Complementary medicines—conventional medicine’s inferior cousin or a key player in health? asks Leanne Philpott

With seven out of 10 Australians using complementary medicines, an ageing population and an ever growing burden of chronic disease— can we afford not to support the use of complementary medicines?

“Complementary medicines are experiencing significant growth, driven by consumer demand. An aging population and a focus on people investing in their own health and wellness is driving demand for Australian complementary medicines, which are recognised around the world for their high quality, safety and efficacy,” says Carl Gibson, CEO Complementary Medicines Australia (CMA).

“The value of sales of Australian complementary medicines has doubled from $2.3 billion to $4.7 billion in just over three years, reflecting the growing level of consumer demand both here and internationally.”

According to a systematic review of ‘utilisation, perceptions and factors associated with use of complementary medicines by the Australian population’, by Rebecca Reid et al, some of the factors driving the use of complementary medicines include: a dissatisfaction with conventional care and concerns about the safety of pharmaceutical medication, alignment with personal beliefs, attraction to the holistic principles of complementary medicines or desire for greater control of personal wellbeing.

“The public embraces the use of complementary medicines, with two out of three Australians regularly using a natural healthcare product. About half of this use is in relation to the management of major chronic diseases. Increasingly, complementary medicines are being found to contribute to improved health outcomes, through increased effectiveness, safety and cost effectiveness, and integration with conventional medical care,” says Gibson.

“Australia’s population is ageing and increasingly overweight, and is challenged by conditions such as coronary heart disease, diabetes and stroke. These diseases are largely preventable.

“There is a real and immediate role for complementary medicines in contributing to consumer health through primary and secondary prevention of illness, creating healthy communities and businesses, and by encouraging and empowering all Australians to take better care of their health.”

He adds, “In Australia, complementary medicines are sold through 5,500 pharmacies, 3,500 supermarkets and 1,500 health food stores. Data from 2015 indicates that Australian consumers still prefer to purchase their complementary medicines from pharmacies due to a large offering of product range and the availability of professional advice from the supervising pharmacist or healthcare professional.

“Dietary supplements sold over the internet are unlikely to have been evaluated by the TGA, which means there is no surety that the product contains what it says it does. Products purchased online from overseas are not subject to the same regulations as those enforced in Australia, and therefore these purchases of supplements should only be made on the recommendation of a qualified healthcare professional or from a reputable retailer.

“Pharmacy is a critical outlet for complementary medicines as it plays a key role in providing impartial and expert advice,” says Gibson.

The evidence debate

“I am tired of the ‘lack of evidence’ argument. I’m worn out by this disrespectful, un-informed perception that there is no evidence,” says community pharmacist and accredited herbalist Gerald Quigley.

“After nearly 100 years of paracetamol use, we still don’t fully know how paracetamol works. It’s the highest liver toxic drug on the market and yet we still use and recommend it.

“People have consistently used complementary medicines for hundreds of years and have found benefit in taking them. Are we really brave enough to say to those people that are using these medicines “you’re wasting your time”? How disrespectful is that?

“There’s a wealth of evidence to support chronic pain herbs turmeric and ginger and guess what—they don’t come with a list of adverse effects and interactions.”

He notes that the optimal dosage is required for the best health outcome, but says this is a key area where pharmacy can assist.

“Experience, passion to help and a willingness to learn all play a role in assisting a person in taking the optimal dosage. Nothing beats clinical experience and feedback. For example, having someone tell you that they take 400mg of lipoic acid a day for their neuropathy and that it’s now under control, whereas it wasn’t before.

“No matter what we do it’s the patient experience that helps us build the clinical personality upon which we become a practitioner.”

He says, “Many Australians take an omega 3 supplement, but it’s likely at a sub-clinical dose because if you’re going to get a clinical effect in omega 3 the dose is usually quite large and most people aren’t prepared to take this.”

He explains that there is a new Omega-3 Index Test, available through select practitioners and pharmacies, which is an effective measure of the omega-3 EPA and DHA levels in people’s red blood cells.

“Knowing where you fit in the profile and knowing what difference an omega 3 supplement might make if you do decide to take it means you’ve got the numbers to make an informed decision.

“As we test for blood sugar, cholesterol and coronary artery calcium, it’s quite refreshing that now we can justify some of the claims and evidence in the enormous range of benefits of using omega 3 supplements.

