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Article Excerpt
Herbal supplements and other complementary therapies are surrounded by clinical and ethical issues, some involving urologists. In this exclusive interview, Mark A. Moyad, MD, MPH, discusses the current controversies and reviews data on commonly used supplements. Dr. Moyad is the Phil F. Jenkins Director of Preventive and Alternative Medicine, Michigan Urology Center, Ann Arbor, and editor-in-chief of the journal Seminars in Preventive and Alternative Medicine. He was interviewed by UT Editorial Consultant Philip M. Hanno, MD, MPH, professor of urology at the University of Pennsylvania, Philadelphia.
Q Tell us how you became interested in complementary medicine, and describe your position at the University of Michigan.
A My father is a urologist who is still practicing at the age of 75, so he influenced me. Before I thought seriously about medical school, I volunteered at Michigan with Ed McGuire, MD, in urology. Prior to medical school, I attended the University of South Florida School of Public Health in Tampa, where I received a master's in public health degree. I had two initial assignments: One was to work a supplement investigation for the state of Florida, in which a dietary supplement was causing deaths in Florida and other states. That same year, I was involved in a project looking at cottonseed oil and its effect on male fertility.
My father was trained by Lester Persky, MD, at the Cleveland Clinic, and Dr. Persky spent the last few years of his life and career teaching at a VA hospital in Tampa, FL, across the street from where I attended public health classes. So we used to meet almost every week for lunch. Ken Pienta, MD, and Jim Montie, MD, provided the support to make it possible to pursue this area full-time, and to start the first AUA course with Bill Fair, MD, Leonard Marks, MD, and Ian Thompson, MD. Like my dad, these individuals were so motivational and ethical, and they insisted on my becoming an educator and a voice of objectivity in the alternative medicine world.
I realized that this was a fascinating area that no one was touching. I also wanted to do some type of cancer research because my family has been affected by it. The fact that natural compounds can do such good and such harm was intriguing. I knew that there was no formal program in medicine for studying natural compounds, although such programs existed in public health. I began to see a huge need in this area.
To be honest, there's no way that you and I would be here had it not been for several patients who donated a large sum of money to set up an endowment that came when I was in medical school. An endowment within urology was established so I could pursue the study of complementary medicine in terms of clinical and basic science research and set up a consulting practice within urology at the University of Michigan.
I now have the best of both worlds. I can pursue what I want to pursue and stay within the area of complementary and alternative medicine, but at the same time, I can do this within the specialty that I love the most. I really believe I am a part of the perfect and best possible occupational marriage by working in urology at Michigan because the bi-directional learning is limitless and, in the end, the patients are really the winners because they receive good, comprehensive care. I hope it has set up a paradigm for other specialties to follow in the future.
Q What makes herbal and complementary medicine preparations different from drugs, apart from their lack of scientific efficacy and side effect data?
A First and foremost, herbal and dietary supplement preparations shouldn't be treated differently than drugs are. The credibility of alternative medicine and dietary supplements is not enhanced unless they are held to the same standards as drugs. The data have to be evidenced based.
I tell patients that no person should take any sort of pill without some background testing, a risk assessment, and evidence-based medicine to suggest they actually qualify for that pill. Alternative medicine is still the only area of medicine where we create dosages simply based on appearance. I may look at a patient and tell him that he needs 800 international units (IU) of vitamin D or that he might need saw palmetto. In reality, these patients should qualify, just as they do with drug therapy, based on some sort of testing.
When patients don't understand this, I use two examples. One is cholesterol testing. You'd never come into a physician's office and ask to be put on a cholesterol-lowering drug without any testing, which is what's being done with some of these supplements.
The other example is vitamin D. We now have a good diagnostic test, the 25-OH vitamin...
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