Civilitiville’s input to ODS Strategic Plan

August 30, 2024

civilitivilleusa

Dear Office of Dietary Supplements’ Strategic Planning Personnel,

The following email presents our input to your strategic plan and is available as an attachment too, for your convenience.

We at Civilitiville USA’s New Life Health Ventures appreciate your soliciting feedback and input for your strategic plan and we would like to see a plan reflective of health care focused on: the human person, truth, building a body of knowledge, and reverence for God’s creation where the science is sound and the money is fair. We have particular interest in mental health but are aware of the broader landscape. As such we would like to see supplements known to be safe options of care on parity with pharmaceuticals when options are presented for care.

To quote your organization, “The dietary supplement market now includes more than 100,000 products and about one half of adults and one-third of children and adolescents in the United States use dietary supplements. Yet questions remain about their cellular mechanisms, metabolism, efficacy, safety, and effects on health.” We want to express that in truth, the same is true for many if not most newer pharmaceuticals and even COVID-19 vaccines, in that many questions remain about them too. Shouldn’t this knowledge availability be the norm? and wouldn’t it be ideal if it could be found in a known, commonly used and reliable repository?

-Dedication to Truth and First Do Know Harm-

Science is an intellectual virtue in the pursuit of truth, and we think that money and politics play a very large and distracting role from “Science” in the FDA and its drug approval process, as well as in its collection of information on adverse events. The FDA fails in its basic premise and raison d’etre of protecting the patient and facilitating informed consent. You just have to listen to the evening news on television to hear pharmaceutical commercials parlaying adverse effects to know we have lost our way. Sadly, this same big money has been used to deter or derail positive attention from homeopathic alternatives now and going back to the turn of the twentieth century with Rockefeller’s influence on pharmaceuticals and medical schools. This influence is bringing about a culture of monopoly-oriented patentable manmade alternatives to natural remedies that are more expensive and more problematic in many cases, as well as a culture more oriented to physician or insurance company dictated treatment vs consumer choice and selection. We believe a good start to turning the tide is to embrace the Hippocratic Oath and “First do no harm.”

-Denotation of Safety-

We would like to see a denotation of safety for supplements that are deemed safe, and further investigation and warnings for those that are not “safe”. This implies prioritizing an importance on research on cellular mechanisms, safety and effects on health as well as interactions with probable pharmaceuticals. We think a rating of “Not known to cause harm when used as prescribed” is appropriate for most natural medicines and food supplements. Bearing in mind that this is true, it leaves the patient/consumer free to experiment without fear. “By living we learn” and a good first step is trying when there are a variety of “safe” options.

-Quantity and Structure of Grant Money-

While we believe that the mass amount of Federal Grant Money for medical research is problematic in that it creates a research culture of selfishness, dependence on government, and lack of interest in the work of others in the world of “research”, we believe that the Office of Dietary Supplement’s inability to give direct grants is problematic as is its supporting grant mechanism. We would like to see movement toward direct grants in this endeavor and paradoxically a severe reduction of Federal Grant money in general.

The National Institute of Mental Health provides over $2 billion in grant funding each year worldwide and is proud to be the world’s largest funder of research for mental health research. We see such a concentration of power, especially by government as very problematic and stifling. We would like to see greater demarcation between public and private research and believe that “big money approaches to research” yields “big money treatments” at a time when healthcare is already comprising too large a percent of our nation’s GDP and too high a percentage of family budgets and suffering from monopolistic thoughts and approaches.

We would like to see a deflation in the moneys spent by universities, see them return to their more altruistic roots, and see less of a revolving door between politicians, government agencies, big pharma and universities as they should have vastly different goals and temperaments. Truthfully, we would like to see an end to publicly held healthcare organizations as we see the big money as too distracting and we believe that at its best, healthcare is a calling.

We believe that healthcare is information centric and that providing good information is perhaps the most effective tool for assuring a good use of time and decision-making. Confidence in healthcare today and is sorely lacking in many areas and for many conditions, especially mental health.

