
"Investigational Drug Research: Current Studies and Philosophy". Lucinda Miller, PharmD and Barry Carter, PharmD, Department of Family Medicine, Baylor College of Medicine, Houston, TX, January 12, 1989.
"Effect of Smoking on Clinical Pharmacokinetics and Pharmacodynamics", Predoctoral Family Medicine Clerkship, Department of Family Medicine, Baylor College of Medicine, Houston, TX, February 9, 1989; February 13, 1990, March 27, 1990, May 22, 1990, July 31, 1990, September 18, 1990.
"Ciprofloxacin" Uses and Misuses" with Susan Miller MD, Predoctoral Family Medicine Clerkship, Baylor College of Medicine, Houston, TX, July 25, 1989.
Journal Club, Predoctoral Family Medicine Clerkship, Baylor College of Medicine, Houston, TX, September 12, 1989.
"Pharmacologic Issues in the Management of Obesity". Department of Family Medicine. Baylor College of Medicine, Houston, TX, January 24, 1990.
"Selecting NSAIDS", Predoctoral Family Medicine Clerkship, Department of Family Medicine, Baylor College of Medicine, Houston, TX, October 30, 1990, January 15, 1991, April 9, 1991, November 19, 1991, February 4, 1992.
"Parkinson's Disease". Department of Family Medicine, Baylor College of Medicine, Houston, TX, November 27, 1990.
"Drug Use in the HIV Population: drug-drug interactions and adverse effects", Department of Family Medicine, Baylor College of Medicine, Houston, TX, March 20, 1991.
"Pharmaceutical detailing: implications in a family medicine residency program", Department of Family Medicine, Baylor College of Medicine, Houston, TX, ethics conference, Warren Holleman, Ph.D., Lucinda Miller, PharmD, Larry McCullough, PhD, January 29, 1992. February 26, 1992.
"Attention deficit hyperactivity disorder (ADHD): diagnosis and treatment considerations for the family physician", Department of Family Medicine, Baylor College of Medicine, Houston, TX, May 14, 1992.
4. Other Institutions
"Code Blue Medications," Intensive Care Nursing Inservice, Park Plaza Hospital, Houston, TX, October 8, 1981.
"Clinical Aspects of Asthma," lecture to undergraduate pharmacy students, University of Houston, Houston, TX, November 1983, February 1984, October 1984, March 1985, February 1986.
"Clinical Aspects of Emphysema," lecture to undergraduate pharmacy students, University of Houston, Houston, TX, November 1983, February 1984, October 1984, March 1985, February 1986.
"Drug Information," three credit-hour course to undergraduate pharmacy students, University of Houston, Houston, TX, Fall Semester 1983.
"COPD: An In-Depth Look at Asthma," Disease and Advanced Therapeutics class, lecture to graduate students, University of Houston, Houston, TX, September 1984 and November 1986. "COPD: An In-Depth Look at Emphysema and Chronic Bronchitis," Disease and Advanced Therapeutics class, lecture to graduate students, University of Houston, Houston, TX, September 1984 and November 1986.
"Use of the Drug Information Center." Pharmacy Education Conference. The Methodist Hospital, Houston, TX, June 6, 1985.
"Use of Emergency Box Medications," six inservices to Peripheral Vascular Lab nurses, The Methodist Hospital, Houston, TX, June-October 1985.
"Drug Utilization Reviews: Why and How," Lucinda Miller and Christene Jolowsky, Pharmacy Education Conference, The Methodist Hospital, Houston, TX, February 4, 1986.
"Monitoring of Tricyclic Antidepressants," Lucinda Miller, Pharmacy Education Conference, The Methodist Hospital, Houston, TX, February 18, 1986 and March 3, 1987.
"The Pharmacist in the Drug Information Center," explanation of career opportunities to pre-pharmacy class, University of Houston, Houston, TX, February 28, 1986.
"Recently Approved Medications: An Overview," Special Chemistry Laboratory, The Methodist Hospital, Houston, TX, May 21, 1986.
"New Drugs and Indications," Lucinda Miller, Pharmacy Education Conference, The Methodist Hospital, Houston, TX, July 15, 1986.
