Handbook of Essential Oils: Science, Technology, and Applications

Issue: 112 Page: 72



by Francis Hadji-Minaglou, PharmD

HerbalGram. 2016; American Botanical Council

Handbook of Essential Oils: Science, Technology, and Applications, 2nd ed., by Gerhard Buchbauer and K. Hüsnü Can Başer, eds. Boca Raton, FL: CRC Press; 2016. Hardcover; 1,109 pages. ISBN: 978-1-4665-9046-5. $199.95.

The second edition of Handbook of Essential Oils: Science, Technology, and Applications is a collective work, written by top scientists and led by two eminent specialists in medicinal and aromatic plants: Gerhard Buchbauer, PhD, and K. Hüsnü Can Başer, PhD.

This text is 1,109 pages of pure interest on essential oils, and it provides a crucial compilation of information related to their development, use, and marketing, with a particular focus on their chemistry, pharmacology, and biological activities.

No topic is left out: history and production, chemical analysis and quality control, toxicity and adulteration, pharmacognosy and medical use, pharmacodynamics and biotransformation by the living, galenic and industrial use, trade and legislation. Each topic has its own chapter(s), well-documented, with an extensive bibliography.

Whether it be researchers, professors, professionals and industrials, herbalists, or simply curious individuals, this work is of considerable interest to essential oils enthusiasts, thanks to its large knowledge base, which is supported by up-to-date data.

If I could borrow from Woody Allen, I would name this book Everything You Always Wanted to Know about Essential Oils but Were Afraid to Ask.

Compared to the first edition, this book presents new chapters on the natural variability of components occurring in essential oils, and on the natural processes that cause adulteration of essential oils; revisions, updates, and expansions of previous chapters; and a split of the previous chapter on biological activities and antioxidative properties of essential oils.

The book is divided into several large sections:

Part I describes the sources, production, and natural variability of essential oils. This part is a beautiful study, precisely integrating the concept of “chemotype,” which is essential for the understanding of aromatherapy.

Part II concerns chemistry. These chapters lead to the understanding of the biosynthetic pathways of aromatic compounds, discuss the most relevant analytical methods for quality control, describe adulteration, and lay the foundations for the safe use of aromatic molecules and essential oils.

Part III focuses on pharmacology, toxicology, and biological activity of essential oils, with two very important chapters describing the metabolism of terpenoids in animal models and humans, as well as encapsulation and other programmed released techniques for essential oils and volatile terpenes.

Part IV describes the biotransformation mechanisms of terpenoids in microorganisms, fungi, green algae, insects, mammals, and other living things. This is timely now that ecotoxicology is becoming more and more important.

Part V discusses the use of essential oils in aromatherapy, veterinary medicine, agriculture, and cuisine.

Part VI describes the trade, storage, labeling, and transport of essential oils.

Part VII reviews the recent European Union legislation update on flavors and fragrances and its impact on essential oils.

This “handbook” will assist anyone working on or interested in essential oils. The first edition never leaves me, nor will the second. The quality of this book definitely outshines its price, considering the amount of knowledge it provides.

—Francis Hadji-Minaglou, PharmD

Scientific Director, BOTANICERT

Grasse, Franc

Peyote: History, Tradition, Politics, and Conservation

Issue: 112 Page: 73-74


by Bret Blosser, PhD

HerbalGram. 2016; American Botanical Council

Peyote: History, Tradition, Politics, and Conservation by Beatriz Caiuby Labate and Clancy Cavnar, eds. Santa Barbara, CA: Praeger; 2016. Hardcover, 280 pages. ISBN: 978-1-4408-3400-4. $60.00.

This book is a welcome addition to scholarly publications regarding the spineless psychoactive cactus peyote (Lophophora williamsii, Cactaceae). The editors, Beatriz Caiuby Labate, PhD, and Clancy Cavnar, PsyD, have assembled a dozen essays by scholars, legal specialists, and a Native American Church leader on a range of topics. Readers with an interest in botanical entheogens (i.e., compounds that alter consciousness), indigenous North American spiritual practice, and native peoples’ religious rights will find a close reading of these essays rewarding.

Unlike previous publications in this field, these authors hail from several disciplines and illuminate distinct aspects of the human/cactus relationship. However, it must be mentioned that the book’s subtitle, “History, Tradition, Politics, and Conservation,” does not spell out the essayists’ primary concerns. A more accurate subtitle might be “History, Law, and Tourism.” The reader can easily find a wealth of information on peyote tradition from the classic studies on peyote use by Native Americans described in People of the Peyote: Huichol Indian History, Religion, and Survival by Stacy Schaefer, PhD, and Peter Furst, PhD (University of New Mexico Press, 1997). However, in the present book only one chapter, “From Solid to Frothy: Use of Peyote in the Cora and Huichol Easter in Western Mexico,” is concerned with “tradition.”

While several chapters explore the intricate and prolonged struggle for legal religious use by native peoples in the United States and Mexico, these processes are discussed from the perspective of court rulings, and the politics of supporting and opposing constituencies are discussed only in passing. In their instructive introduction, James Bauml, PhD, and Schaefer draw attention to the issue of conservation and raise an alarm regarding declining peyote populations in the Texas borderlands, apparently resulting from “improper harvesting techniques,” as well as habitat degradation resulting from “mining, agriculture, raising cattle, oil developments, and construction of wind farms.”

Kevin Feeney, JD, in his chapter “Peyote, Conservation, and Indian Rights in the United States,” addresses legal aspects of potential cultivation to reduce pressure on remaining peyote populations in this country. Bob Prue, PhD, offers insight into Native American Church members’ attitudes toward cultivation as a response to diminishing supply in his chapter, “Protecting the Peyote for Future Generations.” These authors are understandably preoccupied with the approach of a drastic shortfall in the supply of a sacramental substance crucial to spiritual practice, healing, and community for thousands of Native American Church members in the western United States and Canada. Reading between the lines, it seems clear that interested parties, many of whom are familiar with the myriad factors at play, have yet to generate a plan for the recovery of peyote populations in the United States and the protection of endangered Mexican populations.

