hello, i'm geraldine moses. welcome to this programon complementary medicines - the best advice. in australia today, over 60% of peopleuse some kind of complementary medicine. to help consumers use them wisely, it's important that health professionalsare familiar with these medicines as they are pharmacologicallyactive substances with the potential for adverse reactionsand drug interactions. however, surveys indicatethat only half of all users
inform their medical practitioners about their useof complementary medicines. so health professionals also needthe skills to encourage consumersto disclose their use and make rational decisionsabout the potential benefits and risks in managing their health. this program looks at these key issues, including the quality,safety and efficacy of comp meds. we're not going to be judging whetherspecific remedies work or not,
our focus is on skills for healthprofessionals to help their patients. we want you to be able to ask the rightquestions and to give the best advice. as usual, you'll find a numberof useful resources available at the rural health educationfoundation's website - that's www.rhef.com.au now let's meet our expert panel. firstly, dr trevor cheneyis a general practitioner from bellingen in new south wales and the vmoat bellinger river district hospital. he has practised for 14 yearsas a rural gp throughout australia.
his group practice successfully blendsintegrative medicine and complementary therapiesinto daily gp practice. - welcome, trevor.- g'day. dr ken harveyis a public health physician with a particular interestin medicines policy. he currently holds the positionof adjunct associate professor, school of public healthat la trobe university in melbourne. - welcome, ken.- thanks, geraldine. professor stephen myers is thefoundation director of natmed-research,
in plant scienceat southern cross university. he initially qualified as a naturopathand, later, as a medical doctor. he also has a phd in pharmacology. - welcome, stephen.- thanks, geraldine. dr evelin tiralongois a senior lecturer in pharmacy at griffith university's pharmacy schoolon the gold coast in queensland. she is a registered pharmacistwith extensive practical knowledge in complementary medicinesand retail pharmacy. - welcome, evelin.- thanks, geraldine.
and, finally, dr jon wardle. he is a practising naturopathand a research scholar at the school of population healthat the university of queensland. his phd was on the use of complementarymedicines in rural practice. - welcome to you all.- thanks, geraldine. now, jon, i wonder if you couldjust briefly tell us a little bit about your findings in your phd because we have a rural and remoteaudience out there. tell us what your findings were.
certainly. the whole impetusbehind doing the phd was the evidence that suggestscomplementary medicine is used more in rural populationsthan urban, which is kind of a surprise to most. geraldine: more in rural practice. wow. even in areas that are well servedby general practitioners so it's not necessarilythey can't find a real doctor, so they see a cam practitioner. it was actually several cultural reasonsand historical reasons for that use.
and the way i like to remindgeneral practitioners is that their patients are more likely thannot to be seeing a cam practitioner, using a cam productand more likely than not to not want to talk about itwith their doctor. so i think this is a very timely,uh, talk today. yes. now, evelin,we can tell by your german accent that you were not born in australiabut you studied pharmacy in germany. can you tell us a little bit about yourview of complementary medicines and the way we're different in australiaabout how we call them these things.
yeah, i studied in germany, so, for me, the term complementarymedicine is quite strange. in fact, i wasn't introducedto this term until i immigrated to australia in 2003. so for me, during my study in germany, we were taught on herbal medicineand homeopathic medicine as part of our degree and we practisedit as part of mainstream so it's more like... what's effectiveand what's ineffective and i think that's whatwe tried to bring out today
and tonight in this showthat we're trying to go by the evidence rather than calling it too muchcomplementary medicines. now, stephen, you've crossedthe boundary between naturopathy and clinical medicine, and you're alsoinvolved with the tga, i understand, therapeutic goods administration. perhaps you can tell us what we shouldbe seeing as complementary medicines. what's the definition? well, the definitionof complementary medicines and i think the first thing thatwe need to actually acknowledge
is that there is a body of knowledgecalled complementary medicine which involves both therapiessuch as acupuncture, traditional chinese herbalism,western herbal medicine, naturopathy, and then the medicines,the ingestible medicines that are actually used. the therapeutic goods administration actually saysthat complementary medicines, also known as traditional medicinesand alternative medicines, are made up of a range of substances
that include vitamin, mineral, herbalmedicines, aromatherapy, and homeopathic products. so it's this eclectic rangeof different substances. it's important to note that it doesn'tinclude prescription medicines, that's completelya separate component. complementary medicine may becomea prescription medicine but it's regulated very differently and it doesn't includeany parenteral medicines so if it's for injection,
it doesn't fall under the realmof complementary medicine. they used to define it by a whole rangeof different substances but they've now gota more broader definition. and what would you say would be the mostpopular or most commonly used complementary medicinesat the moment in australia? well, probably the onethat everyone in the audience will actually know about is fish oils. there was a time thatthat was very fringe therapy. and i would even question whetherit's a complementary medicine anymore
because it's so embeddedin mainstream medicine now. - calcium is a complementary medicine.geraldine: you're joking. no. and folate, which we actuallyobviously use in pregnancy. geraldine: every pregnant woman. neural tube defect,that's a complementary medicine. it's a vitaminthat fits under the definition and is regulated bytherapeutic goods administration as a complementary medicine. ken, i'll pass to youabout this definition.
are you comfortable with that?do you think that serves our purpose when we're trying to help peoplewith comp meds? well, i think it's important. um... the other important thingthat stephen didn't mention is that consumers can get a feelfor whether something is regulated as a complementary medicine because it has on the label an austlfor a listed product. as stephen said, the regulatory processfor listed products is very different to thoseof registered products
of prescription medicines. it's a more light touch regulation,we can perhaps go into that later. yes, and, trevor,as a person in general practice who uses these medicines, how do you feel about the waycomplementary medicines are regulated and this definitionthat we're using tonight? as a... i did orthodox training. i did a scientific training in medicine, which i love and respectand i use every day,
but i've noticed ever since i graduated,there were still holes and, in actual fact,not everybody fits the paradigm. and i ended up...i've seen a lot of patients who do not fit the paradigm and another 25% whothat drug doesn't work for whatever and they come back to a gp and say,well, what am i going to do now? and so that made me takea scientific approach and say let's keep questioning, and that's what my training is,to be scientific, to question,
what else can i doto service this patient? the boundaryof what is complementary and not seems to me to be rather shiftyin modern practice. you just mentioned fish oil, calcium. calcium was in, now it's actuallygoing out again in medicine. glucosamine has been out and then inand now is being questioned but i think the evidenceis rising for it. i use a lot of nutritional therapywhich i learnt in basic medical school and we all forgot when we graduated
and that's considered complementary but it's absolutely essentialto basic health. so the boundary for me is fuzzy, when you start learningabout these different therapies. what it does is add a whole new setof tools to your armamentarium. so you can treat a personthat fits the paradigm orthodoxly, you can treat somebody who is notprepared to take that paradigm and have the conversation with them, or you've got this whole new branchof options you can use that also work.
