Traditional/Complementary & Alternative Medicine

Question 1

What is Traditional and Complementary/Alternative Medicine (TCAM)?

Answer 1

This encompasses medical and health care therapies outside the territory of conventional medicines, some of which are yet to be validated using scientific methods.

Question 2

Define: Traditional medicine

Answer 2

It is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.
- Includes Chinese, Indian, Arabic traditional medicines

Question 3

Define: Complementary/Alternative medicine

Answer 3

Refer to a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health-care system. They are used interchangeably with traditional medicine in some countries

Question 4

list the most common types of TCAM in UK

Answer 4

1) Chiropractic
2) Herbal medicine
3) Acupuncture
4) Naturopathy
5) Osteopathy
6) homeopathy - Herbal medicine – including Traditional Chinese Medicine(TCM) and Ayurveda

Question 5

outline Acupuncture

Answer 5

inserting ultra-fine sterile needles into specific acupuncture points, a traditional acupuncturist seeks to re-establish the free flow of qi to restore balance and trigger the body’s natural healing response

Question 6

outline Osteopathy and Chiropractic

Answer 6

1) Osteopathy – work with joints, muscles and connective tissue to treat soft tissue imbalances and abnormalities in skeletal function
2) Chiropractic – focuses on the relationship between the body’s structure—mainly the spine—and its functioning

Question 7

outline Naturopathy

Answer 7

uses wide range of “natural” modalities, including homeopathy, herbalism, acupuncture, nutrition and lifestyle counselling.

Question 8

what is Homeopathy

Answer 8

Homeopathy is a system of medicine which involves treating the individual with highly diluted substances. also like clears like

Question 9

Why do people use TCAM?

Answer 9

1) Part of culture and identity
2) Personal experience of successful use
3) Dissatisfaction with modern/conventional medicine
4) Perceived effectiveness
5) Non-invasive and safer than Western medicine
6) Emphasis on the whole person (holistic approach)
7) Personal feeling of control over the treatment process
8) Belief in all things ‘natural’ and ‘green’, awareness of environmental issues and sustainability

Question 10

How do people use TCAM?

Answer 10

1) Always use TCAM instead of Western Medicine only after Western medicine has failed
2) Occasionally, depends on suitability of treatment and severity of illness
3) In addition to, and concurrently with Western medicine, with or without the knowledge of the doctor

Question 11

discuss the Criticism of TCAM

Answer 11

1) They are ‘non-scientific’ and not ‘evidence based’ – i.e. mostly unsupported by clinical trial evidence
2) Unregulated - anyone can ‘practise’ and there is a lack of accredited training of TCAM practitioners
3) Perceptions of TCAM such as of unsafe practice
It is all down to placebo effect?!

Question 12

are TCAMs becoming more common ? and what does WHO recommend?

Answer 12

1) TCAM is becoming more common.
2) homeopathic, aromatherapy and herbal remedies market valued at £147 million.
3) WHO strategy for 2014-2023 is calling for integration of TCAM with conventional medicine
4) Herbal medicines are being sold in many community pharmacies
5) Acceptance by UK professional medical bodies has increased significantly

Question 13

what is the Pharmacist’s role with regards to TCAMs?

Answer 13

1) Good awareness of TCAM products e.g. dietary supplements, herbal medicines, homoeopathic remedies and aromatherapy oils.
2) Providing information on the appropriate use of TCAM.
Asking questions about use of TCAM during consultations.
3) Being aware of potential adverse reactions and interactions with conventional medicines.

Question 14

discuss the Pharmacist’s responsibilities with regards to the supply and provision of advice of TCAMs

Answer 14

1) ensure that their knowledge is up to date
2) To ensure that stocks of TCAM are obtained from a reputable source of supply( most sold as food sups)
3) Not to recommend any remedy where you have any reason to doubt its safety or quality
4) Only to offer advice on homeopathic or herbal medicines if you have undertaken suitable training or have specialised knowledge.
5) Many TCAM practitioners are mostly unregulated. The British Register of Complementary Practitioners has a list of practitioners registered
6) may using TCAM in addition to, conventional meds
7) Questions about TCAM use should form part of any medication review or response to symptoms. (dont judge)
8) inform patients that TCAM is often thought to be safer, but they are not risk free and risk of interactions.
9) The yellow card scheme to report adverse reactions

Question 15

outline the EU regulations on Traditional Herbal Medicinal Products

Answer 15

1) The Directive on Traditional Herbal Medicinal Products (Directive 2004/24/EC) came into effect on 30 Apr 2011.
2) All manufactured herbal medicine products are required to have either a full marketing authorisation or a traditional herbal registration.
3) It creates a unified licensing system for traditional herbal medicine product.

Question 16

outline the UK regulations on Traditional Herbal Medicinal Products for Human Use. state the 3 ways TCAM can continue to be sold in the UK

Answer 16

1) The EU Directives is implemented in the UK by the MedicinesRegulations 2005, which came into force on 30 Apr 2011.
2) 3 ways TCAM can continue to be sold in the UK:
- Achieving traditional herbal medicines registration (THR) via an assessment on application to the MHRA
- Being licensed as a medicine under a marketing authorisation
- Being prepared for a specific patient by a practitioner following a one to one consultation

Question 17

outline the UK Traditional Herbal Medicines Registration Scheme

Answer 17

1) The Traditional Herbal Medicines Registration Scheme is administered by the MHRA.
2) ATHRis only granted if the medicine is used for minor health conditions where medical supervision is not required (eg a cold).
3) If the TCAM claims to treat major health conditions, will then need to apply for a MA.
4) Products not registered under THR can only be sold as dietary supplement and no health indications are allowed.
5) To guarantee quality and safety (but not efficacy).

Question 18

outline the criteria for the Eligibility of Traditional Herbal Medicines Registration (THR)

Answer 18

1) History of traditional use for at least 30 years (of which generally 15 years must have been in the EU);
2) Evidence of safety;
3) Adherence to appropriate manufacturing standards; and Provision of appropriate product information to users.

Question 19

who is exempt from THR?

Answer 19

herbal practitioners do not need a licence to supply herbal medicines create on their premises to patients following one-to-one consultations