-The Need for Gentler, Safer Approaches for Mental Health-

Our nation is experiencing an epidemic in mental health, especially in adolescents and unfortunately it is not unusual for this over loaded system to resort to pharmaceutical treatment as a first line of treatment for questionable diagnoses and with a false premise that the medications are safe and effective. In reality, the evidence for most medications is low quality and low certainty and the 6-week clinical trial period is insufficient in duration to be valid or representative of reality regarding real life treatment. Virtually no testing is done regarding drug dependence and withdrawal which is a real and complex and dangerous problem. Its tacit exclusion presents an incomplete picture of the true dangers and complications of the pharmaceuticals and the advantageous nature of supplements which do not have these drawbacks.

Daily, many mental health diagnoses are being medicated with pharmaceuticals that may do more harm than good. Informed consent is compromised in that the true known ramifications are minimized if presented at all and an urgency of treating the condition is used as justification for risky treatment. Most information is of “low quality” and “low certainty” and/or woefully incomplete for known to be complex conditions which frequently have their root in human pain and sorrow. We would therefore like to see supplements play a first line treatment role and be actively promoted for conditions of depression and anxiety and even insomnia. GABA (Gamma-Aminobutyric Acid) L-Theanine and 5-HTP are a few of the powerful supplements that should be considered for first line treatment for stress, depression, anxiety and insomnia.

-Clinical Trials can Vary-

There is a need for a different approach in conducting a clinical trial for GABA or 5-HTP vs a complex new generation anti-psychotic, in that the first order of testing- safety- need be significantly more robust for the pharmaceutical and only if a pharmaceutical is deemed safe should efficacy testing commence. In contrast, with known to be safe substances such as GABA or 5-HTP, satisfactory efficacy results need not be seen by a majority of patients in complex conditions as this gentler approach may work for some body types, conditions and level of care and not for others. Having more options that work for some but perhaps not for others but are all known to be safe presents a culture of safe experimentation for treatment and satisfies the need for a wider spectrum of options for care and a more diverse ecosystem of safe treatments- most of which are in abundance and therefore relatively inexpensive, in contrast to patented highly developed and marketed pharmaceuticals which monopolize today’s practiced care landscape. A more diverse landscape of safe treatment options should be a goal and a common mindset for healthcare professionals as it is likely to yield the greatest overall results for all patients and allows the patient to take into consideration his or her goals and his or her risk comfort level.

Sadly, pharmaceuticals with known serious adverse effects are readily granted approval and the available adverse effect information is minimized and marginalized over time. All FDA trial studies should be continuously available to the general public in the interest of health and science. We think it prudent that supplements be included and contrasted both for their efficacy and safety and certainty with respect to adverse events in clinical trials of pharmaceuticals designed to treat like conditions.

Our experience with ClinicalTrials.gov is that it is not helpful. It is very cumbersome and not very informative. Protocol can and should be developed where included studies have a brief statement of results that is guided by a universal protocol for succinctly sharing efficacy and safety concerns.

-What Such a Comprehensive Integrated Database Could Facilitate/Make Happen-

Imagine a patient and or a provider both having access to the same comprehensive list of treatments for a given condition, or a comprehensive list of adverse effects and benefits and area of the body impacted by a given substance. What wonderful conversations and trust this would promote! Truly informed consent and likely cost saving as a variety of options will be selected. To further have appropriate substantiating and conflicting studies and clinical trials linked and available for review and scrutiny truly presents health and healthcare in the open dignified manner worthy of mankind.

-The Need for an Integrated Database with Links to Indexed Studies and Trials-

To best make this happen, there is a need to structure a database of all supplements by:

Conditions they treat-general and specific,

Parts of the anatomy they impact and treat

and to profile supplements by a multitude of factors including: ingredients, cellular mechanisms impacted, safety, comparable effectiveness charts for conditions, links to studies, and cautions/warnings for example.

As stated in the paper, Johanna T. Dwyer et al "Dietary Supplement Databases: Public Health Tools , Journal of Food Composition & Analysis Jan 2022 “Federal government involvement can help to develop DS databases for public use, establish appropriate standards for compiling databases, develop uniform, common definitions for similar ingredients in DS, food, and drug databases, and maximize interoperability between them. Robust, modernized DS databases can be achieved by funding and applying advances in software, data science, and database technology.”