The three chapters by Mexican specialists indicate that the cactus has been overharvested in that portion of its extensive range in the central deserts of northern Mexico known as Wirikuta, a complex landscape sacred to the Huichol people who reside far from peyote habitat in the Sierra Madre Occidental of western Mexico. This overharvesting is the result of sustained enthusiasm for an authentic experience by non-indigenous seekers, both Mexican and international, and from entrepreneurs’ extraction of “organic mescaline” for the recreational drug trade. A chapter on conservation from the biological perspective would have been illuminating and would justify, for plant-oriented readers, the use of the term “conservation” in the subtitle.

Readers not familiar with the existing literature will find brief but useful introductions to peyote biology, history, and Native American Church and Huichol peyote practices. Those versed in the basics will find new tales of the cactus’s adventures in humanland. For example, a chapter by Erika Dyck, PhD, “Peyote and Psychedelics on the Canadian Prairies,” not only documents the little-studied arrival of peyote ceremonialism in Canada but also brings to light the strategic and serendipitous confluence of Canada’s early psychedelic research scientists and the nascent Canadian Native American Church, then facing stiff government repression.

Also outstanding are three chapters on legal history and legal status of Native American peyote use in the United States: “Peyote, Christianity, and Constitutional Law” by Varun Soni, PhD, JD; “State and Federal Legal Protections for Peyote Use in the United States” by John P. Forren, PhD; and Feeney’s “Peyote, Conservation, and Indian Rights in the United States.” The Native American Church’s legal travails and victories have been detailed in previous publications, but these chapters, which are mostly accessible to non-specialist readers, uncover broader implications for Native American rights and the practice of minority religion in general.

This focus on legal aspects of peyote continues with Labate and Feeney’s chapter, “Paradoxes of Peyote Regulation in Mexico,” an exhaustive and groundbreaking account of international treaties, national legislation, and regulations pertaining to the protection and use of peyote. The authors highlight the “lack of recognition of mestizo folk uses, as well as of contemporary hybrid ceremonies.” They find this lack especially deplorable because of Mexico’s history of exchange and fusion between local and European cultural traditions. In their introduction, Bauml and Schaefer point to a corresponding discrepancy north of the border, questioning “whether or not it makes sense to have our governments continue to police racial boundaries as they did in the past.” Non-native use, either medical or spiritual, outside of recognized religious context is the elephant in the courtroom.

Perhaps the most notable contribution to peyote literature is made by Vincent Basset, PhD, and Mauricio Genet Guzman Chavez, PhD. Their chapters address issues arising from burgeoning international guided spiritual and cultural tourism in Wirikuta (the focus of Huichol pilgrimage) and from the embrace of practices derived from Huichol pilgrimage, and based in Huichol sacred landscape by Mexicans seeking connection with ancestral roots. The authors refrain from disparaging the aspirations and ceremonies of guides, tourists, and culture seekers, but make it clear that neither cactus nor Huichol pilgrims can sustain this attention.

—Bret Blosser, PhD

Moab, Utah

Philippe Rasoanaivo 1946-2016 / Martin Wedel 1954-2016

Issue: 112 Page: 77

Philippe Rasoanaivo
1946-2016 

by Hannah Bauman

HerbalGram. 2016; American Botanical Council

Renowned phytochemist Philippe Rasoanaivo, PhD, passed away on July 13, 2016, at the age of 69, after a heart attack. Rasoanaivo dedicated his professional career to bioprospecting the rich plant life of his native Madagascar for new plant-based medicines, particularly for malaria, and co-founded the Association for African Medicinal Plants Standards (AAMPS). At the time of his death, he was the research director at the Malagasy Institute of Applied Research (IMRA) and a professor at the University of Antananarivo (UA) in Antananarivo, Madagascar.

Rasoanaivo was instrumental in building up the natural products research industry in Madagascar and established collaborative connections throughout Africa. After earning his doctorate at UA, he pursued his post-doctoral studies with Norman R. Farnsworth, PhD, at the University of Illinois at Chicago as a Fulbright Scholar. He returned to Madagascar to continue his research on ethnomedicinal plant use for malaria and neurological diseases, working as a researcher at the National Centre for Applied Pharmaceutical Research. Upon joining the faculty at UA, he supervised more than 30 doctoral dissertations and mentored many young researchers.

“Philippe was not only a friend to many of us, but also one of the founding fathers of the [AAMPS],” wrote Thomas Brendler, CEO of Plantaphile (email to M. Blumenthal, August 22, 2016). “He was a major contributor to the African Herbal Pharmacopoeia and other AAMPS publications.”

The International Foundation for Science (IFS) awarded Rasoanaivo a total of four grants in the 1970s and 1980s, first in 1975 for his research on the wound-healing properties of Ilex mitis (Aquifoliaceae). From this work, clinical trials were performed on an extract called Fanaferol, which later became available for clinical use. Following a resurgence in malaria cases in Madagascar, Rasoanaivo switched his focus to traditional malaria remedies. He analyzed remedies used by rural populations, which led him to study alkaloids from Strychnos myrtoides (Loganiaceae) as an adjuvant therapy to chloroquine, an antimalarial drug. The combination therapy was more effective than chloroquine alone. In 2001, IFS awarded Rasoanaivo the sixth Sven Brohult Award. Named after the first president of IFS, the Sven Brohult Award recognizes excellence in research in developing countries, and is awarded every three years.

As the research director at IMRA, Rasoanaivo sought to balance modern techniques with local knowledge to keep treatments affordable and attainable. His approach to bioprospecting native plant remedies promoted economic development in Madagascar, where he also worked to sustain wild populations and biodiversity.

In 2002, Madagascar’s Ministry of Health established the Department of Traditional Medicine and Pharmacopoeias. There, Rasoanaivo worked closely with officials to create a regulatory framework that encouraged the use of traditional remedies while combating the ever-present threat of biopiracy. He also worked with international research and academic centers to collect more than 800 plant specimens over a period of seven years. This cooperative arrangement resulted in improved laboratories and equipment for UA, and the university continues to play a key role in the extraction of compounds from medicinal plants.

Rasoanaivo received numerous awards, grants, and other recognitions for his long and fruitful career. He was an invited professor at institutions in Italy and France, and served as an advisor for a World Health Organization initiative that promoted traditional medicine in Africa. He published more than 100 papers and held seven patents.