it's been shown actuallythat practitioners who have additional knowledge of complementarymedicines are better practitioners because they have a higherself-awareness and also more knowledge about evidence-based practicebecause they're looking at those skills not only with regardsto complementary medicines but also with regardsto their conventional medicines. jon, you've done some broad study aboutwho uses complementary medicine. can you please describe who are the mostcommon users of comp meds? it's not that differentfrom who the most common users
of health services more generally are. higher education, higher income usually, because it does existas an out-of-pocket expense outside the health systemfor most people. generally women, which also usehealth services a lot more, and younger women,18-34 usually, and that's probably, i guess,a product of the fact that, you know, we don't unquestionably take onwhat our doctor tells us
without actually lookingfor other options... geraldine: so you thinkit's a gen y thing? gen y thing, but people are moreeducated about their health. health literacy is rising. we've seen the growthof the expert patient and also, i think,with that case of women, there's a lot of women's health problems which don't necessarily fit intoconventional treatment really easily, and rather than just accepting, womenare out there looking for options.
does this profile of the patient fitwhat you saw in your research into who uses comp medsin rural settings? it's pretty similarand there's been a lot of work done with the australian longitudinal studyon women's health which generally showsthe same patterns exist. the usage is a little higherin rural areas. also, stephen, there's the questionabout people... people always talk about how much moneyis spent on comp meds. could you briefly tell us about thosestudies that have been done?
fundamentally, the interesting aspectof that is that australians don't actually pay the real costfor medicines out of our pockets. our government actually underpinsthe cost of medicines through the pharmaceuticalbenefits scheme. and, you know, currently the figuresseem to be on parity that the public spend about $2 billionon, out of pocket, for medicines on thepharmaceutical benefits scheme and about $2 billion out of pocketfor complementary medicine. so there's... certainly good evidence
to suggest that the publicare interested in purchasing, uh, these products even if they have to payfor them themselves for the benefits that they perceivethey actually give them. - could i make a comment?geraldine: yes. other practitionershave probably heard this as well. whenever you talk aboutcomplementary medicines, always the lead commentis how much people spend and i think it's a real distraction, and i think it also raisesa competition issue.
they spend that money, they shouldn't... the complementary practitionersdon't deserve that amount of money. it's missing the point. the point is do we have therapiesoutside one paradigm that work and do we have things that are dangerous- that's what we need to know. and the money's a bit of a distraction. it's important for governments,not for a practitioner. there's a critical issue there,you know. from my perspective, one of the problemsis the 65-year-old woman
who might come to see youwho's a pensioner who has got osteoarthritis and the option is that you mightbe able to give her a medicine on the pharmaceutical benefits schemethat might take away her pain but may actually deteriorateher kidneys and give her a riskof gastrointestinal bleeding. yet, equally effective medicinesin terms of removing the pain aren't on the pharmaceuticalbenefits scheme. so at some stage,we have to talk those economic issues.
ken: if i could just makea comment there. it's perfectly possible for the sponsoror the manufacturer of a complementary medicine who believesit's efficient and effective to put in a submission to thepharmaceutical benefits scheme and to get it subsidised and, indeed, some have tried to do thatwith glucosamine, for example, it didn't get up because it was notthought to have the evidence and cost effectiveness data there. so, again, the system is not unfair,
it simply asksthat the complementary medicine person provides the evidenceto the government committee and then it would be subsidised. well, i hear that, ken. one of the things that i'd argueis that it's in the public benefit that the government actually makessome decisions that certain medicinesare in the public's benefit and that, actually, for those thingsthat are generic and they're in the public domain
and there's no patent associated with itand no company specifically pushing it that we make those medicines available. we'll come back to costand who should pay for the medicines when we talk about, um... which work,i suppose, and equity of access. so we'll now go to our first case studywho's john, a 55-year-old professionalwith a bmi of 27. he has a stressful and sedentary job, he runs twice a week and plays a bitof competition tennis on the weekends to keep fit.
but he's also got a bit of hypertension and hypercholesterolemia. he's had that for about five years, for which he takes a low dose of perindopril and amlodipine, 40mg of simvastatin a day and a bit of low-dose aspirin. lately, he's been experiencing significant knee pain
during and after tennis and his local pharmacist has suggested that he takes 1,500mg a day of glucosamine sulphate as well as 8-10 capsules a day of fish oil to relieve the pain. he presents to his local gpfor a second opinion on this regimen, especially since it's quite expensive, which is relevantto our recent discussion.
so, trevor, let's say this johnpresents to you, how would you approach himand also his decision to follow the pharmacist's adviceto purchase these medicines? ahem. firstly, he's come for an opinion and as a qualified doctor, people sometimes forget our job is actually to take a very professionalapproach to this. firstly, i want to be askingwhy is he having knee pain, why he's on perindopril,why he's on amlodipine,
one of the least evidence-supportedmedications that is one of the highest sellersfrom pharmaceutical industry, and why he's on simvastatin. i'd really like to lookat all those things because his knee pain is not just, um...necessarily 'i play tennis, i get knee pain.' there are a number of issuesin his history that, as a doctor, as a practitioner, i need to actually go into first.
but i'm actually happy to havethe conversation with him about the glucosamine and the fish oil because i've also seen evidenceto say they're beneficial. are you suggestingthat you first want to establish that the diagnosis is correct,that he has osteoarthritis? well, that's right. i'm questioningwhether he actually has osteoarthritis. even then, is there a role for fish oilin the management of oa? i believe that's controversial and, um... i've seen lots of conflictinginformation about that.
in terms of my own practice, it's one of the options that i discusswith people and people want to try it. some people come back and say, 'i can'tbelieve how much better i feel.' and i can't deny that reality. if they are that much better,that's fantastic. if they're not, i say,'don't waste the money.' so should this guyfirst have come to you before he purchasedthe complementary medicines? i think it's great that the pharmacistsuggested he actually get investigated
and that's really... the key is a teamwithin the therapeutic alliance with pharmacists, the gps,nurse practitioners, whatever, saying, hang on,what we're missing here, we really need to check into this guy because it may be arthritis, it mayactually be simvastatin-induced muscle weakness and wasting, which, at 55, is pretty horribleand is actually often ignored. so that actually needs to be looked at. at first glance,this case looks pretty simple.
they look like effective therapies withvery little risk and lots of benefit. but, evelin,i wonder if you'd like to comment on, perhaps, what else the pharmacistcould have done. if i would have been the pharmacistwho'd first seen that patient, i would have not... i'd have probablysuggested those as a possibility but would have said to seethe medical practitioner to actually get a diagnosis. i would have made a referralto the practitioner and said, 'what is your knee pain?is it osteoarthritis?
