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There
is no argument that when an illness has arisen, drug treatments
are necessary.
But there are many stages that occur before an illness becomes
full blown.
These often manifest as sub-clinical symptoms that can represent
a body system out of balance.
It can also represent a form of nutritional deficiency that can
be corrected through diet or supplementation.
Even when illness has been diagnosed and drug treatment has begun,
there are a range of complementary options that can support such
treatment. This can occur through complementary medicines providing
synergy with orthodox medicines, which can further result in a
reduced dosage of medication, or a reduced duration of total treatment.
Often complementary medicines can replace orthodox medicines by
giving similar (sometimes better) results in a safer and cheaper
form.
It is a pity that the image of complementary medicines has suffered
on occasions, often by health professionals, jealous of preserving
their own turf, and by manufacturers, who had vested interest
in protecting their own patents.
This is not to say that some of the criticism was not valid, and
that some complementary medicine practitioners were downright
dangerous.
Complementary medicines are generally attacked because most of
them are not "evidence-based" and because research costs
have not been built into the selling price (as for patented drugs).
Thus evidence has been difficult to produce.
Lack of evidence does not necessarily relate to lack of efficacy,
and there is an argument for government institutions to provide
this evidence, rather than have to pay for it in an inflated price
through the Pharmaceutical Benefits Scheme (PBS).
There is a rightful place for complementary medicines, and they
ought to be part of the armoury of treatments available to Australians.
They need to be positioned in the area of patient self-help, one
stage before consulting a formal health professional.
However, consumers need some assistance in the form of good information,
and this is where pharmacy can now provide some dynamic assistance.
The
recent announcement by the Pharmaceutical Society of a new form
of Medication Assistance Service (MAS) able to be provided by
pharmacists, with a reimbursement of patient cost through a medical
fund, opens the door to provide some support for complementary
medicines. It is also my belief that a large number of patients
are prepared to pay for this type of service without subsidy of
any kind.
MAS can therefore be seen as an opportunity to upgrade the area
of complementary medicines to a full consultancy service in a
private capacity.
I have described this service in a previous article (see The
Consultant Pharmacist Model - Value Adding to Services) and
I believe that any pharmacist interested in this subject should
revisit that article and those subsequent to it, particularly
The Consultant Pharmacist
Model - Integrating the people , where the physical and human
resources to back MAS and consulting services is described in
some detail.
My
congratulations go out to the Pharmaceutical Society for providing
a sanction for this type of service, for I believe that this is
where cognitive services in pharmacy will really take off.
Congratulations are also in order for the Medical Benefits Fund
(MBF) which is the fund providing the cover. I envisage that the
MBF will realise substantial benefits down the track as more people
are encouraged to use complementary medicines, or seek good advice
on how to use their orthodox medicines.
It has to be a win-win situation for all involved, and it should
stimulate MBF membership as well.
In
a recent press release entitled "Solution to the escalating
PBS" the Complementary Healthcare Council of Australia (CHC),
stated:
"PBS costs could be cut back as a result of an increased
use of proven natural healthcare products in the major areas of
heart disease, cancer, dementia, arthritis, mental illness and
age related disorders within the public healthcare system.
To demonstrate the option's feasibility, the CHC today announced
the commencement of a cost benefit analysis, to present to Treasurer
Costello, and the Ministers for Finance and Administration and
Health and Aged Care during the Spring Parliamentary sessions."
CHC
executive director Val Johanson also said:
"Many natural supplements have been shown to be as effective
if not better than pharmaceutical drugs in preventing serious
illness as well as managing age related conditions.
Our own research shows that more than 80 percent of Australians
agree that supplements have a role to play in maintaining good
health and preventing illness. Despite this massive vote of confidence,
we have a public healthcare system that focuses only on a drug
tradition that has dictated our healthcare system for decades.
Drug treatment has an essential role to play in acute and some
chronic health management. But long-term good health and wellbeing
is much better served by a holistic approach using natural healthcare
products combined with diet and lifestyle changes.
The majority of Australians have shown they are willing to spend
their discretionary health dollars on trying to stay healthy.