“Everything you need comes in a kit. One drop of blood is all that’s required. It’s dropped onto a pad, which is then sealed; the patient’s details are filled in, and it’s sent off to the US for testing. In 2018 there will be an Australian testing laboratory, so the results will be obtained quicker than they are currently.

“Those results give an index scale. It’s considered that an omega-3 index up around eight would be appropriate. Most Australians would be very much below that. I’ve seen improvements in some of my patients who have gone from an index of two or three up to six or seven in six months and they’ve been very pleased.

“An improved index corresponds to health benefits including a better cardiovascular profile perspective, cholesterol and triglyceride measurements, cognition and skin improves. All the benefits of omega 3 essential fatty acids (EFAs), whether plant or marine based, become evident with long-term use.”

Quigley says there are pharmacists that like to encourage their patients to get involved and take control of their own health, it’s all about patient empowerment, but there are others who are just happy to sell the products.

“If you don’t believe in complementary medicines then don’t stock them—otherwise you’re sending confused messages. You’re either a passionate pharmacy practitioner or a retailer; it comes down to choice.

“Even though the Omega-3 Index Test is a take home kit, I believe if you’re going to sell the kit there’s an obligation to provide adjunct advice on adequate omega 3 supplementation.

“I advise my patients to use krill oil 1,000mg a couple of times a day as their underlying support and urge them to eat oily fish a couple of times a week but if they miss out and don’t eat the fish it’s not the end of the world because they still have it coming into their system in supplement form.”

Integration

Quigley says, “I have people who come to see me with a bucketful of pharmacological and complementary medicines who still feel unwell; their osteoarthritis pain is still there, they’re not sleeping, their blood pressure is high, they’re always tired— they ask, ‘what can I do?’

“What an opportunity to be trusted by a person. What an opportunity to make a long-term engagement.”

He says integration isn’t about looking for a complementary medicine to replace a drug. Integration is about working together and in doing so helping these people who are disenchanted at not being well.

Naturopath, owner of Pinnacle Clinics and president of the Australian Complementary Medicine Association Will Shannon believes there’s a place for both complementary and Western medicine.

“There’s a long history of use of both. I think both have their own unique purposes and each have their strengths and context.

“I’m pleased to see GPs, pharmacists and compounding pharmacies having a greater knowledge of complementary medicines than ever before. As a naturopath I’m seeing more and more clients who feel they can ask their pharmacist about their complementary medicine and get a more informed answer.”

In the same way that Western and complementary medicine can be integrated, Shannon says practitioners from different modalities can work in union. “I had a pharmacist personally call me to inform me that a patient was allergic to one of the preservatives in Pinnacle’s Herbal Cream. With this input from the pharmacist we were able to collaborate with our development team on an equally as efficacious product with a different preservative to achieve the same result.

“The education of the pharmacist and their open mindedness is crucial to ensure the best patient outcome.”

Communication and education

“Consumers need to stay educated and feel they can disclose to healthcare practitioners the full list of medicines they’re taking—whether Western or complementary. Healthcare professionals also need to remain up-to-date and be open to communicating with people about the potential role of complementary medicines,” says Shannon.

“While I’m pleased to see Western practitioners, including pharmacists, having a richer appreciation and more important understanding of the place of complementary medicines, ongoing education is paramount,” he adds.

“More educated healthcare professionals, pharmacists included, means a more educated consumer, providing this information is passed down, and less opportunity for errors handed down to the consumers.”

“There is an increased demand by the professional bodies for pharmacists to provide information that guides the appropriate and safe use of these medicines,” says University of Sydney lecturer Joanna Harnett.

As such in 2018 the University of Sydney is offering a new course for pharmacists who wish to expand their knowledge in the area of complementary medicines.

Harnett says, “A number of factors prompted us to develop this course including the results from research indicating pharmacists lack confidence in their knowledge about complementary medicines yet the public have an expectation that pharmacists are knowledgeable about complementary medicine products.

“In addition professional organisations have published position statements about the importance of pharmacists providing evidence-based information about complementary medicine products. Healthcare professionals can’t ignore that more than half of Australians are choosing to take complementary medicines, and a substantial portion are buying these complementary medicines from pharmacies.”