Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Natural Medicines - the good, the bad and the ugly

Loretta Marron OAM BSc

articles by this author...

From a Skeptics Perspective: Loretta Marron, a science graduate with a business background, was Australian Skeptic of the Year for 2007 and in 2011. She is the Chief Executive Officer of the Friends of Science in Medicine and that organisation won Australian Skeptic of the Year for 2012. On Australia Day 2014 she was awarded the Medal of the Order of Australia (OAM ) for "service to community health"  Loretta edits the websites &

I am often asked if I am 'for or against' complementary medicines (CMs) .
My one-liner response is to say "it depends on the evidence".
So why do I find this question so difficult to answer?
CMs can be categorised into narrative-based medicine, evidence-based medicine or snake-oil.
Throughout history, and across all cultures, narrative-based medicines(NBMs) were carefully prepared by traditional healers from recipes passed down through the generations.  Made from concoctions of combinations of local flora and fauna and the occasional mineral, they were used to treat a wide range of health complaints.

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Our own aborigines knew about the properties of penicillin and were using it successfully long before it was accidently 'discovered' by Alexander Fleming in 1928.  To cure infections, they used bandages made of a mouldy bark growing on the shaded sides of trees. 

Documented as far back as 377 BC, records left by Hippocrates, included details of a pain relief remedy derived from the bark and leaves of the willow tree.  By 1829 scientists discovered that it was the compound called salicin in willow plants that provided some pain relief; from this discovery came aspirin

While penicillin and aspirin are now synthesized, other well known natural mainstream drugs are not.  The chemotherapy drug  Docetaxel is extracted from the needles of the European Yew Tree.

Even today, traditional remedies  remain a invaluable resource, as we continue to look for new or potentially better drugs from the unique properties of plants.

Fortunately, the billions of dollars spent on CMs and pressure from consumers, has encouraged some Governments to undertake research into the efficacy and safety of the more popular remedies .  Clinical trials have identified  products that show promise such as Devil's Claw for osteoarthritis pain, ginger for pregnancy-related nausea and fish oil for rheumatoid arthritis patients.

However, other products have failed to work better than placebos.  These include all homeopathic remedies, glucosamine hydrochloride, Saw Palmetto, Red Clover and Black Cohosh which have failed to provide the health benefit claimed.

Another question in selecting a promising CM, is whether it has the same active ingredients as the one used in the clinical trials.

 In 2000, a crystalline glucosamine sulphate formulation, trialled by Italian Rotta Pharmaceuticals suggested that their product might be useful for osteoarthritis.  However, this is not the same formulation as  the products sold locally, which have failed when tested.  

Plants are made up of  parts that include their fruit, leaves, bark, roots, stems, seeds and flowers which offer different active ingredients in different concentrations at different times of the year and may also include natural toxins and pesticides.  The same plant variety when grown in different geographical locations may also bring about variations in active ingredients.  So it is important, when using a CM to ensure that it is the same brand as the one that has been tested.

The Therapeutic Goods Administration (TGA) are the regulators of all CM's.  However, many natural remedies are electronically entered and  accepted onto the Australian Register of Therapeutic Goods (ARTG) based on their history of 'traditional usage' without any requirement to make any references  to failed clinical trials.  An Aust L number on packaging does not mean the TGA has independently tested the product.

Approximately 2000 new CM's are entered through the TGAs honestly-based data-entry system which has very few checks and balances. Only 236 desktop reviews were conducted on complementary medicines (CMs) listed from mid 2009 to the end of 2010.  Of these reviews, only 201 were completed and 90% failed compliance requirements, resulting in 15% being voluntarily withdrawn by their sponsors and 33% of them being cancelled by the TGA.  A recent audit  by the Australian National Auditors Office shows that for CM's, it remains a free-for-all.   

Acceptance onto the ARTG only suggests that the product may be safe.  However, despite an alert  by the TGA for its potential to cause liver failure, there are nine products containing Kava on the ARTG, including products that exceed the daily dose of not more than 250mg of kavalactones.

CMs are non-prescription drugs and despite the misinformed claims that 'natural=safe', they do come with risks. 

NPS recommended CM databases are used  by over 100,000 Australian's, including many pharmacists, but as very few CMs are clinically proven to provide the benefits claimed, pharmacy owners clearly don't want their customers to know the 'bottom line' for them - after all,  CMs are a very lucrative income stream and it could be bad for business.


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Submitted by Jenny on Fri, 16/03/2012 - 09:31.

Why so much concern about the health benefits of retail herbal tablets. FDA only has to clear these useless retail products to be safe. During the PAN outrage in 2003, a spokesman for the FDA made the following statement to the media " Retail natural medicine come under the scrutiny of the Food and Drug Administration and their key requirement is safety. There is no scrutiny of these products to contain a standard of therapeutic benefits. When purchasing retail supplements such as Echinacea, people are not likely to achieve any health benefits and are often just wasting their money. " In other words, they don't contain enough active ingredients to do anything and any benefits are likely to be placebo.
What they are saying is that if people want health supplements that have been approved by TGA to have therapeutic health benefits, they need to be prescribed by an registered practitioner that has studied herbal medicine, nutrition, pharmacology and clinical medicine and is authorised to prescribe practitioner-only products. These products are only available by prescription during a consultation and are prohibited from sale over the counter. This regulation is frequently breached in pharmacies and health food outlets that employ a Naturopath in order to obtain the stock in the name of profit. Untrained assistants regular hand them to customers on request and there is little policing. All this about nutritional and herbal supplements that rarely cause a medical emergency.
However, where were the TGA napping on the job when they approved industrial grade silicon breast implants ?

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