tag:theconversation.com,2011:/id/topics/complementary-medicine-2178/articlesComplementary medicine – The Conversation2023-11-15T02:02:29Ztag:theconversation.com,2011:article/2164452023-11-15T02:02:29Z2023-11-15T02:02:29ZWhat is the PanaNatra line of painkillers and can herbal products effectively relieve pain?<p>In an era where <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201926/#:%7E:text=Globally%2C%20it%20has%20been%20estimated,pain%20each%20year%20%5B1%5D">chronic pain affects millions worldwide</a>, the search for effective and safe pain relief has never been greater. </p>
<p><a href="https://www.pananatra.com.au/products/">PanaNatra</a> is a line of herbal products from <a href="https://www.haleon.com/">Haleon</a>, the makers of Panadol. Haleon <a href="https://www.pananatra.com.au/products/">claims</a> the three PanaNatra’s products, made from plant extracts, help manage and provide relief from mild joint aches, mild muscle pain, and mild pain affecting sleep. </p>
<p>They contain different combinations of four plants:</p>
<ul>
<li><em>Boswellia serrata</em> (contained in the joint and muscle products) </li>
<li><em>Curcuma longa</em> (in the joint and muscle products)</li>
<li><em>Piper nigrum</em> (just in the joint product)</li>
<li><em>Withania somnifera</em> (just in the sleep product).</li>
</ul>
<p>These products are “<a href="https://www.tga.gov.au/products/medicines/non-prescription-medicines/listed-medicines">listed medicines</a>” in Australia. This means the ingredients are considered broadly low risk, have been used in traditional medicine, and are manufactured to a high standard. But the manufacturer has not provided evidence to the government regulator that they work. </p>
<p>So can herbal ingredients effectively and safely relieve different types of pain? </p>
<h2>What does the evidence say?</h2>
<p>Let’s consider the evidence for the four main ingredients.</p>
<p><strong><em>Boswellia serrata</em></strong></p>
<p>Indian Frankincense (<em>Boswellia serrata</em>) has been described in traditional Indian Ayurveda texts since the 1st century AD. Key active compounds derived from the gum resin of the tree called <a href="https://pubmed.ncbi.nlm.nih.gov/27671822/">boswellic acids</a> are thought to have anti-inflammatory effects. </p>
<figure class="align-center ">
<img alt="Boswellia serrata" src="https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"><em>Boswellia serrata</em> is also known as Indian Frankincense.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/boswellia-serrata-73147612">Shutterstock</a></span>
</figcaption>
</figure>
<p>The <em>Boswellia serrata</em> dry concentrate extract (Rhuleave K) used in the Muscle Pain product contains 50 mg of the herb per tablet, whereas the Joint Pain product includes 33.3 mg as a different formulation (Apresflex).</p>
<p>A review of various human clinical trials using a range of formulations of this herb <a href="https://www-ncbi-nlm-nih-gov.ezproxy.library.sydney.edu.au/pmc/articles/PMC7368679/pdf/12906_2020_Article_2985.pdf">supports its ability</a> to reduce some types of pain and improve function in osteoarthritis. But a key finding of the study was that improvement only begins when <em>Boswellia serrata</em> is used continuously for four weeks and at a dose of at least 100–250 mg per day.</p>
<p>In a <a href="https://pubmed.ncbi.nlm.nih.gov/21060724/">clinical trial</a>, 100 mg daily of a <em>Boswellia serrata</em> gum-based product was found to reduce pain and improve physical functions for people with osteoarthritis.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/9-signs-you-have-inflammation-in-your-body-could-an-anti-inflammatory-diet-help-210468">9 signs you have inflammation in your body. Could an anti-inflammatory diet help?</a>
</strong>
</em>
</p>
<hr>
<p><strong><em>Curcuma longa</em></strong></p>
<p>Turmeric (<em>Curcuma longa</em>) has been used in Chinese and Indian medicine for at least 2,000 years. It contains a well-known chemical called curcumin, a natural compound used for its anti-inflammatory properties, especially for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8273926/">osteoarthritis</a>. </p>
<figure class="align-center ">
<img alt="Turmeric root (Curcuma longa)" src="https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"><em>Curcuma longa</em> is also known as turmeric.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/turmeric-root-curcuma-longaherb-plant-786438259">Shutterstock</a></span>
</figcaption>
</figure>
<p>Turmeric compounds such as curcumin are <a href="https://journals.sagepub.com/doi/10.1177/1759720X221124545">often combined</a> with <em>Boswellia serrata</em> compounds to improve their anti-inflammatory effects to reduce pain. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/33511486/">review of 16 different clinical trials</a> found turmeric extracts were effective for knee osteoarthritis. </p>
<p>A similar conclusion was drawn from a <a href="https://www.sciencedirect.com/science/article/pii/S0965229921001163">review of 11 clinical trials</a> which examined the use of curcuminoids (of which curcumin is one) for one to four months. It found curcuminoids had similar pain-relieving qualities as non-steroidal anti-inflammatory based drugs. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/these-5-foods-are-claimed-to-improve-our-health-but-the-amount-wed-need-to-consume-to-benefit-is-a-lot-116730">These 5 foods are claimed to improve our health. But the amount we'd need to consume to benefit is... a lot</a>
</strong>
</em>
</p>
<hr>
<p><strong><em>Piper nigrum</em></strong></p>
<p>Black pepper (<em>Piper nigrum</em>) contains the chemical <a href="https://www.mdpi.com/2076-3417/9/20/4270">piperine</a>, which has anti-inflammatory properties.</p>
<figure class="align-center ">
<img alt="Piper Nigrum (peppercorn)" src="https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"><em>Piper nigrum</em> is also called black pepper.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pepper-piper-nigrum-peppercorn-common-1158781747">Shutterstock</a></span>
</figcaption>
</figure>
<p><em>Piper nigrum</em> is often added to curcumin products to improve the absorption of curcumin, as is the case with the PanaNatra Joint Pain product.</p>
<p>For musculoskeletal pain, a <a href="https://pubmed.ncbi.nlm.nih.gov/32664057/">preliminary human trial</a> that examined the effects of a 1,000 mg daily dose of Rhuleave K (the extract used in PanaNatra) found it was as effective as paracetamol. </p>
<p>But the study was not placebo-controlled and the dose of paracetamol given (1,000 mg per day) was below the recommended daily intake for pain relief.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/knee-pain-heres-why-it-happens-and-how-you-can-fix-it-211858">Knee pain: here’s why it happens and how you can fix it</a>
</strong>
</em>
</p>
<hr>
<p><strong><em>Withania somnifera</em></strong></p>
<p><em>Withania somnifera</em> (also called Ashwagandha) has been used in <a href="https://medlineplus.gov/druginfo/natural/953.html">traditional Indian Ayurvedic medicine</a> for thousands of years to reduce stress and ease inflammation. </p>
<figure class="align-center ">
<img alt="Withania somnifera plant, commonly known as Ashwagandha (winter cherry)" src="https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ashwagandha, or <em>Withania somnifera</em>, is sometimes called winter cherry.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/withania-somnifera-plant-commonly-known-ashwagandha-2237392831">Shutterstock</a></span>
</figcaption>
</figure>
<p>One of the key chemicals appears to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8705790/">withaferin A</a> which interferes with the inflammatory signalling pathway. </p>
<p>PanaNatra’s Pain and Sleep product contains 300 mg per tablet of a <em>Withania somnifera</em> extract called KSM66.</p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/32818573/">human trial</a> found a daily 600 mg dose of <em>Withania somnifera</em> extract improved sleep quality and helped in managing insomnia.</p>
<p><a href="https://assets.cureus.com/uploads/original_article/pdf/25730/1612429507-1612429503-20210204-18590-tdgx00.pdf">In a separate trial</a>, <em>Withania somnifera</em> was found to improve sleep quality, again when administered at a dose of 600 mg per day.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-ayurveda-to-biomedicine-understanding-the-human-body-85631">From Ayurveda to biomedicine: understanding the human body</a>
</strong>
</em>
</p>
<hr>
<h2>So what does this mean?</h2>
<p>Whether, and how well, a herbal medicine works is largely dependent on the formulation (how it’s made and the extract used) and the dose provided. The same herb used in one formulation may result in a different outcome than a different formulation containing the same herb. </p>
<p>It’s also important to note that effectiveness for one type of pain does not mean a product will work for other types of pain. </p>
<p>Overall, similar herb extracts to those that have been included in the PanaNatra products do have some evidence that they work for pain and sleep. Whether they work for you will depend on a number of factors including the effectiveness of the PanaNatra formulation, how much you take, and the extent of your pain.</p>
<h2>Are they safe?</h2>
<p>PanaNatra needs to be used carefully by some patients. </p>
<p>Overall, there is insufficient human data to recommend any of these herbal ingredients in pregnancy or lactation. In fact there is some evidence that <em><a href="https://www.sciencedirect.com/science/article/pii/S2210803321000142">Withania somnifera</a></em> may be unsafe to use in pregnancy, and other than the amounts commonly found in food, turmeric and its compounds are <a href="https://www.nccih.nih.gov/health/turmeric">not considered safe</a> to use in pregnancy either. </p>
<p>The herbs may also impact the effectiveness and safety of other medicines. For example, the blood levels of the cancer drug <a href="https://link.springer.com/article/10.1007/s00280-023-04504-z">tamoxifen may be reduced</a> when taken concurrently with turmeric supplements. </p>
<p><em>Withania somnifera</em> has been associated with drowsiness and cases of <a href="https://www.mdpi.com/1660-4601/20/5/3921">liver toxicity</a>.</p>
<p><em>Curcuma longa</em> products, including formulations containing curcumin and piperine, have also been associated with liver toxicity. As such, Australia’s Therapeutic Goods Administration has proposed <a href="https://consultations.tga.gov.au/medicines-regulation-division/low-neg-risk-2023-2024/user_uploads/tga---low-negligible-risk-annual-consultation-2023-2024---final.pdf">adding warning labels</a> to any products that contain those ingredients. But this discussion is ongoing and a decision won’t be made until next year. </p>
<h2>Bottom line</h2>
<p>While there is a long history of traditional use of the herbs in the PanaNatra products, there is limited high-quality scientific evidence for the effectiveness and safety for these specific products. </p>
<p>Pregnant and breastfeeding women should not take these products, and you should not exceed the daily dose recommended by the manufacturer. </p>
<p>If you have an underlying health condition, or are taking other medication, before you try them, consult your doctor or pharmacist to check if these products are suitable for you.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-you-know-whats-in-the-herbal-medicine-youre-taking-72726">Do you know what's in the herbal medicine you're taking?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/216445/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd a medical device company, and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design, and testing.</span></em></p><p class="fine-print"><em><span>Joanna Harnett is an academic University of Sydney’s Faculty of Medicine and Health Pharmacy School where she teaches and conducts research in the field of traditional, complementary, and integrative medicine (TCIM). She has received research funds from universities, organisations, and/or industry for TCIM research and education and received payments for providing expert advice about TCIM to industry, government bodies and/or non-government organisations, and/or spoken at workshops, seminars and/or conferences for which registration, travel and/or accommodation has been paid for by the organisers.
The institutes, centres and universities associated with the authors receive research grants, donations and endowments from foundations, universities, government agencies, individuals, and industry. Sponsors and donors have provided untied funding to advance TCIM education and research. This viewpoint article was not undertaken as part of a contractual relationship with any donor or sponsor.
</span></em></p>PanaNatra is a line of herbal products from the makers of Panadol. But can herbal ingredients relieve different types of pain?Nial Wheate, Associate Professor of the School of Pharmacy, University of SydneyJoanna Harnett, Lecturer (Complementary Medicines) Sydney Pharmacy School, Faculty of Medicine and Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2125022023-09-06T12:27:15Z2023-09-06T12:27:15ZTraditional medicine provides health care to many around the globe – the WHO is trying to make it safer and more standardized<figure><img src="https://images.theconversation.com/files/546464/original/file-20230905-503-nlkg3v.jpg?ixlib=rb-1.1.0&rect=3%2C9%2C2114%2C1400&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ayurveda is one form of traditional medicine that can integrate aromatherapy. It's popular in South Asia. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/ayurveda-aromatherapy-with-essential-oil-diffuser-royalty-free-image/1333713382?phrase=ayurveda&adppopup=true">Microgen Images/Science Photo Library</a></span></figcaption></figure><p>For approximately <a href="https://www.who.int/news/item/25-03-2022-who-establishes-the-global-centre-for-traditional-medicine-in-india">80% of the world’s population</a>, the first stop after catching a cold or breaking a bone isn’t the hospital — maybe because there isn’t one nearby, or they can’t afford it. Instead, the first step is consulting traditional medicine, which cultures around the world have been using for thousands of years.</p>
<p><a href="https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_1">Traditional medicine</a> encompasses the healing knowledge, skills and practices used by a variety of cultures and groups. </p>
<p>Examples of traditional medicine include <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/herbal-medicine">herbal medicine</a>; <a href="https://www.mayoclinic.org/tests-procedures/acupuncture/about/pac-20392763">acupuncture</a>; <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/tui-na">Tui Na</a> – which is a type of massage originating in China; <a href="https://www.nccih.nih.gov/health/ayurvedic-medicine-in-depth">Ayurveda</a> – which is an ancient system of promoting health through diet, exercise and lifestyle from India; <a href="https://www.britannica.com/science/Unani-medicine">and Unani</a> – which is another ancient system of health from South Asia, balancing key aspects of the mind, body and spirit. </p>
<p>In recognizing that traditional medicine and other alternative forms of healing are critical sources of health care for many people worldwide, the World Health Organization and the government of India co-hosted their first-ever <a href="https://www.who.int/news-room/events/detail/2023/08/17/default-calendar/the-first-who-traditional-medicine-global-summit">Traditional Medicine Summit</a>. The summit took place in August 2023 in Gandhinagar, Gujarat, India. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/jW-B8BpLQJE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">August 2023 marked the WHO’s first global summit on traditional medicine.</span></figcaption>
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<p>The summit brought together health care policymakers, traditional medicine workers and users, international organizations, academics and private sector stakeholders from 88 <a href="https://www.who.int/countries">WHO member states</a>. Leaders at the summit aimed to share best practices and scientific evidence and data around traditional medicine. </p>
<p>As researchers interested in how to provide patients both in the U.S. and around the globe with the best <a href="http://gsm.utmck.edu/internalmed/faculty/terry.cfm">possible medical care</a>, <a href="https://scholar.google.com/citations?user=Wng1Wh0AAAAJ&hl=en">we were interested</a> in the summit’s findings. Understanding traditional medicine can help health care professionals create sustainable, personalized and culturally respectful practices.</p>
<h2>Critical health care for many</h2>
<p>In many countries, traditional medicine costs less and is <a href="https://doi.org/10.1093%2Fheapol%2Fczw022">more accessible</a> than conventional health care. And many conventional medicines come from the same source as compounds used in traditional medicine – <a href="https://doi.org/10.1021/acs.jnatprod.9b01285">up to 50% of drugs</a> have a <a href="https://theconversation.com/nature-is-the-worlds-original-pharmacy-returning-to-medicines-roots-could-help-fill-drug-discovery-gaps-176963">natural product root</a>, <a href="https://doi.org/10.1016/j.vph.2018.10.008">like aspirin</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An elderly man wearing a gray button-down shirt sorts bundles of dried herbs into eight piles, behind him is a wall of wooden drawers." src="https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An herbalist sorts herbs at the Great China Herb Company in Chinatown in San Francisco. Herbal medicine is one form of traditional medicine.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TravelTripSanFranciscoChinatown/c09c3fae7725457ca4e548ceda2a2f34/photo?Query=traditional%20medicine&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=377&currentItemNo=1&vs=true">AP Photo/Eric Risberg</a></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.2147/PPA.S398644">Many factors</a> may influence whether someone chooses traditional medicine, such as age and gender, religion, education and income level, and <a href="https://doi.org/10.1155/2021/9962892">distance to travel for treatment</a>. Cultural factors may also influence people’s use of traditional medicine. </p>
<p>In China, for example, as more people have embraced Western culture, fewer have <a href="https://doi.org/10.2105/AJPH.93.7.1082">chosen traditional medicine</a>. In contrast, many African migrants to Australia continue to use traditional medicine to express their cultural identity and maintain <a href="https://doi.org/10.1186/s12906-021-03424-w">a cohesive ethnic community</a>. A patient’s preference for traditional medicine often has significant personal, environmental and cultural relevance.</p>
<h2>A framework for traditional medicine</h2>
<p>Countries have been pushing the WHO to study and track data on traditional medicine for years. In the past, WHO has developed a “<a href="https://www.who.int/publications/i/item/9789241506096">traditional medicine strategy</a>” to help member states research, integrate and regulate traditional medicine in their national health systems. </p>
<p>The WHO also <a href="https://www.who.int/teams/integrated-health-services/traditional-complementary-and-integrative-medicine">created international terminology standards</a> for practicing various forms of traditional medicine.</p>
<p>The practice of traditional medicine varies greatly between countries, depending on how accessible it is and <a href="https://www.who.int/publications/i/item/978924151536">how culturally important it is</a> in each country. To make traditional medicine safer and more accessible on a broader scale, it’s important for policymakers and public health experts to develop standards and share best practices. The WHO summit was one step toward that goal.</p>
<p>The WHO also aims to collect data that could inform these standards and best practices. It is conducting the <a href="https://www.who.int/news-room/events/detail/2023/08/17/default-calendar/the-first-who-traditional-medicine-global-summit">Global Survey on Traditional Medicine</a> in 2023. As of August, approximately 55 member states out of the total 194 have completed and submitted their data.</p>
<h2>Acupuncture – a case study in safety and efficacy</h2>
<p>Some traditional medicine practices <a href="https://doi.org/10.7453/gahmj.2014.042">such as acupuncture</a> have shown consistent and credible benefits, and have even started to make it <a href="https://time.com/6171247/acupuncture-health-benefits-research/">into mainstream medicine</a> in the U.S. But leaders at the summit emphasized a need for more research on the efficacy and safety of traditional medicine. </p>
<p>Although traditional medicine can <a href="https://www.who.int/news-room/feature-stories/detail/traditional-medicine-has-a-long-history-of-contributing-to-conventional-medicine-and-continues-to-hold-promise">have a range of benefits</a>, some treatments come with health risks. </p>