look at the exercise you're doing.' also diet and lifestyle issues may playa role for this particular person. i think, as pharmacists, we get trainedin looking at those things and we should remind ourselves that we should lookat those other possibilities. and then, if you look at glucosamine, there is evidence out therethat it is useful in osteoarthritis and it depends really onwhat evidence you look at. whether... which salt is reallythe most effective one
and there's a big debateon which product to use. but it seems to be that glucosaminesulphate is appropriate but i would have probably also said chondroitin sulphate should be usedin combination with that because there is evidence for it. and with fish oil, of course, with regards to the indication, it could be used on that patient but it's not as high in evidencefor a particular osteoarthritis.
so if you do, as a pharmacist,if the patient comes to you, i think you need to establish firstwhether it is the indication, what the patient actually hasto make an appropriate counselling. i'm perfectly happy with tryingto tail a therapy to the patient but, i mean, there are some facts. glucosamine, as evelin said, there's variable evidence,often it's product specific. it's been taken off the danishreimbursement system because it was feltthere wasn't sufficient evidence
to subsidise glucosamine. fish oil again, i mean,there's good evidence for its use in rheumatoid arthritis and, certainly, forhypercholesterolemia. but osteoarthritis is dubious. wearing my public health hat,i'd say, look, this guy, 55 or so, perhaps it's time he stoppedplaying tennis. i mean,that's pretty stressful on joints. what about swimming? what about walking?
there are easier things to do.i mean, you're not young all your life. geraldine: that's right. and adding to that isquality use of medicines actually suggests that we need to always ask the question about whether we should be prescribing medicinesin the first place. are there non-pharmacologicalapproaches? and if trevor's investigationsdemonstrate that he does have osteoarthritis,
then acupuncture might bea very successful therapy and there's some very good evidenceabout the role of acupuncture... ken: sham acupunctureor genuine acupuncture? no, genuine acupuncture. i saw a study recentlyof a meta-analysis of 18,000 patients which, i think,has proven beyond a doubt that acupuncture is very effective for pain managementin musculoskeletal problems. so, you know,there are other things to look at.
interestingly, a number of these thingsmay have ancillary benefits. you know, i've published,from my research group, on the benefits of fish oilin occupational stress which this guy suffers from. so, as trevor said, if he finds that thefish oil is benefiting his arthritis, it may be actually having other benefitsbecause it has systemic action. but you hit ona very important point there that's people... sometimes employ some... let's say, justificationsfor their purchase of remedies,
partly because it's a way of not havingto spend the time going to the doctor but also it's a safe plan b that you can take these remediesand, even if it doesn't work, it's got some additional benefitsand it's sort of 'healthy'. i mean, do you have a comment on that,stephen? well, look, at the end of the day, i think, you know, there's an issuebetween theory and practice. i believe, in theory, that we should beable to get everything from our diet and the environment that we live in.
in practice, i don't thinkthat actually works out. i live in the country, i came downto sydney for this program. i find the idea of breathing this air in to be pretty intolerableon a long-term basis. you know, i know a lot about diet. i know that i err when i'm travelling, when i'm under significant stress. all of the dietary studiesin this country have shown that there are at-risk groupswith nutrient deficiencies.
so i think that there's probablya good place for supplementation and it's part of that,you know, the practice of us all living the good lifedoesn't actually happen out there. we have to differentiate betweennutritional supplements and remedies that are morepharmacologically active substances. this guy won't be sufferingfrom a glucosamine deficiency or a fish oil deficiency and if he were, then a lower dosewould surely be employed. i've heard it argued by james dukefrom... x,
the department of agriculturein the united states that maybe some of these people are suffering fromphytonutrient deficiencies. i mean, really, if you summed upthe whole last 50 years of nutritional research, it's eat morefruits and vegetables. if we all did that, we'd actually besignificantly healthier. so i think there's a placeif people aren't having all of the stuff that they need to haveto actually be healthy to provide some of those supplements
that might give them some of thosephytonutrients that they need. jon: i think that was an interestingpoint you were making as well that the thing that really stands out, regimen in naturopathic medicinehas a very different meaning to what's used here,it's actually diet and lifestyle. what we're really seeing hereis the extension of drug therapy. they're natural drugsbut they're just drugs. there's no, i guess... that is a big thingin complementary medicine,
without the complementary medicinepractice, they really are just extra drugs. they may have lower side effects, but they're using that samebiomedical reactionary model and that's generally probably causing alot of that problem with effectiveness. there are many myths and misconceptionsassociated with complementary medicine, one of which you just alluded to,people think 'natural' equals safe. i think we all understandthe weakness of that argument. but there are some other ones like,you know,
'i can give it a gobecause there's no potential harm.' i mean, ken, would you like to talkabout some of the potential harms associated with the useof complementary medicines? clearly, they are lower risk medicines and that's how they're regulated by thetherapeutic goods administration. having said that, that doesn't meanthey're without risk. some of them havetheir own side effects. certainly, many of them interactwith conventional medicines which is why it's so importantto take a comprehensive history
and make sure you knowwhat the patients are taking. and, equally, well, they can have quitean impact on the patient's hip pocket. these are quite expensive and if they'renot actually providing a useful benefit, then that's a problem, especiallyas often patients can't afford all their conventional medicinessometimes. last but not least,and a particular worry, is that sometimes, they're usedby practitioners and patients as an alternative to a conventional,more evidence-based approach. that's where we've seen some patientsget into really dire straits
where they reject conventional medicine and use these alternatives instead. - or a delay of more effective therapy.ken: yes, exactly. one of the misconceptions, stephen, i just thought you might wantto elaborate on the idea that traditional evidenceis... what's the usual saying? something like 3,000 yearsof ayurvedic medicine can't be wrong. what are some of the weaknessesin that argument? i think one of the things we have toappreciate right from the word jump
is that there's a difference betweenan anecdote and empiricism. an anecdote isthat i caught a train today. it's a part of a personal narrativeand is generally a single incident. empiricism is people actuallyusing observation to be able to determine outcomes. and i would argue and have argued to mymedical colleagues on many occasions that herbal medicine, for instance,is an empirical science. it's the result of trial and error of literally probably millionsof herbalists
over billions of hours of usage over trillions of trillions of patients. now, as a medical scientist, i'd actually say it's not the highestlevel of evidence. there are cultural biases,there are social biases, there are observational biases,but it is a form of science. and to back that up, we did experimentsat southern cross university where... we took plantsthat were used in china and plants used in australiaby indigenous australians
that we believe, because of the waythat they were used, were anti-inflammatory. the same plant in both countries used by different populationsfor primarily the same purpose. um, the pharmaceutical industrywould tell us that there's one hit in 1,000 plantsin random bio-prospecting. we got 24 hits out of 30, which is an 800% increase in random bio-prospecting.
