[e-drug] Complementary Medicines: Australian NPS research findings

E-DRUG: Complementary Medicines: Australian NPS research findings
-------------------------------------------

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

http://www.nps.org.au/research_and_evaluation/research/current_research/complementary_medicines/cms_users_research

http://www.nps.org.au/research_and_evaluation/research/current_research/complementary_medicines/cms_health_professionals_research

My own comments follow.

The NPS research highlights the gap between the widespread and
increasing use of complementary medicines and the limited evidence
available to justify much of this use. It also shows a major disconnect
between the consumer perception of complementary medicines as "natural"
and "risk-free" and the reality that these medicines contain
pharmacologically active substances that can cause adverse effects,
albeit less frequently with conventional medicines. In addition, the use
of complementary medicines for indications in which they lack efficacy
can have a significant adverse effect on consumers hip pockets (or
purses) and, more importantly, can delay or prevent the use of more
evidence-based therapy.

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

The solution proposed by the NPS (given its limited brief) was better
education of health professionals and consumers about complementary
medicines. This required an independent and reliable source of
information about complementary medicines, to be made available to both
consumers and health professionals. The final NPS report (due in January
2009) will suggest possible sources of such information. This might
include obtaining a n Australian licence to an internationally
recognised database such as the U.S. "Natural Medicines Comprehensive
Database" or the "Natural Standard Professional Database".

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

Sponsors currently perpetuate the misconception that all complementary
medicines containing the same ingredients are equally effective. The
reality is that complementary medicines, especially herbal medicines,
are complex products with numerous biologically active components. This
means that evidence of benefits (and risks) are specific to the product
tested and cannot necessarily be extrapolated. The "generic" concept
which is valid for conventional medicines, for example the
interchangeability of paracetamol containing products, is invalid for
CM. This means that a prescription for "St John's wort" for example, is
not reliable as St John’s wort is not one substance. In addition,
meta-analyses and systematic reviews of a "substance", for example a
herb, or glucosamine, are easily misinterpreted because the products
made from that "substance" can be so different that any conclusions
drawn can only be applied to the specific products trialled. [2]

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

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

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

Cheers
Ken
--
Dr. Ken Harvey
Adjunct Senior Research Fellow
School of Public Health, La Trobe University
http://www.medreach.com.au
VOIP: 03 9029 0634; Mobile 04 1918 1910

References

1. Harvey KJ, Korczak VS, Marron LJ, Newgreen DB. Commercialism, choice and consumer protection: Regulation of complementary medicines in Australia. Med J Aust 2008; 188: 21-25. Available at: http://www.mja.com.au/public/issues/188_01_070108/har10522_fm.html
2. Pollard NA || Santoro A || Kotsirilos V || Masters CS || Harvey KJ, Korczak VS, Marron LJ and Newgreen DB. Commercialism, choice and consumer protection: regulation of complementary medicines in Australia [letters]. Med J Aust 2008; 189 (1): 50-53. Available at:
http://www.mja.com.au/public/issues/189_01_070708/letters_070708_fm-2.html
3. Harvey KJ. Controlling complementary medicine claims [Editorial] Aust Prescr 2008; 31(6): 142-143. Available at: http://www.australianprescriber.com/magazine/31/6/142/3/