The above paper echoes many of our thoughts and is from the Office of Dietary Supplements. We would be delighted to share more thoughts on this area and hope to establish a relationship with those in your organization that think big when it comes to databases!

-Databases and Practices that Present a Good Start-

Our cursory review of government, commercial and book resources on the subject suggests there is much work to be done yet. it is doable to create a robust database of supplements and/or their ingredients containing basic demographic information as well as: conditions, effectiveness, interactions, nutrient depletion, advisories and links to studies among other things. The TRC database and the Medline Plus Dietary Supplement Fact Sheets of the National Library of Medicine present good starts and information that could be incorporated in a master database that could be linked by condition to a pharmaceutical database with a complementary structure.

We see the indexing and comparable effectiveness ratings of supplements and all treatment options as being a necessary step. We approve of NatMed’s Comparative Effectiveness Chart scale of likely effective, possibly effective, possibly ineffective and insufficiently reliable evidence to rate as appropriate categories for statistical information and note that pharmaceuticals that cause suicidal ideation would be listed in possibly ineffective for example. Effectiveness ratings avoid the pitfall of individual prediction and reflect the probabilistic nature of outcomes.

NatMed’s Comparative Effectiveness Charts present a good starting schema and assurance that it can be done and will likely be evolutionary in nature. We are compelled to add, however that Natural Medicine, the databases parent company was a subsidiary of Merck and we consider this a grave conflict of interest. TRC Healthcare is now its parent company and it is now part of Colibri Group, a professional education company. Colibri Group is owned by a venture capital group which we see as potentially problematic and may not provide the atmosphere necessary for a scientific endeavor. We will also add that the database is geared to providers and we envision one that is geared both to providers and patients and we believe that the audience for all healthcare research and resources must include the patient. Please click the Comparative Effectiveness Charts link to see the Insomnia example. Please refer to Appendix 1 to see Natural Medicine Article/Overview or click this link.

We believe that that there should be three primary entities for the database:

The substance- dietary supplement or pharmaceutical.

We see the FDA’s Global Substance Registration System with its UNII (Unique Ingredient Identifier) codes as helpful in this endeavor and envision academic papers and clinical trials being indexed by UNII code.

The condition or symptoms. (i.e. breast cancer or depression)

We believe that the Medicare ICD 10 codes or a linkable modification thereof could be used. These codes would be used to index all studies and clinical trials.

The part or parts of the anatomy impacted.

We are unaware of standardized codes for this but that does not mean they do not exist. We would like to see findings and studies on anatomy indexed by code and linked to this database.

These three elements would be linked together so each substance would be indexed/profiled by condition or symptoms it addresses as well as parts of the body it impacts.

The database could also include a treatment cost in cost per treatment and annual cost if applicable.

-Capturing Mechanisms for How Drugs/Supplements Work and the Parts of the Body they Impact-

There are several new and promising techniques for understanding how a drug works and the cells and areas of the body it encounters and impacts. We believe that these techniques should be used to understand supplements and the areas of the body they encounter, as well as the impact. These results should be published and linked appropriately. Information is power- and it is time the government return power to its citizenship, over their bodies, their health and their care. May freedom and choice/truly informed consent reign!

Dataset S1: Drugs from the top 100 best-selling drugs list that target circadian genes.