He received the Prize of the Malagasy Academy and a research prize awarded by the Ministry of Higher Education in Madagascar, as well as international honors from Cape Town, South Africa, to an entrepreneurship prize in Malaysia. In June 2016, he was awarded the prestigious Olusegun Obasanjo Prize for Scientific Discovery and Technological Innovation, which is bestowed by the African Academy of Sciences every two years to individuals whose scientific discoveries and innovations have helped improve their societies. The award was given in recognition of Rasoanaivo’s work on plant-based treatments for psychiatric and sleep disorders, convulsions, and male sexual dysfunction. When speaking of the award, Rasoanaivo was quoted as saying, “African problems require African solutions.”1

Rasoanaivo is survived by his wife and five daughters.

—Hannah Bauman

Reference

1.         Ackbarally N. Plant medicine research makes scientist win science prize. SciDev.net. July 13, 2016. Available at: www.scidev.net/sub-saharan-africa/medicine/news/plant-medicine-scientist-win-science-prize.html. Accessed September 21, 2016.

Martin Wedel
1954-2016 

by Hannah Bauman

HerbalGram. 2016; American Botanical Council

Martin Wedel, the managing director of purchasing and procurement at the Martin Bauer Group and grandson of company founder Martin Bauer, died on September 21, 2016, at the age of 62, after a battle with cancer. Wedel had been involved with the Martin Bauer Group from a young age, inspired by the examples of his grandfather and his father, Hans Wedel. According to a press release issued by the Martin Bauer Group on September 23, 2016, Martin Wedel “was well known not only for his good sense of humor but for his social involvement as well.”1

Wedel was born in 1954 in Vestenbergsgreuth, Germany, the first child of Hans and Sofie Wedel-Bauer. During his childhood, he often accompanied his father on trips to the Balkan Peninsula to visit suppliers of the botanicals used by the Martin Bauer Group, which has grown to become the leading botanical supplier in the world. This early exposure to the business allowed him to learn the intricacies of the tea industry, leaving him well positioned to join his father and grandfather’s business in 1978. Later, his younger brother, Adolf, joined him.

As the focus of the company shifted from herbal raw materials to medicinal tea formulations and standardized extractions, Wedel stayed innovative throughout the changing demands in supply. He helmed the purchasing and procurement department as it sought new supply regions and markets, and diversified its growing range of products to meet the needs of clients. Under his leadership, the Plantextrakt subsidiary developed the company’s first line of plant extracts in 1980, followed by phytopharmaceutical extracts in 1989. The Martin Bauer Group processes tens of thousands of tons of raw materials from more than 50 countries, but some of that production occurs near its headquarters in Vestenbergsgreuth. Wedel’s extracts divisions (which now include the Finzelberg company, a maker of phytomedicinal extracts) promote sustainability among their raw material suppliers, and they now represent a key success area for the company.

In addition to his dedication to his business, Wedel was deeply involved with his local community. He was the chairman of his father’s charity, the Hans Wedel Foundation, which promotes employment in Vestenbergsgreuth and the conservation of Christuskirche, the local Lutheran church, which was built in 1959. He also served as a member of the town council for more than 30 years. On Wedel’s 60th birthday, Mayor Helmut Lottes personally honored Wedel with a certificate of honorary citizenship. A press release from the Martin Bauer Group issued on April 16, 2014, noted that the community was “particularly appreciative of Martin Wedel’s humor, with which he could relax some difficult situations, and his uncomplicated way, [which] he has always maintained despite his position.”2 He was also an honorary member of the local soccer club, TSV Vestenbergsgreuth, which was founded by his father. Wedel earned recognition on a national stage, as well. In 2015, he received the Order of Merit of the Federal Republic of Germany in honor of his long and successful career and his service to the community and botanical industry.

Wedel is survived by his wife Anita, sons Martin, Viktor, and Jochen, daughter Sofie, and brother Adolf, who still serves as managing director at the Martin Bauer Group.

—Hannah Bauman

References

1.          Following a long and serious illness, Martin Wedel, successful entrepreneur and a recipient of the Order of Merit of the Federal Republic of Germany, has died at the age of 62 [press release]. Vestenbergsgreuth, Germany: Martin Bauer Group; September 23, 2016.

2.          Martin Wedel celebrating his 60th birthday and is an honorary citizen of Vestenbergsgreuth [press release]. Vestenbergsgreuth, Germany: Martin Bauer Group; April 16, 2014. [translated from German]

GÖtz Harnischfeger 1939-2016 / Narendra Singh: 1935–2012

GÖtz Harnischfeger
1939-2016 

by Hannah Bauman

HerbalGram. 2016; American Botanical Council

Götz Harnischfeger, PhD, died on April 26, 2016, at the age of 77. Harnischfeger was a botanist, chemist, and pharmacist who expanded the fields of plant biochemistry and medicinal plant research as both an educator and a member of the German phytomedicine industry. He spent most of his career at Schaper & Brümmer, a German company that developed the world’s leading clinically studied black cohosh (Actaea racemosa, Ranunculaceae) extract.

Harnischfeger studied pharmacy at the University of Frankfurt in Germany before earning his PhD in the United States at Florida State University. He returned to Germany to complete his post-doctorate studies at the University of Göttingen in 1976, after which he served as a professor of botany for the university. In 1982, he was appointed as a professor of plant biochemistry.

After leaving academia, Harnischfeger joined the phytopharmaceutical industry in a variety of management and research positions, focusing his efforts on improving standardization of phytomedicines and embracing the challenge of staying ahead of rapidly evolving analytical methods. His reputation as an expert on natural product research grew, and he co-authored and assisted in the development of several landmark publications on the subject, including Stabilitätsprüfung in der Pharmazie(“Stability  Testing in Pharmaceutics”) and an updated edition of Hermann Hager’s Handbook of Pharmaceutical Practice.

“I met Professor Harnischfeger in 1991 when I joined the natural product research-oriented pharmaceutical company Schaper & Brümmer, where he was manufacturing/production manager,” wrote Eckehard Liske, PhD, who was the head of the international medical department at Schaper & Brümmer (email to M. Blumenthal, June 27, 2016). “In the following years we had numerous discussions on central issues of rational phytotherapy regarding plant extraction, whole extract versus single marker substances, active ingredients, and quality control. Pretty soon I realized that Professor Harnischfeger was a world-renowned expert in this research field. Looking back, I must say that he made me familiar with the philosophy of rational phytotherapy resulting in evidence-based herbal medicine. I am very grateful to him for these discussions.”

