Complementary medicines: an interview with Associate Professor Evelin Tiralongo, Griffith University

Interview conducted by April Cashin-Garbutt, MA (Editor)Jun 23 2014

A/Prof. Evelin TiralongoTHOUGHT LEADERS SERIES...insight from the world’s leading experts

How are complementary medicines defined?

Complementary medicines are generally being defined as medicines which are non-mainstream medicines and are mostly given together with conventional medicines.

In Australia, medicinal products that contain herbs, vitamins, minerals, nutritional supplements, homoeopathic and certain aromatherapy (essential oil) preparations are referred to as “complementary medicines” and are regulated as medicines under the Therapeutics Goods Act.

Are complementary medicines different to alternative medicines?

Often alternative medicines are considered as medicines which would be taken instead of so called “conventional” medicines. In reality, true alternative medicines are less common in first world countries as most people use “complementary” medicines not as an alternative, but alongside so called ”conventional” medicines.

The issue is complicated by the fact that in some countries “traditional” medicines are classified as “alternative” medicines, whereas in Australia for example they are classified as “complementary” medicines.

Worldwide the terms “complementary medicines,” “alternative medicines”, “complementary and alternative medicines”, and even “unorthodox” and “integrative medicine” are often used interchangeable.

Personally, I prefer to identify a medicine as effective or ineffective, rather than classify it into one of the abovementioned categories.

For example, although vitamin B6, peppermint oil and iron are classified as complementary medicines in Australia they are recommended as first choices for pregnancy related nausea and vomiting, for abdominal pain in patients suffering from Irritable Bowel Syndrome (IBS) and for iron deficient anaemia, respectively. And there are numerous other such examples.

How many people are thought to use complementary medicines?

A lot of research has been conducted in this area. The WHO states that in developing countries up to 90% of the population relies on traditional medicines.

In developed countries the use of complementary medicines ranges from 40 to 80% depending on the individual country.

In Australia, the latest reports, including our research, show that over 70% of the general population uses complementary medicines.

How important is it for consumers to discuss their use of complementary medicines with their doctor or pharmacist?

The short answer is very important. Research conducted by us and others has shown that approximately 50% of complementary medicine users take these medicines alongside their “conventional” medicines and only the minority of them tell their pharmacist or doctor about it.

Given that these medicines are active formulations marketed with a specific indication or effect there is of course always the risk that they can have certain side effects or are not suitable/contraindicated in a specific individual or could interact with the medicines that person is already taking. Thus an open discussion between consumers and health professionals is vital.

Do consumers expect their pharmacist or doctor to be able to advise them on complementary medicines?

Again, the short answer is yes. When we surveyed over 1,000 Australian consumers a couple of years ago the overwhelming majority (92%) indicated that pharmacists should provide safety information about complementary medicine and 90% thought they should routinely check whether complementary medicines interact with prescription medicines.

Additionally, 87% thought pharmacists should recommend complementary medicines if they are effective and 78% thought pharmacists should record complementary medicines taken by customers in their medication profile. International research shows similar expectations for pharmacists, and also doctors.

Please can you outline the new online short course available to healthcare professionals who want to learn more about complementary medicines?

My colleague Adjunct A/Prof Greg Mapp and I originally developed and launched the Short Course in Integrative Medicine, as a 1.5-day face-to-face workshop format, to address the skills and knowledgebase of pharmacists with respect to clinical evidence for complementary medicines. The training was rolled out in all major Australian cities between 2010 – 2013.

The key feature of the Short Course was its independent and unbiased presentation of the clinical evidence based on scientific research combined with our practical experience in integrative medicine.

The collaboration opportunity with Blackmores Institute has now enabled us to take this existing content, update it based on current clinical evidence, and make it freely available to all Australian pharmacists and other health practitioners via Blackmore Institute’s online education platform.

It is important to stress that the updated content remains independent, is underpinned by clinical evidence and not biased towards any manufacturer’s complementary medicine products.

The online modules, which are Continuous Professional Development (CPD) accredited by the Australian Pharmacy Council, cover the use of complementary medicines in a wide range of disease states and include case studies and assessment

Upon successful completion of all online modules health care professionals will be eligible to enrol in a newly designed Griffith University 1-day, face-to-face masterclass which will be offered in various capital cities in Australia, and possibly New Zealand, from 2015.

This masterclass will also be CPD accredited and will focus on evidence assessment, in-depth case studies and on extending the practical relevance and application of the material presented in the online modules.

The content of the masterclass will also be independent and underpinned by clinical evidence focussing on complementary medicines and the assessment of product quality rather than featuring complementary medicine products from a particular manufacturer.

We believe that this new course will appeal to a wider audience as it offers flexibility through the online format, but also relevant depth and application of knowledge through group work, interaction and discussion at the face-to-face masterclass.

As such it is now even better placed to provide pharmacists and other healthcare professionals with practical information on key health conditions, thus enabling them to deliver evidence-based complementary medicine advice to their patients and customers.

What feedback have you had from healthcare practitioners who have completed the course so far?

As we just launched the course in its new format, we don’t have any current evaluations.

However, we received remarkable evaluations and testimonials from pharmacists and other health professionals who completed the Short Course in Integrative Medicine in its previous format (1.5 day face-to-face workshop) between 2010-2013.

