A wise choice


Say no to homeopathic products, be cautious with complementary medicines and be careful when adding additional treatments for patients with multiple medications, PSA advises  

New recommendations on the prescribing of multiple medicines and the effectiveness of complementary medicines, including homeopathy, have been released today by the PSA and NPS through the Choosing Wisely Australia initiative.

The PSA developed its inaugural Choosing Wisely list of six recommendations for Australians to consider around medicines use – including prescription, over-the-counter and complementary medicines.

The six recommendations are:

  1. Do not initiate medications to treat symptoms, adverse events, or side effects (unless in an emergency) without determining if an existing therapy or lack of adherence is the cause, and whether a dosage reduction, discontinuation of a medication, or another treatment is warranted.
  2. Do not promote or provide homeopathic products as there is no reliable evidence of efficacy. Where patients choose to access homeopathic treatments, health professionals should discuss the lack of benefit with patients.
  3. Do not dispense a repeat prescription for an antibiotic without first clarifying clinical appropriateness.
  4. Do not prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements should or can be reduced or discontinued.
  5. Do not continue benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium for more than three months without review.
  6. Do not recommend complementary medicines or therapies unless there is credible evidence of efficacy and the benefit of use outweighs the risk.

NPS MedicineWise client relations manager, Dr Robyn Lindner, said: “Sometimes people are unsure of what medicines they’re taking and why. We encourage you to discuss the implications of each new medicine with your healthcare provider and ensure you are fully informed about issues such as necessity, risks and side effects.

“These new recommendations will help guide health professionals and their patients in a discussion about appropriate use of medicines based on the latest evidence.” 

PSA National President Dr Chris Freeman said “While the use of medicines offers significant benefits for many people, they may also cause unnecessary harm. It is important that we balance the positive and negative effects of each medicine, tailored to each individual with their care goals front of mind.

“As experts in medicines, pharmacists have the ability to provide specialised review of a person’s medication regimen, resulting in recommendations or actions to help people get the most out of their medicines. Any person taking multiple medicines, high-risk medicines, or who is at high risk of medicine misadventure, including transitioning between care settings, should have their medicines reviewed.” 

“In regards to homeopathic products there is no reliable evidence of efficacy. All health professionals should take the time to discuss with health consumers, who are taking or considering taking these products, the lack of efficacy and the risks in rejecting or delaying other treatments known to be safe and effective.

“Prescribing data shows that close to 25% of repeat antibiotic prescriptions were dispensed more than four weeks after the initial dispensing, indicating potentially inappropriate antibiotic use in the community. Pharmacists can help to reduce the burden of antibiotic resistance by first clarifying the clinical appropriateness of repeat antibiotic prescriptions before dispensing.”

Dr Freeman said many health consumers turned to complementary and alternative medicines for a variety of reasons and often sought expert advice from pharmacists relating to these products.

“Pharmacists and medical practitioners should present clear information to consumers about the safety of and evidence for complementary and alternative medicines and only recommend these products when the known benefit outweighs the potential harm,” he said.

 

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8 Comments

  1. Ron Batagol
    14/12/2018

    All points of excellent advice. I would, however, add to the advice on homeopathics- be aware and advise accordingly, that where health issues of infants or children are of concern, it is critical for parents not to avoid proper medical assessment if symptoms are of concern to them, in favour of of homeopathic “placebos” which could easily mask potentially serious childhood diseases and delay the chance of recovery! ( Btw, Over thew years, I’ve tried, obviously unsuccessfully to date , to encourage TGA to ban the sale of homeopathics for infants and children!)This, of course, also applies to adults with issues such as symptoms of prostatic enlargement etc.

    • Jarrod McMaugh
      14/12/2018

      The issue you raise with children goes beyond homeopathic products and includes products like amber beads, CAMs, and Allopathic medicines that don’t have evidence of safety or efficacy.