"Midazolam: A comparison with Lorazepam and Diazepam," Fondren Radiologists, The Methodist Hospital, Houston, TX, October 3, 1986.
"Aseptic Technique in the Preparation of Intravenous Fluids," Nursing Orientation, The Methodist Hospital, Houston, TX, March 14 and 25, 1987.
"Drug Information Practice," lecture to undergraduate pharmacy students, University of Houston, Houston, TX, March 24, 1987.
"Integration of Pharmacokinetic and Pharmacodynamic Issues in the Clinical Setting." Clinical Pharmacokinetics course, College of Pharmacy, University of Houston, Houston, TX, November 20, 1990.
"Pharmacokinetic Considerations in Assessing Drug-Drug Interactions" University of Houston College of Pharmacy, Pharmaceutics Course, November 18, 1991.
"Smoking and Drug Therapy: Pharmacokinetic and Pharmacodynamic Considerations," University of Houston College of Pharmacy, Pharmaceutics Course, November 18, 1991.
B. Non-didactic Teaching
1. Family Medicine Resident Physician Training
Inpatient: rounding activities at St. Lukes Episcopal Hospital, Houston, TX, 1987 to 1993.
Outpatient: Daily drug therapy consultations
at the Baylor Family Medicine Clinic, Houston, TX, 1987 to 1993.
2. Family Medicine Resident Physician Training
Inpatient: rounding activites at Baptist St. Anthony Hospital, Amarillo, TX, 1997 to present
3. Graduate student training:
a. Bhaskara Vytla, M.S. thesis committee member. Sucralfate and erythromycin ethylsuccinate:
formulation and pharmacokinetic evaluation,
Department of Pharmaceutics, College ofPharmacy, University of Houston, Houston, TX 1990.
b. Sanchali Basa, Ph.D, thesis committee member: In vitro/in vivo pharmacodynamic correlations with antibiotics, Department of Pharmaceutics, College of Pharmacy, University of Houston, Houston, TX, 1991-3.
3. Hospital pharmacy resident training
a. Sherry Moonen, M.S., ambulatory pharmaceutical care rotation, St. Luke's Episcopal Hospital, Houston, TX, June-July, 1992.
b. Judy Ikwuagwu, PharmD, ambulatory pharmaceutical care rotation, St. Luke's Episcopal Hospital, Houston, TX, July-August, 1992.
c. Andrew Edokpa, PharmD, ambulatory pharmaceutical care rotation, St. Luke's Episcopal Hospital, Houston, TX, November 1992.
d. Shay Reichert, BS, ambulatory pharmaceutical care rotation, St. Luke's Episcopal Hospital,
Houston, TX, March-April, 1993.
4. Pharmacy student practicum
Judge, SAPhA pharmacy student patient counseling contest, University of Houston, College of Pharmacy, Houston, TX 1982.
b. Judge, APhA-ASP pharmacy student patient counseling contest, University of Nebraska Medical Center, College of Pharmacy, Omaha, NE, 1994-95, 1996.
C. Visiting Professorships
Visiting professor, Department of Internal
Medicine, Ventura County Medical Center, UCLA affiliate, Ventura, CA, August 11-12, 1988.
D. Actigraphy Consultant and Member of Research Committee for the Hermann Chronobiology and Chronotherapeutics Center, 6410 Fannin, Suite 833,
Houston, TX 77030-3003, 1991-1993.
E. Clinical Services
In addition to the Family Medicine inpatient and outpatient activities, I also provided clinical rounding and pharmacotherapy consultations in the following capacities:
1. Movement disorder inpatient service, with Dr. Joseph Jankovic, MD, Department of Neurology, Baylor College of Medicine, The Methodist Hospital, Houston, TX, 1986-1993.
2. Child, adolescent and adult psychiatry outpatient service, with Dr. Irvin Kraft, MD, Department of Psychiatry, University of Texas Health Sciences Center and private practice, Houston, TX, 198993.