These testimonials are listed on our website. Here are some examples:

“Very thorough and practical information, factual and concise, easy to apply in the pharmacy; fantastic; Great efforts were made to ensure all information was backed with evidence from well-known medical journals." Perth 2012

"Great course, clarified many aspects of complementary medicines that I didn't understand and provided a balanced and evidence-based perspective of the use and benefits of complementary medicines used in pharmacy." Brisbane 2011

“This course has sparked a real interest in me for complementary medicines. I wasn’t expecting to find it so interesting and would like to do further study; I particularly appreciated the unbiased and scientific focus; Lectures easy to follow and easy to learn how to integrate complementary medicines with prescription medicines.” Auckland 2012

“Has provided a very good starting point for recommending complementary medicines with confidence; Excellent clinical evidence. References were given for future study and resources were referenced; A plethora of information coupled with eloquent speakers, useful in both retail & clinical sense.” Sydney 2011

What more do you think can be done to improve the understanding of complementary medicines?

I believe that a shift in attitude through more targeted research and education is the way forward.

Given the consumer driven demand for holistic and integrative healthcare, as well as the growing amount of evidence outlining the benefits of certain complementary medicines, it becomes professionally and ethically impossible for health professionals to ignore this option of healthcare.

This means that all health professionals need to be prepared for an unbiased, non-judgemental and informative assessment of the suitability of complementary medicines in their practice.

We believe that more can be done to achieve this objective. Most health professionals claim lack of knowledge, information sources, time and evidence-based products as barriers for discussing and recommending complementary medicines.

Thus, more efforts should be made towards:

1. the sufficient and high quality evidence-based complementary medicine education as a core part of health professional education including multi- and inter-professional training;
2. the development of high standard competency and registration requirements with regards to evidence-based complementary medicines; and
3. the comprehensive integration of evidence-based complementary medicine information into professional resources.

These efforts will ultimately help to rationalise the biased, sceptical and judgemental attitude still shown by some practitioners, and help others who want to learn about complementary medicines.

Sociological research suggests that complementary medicines education may also lead to practitioners with improved core competencies such as evidence-based practice, higher self-awareness and enhanced cultural competency. Isn’t this something that we should all aim for, independent of our background, beliefs and area of practice?

Where can readers find more information?

• Review of Information Resources for Complementary Medicines by the National Prescribing Service, Australia (2009); http://www.nps.org.au/about-us/what-we-do/our-research/complementary-medicines/review-of-info-resources
• National Centre for Complementary and Alternative Medicine (NIH, US); http://nccam.nih.gov/health
• Tiralongo, E.: ”Why universities should teach alternative medicine”, The Conversation (3.2.2012); http://theconversation.com/why-universities-should-teach-alternative-medicine-5159
• Short Course in Integrative Medicine; http://www.integramedshortcourses.com/
• Tiralongo, E, Braun, LA, et al.; Exploring the integration of Complementary Medicines into Australian Pharmacy Practice with a focus on different practice settings, Journal of Complementary and Integrative Medicine, 2010, Vol. 7 : Iss. 1, Article 37; http://www98.griffith.edu.au/dspace/bitstream/handle/10072/35832/66443_1.pdf?sequence=1
• Braun, LA, Tiralongo, E, et al., Perceptions, use and attitudes of pharmacy customers on complementary medicines and pharmacy practice, BMC CAM, 2010, 10:38; http://www.biomedcentral.com/1472-6882/10/38

About Associate Professor Evelin Tiralongo, BPharm (Hons.), PhD, Grad. Cert. Higher Ed.

A/Prof. Evelin Tiralongo is a foundation member of Griffith University’s Pharmacy School and is the discipline head for complementary medicine teaching and research at the School. She is a German trained and registered pharmacist with an Honours degree in herbal medicine and a PhD in biochemistry. She gained extensive practical experience in integrative medicine as a registered pharmacist in German pharmacy practice, and has also completed her Australian registration as a pharmacist.

Her research focusses on complementary medicines and natural products, and spans from laboratory to practice based and clinical projects. As a chief investigator she has won over $1.3 million in research funding and has co-authored 38 peer-reviewed publications and one patent. She is a member of the National Health and Medical Research Council (NHMRC) Homeopathy Advisory Committee and the Advisory Committee for the Australian Research Council (ARC) “Complementary and Alternative Medicine (CAM) - Quality Use of Medicines” project. She acts as a reviewer and editor for several internationally recognised journals (e.g. eCAM), is an associate editor for the 4th edition of “Herbs and Natural supplements - An evidence based guide” by Braun & Cohen, has given numerous presentations on national and international conferences and industry meetings, and has served on the scientific board of international conferences and forums such as the 5^th International Conference on Mechanisms of Action of Nutraceuticals (ICMAN5).

Evelin has integrated Complementary medicine education into the pharmacy curricula at Griffith University and received two teaching awards. She designed online complementary medicine resources for the textbook “Pharmacology for Health Professionals” by Bryant et. al. and has also contributed to various editions of “Herbs and Natural supplements - An evidence based guide” by Braun & Cohen.

Regarded as an expert in her field, Evelin conducts continuous professional development seminars on complementary medicines to pharmacists and other health professionals and is co-founder of the Short Course in Integrative Medicine (http://www.integramedshortcourses.com/).