Ethical and practical considerations in prescribing animal-derived medication

Corfield, Lorraine; Granne, Ingrid

doi:10.1136/postgradmedj-2012-131053

Cited by 9 publications

(10 citation statements)

References 3 publications

(3 reference statements)

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“…Unfortunately, the source of stearate is not indicated on most labels [11]. Other common problematic ingredients include albumin, which may be either human or bovine in origin; insectderived carmine, cochineal, and shellac; bovine-derived casein; bovine or ovine deoxycholate; piscine-derived protamine; and tallow, which may be bovine, ovine, or porcine in origin [9][10][11].…”

Section: Potentially Problematic Drugs and Drug Productsmentioning

confidence: 99%

“…One aspect of patient cultural belief that may impact medical care involves medicines and surgical products derived from animal and human sources [9][10][11]. A growing consensus is emerging among prescribers regarding the need to inform patients who might object to animal-derived medications [12,13], though prescribers are often unaware that medicines contain animal-derived ingredients [9]. Several nations have published guidelines to address pharmaceuticals of animal origin.…”

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confidence: 99%

“…As a systematic review focused on the impact of religious belief on medication selection related to animalderived drug ingredients, the primary objective of this research was to provide quantified categorical information to promote awareness of the importance of the issue. We update and expand upon earlier reports and editorials [9][10][11][12][13][14][15][16][17] to focus on studies that investigate patient, religious leader, and physician-provider perspectives. We offer brief synopses of beliefs in six major United States' religious sects to identify common beliefs that may impact patient satisfaction with medication selection.…”

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confidence: 99%

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Animal-derived medications: cultural considerations and available alternatives

Babos

Perry

Reed

et al. 2021

Journal of Osteopathic Medicine

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Context Cultural competency is a cornerstone of patient-centered health care. Religious doctrines may define appropriate consumption or use of certain animals and forbid use of others. Many medications contain ingredients that are animal-derived; these medications may be unacceptable to individual patients within the context of their religious beliefs and lifestyle choices. Knowledge of animal-derived medications as a component of cultural competency can facilitate a dialogue that shifts focus from the group to the individual, away from cultural competency toward cultural humility, and away from a paternalistic provider/patient dynamic toward one of partnership. Objectives To explore how animal-derived drug components may impact medication selection and acceptability from the perspective of patients, physicians, and religious leaders as evidenced by studies that explore the question via survey or questionnaire. A secondary objective is to use the context of animal-derived drug products as a component of cultural competency to build a framework supporting the development of cultural humility. Methods A systematic search was performed in the PubMed, CINAHL, Cochrane, and ProQuest databases using combinations of the following terms: “medication selection,” “medication,” “adherence,” “pharmaceutical preparations,” “religion and medicine,” “religion,” “animal,” “dietary,” “porcine,” and “bovine.” Studies that reported using surveys or questionnaires to examine patient, physician, or religious leader perspective on animal-derived medications published in English between 1990 and 2020 were included. Review articles, opinion pieces, case reports, surveys of persons other than patients, religious leaders, or physicians, and studies published in languages other than English were excluded. Three authors independently reviewed articles to extract information pertaining to perspectives on animal-based medication ingredients. Results Eight studies meeting the described criteria were found that queried beliefs or knowledge of patients, religious leaders, or physicians regarding medications and medical products of biologic origin. Those studies are described in full in this review. Conclusions Knowledge of animal-derived ingredients may help open conversations with patients around spiritual history and cultural competency, particularly for those patients belonging to religious sects with doctrines that define appropriate use of human- or animal-derived products. Further formal study is needed to explore more fully the extent to which religious beliefs may impact selection of animal- or human-derived medications. Guidelines developed from this knowledge may aid in identifying individual patients with whom the discussion may be particularly relevant. More studies are needed to quantify and qualify beliefs regarding animal-derived medication constituents.

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Section: Potentially Problematic Drugs and Drug Productsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Animal-derived medications: cultural considerations and available alternatives

Babos

Perry

Reed

et al. 2021

Journal of Osteopathic Medicine

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“…Researchers have discovered some synthetic methods for LCA, which are mainly divided into the following two categories: (1) the use of commercially available domestic animal bile-based materials, such as cholic acid, deoxycholic acid, chenodeoxycholic acid, and hyodeoxycholic acid (Figure ), as starting materials for the synthesis of LCA , and (2) the use of commercially plant-sourced materials as starting materials (bisnoralcohol BA, Figure ) for the synthesis of LCA . However, animal-sourced materials have some potential risks, such as avian influenza, bovine spongiform encephalopathy, and swine influenza. , Moreover, the target LCA is often obtained after a multistep operation with existing low yields and difficult separation of isomers, which limits their further applications. Recently, Qiu et al used plant-sourced bisnoralcohol as the starting material, owing to its low cost, availability, and accessibility, to develop a five-step synthetic route for LCA (68% overall yield) (Scheme A).…”

Section: Introductionmentioning

confidence: 99%

Optimization and Impurity Control Strategy for Lithocholic Acid Production Using Commercially Plant-Sourced Bisnoralcohol

Zeng

Cui

et al. 2023

ACS Omega

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In this study, lithocholic acid (LCA) was prepared using commercially available plant-sourced bisnoralcohol (BA), and the overall yield of the product was 70.6% for five steps. To prevent process-related impurities, the isomerizations of catalytic hydrogenation in the C4−C5 double bond and reduction of the 3keto group were optimized. The double bond reduction isomerization was improved (5β-H:5α-H = 97:3) using palladium− copper nanowires (Pd−Cu NWs) instead of Pd/C. The reduction of the 3-keto group was 100% converted to a 3α-OH product by 3α-hydroxysteroid dehydrogenase/carbonyl reductase catalysis. Moreover, the impurities during the optimization process were comprehensively studied. Compared with the reported synthesis methods, our developed method significantly improved the isomer ratio and overall yield, affording ICH-grade quality of LCA, and it is more cost-effective and suitable for large-scale production of LCA.

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“…Therefore, following reflection about their own provision, they have provided suggestions as to where educators could integrate veganism teaching into pharmacy degree programs (Table 3). Examples of resources to support this teaching include: general considerations for vegan patients about excipients, 20 implications of religious and cultural beliefs on selection of medicines, 29 ethical and practical considerations in prescribing animal-derived medication, 30 databases which provide product ingredients (although it may not be obvious which excipients are animal-derived and thus the manufacturer may need to be contacted directly), health publications databases and government-endorsed organizations (including dietetic associations) information about nutrition and diet. Optional self-directed reading for students (given existing time constraints within pharmacy degree programs) could include: vegan and animal ethics societies (websites), "Critical Perspectives on Veganism", 31 and the "Oxford Handbook of Food Ethics."…”

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confidence: 99%