Cures or placebos?

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The sun shines on alternative therapies, but few are approved for their remedial effects, reports MALLI IYER

alternative-medicine

Every time you step into a pharmacy these days, you cannot escape noticing that the shelves all around are stacked with colourful bottles and packets from pharmaceutical companies that claim to treat a plethora of ailments. The prescription medicine that you really want to buy is available at the back end of the shop, and involves some waiting time.  In the meantime, you are encouraged to browse through the shelves because there is staff in every aisle waiting to help. If you are in the 60+ age group, you are the main target audience for businesses selling and marketing these products.

Welcome to the world of complementary and alternative therapies that have invaded prime space in all pharmacies.  42% of the Australian population (just under 10 million) spend $4 billion a year on self-medication. The scope of complementary therapies cover a wide range – chiropractic, naturopathy, vitamin, nutritional and mineral supplements, aromatherapy, even barrier creams and sunscreens for skin protection. What is amazing is that they are available over the counter, but are not prescribed or endorsed by any of the 26,000 doctors/general practitioners who are members of the Australian Medical Association. They are not covered by the Pharmaceutical Benefits Scheme or by any of the private health insurance companies. A majority of these pharmaceutical companies are registered with the Therapeutic Goods Regulatory Authority (TGRA), are regularly monitored and regulated for safety, quality and good manufacturing practice; but are not approved for their remedial effects. The Therapeutic Goods Authority (TGA) rarely prosecute anyone for breach of their regulations and an audit by their inspectors in 2010 showed 9 out of 400 products were in breach. They are classified as ‘low risk’ by TGA. The organisation also does not regulate medical products bought over the internet and via online shopping, as complementary medicine is increasing in volume each day.

Cyber quackery is not unknown and products bought online can be fake on account of poor regulation in some countries. If any clinical trials are carried out by the manufacturers, it is not widely publicised.

There are legal aspects involved in the use of alternative medicines, their use is not medically supervised. No information is given about side effects, it is known to the medical world that Gingko and Chamomile when used along side anti-coagulants and aspirin, can increase bleeding for people who are asthmatics and have hypertension. There is a risk of miscarriage amongst pregnant women using some herbal supplements. Therapists who propagate the use of alternatives do not have to be qualified, trained or experienced.

Thus, conventional medical practitioners have misgivings about the safety of these products and they also harbour fears of malpractice lawsuits from their patients. None of these are inhibiting factors for users of complementary medicines.

It is worth investigating the reasons that bring customers by the droves to try complementary medicines, and they are called ‘evidence based healthcare products’ for a reason.  They claim that they are scientifically manufactured and their proven efficacy is widely debated. An aging population is arguably a factor, but hospital waiting times for elective surgery in ‘less than perfect’ healthcare regimes across the western world, increased migration and influence of oriental medicine systems have contributed to changing value systems.  Ayurveda, reflexology, acupuncture and other Chinese herbal medicine systems have gained a foothold in the Australian psyche and have compelled the public to make their own ‘informed’ decisions about pain and illness management. There is no way of knowing if the ‘placebo effect’ of some remedies and ‘word of mouth’ recommendations have given alternate therapy sales a shot in the arm (excuse the pun).  There is evidence that poorer sections of population have taken recourse to alternative therapies due to escalating medical costs of GP visits and prescription medicines.

Complementary medicines are loosely defined as those that use amino acids, charcoal and minerals, choline salts, essential oils, plant or herbal materials, plant fibres, enzymes, algae, fungi, cellulose, chlorophyll, mucopolysaccharides, non-human animal material such as dried bone cartilage, fats, oils and other extracts, lipids, fatty acids, beeswax and jelly, micro-organisms, homeopathic formulations, sugars and carbohydrates.  The evolution of complementary medicines has definitely helped bring to the forefront medicinal and remedial therapies that offer better health for the suffering and in many cases, preventive care.

Stereotypical remedies offered by these products are preventive or curative, and claim to benefit

sufferers from cold and respiratory ailments (asthma, allergies, sinus problems); joint and back pain (mainly arthritis and osteoporosis); muscular, nerve and internal injuries (sprains, sports injuries, spondylosis); sleep related (sleep apnoea); and age related (diabetes); or slowing of metabolism. These products are a definite challenge to conventional medicine and have surely become a part of our lives in the long term. There is increasing evidence of teaching programs in school curriculums that include alternative therapies, and medical practitioners are arming themselves with detailed knowledge of these systems.

With regular advances in conventional medicine and diagnostics, complementary and alternative medicines offer prospects of more complete healthcare in the foreseeable future.