Mark Blumenthal, founder and executive director of the American Botanical Council, recalled the first time he met Harnischfeger. “I met Dr. Harnischfeger through the late Professor Varro E. Tyler, with whom he had formed a professional relationship and friendship over the years,” he said. “As a key scientist at Schaper & Brümmer, he made an excellent (and entertaining) presentation at one conference on his company’s production of black cohosh extract. He was instrumental in developing a unique program in which the company grew its own black cohosh in Germany — probably the first commercial-scale cultivation of this indigenous wild eastern North American medicinal plant outside of the United States — thereby reducing pressure on wild populations.”

Harnischfeger’s commitment to the safety and quality of herbal medicinal products drew him to a number of professional committees. He was a member of Gesellschaft Deutscher Chemiker (German Chemical Society), Deutsche Botanische Gesellschaft (German Botanical Society), and Gesellschaft für Arzneipflanzen- und Naturstoff-Forschung (GA; Society for Medicinal Plant and Natural Product Research). He also served as an elected member of the Deutscher Arzneibuch Ausschuss Pharmazeutische Biologie (German Pharmacopeia Committee on Pharmacognosy) from 1992 to 2005, and a member of the expert group on phytochemistry for the European Pharmacopoeia for 15 years. In recognition for his work relating to public health, he was awarded the Order of Merit of the Federal Republic of Germany in 1999.

“The internationalization of GA is … due [in part] to his never-ending activities to promote this society to a global acceptance and impact,” noted Gerhard Franz in his remembrance of Harnischfeger for the July 2016 GA newsletter. “He attended all the annual member meetings and his criticism was feared by many members and even some presidents of the GA.”

In his personal life, Harnischfeger was a deeply devout Catholic and served as an archivist and church historian for his parish. He was also a member of the German Association of the Holy Land and was awarded the Star of the Order of the Holy Sepulchre in Jerusalem in 1996. He is survived by his wife Jeanne.

—Hannah Bauman

Narendra Singh: 1935–2012 

by Memory Elvin-Lewis, PhD, DSc

HerbalGram. 2013; American Botanical Council

Narendra Singh, MD, was a man of numerous accomplishments who spent his lifetime dedicated to the study of Ayurveda and medicinal herbs in the context of his dual expertise in pharmacology and conventional medicine. He served as referee for numerous national and international journals, in addition to being on the editorial board of the Journal of Medicinal and Aromatic Plant Sciences and serving as editor of the Journal of Biological and Chemical Research, the Journal of Biotechnology in Medicinal Plant Research, and the book Clinical Studies on Kamala (Jaundice) and Yakrit Rogas (Liver Disorders) with Ayurvedic Drugs (1988). Dr. Singh was well-regarded professionally and held several honorary fellowships from a variety of organizations in science, nutrition, longevity research, herbal medicine, and brain research. He passed away on July 31, 2012.  

Dr. Singh was born in the village of Kamhenpur in Uttar Pradesh, India, where he was introduced at a young age to Sanskrit and the Vedic tenets of Hinduism. This influence was pivotal to the evolution of his holistic approach to medicine. Following his training as a physician and surgeon (MBBS, Bachelor of Medicine and Bachelor of Surgery) at the Sarojini Naidu Medical College in Agra, and service in the Indian Army, he returned to academia. In 1967, Dr. Singh received his MD in Medicine and Pharmacology from King George’s Medical College, Lucknow. He eventually was appointed as the college’s Head of Ayurvedic Research in the Department of Pharmacology and Therapeutics, as well as Head of the Regional Ayurvedic Research Institute of the Indian government’s Department of Health; he retained these titles until 1995. In 1999, Dr. Singh received a Doctorate in Alternative Medicine from the Indian Board of Alternative Medicine, Calcutta. 

His most recent titles include Director of the International Institute of Herbal Medicine & Clinic (Lucknow),as well as President of the International Society for Herbal Medicine. In 1997, he was appointed Scientific Director of research and development at Organic India Pvt. Ltd, Lucknow.

Over the years, Dr. Singh’s research focused on evaluating Himalayan community pharmacopeias and the medicinal herbs mentioned in ancient Ayurvedic texts. Throughout the course of his clinical career, he applied this knowledge to the formulation of Ayurvedic herbal remedies, sometimes combining them with Western medicine to elicit optimal clinical outcomes. His book Herbal Medicine — Science Embraces Tradition (2010), co-written with the clinical biochemist Marilena Gilca, MD, reflects his confidence in the integrative approach and in how holistic treatments can be developed with an appreciation of the limitations of each medical system.

Ever mindful of the need to develop natural herbal remedies in a safe and sustainable manner, Dr. Singh recently applied his expertise to create numerous herbal formulations under the auspices of Organic India, a private company that grows, manufactures, and markets certified-organic Ayurvedic herbs and teas through direct partnership with village agricultural communities. He is best known for his research on the adaptogenic and anti-stress properties of classic medicinal and Ayurvedic herbs. For example, his 2002 book, Tulsi: The Mother Medicine of Nature, written with Yamuna Hoette and Ralph Miller, elaborates upon the value of tulsi (Ocimum tenuiflorum, Lamiaceae) for a variety of medicinal uses associated with its adoptogenic and healing properties. Revered in India, tulsi (also known as holy basil) is described in terms of its traditional religious value and as an Ayurvedic remedy to heal mind, body, and spirit. Information regarding a wide range of current experimental and clinical research affirming the rationale behind its potential medicinal worth also is included.

Considered both a scholar and gentleman, Dr. Singh was well-respected by all who knew him. His winning smile, humble demeanor, and genuine congeniality will be missed by all of us who called him a friend and colleague. Most importantly, his lifetime of work toward providing a better understanding of the value of Ayurveda in the context of modern medicine is not only a well-deserved legacy, but also serves as an important example to those who continue to explore the value of traditional medicinal systems in a scientific context. For those wishing to review Dr. Singh’s extensive contributions to science and medicine, his curriculum vitae is available at www.organicindia.com/doctor-narendra-singh.

Dr. Singh is survived by his wife Savitri, daughter Anita, and his three grandchildren Vaubhav, Abhisarika, and Parul.