IV. MEDICAL: SERVICE INFORMATION
Texas Tech University Health Sciences Center, Amarillo, TX (1997-present) Member, Primary Care Symposium, School of Medicine
Member, Search Committee for Clerkship Coordinator, School of Pharmacy Chair, Internal Seed Grant Review, School of Pharmacy
Chair, Search Committee for Medicine Faculty positions; Lubbock and Amarillo, School of Pharmacy (7 positions)
Member, Faculty Development Committee, School of Pharmacy
Chair, Primary Care Residency Development and Recruitment Committee,
School of Pharmacy (through 3/98 when residency coordinator was appointed)
Chair, Basic Clinical Skills Clerkship: Inpatient and Outpatient Courses: Development Committee, School of Pharmacy
Member, Assessment Committee, School of Pharmacy
University of Nebraska Medical Center , Omaha, NE- Committees (1993-1997) Member, Applied Medical Informatics Committee, UNMC committee 1995-97
Member, Curriculum Committee, College of Pharmacy, 1994-1996 Member, Computer Committee, College of Pharmacy, 1994-95, 1996-1997 Member, Continuing Education Committee, College of Pharmacy 1995-96 Advisor, Kappa Epsilon Omaha-UNMC Chapter, College of Pharmacy,
1994-97
Chairman, Search Committee for Family Medicine/Ambulatory Care, faculty position, College of Pharmacy, 1994
Member, Quality Improvement Committee for Applied Therapeutics Course, College of Pharmacy, 1993-4
Member, Adhoc Department of Pharmacy Practice Committee on Curriculum Reform, 1996
Chairman, Computer Committee, College of Pharmacy, 1996-97 Member, Student Discipline Committee, College of Pharmacy, 1995-97 Member, Patient Education Subcommittee, Lied Transplant Center, University
Hospital, 1996-1997
Members, IntraNet Committee, University of Nebraska Medical Center 19961997
Baylor College of Medicine, Houston, TX (1987-1993) Family Medicine Research Committee
Family Medicine Medical Records Task Force
Family Medicine Patient Education Committee (1987-88) Family Medicine Quality Assurance Committee Family Medicine Computer Committee
Family Medicine Curriculum/Residency Committee Baylor Information Technology Committee
Baylor Substance Abuse Committee
Methodist Hospital, Houston, TX (1985-87)
Pharmacy and Therapeutics Committee (Ex-Officio)
Drug Utilization Review Subcommittee of th P&T Committee Investigational Drug Service Subcommittee of th P&T Committee Drug-Nutrient Interaction Committee
Clinical Pharmacy Committee
JCAH Task Force
National Committees
Practice Interest Advisory Panel, American Society of Hospital Pharmacists, 1989-90; member
Board Certification Affairs Committee, American College of Clinical Pharmacy, 1996, 1997; member
National Library of Medicine, Regional Advisory Council, 1994-96,1996-2001; member
Computer Technologies Committee, American Association of Colleges of Pharmacy Council of Faculties, 1996-97; member
Alternative and Complementary Therapies Subeommitte of the Ambulatory Care PRN, American College of Clinical Pharmacy 1998; Chair
V. ADMINISTRATIVE ACTIVITIES
Vice-Chair, Department of Pharmacy Practice, Texas Tech University Health Sciences Center: duties include to assist in the development, deliver and evaluation of course offerings within the didactic and experiental education programs. The Vice-Chair carries the teaching, practice, scholarship and service responsibilites common to all tenure trace practice faculty in addition to providing targeted administrative support in developing and supporting the academic programs within primary care pharmacy initiatives. The Vice-Chair ensures consistency in instruction of core competencies across all instructional set_ings an assls: is culi:cuiuli: cksl1 and iniplenlentatica Iii: all T T UHSC School of Pharmacy campuses. The Vice-Chair serves on the departmental strategic planning team and also provides individual feedback and guidance to practitioners/educators in their personal development as contemporary pharmacy practice instrucors and practitioners. (1997-present)
Interim Associate Dean -for Clinical Research, School of Pharmacy, Texas Tech University Heatlh Sciences Center: duties include development of Internal Seed Grant Program: assembled a review committee to develop criteria, critique and disperse awards. Also disseminated grant announements for faculty and students. Assisted same in development of grants acting as school liasion. Additionally, monitor for research news and disperse as appropriate. (1997-present)
Director, Nebraska Drug Information Network: direct daily operations, site design and implementation, site visits, ongoing review and selection of hardware and software, supervision of computer analyst, budget management, and grant development, procurement and administration (primarily pharmacoepidemiology and telecommunications). 1993-1997
VI. COMMUNITY PRESENTATIONS
A. Lectures and presentations
"Teratogenesis and Breast Feeding," Florence Crittenton Services (School for Unwed Mothers), Houston, TX, November 17, 1982; April 20, 1983; November 22, 1983.
