Thesis (M.P.H.)--University of Hong Kong, 2008. / Includes bibliographical references.

published_or_final_version / Community Medicine / Master / Master of Public Health

Natural health products (NHP) have been experiencing strong growth in consumer demand, both domestically and in foreign markets. The nature of NHP and the small sector of the population that used them in the past, has allowed them to slip between the cracks of regulatory bodies. As NHPs have become mainstream and have been marketed and distributed through major agri-food supply chains, governments have had to become more active regulators. New Natural Health Product Regulations came into force in Canada on January 1, 2004 to regulate these product which had been generally regulated under the Food and Drug Act. Canada is not alone in its regulatory reform and other countries have begun to create new and often more rigorous regulations for NHP. It as often the case that domestic regulations have unintended and sometimes trade restricting side effects. The current restructuring and focus on regulations of NHP, and the potential importance of trade within this sector, suggests that a better understanding of the non-tariff barriers that may arise could be important for the development of the industry in Canada and elsewhere. Analysis of trade effects arising from standards and regulations is not an easy task. Non-tariff barriers to trade tend to have product-specific effects making it difficult to find general results. Using a review of current approaches to address technical barriers, an analytical framework has been selected and applied to case studies. The cases studies examined the welfare effects of regulations as they pertain to three products with different characteristics; flax omega-3 supplement, elk velvet, and a probiotic supplement. The case studies identified a range of non-tariff barriers arising from international regulatory divergence. The results suggest that trade barriers are likely to arise in the NHP industry and that they will differ from product to product. As a result, there is unlikely to be a single policy prescription that will facilitate the removal of barriers to international market access. Suggestions are made as to how barriers could be eliminated or reduced through formal trade negotiations or less formal bilateral discussions.

Natural health products (NHP) have been experiencing strong growth in consumer demand, both domestically and in foreign markets. The nature of NHP and the small sector of the population that used them in the past, has allowed them to slip between the cracks of regulatory bodies. As NHPs have become mainstream and have been marketed and distributed through major agri-food supply chains, governments have had to become more active regulators. New Natural Health Product Regulations came into force in Canada on January 1, 2004 to regulate these product which had been generally regulated under the Food and Drug Act. Canada is not alone in its regulatory reform and other countries have begun to create new and often more rigorous regulations for NHP. It as often the case that domestic regulations have unintended and sometimes trade restricting side effects. The current restructuring and focus on regulations of NHP, and the potential importance of trade within this sector, suggests that a better understanding of the non-tariff barriers that may arise could be important for the development of the industry in Canada and elsewhere. Analysis of trade effects arising from standards and regulations is not an easy task. Non-tariff barriers to trade tend to have product-specific effects making it difficult to find general results. Using a review of current approaches to address technical barriers, an analytical framework has been selected and applied to case studies. The cases studies examined the welfare effects of regulations as they pertain to three products with different characteristics; flax omega-3 supplement, elk velvet, and a probiotic supplement. The case studies identified a range of non-tariff barriers arising from international regulatory divergence. The results suggest that trade barriers are likely to arise in the NHP industry and that they will differ from product to product. As a result, there is unlikely to be a single policy prescription that will facilitate the removal of barriers to international market access. Suggestions are made as to how barriers could be eliminated or reduced through formal trade negotiations or less formal bilateral discussions.

Objective: To reach consensus on entry-to-practice natural health product (NHP)-related competency statements for Canadian pharmacy students. Methods: Four rounds of a modified Delphi method were conducted. Participants; pharmacy educators,and representatives from Canadian pharmacy organizations (n=17), ranked their level of agreement using a 5-point Likert scale. Results: Consensus occurred when all participants ranked a statement 4 or 5. Three core NHP-related competencies were identified: 1) the ability to incorporate NHP knowledge when providing pharmaceutical care; 2) the ability to access and critically appraise NHP-related information sources, and 3) the ability to provide appropriate education to patients and other health care providers on the effectiveness and potential adverse effects and drug interactions of NHPs. Two additional NHP-related competency statements emerged as important, but consensus was not achieved. Conclusions: If the developed core NHP-related competency statements are widely implemented, Canadian pharmacists will be able to fulfill their NHP-related professional responsibilities upon entry-to-practice.