so traditional medicinehas actually got a value from a scientific perspectiveas a repository of knowledge. yeah, but it's still observational dataand, jon, didn't you allude to this in some of your reports that you'vewritten for the regulatory agencies that we have to remember the weaknessesof observational data. well, there are weaknessesbut i think there are strengths as well. it doesn't mean that we should stopat observational data but i think that observational data doesgive us somewhere to jump off from and i was just talkingwith ken outside -
the indian government, for example, have actually developed what they callthe traditional knowledge database which is essentially digitisingold texts from traditional medicine as a tool for researchers, so they canactually see what was used traditionally so they can do the research from that -it shouldn't be discarded entirely. especially the world health organisationis really pushing traditional medicines and over 80% of the world's populationis using traditional medicine so we definitely can't dissuade... clearly, there's been good western drugs
that have come outof traditional medicine. aspirin out of willow bark,digitalis out of foxglove, artemisinin derivatives out of chineseherbal medicines for malaria, malarial parasites. but equally, well,there's been big problems. i mean, we used,in traditional medicine, uh... bloodletting for 300 years. now, we still use bloodlettingoccasionally for haemochromatosis
and a few areas where it works but that was, again,found by controlled clinical trials when you counted the bodiesafter bloodletting compared to no bloodletting,that, in fact, it was very harmful. so the essence is we've got to put thistraditional knowledge to clinical trial. i don't think any of uswould dispute that. we should also remember that the tgaallows traditional use evidence and i think that is one partwhich a lot of practitioners don't know and i think that is important.it's defined in the regulation.
geraldine: we need to move onto our second case study. our second case study is sharn,a 52-year-old woman who presents to the local pharmacywanting something to alleviate her menopausal symptoms which include frequentday and night sweats, sleeplessness at night, excessivetiredness during the day, mood swings and increasing anxiety. she says that she's heard that valerianand black cohosh are helpful. she's clear she does not want hrtand intends to visit a local naturopath.
so, evelin, what would you suggestfor this woman? well, as a pharmacist,i look at the evidence and for black cohosh,the overwhelming evidence, - there's some controversial as well, as of almost everycomplementary medicine - but for black cohosh, it says thatmostly there is evidence for decreasing menopausal symptoms,especially hot flushes. so black cohosh is definitelya possibility and valerian is not used in menopausalor hasn't been tried
in menopause of womenbut it is used for insomnia. there's enough evidence out therethat it helps with insomnia. so i would clearly say to that lady thatit is a possibility to use black cohosh to help with hot flushes and try valerian for insomnia. but there are obviously risks associatedwith complementary medicines as well and so i would point out, for example,with black cohosh, although it's a relatively safe herb, there have been reports onhepatotoxicity with black cohosh,
and i would allude to the fact that ifshe has a pre-existing liver condition that she shouldn't use it, for example. although, it's controversial againwhether it is really that bad, if there's a really close relationship between the reported casesand black cohosh. can you quantify the degree of benefitfor this woman's hot flushes? you say that the black cohoshis particularly beneficial for that. so say she normallygets 20 hot flushes a day, can you tell a person how muchthat might be reduced by?
i wouldn't be able to quantify it because no studieshave really shown that, but apparently, it is the amountof the number of hot flushes a day and the severity is decreasedfrom what we've heard and what we've seenin the clinical trials. and with valerian, it helps you tofall asleep, for example, and easier... geraldine: ken? again, i think going back to trevor'sconcerns about asking the patient. i'd be interested in why she doesn'twant hormone replacement therapy.
clearly, there's been concerns aboutthe long-term use of that but, uh... current thought is thatshort-term use is very effective in terms of relieving symptoms and unlikely to be particularly harmful. again, it's just somethingthat could be explored. it may be that she's got somemisconceptions about this. there's been a lot of badmedia publicity. it may be it's a reasonably held belief. geraldine: do you agree, trevor?
well, there's a couple of pointsi'd like to make. one is although evelin can't sayhow many hot flushes the black cohosh will reduce, i couldn't say the same thingabout estalis patches either. i can't tell the woman that will reducethe flushes by ten per day. really, all i can say is that this isthe amount of evidence i've got and... you can try this, it's a medicinei think would be beneficial for you if the diagnosis had been properly made. but i will take your feedback.
the critical question here is she said she has heard of valerianand black cohosh are helpful. what i would like to say is,'so have i.' i've heard they're helpful. i actually don't know about valerian,so i'm not going to presume to know, but let's agree that we're goingto look into this together. that's right, surely you'd go look itup, which we'll talk about later. and the thing is, if she's come saying,'i don't want hrt', and if i stand up there and say, 'well,you bloody well should have hrt,'
we've lost the battle. if i can say,'yeah, i'll hear about it. the symptoms you've describedcould actually be hiv, could be hepatic liver...alcoholic liver disease, or it could be hepatitis.' again, she's not necessarilyjust a walking symptom. - you have to have a diagnosis.trevor: right. if that's what she's going to do,that's fine, but we'll have the conversation laterif you need help.
there's a critical issue that i thinkis important to emphasise - the fact is that there area range of therapies and i think part of our responsibilityas health professionals is to communicate to peoplewhat their range of choices are. as ken pointed out,short-term hrt is effective. you know... black cohosh is effective. we're currently doing a study,looking at acupuncture in menopause and there's good evidence to suggest that acupunctureis an effective treatment.
