Importance of Complementary Medicine

Australians enjoy access to a wide range of complementary medicines and therapies (CM). It ┬ís an industry with growth of 4.1% per annum over the past 5 years, with a revenue forecast to total $3.8B in 2013-14, worthy of consideration in the context of total government expenditure on pharmaceuticals of $9.1B in 2012.1,2

The scientific evidence is increasingly clear that some CM interventions offer substantial value to our health system in improving clinical outcomes and reducing the burden of chronic disease. CM can make a cost-effective contribution to public health in chronic disease management, preventative care and aged care. For example, fish oils rich in omega-3 are the most effective intervention in reducing the risk of secondary myocardial infarction.3,4 Preliminary studies have reported reduced hospital stays associated with nutritional supplementation prior to cardiac surgery.5 There is high level scientific evidence that acupuncture works in managing some painful conditions and in treating nausea.6,7 The UK National Institute of Clinical Excellence recognises there is sufficient evidence for acupuncture to be used in the management of chronic low back pain.8 However, many other conditions are also likely to benefit given the wide range of neurohormones stimulated under acupuncture (including endogenous opioids, serotonin, catecholamines, acetylcholine and others).9 Acupuncture is regulated as a medical specialty in France and can be covered under Medicare in Australia however, we need further funds to undertake definitive research in key clinical areas.

It is no surprise, given the potential risks associated with the long-term use of some pharmaceuticals, that consumers express interest in exploring herbal medicines used in some of the world's largest public hospitals in China, Korea or Japan. In a timely fashion Australian Health Ministers have mandated that Chinese herbal medicine practitioners be registered throughout Australia from July 1, 2012 to ensure high standards of clinical practice and education, which means Australia will be the first western country in the world to implement national registration for TCM practitioners. In the UK it is anticipated that herbal medicine practitioners will also be registered by the Government.

Australia's National Medicines Policy (opens in a new window) specifically includes complementary medicines. It is important that health professionals support all Australians to make informed healthcare decisions, and that patient preferences are recognised and supported with appropriate research to build the evidence base and strengthen high quality integrative care.  At least one third of those using CM do so concurrently with pharmaceuticals.10

A strong link between the research and teaching of CM in Australian universities helps ensure the fruits of the research are rapidly and effectively communicated to clinicians to help strengthen evidence based clinical practice. Like Australia, university CM education in Europe is progressing strongly, as is patient demand for coverage by health funds. In the UK there are university-funded courses in chiropractic, osteopathy and more recently in herbal medicine, including Chinese herbal medicine. The UK General Medical Council advises all UK medical schools to teach familiarisation courses in complementary medicine and the majority of UK medical schools do offer this option.11  At least one or more CM therapies is offered to patients in 42% of hospitals in the US according to respondents to an American Hospital Association 2010 complementary and alternative medicine survey.12

Universities need to continue researching natural compounds, understand how they have been used most effectively clinically, and teach the fruits of this research. Cost-effectiveness studies (such as those undertaken by NICM) provide critical information to guide relevant government policy formation. With increasing rates of chronic disease, an aging population and ballooning healthcare costs, now is the time to redouble our efforts in CM research, and to focus on implementing the evidence through integrative clinical practice.


References


1. Whytcross D. Alternative health therapies in Australia. Healthy outlook: Increased availability and acceptance has boosted industry growth: IBISWorld Industry Report X0015, October 2013. Available from http://clients1.ibisworld.com.au/reports/au/industry/default.aspx?entid=1914

2. Pharmaceutical Benefits Scheme (PBS). Expenditure and Prescriptions twelve months to 30 June 2012. Australian Government Department of Health and Ageing. Available online at:
http://www.pbs.gov.au/info/statistics/expenditure-and-prescriptions-30-06-2012

3. Colquhoun D, Ferreira-Jardim A, Udell T, Eden B, Nutrition and Metabolism Committee of the Heart Foundation. Review of evidence. Fish, fish oils, n-3 polyunsaturated fatty acids and cardiovascular health, August 2008. Available from https://heartfoundation.org.au/images/uploads/main/For_professionals/Fish-FishOils-revie-of-evidence.pdf

4. Shergis J. Cost effectiveness of complementary medicines: Report by Access Economics for the National Institute of Complementary Medicine, August 2010. AJACM. 2010; 5(2).

5. Leong JY, Merwe J, Pepe S, Bailey M, Perkins A, Lymbury R, et al. Peri-operative metabolic therapy improves redox status and outcomes in cardiac surgery patients: A randomised trial. Heart, Lung and Circulation. 2010;19(10):584-91. DOI: 10.1016/j.hlc.2010.06.659.

6. Lee A, Fan LTY. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane DB Syst Rev. 2011;1.

7. Macintyre PE, Australian and New Zealand College of Anaesthetists, Faculty of Pain Medicine, National Health and Medical Research Council (Australia), editors. Acute pain management: Scientific evidence. 3rd ed. Melbourne: Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine 2010.

8. Savigny P, Kuntze S, Watson P, Underwood M, Ritchie G, Cotterell M, et al. Low back pain: Early management of persistent non-specific low back pain. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners 2009. Available from http://www.healthandwellbeing.nhslocal.nhs.uk/sites/default/files/NICE%20LOW%20BACK%20PAIN_0.pdf

9. Bensoussan A, Myers SP. Towards a safer choice: The practice of Traditional Chinese Medicine in Australia. Campbelltown, NSW, Australia: Faculty of Health, University of Western Sydney; 1996.

10. Lin V, Bensoussan A, Myers S, Mccabe P, Cohen M, Hill S. The practice and regulatory requirements of naturopathy and western herbal medicine. Melbourne: La Trobe University Press; 2006.

11. Owen D, Lewith G. Teaching integrated care: CAM familiarisation courses. MJA. 2004;181(5):267-78.

12. Fenwick M, Hutcheson D. More hospitals offering complementary and alternative medical services American Hospital Association & Samueli Institute, September 2011. Available from http://www.aha.org/presscenter/pressrel/2011/110907-pr-camsurvey.pdf