Clearly there are massive PBS savings for Government and health
benefits for individuals if our healthcare system can be relieved
of its current reliance on pharmaceutical healthcare."
I
guess it could be stated that our healthcare system has really
failed, because it is bedeviled with spiraling costs. People become
more ill because existing body systems are not supported, and
the introduction of drugs tends to disturb homeostatic mechanisms.
If the system was working, costs would stabilise or reduce. It
is obvious that we have one of the most efficient drug distribution
systems in the world, but it is not a health system - more an
illness system. We need to get ahead of the game.
The
CHC state that they will demonstrate a potential public healthcare
cost savings through the use of natural products proven to:
1.
Reduce the risk or slow the onset of diseases such as cancer and
heart disease.
2.
Improve the quality of life through better nutrition.
3.
Enhance the health of an ageing population.
US
research has already shown hip fractures can be reduced by 20
percent (savings up to US$2 billion), and that folic acid and
Vitamin B12 supplementation in men 45 years+ and women 55 years+
would save another US$2 billion in treatment costs over ten years.
Quoting
a recent study, CHC said:
"A double blind placebo controlled study of 2002 people with
a history of coronary heart disease conducted in the UK showed
a 75 percent reduction in heart attacks in those who took up to
800 iu of Vitamin E daily. In NSW alone, 22 percent of deaths
result from coronary heart disease with four percent higher hospitalisation
for the condition."
Previous
conflicting studies of Vitamin E in heart conditions do not appear
to have used such a high dose.
Even
the British Journal of Pharmacy is beginning to promote nutritional
medicine. In their edition of the 25th May 2002, they publish
a current study being carried out with 120 primary school children
(age 6-11 years) over a six month period. The children have various
types of learning difficulties, and were given supplements of
fish oil (n-3 fatty acids) and evening primrose oil (n-6 fatty
acids).
The children's disorders included dyspraxia, dyslexia, ADHD, and
autistic spectrum disorder.
Three months into the trial, some children are already showing
improvements in reading skills and ability to concentrate, but
as the trial is not due for completion until September this year,
it is too early to draw any conclusions.
British pharmacists are advised that the supplements are not harmful
and if any carers or parents wish to use them. Caution is made
not to give false hope as the supplements may not work in all
cases.
This study follows on from studies from other researchers who
have shown similar positive results.
There
are a number of Australian pharmacists who have qualified through
the now defunct Pharmacy Guild College of Nutrition with an Advanced
Diploma of Nutritional Pharmacy. These people should now see the
wisdom of their investment in this qualification, as they will
be progressively sought to provide the nucleus for pharmacy nutritional
cognitive medicine services.
Already the Australian Government has been making noises about
doctors trying other treatments rather than drug treatments, and
this implies lifestyle and diet adjustments as the first level,
followed on by nutritional or phytosupplementation as a second
level.
Models of this type of approach already exist, particularly in
European countries.
Germany would have one of the most advanced models on offer, and
its government has funded a lot of research into complementary
medicines. Most of the findings are documented in a publication
titled "German Commission E", which is often utilised
as a reference by orthodox practitioners.
As
the Australian Government works its way through the current PBS
funding crisis, alert pharmacists will have already geared up
their strategies to harness any opportunities that may become
available.
Governments should ensure that any systems and policies developed
for this area of preventive medicine should be as free of restriction
as possible, and encourage a high level of consumer input and
participation, to develop a self-managed model.
Information and education will be the key to its success, and
government funding should look to provide funds for evidence based
research into complementary medicines, and information systems
for consumers and health professionals. It could even be funded
through a levy on the fast food providers, because they are contributing
in a big way to the health problems in this country, and overseas.
All efforts should be made to keep product cost to a minimum,
including the registration process through the Therapeutic Goods
Administration (TGA).
As the pharmacist is the closest professional to the community,
pharmacy as a whole can only benefit.
Readers
are advised that they should read my article series in total,
as there are a number of basic strategies outlined that can be
taken advantage of.
Just follow the "authors" link in the navigation bar
at the top of this page and when you arrive, scroll down and click
on my link.
This will take you to a series of article titles which you can
select as you wish.
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