one of the things we need to dois to let people know what their range of choices are and support them taking those effectivesorts of therapies. i think that's why it's so relevantto talk about this in the setting of rural and remote practitionersand patients because not all the choicesare available so you can talk till you're blue in theface about going to have acupuncture but there might not bean acupuncturist around. but the beauty ofa lot of complementary medicines
is that you can order themover the internet! in fact, we have had a questionfrom a gp in the northern territory who asks, 'what do i sayto some of my patients who tell me that they can buy cmsfrom overseas on the internet. can't really get them in australia,is there a quality issue even for products like evening primroseoil for menstrual pain? - the answer is don't do it!- (all laugh) just be very clear to your patients,don't do it. the reason for that is there's at leasta sort of 30-50% probability
that those products purchasedover the internet are substandard, counterfeit,have no active ingredient, or are adulteratedwith things that shouldn't be. again the therapeutic goodsadministration has been quite good at picking up those sorts of things butthe message again, i'll just reiterate, do not purchase productsfrom the internet overseas. trevor, i believe you're absolutelyfrightened of remedies from overseas. - is that correct?- yes. i think i've seen too many storiesand cases about, as was mentioned,
counterfeit medications. and we do not have any controlover stuff that has come throughthat sort of a source and anybody who gets on their emails - all the advertisements for viagra andviagra equivalents would know that! how much marketingthere is in that stuff. i think that's what we have to... for all its faults, the tga doesa fantastic job in some things and is world-leading in many respects
and one of the things that you can beguaranteed of in australia is that if an australian productsays it has something in there, it has a tga standard nameso it actually has that in there. when you're looking at interactions, you can be pretty sure that's goingto interact with that. in american products,they don't have standard names. you may have the one substancelisted there four times if it's even on the label at all, so there are safeguardsthat exist in australia
that just don't exist anywhere else. don't buy australian productsover the internet because a lot of themare also counterfeit, so that's another problem. for example, it was highlighted by ablackmores ceo at an industry meeting that ebay has lots of rangeof blackmores products and they doubt whether those onesare particularly... they can't tell you whether they areactually made in australia or not. so, again, there's an issuewith buying australian products
over the internet fromgod knows which sources. i think we need to be clear that there are reputable australianinternet pharmacies that do produce australian regulatedproducts of good quality. what we're talking about hereis overseas internet, which, as evelin said, can mimicand counterfeit australian products but, again,the message is don't buy them. i think, getting back to this case, i think it's very importantfor us to also emphasise
that, in talking with patients abouttheir complementary medicine use or intention to use,we need to take an adequate history. so partly, i think i'd like to know,trevor, what you think if this lady had a historyof breast cancer and also what should we teach thosewatching the program tonight about taking a history of the people'scomplementary medicines themselves. one of the first thingsis not to be shocked and frightened to ask the questionand to hear what people say. they will say, 'you're one of thosedoctors that's going to lecture me.'
whereas if you can say,as i said, 'valerian, i don't know. i understand what valerianis, um, but we'll look at that and the black cohosh, i have someinformation, some knowledge on that.' once you start saying, yeah,let's talk about this, you've actually got a chanceto work through whatever the best option's going to beand actually protect the patient from some of the scamsthat are being talked about here. but that takes time and you can't do itin a six-minute consultation. evelin, what do you teach your pharmacystudents at griffith university
about taking a historyof complementary medicines? we actually say... we teach that theyshould actually take a record of what patients are purchasingincluding complementary medicines and that's actually what we found whenwe did a national survey of consumers. we found that consumersactually expect pharmacists to take a record on those products. and they have to documentthe actual brand, don't they? exactly, because obviously not everycomplementary medicine product is the same so you need to reallydistinguish between products
and, um, look at the active ingredientsand extracts for herbal medicines. and the dose. yes. evelin: treat them like medicines,basically. geraldine: exactly!like any other medicine. but prescription drugs, because oftenwe have generics that will be more or less equivalent, people wouldjust put down the active ingredient, but you just can't do thatwith comp meds, can you? no. but that's why, if you workin a pharmacy, you are the owner, if you stock productswhere you know the evidence
and you knowthey are good quality products, then you're already one step ahead. if you have regulars coming in,you get to the point where they're purchasing those productswhich you know are quality products, and that's where we want to get to. that's right. we'll talk some moreabout products in a second. we'll just get onto our third case study which brings up some of these issues. so this case is marjorie.
she's a 65-year-old womanwith rheumatoid arthritis. she's currently takinghydroxychloroquine, she's also on alendronatefor her osteoporosis and a bit of prednisone. she's begun taking a digestive enzymeproduct that contains minerals as well which she ordered onlinefrom the united states. the thing is,there are some interactions here and also issues of product quality. so, jon, could you please commenton how should someone assess
the risk of takinga complementary medicine product with their prescription drugs? well, as i said, i would just consider complementary medicinesto be natural drugs. some of them aren't even that natural but you should just treat themexactly the same there. they're usually pharmacologically activesubstances with a risk profileand a benefit profile and, hopefully,the benefit outweighs the risk profile.
so i would not think of themany differently and it is really somethingthat gps should be cognitive of and actually learn how a lot of these, particularly the common ones,actually do work pharmacologically. in this being a real case, the problem was she actually hadn'tnoticed the minerals. when they were...if minerals were presented to her as substances from a doctoror a pharmacist, she would've thoughtabout drug interactions
but because they were lumpedinto this... and this raises that point of purchasingsomething not with that tga safety because in the us,you don't actually, um... the labelling laws that exist there don't necessarily come anywhere nearthe australian ones. so even knowing what was in there,even if you actually had it, the only way to be sure,you'd have to send it off for analysis, which you can't obviously do. if you bought an australian product,you would know what was in there
and whether it was interactingwith your medicines. i think that's a critical issuethat we need to just acknowledge. i mean, it's one of the areasthat i think the tga has done... made major mileagein comparison to other countries. back in 1985, they actually mandated that all companies manufacturetherapeutic goods in this country to pharmaceutical grade standards, to pharmaceutical good manufacturingpractice or gmp. a lot of small companies that weren'table to do that went out of business
at that particular point in time and the industry now, i think,is actually rightfully proud of the fact that, you know,certainly the majority of the industry actually follow those standards,i think, with pride. in comparison, in the united states, complementary medicinesare made at food grade standard. now, it's not that there wouldn't besome companies who up the ante and play a higher game but there are products in the us market
that, you know, i wouldn't feed to a petanimal, let alone actually consider taking myself or giving themto anyone that i actually cared for and certainly would never considergiving them to a patient. one of the critical issues ispick up any complementary medicine in this country,pick up any pharmaceutical drug and it'll have an austl numberif it's a complementary medicine and an austr numberif it's a pharmaceutical drug. and they mean that it's partof the therapeutic goods regulation in this country,it's either listed or regulated,
and one of the things that the tga doesis to actually determine how medicines are actually regulated based on a riskframework - from low risk to high risk. that risk framework actually startsto set the standard for how complementary medicinesshould be regulated internationally. they're the only way that someonecan bring in a therapeutic good into australiaand legally market it, isn't it? if there's no austl or austr,is that right to say it's illegal? it's illegal, yes. if you go to a shop somewhere in...
in, uh, an area of the city and there are productson the market for sale and they look like therapeutic goods and, you know, i think there's a sayingamong my colleagues at the tga is 'if it looks like a duckand it quacks like a duck, it's a duck' so if it's a bottle and it's got tabletsin it, it's a therapeutic good and therefore, it must actually be part of the australian registerof therapeutic goods and if there's no austl or austr numberon it, it's an illegal product.