      On the TGA issue, I’d love to see this too, but I wonder if the TGA holds the same view as many pharmacists, which is “well, if we regulate it, then we can at least control it”

      In the case of TGA, if they banned it, nothing would stop companies from marketing them as lifestyle products or something that doesn’t require any regulation at all (hello Vitamin Water…). In the case of pharmacists, most I’ve spoken to who still range it say that it gives them an opportunity to discuss real health with the person who asks for it…. Both attitudes are misguided in my opinion.

      The greatest harm from homeopathy is the perception that it is a health product, with the ensuing delays to treatment or squandering of an individual’s health budget. By removing them from health (ie no sale in pharmacies, TGA ban on describing or marketing as a health product) then this power is taken away.

      They’ll still be available (you can’t outright ban water, or lactose tablets) but they lose that unearned appearance of legitimacy.

      • Ron Batagol
        14/12/2018

        Yes, Jarrod, I agree with you about CAMs etc. ( Indeed, I’ve had “safe in pregnancy” claims removed by TGA in the past, just by reviewing and analysing data in specific instances, that, in fact, demonstrates that they aren”t safe in pregnancy). Your other points about the effectiveness, or lack of, in banning homeopathic products for children and infants are valid, but I always think about the real cases we’ve read about, involving the use of homeopathics alone, with severe, even life-threatening, outcomes occurring, in situations that could have been effectively managed with proper medical attention.

        Therefore, I just think that, on balance, it’s too risky a proposition to continue to allow homeopathic products for children and infants to remain on the market, thereby giving an appearance of an overall “official safety endorsement” for their general sale, whilst makers of these products are permitted to claim that they “give relief” in a wide range of disease indications, some of which may be masking more serious underlying conditions,

  2. Bevyn Jarrott
    14/12/2018

    With regard “to homeopathic products there is no reliable evidence of efficacy. All health professionals should take the time to discuss with health consumers, who are taking or considering taking these products, the lack of efficacy and the risks in rejecting or delaying other treatments known to be safe and effective.” So how do “health consumers” shopping in a ‘warehouse” get advice on lack of efficacy and risks from a 17 yo at the POS terminal ?

    • Jarrod McMaugh
      14/12/2018

      G’day Prof. Jarrott

      I would suggest that the specific scenario you describe wouldn’t provide that advice as expected from the choosing wisely document and PSA’s professional Practice Standard (as endorsed by the Pharmacy Board)

      If you’ve witnessed or experienced such a scenario, I’d recommend making a complaint to the Pharmacy Board. If you’ve heard this from others, I’d recommend you advise those people to do the same.

      The Pharmacy Board is responsible for administering the regulations – they can’t do so if they don’t receive notifications of instances when they aren’t being met.

    • PharmOwner
      18/12/2018

      Short answer: they don’t. I’ve self selected numerous paracetamol formulations, antihistamines, steroid nasal sprays and nicotine replacement products from a major big-box discounter, because let’s face it, they’re cheaper than the wholesalers (that’s a story for another day). NOT ONCE has any staff member there asked if i was taking any other medications, whether the medication was for me, do I have any allergies, what dose do I take etc.

  3. Michelle Gerrie
    16/12/2018

    In regards to point #6 – Do not recommend complementary medicines or therapies unless there is credible evidence of efficacy and the benefit of use outweighs the risk….I utilise the Natural Medicines Comprehensive Database for any queries and find it an amazing resource..http://naturaldatabase.therapeuticresearch.com/mobile/home.aspx?cs=&s=ND. I work alongside a functional medicine GP and have seen remarkable changes in patient health conditions once a holistic approach is adopted..We need to be more open minded I feel, much like they are in Europe A prime example…a friend of mine in her 50’s feeling a bit run down, lives in France and went to the GP. He prescribed Vitamin D and one massage per month and she has never felt better. There is also a GP in the USA who prescribes a box full of green veggies etc instead of medication for some of his patients! Food for thought.

    • Gavin Mingay
      16/12/2018

      I would have thought Vitamin D was a mainstream treatment nowadays with well proven evidence. The green veggies treatment is really just common sense – if people actually ate better, there would be much less need for medications (majority of PBS spend is on lifestyle diseases)

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