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I t’s an industry worth $4.1 billion in Australia and provides “therapies \\\\\\\\\\\\\\\[that\\\\\\\\\\\\\\\] are used to either complement conventional Western medicine or as alternatives to conventional practices”.1 However, due to the “extensive variety” of therapies that fall under the complementary medicine blanket, it’s a part of the healthcare system that’s often tricky to define. What is complementary medicine exactly? How can pharmacists own this space that’s currently largely the domain of ‘natural health food’ shops, and optimise their opportunities? And where does the emerging use of medicinal cannabis fit within all of this? Defining the hard to define The World Health Organization defines complementary medicine as “a broad set of healthcare practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant healthcare system”.2 According to Australia’s National Institute of Complementary Medicine (NICM) Health Research Institute, “complementary medicine is a broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system in Australia”. The Institute adds that “medicinal products containing such ingredients as herbs, vitamins, minerals, nutritional supplements, homeopathic and certain aromatherapy preparations are referred to as ‘complementary medicines’ and are regulated as medicines under the Therapeutic Goods Act 1989”.3 Warning that, as an adjunct therapy, “complementary medicines should not replace medical treatments recommended by healthcare professionals”, the Therapeutic Goods Administration (TGA) gives examples that include “traditional herbal medicines; some nutritional supplements; vitamins and minerals; homeopathic (diluted) preparations; aromatherapy preparations, including essential oils; traditional Chinese medicines; and Ayurvedic (traditional Indian) medicines”.4 Community pharmacist and master herbalist Gerald Quigley says defining complementary medicine is tricky because it’s such a broad term that encompasses a variety of healthcare modalities. He adds that it’s important not to “pigeonhole” complementary medicine with attempts at ascertaining a definition because “there’s no clear definition”. “\\\\\\\\\\\\\\\[It’s\\\\\\\\\\\\\\\] so hard to define and I think it’s probably named incorrectly,” he said. “I think the phrase these days is ‘integrative medicine’. We’re using particular substances based on evidence to make a difference to a person’s quality of life and \\\\\\\\\\\\\\\[to\\\\\\\\\\\\\\\] empower them to be involved in whatever particular problem they’ve got, be it short-term or long-term chronic disease.” An adjunct to traditional practices Using complementary medicines as an adjunct to what’s typically seen as traditional medical practices (eg, prescribed medications or OTC medicines selected by a pharmacist) entails some consideration for their potential interactions with other medications someone may be taking. Can taking a certain vitamin or mineral interact with a medication? Can taking a herbal medicine such as cinnamon, turmeric or curcumin interact with other medicines? “In clinical situations, we see very few interactions ... the more you talk to a person and listen to their particular battles with illnesses, the more you understand that integrated medicine plays a role, along with nutritional medicine as well ,” Mr Quigley said. “To give you an example, there are people with fatty liver who would benefit from having milk thistle every day, and that’s important – that’s a clear indication. There are other people who would benefit from weight control and from a digestive perspective to regularly take milk thistle. “As far as the interactions of milk thistle are concerned, they’re well documented and there’s incredibly few. This is just one example. There are hundreds of others.” Accredited Practising Dietitian at CANutrition and spokeswoman for Dietitians Australia, Jane Freeman, points out that “people sometimes go onto supplements because they feel they will put them onto a path of good health”. “Vitamins and minerals do have a place, and there are certain indications for use, but for the general population ... they’re better to initially look at and work on their diet to ensure they’re meeting recommended intakes of the food groups,” she said. “Where supplements might be indicated is for some people who may be unwell, not eating properly because they’re going through something, like cancer treatment, which is causing them side effects such as sore mouth or nausea and they’re just not maybe able to get enough nutrition in. “So, in those instances it could be prudent to top up the diet with some sort of multivitamin and mineral supplement. But as someone who works in cancer treatment, sometimes the antioxidants \\\\\\\\\\\\\\\[found in vitamin and mineral supplements\\\\\\\\\\\\\\\] can interact with treatments like chemotherapy, and dilute their potency. “In those instances it’s very important that people do talk to their doctor, oncologist or dietitian, whoever they’re working with, to let them know that they were thinking of taking these supplements and just making sure everybody knows and is happy with it – so there’s no interactions that could impact on the treatment outcomes.” Ms Freeman adds that for most people, it’s important to remember that putting more nutrients in doesn’t necessarily “equate to better or improved health”, and that in some cases – for example, vitamin A – excess levels can, in fact, be toxic. “The water-soluble vitamins B and C will just get excreted in your urine \\\\\\\\\\\\\\\[if excessive amounts are consumed\\\\\\\\\\\\\\\],” she said. “So, you’re just going to end up with expensive, colourful urine.” TO PAGE 28 COMPLEMENTARY MEDICINE 27 While homeopathic preparations are included within the TGA definition of complementary medicine, the issue of whether homeopathic preparations should be sold within retail pharmacy has been hotly debated over the past few years. RETAIL PHARMACY ASSISTANTS • AUG 2020