—Memory Elvin-Lewis, PhD, DSc
Professor of Biomedicine in Microbiology and Ethnobotany
Adjunct Professor of Biology

Results of New Cranberry Trial in JAMA Misreported to the Public

HerbalEGram: Volume 13, Issue 11, November 2016

JAMA editorial and inaccurate media reports suggest that cranberry has no value in preventing urinary tract infections Reviewed: Juthani-Mehta M, Van Ness PH, Bianco L, et al. Effect of cranberry capsules on bacteriuria plus pyuria among older women in nursing homes: A randomized clinical trial. JAMA. 2016;316(18):1879-1887. doi:10.1001/jama.2016.16141. On October 27, 2016, the Journal of the American Medical Association (JAMA) published online a randomized, double-blind, placebo-controlled clinical study by Juthani-Mehta et al. from the Yale School of Medicine.1 The trial was designed to evaluate the effects of a cranberry (Vaccinium macrocarpon, Ericaceae) juice extract preparation on bacteriuria plus pyuria (the presence of bacteria and pus in the urine, respectively) in elderly female nursing home residents. The authors reported that administration of two capsules of a standardized cranberry extract (Ellura capsules, each containing 36 mg proanthocyanidins [PACs]; Pharmatoka; Rueil-Malmaison, France) for 12 months failed to provide a statistically significant difference in the percentage of patients with bacteriuria and pyuria compared to placebo. The authors also did not find any statistically significant differences in the secondary outcome measures, such as symptomatic urinary tract infections (UTIs), mortality, number of hospitalizations, presence of multi-drug resistant bacteria in the urine, antibiotic treatments for suspected UTIs, and total antimicrobial pharmaceutical drugs administered. The study results have been covered, often uncritically, by major media outlets. For example, an article in The New York Times titled “The Cure for UTIs? It’s Not Cranberries” inaccurately generalized the results of the study with its misleading headline.2The study did not look at the effects of the cranberry extract preparation to cure, or even treat, existing UTIs as the title of The New York Times article suggests, but rather at its efficacy in the prevention of bacteriuria and pyuria in older women. According to data published by the same research group, 25-50% of women living in nursing homes suffer from bacteriuria.3 Since clinical trials evaluating conventional antibiotic treatments have not shown a reduction in urogenital infection-related diseases and deaths, the current medical practice guidelines for institutionalized adults do not recommend antibiotic treatments for bacteriuria or non-specific UTI symptoms because of escalating antibiotic resistance.4,5 Due to previous clinical trials that have shown positive outcomes for cranberry preparations in preventing the incidence and recurrence of UTIs, cranberry is seen as a potential alternative to low-dose antibiotics for UTI prevention. The new clinical study included 185 women aged 65 or older who lived in 21 nursing homes in the New Haven, Connecticut, area. The women had to speak English, had to have lived in the nursing home for at least four weeks, had to have a life expectancy of more than one month, and had to be able to provide a clean catch urine sample. Exclusion criteria included the following: the women could not be on anti-infective therapy for recurrent UTIs, could not be undergoing dialysis for end-stage renal disease, could not be receiving warfarin, could not have a history of kidney stones, could not have a bladder catheter, or be allergic to cranberry. In-service nurses were trained to collect appropriate urine samples in order to have valid results. Urine samples were evaluated every two months for the presence of bacteriuria (at least 100,000 colony-forming units of one or two types of bacteria per mL of urine) and pyuria (any presence of white blood cells in the urine). From the 185 women that started the study, a follow-up after 12 months for the presence of bacteriuria and pyuria was possible only for 90; patients were lost due to protocol-unrelated deaths, transferal to hospice care, or development of urinary incontinence. While urine analyses after four and six months showed lower bacteriuria in the treatment group, the trend was reversed in the last six months of the study, but without reaching statistical significance at any time period. During the study period, a total of 350 UTIs were suspected, but only 22 (10 in the treatment group and 12 in the placebo group) were confirmed as symptomatic UTIs. The number of hospitalizations, presence of multi-drug resistant bacteria, antibiotic treatments for suspected UTIs, and total antimicrobials administered all trended in favor of the cranberry treatment; however, the differences were not of statistical significance. No treatment-related serious adverse events were observed. The frequency of protocol-related non-serious adverse events, including altered mental status, gastrointestinal discomfort, oral cavity issues, skin and soft tissue changes, and weight loss, was similar in both groups. The authors concluded that cranberry administration does not reduce the occurrence of bacteriuria in older women living in nursing homes. However, 30% of the subjects in both arms had asymptomatic bacteriuria at enrollment and none were treated with antibiotics prior to starting the study. Cranberry has not been consistently effective at reducing existing bacteriuria, as this could be considered a “treatment” effect, which would not be an anticipated result for cranberry. Various aspects were considered to be strengths of this study: the use of a standardized cranberry product, compliance with the dosage regimen, and use of objective criteria to evaluate treatment success. Listed shortcomings included the inability to obtain urine samples from many women as the study progressed due to subjects’ physical and mental impairments, the lack of an anti-adhesion test (the interference of cranberry PACs with bacterial proteins, inhibiting bacterial adherence to the mucous membranes of the urinary tract is one of the mechanisms by which cranberry exerts its benefits rather than bactericidal effects), and the inability to assess the efficacy of cranberry supplementation in women with a history of recurrent UTIs. Since previous clinical trials have shown cranberry to be mainly effective in the prevention of recurrent UTIs,6-10 the lack of benefits in this study may not come as a surprise since only 1% of the participants in the treatment group had three or more UTI episodes of in the 12 months prior to enrollment. While this clinical study suggests that there is no benefit to using cranberry to prevent the presence of bacteriuria in this particular population, a number of recent clinical trials carried out with cranberry extracts provides evidence that cranberry has its place in the therapeutic arsenal to prevent recurrent UTIs and radiation-induced cystitis.11 As such, the suggestion to “move on from cranberries,” as stated by Lindsay E. Nicolle, MD, professor at the Department of Internal Medicine and Medical Microbiology at the University of Manitoba, in a JAMAeditorial12 based on the results of this study is not supported when scientific evidence from all the published clinical trials is taken into account. Results cannot be extrapolated beyond a negative effect of cranberry on prevention of bacteriuria. This opinion was echoed by Kalpana Gupta, MD, Associate Professor of Medicine at Boston University School of Medicine, who commented that she is “not ready to walk away from cranberries,” and “some women with recurrent UTIs may still want to discuss cranberry treatment with their doctors.”2 Concerns about the validity of the data were also raised in a statement issued by the Cranberry Institute (CI), an organization dedicated to supporting research on cranberries and promoting cranberry health benefits, and in a letter written by Amy Howell, PhD, associate research scientist at the Philip E. Marucci Center for Blueberry and Cranberry Research and Extension at Rutgers University.13,14 Both the statement by the CI and Howell’s letter listed characteristics of the clinical study design and results that do not support the conclusions expressed in Nicolle’s editorial. Since this study was not designed to detect the efficacy of cranberry on UTI prevention, conclusions about the benefits of cranberry extracts to prevent recurrent UTIs should not be made based on the results. —Stefan Gafner, PhD References 1.       Juthani-Mehta M, Van Ness PH, Bianco L, et al. Effect of cranberry capsules on bacteriuria plus pyuria among older women in nursing homes: A randomized clinical trial. JAMA. 2016. 2.       Hoffman J. The Cure for UTIs? It’s not Cranberries. New York Times. October 27, 2016. 3.       Juthani-Mehta M, Datunashvili A, Tinetti M. Tests for urinary tract infection in nursing home residents. JAMA. 2014;312(16):1687-1688. 4.       Nicolle LE, Mayhew WJ, Bryan L. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. The American Journal of Medicine. 1987;83(1):27-33. 5.       Rowe TA, Juthani-Mehta M. Diagnosis and management of urinary tract infection in older adults. Infect Dis Clin North Am. 2014;28(1):75-89. 6.       Stothers L. A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol. 2002;9(3):1558-1562. 7.       Walker EB, Barney DP, Mickelsen JN, Walton RJ, Mickelsen Jr RA. Cranberry concentrate: UTI prophylaxis. J Fam Pract. 1997;45(2):167-168. 8.       Ferrara P, Romaniello L, Vitelli O, Gatto A, Serva M, Cataldi L. Cranberry juice for the prevention of recurrent urinary tract infections: A randomized controlled trial in children. Scand J Urol Nephrol. 2009;43(5):369-372. 9.       Sengupta K, Alluri KV, Golakoti T, et al. A Randomized, Double Blind, Controlled, Dose Dependent Clinical Trial to Evaluate the Efficacy of a Proanthocyanidin Standardized Whole Cranberry (Vaccinium macrocarpon) Powder on Infections of the Urinary Tract. Curr Bioact Comp. 2011;7(1):39-46. 10.     Caljouw MAA, van den Hout WB, Putter H, Achterberg WP, Cools HJM, Gussekloo J. Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infections in Vulnerable Older Persons: A Double-Blind Randomized Placebo-Controlled Trial in Long-Term Care Facilities. J Am Geriatr Soc. 2014;62(1):103-110. 11.     Bone K. Further evidence for the clinical efficacy of cranberry: A brief review of recent clinical trials. HerbalGram. 2016;112:29-33. 12.     Nicolle LE. Cranberry for prevention of urinary tract infection?: Time to move on. JAMA. 2016. 13.     Efficacy of Cranberry Products in Urinary Tract Health. 2016; http://cranberryinstitute.org/JAMA%20Response%20Statement%20-%20For%20CI%20Website.pdf. Accessed November 02, 2016. 14.     Howell AB. Comments on JAMA Study and Editorial on Cranberry and Bacteriuria. Chatsworth, NJ: Rutgers University; 2016.

