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What you don’t know (but should) about complementary medicines: Dr Ken Harvey

Dr Ken Harvey writes:

Two important research reports on the complementary medicines information needs of Australian consumers and health professionals are now available from the National Prescribing Service (NPS).

In my view, the NPS research highlights the gap between the widespread and increasing use of complementary medicines and the limited evidence available to justify much of this use.

It also shows a major disconnect between the consumer perception of complementary medicines as “natural” and “risk-free” and the reality that these medicines contain pharmacologically active substances that can cause adverse effects, albeit less frequently with conventional medicines.

In addition, the use of complementary medicines for indications in which they lack efficacy can have a significant adverse effect on consumers hip pockets (or purses) and, more importantly, can delay or prevent the use of more evidence-based therapy.

Only about 40% of GPs and community pharmacists surveyed felt confident discussing complementary medicines with patients. Many GPs and pharmacists were not aware of the side effects of some commonly used complementary medicines and their potential interactions with conventional medicines. In addition, they did not always discuss the use of complementary medicines with their patients and were often unaware of complementary medicines use by their patients.

The solution proposed by the NPS (given its limited brief) was better education of health professionals and consumers about complementary medicines. This required an independent and reliable source of
information about complementary medicines, to be made available to both consumers and health professionals.

The final NPS report (due in January 2009) will suggest possible sources of such information. This might include obtaining a n Australian licence to an internationally recognised database such as the U.S. “Natural Medicines Comprehensive Database” or the “Natural Standard Professional Database”.

However, information about generic complementary medicines has major limitations compared to that about conventional medicines because of the current “two-tiered” Australian regulatory system. Unlike conventional (registered) medicines, complementary (listed) medicines are not evaluated for efficacy or therapeutic equivalence. [1]

Sponsors currently perpetuate the misconception that all complementary medicines containing the same ingredients are equally effective. The reality is that complementary medicines, especially herbal medicines, are complex products with numerous biologically active components. This means that evidence of benefits (and risks) are specific to the product tested and cannot necessarily be extrapolated.

The “generic” concept which is valid for conventional medicines, for example the interchangeability of paracetamol containing products, is invalid for CM. This means that a prescription for “St John’s wort” for example, is not reliable as St John’s wort is not one substance.

In addition, meta-analyses and systematic reviews of a “substance”, for example a herb, or glucosamine, are easily misinterpreted because the products made from that “substance” can be so different that any conclusions drawn can only be applied to the specific products trialled. [2]

Because of this, the U.S. “Natural Medicines Database” NMBER system provides specific brand name products that have been studied in clinical trials with a unique effectiveness rating based on the evidence specific
to that product. In addition, independent testing of product quality by the U.S. Pharmacopoeia (who provide a USP trademark) also contributes to the NMBER rating.

In short, to be useful, we would need to augment any database of generic information about complementary medicines with specific information about whether or not products on the Australian market were identical
(or bio/phyto/equivalent to) products proven in clinical trials. This is what the opt-in, independent evaluation system suggested by Choice and others would provide. [2]

In addition, as well as increasing access to good information about complementary medicines, there is also a need to decrease the inaccurate, misleading and unbalanced information currently being promulgated and preferably limiting the listing of products that lack evidence of efficacy. In short, better information needs to be supported by regulatory reform. [3]

• Dr Ken Harvey is Adjunct Senior Research Fellow, School of Public Health, La Trobe University
http://www.medreach.com.au

References

1. Harvey KJ, Korczak VS, Marron LJ, Newgreen DB. Commercialism, choice and consumer protection: Regulation of complementary medicines in Australia. Med J Aust 2008; 188: 21–25. Available at: http://www.mja.com.au/public/issues/188_01_070108/har10522_fm.html

2. Pollard NA || Santoro A || Kotsirilos V || Masters CS || Harvey KJ, Korczak VS, Marron LJ and Newgreen DB. Commercialism, choice and consumer protection: regulation of complementary medicines
in Australia [letters]. Med J Aust 2008; 189 (1): 50-53.
Available at: http://www.mja.com.au/public/issues/189_01_070708/letters_070708_fm-2.html

3. Harvey KJ. Controlling complementary medicine claims [Editorial] Aust Prescr 2008; 31(6): 142-143. Available at: http://www.australianprescriber.com/magazine/31/6/142/3/

Comments 5

  1. Melissa Sweet says:

    This New York Times article highlights an issue that is often overlooked in discussions about complementary health products and practices: their use by children and young people. It raises some questions worth considering, by parents and health professionals alike.
    http://www.nytimes.com/2008/12/11/health/research/11children.html?_r=1&ref=health

  2. loretta says:

    The NPS identified that consumers number 1 choice is their GP to tell them about CM. I hope that when the NPS announce their recommendations on the CM database, their choice of resource should be a compulsory addition to medical training. It would also be a good idea to include it in pharmacy, nursing and naturopathy training.

    Currently when a complaint is submitted against an advert making incorrect health claims, the complainant has to include their own research. I also would like to see the Complaints Resolution Panel accept the conclusions of the NPS recommended database (eg if the monologue says the active ingredient is not effective) – it would save a lot of attachments.

    It will also be interesting to see if the TGA will bother reading the database before accepting new listings (eg for Glucosamine Hydrochloride which is considered not effective) – it might stop pharmacies from selling placebos (but I’m not optimistic on that one)

  3. Jon Hunt says:

    I think that one of the impediments for the recognition of complementary medicines by GPs is a reluctance to complicate things even more than they are. Time is short, people are waiting, and you don’t know what the significance of these “medicines” might be. You would have to take time to research it. You’re meant to ask about them of course, but it can seem just too hard at the time. Not a good excuse I agree, but I believe this is probably the case.

  4. Ken Harvey says:

    Jon’s concerns about the difficulty of finding evidence-based information on complementary medicines was reiterated by many doctors and pharmacists who responded to the NPS research questionnaires and focus groups.

    After all, if you ask patients if are they taking complementary medicines this is likely to prompt responses that need answering, such as, “could they interact with the other medication I’m on?” and “do you think they work?”.

    While we wait for the NPS (or TGA or government) to assist there are useful Internet sites &/or books that can help find out the answers to such questions, for example:

    Medline Plus: http://www.nlm.nih.gov/medlineplus.

    Braun L, Cohen M. Herbs and natural supplements. An evidence-based guide 2nd Ed. Elsevier Mosby, 2007

  5. doctor_no96 says:

    With regard to education: a first step for any newly graduating doctor should be attendance at the short courses offered by the Australasian College of Nutritional and Environmental Medicine (www.acnem.org/). Doctors (and other health professionals) find the information learned at this Melbourne college an absolute eye opener. The courses are open to any health professional, no matter how long since graduation, and everyone receives ongoing support. This is what patients want.

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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
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2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
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#OTCC2017
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#TheMHS2017
#VMIACConf17