Ethical considerations in clinical research on herbal medicine for prevention of cardiovascular disease in the ageing.

BACKGROUND: Cardiovascular disease (CVD) in the ageing is a major public health problem worldwide. The nature of most CVD is subclinical with pathological processes that can span over years. Use of preventive measures could be an appropriate approach to prevailing over CVD in the ageing, and herbal medicine is one of the promising preventive approaches and is currently of interest among medical societies. In the evidence-based era, herbal medicine is, however, often underestimated and approached with skepticism, mainly due to the paucity of scientific evidence. Properly designed clinical trials on herbal medicine for prevention of CVD in a geriatric population are thus of importance and of clinical value. PURPOSE: To review ethical issues and discuss considerations when such research is proposed. CHAPTERS/SECTIONS: Four ethical issues, including the scientific validity of research, risk-benefit assessments, subject selection and vulnerability, and informed consent, are structured and extensively discussed in this article. CONCLUSIONS: Ethical core considerations of prevention research of CVD on herbal medicine involve particular attention on the scientific validity of research, risk-benefit assessments, subject selection and vulnerability, and informed consent. These issues and considerations are keys, although they must be adapted to an individual research setting in which a clinical study is proposed.

[Aflatoxin contamination of Chinese herbal medicine in China and its potential management strategies].

The mould phenomenon occurred commonly in the cultivation, processing and storage period of medicinal materials, which may result in production of mycotoxins. Mycotoxin contaminations caused by fungi are major issues related to the quality and safety of Chinese herbal medicine. This review summarized the work published in aflatoxins contamination of Chinese herbal medicine in China through the previous decade. The conclusion to be drawn from this survey is that aflatoxin exposure remains an important aspect of Chinese herbal medicine safety which needs to be paid great attention. We raised some points that should be focused on in future. The strategies of changing environment to suppress growth of toxin-producing fungus, so as to reduce aflatoxins are the most practical and effective ways, while biological control in the field production is a promising approach.

Use of complementary and alternative medicine (CAM) in autism spectrum disorder (ASD): comparison of Chinese and western culture (Part A).

A cross-sectional survey of the use of CAM by children was undertaken in the Duchess of Kent Children's Hospital in Hong Kong (March-December 2006). A questionnaire survey concerning the use of CAM was administered to chief caretakers (only the mothers) who accompanied children with neurodevelopmental disabilities followed up in our Neurodevelopmental paediatrics clinics. Four hundred and thirty agreed for interview of which 98 (22.8%) had Autism Spectrum Disorder (ASD). CAM was used in 40.8% for ASD and 21.4% of non-ASD (p < 0.001). We describe the profile of use of CAM in ASD in this part A paper. The three most common type of CAM use was Acupuncture (47.5%), Sensory Integration (42.5%), and Chinese Medicine (30%). About 76.9% of interviewees expected CAM to augment conventional treatment. Although 47.5% used both conventional western medicine and CAM, only 22.4% disclosed the use of CAM to Doctors. The following factors were significantly related to CAM use: father's job and mother's religion. Our frequency of CAM used in children with ASD was lower in Canada (52%) and USA (74%, 92%). The main CAM use in western culture was biological-based therapy whereas acupuncture was the most common CAM used in our locality.