From Bush Medicine to Modern Phytopharmaceutical: A Bibliographic Review of Devil’s Claw (Harpagophytum spp.)

Devil’s claw (Harpagophytum spp., Pedaliaceae) is one of the best-documented phytomedicines. Its mode of action is largely elucidated, and its efficacy and excellent safety profile have been demonstrated in a long list of clinical investigations. The author conducted a bibliographic review which not only included peer-reviewed papers published in scientific journals but also a vast amount of grey literature, such as theses and reports initiated by governmental as well as non-governmental organizations, thus allowing for a more holistic presentation of the available evidence. Close to 700 sources published over the course of two centuries were identified, confirmed, and cataloged. The purpose of the review is three-fold: to trace the historical milestones in devil’s claw becoming a modern herbal medicine, to point out gaps in the seemingly all-encompassing body of research, and to provide the reader with a reliable and comprehensive bibliography. The review covers aspects of ethnobotany, taxonomy, history of product development and commercialization, chemistry, pharmacology, toxicology, as well as clinical efficacy and safety. It is concluded that three areas stand out in need of further investigation. The taxonomical assessment of the genus is outdated and lacking. A revision is needed to account for intra- and inter-specific, geographical, and chemo-taxonomical variation, including variation in composition. Further research is needed to conclusively elucidate the active compound(s). Confounded by early substitution, intermixture, and blending, it has yet to be demonstrated beyond a reasonable doubt that both (or all) Harpagophytum spp. are equally (and interchangeably) safe and efficacious in clinical practice.

Attitudes and Practices of Pharmacists and Physicians towards Bush Medicine in Guyana

Aims: To examine the attitudes and practices of physicians and pharmacists towards bush medicine, and explore the factors influencing their attitudes. Also, to determine whether a video educational intervention impacted attitudes. Study Design: This was a cross-sectional study of registered physicians and pharmacists. Place and Duration of Study: A total of 274 persons participated: 134 pharmacists attending their first Continuing Pharmacy Education (CPE) of 2015 and 140 physicians attending their annual Medical Scientific Conference. Methodology: A pre-tested, self-administered questionnaire was distributed and collected, a video intervention was shown, and a post-intervention questionnaire was administered. Data were analysed using latent class cluster analysis, and the best-fitting model was determined using mainly the Bayesian Information Criterion (BIC). Logistic and multinomial regression and Fisher's exact test were also employed to investigate associations with demographic variables and the impact of the intervention. Results: Most of the participants (56.4%) were 20-30 years old, and the majority (52%) had five years or less professional experience. Pharmacists displayed a more positive attitude to bush medicine than physicians. Most (99%) believed that patients should inform their physician/pharmacist about their bush medicine use, but only 53% routinely requested this information. More than half (52%) had personally used bush medicine, but only 38% had ever recommended its use. More than 90% believed that clinical trials should be conducted with bush medicine before it is used, and 88% were interested in further training. Ethnicity, years of professional experience and type of profession influenced attitudes and the intervention led to an improved outlook regarding bush medicine. Conclusion: Overall, most participants had some misgivings about bush medicine but were willing to learn more and were interested in clinical trials. Evidence-based clinical research and training at the tertiary level or future continuing education sessions should be implemented using the content in the video as a template.