BackgroundThe unprecedented global increase in the use of herbal remedies is set to continue apace well into the foreseeable future. This raises important public health concerns, especially as it relates to safety issues including adverse effects and herb-drug interactions. Most Western-trained physicians are ignorant of the risks and benefits of this healthcare modality and assessment of acceptance and knowledge would identify appropriate intervention strategies to improve physician-patient communication in this area.MethodsA cross-sectional survey was done using an interviewer-administered pilot tested de novo questionnaire at six public hospitals in Trinidad between May–July 2004. The questionnaire utilized weighed questions to quantify acceptance (maximum score = 14 points) and knowledge (maximum score = 52 points). Acceptance and knowledge scores were analyzed using the ANOVA and Tukey's tests.ResultsOf 192 physicians interviewed, most (60.4%) believed that herbal remedies were beneficial to health. Respondents had relatively high acceptance levels (mean = 5.69 ± 0.29 points or 40% of total possible score) and poor knowledge (mean = 7.77 ± 0.56 points or 15% of total possible score). Seventy-eight physicians (40.6%) admitted having used herbs in the past, and 60 of these (76.9%) were satisfied with the outcome. Although 52 physicians (27.1%) recommended the use of herbs to their patients only 29 (15.1%) were able to identify at least one known herb-drug interaction.ConclusionThe use of herbal remedies is relatively high in Trinidad, as throughout the world, and most patients self-medicate with or without the knowledge of their attending physician. Surprisingly, we demonstrated relatively high acceptance levels and use of herbs among physicians in Trinidad. This interesting scenario of high acceptance levels and poor knowledge creates a situation that demands urgent intervention. We recommend educational intervention to narrow the gap between acceptance and knowledge so that physicians would be adequately equipped to communicate with their patients on this modality. The integration of herbal medicine into the curriculum of medical schools, continuing education programs and the availability of reputable pharmacopoeias for referencing at public health institutions are useful instruments that can be used to close this gap and promote improved physician-patient communication.

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Albedo (the inner, white part of the rind) of the grapefruit (Citrus parodisi) and the flowers of the garden hibiscus (Hibiscus rosa-sinensis) were analysed for the presence of chemo-stimulants for the leaf-cutting ants Atta cephalotes (L.) and Acromyrmex octospinosus (Reich). Two distinct types of chemical substances in grapefruit albedo (unabsorbed sapids from a cation-exchange resin I.R. 120, and the total lipid fraction) were significant arrestants for Atta cephalotes, whilst five types of chemical substances (absorbate on the cation-exchange resin I.R. 120, unabsorbed sapids from the same resin, the total lipid fraction, absorbate on a polyamide resin, and neohesperidosides) arrested Acromyrmex octospinosus. For both ant species, the unabsorbed sapids from the polyamide resin appeared to be the most attractive of the relatively refined fractions. A preliminary analysis showed a similar situation for hibiscus flowers.Both ant species preferred young to older grapefruit leaves. There appears to be a chemical basis for this, and in the case of A. octospinosus there was evidence of the existence of repellents in the older leaves and in grapefruit flavedo (the outer, yellow part of the rind).Substantial heterogeneity in preferences was detected in a given nest from day to day, between different nests of the same species, and between the two species. It is suggested that this is attributable to social phenomena evolved by the ants.