Re: Cranberry Supplementation Reduces PSA Levels in Patients with Prostate Cancer

Cranberry (Vaccinium macrocarpon, Ericaceae) Prostate Cancer
Date: 12-30-2016	HC# 121661-559

Student V, Vidlar A, Bouchal J, et al. Cranberry intervention in patients with prostate cancer prior to radical prostatectomy. Clinical, pathological and laboratory findings. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016;160(4):559-565.

Prostate cancer (PCa) impacts the lives of many men throughout the world. Cranberry (Vaccinium macrocarpon, Ericaceae) fruit extract and some of its constituents (flavonoid, proanthocyanidin, and triterpenoid fractions) have been shown to have anticancer bioactivity in vitro. This team's 2010 clinical trial showed that consumption of 1500 mg of cranberry fruit powder daily for 6 months decreased prostate-specific antigen (PSA, a marker for early detection of PCa) in men with lower urinary tract symptoms (chronic nonbacterial prostatitis and/or benign prostatic hyperplasia), a subpopulation with greater risk for the development of PCa. The primary objective of this randomized, double-blind, placebo-controlled study was to measure the impacts of cranberry fruit powder consumption on PSA concentrations and other biomarkers in patients with PCa scheduled for radical prostatectomy.

This study took place at the Department of Urology, University Hospital Olomouc, Czech Republic, from May 2012 to May 2013. Included (otherwise healthy) patients had a PCa diagnosis and a body mass index (BMI) of < 37. Those using antibiotics or who had undergone radiation or chemotherapy were excluded. In total, 64 patients were enrolled in the study and randomly assigned to receive 1500 mg/day of either cranberry powdered extract or placebo for at least 21 days prior to a prostatectomy surgery. Patients were told to avoid soy (Glycine max, Fabaceae) and foods rich in anthocyanins. The placebo was composed of maltodextrin, canola (Brassica napus, Brassicaceae) oil, Red 40 Lake, sodium aluminum silicate, and Blue 1 Lake. Cranberry fruit powder (Pacran®) was provided by NATUREX-DBS (Sagamore, Massachusetts); according to the manufacturer's website, Pacran is standardized to contain ˃ 1.5% proanthocyanidins. However, the authors' analysis found that total proanthocyanidins were 41 mg/100 mg and total anthocyanins/anthocyanidins were 234 mg/100 mg. The cranberry/placebo capsules were provided by Walmark, a.s. (Třinec, Czech Republic).

Blood and urine samples were collected at baseline and immediately before surgery, and prostatectomy specimens were collected during surgery for routine immunohistochemistry examination of prostate tissue markers. Basic biochemical and hematological parameters that were assessed included the following: total cholesterol, low-density lipoprotein, high-density lipoprotein, triacylglycerols, C-reactive protein, alanine aminotransferase, gamma-glutamyltranspeptidase (GGT), glycaemia, creatinine, blood urea nitrogen, interleukin-6, testosterone, PSA, insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein, and free testosterone. Markers of oxidative stress selected for evaluation included total sulphydryl groups, lipid peroxidation products such as malondialdehyde in plasma (PMDA) and erythrocytes (MDA), glutathione, glutathione peroxidase, glutathione reductase, superoxide dismutase, catalase in erythrocytes, paraoxonase 1 (PON1) activity, and plasma 8-hydroxydeoxyguanosine (8-OHdG). Urine samples were analyzed to determine levels of free phenolics, total phenolics, anthocyanins/anthocyanidins, proanthocyanidins, and 7 genetic markers for PCa. Protocol compliance was measured by counts of returned capsules.