Rank	Sales	Trade name	Drug	Indications	Circadian-gene targets	Organs in which targets oscillate
1	$1.53 b	Abilify	aripiprazole	Bipolar disorder, Major depressive disor...	Htr2c, Htr1b, Htr2a, Chrm2, Drd4, Adra2b, Adra1b, Adra1a	lung, heart, brainstem, white fat, adrenal gland, liver, brown fat, kidney, skeletal muscle, cerebellum
2	$1.46 b	Nexium	esomeprazole	Gastritis, GERD, Esophagitis	Atp4a	liver
3	$1.30 b	Cymbalta	duloxetine	Chronic pain, Fibromyalgia, Diabetic neu...	Slc6a4	adrenal gland, kidney
4	$1.30 b	Crestor	rosuvastatin	Hyperlipidemia	Hmgcr, Abcc1, Abcc4	lung, heart, hypothalamus, liver, brown fat
5	$1.28 b	Advair Diskus	fluticasone + salmeterol	Asthma, Chronic obstructive pulmonary di...	Serpina6, Pgr, Nr3c2, Adrb2, Pla2g4a	lung, heart, liver, kidney, skeletal muscle, aorta
6	$1.22 b	Humira	adalimumab	Rheumatoid arthritis, Crohn's disease, U...	Fcgr2b, Fcgr3	liver, kidney
7	$1.08 b	Enbrel	etanercept	Rheumatoid arthritis, Psoriasis	Fcgr2b, Tnfrsf1b, Fcgr3	hypothalamus, liver, kidney
10	$859 m	Neulasta	filgrastim	Acute myeloid leukemia	Csf3r	lung
11	$794 m	Rituxan	rituximab	Rheumatoid arthritis, Non-Hodgkin's lymp...	Fcgr2b, Ms4a1, Fcgr3	liver, kidney, skeletal muscle
12	$726 m	Spiriva	tiotropium	Chronic obstructive pulmonary disorder	Slc22a5, Slc22a4, Chrm2	heart, brainstem, brown fat, kidney, aorta
14	$701 m	Januvia	sitagliptin	Diabetes mellitus T2	Abcb1a, Dpp4	heart, adrenal gland, liver, kidney
16	$641 m	Avastin	bevacizumab	Colorectal cancer, Non-small cell lung c...	Fcgr2b, Vegfa, Fcgr3	heart, brown fat, liver, kidney, skeletal muscle, aorta
17	$637 m	Lantus Solostar	insulin glargine	Diabetes mellitus T2	Igf1r	kidney
18	$592 m	Lantus	insulin glargine	Diabetes mellitus T2	Igf1r	kidney
20	$538 m	Diovan	valsartan + hydrochlorothiazide	Hypertension, Heart failure	Slc22a6, Agtr1a, Slco1b2, Car4, Kcnma1, Car12, Car2	heart, adrenal gland, liver, kidney, skeletal muscle

The above is an example from Ray Zhang et all’s “A circadian gene expression atlas in mammals: Implications for biology and medicine”, PNAS Oct 27, 2014 as well as a link to the study. Note the current version no longer includes the #1 drug Abilify, a mental health drug. Abilify’s mysterious exclusion after we wrote the study’s authors and the drug’s manufacturer, the FDA and others - is part of the reason we think information like this should be linked to a centralized supervised repository so helpful information no longer goes missing.

-Thoughts on Who and How This can be Done-

While we acknowledge government suffers from a lack of trust and credibility with the general public regarding healthcare, we believe government is the entity to provide this type of information and encourage the involvement of the Office of Dietary Supplements to offer “science” at its best and we concur that work in this endeavor and/or the final product could and should have global implications.

We are also aware that the United States lags behind other nations like Canada, the UK and Australia in its efforts to “handle and properly promote” supplements so we encourage reaching out to foreign agencies for ideas and support. Perhaps an ideal structure would be for the Office of Dietary Supplements to form a strategic relationship with respected nonprofits and/or universities to handle this venture. The key is that it be nonprofit in nature and that the moneys be sufficient but not exorbitant and that the quest be scientific in nature. The acceptance and success of such work will be self-evident if the project is focused on objectivity and truth and in accordance with new product development principles. We believe it should be developed by a small team that networks extensively with a variety of constituents yet is committed to objectivity, truth and science. We believe an RFP process might work best for selecting candidates of this important project and would be delighted if students at universities were to play a role.

There is a saying in “tech”, “where there is mystery there is money” and sadly the same is true for healthcare and promises to be even more so as the two industries join forces. We see health as a gift from God and therefore sacred and as such believe an open, honest, scientific approach rigorously maximizing data for the sake of service to the patient is called for: An approach that serves people and uses data, not an approach that uses people and serves data!