<p>For example, acupuncture is <a href="https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know#">a traditional healing practice</a> that entails inserting needles at specific points on the body to relieve pain. But acupuncture can <a href="https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know">cause infections and injuries</a> if the practitioner doesn’t use sterile needles or if needles are inserted incorrectly.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two hands insert a needle into a patient's back, which is partially covered with a towel and which already has seven needles stuck in two lines." src="https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=372&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=372&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=372&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=467&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=467&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=467&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Acupuncture is an example of a form of traditional healing that’s been implemented on a wide scale in the U.S. It has a variety of benefits, including no risk of addiction.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/AcupuncturePainRelief/0b79ca38552c4b86a845bf4645755106/photo?Query=acupuncture&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=246&currentItemNo=1&vs=true">AP Photo/M. Spencer Green</a></span>
</figcaption>
</figure>
<p>Still, acupuncture is the most commonly used traditional medicine practice across countries, with <a href="https://www.who.int/publications/i/item/978-92-4-001688-0">113 WHO member states</a> acknowledging their citizens practiced acupuncture in 2019.</p>
<p>Interestingly, <a href="https://news.va.gov/94087/battlefield-acupuncture-an-emerging-and-promising-alternative-to-risky-pain-medications/">battlefield acupuncture</a> has successfully treated many U.S. military members, for example, for pain reduction. It is simple to use, transportable and has no risk of addiction.</p>
<p>There’s also some evidence supporting the use of traditional medicine, including <a href="https://www.va.gov/WHOLEHEALTH/professional-resources/Acupuncture.asp">acupuncture</a>, <a href="https://www.va.gov/WHOLEHEALTH/professional-resources/Meditation.asp">meditation</a> and <a href="https://www.va.gov/WHOLEHEALTH/professional-resources/Yoga.asp">yoga</a> to treat post-traumatic stress disorder. </p>
<p>However, acupuncture practitioners aren’t trained in a uniform way across countries. To provide guidelines for best practice, the WHO developed standardized <a href="https://www.who.int/publications/i/item/978-92-4-001688-0">benchmarks for practicing acupuncture</a> in 2021. The WHO aims to develop similar standards for other forms of traditional medicine as well. </p>
<p>Interest in traditional medicine is growing among those who have mainly used conventional medicine in the past. More research and collaborative efforts to develop safety standards can make traditional medicine accessible to all who seek it.</p><img src="https://counter.theconversation.com/content/212502/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Ling Zhao received her medical training in China and PhD in the US. Her research focuses on novel interventions for chronic diseases. She has received research funding from NIH, including NCCIH. </span></em></p><p class="fine-print"><em><span>Paul D. Terry does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More people are seeking out traditional forms of medicine, from acupuncture to herbal medicines. The WHO is working to develop standards to make these healing practices implementable on a wide scale.Ling Zhao, Professor of Nutrition, University of TennesseePaul D. Terry, Professor of Epidemiology, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1983452023-02-02T12:23:35Z2023-02-02T12:23:35ZVitamins and supplements: what you need to know before taking them<figure><img src="https://images.theconversation.com/files/507046/original/file-20230130-20-x1ljxi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Supitcha McAdam/Shutterstock </span></span></figcaption></figure><p>If you were to open your medicine cabinet right now, there’s a fair chance that you’d find at least one bottle of vitamins alongside the painkillers, plasters and cough syrup.</p>
<p>After all, people are definitely buying vitamins: in 2020, the global market for complementary and alternative medicines, which includes multivitamin supplements, had an estimated value of <a href="https://www.grandviewresearch.com/industry-analysis/complementary-alternative-medicine-market">US$82.27 billion</a>. The use of natural health products such as minerals and amino acids has <a href="https://journals.lww.com/nutritiontodayonline/Abstract/2007/03000/Why_People_Use_Vitamin_and_Mineral_Supplements.4.aspx">increased</a> – and continues to rise, partly driven by consumers’ buying habits during the COVID-19 pandemic.</p>
<p>People <a href="https://www.businesslive.co.za/bd/companies/healthcare/2021-02-08-native-sales-of-sas-vitamins-and-nutritional-supplements-boom/">sought out</a> vitamins C and D, as well as zinc supplements, as potential preventive measures against the virus – even though the <a href="https://www.health.harvard.edu/blog/do-vitamin-d-zinc-and-other-supplements-help-prevent-covid-19-or-hasten-healing-2021040522310">evidence</a> for their efficacy was, and <a href="https://pubmed.ncbi.nlm.nih.gov/35888660/#:%7E:text=Concluding%2C%20available%20data%20on%20the,trials%20(RCTs)%20are%20inconsistent">remains</a>, inconclusive. </p>
<p>Multivitamins and mineral supplements are easily accessible to consumers. They are often marketed for their health claims and benefits – sometimes unsubstantiated. But their potential adverse effects are not always stated on the packaging.</p>
<p>Collectively, vitamins and minerals are known as micronutrients. They are essential elements needed for our bodies to function properly. Our bodies can only produce micronutrients in small amounts or not at all. We get the bulk of these nutrients <a href="https://www.iprjb.org/journals/index.php/IJF/article/view/1024">from our diets</a>. </p>
<p>People usually buy micronutrients to protect against disease or as dietary “insurance”, in case they are not getting sufficient quantities from their diets. </p>
<p>There’s a common perception that these supplements are harmless. But they can be dangerous at incorrect dosages. They provide a false sense of hope, pose a risk of drug interactions – and can delay more effective treatment. </p>
<h2>Benefits</h2>
<p>Vitamins are beneficial if taken for the correct reasons and as prescribed by your doctor. For example, folic acid supplementation in pregnant women has been shown to prevent neural tube defects. And individuals who reduce their intake of red meat without increasing legume consumption require a vitamin B6 supplement. </p>
<p>But a worrying trend is increasing among consumers: intravenous vitamin therapy, which is often punted by celebrities and social media marketing. Intravenous vitamins, nutrients and fluids are administered at pharmacies as well as beauty spas, and more recently “<a href="https://www.health.harvard.edu/blog/drip-bar-should-you-get-an-iv-on-demand-2018092814899">IV bars</a>”. Users believe these treatments can quell a cold, slow the effects of ageing, brighten skin, fix a hangover or just make them feel well. </p>
<p>Intravenous vitamin therapy was previously only used in medical settings to help patients who could not swallow, needed fluid replacements or had an electrolyte imbalance. </p>
<p>However, the evidence to support other benefits of intravenous vitamin therapy is limited. No matter how you choose to get additional vitamins, there are risks. </p>
<h2>Warning bells</h2>
<p>Most consumers use multivitamins. But others take large doses of single nutrients, especially vitamin C, iron and calcium. </p>
<p>As lecturers in pharmacy practice, we think it’s important to highlight the potential adverse effects of commonly used vitamins and minerals: </p>
<ul>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-a/">Vitamin A/retinol</a> is beneficial in maintaining good eye health. But it can cause toxicity if more than 300,000IU (units) is ingested. Chronic toxicity (hypervitaminosis) has been <a href="https://www.ncbi.nlm.nih.gov/books/NBK532916/">associated</a> with doses higher than 10,000IU a day. Symptoms include liver impairment, loss of vision and intracranial hypertension. It can cause birth defects in pregnant women.</p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/niacin-vitamin-b3/">Vitamin B3</a> is beneficial for nervous and digestive system health. At moderate to high doses it can cause peripheral vasodilation (widening or dilating of the blood vessels at the extremities, such as the legs and arms), resulting in skin flushing, burning sensation, pruritis (itchiness of the skin) and hypotension (low blood pressure). </p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-b6/">Vitamin B6</a> is essential for brain development and in ensuring that the immune system remains healthy. But it can result in damage to the peripheral nerves, such as those in the hands and feet (causing a sensation of numbness and often referred to as pins and needles) at doses over 200mg/daily.</p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-c/">Vitamin C</a> is an antioxidant and assists in the repair of body tissue. Taken in high doses it can cause kidney stones and interactions with drugs, such as the oncology drugs doxorubicin, methotrexate, cisplatin and vincristine. </p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-d/">Vitamin D</a> is essential for bone and teeth development. At high doses it can cause hypercalcaemia (calcium level in the blood is above normal) that results in thirst, excessive urination, seizures, coma and death.</p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/calcium/#:%7E:text=Calcium%20is%20a%20mineral%20most,heart%20rhythms%20and%20nerve%20functions">Calcium</a> is essential for bone health, but can cause constipation and gastric reflux. High doses can cause hypercalciuria (increased calcium in the urine), kidney stones and secondary hypoparathyroidism (underactive parathyroid gland). It can have drug interactions with zinc, magnesium and iron. </p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/magnesium/">Magnesium</a> is important for muscle and nerve functioning. At high doses it can cause diarrhoea, nausea and abdominal cramping, and can interact with tetracyclines (antibiotics).</p></li>
<li><p>Zinc <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781367/">can impair</a> taste and smell, and doses over 80mg daily have been <a href="https://link.springer.com/article/10.1007/s10654-022-00922-0#:%7E:text=Zinc%20supplementation%20of%20more%20than,zinc%20supplements%20among%20adult%20men.">shown</a> to have adverse prostate effects.</p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/selenium/">Selenium</a> can cause hair and nail loss or brittleness, lesions of the skin and nervous system, skin rashes, fatigue and mood irritability at high doses.</p></li>
<li><p><a href="https://www.sciencedirect.com/science/article/pii/S0098299720300364#:%7E:text=Expert%20guidelines%20for%20oral%20iron%20supplementation&text=Traditionally%2C%20the%20recommended%20daily%20dose,iron%20(Brittenham%2C%202018).">Iron</a> at 100-200mg/day can cause constipation, black faeces, black discoloration of teeth and abdominal pain.</p></li>
</ul>
<h2>Recommendations</h2>
<p>People need to make <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8377299/">informed decisions</a> based on evidence before consuming health products. </p>
<p>Regular exercise and a well-balanced diet are more likely to do us good, as well as being lighter on the pocket.</p>
<p>Seeking advice from a healthcare professional before consuming supplements can reduce the risk of adverse effects.</p>
<p>Be aware of the potential adverse effects of vitamins and seek a healthcare professional’s guidance if you have symptoms.</p><img src="https://counter.theconversation.com/content/198345/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s a common perception that supplements are harmless. But they can be dangerous at incorrect dosages.Neelaveni Padayachee, Senior Lecturer, Department of Pharmacy and Pharmacology, University of the WitwatersrandVarsha Bangalee, Associate Professor, Pharmaceutical Sciences, University of KwaZulu-NatalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1813482022-07-11T12:29:10Z2022-07-11T12:29:10ZMigraine sufferers have treatment choices – a neurologist explains options beyond just pain medication<figure><img src="https://images.theconversation.com/files/472113/original/file-20220701-26-9o11ui.jpg?ixlib=rb-1.1.0&rect=7%2C22%2C5084%2C3359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For some, too much medication might make migraine worse.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/headache-conceptual-artwork-3d-illustration-royalty-free-image/1156927795?adppopup=true">peterschreiber.media/iStock via Getty Images Plus</a></span></figcaption></figure><p>Migraine headaches currently affect more than one billion people across the globe and are the <a href="https://doi.org/10.1186/s10194-020-01208-0">second-leading cause</a> of disability worldwide. Nearly one-quarter of U.S. households have at least <a href="https://doi.org/10.1046/j.1526-4610.2001.041007646.x">one member who suffers from migraines</a>. An estimated <a href="https://doi.org/10.1177/0333102410363766">85.6 million workdays</a> are lost as a result of migraine headaches each year. </p>
<p>Yet many who suffer with migraine dismiss their pain as simply a bad headache. Rather than seeking medical care, the condition often <a href="https://pubmed.ncbi.nlm.nih.gov/25588281/">goes undiagnosed</a>, even when other incapacitating symptoms occur alongside the pain, including light and sound sensitivity, nausea, vomiting and dizziness.</p>
<p>Researchers have discovered that genetics and environmental factors play a role in the condition of migraine. They happen when changes in your brainstem activate <a href="https://my.clevelandclinic.org/health/body/21581-trigeminal-nerve">the trigeminal nerve</a>, which is a major nerve in the pain pathway. This cues your body to release inflammatory substances such as <a href="https://www.scienceofmigraine.com/pathophysiology/cgrp">CGRP</a>, short for calcitonin gene-related peptide. This molecule, and others, can cause blood vessels to swell, producing pain and inflammation.</p>
<h2>For some, medication has its limits</h2>
<p>A migraine can be debilitating. Those who are experiencing one are often curled up in a dark room accompanied by only their pain. Attacks can last for days; life is put on hold. The sensitivity to light and sound, coupled with the unpredictability of the disease, causes many to forego work, school, social gatherings and time with family.</p>
<p>Numerous prescription medications are available for both the prevention and treatment of migraine. But for many people, conventional treatment has its limitations. Some people with migraine have a poor tolerance for certain medications. Many can’t afford the high cost of the medicines or endure the side effects. Others are pregnant or breastfeeding and can’t take the medications.</p>
<p>However, as a <a href="https://som.ucdenver.edu/Profiles/Faculty/Profile/29586">board-certified neurologist</a> who specializes in headache medicine, I’m always amazed at how open-minded and enthusiastic patients become when I discuss alternative options. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/qwZypa0iKq8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Your brain sends you warning signals, such as fatigue and mood changes, to let you know a migraine may be on the way.</span></figcaption>
</figure>
<p>These approaches, collectively, are called <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/types-of-complementary-and-alternative-medicine">complementary and alternative medicine</a>. It might be surprising that a traditionally trained Western doctor like me would recommend things like yoga, acupuncture or meditation for people with migraine. Yet in my practice, I value these <a href="https://doi.org/10.7326/0003-4819-135-5-200109040-00011">nontraditional treatments</a>. </p>
<p>Research shows that alternative therapies are associated with <a href="https://doi.org/10.1016/j.ctcp.2017.12.003">improved sleep, feeling better emotionally and an enhanced sense of control</a>. Some patients can avoid prescription medications altogether with one or more complementary treatments. For others, the nontraditional treatments can be used along with prescription medication. </p>
<p>These options can be used one at a time or in combination, depending on how severe the headache and the cause behind it. If neck tension is a contributor to the pain, then physical therapy or massage may be most beneficial. If stress is a trigger, perhaps meditation would be an appropriate place to start. It is worth talking to your provider to explore which options may work best for you. </p>
<h2>Mindfulness, meditation and more</h2>
<p>Because stress is a <a href="https://www.healthline.com/health/migraine-from-stress#bottom-line">major trigger for migraines</a>, one of the most effective alternative therapies is <a href="https://americanmigrainefoundation.org/resource-library/understanding-migraine-cattreatmentmindfulness-meditation-migraine/">mindfulness meditation</a>, which is the act of focusing your attention on the present moment in a nonjudgmental mindset. Studies show that mindfulness meditation can reduce <a href="https://medcentral.net/doi/full/10.4103/0366-6999.228242">headache frequency and pain severity</a>. </p>
<p>Another useful tool is <a href="https://americanmigrainefoundation.org/resource-library/biofeedback-and-relaxation-training/">biofeedback</a>, which enables a person to see their vital signs in real time and then learn how to stabilize them. </p>
<p>For example, if you are stressed, you may notice muscle tightness, perspiration and a fast heart rate. With biofeedback, these changes appear on a monitor, and a therapist teaches you exercises to help manage them. <a href="https://doi.org/10.1016/j.pain.2006.09.007">There is strong evidence</a> that biofeedback can lessen the frequency and severity of migraine headaches and reduce headache-related disability.</p>
<p><a href="https://www.medicalnewstoday.com/articles/yoga-for-migraine#can-it-help">Yoga</a> derives from traditional Indian philosophy and combines physical postures, meditation and breathing exercises with a goal of uniting the mind, body and spirit. Practicing yoga consistently <a href="https://americanmigrainefoundation.org/resource-library/yoga-and-migraine/">can be helpful</a> in reducing stress and treating migraine.</p>
<figure>
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<figcaption><span class="caption">Meditation is an alternative therapy that could help with your migraine.</span></figcaption>
</figure>
<h2>Manipulation-based therapy</h2>
<p><a href="https://www.webmd.com/migraines-headaches/physical-therapy-for-migraine">Physical therapy</a> uses manual techniques such as <a href="https://www.myofascialtherapy.org/myofascial-therapy">myofascial and trigger-point release</a>, <a href="https://www.healthline.com/health/exercise-fitness/passive-stretching">passive stretching</a> and <a href="https://www.verywellhealth.com/manual-cervical-traction-2696409">cervical traction</a>, which is a light pulling on the head by a skilled hand or with a medical device. Studies show that <a href="https://doi.org/10.1016/j.apmr.2015.12.006">physical therapy with medication was superior</a> in reducing migraine frequency, pain intensity and pain perception over medications alone. </p>
<p>By lowering stress levels and promoting relaxation, massage can <a href="https://www.webmd.com/migraines-headaches/migraine-massage-therapy">decrease migraine frequency</a> and <a href="https://doi.org/10.1207/s15324796abm3201_6">improve sleep</a>. It may also reduce stress in the days following the massage, which adds further protection from migraine attacks. </p>
<p>Some patients are helped by <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/acupuncture">acupuncture</a>, a form of traditional Chinese medicine. In this practice, fine needles are placed in specific locations on the skin to promote healing. A large 2016 meta-analysis paper found <a href="https://doi.org/10.1111/head.12857">acupuncture reduced the duration and frequency of migraines</a> regardless of how often they occur. Acupuncture benefits <a href="https://doi.org/10.1001/jamainternmed.2016.9378">are sustained after 20 weeks of treatment</a>.</p>
<p>What’s also fascinating is that acupuncture <a href="https://doi.org/10.2147/JPR.S162696">can change the metabolic activity</a> in the thalamus, the region of the brain critical to pain perception. This change correlated with a decrease in the headache intensity score following acupuncture treatment.</p>
<h2>Vitamins, supplements and nutraceuticals</h2>
<p><a href="https://my.clevelandclinic.org/health/drugs/15829-herbal-supplements">Herbal supplements</a> and <a href="https://americanmigrainefoundation.org/resource-library/nutraceuticals-for-migraine/">nutraceuticals</a>, which are food-derived products that may have therapeutic benefit, can also be used to prevent migraine. And there is evidence to suggest vitamins work reasonably well compared to traditional prescription medication. They also have fewer side effects. Here are some examples:</p>
<ul>
<li><p>Magnesium is believed to help regulate the <a href="https://doi.org/10.1111/j.1526-4610.2011.01847.x">blood vessels and electrical activity in the brain</a>. A study found that patients given 600 milligrams of magnesium citrate daily for 12 weeks had a 40% <a href="https://doi.org/10.1046/j.1468-2982.1996.1604257.x">decrease in migraine</a>. Side effects included diarrhea in nearly 20% of patients. </p></li>
