dr. shurtleff: goodmorning everyone. welcome to our 2014 nccamintegrative medicine lecture series. it's my pleasure towelcome dr. bill gurley who is our first speakerin this 2014 series. dr. gurley is a professor inthe department of pharmaceutical sciences and director ofthe clinical pharmacokinetics laboratory at theuniversity of arkansas for medical sciencescollege of pharmacy. he's also chief science officerfor balm scientific innovations,
an incubator company forthe university as well. dr. gurley's nih-fundedresearch focuses on herb-drug interactions, a very importantarea for nccam as we've been having lots of discussionsover the last actually couple of years on this topic. and he's an internationallyrecognized expert in the area of botanical dietary supplementsand the effects on human drug metabolism and disposition. his specific research interestsinclude phytochemical-mediated
modulation of human drugmetabolism and transport, pharmaceutical aspects ofbotanical dosage forms, and assessment of dietarysupplement safety and efficacy. all extremely importantissues for our mission at nccam. his research has resulted inmore than 150 publications and abstracts and since 2000he has given more than 100 invited lectureson various aspects of botanical supplement safety to bothpublic and professional audiences. today dr. gurley willprovide an historic overview
of herb-drug interactions, discuss their mechanisms usingclinically relevant examples, and examine prospects forfurther research in this area. so please welcome dr. gurley. (applause) dr. gurley: thank you davidfor such a nice introduction. it's indeed a pleasure for meto speak to nccam this morning. there are a lot of familiarfaces in the audience and i greatly appreciatethe opportunity.
of course most of you, well,most of you don't know me, but my laboratory was a veteran,that's what i like to call it, a veteran of the ephedra warsback in the day and then since that time has been involved inconducting prospective clinical trials to assess the potentialfor various botanical dietary supplements to modulatehuman drug metabolism. and so most of that data overthe last 18 years i'm going to kind of use to, as for thebasis of this talk this morning. of course we are all well awarethat plants have been a source
of drugs since time immemorial. but the issue of herb-druginteractions really didn't come to the forefront until afterthe second world war when drugs moved from multi-componentplant-based preparations to purified single-ingredientsynthetic drug compounds. all right, and if one delves intothe medical literature it's pretty obvious that phytochemicalshave been recognized for their ability to modulate the activityof conventional drug metabolism for many decades.
now one interaction that'soften described in the medical literature is theability of phytochemicals, particularly those presentin cruciferous vegetables like the isothiocyanates, to modulate certain drugmetabolizing enzymes and thus the pharmacokineticsof a variety of drugs. and, of course, the abilityof cruciferous vegetables to modulate human drugmetabolism is actually a good thing; it's probably from more ofa chemopreventative aspect.
but the concern for herb-druginteractions really didn't come into its own until around1991, and that was the year that grapefruit juice kind oftook everybody by surprise for its ability to increase theoral absorption of many drugs and possibly their toxicity. and then soon after the grapefruitjuice issue came to light the dietary supplement healthand education act was passed, and a plethora of uniquephytochemicals became available for consumptionin the united states
in the form of botanical dietary supplements. the real issue of herb-drug interactions,at least from my perspective, really didn't come into its ownuntil around 1998, when an article was publishedin the journal of the american medical association, and thearticle dealt with alternative medicine use inthe united states. and in the article the authorsestimated that in 1997 15 million adults took prescriptionmedications concurrently with herbal remedies or high dosevitamins which is about
18 percent of all prescriptionusers based on that study. they also went on in thearticle to estimate that nearly three million adults,ages 65 years or older were also takingconventional medications concurrently with herbal remedies. and so because the elderlyare our greatest consumers of conventional medications thenthey may be at an increased risk for herb-drug interactions. and, of course, since that timea wide variety of surveys have
appeared in the medicalliterature indicating that at least i've always found thisstatistic quite interesting that between 30 and 60 percent ofhospital patients use botanical supplements on a regular basis. and, of course, a numberof other surveys kind of corroborate that initialsurvey that came out in jama, about 20 to 30 percent of allprescription drug users take botanical supplementson a regular basis. what's even more interestingis that about 70 percent of all
supplement users also takeprescription medication. so there's certainlya likelihood for herb-drug interactionsto occur. and i think one of the mostimportant statistics for health care providers to understandis that less than 40 percent of patients ever reveal the factthat they're taking a botanical supplement to a health careprofessional so that oftentimes you literally have topull it out of them. now another studythat came out oh,
in 2001 i believe thatalso kind of caught a lot of, particularly themedical community, not necessarily the pharmacycommunity or the alternative medicine community, butthe allopaths of the world, and it was a study that wasdone by the department of anesthesiology at texas techmedical branch in lubbock. and what they did is theysurveyed a little over a thousand patients, just prior togoing into surgery for their use of alternative medicines.
and it wasn't that surprising thatmost of them were using vitamins. no big deal there. but what was quite surprising tothem was the number of patients that were actually using garlicand ginkgo and st. john's wort were prettysubstantial percentages. and as we'll talkabout many of these, or at least a few of these can cause some significantherb-drug interactions. and so that in itself kind ofwas quite an eye-opening finding
for the medical community.
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