"Drug Interactions Can Affect You, "Women's Tuesday Club, Jewish Community Center, Houston, TX, January 11, 1983.
"Substance Misuse: The Current Flow ofFraffic," St. Andrews United Methodist Church Youth Group, Houston, TX, March 16, 1983.
"Drug Abuse: Current Trends," Northwest Chateau Civic Club, Houston, TX, September 6, 1983.
"The Many Faces of Drug Interactions," Women's Forum, Houston, TX, February 2, 1984.
"Drug Interactions in the Elderly," Continuing Education Class, Jewish Community Center, Houston, TX, March 15 and 22, 1984.
"Nebraska Drug Information Network: present and future" presentation to the Rural Health Education Network (RHEN) Steering Committee, Grand Island, NE, March 11, 1994.
B. Other Community Activities
"Christmas Plants-Poisonous," Local News, KTRH Radio, Houston, TX, December 6, 1982,
"Dangerous Christmas Plants," Local News, KUHF Radio, Houston, TX, December 8, 1982.
"Poisonous Christmas Plants," Local News, KQUE Radio, Houston, TX, December 16, 1982.
"How to Get the Most from your Pharmacist," by Tom Overton, Houston Post, quotes concerning
available pharmacy services, January 14, 1983.
"We Take Aspirin by the Ton, Now Read About the Train Car Syndrome," cover story by Eric Miller,
interviewed concerning aspirin drug interactions, Texas Health Newsletter, 1983;3:15.
"Pregnancy, drugs just don't mix," by Eric Miller, interviewed regarding teratogenicity, TMC News, 1983;5:6,15.
"Turner Drug Information Center: Services Offered," booth activities at the Texas Medical Center's Sportathon V, Houston, TX, April 1983.
"A New Perspective on Aspirin," interviewed
concerning adverse effects, drug interactions and
new dosage forms of aspirin, Local News, KPRC-TV, Houston, TX May 1983 and Atlanta, GA, December 8, 1983.
"Autry's Execution Raises Questions About TDC's Method" by Frank Michel and John Makeig, quoted regarding lethal injections, Houston, Chronicle, Section 1, p. 24, March 16, 1984.
"Lethal Injection in Texas," interviewed regarding drugs used in lethal injections, Local News, KRIV-TV, Houston, TX, March 30, 1984.
"Turner Drug Information Center: Services Offered, "booth activities at the Annual Spring Fair, University of Houston, April 12, 1984.
"Med Check," KUHF Radio, Houston, TX, daily two -minute briefs on drugs and drug-related topics, March 1984 to March 1985.
"Drug Info a Call Away," by Bonnie McVaney, interviewed regarding TDIC Services, The Daily Cougar (university newspaper), July 11, 1984, p. 10.
"Aspirin Warning: Don't Forget It's a Real Drug That Can Produce Real Side Effects," by Patricia McMarrow, quoted regarding the use of aspirin
The Brazosport Facts (newspaper), Brazosport, TX, August 12, 1984, Section C, p. 1.
"Diuretic, Not Tranquilizer, Tops Most--Prescribed
List," by editorial staff, quoted regarding
prescription statistics, Texas Health Newsletter, 1984;4:7.
Public Service Announcement: "University of Houston: Excellence," one of five people in a promotional video for the University, Fall 1984.
SAPHA Patient Counseling Contest--UH Finals, Faculty Official, November 1984.
Asthma Self-Help Group, Clear Lake City, TX, with Shirley McKee, November 1984.