<li><p>Vitamin B2, or riboflavin, <a href="https://doi.org/10.1111/head.12789">is also considered useful in migraine</a> prevention. When dosed at 400 milligrams daily for 12 weeks, researchers found it <a href="https://doi.org/10.1111/head.12789">reduced migraine frequency by half</a> in more than half of participants. </p></li>
<li><p>Another beneficial supplement is Coenzyme Q10, which is involved in <a href="https://doi.org/10.1073/pnas.95.15.8892">cellular energy production</a>. After three months, about half of those taking 100 milligrams of Coenzyme Q10 three times a day <a href="https://pubmed.ncbi.nlm.nih.gov/15728298/">had half the number of migraine attacks</a>. </p></li>
<li><p>A potential natural solution is <a href="https://headaches.org/feverfew-tanacetum-parthenium/">feverfew</a> or <em>Tanacetum parthenium</em>, a daisylike perennial plant known to have <a href="https://doi.org/10.4103/0973-7847.79105">anti-migraine properties</a>. Taken three times daily, feverfew <a href="https://doi.org/10.1111/j.1468-2982.2005.00950.x">reduced migraine frequency by 40%</a>. </p></li>
</ul>
<h2>Devices can be beneficial</h2>
<p>The Food and Drug Administration has approved several <a href="https://www.everydayhealth.com/migraine/guide/treatment/nerve-stimulation-devices/">neurostimulation devices</a> for migraine treatment. These devices work by neutralizing the pain signals sent from the brain.</p>
<p>One is the <a href="https://doi.org/10.3389/fpain.2021.753736">Nerivio device</a>, which is worn on the upper arm and sends signals to the brainstem pain center during an attack. Two-thirds of people report pain relief after two hours, and side effects are rare. </p>
<p>Another device that shows promise is the <a href="https://americanmigrainefoundation.org/resource-library/understanding-migrainecefaly-for-migraine-prevention/">Cefaly</a>. It delivers a mild electrical current to the <a href="https://my.clevelandclinic.org/health/body/21581-trigeminal-nerve#">trigeminal nerve</a> on the forehead, which can lessen the frequency and intensity of migraine attacks. After one hour of treatment, patients experienced a nearly 60% reduction in pain intensity, and the relief lasted up to 24 hours. Side effects are uncommon and include sleepiness or skin irritation. </p>
<p>These alternative therapies help treat the person as a whole. In just my practice, many success stories come to mind: the college student who once had <a href="https://migrainetrust.org/understand-migraine/types-of-migraine/chronic-migraine/">chronic migraine</a> but now has rare occurrences after a regimen of vitamins; the pregnant woman who avoided medication through acupuncture and physical therapy; or the patient, already on numerous prescription medications, who uses a neurostimulation device for migraine instead of adding another prescription. </p>
<p>Granted, alternative approaches are not necessarily miracle therapies, but their potential to relieve pain and suffering is notable. As a physician, it is truly gratifying to see some of my patients respond to these treatments.</p><img src="https://counter.theconversation.com/content/181348/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle Wilhour does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research suggests that alternative treatments for migraine, including physical therapy, massage and vitamin supplements, can make a difference.Danielle Wilhour, Assistant Professor of Neurology, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1653772021-08-05T12:41:37Z2021-08-05T12:41:37ZOlympic athletes excel at their sports but are susceptible to unproven alternative therapies<figure><img src="https://images.theconversation.com/files/414386/original/file-20210803-25-khztso.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5000%2C3532&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cupping, K-tape and cryotherapy are a few alternative therapies commonly used by athletes.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/massage-and-spa-for-men-male-torsos-in-the-royalty-free-illustration/1268389138">juliawhite/iStock via Getty Images Plus</a></span></figcaption></figure><p>Australian Olympic swimmer Kyle Chalmers earned a silver medal and his personal-best time in the 100-meter freestyle event at the 2021 Tokyo Games. While most of the world focused on his thrilling performance, others were equally interested in the <a href="https://www.independent.co.uk/life-style/health-and-families/olympics-cupping-circles-swimmers-backs-b1892490.html">conspicuous, circular bruises</a> on his back and shoulders. Similar marks were seen on <a href="https://well.blogs.nytimes.com/2016/08/08/what-are-the-purple-dots-on-michael-phelps-cupping-has-an-olympic-moment/">Michael Phelps</a> in 2016 when he added six medals to his tally to cement his title as history’s most successful Olympian.</p>
<p>Those blemishes were the work of <a href="https://doi.org/10.1016/S2005-2901(11)60001-0">cupping</a>, an alternative therapy in which small glass cups are placed on the skin at sites of injury or soreness, and used to create suction that stimulates “energy flow.” One form of cupping – wet cupping – involves piercing the skin to bleed the area and remove stagnant blood and toxins.</p>
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<p>As an <a href="https://scholar.google.com/citations?user=F8Gr-jAAAAAJ&hl=en">exercise physiologist</a> who studies critical thinking, I can’t help but wonder how an athlete’s unwitting endorsement of alternative therapy might influence the progression of a sport. This is because cupping is fairly characteristic of <a href="https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_1">alternative therapy</a> that, by definition, hasn’t been accepted by conventional science and medicine. When tested in <a href="https://doi.org/10.1016/S2005-2901(11)60001-0">controlled studies</a>, cupping doesn’t work. </p>
<p>In fact, all alternative therapies exist on a spectrum, from treatments with some merit to scientifically disproven nonsense. And interventions like cupping, that masquerade as science without fulfilling its robust methodology, are known as <a href="https://www.scientificamerican.com/article/what-is-pseudoscience/">pseudoscience</a>.</p>
<h2>Alternative therapies are rife in sport</h2>
<p>When it comes to unproven alternative therapies, cupping is just the tip of the iceberg. Other such practices in sport include <a href="https://pubmed.ncbi.nlm.nih.gov/21952385/">chiropractic spinal manipulation</a>, <a href="https://doi.org/10.1007/s00405-020-06202-5">nasal strips</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737916/">hologram bracelets</a>, <a href="http://dx.doi.org/10.1136/bjsm.2006.028936">oxygen drinks</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/25835541/">reiki (healing hands)</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/26383887/">cryotherapy</a> and <a href="https://doi.org/10.1177%2F0269215520963846">kinesiology tape or K-tape</a>. </p>
<p>While an estimated <a href="https://www.cdc.gov/nchs/data/nhsr/nhsr012.pdf">40% of Americans have used alternative therapies</a>, approximately 20% have used alternative therapies to enhance <a href="https://pubmed.ncbi.nlm.nih.gov/28987072/">athletic performance</a>. <a href="https://doi.org/10.3810/psm.1998.06.1066">Studies</a> <a href="https://doi.org/10.1177%2F1012690205057199">in</a> <a href="https://doi.org/10.1097/00042752-200605000-00008">amateur</a> and <a href="https://doi.org/10.1155/2021/5572325">elite</a> <a href="https://doi.org/10.1159/000511247">athletes</a> show a higher prevalence of 50% to 80%.</p>
<p>A detailed discussion of the evidence – or lack thereof – underpinning each practice can be found in <a href="https://doi.org/10.4324/9780429446160">books and scientific journals</a>. However, most alternative therapies generally have three things in common:</p>
<p>1) They’re sold on strong claims and weak evidence.</p>
<p>2) They invoke scientific-sounding terms like “energy,” “metabolites” and “blood flow” to feign scientific legitimacy.</p>
<p>3) They’re based on low-quality studies that are poorly controlled and have small samples sizes. This makes it impossible to distinguish the real benefits of the treatment from perceived or imagined ones.</p>
<h2>Why do some athletes love alternative therapies?</h2>
<p>Despite scientific consensus on their poor efficacy, alternative therapies appear to be more popular among athletes than the general population. So what makes them so popular?</p>
<p>Humans evolved to take mental shortcuts called <a href="https://doi.org/10.1126/science.185.4157.1124">heuristics</a> that lead to rapid but imperfect solutions, particularly when making <a href="https://doi.org/10.3389/fpubh.2019.00006">health and fitness decisions</a>. Proponents of some alternative therapies exploit the economy heuristic by offering grand rewards for comparatively little investment. Athletes are always chasing the extra 1% and may be particularly susceptible to extravagant claims.</p>
<p>In some instances, a lack of scientific evidence for a given alternative therapy may be the very reason that someone is drawn to it in the first place. The last decade has seen an upswing in <a href="https://doi.org/10.1371/journal.pbio.3000683">anti-science movements</a> and unprecedented attacks on scientists around the world. An individual may turn to alternative treatments due to dissatisfaction or distrust in conventional science, <a href="https://doi.org/10.1136/bmj.321.7269.1133">rejection of societal norms</a>, or both. A therapy may become popular simply because it defies the established order.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"426647061870956544"}"></div></p>
<p>Sponsorship is another factor. American athletes only win between <a href="https://www.cnbc.com/2021/07/29/tokyo-olympics-how-much-athletes-earn.html">$15,000 and $37,500 for an Olympic medal</a>, while British athletes receive no prize money whatsoever. Many have <a href="https://www.goodhousekeeping.com/life/money/news/g3797/how-olympians-make-money/">regular jobs</a>, while some earn the bulk of their income from <a href="https://www.forbes.com/sites/oliviaevans/2021/07/31/what-do-some-us-olympic-athletes-spend-and-how-much-can-they-make-going-for-gold/?sh=439e4cfc1f00">paid advertising</a>. Marketing companies are shrewd: <a href="https://www.researchgate.net/publication/312116633_Consuming_rationally_How_marketing_is_exploiting_our_cognitive_biases_and_what_we_can_do_about_it">They understand our biases better than we do</a>. A company can increase product sales by sponsoring an athlete and affiliating itself with success, fitness and beauty. It’s a win-win because athletes are able to leverage their hefty social media followings into an advertising base. Seemingly innocuous <a href="https://doi.org/10.1080/16184742.2020.1806897">Instagram posts</a> must not be taken at face value.</p>
<p>Finally, some products like <a href="https://sciencebasedmedicine.org/olympic-pseudoscience-tokyo-edition/">K-tape</a> boost their sales through visibility. This phenomenon, where consumers prefer products they’re more familiar with, is called the <a href="https://doi.apa.org/doi/10.1037/h0025848">exposure effect</a>. Increased visibility leads to increased popularity in an ongoing, reciprocal relationship.</p>
<p>Importantly, none of these factors speak to the effectiveness of a product.</p>
<h2>How do alternative therapies benefit athletes?</h2>
<p>It’s not all squandered time and money, however, and there are benefits to some alternative therapies. <a href="https://doi.org/10.1016/j.jad.2020.09.134">Meditation</a> has been used to successfully improve anxiety, depression and psychological well-being, and <a href="https://doi.org/10.1016/j.ypmed.2016.03.013">yoga</a> is a valid means of weight loss. Moreover, <a href="http://dx.doi.org/10.1136/bjsm.32.3.212">massages</a> and other soft tissue therapies appear to reduce muscle soreness and possibly prevent injury. </p>
<p>A distinction can be made between these and unproven alternative therapies based on the data. Care should be taken not to confound plausible claims like weight loss and relaxation with implausible ones like physical healing and detox. </p>
<p><iframe id="Prqt8" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Prqt8/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Even without a quantifiable mechanism of action, many alternative remedies claim efficacy based on <a href="https://doi.org/10.2165/00007256-200939040-00004">placebo effects</a>. The placebo effect manifests when a product improves performance via a positive psychological outcome, attributable to an individual’s belief in the product’s effectiveness. The outcome can be powerful. For instance, <a href="https://doi.org/10.1097/00005768-200009000-00019">one study</a> administered flavored water to competitive cyclists and told them it was a glucose supplement. They saw performance improve by 4% relative to a second group, which was told they’d received a placebo.</p>
<p>In Olympic sport, where gold and silver can be decided by less than a half-second, it’s understandable why sports teams may condone use of placebos, particularly when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778695/">athletes believe in the powerful effects</a>.</p>
<h2>Are there risks of alternative therapies in sport?</h2>
<p>The downside is that, yes, there are clear risks associated with certain alternative therapies. For instance, there are numerous reports of serious injury and even death following both <a href="https://doi.org/10.1111/j.1742-1241.2010.02352.x">chiropractic spinal manipulation</a> and <a href="https://doi.org/10.3233/JRS-2010-0503">acupuncture</a>. Moreover, skin burns are a common side effect of <a href="https://doi.org/10.5694/mja17.00230">cupping therapy</a>. </p>
<p>Of course, all medical procedures carry risk. But in conventional medicine, physicians make treatment decisions based on a <a href="https://doi.org/10.1016/s0197-2456(96)00092-x">risk-to-benefit ratio</a>. When the benefit of alternative therapy hinges on a placebo, the potential risks become hard to justify, especially given the possible loss of training time due to injury or other negative outcome that results from an alternative treatment.</p>
<p>The broad and indiscriminate use of alternative therapies in sport may also have downstream consequences for clinical practice. This is because it’s impossible to restrict placebo use only to minor ailments and sports performance. A sincere belief in the effectiveness of an alternative therapy that isn’t backed by science will lead to its inevitable use by some individuals to treat a potentially <a href="https://www.independent.co.uk/news/world/americas/parents-found-guilty-letting-baby-son-die-meningitis-a7003866.html">serious</a> <a href="https://doi.org/10.1136/bmj.j4006">condition</a>, sometimes with <a href="http://whatstheharm.net/index.html">fatal consequences</a>.</p>
<h2>Is there a place for alternative therapy?</h2>
<p>Might alternative treatments complement those endorsed by science? Perhaps. But safe practice requires drawing a clear line in the sand to restrict alternative therapies to minor ailments and sports performance, not replace modern medicine.</p>
<p>Pseudoscience is a major barrier to both <a href="https://dx.doi.org/10.1016%2Fj.optom.2017.08.001">evidence-based practice</a> and <a href="https://doi.org/10.1002/(SICI)1098-237X(199806)82:3%3C407::AID-SCE6%3E3.0.CO;2-G">science education and literacy</a>. That’s why it’s a potential burden in sport, and why education programs are needed to help people <a href="https://plato.stanford.edu/entries/pseudo-science/">distinguish science from pseudoscience</a>. Not just in sport, but in all facets of society.</p>
<p>And despite what you may hear in Olympics coverage, <a href="https://news.berkeley.edu/2018/05/23/rehabilitating-lactate-from-poison-to-cure/">lactic acid does not cause fatigue</a>.</p><img src="https://counter.theconversation.com/content/165377/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas B. Tiller is a board member of the Pulmonary Education and Research Foundation (PERF). </span></em></p>Many elite athletes turn to alternative therapies to improve performance and enhance recovery. But are these treatments helping or hindering their quest for sporting success?Nicholas B. Tiller, Research Fellow (exercise physiology/respiratory medicine), University of California, Los AngelesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1149802019-05-30T19:50:13Z2019-05-30T19:50:13ZTraditional medicines must be integrated into health care for culturally diverse groups<figure><img src="https://images.theconversation.com/files/276758/original/file-20190528-42588-uc0t6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Traditional Chinese herbal remedies are today used in many countries.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p><em>This article is the fifth part in a series, <a href="https://theconversation.com/au/topics/where-culture-meets-health-70226">Where culture meets health</a>.</em></p>
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<p>Many people seek <a href="https://www.racgp.org.au/afp/2017/may/patterns-of-complementary-and-alternative-medicine-use-and-health-literacy-in-general-practice-patients-in-urban-and-regional-australia/">complementary treatments</a> for various ailments. Perhaps herbal remedies to cure a cold, or acupuncture to ease lower back pain. </p>
<p>“Complementary medicine” refers to practices outside Western medicine, adopted from other cultures, and often used in high-income countries.</p>
<p>But “traditional medicine” covers a range of practices and therapies indigenous to their practising population. Based on historical and cultural foundations, it operates outside of mainstream health care. </p>
<p>So for example, traditional Chinese medicine is indigenous to the Chinese and is therefore classified as a traditional medicine. But when it’s used by non-Chinese ethnicities, we’d call it a complementary medicine.</p>
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Read more:
<a href="https://theconversation.com/nearly-1-in-4-of-us-arent-native-english-speakers-in-a-health-care-setting-interpreters-are-essential-115125">Nearly 1 in 4 of us aren't native English speakers. In a health-care setting, interpreters are essential</a>
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<p>While many people use complementary medicines, traditional medicines form a particularly important influence on the way migrants look after their health.</p>
<p>This can present a challenge in the delivery of Western medical care to diverse communities in their destination countries.</p>
<p>But even where there’s little consensus around their efficacy, as we strive to achieve better health outcomes for culturally and linguistically diverse people, we must recognise traditional and complementary medicines as an essential component of their health care.</p>
<h2>A holistic approach</h2>
<p>Traditional and complementary medicines <a href="https://link.springer.com/article/10.1007%2Fs10903-018-0832-4">used among culturally and linguistically diverse populations</a> include herbal medicine, acupuncture, massage, traditional Chinese medicine, yoga, ayurveda, homeopathy, and tai chi. Different modalities are favoured in different communities.</p>
<p>Ayurveda is more than 5,000 years old and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ayurveda">native to India</a>. It combines lifestyle, diet, exercise and predominantly plant products as treatment options. Translating to “life science”, it aims to cleanse a person of disease-causing substances and restore balance in the body. </p>
<p>Ayurvedic practitioners believe this approach is effective in managing a number of acute and chronic conditions including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718571/">diabetes</a>, <a href="http://www.plantsjournal.com/archives/2017/vol5issue1/PartA/4-6-26-508.pdf">cancer</a>, <a href="http://www.ayurvedjournal.com/JAHM_201843_03.pdf">anxiety</a> and <a href="https://www.researchgate.net/profile/Rajkala_Patil/publication/319037230_Management_of_Rheumatoid_Arthritis_through_Ayurveda/links/598c2890a6fdcc58acb737ec/Management-of-Rheumatoid-Arthritis-through-Ayurveda.pdf">rheumatoid arthritis</a>.</p>
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<a href="https://theconversation.com/does-traditional-chinese-medicine-have-a-place-in-the-health-system-6166">Does traditional Chinese medicine have a place in the health system?</a>
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<p>While some studies point to its efficacy – one found ayurvedic formulations <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Ayurvedic+medicine+offers+a+good+alternative+to+glucosamine">were comparable to conventional medicines</a> such as glucosamine to treat knee osteoarthritis – varied results and limited study designs make it difficult to draw firm conclusions.</p>
<p>Meanwhile, traditional Chinese medicine has evolved since it was first used more than 2,000 years ago. But it remains grounded in its aim to treat the whole body, rather than targeting the problem alone.</p>
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<img alt="" src="https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Traditional remedies often accompany migrants to their destination countries.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<p>Encompassing practices including tai chi, acupuncture, and a variety of herbal remedies, Chinese medicine is today used to prevent and treat many conditions.</p>