Natural health products (NHPs) are increasingly sold in pharmacies. The purpose of this study was to determine Canadian pharmacists’ attitudes about their professional responsibilities regarding natural health products. A cross-sectional, random sample survey design was used: 3356 questionnaires were mailed to a random sample of licensed pharmacists in all provinces/territories in Canada (except Nunavut). Survey responses were evaluated using descriptive statistics and logistic regression analyses. Response rate was 61%. Overall, respondents were most likely to endorse pharmacist responsibilities related to vitamins and minerals, followed by herbal medicines, then homeopathic medicines. Responsibilities regarding knowledge of NHPs and counseling on NHPs were more frequently endorsed than responsibilities associated with NHP-related documentation. Self-reported knowledge was positively associated with endorsement of NHP-related responsibilities for all NHP types.

Natural health products (NHPs) are increasingly sold in pharmacies. The purpose of this study was to determine Canadian pharmacists’ attitudes about their professional responsibilities regarding natural health products. A cross-sectional, random sample survey design was used: 3356 questionnaires were mailed to a random sample of licensed pharmacists in all provinces/territories in Canada (except Nunavut). Survey responses were evaluated using descriptive statistics and logistic regression analyses. Response rate was 61%. Overall, respondents were most likely to endorse pharmacist responsibilities related to vitamins and minerals, followed by herbal medicines, then homeopathic medicines. Responsibilities regarding knowledge of NHPs and counseling on NHPs were more frequently endorsed than responsibilities associated with NHP-related documentation. Self-reported knowledge was positively associated with endorsement of NHP-related responsibilities for all NHP types.

No description available.

Objective: To reach consensus on entry-to-practice natural health product (NHP)-related competency statements for Canadian pharmacy students. Methods: Four rounds of a modified Delphi method were conducted. Participants; pharmacy educators,and representatives from Canadian pharmacy organizations (n=17), ranked their level of agreement using a 5-point Likert scale. Results: Consensus occurred when all participants ranked a statement 4 or 5. Three core NHP-related competencies were identified: 1) the ability to incorporate NHP knowledge when providing pharmaceutical care; 2) the ability to access and critically appraise NHP-related information sources, and 3) the ability to provide appropriate education to patients and other health care providers on the effectiveness and potential adverse effects and drug interactions of NHPs. Two additional NHP-related competency statements emerged as important, but consensus was not achieved. Conclusions: If the developed core NHP-related competency statements are widely implemented, Canadian pharmacists will be able to fulfill their NHP-related professional responsibilities upon entry-to-practice.

The research presented in this thesis addressed knowledge gaps for three medicinal plant taxa, Souroubea spp. (Marcgraviaceae) and Platanus (Platanaceae) as well as Echinacea spp. (Asteraceae). The primary pharmacological mechanism of Souroubea sympetala and Platanus occidentalis were well established, with pentacyclic triterpenes identified as major active principles. My results indicate that major triterpenoids, and crude plant extracts, selectively inhibited monoacyglycerol lipase (MAGL) activity but not fatty acid amide hydrolase (FAAH) activity. These data suggest a possible secondary anxiolytic mechanism of action through the endocannabinoid system (ECS). My study of herb-drug interactions of Souroubea and Plantanus products showed some potential risk when combined with a classic benzodiazepine class drug, diazepam, and I proposed a mechanism through in vitro CYP450 enzyme inhibition. The pharmacokinetic study revealed the difficulty of detecting betulinic acid in animal blood. To support the development a commercial botanical composed of these medicinal plants, an extraction method and a highly sensitive and selectivity HPLC-APCI-MS based quantification method was successfully developed and validated. Part II of this thesis focused on the impact of phytochemical variation and hepatic metabolism on the ECS activity of Echinacea spp. and explored the potential for new applications of Echinacea spp. as a natural health product. My research indicated that considerable variability in the content of phenolic and alkylamide (AKA) compounds reflected similar variability in in vitro bioactivity at ECS-related pharmacological targets. Following biochemometric analysis, several phenolic compounds and AKAs in Echinacea spp. were found to be significant independent variables determining FAAH inhibition and CB receptor activation. Hepatic metabolism was also found to affect the FAAH inhibition of AKA, as increased FAAH inhibitory effects were observed after CYP450-mediated metabolism of both individual AKAs and crude extracts of E angustifolia and E. purpurea, suggesting a “pro-drug” mechanism. Dose dependent activities were observed with oral administration of both E angustifolia and E. purpurea root extract in rat paw model of inflammation and pain. Further tests indicated these activities can be partially blocked by co-administration of CB1 and CB2 receptor antagonists AM251 and AM630, respectively. This evidence suggests activity for peripheral pain was at least partially mediated through the ECS.