Natural Medicines

Natural Medicines is the combination of two of the leading evidence-based information databases in the field of complementary and alternative medicine: the Natural Medicines Comprehensive Database (NMCD) and Natural Standard. In 2013, the Therapeutic Research Center merged with Natural Standard in order to create Natural Medicines, calling itself, “The most authoritative resource available on dietary supplements, natural medicines, and complementary alternative and integrative therapies” [1].

The goal of Natural Medicines is to provide “unbiased, evidence-based information and ratings for over 90,000 dietary supplements, natural medicines, and integrative therapies” for health care professionals [2]. This combined product provides A–Z listings of over 1,400 monographs, updated daily. According to a representative of the Therapeutic Research Center, the product includes more than 50,000 scientific citations, which the center states is the “largest natural medicines database in the world,” with approximately 1,200 monographs on natural ingredients and over 200 monographs on complementary and alternative treatments [2]. This content is divided into 4 main headings: Databases, Tools, [Continuing Education/Continuing Medical Education] CE/CME Center, and Colleagues Interact, detailed below, plus News and About Us sections. Patient handouts are included with all monographs, and ingredient monographs include background information, history, toxicology, and pharmacokinetics, as well as expanding on preexisting information such as dosing and administration.

DATABASES

Natural Medicines provides seven searchable resources in its databases section:

• ▪Food, Herbs & Supplements includes evidence-based monographs on the safety and effectiveness of “vitamins, herbs, minerals, non-herbal supplements, naturally sourced chemical compounds, and foods” [3].
• ▪Health & Wellness includes evidence-based monographs on complementary therapies and specialized diets (e.g., acupuncture, kosher diet, gluten-free diet, yoga). Monographs in this section include information on safety and effectiveness as well as any interactions. This section has recently been expanded to cover many popular therapies and diets.
• ▪Sports Medicine contains monographs relevant to sports medicine, which includes “specific exercise regimes, injury treatments, and sports supplements” [3].
• ▪Comparative Effectiveness lists multiple therapies for a specific condition in a single chart. The charts in this section are clear and concise. Therapies are also ranked by their levels of effectiveness.
• ▪Manufacturers includes a list of all commercial product manufacturers found in the Natural Medicines Commercial Products section.
• ▪Commercial Products includes information on more than 92,000 products. Monographs cover product ingredients, information on product safety and effectiveness, adverse events and interactions, and the Natural Medicines Brand Evidence-based Rating (NMBER).
• ▪Medical Conditions includes a detailed summary of conditions, with information such as related terms, background, causes, signs and symptoms, diagnosis, complications, treatment, integrative therapies, and prevention.

NATURAL MEDICINES BRAND EVIDENCE-BASED RATING (NMBER)

Natural Medicines now includes a new grading system, the NMBER, which “takes into account Safety Ratings and Effectiveness Ratings from Natural Medicines Comprehensive Database as well as manufacturing quality data directly from adverse event report systems and recognized sources such as the United States Pharmacopeia (USP) and other regulatory agencies” [4]. NMBER is a color-coded, numeric scale from 1–10. Products with lower numbers have potential safety concerns, whereas products with higher numbers have met rigorous standards and have shown positive results. The color-coded marking identifies products with Major (red), Moderate (yellow), or Insignificant (green) levels of significance. In addition, citations to published literature are included, along with links to abstracts in PubMed where available.

TOOLS

In addition to basic and advanced search functionality, the following search tools are available for herb, supplement, vitamin, mineral, or complementary practices: Interaction Checker, Effectiveness Checker, Nutrient Depletion Checker, Pregnancy & Lactation, and Adverse Effects. The Interaction Checker allows users to search for interactions in natural medicine agents but clearly states that this checker “does not check for drug-drug interactions” [1]. The Effectiveness Checker gives users the ability to enter the name of a condition or disease and see lists of natural medicines based on effectiveness. Results are listed in four categories: Likely Effective, Possibly Effective, Possibly Ineffective, and Insufficient Reliable Evidence To Rate. The Nutrient Depletion Checker tool allows users to search for nutrients that might be depleted by prescription or over-the-counter medication. The Pregnancy & Lactation checker searches ingredients and grades them on their level of safety for pregnant and breastfeeding women; citations to related articles are provided when available. Finally, the Adverse Effects tool allows users to select adverse effects from an alphabetized list and provides a list of agents that can be associated with each effect.

The Tools section can be found in two locations: along the header and along the left-hand side. The content in both locations is the same, except that the Charts and Natural MedWatch sections are only available under the header. The Charts section provides a comprehensive alphabetical list of monographs for herb classifications, plus a “special chart for Caffeine Content of Energy Drinks and Shots” [3]. Natural MedWatch is an online form that allows users to make confidential reports of adverse events and side effects of any natural medicine.

PATIENT HANDOUTS

Each monograph in Natural Medicines includes patient handouts in English, Spanish, and French. Patient handouts include general information on products, their level of effectiveness, a brief explanation of how the product works, safety concerns, food or drug interactions, dosing information, and alternative names. All of this information is presented in a format that is clear and easy to read.

CONTINUING EDUCATION/CONTINUING MEDICAL EDUCATION CENTER

CE and CME credit is available via the CE/CME Center with two options for coursework: a Clinical Management Series on the “clinical management of disease states and medical conditions” and Monograph-Based Courses “focused on safety and effectiveness of natural medicine ingredients” [5]. The Clinical Management series carries over from NMCD and is continuously updated with the most current information available [6]. Users who wish to access CE/CME coursework in the Clinical Management Series will be required to create a CE ID number. The Monograph-Based Course series is a carryover from the former Natural Standard and will only be offered through March 24, 2017 [7].

COLLEAGUES INTERACT

The Colleagues Interact section is a forum that allows members to post, search, and comment on messages created by other members. A member's CE ID number is required to be able to post and comment on messages in this section. Comments and additional feedback from the Natural Medicines editorial team are easy to find, because each of these posts are designated with a highly visible red star.

THE APP

Currently, there is no app that includes the newly combined data from NMCD and Natural Standard. However, the NMCD app is still available. Subscribers to Natural Medicines can access the app's subscribers-only content, which includes access to all the features of NMCD. A free consumer version of the app is also available. Although the consumer version of the app does not include the full suite of subscribers-only content, it does include the Effectiveness Checker, Nutrient Depletion Checker, Natural Product/Drug Interaction Checker, and NMBER rating. Both apps are available for iOS and Android devices and, to remain unbiased and noncommercial, do not include any endorsements or advertisements [8]. The app can be used offline, with content updated automatically whenever a WiFi connection is available.

CONCLUSION

The merger between NMCD and Natural Standard has had an overall positive impact on the creation of the Natural Medicines database in numerous ways, including improved ingredient monographs, additional monograph types, expanded tools, and an updated user interface. The merger has also dramatically increased the amount of searchable content.

Natural Medicines would be an asset to any medical institution for both educational and clinical purposes. It provides high-quality, evidence-based information on natural medicines and alternative therapies in an often-overlooked area of medicine. No other resources in this field seem to offer an equivalent amount of evidence-based rigor. However, subscribers would benefit greatly from a new Natural Medicines mobile device app that includes the merged content from NMCD and Natural Standard.