<p>Patients with <a href="https://www.ncbi.nlm.nih.gov/pubmed/19877092">knee osteoarthritis</a> who practised tai chi recorded significant improvements, while there have been positive results for acupuncture in relieving <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/413107">lower back pain</a> and nausea associated with chemotherapy. </p>
<p>Traditional Chinese medicine has also been used for the prevention of <a href="http://www.onlinejacc.org/content/69/24/2952?_ga=2.21281211.1216051978.1500588607-1243537711.1500588607&sso=1&sso_redirect_count=2&access_token=">heart disease and stroke</a>, and to improve quality of life for people with <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/227164">chronic heart failure</a>.</p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/28619197">recent review</a> found certain Chinese medicines may control some risk factors for heart disease, like diabetes and high blood pressure. But several studies were limited by small sample sizes and flawed research designs.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/do-you-know-whats-in-the-herbal-medicine-youre-taking-72726">Do you know what's in the herbal medicine you're taking?</a>
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<p>Herbal remedies from Chinese medicine and beyond are employed to treat a range of conditions. St John’s wort has been used <a href="https://www.ncbi.nlm.nih.gov/pubmed/18843608">to treat mild depression</a>, Ginkgo Biloba for memory loss, and ginseng for musculoskeletal conditions. </p>
<p>Despite <a href="https://www.ncbi.nlm.nih.gov/pubmed/18843608">some promising results</a>, a substantial gap still exists between the strength of evidence supporting many of these practices and consumers’ use and acceptance of traditional and complementary medicines.</p>
<h2>If the evidence is limited, why should we pay attention?</h2>
<p>Some migrant communities experience poorer health than their host populations. For example, <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-252">the rates of type 2 diabetes</a> are higher among migrants than in the wider Australian population.</p>
<p>It’s important to recognise that for minority groups, feeling as though a doctor doesn’t understand their cultural needs can be a barrier to help-seeking.</p>
<p>For instance, if a person doesn’t believe their doctor will approve of their use of traditional medicines, they may not disclose it. We know <a href="https://link.springer.com/article/10.1007%2Fs10903-018-0832-4">non-disclosure</a> of traditional and complementary medicine use is common among culturally diverse groups.</p>
<p>This can be dangerous, as some traditional and complementary medicines can <a href="https://europepmc.org/abstract/med/28762712">negatively interact</a> with other drugs.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/going-to-the-naturopath-or-a-yoga-class-your-private-health-wont-cover-it-110699">Going to the naturopath or a yoga class? Your private health won't cover it</a>
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<p>Where patients feel their practitioners are non-judgemental or even accepting of their traditional medicine use, they are <a href="https://www.ncbi.nlm.nih.gov/pubmed/19273869?dopt=Abstract">more likely to disclose it</a>.</p>
<p>So medical providers may benefit from education around different types of traditional and complementary medicines, including culturally sensitive methods to enquire about their use.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Acupuncture, a popular complementary therapy, has its roots in Chinese medicine.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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</figure>
<h2>What does Australia need to do?</h2>
<p>The most mature integrative health care systems are evident in Asia. Countries like South Korea and India <a href="https://www.bmj.com/content/322/7279/164.extract">have regulated</a> traditional and complementary medicines into their national health policies.</p>
<p>To effectively tackle health inequities, our health systems need to consider and address the impact of cultural influences on patients’ health-care decisions. This is vital even when the treatments they value may not be grounded in evidence.</p>
<p>Investigating and considering these practices will ultimately help us to design and facilitate safe, effective, culturally sensitive and coordinated care for all patients and communities across Australia.</p>
<p><em>Professor Jon Adams contributed to this article.</em></p><img src="https://counter.theconversation.com/content/114980/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Josephine Agu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From herbal remedies to acupuncture, traditional therapies are valued particularly by ethnically diverse groups.Josephine Agu, PhD candidate, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/898542018-03-28T02:49:39Z2018-03-28T02:49:39ZHow complementary medicine practitioners can help get kids vaccinated<figure><img src="https://images.theconversation.com/files/211281/original/file-20180321-80640-1a5h7a8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Complementary medicine practitioners could prove to be a valuable source of information about vaccinations</span> <span class="attribution"><span class="source">Stutterstock</span></span></figcaption></figure><p>Australian parents who take their children to a complementary medicine practitioner such as a naturopath or chiropractor are more likely to delay or reject vaccination, according to our <a href="https://www.sciencedirect.com/science/article/pii/S0264410X17317899">research</a>.</p>
<p>Vaccine coverage for five-year-old children is over 93% across Australia, according to recent <a href="https://www.myhealthycommunities.gov.au/national">figures</a> from the Australian Institute of Health and Welfare. However, in certain areas, such as parts of northern New South Wales, uptake is <a href="https://www.northernstar.com.au/news/northern-rivers-immunisation-rates-still-too-low/3187354/">reportedly</a> as low as 73.2%. This increases the risk of disease outbreaks.</p>
<p>Initiatives that focus on increasing vaccination in these communities are critical. If properly trained, complementary health practitioners in areas of low vaccination uptake could provide a vital link to help educate concerned or sceptical parents about the need to vaccinate their children.</p>
<h2>Practitioners, parents and vaccine uptake</h2>
<p>We surveyed 429 parents with at least one child under the age of six from all states in Australia. We asked about their children’s visits to medical, allied and complementary medicine practitioners. We also asked whether their children’s immunisations were up to date and about their own attitudes to vaccination.</p>
<p>We found parents who are cautious about vaccination often seek complementary health services over conventional medical services. This supports earlier <a href="https://www-sciencedirect-com.ezproxy.lib.uts.edu.au/science/article/pii/S027795361730686X?via%3Dihub#bbib1">research</a> that has found many vaccine-hesitant parents believe complementary medicine is safer and more personal than Western biomedicine. </p>
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<strong>
Read more:
<a href="https://theconversation.com/a-short-history-of-vaccine-objection-vaccine-cults-and-conspiracy-theories-78842">A short history of vaccine objection, vaccine cults and conspiracy theories</a>
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<p>Many parents who have concerns about immunisation are more likely to trust
information about vaccination received from a complementary medicine practitioner than a conventional medical provider. Parents appear to trust complementary medicine practitioners as they have always used this system of health care. Consequently, they continue to do so for their children’s health. </p>
<p>For example, many parents <a href="https://www-sciencedirect-com.ezproxy.lib.uts.edu.au/science/article/pii/S027795361730686X?via%3Dihub#bbib1">describe</a> being taken to see complementary medicine practitioners as children themselves. Parents may also be attracted to these practitioners after perceiving their general practitioner did not adequately answer their concerns about vaccination or take them seriously.</p>
<h2>Anti-vax views common in ‘alternative communities’</h2>
<p>While vaccine rejection is <a href="https://theconversation.com/australians-attitudes-to-vaccination-are-more-complex-than-a-simple-pro-or-anti-label-74245">multi-factorial and complex</a>, we found that many parents who are cautious about vaccination have cultural beliefs that are common in <a href="https://www.sciencedirect.com/science/article/pii/S0264410X15013821?via%3Dihub">alternative lifestyle communities</a>. The upper Blue Mountains of New South Wales is one such community with well-known low vaccine coverage. </p>
<p>We are conducting research in partnership with the <a href="http://www.nbmphn.com.au">Nepean Blue Mountains Primary Health Network</a> to explore complementary medicine practitioner attitudes to vaccination in this area. The latest <a href="https://www.myhealthycommunities.gov.au/interactive/immunisation">immunisation figures</a> show that only 80% of two-year-olds are vaccinated in Lawson, Wentworth Falls, Katoomba, Leura and Medlow Bath. </p>
<p>Our qualitative <a href="https://www.sciencedirect.com/science/article/pii/S0264410X17317899">research</a> found that many complementary medicine practitioners said they personally support immunisation but rarely feel “free” to have a conversation with parents about its benefits. </p>
<p>While there are various reasons for this, lack of confidence due to lack of vaccination training was a common concern. Many of the complementary medicine practitioners we spoke to recommended parents talk to their general practitioner, or suggested parents do their own research.</p>
<p>These findings support <a href="https://www.sciencedirect.com/science/article/pii/S0264410X16306090">research</a> from other countries that has found no default position on immunisation among complementary medicine practitioners. Many do support vaccination.</p>
<p>Complementary medicine practitioners are part of the Australian healthcare system, with accredited degree programs available. Therefore, they cannot be ignored as a potential source of information about vaccination – particularly for parents who are sceptical about it.</p>
<h2>What about No Jab No Pay?</h2>
<p>The Australian government introduced the <a href="http://www.ncirs.edu.au/consumer-resources/no-jab-no-play-no-jab-no-pay-policies/">No Jab No Pay policy</a> in 2015 with the aim of increasing childhood vaccination uptake. Our <a href="https://www.sciencedirect.com/science/article/pii/S0264410X17317899">study</a> found its impact was minimal. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/no-jab-no-pay-policy-has-a-serious-ethical-sting-40078">'No jab, no pay' policy has a serious ethical sting</a>
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<p>More than three-quarters of parents whose youngest child was not vaccinated said No Jab No Pay had no influence or made them less likely to vaccinate their child. Early successes may be related to catch-up vaccinations in older children. The new measures may further alienate some parents and therefore <a href="https://theconversation.com/australians-attitudes-to-vaccination-are-more-complex-than-a-simple-pro-or-anti-label-74245">erode public confidence</a>.</p>
<p>While it’s still too early to entirely judge the success or failure of No Jab No Pay, our <a href="https://www.sciencedirect.com/science/article/pii/S0264410X17317899">research</a> indicates that alternative ways of providing information and support to parents may be most effective.</p>
<h2>Complementary medicine practitioners may be part of the solution</h2>
<p>Unfortunately, the topic of vaccination has become politicised and controversial in Australia. But discussion about alternative ways to communicate with vaccine-hesitant parents remains essential. </p>
<p>Many parents are taking their children to see complementary medicine practitioners for general health care. If proper training is provided, these practitioners could be part of the solution to increasing vaccine uptake. </p>
<p>Ideally, this training could include a compulsory module on immunisation that covers history, benefits and risks of vaccination, the science behind the vaccine schedule and how to communicate with parents about immunisation. Ensuring complementary medicine practitioners are equipped with the skills to have evidence-based conversations with parents may be an effective way of overcoming vaccine concern and scepticism. </p>
<p>Complementary medicine practitioners offer an important potential means to convince concerned or sceptical parents of the benefits of vaccinating their children.</p><img src="https://counter.theconversation.com/content/89854/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Frawley receives funding from the National Health and Medical Research Council (NHMRC) and the Nepean Blue Mountains PHN to conduct research in the area of vaccine uptake.</span></em></p><p class="fine-print"><em><span>Erica McIntyre does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Australian parents who visit complementary health practitioners are less likely to vaccinate their kids. But could these practitioners be best placed to educate sceptical parents about vaccination?Jane E Frawley, NHMRC Research Fellow, University of Technology SydneyErica McIntyre, Postdoctoral Research Fellow in Public Health, Faculty of Health, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/906252018-01-25T05:15:11Z2018-01-25T05:15:11ZScrapping pre-approval of medicine ads will put consumers at risk<figure><img src="https://images.theconversation.com/files/203351/original/file-20180125-107943-1t0oa6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">vitamins</span> </figcaption></figure><p>A <a href="https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=r5977">government bill</a>, currently before a <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/TGA2017MeasuresNo1">Senate inquiry</a>, aims to simplify the process for advertising medicines. These include over-the-counter products such as Nurofen, and complementary medicines such as vitamins, herbals and homeopathic products. Advertising for prescription medication is not permitted in Australia. </p>
<p>If the bill passes, the current limited (but useful) process of pre-approving claims made in advertisements for medicines, to ensure they don’t mislead or deceive consumers, will be abandoned. This means advertisements are seen by two industry bodies before they are published or aired. Where problems are found, the bodies work with the advertiser to ensure compliance.</p>
<p>The government has argued removing the pre-approval process won’t put consumers at risk because other measures in the bill would compensate. These include greater surveillance when the product is on the market and increased penalties for regulatory violations. But <a href="http://regnet.anu.edu.au/news-events/events/7047/civil-society-hearing-therapeutic-goods-amendment-bill">civil society groups</a> want pre-approval to continue until these other measures have shown it’s no longer necessary. </p>
<h2>What is the current process for advertising?</h2>
<p>Advertisements for therapeutic goods directed at consumers must comply with the national <a href="https://www.legislation.gov.au/Details/F2015L01787">Therapeutic Goods Advertising Code 2015</a>. The object of the code is to ensure the marketing and advertising of therapeutic goods is conducted in a socially responsible manner that promotes their quality and safe use, and doesn’t mislead or deceive the consumer.</p>
<p>There are several other <a href="https://www.tga.gov.au/regulation-therapeutic-goods-advertising-australia">relevant laws and regulations</a>. For example, Section 22(5) of the Therapeutic Goods Act 1989 specifies advertising of a therapeutic good can only refer to indications or product claims that are included in the Australian Register of Therapeutic Goods (<a href="https://www.tga.gov.au/australian-register-therapeutic-goods">ARTG</a>). This is an electronic register on which information is entered by the manufacturer without oversight from the Therapeutic Goods Administration (TGA).</p>
<p>Manufacturers have worked around this provision by placing creative indications and claims on their ARTG entry, so they can make equally creative advertising claims.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/203372/original/file-20180125-107937-bgi87o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Pre-approval is only required for advertisements for medicines mainly in print, radio and TV – but not the Internet.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<p>The responsibility for authorising pre-approval has been delegated by the TGA to the advertising service managers of two industry associations: Australian Self Medication Industry (<a href="http://www.asmi.com.au/">ASMI</a>) and Complementary Medicines Australia (<a href="http://www.cmaustralia.org.au/">CMA</a>). </p>
<p>The assessments don’t usually extend to a detailed evaluation of the evidence used to support claims of efficacy, because of lack of time. Thus, pre-approval of an advertisement by one of the responsible industry bodies is not a guarantee the advertisement is compliant with all the requirements of the advertising framework. </p>
<p>Nurofen’s “<a href="https://www.accc.gov.au/media-release/court-finds-nurofen-made-misleading-specific-pain-claims">specific pain range</a>” is a good example of misleading claims that apparently slipped through the pre-approval system. The products were on <a href="http://www.adnews.com.au/news/nurofen-ad-pulled-pending-court-battle">sale and advertised</a> as targeting specifics types of pain (like migraine and backache), when they in fact contained the same ingredient. </p>
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Read more:
<a href="https://theconversation.com/tga-failure-gives-nurofen-consumers-a-headache-8762">TGA failure gives Nurofen consumers a headache</a>
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<p>Pre-approval is only required for advertisements for medicines (but not medical devices) in specified media – mainly print, radio and TV – but not the Internet. This is a problem, as it means the process has not kept up with current advertising trends.</p>
<h2>Pre-approval the only defence</h2>
<p>Removing pre-approval is a reduction in red tape as part of <a href="https://www.cuttingredtape.gov.au/">government policy</a>, and was a trade-off for industry accepting greater post-market surveillance and increased penalties and sanctions for regulatory violations. The bill also includes a controversial list of <a href="https://theconversation.com/new-complementary-medicine-health-claims-lack-evidence-so-why-are-they-even-on-the-table-80896">permitted indications</a>, which was meant to limit the industry’s ability to make creative claims about their products’ effectiveness.</p>
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Read more:
<a href="https://theconversation.com/new-complementary-medicine-health-claims-lack-evidence-so-why-are-they-even-on-the-table-80896">New complementary medicine health claims lack evidence, so why are they even on the table?</a>
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<p>The pre-approval process is a form of weak co-regulation in a sector where some businesses can game the system. But it does give vendors, publishers and broadcasters some certainty about what is acceptable. Importantly, it seeks to prevent seriously harmful ads going live. It’s preferable to prevent harm from occurring than trying to remedy that harm after the fact.</p>
<p>Pre-approval is the only defence against seriously misleading advertisements appearing on prime-time television or in national newspapers. The <a href="https://www.doctorportal.com.au/mjainsight/2016/38/advertising-reform-watering-down-consumer-protection/">current process</a> reviews over 2,000 advertisements per year, with an average turnaround time of seven days. Most require changes, sometimes wholesale revisions.</p>
<p>The complaint system takes a long time to remove bad advertisements. Meanwhile, the damage has been done. It is also more economically efficient, given fraudulent therapeutic claims create unnecessary health expenditure and divert scarce health resources from remedies that work to ones that don’t.</p>
<p>The bill comes with a proposal from government for a three-year independent review. Consumer groups argue continuing the pre-approval process until this review would provide a good performance indicator to judge whether the new advertising system is better than the old one. One would expect the number of pre-approved advertisements requiring revision to fall if other measures in the package are successful.</p>
<p>Submissions to the <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/TGA2017MeasuresNo1">Senate inquiry</a> into the bill have emphasised policy-making on the basis of solid data rather than industry self-interest. The Senate is due to report on the legislation on February 2.</p><img src="https://counter.theconversation.com/content/90625/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Harvey represents Choice (the Australian Consumers' Association) on the Therapeutic Goods Advertising Code Council and TGA stakeholder consultations on advertising and complementary medicine reform. He is also on the executive of Friends of Science in Medicine and a member of Skeptics Australia (Victorian Branch).
