All have a role in CM safety

CMs in half an orange

Consumers need reliable, professional advice on CMs, writes Dr Penny Caldicott

The Australasian Integrative Medicine Association (AIMA) Board has watched and listened with interest to the recent debate about our community’s ever increasing interest in and use of complementary medicines.

We too are concerned that the safety of the public is paramount and that we all have a role to play to ensure that this is a priority.

In 2008 an Australian survey found that 70% of Australians used complementary medicine in the previous 12 months. This number is likely to be higher now.

Our members are registered doctors whose rationale for practising integrative medicine adds considerably to this public debate. Since AIMA’s inception in 1992 we have been driven by the desire to deliver patient-centred care within a respectful partnership with our patients, who are often looking for a different model of care.

Our integrative doctor members have been guided by the shared articulated expectations of the growing numbers of patients wanting to see us. Over time we have learnt that our patients make appointments at our clinics for a variety of reasons and that basically these can be divided into two groups.

The first group are patients with chronic illnesses seeking ways to improve their overall health who are also hoping to minimise their dependence on pharmaceuticals and the side effects that can be present. They look for doctors who listen to, respect and respond confidently to their concerns and fears.

Many of these patients also desire a more “natural medicine” but need guidance to make safe choices.

Doctors practice evidence-based medicine when providing individualised advice. This approach includes understanding relevant research, utilising their own clinical experience and combining this with the expressed desire of the patient in front of them. Amongst other treatments, integrative doctors may prescribe nutritional supplement or herbs, and will have conversations with patients that include potential interactions with prescribed and over the counter medications, food and any possible adverse reactions.

The Consumer Board Member of AIMA, Ms Tricia Greenway, was for many years the Senior Policy Manager at Arthritis Victoria. In this role she tells us that many people with arthritis confided to her that they were “trying other things” to manage their pain and their mobility, but most were afraid to tell their doctors for fear of being “growled at”.

When presented with this risk issue Ms Greenway reported that Arthritis Victoria endorsed “awareness raising” amongst its consumer members, doctors, pharmacists and rheumatologists by looking at ways to improve dialogue and mitigate harmful outcomes.

This activity was followed by an invitation from the Federal Health Minister to speak about what Arthritis Victoria had learnt about consumer attitudes to Complementary Medicine at the satellite launch of the Office of Complementary Medicines in 1999.

Last year Prof Marc Cohen, former AIMA president, was requested by the consumer membership to speak at Arthritis Victoria‘s Annual Lecture on Complementary Medicine.

Ms Greenway has since been very enthused by the work of the Clinical Oncological Society of Australia (COSA), particularly about its Position Statement on the use of Complementary and Alternative Medicine by Cancer Patients, which she believes is a great example of respectful shared care.

Developed with consumer input, its introduction states “COSA encourages health professionals to focus on open discussion with their patients regarding CAM”.1

The second group of patients (often referred to as New Consumers) are those who are looking to stay well and are generally health conscious. For these people access to credible and up-to-date information and practitioners is of crucial importance.

Consumer Research conducted by pharmacist, Dr Lesley Braun et al in 20102 and that  of Ms Greenway as part of ‘the Consumer Needs Project ‘for the 5th Pharmacy Agreement agreed that: “Complementary Medicines are widely used by customers, of all ages, who want pharmacies to be more involved in providing advice about these products “

The trust that consumers have in their community pharmacist is also aided by the fact that consumers can get free, accessible and increasingly well-supported advice, particularly when records of their pharmaceutical medications are held by the same pharmacy. Relying on the supermarket or the often questionable information from the internet is clearly more risky for the health conscious patient.

AIMA is concerned that some of the current negative commentary may erode general trust in health professionals and their capacity to contribute to patient safety.

AIMA has for its part long worked to support and ensure that the upskilling of its members is designed to meet the needs of both patient and practitioner. As such our members have long been directed to interactions databases, such as IMgateway, which is available also to pharmacists and now is also included in E Mims.

This highly credible resource was created at the Pharmacy Faculty the University of Sydney by Emeritus Professor Basil Roufogalis and is now directed Professor Andrew McLachlan.

Recently we hear that the undergraduate pharmacy students association (NAPSA) has signed up its members to this program ensuring that they will be able to meet the growing future needs of the community.

Our inaugural AIMA Consumer Board Member became known to us following her challenge to the IT company who built this same health professionals database, to adapt it to make it consumer friendly so that those seeking to self-manage could also have access to such credible information about potential interactions between complementary medicines, pharmaceuticals and with food.

A Cochrane consumer reviewer has prepared the early framework and the Breast Cancer Network has signed on for a trial after which it will hopefully be provided free of charge to all patient organisations and individual consumers.3

“It is noticeable”, says Ms Greenway, “that consumers are becoming sceptical of the many claims that complementary medicine lacks evidence”.

She reports hearing comments such as “they keep changing what they say anyway” and more recently “we actually feel quite insulted and just switch off”.

Having well informed and trusted practitioners with good listening and communication skills is our goal to meet the needs of the many people who desire to safely integrate their models of care.

Dr Penny Caldicott is the president of AIMA.

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