From the total of 32 patients per group at the start of the trial, 1 patient in each group was withdrawn from the study due to a cancelled prostatectomy or early surgery date, leaving 31 patients in each group for final analysis. At baseline, there were no significant differences between groups in age, BMI, or blood concentrations of zinc or selenium; however, the cranberry group had a significantly elevated mean concentration of PSA as compared with placebo. Stage of cancer (mean Gleason score) was not significantly different between groups either before or following surgery.

In the cranberry group, the PSA concentrations were significantly decreased (22%) over the course of the study (8.83 ng/ml vs. 6.84 ng/ml, P<0.05); in the placebo group, PSA concentrations were significantly increased (5.38 ng/ml vs. 5.43 ng/ml, P<0.05). IGF-1 concentrations significantly increased over the course of the study in the cranberry group (P<0.01) but not in the placebo group (there is some evidence that elevated IGF-1 levels in patients with advanced cancer are associated with a longer survival time). GGT (a marker of liver function) significantly decreased in the cranberry group (P<0.01) but did not change in the placebo group.

MDA, PMDA, and total thiol concentrations were significantly elevated in both groups (P<0.05 for all). PON1 was significantly elevated only in the placebo group (P<0.01), while catalase was significantly elevated only in the cranberry group (P<0.05). There were no significant differences in immunohistochemical tissue markers or urinary total phenol concentrations between groups. No anthocyanins or proanthocyanidins were detected in the urine analyses. There was a trend for downregulation of beta-microseminoprotein (MSMB) after cranberry supplementation; in 6 out of 9 patients, this decrease was also associated with a downregulation of PSA.

This study found that 1500 mg/day of cranberry fruit powder for 21 days decreased PSA levels in patients with PCa, suggesting a potential use of this botanical in the treatment or prevention of PCa. The elevation of markers of oxidative stress suggests cranberry supplementation did not have an antioxidant effect in this study. Limitations of the study include the small sample size and short treatment duration; it should also be noted that all the P values reported were for the change from baseline, not the difference between groups. The authors conclude that "these data suggest that further studies to evaluate cranberry consumption as a prophylactic against the biochemical recurrence of prostate cancer in patients after surgery is warranted." 

—Amy C. Keller, PhD 

Re: Grape Seed Extract May Slow Progression of Chronic Kidney Disease

Grape (Vitis vinifera, Vitaceae) Seed Extract Chronic Kidney Disease Date: 12-30-2016 HC# 121621-559 Turki K, Charradi K, Boukhalfa H, Belhaj M, Limam F, Aouani E. Grape seed powder improves renal failure of chronic kidney disease patients. EXCLI J. June 27, 2016;15:424-433. Chronic kidney disease (CKD) is a slow, progressive decline of renal function characterized by high creatinine, low glomerular filtration rate (GFR), and proteinuria. Oxidative stress and inflammation are commonly observed in patients with CKD and contribute to disease progress. Grape (Vitis vinifera, Vitaceae) seed extract (GSE) is a polyphenolic mixture that has demonstrated antioxidant and anti-inflammatory properties. This randomized, double-blind, placebo-controlled, pilot study tested the effect of GSE on kidney dysfunction in patients with different stages of CKD. Patients with CKD with renal failure at stages 2, 3, or 4 were recruited at the hemodialysis unit of the Regional Hospital of Menzel Bourguiba, Tunisia. All exhibited diabetic nephropathy and hypertension. The study was conducted from May to October 2011. Patients continued with their current treatment of insulin (2 doses/day), captopril 50 mg (2 doses/day), furosemide 40 mg (2 doses/day), folic acid (2 tablets/day, doses not specified), and iron for anemia (2 tablets/day, doses not specified) through the study period. Patients were excluded if they were smokers or received antioxidant treatment in the past 6 months. Patients in the placebo group (n = 10) consisted of 3 patients in stage 2 (GFR ≤ 90 mL/min/1.73 m2), 4 patients in stage 3 (GFR ≤ 60 mL/min/1.73 m2), and 3 patients in stage 4 (GFR ≤ 30 mL/min/1.73 m2). The GSE group (n = 23) had 6 patients in stage 2, 11 patients in stage 3, and 6 patients in stage 4. Patients in the GSE group were instructed to take 6 capsules of GSE, each containing 350 mg of grape seed powder, daily. The placebo group received capsules containing starch. Blood samples, after overnight fasting, and urine samples were collected at baseline and after 6 months, and panels of markers of kidney function and inflammation, and blood cell counts, were measured. GSE was processed from the grape cultivar Carignan grown in northern Tunisia. Seeds were separated, washed, dried, ground with an electric grinder to a fine powder, and mixed with 3% colloidal silica. The GSE polyphenol composition is described in a previous publication.1 Proteinuria was comparable in the GSE and placebo groups at the start of the study. After 6 months of supplementation, proteinuria had increased in both groups but was significantly lower in the GSE group (−32.67%, P = 0.041). At 6 months, the inverse of the plasma creatinine ratio (i.e., units of L/mmol) was significantly higher in the GSE group (+19.42%, P = 0.044), due to a decrease in the placebo group that was not seen in the GSE group. GSE had no significant effect on plasma urea or uric acid. There was a nonsignificant trend toward improvement in GFR (+18.70%, P = 0.604) in the GSE group, versus no mean change in the placebo group. The initial numbers of stage 4 and stage 3 patients in the GSE group decreased from 6 to 2 and from 11 to 10, respectively, resulting in 11 of 23 patients in the GSE group being in stage 2 by the end of the study (+83.33%).   The GSE group showed significant decreases in plasma malondialdehyde (−14.96%, P = 0.0307) and protein carbonylation (−38.82%, P = 0.0319). There was no significant effect on hydrogen peroxide. GSE significantly increased plasma catalase by 95.94% (P = 0.015) and superoxide dismutase by 25.99% (P = 0.049). There was no significant effect on plasma glutathione peroxidase activity. There was a nonsignificant 12.81% reduction in plasma C-reactive protein at 6 months (P = 0.168), which increased during the study period in both groups. The authors state that GSE "totally counteracted [increases in] plasma LDH [lactate dehydrogenase]," but this result was nonsignificant (P = 0.623). There was a slight, nonsignificant decrease in triglyceride levels in the GSE group (−16.44%, P = 0.067), and a significant increase in plasma lipase activity (+29.67%, P = 0.006).  Overall, there was no effect on cholesterol levels. The GSE group showed a slight, nonsignificant increase in white blood cells (+23.48%, P = 0.276), especially granulocytes. GSE also prevented anemia of patients with CKD (GSE increased free iron by 13.26% [P = 0.019] versus placebo). A nonsignificant tendency toward decreasing red blood cells was noticed in the placebo group (4.72 ± 0.14 to 4.37 ± 0.19; P = 0.127), but not in the GSE group (4.22 ± 0.21 to 4.23 ± 0.25; P = 0.692). GSE did not affect hemoglobin or the decrease of hematocrit, which was observed in both groups. Platelet count increased significantly from baseline in the GSE group (+24.63%, P = 0.030) and nonsignificantly in the placebo group (+10.93%, P = 0.327), but the difference between groups was not significant. While the sample size of this study was too small to create strong statistical significance, the results of this study are hopeful, if preliminary. Future studies should be larger, and perhaps longer. The authors suggest using a far higher GSE dose to obtain more significant outcomes, based on animal studies; however, human patients might find the necessary volume unacceptable.  —Alexis Collins, MA, MS Reference 1Charradi K, Elkahoui S, Karkouch I, et al. Protective effect of grape seed and skin extract against high-fat diet-induced liver steatosis and zinc depletion in rat. Dig Dis Sci. 2014;59(8):1768-1778.