Asst Prof Arnold is a member of Friends of Science in Medicine.</span></em></p><p class="fine-print"><em><span>Bruce Baer Arnold is a member of Friends of Science in Medicine.</span></em></p>There is currently a weak process of checking claims made in advertisements for medicines, to ensure they don’t mislead or deceive consumers -this could be abandoned if a bill passes parliament.Ken Harvey, Associate Professor, School of Public Health and Preventive Medicine, Monash UniversityBruce Baer Arnold, Assistant Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/808962017-07-20T20:10:01Z2017-07-20T20:10:01ZNew complementary medicine health claims lack evidence, so why are they even on the table?<figure><img src="https://images.theconversation.com/files/178771/original/file-20170719-13534-1g6r575.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Australian drugs regulator is overhauling the health claims made by suppliers of complementary medicines, including homeopathic therapies. And some curious options are up for discussion.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/557763373?src=IytjhciZWcCOoNS_bLGpyw-1-61&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Australia’s drugs regulator seems to be endorsing pseudoscientific claims about homeopathy and traditional Chinese medicine as part of its <a href="https://theconversation.com/which-supplements-work-new-labels-may-help-separate-the-wheat-from-the-chaff-73189">review</a> of how complementary medicines are regulated.</p>
<p>In the latest proposed changes, the Therapeutic Goods Administration (TGA) is looking at what suppliers (also known as sponsors) can claim their products do, known as “<a href="http://www.tga.gov.au/draft-list-permitted-indications">permitted indications</a>”. An example of a “low level” permitted indication might be “may relieve the pain of mild osteoarthritis”.</p>
<p>If approved, the suppliers can use this permitted indication to market its listed product, one of about 11,000 listed complementary medicines on the <a href="https://www.tga.gov.au/australian-register-therapeutic-goods">Australian Register of Therapeutic Goods</a> (indicated by “Aust L” on packaging).</p>
<p>However, the spreadsheet of <a href="http://www.tga.gov.au/sites/default/files/draft-list-permitted-indications.xlsx">1,345 draft permitted indications</a> includes many that seem to lack evidence to back them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=236&fit=crop&dpr=1 600w, https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=236&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=236&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=297&fit=crop&dpr=1 754w, https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=297&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=297&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Complementary medicines are the subject of the latest TGA review of permitted health claims.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>For instance, despite the Therapeutic Goods Advertising Complaints Resolution Panel upholding complaints of a lack of evidence that <a href="http://www.tgacrp.com.au/complaint-register/?_search=magnesium">magnesium</a> (and <a href="http://www.tgacrp.com.au/complaint-register/?_search=restless+legs&_id=3101">homeopathy</a>) “relieves muscle cramps (and restless legs)”, this permitted indication is on its draft list.</p>
<p>Other examples include “supports transport of oxygen in the body”, “regulates healthy male testosterone levels”.</p>
<p>The list contains around 140 traditional Chinese medicine indications, such as “Harmonise middle burner (Spleen and Stomach)”, “Unblock/open/relax meridians”, “Balance Yin and Yang”.</p>
<p>There are also around 900 additional indications for unspecified “traditions”. These include, “Renal tonic”, “Helps healthy liver regeneration”, “Emmenagogue”, “Vermifuge” and “Vulnerary”.</p>
<h2>Endorsing traditional medicines without evidence they work</h2>
<p>Australia is a multicultural society, and it’s appropriate we <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam001_complementary_medicine_resource_clinicians_140409.pdf">respect and have some knowledge</a> of complementary medical traditions.</p>
<p>Some observations made in these traditions have led to valuable, efficacious medicines, such as <a href="https://theconversation.com/is-the-2015-nobel-prize-a-turning-point-for-traditional-chinese-medicine-48643">Artemisinin derivatives</a> isolated from a herb used in traditional Chinese medicine.</p>
<p>However, scientific investigation has not substantiated many other aspects of such traditions, such as the <a href="https://theconversation.com/no-evidence-homeopathy-is-effective-nhmrc-review-25368">homeopathic principles</a> of “like cures like” and <a href="https://theconversation.com/are-traditional-chinese-medicines-safe-and-legal-6373">traditional Chinese medicine</a> concepts of meridians through which the life-energy known as “qi” flows.</p>
<p>We also cannot assume traditional medicines are safe, as <a href="https://www.ncbi.nlm.nih.gov/pubmed/22374080">emerging data</a> highlights how common adverse reactions and drug interactions really are.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Just because complementary medicines are based on long-held traditions doesn’t mean they work or are safe, as international data show.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>For example, Hyland’s homeopathic baby teething products were recalled by the <a href="https://www.fda.gov/safety/recalls/ucm552934.htm">US Food and Drug Administration</a> and then <a href="https://www.tga.gov.au/alert/hylands-baby-homeopathic-teething-tablets">the TGA</a>. This was because lack of quality control over potentially toxic ingredients – belladonna alkaloids – associated with <a href="https://www.scientificamerican.com/article/hundreds-of-babies-harmed-by-homeopathic-remedies-families-say/">adverse events in hundreds of babies</a>. </p>
<p>In China, out of the 1.33 million case reports of adverse drug event reports received by the National Adverse Drug Reaction Monitoring Center in 2014, <a href="http://www.sda.gov.cn/WS01/CL0078/124407.html">traditional Chinese medicine represented around 17.3%</a> (equivalent to around 230,000 cases).</p>
<h2>What we propose</h2>
<p>Listed medicines, like those mentioned, are meant to contain pre-approved, relatively low-risk ingredients. They should be produced with good manufacturing practice and only make “low-level” health claims for which evidence is held. However, the TGA does not check these requirements before the product is marketed.</p>
<p>So, to safeguard shoppers, consumer representatives (of which I was one), suggested the proposed list of permitted indications should be short and only contain modest claims such as, “may assist” or “may help”.</p>
<p>We also argued that, for consumers to make an informed purchase, claims based on “traditional use” should always have a disclaimer along the lines of what the <a href="https://www.ftc.gov/system/files/documents/federal_register_notices/2016/12/homeopathic_drugs_frn_12-13-2016.pdf">US Federal Trade Commission uses for homeopathic products</a>. </p>
<p>For example, “This product’s traditional claims are based on alternative health practices that are not accepted by most modern medical experts. There is no good scientific evidence that this product works”.</p>
<p>However, industry representatives <a href="http://www.asmi.com.au/media/30081/asmi_response_to_cm_de-regulation_review__april_2015_.pdf">argued</a> they needed a long list of permitted indications to allow consumers to tell the difference between one product and another. They also argued that disclaimers for traditional medicines were unnecessary. Their wishes made it to the draft list, rather than ours.</p>
<p>While we welcome moves to <a href="https://theconversation.com/which-supplements-work-new-labels-may-help-separate-the-wheat-from-the-chaff-73189">better regulate</a> complementary medicines in Australia, this current list of permitted indications, without disclaimers, represents a government endorsement of pseudoscience.</p>
<p>Worse, it will encourage consumers to purchase often ineffective and sometimes dangerous products.</p><img src="https://counter.theconversation.com/content/80896/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ken Harvey has represented Choice (the Australian Consumers’ Association) on TGA consultations about regulatory reform of complementary medicines. He is also an executive member of Friends of Science in Medicine and a member of the Australian Skeptics Victorian Branch.</span></em></p>Would you trust a complementary medicine described as “vermifuge”, “vulnerary” or “emmenagogue”? That’s what new labelling proposes and not everyone’s happy about it.Ken Harvey, Associate Professor, School of Public Health and Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/651482017-06-26T20:09:08Z2017-06-26T20:09:08ZPharmacists are trusted medical professionals, so they shouldn’t sell remedies that lack evidence<figure><img src="https://images.theconversation.com/files/175548/original/file-20170626-326-1vucnvw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pharmacies are trusted medical professionals, so people trust their products. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>A <a href="http://www.health.gov.au/pharmacyreview#InterimReport">government review</a> has recommended pharmacists explain to consumers the limited evidence for effectiveness of complementary medicines, and keep them in a separate area to regulated medications with proven effectiveness. The review also recommended any pharmacy that receives Commonwealth government approval to dispense PBS medicines should not be able to sell homeopathic medicines.</p>
<p>This review was commissioned by the Commonwealth government to examine the efficiency and value for money of pharmacy services and also the regulations under which pharmacies work.</p>
<p>Complementary and alternative medicines are products such as herbal medicines, dietary supplements and multivitamins, and they’re big business. A <a href="http://www.cmaustralia.org.au/resources/Documents/Reports/CMA%20Industry%20Audit%202014.pdf">2014 survey</a> found the revenue from complementary medicines in Australia exceeded A$3.5 billion and was projected to reach $4.6 billion in 2017-18. Pharmacies are a major player in sales of these products, but the exact percentage of total sales in pharmacies, compared to supermarkets and health food stores, is unclear.</p>
<p>The Pharmaceutical Society of Australia (PSA) issued a <a href="http://www.psa.org.au/downloads/ent/uploads/filebase/policies/position-statement-complementary-medicines.pdf">position statement</a> on complementary medicines in 2015. It highlighted the variable evidence and encourages pharmacists to assist consumers’ decision making by discussing the relevant evidence.</p>
<p>The PSA position statement says they do not support the sale of homeopathic products, but stops short of recommending pharmacists do not sell them. Homeopathic products are different from regular medicines. Homeopathy follows a principal of extreme dilution: a substance is chosen to cure an ill, and then the substance is diluted. The vessel containing the substance is then physically hit against a book or other object. There is no reputable evidence for effect from <a href="http://www.nhmrc.gov.au/guidelines-publications/cam02">these products</a>.</p>
<p>The Royal Australian College of General Practitioners (RACGP) was stronger in their <a href="http://www.racgp.org.au/download/Documents/Policies/Health%20systems/PPI-PositionStatement-Homeopathy-v1.pdf">2015 position statement</a> to their members, which said medical practitioners should not recommend these products and pharmacists should not sell them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The review has recommended alternative medicines be kept separate to regulated medicines so consumers know there’s a difference.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>What these mean for consumers</h2>
<p>The review’s recommendations should increase the information available to consumers to assist them in making an informed purchase. The changes should also educate consumers about the process by which complementary medicine products are assessed by the Therapeutics Goods Administration (TGA) before they can be sold on the Australian market.</p>
<p>Just like any other medicine, consumers should ask at the point of purchase about the evidence for the claims made and any potential side effects and interactions. If these questions cannot be answered (or there is no one to ask), go to another store where they are willing to provide answers and even written information to support those answers.</p>
<p>A ban on homeopathic products would be a positive change for the pharmacy profession. For too long pharmacists have claimed “health professional” status while functioning more like shopkeepers, primarily chasing profits. Some people claim homeopathic products are an expensive placebo and do no harm. But if the person taking the homeopathic remedy delays treatment, they can be causing harm and increasing medical costs if the condition progresses while being “treated”.</p>
<p>The PSA has not been strong enough on homeopathic products, perhaps because it is are a member-based organisation and some of its members would sell these. </p>
<p>If a product is sold by a health professional it means consumers have faith it will work. These products don’t deserve this trust, and health professionals who endorse them are putting profit before reputation. Pharmacists should only stock products with a strong evidence base.</p>
<p>Other review recommendations include:</p>
<ul>
<li><p>removing the $1 allowable discount on the PBS patient co-payment, increasing equity in PBS prices for consumers no matter where they live</p></li>
<li><p>changing the current paper Safety Net scheme (where patients have to collect a sticker for every script) into an automatic electronic recording and alert system.</p></li>
</ul>
<p>It’s important to note the review is not yet finalised – this release is an interim report and is <a href="http://www.health.gov.au/pharmacyreview#InterimReport">available for public comment</a> until 23 July 2017. There are almost 50 “options” on which comments are sought.</p><img src="https://counter.theconversation.com/content/65148/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A review has recommended separating pharmacists from complementary and homeopathic products.Greg Kyle, Professor of Pharmacy, Queensland University of TechnologyKatherine Browne, Associate Lecturer, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/727262017-02-23T19:23:34Z2017-02-23T19:23:34ZDo you know what’s in the herbal medicine you’re taking?<figure><img src="https://images.theconversation.com/files/157614/original/image-20170221-18640-1m65eoo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vitamins are often seen as benign since they're meant to be natural, but the list of ingredients isn't always accurate.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Complementary medicine has received a lot of attention in the past couple of weeks. First, <a href="https://www.mja.com.au/system/files/issues/206_02/10.5694mja16.00614.pdf">a study</a> focused on potential safety concerns about taking herbal products. Second, <a href="http://www.abc.net.au/4corners/stories/2017/02/13/4616948.htm">ABC’s Four Corners</a> looked at the need for better regulation of product claims, and questioned the credibility of the pharmacy industry for endorsing and selling these products.</p>
<p>Both of these are particularly relevant, <a href="https://www.ncbi.nlm.nih.gov/pubmed/12200102">considering complementary and alternative medicines</a> are <a href="https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm">widely used</a> by <a href="https://www.mja.com.au/journal/2006/184/1/continuing-use-complementary-and-alternative-medicine-south-australia-costs-and">different populations</a> and by more than <a href="http://www.nicm.edu.au/health_information/information_for_consumers/reports,_surveys,_audits">half of all people</a>. People like complementary medicines often because they find such natural alternatives to be more in line with their <a href="https://www.ncbi.nlm.nih.gov/pubmed/9605899">values and beliefs</a>, and desire to lead a more “natural” life.</p>
<p>However, in many instances complementary medicines have no added benefit when compared to placebo, or weak evidence. These include <a href="http://www.cochrane.org/CD000980/ARI_vitamin-c-for-preventing-and-treating-the-common-cold">dietary supplements such as vitamin C</a> and <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000530.pub3/abstract">echinacea</a> for the common cold, and <a href="http://www.metabolictrial.com">weight-loss</a> <a href="https://theconversation.com/do-over-the-counter-weight-loss-supplements-work-53167">supplements</a>. </p>
<p>On the other hand, there is evidence for complementary medicines in preventing or managing a range of conditions. Some examples include <a href="https://www.ncbi.nlm.nih.gov/pubmed/10759336">improvement</a> in <a href="https://www.ncbi.nlm.nih.gov/pubmed/23832433">mental health</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/17174460">conditions</a>, managing <a href="http://jamanetwork.com/journals/jama/fullarticle/2529629">menopausal symptoms</a>, and for <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1503734">healthy outcomes during pregnancy</a>.</p>
<h2>How complementary meds end up on our shelves</h2>
<p>In contrast to pharmaceuticals (otherwise known as conventional “Western” medicines), government typically does not subsidise complementary medicines. Therefore, the cost burden is shifted to consumers. While this is good news for government budgets, consumers need to have confidence the products they’re spending their money on are safe and effective.</p>
<p>All herbal medicines (these are products derived from plant sources and fall under the complementary medicines umbrella) must be listed on the Australian Registry of Therapeutic Goods before they are made available for sale. This <a href="https://www.tga.gov.au/listed-medicines">gives them an AUST-L number</a>. However, this still relies on the manufacturer’s honesty with respect to its effectiveness. </p>
<p>This stands in stark contrast to pharmaceuticals. These have high up-front development costs, go through rigorous registration processes and have no guarantee of approval. Once pharmaceuticals are approved they are given an AUST-R number, which is different to the AUST-L number.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=568&fit=crop&dpr=1 754w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=568&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=568&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Echinacea for colds has been found to have limited effectiveness.</span>
<span class="attribution"><a class="source" href="https://www.google.com.au/search?q=echinacea&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjE9YiLqKXSAhVljFQKHZGHBZ0Q_AUICCgB&biw=1960&bih=1118#tbm=isch&q=echinacea+supplements&*&imgrc=qD4fkLWUnoKduM:">Elaine Thompson/AP</a></span>
</figcaption>
</figure>
<p>Natural or herbal medicines do not face the same regulatory scrutiny as pharmaceutical drugs because of their origin from “natural” sources. </p>
<p>However, as the <a href="https://www.mja.com.au/system/files/issues/206_02/10.5694mja16.00614.pdf">recent piece in the Medical Journal of Australia</a> points out, some products (particularly traditional Chinese medicines) often inaccurately list ingredients and may contain undeclared products (including DNA from endangered animals such as the snow leopard) or <a href="http://www.nature.com/articles/srep17475#t1">toxic and pharmaceutical contaminants</a>. </p>
<p><a href="http://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1002657#s4">Similar findings</a> have been reported previously for traditional Chinese medicines.</p>
<p>If a complementary medicine product does not have an AUST-L number you should not buy it: you are putting yourself at risk. </p>
<h2>Not all bad eggs</h2>
<p>It’s often the poor compliance of a few companies tarnishing the industry as a whole. One example is “Hydroxycut”. Not only has the product been banned in the US several times, it has put <a href="http://www.ncbi.nlm.nih.gov/pubmed/20104221">consumers’ health</a> in <a href="http://www.ncbi.nlm.nih.gov/pubmed/19139478">serious jeopardy</a>. </p>
<p>Other dietary supplements have led to questions being asked of the industry due to case reports of liver damage from taking products containing, for example, <a href="http://link.springer.com/article/10.2165/00002018-200831060-00003">green tea extract</a>. It’s the concoction of different ingredients in these supplements that often makes it difficult to pinpoint the exact root of concern. Therefore, tighter regulation of the industry is needed. </p>
<p>But many companies are meeting regulatory requirements and performing good-quality research to support their product claims. One <a href="http://link.springer.com/article/10.1007/s00213-016-4471-y">recent example</a> is an extract from the green–lipped mussel for those with attention deficit hyperactivity disorder (ADHD) or learning difficulties. This supplement showed some benefits in reducing hyperactivity and inattention, and improving memory in children and adolescents. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690059/">Similar studies</a> with other products are under way.</p>
<p>Regulatory reform is needed to protect those companies performing good-quality research from other companies “piggy-backing” off this evidence for their similarly marketed product, perhaps with the same or similar ingredients. The Therapeutic Goods Administration should require manufacturers to have independent testing performed on their products before marketing to ensure <a href="https://www.mja.com.au/system/files/issues/206_02/10.5694mja16.00614.pdf">the ingredients listed on the packet are accurate</a>. </p>
<p>However, this still doesn’t stop people purchasing complementary medicine over the internet, <a href="https://www.tga.gov.au/book-page/purchasing-complementary-medicines-over-internet">despite clear warnings</a> against this.</p>
<p>We need to encourage and better incentivise research and development of complementary medicines. And we need to give adequate resources to a relevant body capable of more closely regulating the listing of complementary medicines to ensure patient safety. </p>
<p>Until this happens, make sure you only purchase supplements with an AUST-L number to ensure it’s safe – and do some research into the efficacy to ensure you’re not wasting your money.</p><img src="https://counter.theconversation.com/content/72726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Fuller has received research grants for clinical trials funded by Australian Egg Corporation, Arnotts Biscuits, SOHO Flordis International Research, Sanofi-Aventis, Novo Nordisk, Allergan, Roche products, MSD, and GlaxoSmithKline.</span></em></p>In many instances complementary medicines have no added benefit when compared to a placebo, or weak evidence of effectiveness.Nick Fuller, Research Fellow, Clinical Trials Development & Analysis, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/731892017-02-20T19:24:29Z2017-02-20T19:24:29ZWhich supplements work? New labels may help separate the wheat from the chaff<figure><img src="https://images.theconversation.com/files/157255/original/image-20170217-4236-nzd71a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">How do you really know if vitamin and mineral supplements really 'help your heart' or 'boost your mood'?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/517627717?src=_bg7SZGmIYpr6LlUowfYLw-3-39&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>New proposals from Australia’s drug regulator should give you a better idea if your complementary medicines do what they say on the packet.</p>
<p>One change proposed by the Therapeutic Goods Administration (TGA) is a “stamp of approval” on the packaging and promotional material of some vitamins, minerals, herbs and other supplements to tell you there is enough evidence to back health claims.</p>
<p>Other proposals include reducing the number of often unsubstantiated indications that manufacturers of complementary medicines currently make on their TGA application, which are then used as the basis for advertising claims. </p>
<p>The TGA also proposes incentives for companies to develop and market products with new active ingredients, or make new claims based on research.</p>
<p>The proposed changes, <a href="http://www.tga.gov.au/consultation/consultation-reforms-regulatory-framework-complementary-medicines-assessment-pathways">which are out for public consultation</a>, follow the recent <a href="http://www.abc.net.au/4corners/stories/2017/02/13/4616948.htm">ABC Four Corners program</a>, which highlighted long-standing problems with the way complementary medicines are currently regulated.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/TKyHvYgP_ZE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">ABC Four Corners’ documentary “Swallowing it” highlights the shortcomings of how complementary medicines are regulated in Australia.</span></figcaption>
</figure>
<h2>What’s the problem?</h2>
<p>The TGA’s proposals are urgently needed to fix three major shortcomings of the current regulatory system.</p>
<p>First, consumer organisations and health professionals have lost confidence in the complementary medicines industry’s ability to regulate its own advertisements, and in the TGA’s ability <a href="https://theconversation.com/dodgy-claims-for-complementary-medicines-heres-how-the-drug-watchdog-could-have-more-bite-69488">to apply adequate sanctions</a> when companies don’t follow the rules.</p>
<p>Second, there is little incentive for the manufacturers of complementary medicines to research new innovative products or prove existing ones work.</p>
<p>There are about 11,000 listed complementary medicines on the <a href="https://www.tga.gov.au/australian-register-therapeutic-goods">Australian Register of Therapeutic Goods</a> (indicated by Aust L on packaging). Listed medicines are meant to contain pre-approved, relatively low-risk ingredients, produced with good manufacturing practice and only make “low-level” health claims for which evidence is held. However, the TGA does not check these requirements before the product is marketed; post-marketing surveillance and upheld complaints show <a href="https://theconversation.com/dodgy-claims-for-complementary-medicines-heres-how-the-drug-watchdog-could-have-more-bite-69488">high levels of regulatory non-compliance</a>. </p>
<p>But there are only 35 <a href="https://www.tga.gov.au/list-evaluated-registered-complementary-medicines">registered complementary medicines</a> (indicated by Aust R on packaging) the TGA says have been thoroughly assessed for safety, quality and efficacy (there is also debate about whether many of these older products should still be on this TGA list). There are fewer products on this list because research to meet registration requirements is expensive, the public doesn’t understand the subtleties between an <a href="https://www.tga.gov.au/community-qa/whats-medicine-label">Aust L and Aust R product</a> and a better return on investment comes from promotional hype and celebrity endorsement of listed products. </p>
<p>Third, the TGA provides only limited transparency about companies and products that fail post-marketing evaluation or have complaints upheld. This information is currently regarded as commercial-in-confidence, fuelling the perception the TGA is more concerned with helping industry than protecting consumers.</p>
<h2>How could the new measures help?</h2>
<p>The proposal to restrict companies to only making pre-approved, “low-level” indications and claims for a product, such as, “may relieve the pain of mild osteoarthritis”, will minimise the risk of misleading consumers. But it is not yet clear how the list of allowed indications will be established nor how a specific product will be matched with an appropriate allowed indication.</p>
<p>The regulator also proposes manufacturers apply for “intermediate-level” health claims falling outside the permitted list (outlined above). An example might be, “our formulation of cranberry reduces the frequency of recurrent urinary infections in women”. For this, the TGA would have to assess the evidence substantiating the claim for a particular product. If the evidence stacks up (and there’s a debate about the type of evidence needed), the product could then carry a TGA “stamp of approval” on the label and any promotional material. But it is not clear what this “stamp of approval” will be. Is it text, a symbol or both?</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/157407/original/image-20170218-10217-n5s5fr.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/157407/original/image-20170218-10217-n5s5fr.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=588&fit=crop&dpr=1 600w, https://images.theconversation.com/files/157407/original/image-20170218-10217-n5s5fr.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=588&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/157407/original/image-20170218-10217-n5s5fr.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=588&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/157407/original/image-20170218-10217-n5s5fr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=739&fit=crop&dpr=1 754w, https://images.theconversation.com/files/157407/original/image-20170218-10217-n5s5fr.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=739&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/157407/original/image-20170218-10217-n5s5fr.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=739&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Not everyone agrees a TGA ‘stamp of approval’ should be in the form of a symbol, like this.</span>
<span class="attribution"><span class="source">(Unofficial mock-up created by Ken Harvey)</span></span>
</figcaption>
</figure>
<p>In preliminary TGA stakeholder consultations, consumer representatives supported a prominent visual identifier (like a logo or symbol) because of the failure of the existing Aust L and Aust R labelling to inform consumers. But industry representatives were concerned a highly visible identifier for a small number of evidence-based complementary medicines might affect sales of the bulk of listed products without one.</p>
<p>The TGA’s proposals encourage innovation because they will stimulate companies to engage in research to qualify for a TGA “stamp of approval”. The proposal also suggests companies that develop a TGA approved evidence-based claim would be awarded a three-year period of data protection to stop others freeloading on their research. </p>
<p>But the proposed changes do not yet address the need for greater transparency in the regulatory process. For instance, it is not clear whether the TGA’s assessment of evidence to back higher-level health claims for complementary medicines will be publicly available, as they are for <a href="https://www.tga.gov.au/australian-public-assessment-reports-prescription-medicines-auspars">prescription medicines</a>.</p>
<h2>What happens next?</h2>
<p>These proposed changes, which are out for public consultation until March 28, 2017, sit alongside <a href="https://theconversation.com/dodgy-claims-for-complementary-medicines-heres-how-the-drug-watchdog-could-have-more-bite-69488">other recommendations</a> aimed at improving the advertising complaints system. </p>
<p>If the TGA implements this package of recommendations, Australia will be a world leader in how complementary medicines are regulated. Despite the substantial and increasing use of supplements, no other country has developed a system that helps consumers and health professionals separate the evidence-based wheat from the chaff, improves confidence in the industry, stimulates more evidence-based products and has the potential to boost exports.</p><img src="https://counter.theconversation.com/content/73189/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ken Harvey has represented Choice (the Australian Consumers’ Association) on discussions about regulatory reform during TGA stakeholder consultations.
