Clinical Pharmacology - Complementary Medicine

Question 1

What are “Complementary and Alternative Medicines”?

Answer 1

The World Health Organisation defines complementary and alternative medicine (CAM) as: a ‘broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system’.

Question 2

What does CAM include?

Efficacy and effectiveness of these medicines?

Users??

Answer 2

CAM approaches are diverse and include modalities such as herbal and homoeopathic therapies, acupuncture, aromatherapy, Reiki, Shiatsu and yoga.

Few CAM approaches are supported by robust efficacy, effectiveness or safety data

Use is wide-spread, with women reportedly the major users both in health and disease

Question 3

What are the concerns of CAM use?

Answer 3

• Implausibility of most therapies
• Lack of evidence for benefit
• Lack of safety data
• Evidence of harm
• Adverse Effects / Herb-Drug Interactions
• Unqualified practitioners / Missed diagnoses
• Stopping conventional medicine
• Cost-effectiveness?

Question 4

Why do people use CAM?

Answer 4

• Desire to have personal control over one’s own health.
• Dissatisfaction with conventional treatment
• Perception that conventional medicine lacks/disregards an holistic approach.
• Concerns about the side effects of prescribed medications
• The majority of CAM users do not appear to be dissatisfied with conventional medicine,
  
  • but find these health care alternatives more congruent with theirown values, beliefs and philosophical orientations toward health and life

Also:

• Think its safe, natural and harmless
• Don’t see any distinction
• Dissatisfaction with conventional medicine
• philosophical
• Side effects
• Lack of effective treatments
• Chronic symptoms
• Hype
• “Holistic”
• Promote health
• Relatives use CAM

Question 5

What are herbal/natural products?

Answer 5

Herbal medicines include herbs, herbal materials, herbal preparations and finished herbal products, that contain as active ingredients parts of plants, or other plant materials, or combinations.

Question 6

What are “active ingredients” in herbal remedies?

Answer 6

§All herbals contain active ingredients

§Often multiple active compounds

§Adulterants

ØHeavy metals

ØBacteria

ØMedicines

Question 7

What is the implication of herbal use for breast cancer?

Answer 7

These tumours are oestrogen responsive.

Some of the herbal remedies supplement oestrogenic activity.

BAD.

Question 8

What are the implications of herbal use throughout pregnancy?

Answer 8

• No safety or efficacy data
• Teratogenesis
• Fetogenesis
• Drug-Herb Interactions

Question 9

Herbalism:

Effective?

Safe?

Answer 9

Not effective

Assumed by patients to be safe, but contamination, adulteration and misinformation etc. Some toxic, lack of data.

Question 11

MAin issues with homeopathy?

Answer 11

When people believe it they stop taking medications.

People go to homeopath, and report “red flag” symptoms. mening these are missed by real doctors.

Question 12

What Do Doctors Need To Know?

Answer 12

• Be aware of what is available via complementary practitioners, on-line and over the counter.
• Ask patients about CAM use, as may not disclose.
• Be aware of the potential for significant harm to patients.
• Be aware of the changing fashion in CAM use
• How to evaluate evidence of safety and efficacy.

Appropriate use in the NHS.