Complementary Medicine

 

2002

 

Preamble

 

(a) Increasing usage - the Growth of Complementary Medicine

 

(i) Overall

 

The use of complementary medicines and therapies in Australia is considerable and increasing.

 

The term complementary medicines refers to a wide range of non-prescription products with health claims such as herbal medicines, homoeopathic medicines, nutritional and other supplements. Well known complementary therapies include acupuncture, chiropractic, osteopathy, naturopathy, and meditation. Others include aromatherapy, the Alexander Technique, reflexology as well as crystal therapy, iridology and kinesiology.

 

The term Complementary Medicine refers to both complementary medicines and therapies.

 

It has been estimated that, in 1993, approximately 50% of the Australian population used at least one complementary medicine per year and that 20% consulted at least one practitioner of complementary medicine. Australians spent more than $900 million per year on the Complementary Medicine sector. (1) While growth may now be levelling out, it is estimated that spending on both complementary medicines and consultations with complementary therapists will double from the 1993 level by 2001. This would result in a $2 billion industry. (2)

 

Some people use Complementary Medicine in situations where they perceive that conventional treatments do not offer successful intervention; others hope to improve their well being and are attracted by the promise of holistic and "natural" health care.

 

(ii) GPs

 

Research indicates that many GPs in Australia have accepted therapies such as acupuncture, chiropractic, hypnosis and meditation as potentially beneficial. Over 80% of the GPs surveyed had referred patients for a complementary therapy at least a few times a year. At the same time, many GPs express greater confidence when therapies are practised by those who are also medically trained. (3)

 

Almost half the GPs surveyed reported an interest in training in areas such as meditation, hypnosis and acupuncture, considerable numbers had undertaken training and a smaller proportion practised these in conjunction with mainstream medicine. Nearly 20% practised one complementary therapy. (3) Acupuncture appears the most popular, with at least 15% of Australian GPs practising this treatment. (4) Such a consultation attracts a Medicare rebate.

 

GPs generally underestimate the extent to which their patients access complementary medicines. (3) In fact, relatively few patients - approximately one third of those who use complementary medicines - inform their medical practitioner of their use. (5)

 

(iii) Medical specialists and hospital departments

 

There has also been a growing interest in complementary medicines and therapies among medical specialties such as those of obstetrics and gynaecology and rheumatology. There has been an increasing need for hospital departments and pharmacies to produce policies in response to patients requesting continued access to their complementary medicines during hospitalisation.

 

(iv) Education and training and professional associations

 

In parallel with the growth in Complementary Medicine, there has been a growth of university courses and training courses offered by private colleges in Complementary Medicine to both medical and non-medical students. There has also been a rise in the number of professional associations and peak bodies, including peak bodies for medical practitioners.

 

(b) The importance of evidence

 

While awareness and interest in Complementary Medicine has grown, there has also been increasing concern that patient outcomes should be critically evaluated and that medical practitioners and consumers should have information about potential benefits, potential adverse effects, and pharmaceutical /herb interactions. There has also been a desire for greater regulation of both products and therapists.

 

Increasingly, scientific evidence is becoming available from research studies designed to assess the effectiveness of Complementary Medicine. This evidence is, for example, being incorporated into the Cochrane Collaboration. Attention is also being given by researchers to developing creative research designs that will enable evaluative studies to be carried out which have valid controls and that are sensitive to the nature and, in some cases, the context of the treatments being tested. (6) Increasingly it will be possible for judgements to be based on evidence of safety, quality and efficacy.

 

(c)            Moves to regulation

 

The Federal Government has moved to provide a regulatory framework for complementary medicines through the Therapeutics Goods Administration (TGA), establishing an Office of Complementary Medicine. As a result, there is now greater regulation of the safety and quality of manufactured complementary medicines and control over the claims that may be made about efficacy. It is important that the TGA increasingly provides information concerning the safety, quality and efficacy of the products it tests.

 

The issue of regulation of practitioners is a State/Territory responsibility but there are moves towards a more consistent national approach. Additionally there are still concerns about the lack of quality controls over the importation and use of raw herbs, which is another State/Territory responsibility.