He is also an executive member of Friends of Science in Medicine.</span></em></p>If the Therapeutic Goods Administration implements new proposals to regulate complementary medicines, you can be more confident they actually do what they say on the packet.Ken Harvey, Adjunct Associate Professor, School of Public Health and Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/694882016-12-19T03:25:45Z2016-12-19T03:25:45ZDodgy claims for complementary medicines? Here’s how the drug watchdog could have more bite<figure><img src="https://images.theconversation.com/files/150426/original/image-20161216-26071-k71cid.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Advertisements for complementary medicines don't always reflect what's in the bottle.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/432958402?src=3HtFGSwDxdg_WNVXzc307A-1-14&id=432958402&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Complementary medicine suppliers are getting away with breaching advertising requirements because Australia’s medicines regulatory authority has no bite, new data confirms.</p>
<p>This means consumers can have little confidence in advertising claims for listed medicines, mainly complementary medicines like herbal, vitamin and mineral supplements.</p>
<p>Instead, we need a robust regulatory system that protects consumers against misleading and deceptive statements.</p>
<p>The <a href="https://www.tga.gov.au/">Therapeutic Goods Administration</a> (TGA) has <a href="https://www.tga.gov.au/book/export/html/731370">recently published data</a> on <a href="https://www.tga.gov.au/listed-complementary-medicine-compliance-reviews#request">post-marketing reviews</a> for listed medicines.</p>
<p>The number of medicines with verified breaches increased from 73% of 212 cases investigated in 2014-15 to 80% of 473 cases investigated in 2015-16. The most common problem was failure to produce evidence to support product claims.</p>
<p>In 2015-16, the independent <a href="http://www.tgacrp.com.au/">Therapeutic Goods Advertising Complaints Resolution Panel</a> found 98% of 141 complaints justified. When the panel requested suppliers fix their breaches, in 40% of cases they refused to do so. This is because the panel has no power to enforce its determinations. These statistics are a sad reflection on the failure of the regulators to bring the complementary medicines industry into check over many years. </p>
<p>In mid-2015, the <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/Expert-Review-of-Medicines-and-Medical-Devices-Regulation">Expert Review of Medicines and Medical Devices Regulation</a> made seven recommendations about regulation of therapeutic goods advertising.</p>
<p>In September 2016, <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/MMD-govresp">the government accepted</a> all seven recommendations. The TGA is now consulting with the public about how to implement these. These are the three most important.</p>
<h2>Approving adverts</h2>
<p>One recommendation is to abandon the process of pre-approving adverts for therapeutic products in favour of a more self-regulatory regime. </p>
<p>Currently, two industry associations pre-approve advertisements for listed products, but these are limited to medicines advertised to the public in “specified media”, mainly television, radio and print advertisements, not the internet.</p>
<p>So why should we be concerned? The pre-approval process is efficient; it reviews about 2,000 advertisements a year with an average turnaround time of seven days. Most advertisements reviewed need changes to avoid breaches; sometimes wholesale revisions are needed. Pre-approval is the only defence between a misleading advertisement on prime-time television and the unwitting consumer. Other avenues such as complaints and post-marketing reviews take a long time to remove such advertisements.</p>
<p>A better alternative to abandoning pre-approval is to extend the process to all advertisements for complementary medicines in all media. Prevention is better than cure.</p>
<p>The self-regulatory regime the government favours is unlikely to be effective as not all companies are members of an industry association, so not all can be self-regulated.</p>
<h2>How to manage complaints?</h2>
<p>Another recommendation is for a new body to manage complaints about advertising of therapeutic goods. The controversy is about who should manage and be involved in the new system, which is important because current bodies differ in how effectively they resolve complaints.</p>
<p>The TGA seems to be positioning itself to take over. This would involve acquiring similar powers to the <a href="https://www.accc.gov.au/">Australian Competition and Consumer Commission</a> (ACCC) and abolishing existing bodies such as the complaints panel.</p>
<p>In doing so, the TGA would take over a role once shared with stakeholders (consumer, health professional, industry and media organisations). There is additional concern the TGA lacks a consumer protection culture, is perceived to be too close to industry, has failed to address long-standing problems, and is not transparent about the outcomes of complaints it handles.</p>
<p>Some vocal groups advocate handing the complaint system to the ACCC. The ACCC has a consumer protection culture, excellent investigative and compliance powers under <a href="https://www.accc.gov.au/about-us/australian-competition-consumer-commission/compliance-enforcement-policy">Australian Consumer Law</a> and the necessary legal expertise. It has also taken on several cases involving the advertising of therapeutic goods, for example <a href="http://www.abc.net.au/news/2016-12-16/nurofen-fined-6m-for-misleading-consumer/8126450">Nurofen targeted pain relief</a> and <a href="http://www.accc.gov.au/media-release/court-finds-homeopathy-plus-vaccine-claims-misleading">Homeopathy Plus!</a>.</p>
<p>But the ACCC receives many thousands of complaints a year covering a wide range of areas. Given current resources it can only pursue a small number of cases through the courts. Moving the complaint system to the ACCC would mean most complaints would not be dealt with, effectively providing <em>no</em> controls. The ACCC has also consistently argued that where there is a need for specialist regulators, they should not be rolled into the ACCC.</p>
<p>A more innovative suggestion is closer partnership between the ACCC and the TGA in the transition to, and in the initial phase of, a new complaint system. This could involve seconding a senior enforcement manager from the ACCC to the TGA to oversee the new system (and change the TGA’s culture, as outlined above) while keeping the best of the current system and fixing its flaws.</p>
<h2>Sanctions and penalties</h2>
<p>The third recommendation is for legislative power to impose substantial fines and the publication of retractions as ways of enforcing determinations against misleading advertising. This is long overdue as any sanctions and penalties must be sufficient to counter the commercial return from breaching the regulations.</p><img src="https://counter.theconversation.com/content/69488/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Harvey represents Choice (the Australian Consumers' Association) on the Therapeutic Goods Advertising Complaint Resolution Panel and the Therapeutic Goods Advertising Code Council. </span></em></p><p class="fine-print"><em><span>Sasha Hall and Tiana Moutafis do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Consumers can’t always be confident claims for complementary medicines stack up. Here’s how to foster truth in advertising.Ken Harvey, Adjunct Associate Professor, School of Public Health and Preventive Medicine, Monash UniversitySasha Hall, Biomedical Science/ Law student, Monash UniversityTiana Moutafis, Biomedical Science/Law student, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/700562016-12-09T04:15:13Z2016-12-09T04:15:13ZThe latest Productivity Commission report isn’t strong enough on improving consumer protection<p>The <a href="http://www.pc.gov.au/#consumer-law-enforcement-and-administration-draft-report">Productivity Commission’s latest report</a> on how consumer law is being enforced assumes the law is working well when, in a number of areas, it’s failing abysmally. It’s time to recognise that better coordination and enforcement are needed.</p>
<p>The report from the Commission joins a few more, such as <a href="https://cdn.tspace.gov.au/uploads/sites/86/2016/10/ACL_Review_Interim_Report_v2.pdf">the review of Australian Consumer Law</a> and the <a href="http://treasury.gov.au/PublicationsAndMedia/Newsroom/MediaReleases/2016/Release-of-the-external-dispute-resolution-review-Interim-Report">Financial Services External Dispute Resolution Review</a>, which have pointed to needed reform. <a href="http://consumerlaw.gov.au/the-australian-consumer-law/">Consumer law</a>, as it works today, has 10 different agencies responsible for enforcing it.</p>
<p>The Productivity Commission has had ideas about reforming consumer law before like reviewing the adequacy of penalties, consumer complaints handling and redress systems and better forms of co-operation between regulators and the court and tribunal system. Sadly, not much has happened on many of those recommendations and this review doesn’t come to grips with them either. </p>
<h2>Learning from international experience</h2>
<p>The overall objectives of Australian consumer law are to:</p>
<ul>
<li>improve consumer well being through consumer empowerment and protection;</li>
<li>foster effective competition;</li>
<li>enable the confident participation of consumers in markets in which <a href="http://consumerlaw.gov.au/files/2015/06/acl_iga.pdf">both consumers and suppliers trade fairly</a>. </li>
</ul>
<p>The United Kingdom and other European Union member states are radically improving <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/377522/bis-14-1122-alternative-dispute-resolution-for-consumers.pdf">complaint processes for consumers</a> through the creation of economy-wide ombudsmen in sectors that don’t have industry specific regulators. It’s bringing remedies to millions of consumers. With virtually no analysis from the Productivity Commission on consumer complaints processes, it’s unlikely any change will occur here.</p>
<p>In relation to penalties there is more welcome news. The commission is endorsing the need to increase penalties under consumer law from A$1 million to A$10 million, to be consistent with competition law. </p>
<p>Equally important is the need for a much wider range of behavioural remedies, including compliance and restitution orders, which already exist in many other countries. The Productivity Commission does not appear to have looked across the rapidly fading borders to update its thinking on best practice consumer protection.</p>
<p>The Productivity Commission laments the absence of sufficient hard data to make a clear assessment of how the law is being administered. This is not the first time this issue has been raised by the Commission. In 2008 it recommended the establishment and public funding of a serious consumer research agency, but this is yet to happen.</p>
<h2>Areas that are in need of consumer protection</h2>
<p>Each year there are thousands of claims made by marketers of over-the-counter, or herbal or complementary medicines, with scant evidence of their efficacy and a <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/Expert-Review-of-Medicines-and-Medical-Devices-Regulationmedia">huge regulatory gap</a> when it comes to taking effective action against them. Campaigners like Dr Ken Harvey, an Associate Professor in the Department of Epidemiology and Preventive Medicine at Monash University, and a long time critic of poor regulation, have made this point many times. It’s disappointing the latest Productivity Commission report has not come to grips with the hard evidence presented by researchers in this area.</p>
<p>It is widely accepted that the Australian Competition & Consumer Commission <a href="https://www.accc.gov.au/">ACCC</a> has the necessary tools, experience and culture for taking on serious breaches of the Australian consumer law in this area, and yet the government is preparing to establish a new enforcement body. This goes against the very policy goal of regulation reduction espoused elsewhere.</p>
<p>Protecting consumers of financial services is another blind spot in this latest review. Although the commission notes the exclusion of financial services from Australian consumer law jurisdiction, as they are regulated by the Australian Investment and Securities Commission (<a href="http://asic.gov.au/">ASIC</a>), there is inadequate recognition of the gaps between these two standards of regulation. This occurs where Australian consumer law provisions are not carried over to apply to financial products and services. </p>
<p>These include the absence of consumer guarantees, prohibitions against unsolicited consumer agreements and single pricing, in which consumers must be given a total price for goods or servivces. Finally, the Australian consumer law protection in relation to proof of transaction, doesn’t apply to financial services. </p>
<p>Throughout this report the Productivity Commission acknowledges that multiple regulators can work well together enforcing the same law, but not when it comes to the financial services sector. </p>
<p>Genuine consumer empowerment should provide avenues for some of these problems to be heard by regulators. In 2008 the commission accepted <a href="https://cdn.tspace.gov.au/uploads/sites/86/2016/10/ACL_Review_Interim_Report_v2.pdf">that UK style complaints procedures</a>, through which market failures can be brought to the attention of regulators, might be useful for Australia. Sadly, the Commission review concludes without evidence that regulators are in the best position to determine where markets aren’t working. </p>
<p>There is still a chance for the Productivity Commission to revise its thinking. In the interests of consumers, I hope it does.</p><img src="https://counter.theconversation.com/content/70056/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Allan Asher received funding from the Australian Treasury in connection with research conducted for the ACL Review. He chairs the Disputes Resolution Panel for Therapeutic Goods and is a former Deputy Chair of the ACCC. Mr Asher and the the co-author, Mr Bill Dee are Directors of the Foundation for Effective Markets and Governance (FEMAG)</span></em></p>The latest Productivity Commission report on how consumer law is being used shows that the same issues still haven’t been addressed for years.Allan Asher, Visitor, Regulatory Institutions Network (RegNet) & Chair of Foundation for Effective Markets and Governance, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/687472016-11-18T03:52:44Z2016-11-18T03:52:44ZWhat is taurine and how can it improve psychosis?<figure><img src="https://images.theconversation.com/files/146339/original/image-20161117-13340-qkdomw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People given taurine had significantly improved overall mental health symptoms.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>A compound found in many foods and energy drinks can decrease symptoms of depression and psychosis, which is where the person loses contact with reality. </p>
<p>In our recent study, <a href="http://www.psychiatrist.com/JCP/article/Pages/2016/aheadofprint/15m10185.aspx">published in the Journal of Clinical Psychiatry</a>, we tested whether supplementing standard treatment with taurine would improve cognition and other mental health symptoms in young people who had experienced their first psychotic episode.</p>
<p>A <a href="http://oyh.org.au/sites/oyh.org.au/files/factsheets/fact1_whatis.pdf">psychotic episode</a> is an episode of psychosis, an umbrella term that represents a range of severe mental health symptoms. The most notable is a loss of contact with reality where someone perceives things that are not real (known as hallucinations) or holds beliefs not based in reality (known as delusions).</p>
<p>Our results showed people given taurine had significantly improved overall mental health symptoms, including those of psychosis, compared to those given placebo. People given taurine also showed improvement in depression symptoms and overall social and occupational functioning. </p>
<p>People experiencing psychosis commonly have impairments in cognitive function including reduced concentration, memory, and problem solving ability. We found no difference in cognitive function between the group given taurine and placebo. </p>
<p>But taurine was found to be both safe and well tolerated.</p>
<p>Antipsychotic medication is the first line treatment for psychosis, but it is not always effective, with a proportion of patients experiencing ongoing symptoms or unwanted side effects. Because of this, complementary treatment options are greatly needed. </p>
<h2>What is taurine?</h2>
<p>Taurine is an important compound that naturally occurs in the body. It has various functions, including aiding the function of the brain and cardiovascular system, made up of the heart and blood vessels. Taurine helps protect the brain from inflammation, toxins and protein deficiencies. </p>
<p>It <a href="http://physrev.physiology.org/content/72/1/101">has an inhibitory influence</a> on the activity of the nervous system – the network of nerves and cells that carry signals to and from the brain.</p>
<p>Apart from being present throughout the body, taurine is found naturally in various foods including scallops, fish, poultry, dairy and breast milk. It is also used as an additive in energy drinks and baby formula and can be taken as a supplement. </p>
<p>Humans have an <a href="https://www.ncbi.nlm.nih.gov/pubmed/19592001">estimated average intake</a> of 40 to 400mg per day naturally in their diet. </p>
<p>A <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(77)91636-1/abstract">study conducted in 1977</a> suggested taurine may help reduce severe psychiatric symptoms such as delirium, hallucinations and mental impairment. </p>
<p>In the study, 22 patients undergoing treatment for alcohol withdrawal were given one gram of taurine three times a day over seven days. They experienced fewer psychiatric symptoms compared to a historical comparison group who hadn’t received taurine. </p>
<p>Taurine concentrations <a href="https://www.ncbi.nlm.nih.gov/pubmed/7595563">have been shown to be decreased</a> in people with schizophrenia, a condition in which people experience constant symptoms of psychosis. Higher levels of taurine in the frontal cortex – an area of the brain associated with cognition – of people with schizophrenia, were found to be associated with better cognitive functioning, specifically faster information processing. </p>
<p>The effects of taurine have also been <a href="https://www.ncbi.nlm.nih.gov/pubmed/19592001">tested on patients with health conditions</a> including depression, heart disease, diabetes, growth retardation and an eye disease called retinal degeneration.</p>
<p>This historical evidence suggested taurine was worth investigating as a potential complementary treatment for first-episode psychosis. </p>
<h2>Why our study matters</h2>
<p>We tested the effects of taurine on 86 patients aged 18 to 25 who had experienced their first episode of psychosis. They were taking low-dose antipsychotic medication and attending early intervention services in Melbourne. </p>
<p>Psychosis <a href="http://oyh.org.au/sites/oyh.org.au/files/factsheets/fact1_whatis.pdf">usually has its first onset</a> in a person’s late teens or early twenties and affects around three out of every 100 people in their lifetime. We randomly allocated 47 patients to receive four grams of taurine, and 39 patients to receive a placebo, once a day over a 12 week period. </p>
<p>Prior to the trial, we assessed their psychiatric symptoms, cognition, social and occupational functioning, tolerance to medication and side effects. We tested these again at six and 12 weeks. </p>
<p>Our positive results provide evidence for the potential benefits of taurine as a safe, complementary treatment for psychosis and possibly other mental health conditions.</p>
<p>As this was the first study to examine the efficacy of taurine in first-episode psychosis, the findings need to be replicated in trials with other samples before its use can be recommended in clinical treatment guidelines. </p>
<p>Future research should aim to find the ideal dose and duration of time taurine should be taken for maximal benefit. Cognitive impairments emerge very early in the course of psychosis and so it is possible that supplements such as taurine need to be trialled earlier if they are to have a positive effect on cognition. </p>
<p>Investigation into complementary supplements for psychosis and other mental health conditions is a growing area of research, which gives hope to people for whom standard treatments do not provide complete relief from symptoms.</p>
<hr>
<p><em>This article was co-authored by Colin O'Donnell from the Department of Psychiatry at the Donegal Mental Health Service in Ireland.</em></p><img src="https://counter.theconversation.com/content/68747/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kelly Allott works for Orygen,The National Centre of Excellence in Youth Mental Health - that led the study. She receives funding from The University of Melbourne and The National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Pat McGorry is the Executive Director of Orygen,The National Centre of Excellence in Youth Mental Health - that led the study. </span></em></p>People given taurine had significantly improved overall mental health symptoms, including those of psychosis, compared to those given placebo.Kelly Allott, Senior and Ronald Philip Griffiths Fellow, The University of MelbournePat McGorry, Professor of Psychiatry, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/637292016-08-09T11:29:47Z2016-08-09T11:29:47ZCupping at the Olympics – what is it and why do athletes use it?<p>You may have noticed several Olympic athletes covered in bruises, including swimmer Michael Phelps and US gymnast Alex Naddour. No, these are not minor injuries obtained during training; they look oddly circular and are located symmetrically all over the body. In fact, they are self-inflicted marks caused by an ancient form of therapy called “cupping”. </p>
<p>Cupping has long existed in many cultures including China, ostensibly to stimulate the flow of energy in the body. In recent months, however, there has been a flurry of renewed interest in it. It seems that cupping is having a comeback, and one does not need to be a clairvoyant to predict that, after the Olympic games, cupping will become flavour of the month. </p>
<p>Essentially there are two types: dry and wet cupping. Dry cupping involves a warm cup being placed over the skin. As the air in the cup cools <a href="https://van.physics.illinois.edu/qa/listing.php?id=896">it creates a suction effect</a> which draws in the skin as the cup is placed on it. The suction is usually strong enough to create a haematoma, a swelling of blood within the tissues that is much larger than a normal bruise. As the cup normally has a circular shape, the haematoma is circular as well. These are the strange marks we see on the Olympic athletes. </p>