perhaps i could add also that peoplecan explore the artg themselves. you can go online and search theaustralian register of therapeutic goods and if a hunger buster,i'm just making that up, any brand of a substance that you seeas a possible therapeutic good isn't there, that's bingo, isn't it?means it's illegal. well, it's not quite as simple as that. i mean, basically, stephen is right,but there are exempt products. some homeopathic products,for example, are exempt. again, there's concern about this
and i think the regulations are goingto be changed but at the moment, although that's 99% right what stephensays, it's not 100% right. equally well, the fact that you can goto the tga website and look at the registerand see products there, complementaries, that's a problem too. because although there's informationon the public record about complementary medicines, it's put there by the sponsor,it's not checked by the tga and a lot of that informationis quite incorrect and wrong.
outrageous claims are being made,for example, by the sponsors and we have the same problemsin promotion too. but i think we're going to come to thatlater when we talk more. ken, just briefly, if this product,this digestive enzyme product from the united stateshad actually been recommended to this lady by a pharmacist or a doctor or a complementary medicinepractitioner and sold, even though it's noton the artg, is that also illegal? ken: yes, it is. it is.- i think that's an important point.
oh, yes, it is,and it is very important. safety and measure,as stephen has highlighted, a customer should look at the label tosee if it's got an austr or austl and if it hasn't got that,it certainly raises questions. it's especially important in regardto herbal products. one of the things that the tga mandateda number of years ago because of issues associatedwith potential substitution of one plant for another and it might be done inadvertentlyat point source
where they're actually gettingthe raw materials, is that if you put a herb in a productin this country, you have to send it offto an independent laboratory to have it botanically identifiedso the herb that's on the label is the herb that's in the product and i think that's one of the guaranteeswe have in australia. again, it's not quite as good as that. we've had the problem of adulterationof herbal products. for example, people may well remembermelamine and milk,
which is not a herbal product, but it was an example of peoplecontaminating milk with melamine to fool chemical tests. now, the same thing, regrettably,is happening with herbal products. in particular, one example in australiawas ginkgo biloba a couple of years ago which looked fine on the basic testbut was actually adulterated with buckwheat so it really didn'tcontain the ginkgo that it was meant to but it fooled chemical tests. again, to give creditwhere credit's due,
the tga has actually uppedthe testing on that. but there's an ongoing problem herewith adulteration and, uh, these sorts of things. i think it's importantto actually acknowledge that people who actually adulteratemedicines are criminals. and one of the things that probably isone of the biggest growing parts of organised crime internationally isthe production of adulterated medicines. there've even been some peoplefrom the who that have estimated that up to 50% of medicinesreaching the developing world
may be actually adulterated. ken: counterfeit.they had no active ingredient. and if people experience adverse effectsfrom these adulterated ingredients, it's really important to reportthose adverse events, isn't it? so we might just remind the audience also that we need to hear from the community about adverse events and safety to identify these problems.
will take calls directly. there's the adverse medicine events line that members of the general public can ring up. ken: health practitioners have access to the tga's blue form, now it's internet based. again, if they're getting a historyof complementary medicines and other medicines and getting someconcerns about adverse reactions,
then fill out those forms,go on the internet. it's the only waywe'll know about those. it's very importantthat they're asking the patient what exact product it was, so they'll beable to specify that on the form and the patient stays anonymous, whichis also important to tell the patient. geraldine: names don't go on the form.- exactly. now, we must move onto our next case study - one of those heart-sink situations where we often see
complementary medicines used because the personis faced with a mortal illness. so this patient is mrs goodwinwho lives in a small coastal town, recently diagnosed with colon cancer, and has had one round of chemotherapy and was very ill throughoutand in post-treatment. she approached a complementary medicinepractitioner who promised miraculous results using certain herbal remedies.
after taking these for two weeks, she began to feel better, the practitioner was not registeredwith any authority and insisted that mrs goodwin trust him and not take any further part in orthodox medicine or treatment. so she stops the chemotherapy and continues with herbal medicines and, after six months or so,
mrs goodwin begins to seriously deteriorateand is in pain. she continues the herbal treatmentbut her husband is very concerned and wants their gp to do something. now, trevor, i understand you've beenfaced with similar patients. tell us what we can do. yeah, we've actually had to dealwith very similar circumstances and, ahem, there's a coupleof hard lessons in here. firstly, we are not our patients' keeper
and, unfortunately, people makebad choices, bad decisions, and we... if we can keep engagedin the conversation, sometimes we can protect themfrom those decisions and balance the information betterand interpret it better. sometimes we can't, in which case,the case that's presented, she's come back after six monthsand things are looking bad. i still... even when she's madea bad decision, i'm not going to judge her because,at the end of those six months, she's going to come back, i'm stillgoing to say, 'i still care for you.
i still respect you as a human, and this hasn't turned out as wellas you might have wanted it to but i've still got a lot of therapyi can offer you to support you and most of thatwill be conventional therapy.' but she's not supposed to engageany of your therapies. so now we need,if we've had that conversation - and we've had this with a patientin our own practice - we've got the opportunity to say,'is this working for you? is this alternative therapy working?'
there comes a timewhen it's actually not working and so, 'will you now talk to me?' i'll be blunt and i'll be honest andopen, i need to be honest and open and say what i can do. the big problem with the caseas it was originally presented was that it didn't workand her disease progressed but what if she was alsoengaging in therapies that were downright dangerousto her health - say, vigorous colonic lavageand enemas galore.
