NICM - An Umbrella for Evidence-Based Complementary Medicine

There were some important points made in the Access Economics report that Peter has ignored.

In particular, "If St John’s wort was to be sold in Australia with ‘depression’ as a therapeutic indication, a higher level of regulatory approval would be required".

My own comments follow.

The authors found that acupuncture as a complement to standard care resulted in significantly better pain outcomes than standard care alone. However, acupuncture alone as an alternative to standard care alone provided a significant improvement in pain only for a short period. No statistically significant benefit of acupuncture over sham was found when all patients received standard care (implying that the benefit observed was probably a placebo effect).

The cost effectiveness of fish oils, as a complement to current preventive therapies for reduced death and morbidity among people with coronary heart disease (CHD), was compared with no fish oils for people who have had a myocardial infarction within three months and who are unable to eat sufficient amounts of oily fish to meet the recommended intake of eicosapentaenoic acid (EPA) and decosahexaenoic acid (DHA). Where dietary changes cannot be made (or sustained) the use of fish oil supplements was shown here to be a cost effective intervention to prevent future cardiovascular mortality in Australia. However, no evidence was presented as to the cost-effectiveness of people without CHD taking fish oil for "heart health" in the hope of preventing disease (which is where much promotion and use occurs with no good supportive data).

Fish oils as an adjunctive treatment with non‐steroidal anti‐inflammatory drugs (NSAIDs), to reduce a patient’s reliance on NSAID treatment, were not found cost effective.

Finally, the report found two herbal medicines cost-effective when compared to conventional medicines: PhytodolorTM (a proprietary standardised mix of populus tremula (aspen), fraxinus excelsior (ash) and solidago virgaurea (goldenrod or woundwort) was found to be more cost-effective than Diclofenac and other NSAIDs in the treatment of osteoarthritis while St John’s wort was found to be cost-saving relative to standard anti‐depressants.

However two important caveats were listed.

First, the literature review on PhytodolorTM was relatively sparse.

Second, complementary medicines available on the Australian market, including products containing St. John’s wort, are neither standardised by the TGA or assessed for clinical efficacy. The active components of such products are known to be variable; thus different products allegedly containing the same ingredients are unlikely to be equally effective. Access Economics noted that, "the results of this review apply only to the preparations tested in the studies included, and possibly to extracts with similar characteristics".

The report also noted that, "If St John’s wort was to be sold in Australia with ‘depression’ as a therapeutic indication, a higher level of regulatory approval would be required".

In addition, the multiple interactions that occur between St John’s wort and many other drugs highlight the need for its use for its potential use for depression to be supervised by health professionals rather than being available over-the-counter as currently occurs.

In short, while this report notes the potential of some complementary medicines to replace and/or complement conventional medicines this potential will only be realised if a higher regulatory standard can be applied to separate out products that have clinical evidence of effectiveness from the rest. This was the purpose of suggesting an opt-in system, funded by an additional fee, that would independently evaluate the effectiveness of specific complementary medicines. A product with reasonable evidence of effectiveness could be awarded a symbol similar to the National Heart Foundation “red tick”. Implementing this measure, together with other recommendations put forward in the literature would assist consumer choice and provide a market advantage for the sponsors of evidence-based, ethically promoted CMs. An alternatively (but more costly regulatory path) is for sponsors of evidence based CM to get their products registered by the Therapeutic Goods Administration (AUST R) rather than Listed (AUST L). Unfortunately, a number of studies show that the public have no idea of the difference between these two labels!

Read this First

Editorial

Columns

Recent Comments

Past Editions

EPublications

NICM - An Umbrella for Evidence-Based Complementary Medicine

Peter Sayers

Published in Information to Pharmacists , 01/09/2010, Volume 2, No. 8

Submitted by Dr Ken Harvey on Tue, 14/09/2010 - 22:00.

Submitted by Peter Kennedy on Tue, 14/09/2010 - 16:47.

Post new comment

Clinical Newsfeed

Research Reports

Practice Development

Information Technology

Preventive Medicine

i2P Alliance Partners