"Topical Use of Minoxidil for Hair Growth," Local News, KHOU-TV, CBS affiliate, March 16, 1987.
"Medical Studies Aside, Doctors Still Bank on Value of Plain Aspirin," by DJ Wilson, interviewed regarding aspirin therapy, Houston Post, Section A, p. 1,7, August 28, 1989. "Aspects of Generic Drug Use," interviewed for Baylor College of Medicine Radio Talk Show, Mark Seegers, September 1989.
"Once-a-day aspirin for heart attacks: it is for everyone?" Interviewed for Baylor College of
Medicine Radio Talk Show, Mark Seegers, August 1991.
"What you should have in your medicine cabinet." Interviewed regarding perils of expired drugs, Health Newsletter, September 1991.
"Use of aspirin: is it the new panacea?" quoted regarding varied indications and side effects of aspirin, for first issue of Debakey Health Nexwsletter, October 1992.
"Summer and medications", by Rick Smith, quoted regarding drug-induced photosensitivity and hyperthermia, Inside Information, April 1993.
"Physician Awareness of Prescription Drug Costs" quoted regarding lack of awareness of drug prices, Medical Benefits. 1993;10:2-3.
"Dots Flunk Cost Quiz" by Holt G, Solimini C, quoted regarding drug cost study. Family Circle, September 21, 1993; 149.
"Prescription Drug Costs: Implications for physicians" abstracted in Lasagna, L, ed. , Yearbook of Drug Therapy, Chicago: Mosby Year Book, Inc., 1994.
"Wayne Pharmacy First in Program", quoted regarding implementation of first site for the Nebraska Drug Information Network, Wayne Herald, October 5, 1993
"Wayne Pharmacy Chosen as Rural Information Center", quoted regarding implementation of first site for the Nebraska Drug Information Network, UNMC News, October 8, 1993
"Tom's Rexall included in Med Center Network", provided information regarding the implementation of the second site of the Nebraska Drug Information Network, West Point News, October 20, 1993
"Nebraska Drug Information Network" entire 15 minutes of programming devoted to the Network; described the role of the Network in serving rural Nebraskans and educating Pharm.D. students at these sites, UNMC Radio News, "The Clinic", December 12, 1993.
"New Health/Drug Information Centers", interviewed as Director regarding the Network highlighting background, service and educational uses as it applies to rural Nebraska;KESW Radio, Kearney November 15, 1993
"Focus on the Nebraska Drug Information Network", featured the Network with taping in Omaha and West Point, LifeQuest (Channel 3), NBC affiliate, aired on February 12, 1994, June 18, 1994, and October 22, 1994,
"Gordon Pharmacy Seelcted as Site for UN Medical Center Information Center, quoted regarding role of the Nebraska Drug Information Network in Gordon, Sheridan County Star, Rushville, NE, December 1, 1993.
"Local pharmacies are rural health sites", quoted regarding plans for future sites for the Nebraska Drug Information Network (related story to above entry) Sheridan County Starr, Rushville, NE, December 1, 1993
"Crawford Pharmacy selected as Information Center for UNMC", quoted regarding role of Nebraska Drug Information Network in Crawford, The Ledger, Hemingford, NE, December 9, 1993.
"Local pharmacies are rural health sites", quoted regarding Nebraska Drug Information Network role in western Nebraska, Record, Chardon, NE, November 30, 1993.
"Gordon pharmacy selected as Rural Health Information Center", quoted regarding the implementation of the Nebraska Drug Information Network in Gordon, Journal, Gordon, NE, December 1, 1993.
"Warren Pharmacy Selected As UNMC Information Center", quoted regarding the implementation of the Network at Warren's Pharmacy, Crawford Clipper, Crawford, NE, December 2, 1993.
"Gaston Pharmacy named site for UNMC Rural Health Info Center", quoted regarding the implementation of the Nebraska Drug Information Network in Sidney, Telegraph, Sidney, NE, November 30, 1993.