what would you do?would you step in? well, i have to be carefulhow much i can step in because, again, if i actually walkedover to her house and held her and said, 'no, you can't do this,'that's an assault. so, again, if i can keepthe communication going, i can actually be honest,maintain the respect and say, 'this is doing you harm.look at what's happened now.' if she refuses my advice,i have to live with that, and, in fact, i probably will need
the help of some of my colleaguesto work through that. other members of the panel,how would you feel, how would you act if this patient facedwith a mortal illness was actually a ten-year-old child and was being taken tothe complementary medicine practitioner, who we're presenting as someonewho's not registered and perhaps engaging in questionablepractices, by the parents. i mean, what do we do? well, in theory,that's assault on the child
and there are legal remedies. but, obviously, as trevor has said, the first thing is to tryto get good communication going and to try to sort it out. having said all that,if that absolutely fails, you have got a duty of careto the child and there are authoritiesthat you can and must go to if that childis ultimately going to be abused. but, again, i'd go backto what trevor has said -
good communication,keeping the lines open, is terribly important. there are important communicationprinciples here, aren't there, about respecting the patient and so on? we have to respectthe patient's autonomy, that doesn't meani'd like what's happening to her. and, in fact, this 'therapist'who's pretending to be a therapist, as has been said,there needs to be some legal control over that sort of behaviour
and bring on regulationof, um, complementary therapies because there are a lot of charlatansout there doing crazy stuff. but, hey... my colleagues, who i know do terrible things to patientsin six-minute medicine. jon: and the communicationis particularly important, too, because, nine times out of ten,if you give a patient a choice between a cam practitioner and a gp,they'll choose the cam based solely on the fact that they getto see their gp for 15 minutes max, they get to see their cam practitionerfor an hour,
there's a greater therapeuticrelationship built on communication. so if you improve communication,you build trust and then the patient can actuallytrust you to take your advice. i was actually once put on the spoton a radio program where somebody asked me, 'how do youtell a good complementary therapist?' one of the things i actually realised from my own trainingand what i actually teach students, is that they have to know the limitsof their practice. i'd say that that's a critical issuefor any therapist
is basically, if you go and seeany therapist, from a surgeonright through to an acupuncturist and you actually say to them,'what are the limits of your practice?' if they don't know any or they believethat their therapy can cure everything, then get out of your chairand run for your life because no therapy is perfect. in this case of mrs goodwin,what advice would you give the husband who's so concerned? well, i think one of the issues i'dprobably be discussing with the husband
is trying to actually expose mrs goodwinto what her full options are. you know, i'd probably be tryingto get her to see somebody who can actually explain everythingfrom the herbal medicine she is taking right through to heroptions in chemotherapy and radiotherapy and talking throughwhat they'd actually do. you know, sometimes,i say to patients, 'i've done 14 yearsof university education and if i was in your bodywith what i know, this is what i'd do.' as a health practitioner,it might be worthwhile also
trying to talk to the complementarymedicine practitioner, you know, if the patient givestheir permission to do so to maybe come up with a combined effortto maybe compromise. maybe even, you know, suggest a secondopinion from another naturopath or another acupuncturistor whatever that cam practitioner is because... i've edited the textbookfor naturopathy. we actually teach studentshow to work with chemotherapy and the acupuncturists do the same,the chiro... this isn't standard complementarymedicine practice,
so finding a complementary medicinepractitioner that will work with conventionaltreatment is an option that you can talkto her husband about. we have received a question from lindawho's a nurse in north queensland about a medicinei've not actually heard of so i'd be interested to knowwhether any of you have. 'how can i interveneon behalf of a child who's being given homeopathic a-p-i-s?' jon: apis.- apis. what is apis?
evelin: bees. geraldine: so bee sting? trevor: homeopathic...evelin: yeah, from bees. who's being given homeopathic apisfor bee stings regularly who is allergic to bee stings?'trevor, a response? keep communicating is one thing because you can say,you can report her to docs, which i've been told toby a specialist before. then you will actually loseall communication with the family,
it'll be a catastrophe. or you can keep saying,'hang on a minute, we need to keep discussing this,this is not working. can we actually engage some tests to seeif it actually has worked?' there are ways you can do that. and keepputting the evidence in front of them. the question iswhy would you want to interfere? has the child been having an allergicreaction to this homeopathic medicine, which raises the questionwhy would that be? if it's a high dilution,it would work in a different way.
so it's a questionof whether she's observing an adverse reactionto that homeopathic medicine. perhaps you can guide this nurseasking the question about what to look for on the product,maybe see how diluted it really is? yeah, it goes into a big discussionabout what homeopathic medicines are and, you know, that the diluted onesare more potentiated. it's a completely different paradigm. it's too difficult to discussin this short period of time. - it raises the issue about resources.evelin: yes.
this is an important issuewe need to spend time on - where to go for information. and that was a questionwe have had from dr craig brown. 'which complementary medicineshave good evidence base and where can i find this information?' so, for example, evelin, if we weregoing to look up homeopathic apis, where would you go to look that up? well, i... the first look would beat the review from the nps which was conducted in 2009and the review on the quality
of complementary medicineinformation resources. and if you go to the nps website, you actually can download the pdf file and, um... in that review, they were looking at all sortsof different resources and the natural medicines comprehensivedatabase was, for example, one of the oneswhich they classified as very good to get information from. the one which is listed there,the fourth one,
the natural standard databasewas another one. those ones are subscription databases. however, the subscription, for example,for the first one is relatively low. for a three-year subscription,you're paying less than $200. so, really,as a healthcare practitioner, you should look at this nps review and every pharmacy in the country should have access to those databases. and some of the other databasesmentioned there
are the general ones we go to - cochrane and pubmed,which are databases which also contain informationon conventional medicines and we should, as health practitioners,be familiar with those anyway. there was another onewhich was an american-based one which is quite good for givingcomplementary medicine information too and i'm sure she would find someinformation on homeopathic medicines in those databases as well. - even google is useful, isn't it?evelin: it depends.
- (all laugh)- depends. maybe not wikipedia. before google and wikipedia, you'djust sit there going, 'what's that?' and hopefully look upa lot of pharmacopoeias but now you can search the world! ken: well, you've got to be verycareful, haven't you? because there's an enormous amountof rubbish on google and the key thing is to sort outwhat are the good resources and again, evelin's made the point that the national prescribing servicehas done a lot of work on this.
there are good resources. i subscribed to at least one of those. it's essential, i think, to be able toget that evidence-based resource. i think it's actually importantto acknowledge and i think one of the thingsthat has a tendency when you get a groupof health professionals together discussing complementary medicine is that we get into this rhetoricof danger. one of my doctoral studentsdid her thesis
looking at this rhetoric of danger, in a media analysis on herbal medicines. and we talk about these interactions and the various, you know,negative things that can occur and i don't, uh, disagreethat those things are possible but we also need to look at the fact that there's a wide range of benefitsthat happen and generally, this is a low-riskfield of medicine. there are not piles of bodies out therein the streets.
um, you know, there are a lotof complementary medicines that have actually got first-class scientific level of evidencefor their usage and i think that's the thing that healthpractitioners need to be aware of. geraldine: trevor, what sortof resources would you use? we have a number of resourcesin our practice and i use the australian college ofnutrition and environmental medicine. do you have to be a memberto access their resources? it doesn't take much to be a member.
geraldine: jump up and down? but they do run a lot of courses that, for somebody who's, again,scientifically trained and is saying, 'what are these things?' it's a fantastic wayto actually start understanding at least what people are talking about and then to decide whether you canincorporate it into your practice. what do you have to doto access their resources? contact the college office in melbourne.
geraldine: do you have to pay money? they're usually pretty helpfulto start with. if people want to do a course,yes, you have to pay money. i think the bottom line is, most ofthese resources are huge, aren't they? trevor: yes.- we have to consult multiple ones. jon, do you have any other favouritesyou'd like to mention? i would recommend maybe, there's bound to besome cam practitioners in the area. some bad ones, but also some good ones.
cam practitioner trainingin australia now does have a lot of critical analysisand research skills in there. they can actually help you,guide you to the evidence as well, and i think that gps and pharmacists, all conventional health practitionerscould benefit from actually, you know,interacting with cam practitioners and i think the cam practitionerscould actually benefit from learning from the gps, nursesand pharmacists as well. i also just want to point out thatsome of the professional literature
which a lot of pharmacists,for example, are using, they don't actually containenough evidence-based complementary medicine information. so there has to beawareness amongst us to tell pharmaciststhat they have to be careful and go to the mhor the therapeutic guidelines or the mims or ausdifor complementary medicine information. it's just not enough what's in there and it's not as actualas we would like it to be.