<h2>Wet and dry</h2>
<p>Wet cupping involves causing a superficial injury to the skin and then applying a cup over the injured site. This procedure will draw a small amount of blood into the cup. Wet cupping is painful and carries a risk of infection. By contrast, dry cupping is harmless and almost painless – when done correctly.</p>
<p>When, about 40 years ago, I worked in a homeopathic hospital, we used dry cupping regularly. There are several techniques, but the method we used was simple: all you need is a small glass cup, some cotton wool and white spirit. You soak a bit of cotton wool in the white spirit, set it alight, place it in the glass cup and then swiftly place the cup on the patient’s skin. The fire stops instantly, and the change in temperature creates the desired suction. After a while, the effect recedes and the cup falls off by itself. This method is simple but I do not advise anyone to try it at home. If you make a mistake, you can burn yourself badly. </p>
<p>Wet cupping is done in much the same way. Only one thing is different: one has to injure the skin before placing the cup over it, and this is what causes the pain. We used to do this with a little device that had multiple needles on it and looked like a miniature hedgehog; alternatively, we employed a scalpel to cut small, superficial incisions into the skin.</p>
<p>Back then, we used cupping mainly for musculoskeletal problems, such as back pain, neck pain or shoulder pain. Did it work? My impression was that it helped ease the pain of most patients. However, there weren’t any proper clinical trials to tell us more back then. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/133516/original/image-20160809-18023-q7mzpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/133516/original/image-20160809-18023-q7mzpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=802&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133516/original/image-20160809-18023-q7mzpg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=802&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133516/original/image-20160809-18023-q7mzpg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=802&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133516/original/image-20160809-18023-q7mzpg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1008&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133516/original/image-20160809-18023-q7mzpg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1008&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133516/original/image-20160809-18023-q7mzpg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1008&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Celebrity follower.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-122722459/stock-photo-los-angeles-aug-11-gwyneth-paltrow-arriving-to-emmy-awards-2011-on-august-11-2012-in-los-angeles-ca.html?src=rZEWcnutzQWnIAK_AIFeeQ-1-21">Shutterstock</a></span>
</figcaption>
</figure>
<p>This lack of evidence continued until recently. I suspect it was <a href="http://news.bbc.co.uk/1/hi/health/3879447.stm">Hollywood actress Gwyneth Paltrow</a> who prompted some research into cupping. In 2004, she was photographed in a shoulderless evening dress which displayed the typical circular haematomas of cupping on her back. These photos went around the world and got people interested in this forgotten form of therapy.</p>
<p>Since then, there have been several clinical trials of cupping showing <a href="http://www.sciencedirect.com/science/article/pii/S2095754814000040">that it can work for pain</a>, but I am not impressed. These studies are of very poor quality – many <a href="http://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-10-70">do not have good controls and/or are subject to bias</a>, and some report results which, quite frankly, are too good to be true.</p>
<p>Yet I can well believe that cupping is effective – after all, I have seen it working with my own eyes. The question is how does it work? The procedure is clearly most impressive to the patient. It would be hardly surprising if cupping generated a significant placebo effect. In addition, it might work via a phenomenon called “counter irritation”. If you have a mild toothache and accidentally hit your thumb with a hammer, you will find that the counter irritation of the hammer strike made your tooth ache disappear instantly, at least for a while.</p>
<p>Of course, this is not what the cupping therapists will tell you. Depending on which tradition they subscribe to, they will spin a long yarn about life forces, chi or energies being put back into order. Like cupping itself, these explanations originate from the pre-scientific era and do not make the slightest sense in the light of what we know today.</p>
<p>Naturally, all this does not matter to the Olympic athletes who obviously swear by cupping. They want to ease the pain of overexertion and, because of the doping regulations, they have to be careful with many types of medicines. So any drug-free method to alleviate their pain is more than welcome. And whether it works via a pronounced placebo effect, counter irritation or some mystical energy is the least of their worries.</p><img src="https://counter.theconversation.com/content/63729/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edzard Ernst does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>They look sore but it’s fairly harmless – and the effect may really be a placebo.Edzard Ernst, Emeritus Professor of Complementary Medicine, University of ExeterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/614662016-07-06T14:50:21Z2016-07-06T14:50:21ZMuscle-building shakes don’t always have as much protein as they claim to<figure><img src="https://images.theconversation.com/files/129374/original/image-20160705-804-othfdk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Protein supplements have become a <a href="http://www.nutritionexpress.com/showarticle.aspx?articleid=1760">widely popular</a> way for avid gym-goers to pump extra protein into their bodies and bump up their muscles.</p>
<p>Protein is essential for the <a href="http://www.webmd.com/men/features/benefits-protein">overall health</a> of the body, building and repairing its tissues and balancing the levels of energy, hormones and many other chemicals. It’s also central in building muscles – often the attraction for its use in body building and fitness products.</p>
<p>Ideally men should get about 56g of protein a day for their normal body processes to continue. Women, it is <a href="http://fnic.nal.usda.gov/dietary-guidance/dri-nutrient-reports/energy-carbohydrate-fiber-fat-fatty-acids-cholesterol-protein">recommended</a>, should have about 46g of protein. </p>
<p>An <a href="http://www.sajcn.co.za/index.php/SAJCN/article/view/747/1079">egg</a> contains about 6g of protein, while a portion of soybeans (half a cup) could contain 15g of protein and one <a href="http://www.ajol.info/index.php/sajas/article/view/121445/110910">lean lamb loin chop</a> could contain 14g of protein. </p>
<p>There has been much debate around people pumping protein supplements into their bodies. <a href="http://www.uni.edu/dolgener/Advanced_Sport_Nutrition/protein_intake.pdf">Some research</a> suggests that people who are undergoing muscle-building training need higher quantities of protein to support maximum muscle growth. But there is <a href="https://www.ncbi.nlm.nih.gov/pubmed/7550257">no scientific agreement</a> that these people really need to consume more protein than the <a href="http://fnic.nal.usda.gov/dietary-guidance/dri-nutrient-reports/energy-carbohydrate-fiber-fat-fatty-acids-cholesterol-protein">recommended dietary allowance</a>. </p>
<p>Yet weight trainers and sportspeople <a href="http://ajcn.nutrition.org/content/72/2/551s.full">often</a> supplement their diets with protein shakes or bars. This could be due to their convenience – they cost less than meat products with the same protein content, and they allow for optimal protein intake without excessive consumption of carbohydrates or fats.</p>
<p>But <a href="http://dischem.co.za/articles/15187-sport-supplements/20742-short-report-understanding-label-compliance-of-high-protein-sports-supplements-to-inform-regulations">our study</a> has found that, when it comes to protein shakes, what is in the tub is not always what meets the eye. Close to 10% of protein shakes evaluated on the market had less than 60% of the amount of protein consumers were paying for.</p>
<h2>The making of a protein supplement</h2>
<p>Protein supplements come in the form of shakes, bars and other meal replacement products. Protein powders are the <a href="http://journals.humankinetics.com/AcuCustom/Sitename/Documents/DocumentItem/2755.pdf">most popular</a>. These powders are usually mixed with water or milk to form a shake that should be consumed immediately before or after exercise, or in the place of a regular meal.</p>
<p>The protein components in these powders are often derived from dairy (whey or casein) or soy. The powders often contain other ingredients, such as flavouring and non-nutritive sweeteners for improved taste. </p>
<p>Our <a href="http://dischem.co.za/articles/15187-sport-supplements/20742-short-report-understanding-label-compliance-of-high-protein-sports-supplements-to-inform-regulations">study</a> looked at the label compliance of protein supplements in South Africa. We analysed 70 products purchased at popular South African retailers and online stores.</p>
<p>We selected two samples from different batches of each product and sent these for nutritional analyses. This would determine the actual nutrients present in the product through <a href="http://www.csir.co.za/food_and_beverage/">accredited methods</a>. And these nutrient values were then compared with the values reported on the product labels.</p>
<p><a href="http://www.sanbwa.org.za/documents/Guidelines.pdf">Regulations</a> around the labelling and advertising of foodstuffs allow for a 25% difference between the actual content of the product and that printed on the label.</p>
<p>In our study we found a difference of up to 80% in the labelled protein content and the value determined during analysis. From the 70 products included in the study, 65 products – or 93% – fell within the regulations.</p>
<p>In 21 products the actual protein in the product was more than 10% less than that stated on the label, but five products over-reported protein content by more than the acceptable limit of 25%. </p>
<p>These five products had between <a href="http://dischem.co.za/protein-content-of-supplements-as-analysed-compared-to-label-declaration">42% and 80% less protein</a> in the tub than what they declared on their product labels. </p>
<h2>A change of plan</h2>
<p>Our study comes amid discussion around the placement of sports supplements in the current South African legislative framework. The South African National Department of Health’s <a href="http://www.thefoodsafetynetwork.co.za/images/stories/docs/consumers/Directorate_Food_Control_information.pdf">Directorate: Food Control</a> and the <a href="http://www.mccza.com/About">Medicines Control Council</a> are negotiating amendments to their regulations. </p>
<p>The general discussion is that products – such as protein shakes – which are pills, jellies and tablets will in future be labelled as foods and fall under the jurisdiction of the <a href="http://www.gov.za/sites/www.gov.za/files/37695_rg10205_gon429.pdf">regulations relating to foods</a>. </p>
<p>But food that makes a medicinal claim will fall under the <a href="http://www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/legislations/acts/medicines_and_related_sub_act_101_of_1965.pdf">Medicines Act</a> as a complementary medicine. </p>
<p>Should protein shakes fall under the Medicines Act, the leeway manufacturers will have in terms of the difference between protein stated on a label and found in a product would be reduced from 25% to 10%. </p>
<p>In the US, fortified or fabricated foods with added nutrients are deemed misbranded under sections of the <a href="http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.9">Federal Food, Drug, and Cosmetic Act</a> if the protein content of the product is not at least equal to, or more than, the value declared on the product label. These violations are subject to <a href="http://definitions.uslegal.com/m/misbranded-food/">civil penalties</a>. </p>
<p>In <a href="http://www.foodstuffsa.co.za/news-stuff/food-labelling-regulations/3089-new-labelling-regs-a-wrap-of-r146-a-year-on">South Africa</a> a guilty party can be fined up to R20,000 for a first offence. </p>
<h2>The next steps</h2>
<p>After establishing the differences in the total protein content listed on the labels of products and the measured values, researchers are now looking at the integrity of the protein. </p>
<p>Many protein shakes claim the presence of certain essential protein fragments such as branched-chain amino acids or individual amino acids on their labels. <a href="http://www.aminoacid-studies.com/amino-acids/what-are-amino-acids.html">Amino acids</a> are the building blocks of protein. Certain amino acids, which are considered to be inferior to whole proteins, have been used by some manufacturers to artificially inflate and falsify higher total protein values in their products, commonly referred to as <a href="http://www.jimstoppani.com/home/articles/protein-spiking?preview">protein spiking</a>. Many protein supplements explicitly state on their labels that they do not spike.</p>
<p>The next step is to determine the amino acid profile of these protein shakes and to compare this with the claims made on the product labels.</p><img src="https://counter.theconversation.com/content/61466/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Prof Hettie Schönfeldt was the lead researcher on the project which was commissioned and financed by Dis-Chem Pharmacies South Africa with the aim to increase responsible retailing of supplements and assist in informing national regulatory developments. </span></em></p><p class="fine-print"><em><span>The research was commissioned and funded by Dis-Chem Pharmacies South Africa with the aim to increase responsible retailing of supplements and assist in informing national regulatory developments. </span></em></p><p class="fine-print"><em><span>Beulah Pretorius does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Protein supplements are all the rage for fitness fanatics and those hoping to boost their muscles – but do they contain as much protein as they claim to?Hettie Carina Schönfeldt, Associate Professor of Human Nutrition at the Institute of Food, Nutrition and Wellbeing, University of PretoriaBeulah Pretorius, Reseacher in Human Nutrition and Food Composition, University of PretoriaNicolette Hall, Researcher in Human Nutrition, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/218272014-01-13T06:12:19Z2014-01-13T06:12:19ZWhat does the public really think about homeopathy?<figure><img src="https://images.theconversation.com/files/38761/original/xt82dmfy-1389291905.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C1022%2C676&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Just add water.</span> <span class="attribution"><span class="source">Richard Craig</span></span></figcaption></figure><p>There is nothing more likely to raise the hackles of any self-respecting rationalist than to be confronted with the latest celebrity story about the miraculous healing power of homeopathy or some other “alternative” or “complementary” quackery. Or, embarrassingly, to discover that some of your best friends are also devotees. </p>
<p>This isn’t a new bugbear in response to some kind of New Age, middle-class hippiedom. Charles Darwin wrote <a href="http://www.darwinproject.ac.uk/letter/entry-1352">in a letter</a> to a cousin: </p>
<blockquote>
<p>You speak about Homeopathy; which is a subject which makes me more wrath, even than does Clair-voyance: clairvoyance so transcends belief, that one’s ordinary faculties are put out of question, but in Homeopathy common sense and common observation come into play, & both these must go to the Dogs, if the infinetesimal doses have any effect whatever</p>
</blockquote>
<p>There is no serious scientific debate about the efficacy of homeopathy. It performs no better than placebo and is based on principles wholly at odds with established scientific understanding. Nevertheless, it whips up what might seem like a disproportionate amount of political controversy. </p>
<p>Health Secretary Jeremy Hunt (yes, the man in charge of UK national health policy) is <a href="http://blogs.telegraph.co.uk/news/tomchiversscience/100179258/jeremy-hunt-health-secretary-thinks-homeopathy-works/">a known sympathiser</a> and got into hot water for allowing <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/hes-at-it-again-prince-charles-accused-of-lobbying-health-secretary-over-homeopathy-8723145.html">Prince Charles to lobby him</a> about prescribing it on the NHS. </p>
<p>A newly appointed public health shadow minister, Luciana Berger, was “forced to renounce” <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/labour-tells-new-health-spokeswoman-to-drop-her-support-for-homeopathy-8876469.html">previously positive</a> views. </p>
<p>And earlier in 2013, Chief Scientist Mark Walport called homeopathy “nonsense”, while his predecessor, John Beddington, said that NHS spending on homeopathy was the only issue where ministers had “fundamentally ignored” his scientific advice. Sally Davis, England’s Chief Medical Officer, said that <a href="http://money.uk.msn.com/socialvoices/why-spend-4m-of-our-taxes-on-homeopathy">the taxpayers’ £4m</a> would be better spent on proven treatments as hospitals suffer painful cutbacks. </p>
<h2>Our survey says</h2>
<p>Yet while binary opposition between support for homeopathy (and other complementary and alternative (CAM) treatments) is how public debate is framed, it is far from clear that the public thinks and does the same.</p>
<p><a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0053174#abstract0">In research</a> we carried out <a href="http://www.wellcome.ac.uk/About-us/Publications/Reports/Public-engagement/WTX058859.htm">using the</a> Wellcome Monitor Survey, we interviewed a random sample of 1179 UK adults aged over 18 about homeopathy and other CAM. We also wanted to know why some people chose or not to use these treatments. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=439&fit=crop&dpr=1 754w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=439&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=439&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hands up if you’ve tried it.</span>
<span class="attribution"><span class="source">Wellcome Monitor, 2009</span></span>
</figcaption>
</figure>
<p>A slim majority of the group reported that they had never used CAM. The most popular treatments with the remaining half were herbal medicines, homeopathy and acupuncture.</p>
<p>A quarter of the respondents who reported that they had never used homeopathy said this was because they hadn’t heard of it; a third because they had never been advised to take the treatment and/or that they’d never had an illness that required it; and 3% said it was because homeopathic remedies were too expensive. </p>
<p>Less than a quarter of non-users said that they had avoided homeopathy because they didn’t believe that it worked, or that conventional medicine worked better. </p>
<p>Of course, this may be in part a result of asking a question in a survey of this kind: it is quite hard for people to single out reasons for not doing things.</p>
<p>The most telling statistics emerged when we asked people that said they had used homeopathy why they had: 49% said they were “willing to try anything and didn’t think it could do any harm”. Only 16% said it was because they believed they worked better than conventional medicine. This means that only around 3% of the population have used homeopathy from a belief that it works where conventional medicine doesn’t. The rest either have not used it, or used it for other reasons.</p>
<h2>Disaffected, conventional and dissonant</h2>
<p>To explore this further, we used a statistical modelling technique called <a href="http://www.methods.manchester.ac.uk/methods/latentclass/">latent class analysis</a>, which helps identify groups of persons that are similar to each other in their profile of survey responses. We selected questions for analysis based on the key dimensions of public debate: the importance of science education, belief in the effectiveness of homeopathy, use of CAM, trust in medical doctors and optimism about medical advances in general.</p>
<p>We found that we could split the public <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0053174#pone-0053174-t001">into three groups</a>. The first, who we called the “disaffected”, comprise just under 30%. They are generally pessimistic about medicine, don’t see the value of science education and don’t believe in the efficacy of homeopathy either. </p>
<p>A second “conventional” group, accounting for just over 30% of citizens, are likely to be supportive and trusting of conventional medicine, reject CAM and value science education. </p>
<p>The third and largest group (just over 40% of the population) is the most interesting. This group is likely to have used CAM and to think that homeopathy is effective. Yet they are overwhelmingly trusting of medical doctors, value science education and are optimistic about medical advances. We call this group the “dissonants” (although they are unlikely to call themselves that). </p>
<p>So what makes it likely that someone will be a dissonant rather than a conventional? Women are <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0053174#pone-0053174-t002">more likely</a> to be found in the dissonant group. Interestingly, people who are better educated are also more likely to be found in this group, (although from a set of questions we posed in the survey, those with a science qualification and who did better in a scientific quiz are less likely to be included), along with those that think that there’s too little regulation of medical research.</p>
<h2>At odds in the public mind?</h2>
<p>Our research suggests that nearly half of the public don’t believe and act as if CAM and conventional medicine are at odds. Coupled with the significant global industry that has grown up around CAM, it is easy to see why politicians have been unwilling to respond to the clear evidence that homeopathy and CAM are ineffective. In the US, <a href="http://www.richarddawkins.net/news_articles/2013/6/19/alternative-medicine-is-a-34-billion-industry-but-only-one-third-of-the-treatments-have-been-tested">it’s a $34bn industry</a> where half of people report using them.</p>
<p>The competition between proponents and opponents of CAM in all likelihood is set to continue. But there’s some evidence that better science education can help people to distinguish between scientific and pseudo-scientific claims, and it appears that at least some of the openness to CAM might stem from concerns about how medical research is regulated. And it is these that might hold the key to who ultimately comes out of the ring in better shape.</p>