-Concluding Thoughts-

All this presents a different vision from today’s predetermined “Standards of care” or AI selected treatment approaches that don’t focus on providing choices nor facilitating truly informed consent and allowing the patient to direct his/her care in accordance with his/her thoughts and values. This patient-centric common sense and open use of data management where medical information and data vs patient records are mined extensively, and options are presented in an orderly fashion of data management, is sadly lacking today perhaps primarily due to an undue attention on treatments and “outcomes” that satisfy the needs of pharmaceutical companies, insurance companies and providers and not the ultimate customer the patient. Healthcare that focuses on the needs of the patient - especially the information needs of the patient - is bound to be more successful and less expensive in the long run. It will also be more dignified and less stressful.

It is our hope that you will come to see that for-profit pharmaceuticals have severe limitations and that there may indeed be kinder, gentler approaches through dietary supplements for care for simple and complex conditions and as such. It is important that this approach be presented and promoted clearly, completely and frequently as first line care options. It is our hope your strategic plan and actions in the coming years reflect this. Failure to embrace this openness is at great expense and promotes the status quo of ever increasingly expensive care, limited choices, and a movement toward consensus if not coerced care which may not jive with the patient’s values. Such high-stakes medicine encourages an attitude by many of “winning at all cost“ which should have no place in healthcare and promotes a culture of mandated or coercive care vs one of freedom and choice.

We recommend four documentaries as informative morale boosters and motivators for your organization:

A New Standard of Care- Alternative Treatments for Cancer Directed, Produced and Written by Megan S. Smith
Second Opinion: Laetrile at Sloan-Kettering
On Being Both A Patient Harmed By Prescribed Psychiatric Medication & A Medical Provider Produced by Nicole Ambersome
Drugging Our Kids by Bay Area News Group

As a final recommendation, we recommend a name unique from the FDA’s Office of Dietary Supplements to avoid confusion. We like “Office of Dietary Medicine and Care”.

-We Know of what we Speak-

We know of what we speak. One of our members is a highly trained and published statistician and a pioneer in pc-based databases. One of our members is a practicing psychiatrist who specializes in helping those that have committed crimes due to being medicated. One of our members suffered severe withdrawal and body damage from aripiprazole poisoning from the drug Abilify and was eventually healed of chronic pain by supplements. Abilify’s manufacturer, Bristol Myers Squibb denied her and the MN Attorney General’s request to provide her with the clinical trials. A few years later she found the animal studies doing a Hail Mary search on “Abilify’s impact on adrenal glands” and later learned that Abilify adversely impacts the peptide relaxin - which recent discoveries on the peptide relaxin have shown impact the entire body and its reproductive system in amazing ways.

You are invited to learn more by going to https://abilifysurvivorsguide.com/ and the New Life Health Ventures page at https://civilitiville.us/.

We thank you for this opportunity to provide comments to your strategic plan and direction and we welcome your thoughts. We hope to start a dialog, and in fact, already have! We thank your office’s Johanna Dwyer for answering our emails and sharing her thoughts.

Merci,

Susan Lein

Ms. Susan Lein

Co-Foundress, Secretariat, Artist-in-Residence

Civilitiville USA

6730 Vernon Ave S. #220

Edina, MN 55436 U.S.A.

https://civilitiville.us/

1-(952) 426-3720

An Umbrella of American Humanitarian Efforts

About New Life Health Ventures

Under the Civilitiville USA Umbrella, New Life Health Ventures strives to be a thought and action leader in healthcare reform, with a focus on: The Human Person, Truth, Building a Body of Knowledge and Reverence for God's creation. We hope to work leaders that are aligned with our vision, surface issues that deserve attention, present new approaches and facilitate methods of organization and communication.

We want to see nutrition, exercise/physical therapy, prayer, the arts and service to others have parity if not greater emphasis than pharmaceuticals and we aim to call out dangerous drugs and processes and procedures and isolate the underlying practices and behaviors that facilitate and encourage them.