"Rural health info, centers selected", quoted regarding the role of the Nebraska Drug Information Network in rural Nebraska, News, Ravenna, NE, November 17, 1993
"NU computer links library to pharmacies; customers get health answers", quoted regarding the implementation of sites of the Nebraska Drug Information Network in western Nebraska, Star-Herald, Scottsbluff,_ NE, December 23, 1993.
"Nebraska Drug Information Network", radio interview with Dave Schroeder, KRVN, Lexington, NE, March 15, 1994.
"Network will unite pharmacies, UNMC", quoted regarding implementation of Network sites in McCook and Indianola, McCook Daily Gazette, McCook, NE , March 7, 1994.
"Gothenburg pharmacy enters computer age", quoted regarding Network site implementation at Gothenburg Discount Drug, Telegraph, North Platte, NE, March 9, 1994.
"Ferrell's is chosen", quoted regarding selection of McCook Network site, Hi-Line Enterprise, Curtis, NE, March 10, 1994.
"Nebraska R.Ph.s go on-line for rural patient care" disc ussion on the Nebraska Drug Information Network, Drug Topics, June 13, 1994.
"Grant award enables pharmacy students to spend time learning instead of driving", quoted regarding receipt of GAPS grant enabling the development of two computer laboratories for pharmacy students, RI/EN Focus 1994;2:8.
"Valentine pharmacy selected as UNMC rural health information center", quoted regarding Nebraska Drug Information Network, Journal, Gordon, NE, August 10, 1994.
"Link Pharmacy selected as UNMC rural health information center", quoted selection of Ainsworth site for Network, Star-Journal, Ainsworth, NE, August 10, 1994.
"Ainsworth and Valentine pharmacies selected as UNMC rural health information center", quoted regarding rural health issues and the Nebraska Drug Information Network, Herald, Springview, NE, August 11, 1994.
"Clinic Pharmacy is rural health information center", Universal Newspaper, quoted regarding Network site implementation, Valentine, NE, August 10, 1994.
"The new infobahn: navigating the information superhighway is pharmacy's future", placement of story regarding the Nebraska Drug Information Network, Drug Topics, August 22, 1994; p56-61.
"UNMC's Nebraska Drug Information Network", interviewed for Dr. Ed Dominquez's health report, Channel 7, Omaha, NE, local ABC affiliate, August 30th, 1994.
"Study Partners", outline of NARD Foundation support of documentation study conducted by pharmacists of the Nebraska Drug Information Network, NARD Journal, 1994; 116: 140-141.
"Right Drug gets new intern and computer", Nebraska Drug Information Network site installation and UNMC pharmacy student involvement at Callaway site. Callaway Courier, Callaway, NE, November 3, 1994.
"Burwell Pharmacy selected as UNMC rural health infomration center", quoted regarding new installation for Network, Tribune, Burwell, NE November 16, 1994.
"Areas pharmacies are part of Network" , quoted regarding installation of Broken Bow sites, Enterprise, Stapleton, NE, November 10, 1994.
"Burwell Pharmacy joins statewide info network", quoted regarding Burwell addition to Network, Ord Newspaper, Ord, NE, November 10, 1994.
"Pharmacy joins Nebraska Network", quoted regarding installation of Callaway site, Telegraph, North Platte, NE, November 26, 1994.
"Wanek Drug selected as health information center. quoted regarding installation of Neligh site, News and Leader, Neligh, NE, November 16, 1994.
"Wanek Drug selected as health information center." quoted regarding installation of Neligh site, Record News, Clearwater, NE, November 16, 1994.
"Mullen clinic connected to infomration network", quoted regarding Network site implemented at Family Medicine Clinic, Telegraph, North Platte, NE, December 7, 1994.
"Drug Info Network Serves Rural Areas", quoted regarding Network implementation, Pulse Metric Currents, 1994:2:4.
"Mullen clinic is part of health information Network", quoted regarding implementation of Network site at Family Medicine clinic, Enterprise, Stapleton, NE, December 8, 1994.
"Sandhills Family Medicine Clinic selected as University of Nebraska Medical Center Rural Health Information Center, quoted regarding College of Pharmacy Network project, Hooker County Tribune, Mullen, NE, December 8, 1994.