 

(d) The need for information

 

There are many reasons for the medical profession to be fully informed about the increasing use of complementary medicine and therapies for medically related conditions. These include the importance of being aware of what medicines and therapies patients are using, their potential benefits, any adverse effects, and potential interactions of mainstream pharmaceuticals and complementary medicines.

 

It is also important that the medical profession sets standards for medical practices and practitioners who wish to augment their medical practice with the use of complementary medicines and therapies.

 

It is important that patients have improved access to information and are aware of the difference in roles of medical practitioners and complementary therapists. It is essential that patients understand both the importance of consulting their GP in relation to medical symptoms and health concerns and the need to obtain a medical diagnosis for any underlying condition.

 

AMA position

 

1.              Overall

 

1.1          The AMA acknowledges the growing use of complementary medicines and therapies by the Australian population. It recognises that evidence based aspects of Complementary Medicine are part of the repertoire of patient care and may have a role in mainstream medical practice.

 

1.2          It is essential that consumers have improved access to well researched information about Complementary Medicine so that they are empowered to question and to raise relevant issues with any complementary therapist they consult and to make well informed choices. The AMA considers it important that education campaigns are provided to assist the public to take an informed role in relation to Complementary Medicine and to be aware of the importance of continuing to consult medical practitioners in relation to medical conditions and health concerns. It is important that patients inform their medical practitioner of complementary medicines and/or therapies they are using.

 

2.              Research and the Principle of Evidence Based Assessment

 

2.1 The AMA considers it essential that scientific research is carried out in such a way as to permit complementary medicines and therapies to be assessed on an evidence basis. The AMA calls on the Federal Government to ensure that additional funding is provided for the design and implementation of appropriate evaluative research in Complementary Medicine.

 

2.2 This key principle of evidence based assessment should be the basis of evaluating complementary medicines and therapies and their use by the medical profession. It should also be the basis of any collaborative relationships between medical practitioners and complementary therapists.

 

3.              Regulation

 

3.1          The AMA welcomes the new TGA regulatory reforms concerning the safety and quality of complementary medicines. Complementary medicines should meet the same standards of safety and quality as orthodox medicines. Labelling and advertising of complementary medicines must be based on the appropriate level of evidence of efficacy.

 

3.2          The AMA considers that there should be greater regulatory enforcement over the importation and use of raw herbs.

 

3.3          The AMA believes it is essential that there is appropriate regulation of complementary therapists. Such regulation should ensure that non-medical complementary therapists cannot claim expertise in medical diagnosis and treatment.

 

4.              Medical Practitioners and Complementary Medicine Information

 

4.1          It is important that medical practitioners are informed about the potential benefits and any potentially adverse effects of complementary medicines and therapies.

 

4.2 The AMA calls on government and professional bodies to develop similar information sources on complementary medicines and therapies for use by medical practitioners as exist for mainstream medicines and therapies.

 

4.3          The medical profession must be an integral part of a systematic approach to information about adverse events and alerts, with medical practitioners providing and receiving information from the TGA. Such a system should also involve complementary therapists and patients.

 

4.4          Medical practitioners should specifically ask patients about their use of Complementary Medicine and take account of this in their management of conditions. Medical practitioners should be sufficiently well informed about Complementary Medicine to be able to provide advice to patients when appropriate.

 

5         Education and Standards

 

5.3          Increasingly, medical practitioners will require a basic understanding of Complementary Medicine and should receive sufficient training in their undergraduate, vocational and further education to enable them to discuss such issues with their patients on an informed basis. This training should also enable medical practitioners to incorporate complementary therapies into their practice if they so decide following due consideration of the evidence. As with any developments which impact on medicine, information about Complementary Medicine should be included in continuing education.

 

5.2 The AMA calls on educational institutions and professional colleges to ensure that medical education provides basic information about Complementary Medicine in relevant areas such as pharmacology and evidence based therapies.

 

5.4          The AMA encourages medical colleges to develop educational and practice standards relevant to Complementary Medicine for use by medical practitioners and medical practices. The regulation of medical practitioners in relation to the use of complementary medicines and therapies is the responsibility of Medical Boards.

 

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