As a thought leader, New Life Health Ventures reviews, categorizes, and hypothesizes about current best practice treatments for healthcare and wellness and we promulgate our findings and advocate for change and new direction to: medical schools, universities, researchers, legislators, government agencies, insurance companies and the general public through direct communication and correspondence and forthcoming means to include: a robust website, a pod cast, and interaction and involvement with the Roman Catholic Church and faith based organizations that promote a culture of virtue and brotherhood.

Appendix I

J Med Libr Assoc. 2016 Oct; 104(4): 371–374.

doi: 10.3163/1536-5050.104.4.029

PMCID: PMC5079512

Natural Medicines

Reviewed by Karen L. Yacobucci

Natural Medicines.One Davis Square, Somerville, MA 02144: Merck Sharp & Dohme, a subsidiary of Merck & Co.2016. https://naturalmedicines.therapeuticresearch.com. Personal subscription $14.99 per month; contact vendor for institutional pricing; NMCD mobile app free with subscription.

Natural Medicines is the combination of two of the leading evidence-based information databases in the field of complementary and alternative medicine: the Natural Medicines Comprehensive Database (NMCD) and Natural Standard. In 2013, the Therapeutic Research Center merged with Natural Standard in order to create Natural Medicines, calling itself, “The most authoritative resource available on dietary supplements, natural medicines, and complementary alternative and integrative therapies” [1].

The goal of Natural Medicines is to provide “unbiased, evidence-based information and ratings for over 90,000 dietary supplements, natural medicines, and integrative therapies” for health care professionals [2]. This combined product provides A–Z listings of over 1,400 monographs, updated daily. According to a representative of the Therapeutic Research Center, the product includes more than 50,000 scientific citations, which the center states is the “largest natural medicines database in the world,” with approximately 1,200 monographs on natural ingredients and over 200 monographs on complementary and alternative treatments [2]. This content is divided into 4 main headings: Databases, Tools, [Continuing Education/Continuing Medical Education] CE/CME Center, and Colleagues Interact, detailed below, plus News and About Us sections. Patient handouts are included with all monographs, and ingredient monographs include background information, history, toxicology, and pharmacokinetics, as well as expanding on preexisting information such as dosing and administration.

DATABASES

Natural Medicines provides seven searchable resources in its databases section:

Food, Herbs & Supplements includes evidence-based monographs on the safety and effectiveness of “vitamins, herbs, minerals, non-herbal supplements, naturally sourced chemical compounds, and foods” [3].

Health & Wellness includes evidence-based monographs on complementary therapies and specialized diets (e.g., acupuncture, kosher diet, gluten-free diet, yoga). Monographs in this section include information on safety and effectiveness as well as any interactions. This section has recently been expanded to cover many popular therapies and diets.

Sports Medicine contains monographs relevant to sports medicine, which includes “specific exercise regimes, injury treatments, and sports supplements” [3].

Comparative Effectiveness lists multiple therapies for a specific condition in a single chart. The charts in this section are clear and concise. Therapies are also ranked by their levels of effectiveness.

Manufacturers includes a list of all commercial product manufacturers found in the Natural Medicines Commercial Products section.

Commercial Products includes information on more than 92,000 products. Monographs cover product ingredients, information on product safety and effectiveness, adverse events and interactions, and the Natural Medicines Brand Evidence-based Rating (NMBER).

Medical Conditions includes a detailed summary of conditions, with information such as related terms, background, causes, signs and symptoms, diagnosis, complications, treatment, integrative therapies, and prevention.

NATURAL MEDICINES BRAND EVIDENCE-BASED RATING (NMBER)

Natural Medicines now includes a new grading system, the NMBER, which “takes into account Safety Ratings and Effectiveness Ratings from Natural Medicines Comprehensive Database as well as manufacturing quality data directly from adverse event report systems and recognized sources such as the United States Pharmacopeia (USP) and other regulatory agencies” [4]. NMBER is a color-coded, numeric scale from 1–10. Products with lower numbers have potential safety concerns, whereas products with higher numbers have met rigorous standards and have shown positive results. The color-coded marking identifies products with Major (red), Moderate (yellow), or Insignificant (green) levels of significance. In addition, citations to published literature are included, along with links to abstracts in PubMed where available.