"Mullen Clinic is part of health information network", quoted regarding Network site implementation, Graphic, Tyron, NE, December 8, 1994.
"Mullen Clinic is part of health information network", quoted regarding Network site implementation, Thomas County Herald, Thedford, NE, December 22, 1994.
"Lexington's Barmore Pharmacy and the Nebraska Drug Information Network", interviewed by Dave Schroeder for KRVN Radio, February 28, 1995.
"Lexington Pharmacy selected as UNMC rural health information center, quoted regarding Network site implementation, Herald, Bertrand, NE, March 2, 1995.
"Pharmacists go on-line", quoted regarding implementation of Edgington site, Kearney Hub, Kearney, NE June 17, 1995.
"An informational drive: Gothenburg seeks Internet port", Gothenburg's involvement in UNMC Drug Information Network cited, Times, Gothenburg, NE, May 24, 1995.
"Rural Health Information Centers established across Nebraska", Impact (UNMC publication), pages 28-29, Spring 1995.
"Business Beat", Nebraska Drug Information Network site in York, News- Times, York, NE, page 6, August 15, 1995.
"UNMC computer link helps health care in rural areas", Lincoln Journal Star, by Larry Pierce, quoted regarding Nebraska Drug Information Network and intervention study, page 2B, September 4, 1995. Also reprinted in Nebraska Assocation of Hospitals and Health Systems Newsletter, September 1995.
"UNMC rural outreach through Nebraska Drug Information Network", interviewed regarding how Network is serving rural communities, featured Crete site, KOLN/KGIN TV, local CBS affiliate, aired September 5, 1995 and September 6, 1995 (during local news segment of CBS This Morning).
"Technology takes metro-sytle care to rural Nebraska, quoted regarding Nebraska Drug Information Network and NARD study finding of $750,000 saved through pharmacist interventions, Scottsbluff Star-Herald, September 7, 1995.
"Technology takes metro-style care to rural Nebraska, quoted regarding Nebraska Drug Information Network and NARD study finding of $750,000 saved through pharmacist interventions, Star-Herald, Scottsbluff, September 7, 1995.
"Computer used in rural medicine", quoted regarding Nebraska Drug Information Network and NARD study finding of $750,000 saved through pharmacist interventions, Sun, Beatrice, NE, September 6, 1995.
"Retaining rural doctors easier with computer net", quoted regarding Nebraska Drug Information Network and NARD study finding of $750,000 saved through pharmacist interventions, Telegram, Columbus, NE, September 5, 1995.
"Rural medicine gets lift", quoted regarding Nebraska Drug Information Network and NARD study finding of $750,000 saved through pharmacist interventions, Hub, Kearney, NE September 4, 1995.
"Keeping rural doctors made easier with computer net", quoted regarding Nebraska Drug Information Network and NARD study finding of $750,000 saved through pharmacist interventions, News-Press, Nebraska City, NE, September 5, 1995.
"Computer net helps rural doctors", quoted regarding Nebraska Drug Information Network and NARD study finding of $750,000 saved through pharmacist interventions, Tribune, Hastings, NE, September 5, 1995.
"Technology helps communities end isolation, keep physicians", quoted regarding Nebraska Drug Information Network and NARD study finding of $750,000 saved through pharmacist interventions, Gazette, McCook, NE, September 5, 1995.
"Computer net helps retain rural doctors", quoted regarding Nebraska Drug Information Network and NARD study finding of $750,000 saved through pharmacist interventions, Star-Herald, Scottsbluff, NE, September 5, 1995.
"Cover Story: Hypertension: frontline practices in blood pressure management", quoted regarding NDIN use of DynaPulse in blood pressure monitoring in rural community practice, Drug Topics, p 68-72, September 18, 1995.
"Nebraska Drug Information Network and pharmaceutical care", Community Health Line, live radio program (half hour) hosted by Dr. Bill Gust and Tom O'Connor, KIOS-FM (local NPR affiliate), Omaha, NE, October 4, 1995.
"Valley Pharmacy selected as UNMC rural health information center", quoted regarding Nebraska Drug Information Network installation at Valley, Douglas County Post-Gazette, p 16, September 19, 1995.