- or as detailed?evelin: yes. yes. none of those resources which areexcellent for conventional medicine were recommended by thenational prescribing service review. evelin: for complementary medicines. there is a need to goto specific resources. wouldn't you say, not to forget yourbasic training in pharmacokinetics and pharmacology and remember to thinkof things from first principles which, again, you might not havespoonfed from a resource, you might have to think about itand go back to looking things up.
i think, critically, in regard to that, there are two resources that i wouldrecommend people think about. if somebody comes inand they're talking about a therapy that they actually don't know, maybe not google but google scholar which actually looks atthe international scientific literature and also pubmed. both two free resources and i'm constantly using themas an academic.
when somebody asks a questionsuch as this program, you know, 'does soy have an influencein breast cancer?' i spent half an hour on pubmedthis afternoon to delineate the fact that it's onlyin her2-positive individuals that soy is a problem. so you can get very specific informationvery rapidly from those sources. that's right. and, um, jon,can you tell us a little bit... you alluded to this before, about complementary medicinepractitioners being regulated.
is there any regulation at the moment? some of them are quite well regulated, the osteopaths, i think,do a very good job. chinese medicine,probably do the next best. there's some groupsthat are statutorily regulated but have a lot of professional problemslike the chiropractors. there's variability there. unfortunately, most cam practitionersare completely, virtually unregulated. i mean, looking at a professionlike naturopathy,
you've got 28 associationsthat are recognised by the tga. you've got... when naturopathsgot gst-free status, kinesiologists, homeopaths,everyone started calling themselves naturopaths overnight becausethere was no protection of title. so it can be very difficult to finda qualified practitioner but there are qualified practitionersout there. usually, i'd recommend that you findsomeone who is recognised by multiple health providers,health benefit associations. - health benefit associations?- private health insurers, sorry.
not just one but multiple ones, becausesome actually have quite lax standards. and, uh... ideally, someonewho's university trained or at least has a four-yeardegree training would be the other thing i'd look at. what should consumers doif they find that the practitioner is not complyingwith expected standards? what would the process be? i think a lot of people give a bit of misplaced loyaltyto their practitioner sometimes.
just as you'd gofor a gp second opinion, you should go for a second naturopathopinion, a second chiropractor opinion. if you're going to see a chiropractorwho wants to sign you up for $5,000 worth of treatment straightaway, run away as quickly as you can. it's about finding someone that actuallyis treating you like an individual. if you've got a chiropractor that'spotentially financially exploiting you, a naturopath, some doctors do itas well, some physiotherapists, don't feel like you have to staywith them. there are other choices inthe complementary medicine field,
just as there are in the medical fieldas well. we recently had that controversy with the blackmores 'coke and fries' issueswith the companion sales. i don't think that's gone away but wouldanyone like to make a comment about what that reflected in terms ofthe complementary medicine environment? look, there's a big problem out therewith complementary medicines and although i'm the first to admit thatthere are good evidence-based products, there's an awful lot of scamsand problems out there, products that are over-hypedand over-promoted.
to some extent, the blackmores dealwas a sort of example of this. they were suggesting that for conditionswith prescription products, that one should automatically consider, a pharmacist should considerrecommending a 'companion' complementary medicine. although there is some evidencethat in some people, that might be appropriate, it certainlywasn't appropriate as a routine and it raises again the real questions of was this just commercial promotionto make a buck?
even more concerningto many health practitioners - we know that people have problems of forwarding the co-paymentson conventional medicines, to have added on an extrafor complementaries would almost certainly mean that some patients would be foregoingnecessary medicines. so this is an example of wherethe commerce really is overcoming... geraldine: potential conflictof interest. very much a conflict of interest.
the pharmacist can make you really upsetthinking about it because you'd pushfor a specific brand rather than evaluating the evidencefor all products out there and taking into consideration theindividual circumstances of a patient, which we should, and that wouldn't havereally been the case in this regard. for me personally, when i saw this, it feels like it gives the 'ready to go'for all pharmacists to just push any complementary medicine, even those who have maybe little or noknowledge of complementary medicines
and those pharmacists still exist and that's just really nota good practice. great comment. thank you. i wonder if we can go to each of you nowto get your take-home message for our audience, please.jon, can we start with you? ok, well, the take-home messagei'd like to put across is we certainly have to be awareof the potential risks of complementary medicinebecause there's quite a few of them. but we should also rememberthe potential benefit
and take the measured approach. as a health professional, get educated and know whereto find evidence-based information. geraldine: stephen? i think my take-home message is thatthere are two bodies of knowledge - one is the rigorously scientificallydefined knowledge and there are a lotof complementary medicines that have got very goodscientific evidence, and then there's the traditionalknowledge
which i believe we need to respect. i believe we need to translate thatinto research but it may take hundreds of yearsof effort by people like myself to make that happen. in the meantime, we have to acknowledgethere's this traditional evidence that does have real value to it. look, i agree there is goodcomplementary medicines out there, evidence-based, but there's alsoan awful lot of hype and really rubbish type products.
and the challenge is sorting them out, for which some of the resourceswe've mentioned on this program and critical appraisal skills will help. geraldine: and, finally, trevor? basically, to be open to learnwith your patients that complementary therapies, especiallyfor me in nutritional therapies, provide an extra set of toolsthat may be of benefit but you have to start learningand it takes a long while to learn. it's not an easy way out,it's an extra lot of knowledge.
be sceptical, as the panellists said,about some of the hype but apply that to both sidesof your training. i'm just as scepticalabout my orthodox training as i am about nutritional medicines. and at the end of the day, rememberthat arrogance equals ignorance and the bottom line is that we're hereto help our patients get well or to do as best as we canfor their health and what works for thatis what i'm looking for. very wise. well, thank you, everyone.
i hope you've enjoyed this program on complementary medicines -the best advice. our thanks to the departmentof health and ageing for making the program possible and thanks to youfor taking the time to attend. if you're interestedin obtaining more information about the issues raised in the program, there are a numberof resources available on the rural health educationfoundation's website at rhef.com.au.
don't forget to complete and send in your evaluation forms to register for cpd points. i'm geraldine moses, goodnight. captions bycaptioning & subtitling international funded by the australian governmentdepartment of families, housing, community servicesand indigenous affairs�
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