<p><em>The research on which this article is based was carried out with Paul Stoneman, Patrick Sturgis and Elissa Sibley.</em></p><img src="https://counter.theconversation.com/content/21827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Allum and team were partially funded by the Wellcome Trust</span></em></p>There is nothing more likely to raise the hackles of any self-respecting rationalist than to be confronted with the latest celebrity story about the miraculous healing power of homeopathy or some other…Nick Allum, Professor of Sociology, University of EssexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/172702013-09-08T20:36:57Z2013-09-08T20:36:57ZComplementary medicines may put cancer patients’ lives at risk<figure><img src="https://images.theconversation.com/files/30858/original/d6mkppc3-1378442390.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Combining complementary medicine with conventional cancer treatment opens up the possibility of drug interactions.</span> <span class="attribution"><span class="source">hkpuipui99/Flickr</span></span></figcaption></figure><p>Recent <a href="http://dx.doi.org/10.1007/s00432-013-1460-y">German research</a> found that more than 70% of people with cancer supplement their regular hospital treatment with complementary and alternative medicine. More worryingly, many do so without advising their doctor. </p>
<p>This is important because interactions of the complementary medicines and their regular drugs could make cancer treatment ineffective, or worse still, cause toxic side-effects that could lead to death.</p>
<p>The study found a high degree of complementary medicine use by people with cancer across all age groups, and higher use among women than men. A small percentage (8%) of cancer patients were found to only use complementary medicines and shun conventional treatment. </p>
<p>A <a href="http://dx.doi.org/10.1089/jpm.2012.0461">separate study</a> also found that many parents of children with cancer (30%) also reported giving complementary medicines to their kids.</p>
<p>Studies in the <a href="http://dx.doi.org/10.1200/JCO.2007.13.5905">United States</a>, and across other <a href="http://dx.doi.org/10.1093/annonc/mdi110">European countries</a>, found similarly high rates of complementary medicine use among cancer patients. Research of this sort hasn’t been conducted in Australia, but high complementary medicine use means it’s likely the same happens here.</p>
<h2>Why people do it</h2>
<p>According to the German study, people supplementing their treatment with complementary medicines do so in a variety of ways, and with different products. By far the most popular options are vitamins, metals such as <a href="http://en.wikipedia.org/wiki/Selenium">selenium</a> and other trace elements.</p>
<p>Some patients also try non-chemical or drug-based therapies, including prayer, relaxation and physical activity; but these tend to be the least used types of complementary therapies.</p>
<p>More than 50% of the participants in the German study expressed an interest in also using acupuncture or medical herbs, and a quarter were interested in trying mistletoe and homoeopathy treatments.</p>
<p>When asked why they were interested in complementary medicines, most people couldn’t give a reason, or said they’d used them before being diagnosed with cancer and merely continued that use. Some believed complementary therapies boosted their immune system and helped to “detoxify” their body. </p>
<p>Interestingly, more than a third of the German patients reported using complementary therapies simply because it enabled them to do something for themselves; it let them feel more in control of their treatment.</p>
<p>There’s considerable debate about the usefulness of complementary therapies, but what is more worrying about all three studies into complementary therapy use is that it happens without the knowledge of the patient’s doctor.</p>
<p>When asked about the source of their information on complementary medicines, the four most common responses in the German study were television and radio, family and friends, books, and the Internet. </p>
<p>The three least used sources of information were, in decreasing order, doctors, non-medical practitioners and pharmacists. In total, fewer than 10% of the people in the study using complementary medicines stated they gained information on them from health professionals.</p>
<p>This could be a problem because there’s no guarantee that popular sources of information about complementary therapies are accurate. <a href="http://dx.doi.org/10.1371/journal.pone.0002406">Australian research</a> from 2008 found that much of the information available in the media about complementary therapies is either incomplete or inaccurate.</p>
<h2>Lurking dangers</h2>
<p>Combining complementary medicine with conventional cancer treatment opens up the possibility of drug interactions that can make cancer treatment ineffective. Worse still, the drugs may interact to exacerbate side-effects of chemotherapy, which can be so severe they endanger the person’s life.</p>
<p>What’s more, many complementary medicines, particularly those marketed herbal or all natural, can contain ingredients not listed on the labels. So people don’t know what they are taking.</p>
<p>The <a href="http://www.tga.gov.au">Therapeutic Goods Administration</a> regularly bans and issues <a href="http://www.tga.gov.au/safety/alerts-current.htm">safety advisories</a> for complementary medicine products that patients are buying over the Internet because they contain unlisted, often prescription-only, ingredients.</p>
<p>Cancer patients should discuss any medicines they plan to use that are outside their normal treatment plan with their doctor. Many complementary medicines they choose will be safe. </p>
<p>Regardless of efficacy, complementary medicines provide people with an important way to gain a feeling of ownership over their treatment. Doctors will always be supportive of their patients and can help choose complementary medicines that are effective and safe for them to use. </p><img src="https://counter.theconversation.com/content/17270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible and the Scottish Universities Life Sciences Alliance for research into anticancer drugs.</span></em></p>Recent German research found that more than 70% of people with cancer supplement their regular hospital treatment with complementary and alternative medicine. More worryingly, many do so without advising…Nial Wheate, Senior Lecturer in Pharmaceutical Chemistry, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/92702012-10-31T03:29:28Z2012-10-31T03:29:28ZAromatherapy: panacea or placebo?<figure><img src="https://images.theconversation.com/files/17033/original/9nqspn8p-1351558750.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There is no convincing evidence that the therapy works.</span> <span class="attribution"><span class="source">Cafemama</span></span></figcaption></figure><p><em>PANACEA OR PLACEBO – A weekly series assessing the evidence behind complementary and alternative medicines.</em></p>
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<p>Aromatherapy is based on the idea that aromatic substances, usually the essential oils of plants, can change how people feel or have an effect on the symptoms of various conditions. Aromatic substances can be delivered through massage, direct inhalation, or diffusion into the air. </p>
<p>People have used essential oils for medicinal purposes for centuries: Chinese traditional medicine uses aromatic plants; the ancient Romans used aromatic plants in their baths; and there are records of Greek doctors using them as far back as the first century. </p>
<p>But the modern practice of aromatherapy as we know it now is only about a hundred years old and probably began with a French chemist, Gattefosse, who published a study about his use of lavender oil to treat his burnt hand. </p>
<p>Different oils are claimed to have different effects on anxiety, agitation, nausea, pain, hair loss, dementia, hypertension, concentration, sleep, depression and infant colic, among others. But much of the research in this area is of <a href="http://www.sciencedirect.com.ezp01.library.qut.edu.au/science/article/pii/S0378512212000060">poor quality</a> and <a href="http://informahealthcare.com/doi/abs/10.1080/00207450802333953">contradictory</a>. </p>
<p>Often, the recommendations found in aromatherapy texts are based on anecdote or clinical experience rather than strong evidence.</p>
<h2>How does aromatherapy “work”?</h2>
<p>The best known and most investigated uses of aromatherapy are for conditions such as anxiety, agitation, stress and nausea. But the mechanism, if any, by which these actions occur remains controversial.</p>
<p>One idea is that scent activates the olfactory system (responsible for our sense of smell) which <a href="http://www.nimr.mrc.ac.uk/mill-hill-essays/the-sense-of-smell-a-milestone-to-understanding-the-brain">triggers the brain’s limbic system</a>. This in turn may produce emotional responses and enhance the retrieval of learnt memories connected with the scent. </p>
<p>Research has shown that our response to scent is <a href="http://cms.unige.ch/fapse/EmotionLab/Ferdenzi_files/Ferdenzi%20et%20al.,%20Emotion%202011.pdf">cultural</a>, in that people of particular cultures often perceive different scents as being pleasant or unpleasant. Our response to scent is also able to be influenced by the prompting of <a href="http://www.ncbi.nlm.nih.gov/pubmed/15362382">researchers</a>, and is dependent on the participant’s <a href="http://www.ncbi.nlm.nih.gov/pubmed/15587240">perception of the scent</a>, which of course makes assessing cause and effect more difficult.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/17031/original/jr2r4q6s-1351557877.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/17031/original/jr2r4q6s-1351557877.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/17031/original/jr2r4q6s-1351557877.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/17031/original/jr2r4q6s-1351557877.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/17031/original/jr2r4q6s-1351557877.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/17031/original/jr2r4q6s-1351557877.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/17031/original/jr2r4q6s-1351557877.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A small study has shown our brains respond emotionally to smell.</span>
<span class="attribution"><span class="source">Express Monorail</span></span>
</figcaption>
</figure>
<p>When participants of <a href="http://www.nursinglibrary.org/vhl/handle/10755/157547">one study</a> were exposed to certain scents and had their responses recorded through <a href="http://science.howstuffworks.com/fmri.htm">functional MRI</a> brain imaging, researchers saw activation in the areas of the brain responsible for emotions. Although this is interesting and could point to evidence of an effect, this <a href="http://www.nursinglibrary.org/vhl/handle/10755/157547">study was small</a> and did not report its methods well, so it’s hard to know how much weight to put on it.</p>
<h2>Supporting evidence</h2>
<p>There are a few well-conducted studies that show aromatherapy may be effective. Laboratory studies using animals have shown that some aromatherapy preparations cause <a href="http://onlinelibrary.wiley.com/doi/10.1211/jpp.60.11.0013/abstract">observable changes</a> in <a href="http://www.ingentaconnect.com/content/maney/nns/2009/00000012/00000002/art00002">biochemistry</a>. </p>
<p>In humans, <a href="http://www.sciencedirect.com/science/article/pii/S0003996908001118">a small pre-clinical study</a> of aromatherapy using healthy volunteers showed a measurable reduction in stress hormones in saliva samples when lavender and peppermint aromatherapy were given following a stressful event. </p>
<p>But these results have yet to be reflected in strong clinical studies and, more importantly, in systematic reviews, the <a href="http://www.health.qld.gov.au/healthpact/docs/gen-docs/lvl-of-evidence.pdf">highest level of clinical evidence</a>. Statistical pooling, or meta-analysis, of study results can help us to understand the overall effectiveness of an intervention much more clearly than a single study alone. </p>
<p>Some systematic reviews have found weak evidence of an effect for aromatherapy for some conditions such as the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1447-0594.2012.00849.x/full">behavioural and psychological symptoms of dementia</a>, and <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007598.pub2/pdf">post-operative nausea and vomiting</a> (although this was with a non-traditional aromatherapy product). </p>
<p><a href="http://www.hawaii.edu/hivandaids/Aromatherapy%20as%20a%20Treatment%20for%20Agitation%20in%20Severe%20Dementia.pdf">One systematic review</a> found convincing evidence of an effect for the use of massage with lemon balm (<em>Melissa officionalis</em>) oil for agitation associated with dementia, however this was based only on one randomised controlled trial.</p>
<h2>The verdict</h2>
<p>When studies of aromatherapy are subjected to close scrutiny, and the results combined, there is <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313734/pdf/10962794.pdf">no convincing evidence</a> that the therapy <a href="http://www.sciencedirect.com.ezp01.library.qut.edu.au/science/article/pii/S0378512212000060">works</a>. </p>
<p>But this may come down to a shortfall of well-designed <a href="http://www.ajronline.org/content/183/6/1539.full">randomised controlled trials</a>, which provide the best experimental evidence when studying a therapy. </p>
<p>It’s difficult to know just how effective aromatherapy is, and it may be that while there are some products that are effective for some conditions, there are many other products on the market that have no effectiveness at all. Either way, it’s important consumers know what they’re using and are alert to the possibility of adverse effects. Just because a product is “natural” does not automatically mean it is “safe”.</p>
<p><em><strong>This is the fifth article in our series Panacea or Placebo. Click on the links below to read the other instalments:</strong></em></p>
<ul>
<li><p><a href="https://theconversation.com/chiropractic-therapy-placebo-or-panacea-8104">Chiropractic</a></p></li>
<li><p><a href="https://theconversation.com/colonic-therapy-panacea-or-placebo-9926">Colonic therapy</a></p></li>
<li><p><a href="https://theconversation.com/modern-acupuncture-panacea-or-placebo-8102">Modern acupuncture</a></p></li>
<li><p><a href="https://theconversation.com/myotherapy-panacea-or-placebo-9183">Myotherapy</a></p></li>
</ul><img src="https://counter.theconversation.com/content/9270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Has received funding from Queensland Health in the form of a research grant in the past.</span></em></p>PANACEA OR PLACEBO – A weekly series assessing the evidence behind complementary and alternative medicines. Aromatherapy is based on the idea that aromatic substances, usually the essential oils of plants…Sonia Hines, Internerd, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/91832012-10-03T04:31:40Z2012-10-03T04:31:40ZMyotherapy: panacea or placebo?<figure><img src="https://images.theconversation.com/files/16071/original/td22dpqn-1349143513.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some of the techniques that form the armamentarium of myotherapy are supported by some positive evidence.</span> <span class="attribution"><span class="source">o5com</span></span></figcaption></figure><p><em>PANACEA OR PLACEBO – A weekly series assessing the evidence behind complementary and alternative medicines.</em></p>
<p>Myotherapy was developed by American <a href="http://en.wikipedia.org/wiki/Bonnie_Prudden">Bonnie Prudden</a> in the 1970s as a system of treating painful and dysfunctional muscles and soft tissue. The term is also used more generally to describe a suite of soft tissue and massage techniques. </p>
<p>Myotherapists are concerned with treating <a href="http://www.mayoclinic.com/health/myofascial-pain-syndrome/DS01042">myofascial pain</a>. This term was coined by <a href="http://en.wikipedia.org/wiki/Janet_Travell">Janet Travell</a> and <a href="http://www.dgs.eu.com/fileadmin/documents/Obituary_DGS_BMJ.pdf">David Simons</a> to refer to pain that arises from areas within muscles and ligaments that are both spontaneously painful and also capable of causing referred pain in predictable patterns. </p>
<p>They were a fascinating and formidable pair: Travell was best known as JFK’s personal physician; Simons was a pioneer of stratospheric flight and the first man to observe the curvature of the earth from the edge of space. Their <a href="http://books.google.com.au/books/about/Travell_Simons_Myofascial_Pain_and_Dysfu.html?id=sU0XupX7DGsC&redir_esc=y">Trigger Point Manual</a> has become a standard reference for clinicians interested in myofascial pain. </p>
<p>Bonnie Prudden was an early leader in promoting physical fitness for the masses, and became interested in the work of Travell and Simons in the early 1970s. She published her book <a href="http://www.getcited.org/pub/102067234">Pain Erasure</a> in 1980 and devoted the rest of her life to teaching and expanding myotherapy from her base in Tucson, Arizona.</p>
<h2>Techniques and evidence</h2>
<p>Trigger points and myofascial pain remain a controversial area of medicine. Few clinicians who see large number of patients with musculoskeletal pain would argue against the idea that painful areas exist in the locations described in the Trigger Point Manual. </p>
<p>As a pain specialist, I have certainly been able to help sort out dozens of patients referred by colleagues with otherwise inexplicable pain by applying the general principles of Travell and Simons. </p>
<p>But nearly half a century after the terms trigger points and myofascial pain were coined, the scientific understanding of them, and the best means of treating the latter remain sketchy. This is largely due to the slow progress of basic science research into muscle and soft tissue pain. </p>
<p>Manual techniques including massage, focused pressure from hands, fingers, knuckles or elbows and the use of modalities such as heat, cold, electrical stimulation and sticking acupuncture needles into the trigger points form the bulk of what myotherapists are trained to do. They also give advice about posture and prescribe exercise programs to remediate the biomechanical imbalances that caused the trigger points to form in the first place. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/16078/original/qkrwxmjk-1349155922.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/16078/original/qkrwxmjk-1349155922.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/16078/original/qkrwxmjk-1349155922.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/16078/original/qkrwxmjk-1349155922.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/16078/original/qkrwxmjk-1349155922.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/16078/original/qkrwxmjk-1349155922.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/16078/original/qkrwxmjk-1349155922.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Myotherapists use manual techniques to alleviate tissue and muscle pain.</span>
<span class="attribution"><span class="source">www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Some of the techniques that form the armamentarium of myotherapy are supported by some positive evidence. Trigger-point injections with local anaesthetic, dry needling and even botulinum toxin have good supporting evidence of short- to medium-term benefit. <a href="http://www.aafp.org/afp/2002/0215/p653.html">This article</a> from the American Family Physician journal gives a comprehensive summary of what is understood about treatment approaches for myofascial pain.</p>
<p>But published studies in the peer-reviewed literature of specific <a href="http://www.bonnieprudden.com/">Bonnie Prudden-approved manual techniques</a> are completely lacking. If you search myotherapy in <a href="http://www.ncbi.nlm.nih.gov/pubmed">Pubmed</a> you find very little: the papers published in the medical literature are merely case reports of a German technique for treating painful jaw muscles.</p>
<h2>Training and practice</h2>
<p>In Australia, Victoria has all the tertiary courses in Myotherapy apart from one. Qualifications from an Advanced Diploma of Remedial Massage (Myotherapy) to a Bachelor-level degree in Myotherapy are available through RMIT University, Australian College of Sports Therapy, Northern Melbourne Institute of TAFE, Southern School of Natural Therapies, Chisholm Institute, Holmesglen Institute and Endeavour College. </p>
<p>Completion of one of these courses is required for membership of the Institute of Registered Myotherapists of Australia (IRMA), but the term “myotherapist” is not a protected professional title. </p>
<p>Most myotherapists work in small individual practices or as part of a multidisciplinary team of allied health clinicians. Many massage therapists also incorporate myotherapy into their practice.</p>
<h2>My verdict</h2>
<p>There is a lingering impression of a cult of personality about myotherapy in general, considering the charismatic individuals involved in pioneering it, and the lack of follow-up development of an evidence base. </p>
<p>Myotherapy is, however, founded on rational principles and does not tend to make claims of benefit beyond the myofascial realm of treatment. </p>
<p>Attending a myotherapist for muscular pain may well have a positive result if your pain is due to trigger points and remains amenable to manual treatments.</p>
<p>It seems a reasonable precaution to prefer a therapist who is a member of the <a href="http://www.myotherapy.org.au/home">IRMA</a>, which represents around 500 therapists, or the <a href="http://aamt.com.au/">Australian Association of Massage Therapists</a>, since these organisation require their members to carry indemnity insurance and participate in ongoing professional development activities.</p>
<p>You can find a consumer guide to attending a myotherapist at the Victorian government’s <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Myotherapy">Better Health Channel</a> website. </p>
<p><strong><em>Read the second instalment of panacea of placebo:</em></strong></p>
<ul>
<li><a href="https://theconversation.com/modern-acupuncture-panacea-or-placebo-8102">Acupuncture</a></li>
</ul><img src="https://counter.theconversation.com/content/9183/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Vagg has a professional subscription to the Journal of Musculoskeletal Pain, which is published by the International Myopain Society.</span></em></p>PANACEA OR PLACEBO – A weekly series assessing the evidence behind complementary and alternative medicines. Myotherapy was developed by American Bonnie Prudden in the 1970s as a system of treating painful…Michael Vagg, Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist, Barwon HealthLicensed as Creative Commons – attribution, no derivatives.