"Computer net connects rural hospitals", quoted regarding function of Nebraska Drug Information Network and the pharmaceutical care documentation study. Press & Dakotan, Yankton, SD, October 5, 1995.
"Nebraska Drug Information Network and pharmaceutical care", interviewed regarding how Network is supporting pharmaceutical care to rural Nebraskans, live interview with Trina Creighton, KMTV, local CBS affiliate, Noon Day Show, November 6, 1995.
"Mail-order drugs: really the best deal", by Sue Wallace quoted regarding mail order pharmacy service. Health: November/December 1995, p. 120.
"Myers Drug in rural health network, quoted regarding implementation of Network site in Chadron, Sheridan Co. Star, Rushville, NE, December 13, 1995 and Record, Chadron, NE, December 12, 1995.
"Mail-Order Drugs: Really the Best Deal?" by Sue Wallace, quoted regarding value of personalized pharmaceutical care. Health 1995: November-December: 120.
"Continuity is important in dealing with pharmacy" by Sue Wallace, quoted regarding value of personalized pharmaceutical care. Dallas Morning News, Dallas, TX, February 26, 1996
"Information network hits goal of 30 sites", Impact: UNMC, 1996:11: 18.
"Pharmacy is part of UNMC Rural Health Info Center", quoted regarding implementation of Valley as Network site plus rural health issues. Douglas County Post-Gazette, Elkorn, NE, Februray 27, 1996.
"Nebrasaka Drug Information Network: Delivering Pharmaceutical Care to Rural Communities", The Clinic, UNMC Radio Health News program, KGOR-FM (Omaha) + 15 other radio stations in Nebraska and Iowa, May 12, 1996.
"Students take innovative approaches to pharmaceutical care", quoted regarding pharmacy student use of DynaPulseTM in monitoring patients' blood pressures during clerkships at the Nebraska Drug Information Network" Pharmacy Student 1996;26:9-13.
"Nebraska program links students, rural pharmacists through DynaPulse monitor", quoted regarding use of DynaPulse for blood pressure
monitoring at the Nebraska Drug Information Network, The Pulse, Summer 1996:2.
"Pharmacist tout savings from their assistance to patients", by Mary McGrath, quoted regarding NARD study finding $752,391 in cost-savings secondary to pharmacist interventions over a two month period. Omaha World Herald, September 18, 1996, p 28.
"High Noon II propels pharmacist care", study noting $750,000 savings by five pharmacists over two months is included, NARD Newsletter, October 1996, p. 1-2.
"Team Up and Talk with Your Pharmacist", National Pharmacy Week, booth activities at Westroads Mall, sponsored by Kappa Epsilon Pharmacy Fraternity, Omaha, NE, October 27, 1996,
"Reaching out through technology", by Tim Kaldahl, quoted regarding use of computer technology for health information in rural communities. Impact (UNMC publication), Omaha, NE, November (Winter) 1996: 11.
"Herbal medications and potential drug-herb interactions", quoted regarding known and potential drug-herb interactions and the rise of interest in herbal medications, KGNC (98FM and 7.1AM), Amarillo, TX, March 16, 1998.
"Herbal medications"; addressed drug-herb interactions and upcoming book, Amarillo Daily News, March 16, 1998.
"Considering the Alternatives: American Medical Association Reports Take Mainstream Look at Nontraditional Therapies", by Susan Okie quoted on drug-herb interactions, Washington Post, November 17, 1998.
"Warning: Avoid Mixing With Prescription Drugs", by Michael Sommermey, quoted regarding drug-herb interactions, LA Times, November 30, 1998.
"Herbal remedies may not mix well with prescriptions" quoted regarding drug-herb interactions, The Charlotte Observer, Charlotte, NC, December 28, 1998.
"Unconventional medical treatmetns drawing more attention from science" by Laura Beil, quoted regarding herbal medicines, Dallas Morning-News, January 18, 1999.
"Herbs can be toxic as well as helpful" by Marian Jones, quoted regarding toxicity of herbs and potential drug-herb interactions, Fox On-Line, February 19, 1999.
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