TOOLS

In addition to basic and advanced search functionality, the following search tools are available for herb, supplement, vitamin, mineral, or complementary practices: Interaction Checker, Effectiveness Checker, Nutrient Depletion Checker, Pregnancy & Lactation, and Adverse Effects. The Interaction Checker allows users to search for interactions in natural medicine agents but clearly states that this checker “does not check for drug-drug interactions” [1]. The Effectiveness Checker gives users the ability to enter the name of a condition or disease and see lists of natural medicines based on effectiveness. Results are listed in four categories: Likely Effective, Possibly Effective, Possibly Ineffective, and Insufficient Reliable Evidence To Rate. The Nutrient Depletion Checker tool allows users to search for nutrients that might be depleted by prescription or over-the-counter medication. The Pregnancy & Lactation checker searches ingredients and grades them on their level of safety for pregnant and breastfeeding women; citations to related articles are provided when available. Finally, the Adverse Effects tool allows users to select adverse effects from an alphabetized list and provides a list of agents that can be associated with each effect.

The Tools section can be found in two locations: along the header and along the left-hand side. The content in both locations is the same, except that the Charts and Natural MedWatch sections are only available under the header. The Charts section provides a comprehensive alphabetical list of monographs for herb classifications, plus a “special chart for Caffeine Content of Energy Drinks and Shots” [3]. Natural MedWatch is an online form that allows users to make confidential reports of adverse events and side effects of any natural medicine.

PATIENT HANDOUTS

Each monograph in Natural Medicines includes patient handouts in English, Spanish, and French. Patient handouts include general information on products, their level of effectiveness, a brief explanation of how the product works, safety concerns, food or drug interactions, dosing information, and alternative names. All of this information is presented in a format that is clear and easy to read.

CONTINUING EDUCATION/CONTINUING MEDICAL EDUCATION CENTER

CE and CME credit is available via the CE/CME Center with two options for coursework: a Clinical Management Series on the “clinical management of disease states and medical conditions” and Monograph-Based Courses “focused on safety and effectiveness of natural medicine ingredients” [5]. The Clinical Management series carries over from NMCD and is continuously updated with the most current information available [6]. Users who wish to access CE/CME coursework in the Clinical Management Series will be required to create a CE ID number. The Monograph-Based Course series is a carryover from the former Natural Standard and will only be offered through March 24, 2017

COLLEAGUES INTERACT

The Colleagues Interact section is a forum that allows members to post, search, and comment on messages created by other members. A member's CE ID number is required to be able to post and comment on messages in this section. Comments and additional feedback from the Natural Medicines editorial team are easy to find, because each of these posts are designated with a highly visible red star.

THE APP

Currently, there is no app that includes the newly combined data from NMCD and Natural Standard. However, the NMCD app is still available. Subscribers to Natural Medicines can access the app's subscribers-only content, which includes access to all the features of NMCD. A free consumer version of the app is also available. Although the consumer version of the app does not include the full suite of subscribers-only content, it does include the Effectiveness Checker, Nutrient Depletion Checker, Natural Product/Drug Interaction Checker, and NMBER rating. Both apps are available for iOS and Android devices and, to remain unbiased and noncommercial, do not include any endorsements or advertisements [8]. The app can be used offline, with content updated automatically whenever a WiFi connection is available.

CONCLUSION

The merger between NMCD and Natural Standard has had an overall positive impact on the creation of the Natural Medicines database in numerous ways, including improved ingredient monographs, additional monograph types, expanded tools, and an updated user interface. The merger has also dramatically increased the amount of searchable content.

Natural Medicines would be an asset to any medical institution for both educational and clinical purposes. It provides high-quality, evidence-based information on natural medicines and alternative therapies in an often-overlooked area of medicine. No other resources in this field seem to offer an equivalent amount of evidence-based rigor. However, subscribers would benefit greatly from a new Natural Medicines mobile device app that includes the merged content from NMCD and Natural Standard.

Footnotes

Karen L. Yacobucci, MLS, ude.uyn.dem@iccubocay.nerak, NYU Health Science Library, New York University School of Medicine/Langone Medical Center, New York, NY

REFERENCES

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