Herbal product education in United States pharmacy schools: Core or elective program?

American Journal of Pharmaceutical Education, Spring 2001 by Mackowiak, Elaine D, Parikh, Ami, Freely, Joshua

This study examined the extent of use and knowledge of herbal drugs by pharmacy students. This data was used to revise an existing core course in nonprescription drugs to include basic information about herbal products. A convenience sample of 370, culturally diverse students completed a print survey on the appropriate use of twelve popular herbal products. Pearson Chi-square analysis evaluated students' knowledge. The average score was only 32 percent Individual student scores were affected by ethnicity, work experience, family tradition, and sources of information. This data demonstrates the need for herbal instruction in core curricula of pharmacy colleges if students are expected to provide comprehensive pharmaceutical care in the area of self-care for their patients. Colleges of pharmacy should include formal instruction on herbal products in their curricula; the remaining question to be answered is whether it should be in the core or elective curricula.

INTRODUCTION

Complementary and alternative medicine (CAM) includes a wide variety of modalities, some of which are more relevant to pharmacy practice than others, such as herbs, megavitamins, and homeopathic products. Other CAM modalities include chiropractic, acupuncture, exercise, massage, biofeedback, aroma therapy, magnetic or energy healing, hypnosis, self-- help, spiritual healing, lifestyle diets, and relaxation techniques.

The use of complementary and alternative medicine (CAM) by the public in the United States increased from 33.8 to 42.1 percent from 1990 to 1997(1), and individual use of herbal products among CAM users was reported as ranging from 12.1 to 26 percent(1-3). Gaedeke et al. reported that 29 percent of a group of college students used herbal products(4). Sales of herbal products were estimated to be as high as $5.1 billion, and many of those sales occurred in community pharmacies(5).

Paradoxically, while herbal product use increased, formal instruction in colleges of pharmacy decreased(6). The popularity of CAM has led to a renewed interest among pharmacy colleges and medical schools to include CAM instruction in the curriculum(7-8). However, as recently as 1997, 13 of 60 pharmacy schools responding to a questionnaire reported that herbal products were not discussed in any course(6). (Only 60 of the 77 U.S. pharmacy schools responded to the survey.) CAM instruction, including herbal products, was not available in 13 of 50 pharmacy schools responding to a survey in 1998(7).

There was considerable variation in the number of contact hours for both herbal and other CAM instruction ranging from 1.5 to 67 hours per course among 36 out of 50 (72 percent) pharmacy schools(7). A survey of medical schools reported that 75 of 117 schools (64 percent) offered CAM course work(8). Contact hours ranged from two to 10 hours for required courses, and one to 160 hours for elective courses. There was also variation as to whether or not herbal and/or CAM instruction was in a required or elective course in both pharmacy and medical schools.

Nursing educators have recommended that CAM therapy becomes a formalized component within the nursing curriculum(9,10). Seven of the 27 schools of veterinary medicine in the U.S. incorporate courses on complementary and alternative veterinary medicine in their programs(11).

Pharmacists graduating in this environment of increasing use of CAM therapies should be prepared to answer consumer questions about them because they represent an increasing area of pharmacy sales. All pharmacists require basic knowledge of these products if they intend to offer comprehensive pharmaceutical care to their patients. The question remains as to whether instruction in CAM should be in core or elective courses, and the extent of instruction required.

Pharmacy students represent a diverse population including different genders, ages, cultural backgrounds, and educational and work experiences. This study was designed to determine if these differences affected students' use and knowledge of herbal products prior to any formal instruction in a pharmacy school's curriculum.

METHODS

A written survey instrument was administered to a convenience sample of 370 pharmacy students in a large, eastern, urban, culturally diverse pharmacy school (Temple University) before the students were scheduled to take a required course in overthe-counter products which discusses popular herbal products. The survey was pre-tested by students enrolled in an elective course. The survey included multiple choice objective questions about the therapeutic use of 12 popular herbal drugs, ginkgo biloba, St. John's wort, garlic, echinacea, ginseng, saw palmetto, valerian, feverfew, cranberry extract, kava-kava, hawthorn extract, and ephedra. The choice of herbs for inclusion in the survey was based on published lists of popular use and sales volume(12,13). The last choice for each question was, "Don't Know," to eliminate guessing. Students' knowledge was calculated as the percent correct of the multiple choice questions.