Exploring approaches to patient safety: the case of spinal manipulation therapy

BMC Complement Altern Med. 2016 Jun 2;16:164. doi: 10.1186/s12906-016-1149-2.

Rozmovits L¹, Mior S², Boon H³.

Author information

• ¹Qualitative research consultant, Toronto, ON, Canada.
• ²Canadian Memorial Chiropractic College, Toronto, ON, Canada.
• ³Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada. heather.boon@utoronto.ca.

Abstract

BACKGROUND:

The purpose of this study was to gain insight into the current safety culture around the use of spinal manipulation therapy (SMT) by regulated health professionals in Canada and to explore perceptions of readiness for implementing formal mechanisms for tracking associated adverse events.

METHODS:

Fifty-six semi-structured telephone interviews were conducted with professional leaders and frontline practitioners in chiropractic, physiotherapy, naturopathy and medicine, all professions regulated to perform SMT in the provinces of Alberta and Ontario Canada. Interviews were digitally audio-recorded for verbatim transcription. Transcripts were entered into HyperResearch software for qualitative data analysis and were coded for both anticipated and emergent themes using the constant comparative method. A thematic, descriptive analysis was produced.

RESULTS:

The safety culture around SMT is characterized by substantial disagreement about its actual rather than putative risks. Competing intra- and inter-professional narratives further cloud the safety picture. Participants felt that safety talk is sometimes conflated with competition for business in the context of fee-for-service healthcare delivery by several professions with overlapping scopes of practice. Both professional leaders and frontline practitioners perceived multiple barriers to the implementation of an incident reporting system for SMT.

CONCLUSIONS:

The established 'measure and manage' approach to patient safety is difficult to apply to care which is geographically dispersed and delivered by practitioners in multiple professions with overlapping scopes of practice, primarily in a fee-for-service model. Collaboration across professions on models that allow practitioners to share information anonymously and help practitioners learn from the reported incidents is needed.

KEYWORDS:

Chiropractic; Physiotherapy; Safety culture; Spinal manipulation

PMID:

27251398

PMCID:

PMC4890537

DOI:

10.1186/s12906-016-1149-2

[PubMed - in process]

Free PMC Article

• 
  

Tyrus Wong, ‘Bambi’ Artist Thwarted by Racial Bias, Dies at 106

 http://nyti.ms/2iOkYQq

Roundtable on Capitalism, Affect, and the “Culture in the Age of Mass Debt”

Extended deadline: Jan 9, 2017

The Critical Feminist Studies Working Group [CFSWG] of the Cultural Studies Association [www.culturalstudiesassociation.org] is pleased to invite submissions for one roundtable and one panel to be presented at the 2017 conference:

• Roundtable on Capitalism, Affect, and the “Culture in the Age of Mass Debt”
  • What cultural spaces/cultural products/case studies illustrate the connections between capitalism and affect through an intersectional lens of Critical Feminist Studies?
  • How does debt, both theoretically and practically, disproportionally impact the lives of women and girls globally and locally?
  • What are the gendered, racialized, classed, and disabling effects of capitalism and debt in both theory and in practice?
  • What popular and contemporary authors on capitalism, affect, and the ‘Culture of Mass Debt’ beg for a dialogically thorough Critical Feminist critique?
• Panel on Critical Feminist Studies and Social Justice
  • What is the future of social justice advocacy under Trump’s presidency? 
  • Should we continue to imagine ‘feminist utopias’, or are there other productive conceptions to focus our efforts towards?
  • What Critical Feminist pedagogical strategies could be developed in the name of Social Justice advocacy?

CFSWG is also organizing a panel at the philoSOPHIA: A Society for Continental Feminism conference, which will take place at Florida Atlantic University from March 30 - April 2, 2017.

* Panel on Affect Theory and Social Justice

We encourage papers that draw from diverse fields including but not limited to: women's and gender studies, sexuality studies, feminist philosophy, sociology, anthropology, political economy, critical race theory, postcolonial theory, media studies, critical disability studies, and/or cultural studies. 

Please indicate which of the above (roundtable, panels) you would like to apply for with an abstract of your paper/presentation (500-700 words) and a short bio (100 words or less). Use the EasyChair submission platform for the CSA calls. Email submissions directly to CSA.CFSWG@gmail.com for the philoSOPHIA call.

Questions about our CSA Working Group can be directed to Dara Persis Murray (dara.murray@mville.edu) and Jennifer Scuro (jscuro@cnr.edu).

Jennifer Scuro

Associate Professor of Philosophy

The College of New Rochelle, NY