Complementary Medicine

Question 1

What is Traditional and Complimentary/Alternative Medicine?

Answer 1

This encompasses medical and healthcare therapies outside the territory of conventional medicines, some of which are yet to be validated using scientific methods.

Question 2

What are the different types of Traditional and Complimentary/Alternative Medicine? (5)

Answer 2

1. Diets and herbals
2. Massage and chiropractic
3. Reiki magnets and qi kong
4. Yoga and prayer meditation
5. Homeopathy and naturopathy

Question 3

What do the terms “complementary medicine” or “alternative medicine” refer to?

Answer 3

They refer to a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health-care system. They are used interchangeably with traditional medicine in some countries.

Question 4

Why do you need to know about Traditional and Complimentary/Alternative Medicine? (3)

Answer 4

• Use of traditional and alternative/complementary medicines is becoming more common
• WHO strategy for 2014-2023 is calling for integration of traditional and complementary medicine with conventional medicine
• Herbal medicines are being sold in community pharmacies

Question 5

Why do people use Traditional and Complimentary/Alternative Medicine? (4)

Answer 5

• Part of culture and identity
• Personal experience of successful use
• Disillusionment with modern medicine and a perception that T&CM are gentler and safer than Western medicine
• Belief in all things ‘natural’ and ‘green’, awareness of environmental issues and sustainability

Question 6

How do people use Traditional and Complimentary/Alternative Medicine? (4)

Answer 6

• Always and instead of Western Medicine
• Only after Western medicine has failed
• Occasionally, according to suitability of treatment and severity of illness
• In addition to, and concurrently with Western medicine, with or without the knowledge of the doctor

Question 7

What are some criticisms of Traditional and Complimentary/Alternative Medicine? (5)

Answer 7

• Criticisms: ‘non-scientific’ and not ‘evidence based’ – i.e. mostly unsupported by clinical trial evidence
• Sometimes TCAM is scientifically implausible e.g. homeopathy
• Unregulated - anyone can ‘practise’ and there is a lack of accredited training of TCAM practitioners
• Perceptions of TCAM such as of unsafe practice
• Is it all down to the placebo effect?!

Question 8

What Regulations/governing bodies are in place to regulate TCAM medicines? (4)

Answer 8

• The 1968 Medicines Act regulates the licensing, supply and administration of medicines.
• The Human Medicines Regulations 2012 is a consolidation of the medicines legislation in the Medicines Act 1968.
• The Medicines and Healthcare products Regulatory Agency (MHRA) regulates medicinal products for human use.
• The MHRA may be called on to determine if a product is a “medicinal product”, if it is then the product is subject to the Human Medicines Regulations 2012

Question 9

What are the types of Licensing for TCAM? (5)

Answer 9

PLR – Product license of right
PL – full Product license
HR – Homeopathic registration
NR – National rules scheme
THR – Traditional Herbal Registration

Question 10

What prerequisites must be met for eligibility for THRs (Traditional Herbal Registration)? (3)

Answer 10

• Used for minor health conditions where medical supervision is not required (eg a cold).
• Show evidence that the herbal medicinal product has been traditionally used to treat the stated condition for a minimum of 30 years, 15 years of which must have been in the European Union (EU).
• Ensure safety and that the product does not contain ingredients that are toxic and cannot be used in the manufacture, import and sale of unlicensed medicines in the UK

Question 11

What exemptions are the for THRs (Traditional Herbal Registration)?

Answer 11

If you’re a herbal practitioner, you don’t need a licence to supply herbal medicines you create on your premises to patients following one-to-one consultations.

Question 12

What are pharmacists responsibility regarding TCAM? (3)

Answer 12

1. To ensure that stocks of homeopathic or herbal medicines or other complementary therapies are obtained from a reputable source of supply
2. Not to recommend an remedy where they have any reason to doubt safety or quality
3. Only to offer advice on homeopathic or herbal medicines or other complementary therapies or medicines if they have undertaken suitable training or have specialised knowledge

Question 13

What are the key responsibilities of a pharmacist?

Answer 13

“Pharmacists must ensure that their knowledge, skills and performance are of a high quality, up to date, evidence based and relevant to their field of practice”

Question 14

What are some patient safety issues associated with TCAM? (6)

Answer 14

1. No rigorous clinical trial testing
2. Interact with conventional medicines
3. Unsafe ingredients used in unlicensed herbal medicines such as
4. Ayurvedic and chinese medicines reported to contain mercury, lead and arsenic
5. Slimming prodducts containing phenolphthalein
6. Sexual health products containing tadalafil and sildenafil

Question 15

Where can patients report suspected side effects/adverse reactions to? (3)

Answer 15

1. Online at www.yellowcard.gov.uk
2. Using the form inside this leaflet found in pharmacies
3. By calling the Yellow Card hotline on 0808 100 3352

Question 16

1) What are herbal medicines made up of?
2) What affect can they have?
3) In what key groups has safety not been established? (4)

Answer 16

1. made up of plants, trees or fungi
2. will have an effect on the body and can potentially be poisonous
3. safety has not been established in certain key groups, including:
   - pregnant women
   - breastfeeding mothers
   - children
   - the elderly

Question 17

What are some examples of TCAM medications? (4)

Answer 17

1. St Johns Wort (Used for treatment of mild to moderate depression) - Interacts with conventional medicines (enzyme inducer).
2. Valeriana officinalis (used as a sedative and hypnotic) - Enhances sedative effects of benzodiazepines, sedative antihistamines, alcohol.
3. Gingko biloba (Used as an aid to memory deterioration, due to aging and milder forms of dementia; it enhances cognitive processes) - Can slow blood clotting therefore interacts with aspirin and warfarin.
4. Aloe vera Aloe spp. (Used topically to aid wound healing, relieve burns including sunburn; Extracts are anti-inflammatory, anti-ulcer and immunomodulatory; Also taken internally as an emollient for ulceration; and also as an immunostimulant and general tonic) - Predicted to interact with drugs that affect or are sensitive to potassium levels in the blood, however, there appears to be little or no evidence that this occurs in practice.

Question 18

1) What is Homeopathy based on?
2) How are the substances for this manufactured?
3) What is the treatment usually from?

Answer 18

1. Based on the principle of ‘like cures like’ – in other words, a substance taken in small amounts will cure the same symptoms it causes if it was taken in large amounts.
2. Manufactured using a process combining serial dilution and succussion (vigorous shaking).
3. Mainly from plants and minerals which are highly diluted and then added to lactose tablets or pills

Question 19

1) Define Supplements
2) What are some types of supplements? (4)
3) What are the majority classed as and sold under?

Answer 19

1. Defined as foods in unit dosage form taken to supplement diet
2. Includes vitamins, minerals and other supplements such as garlic and evening primrose oil
3. Majority are classed as foods and sold under food law thus do not have same rigorous testing as conventional medicines

Question 20

Which supplement is an Antibiotic, expectorant, anti-thrombotic?

Answer 20

Garlic Allium sativum:
- Antibiotic, expectorant, anti-thrombotic. Used for respiratory infections such as colds, flu and bronchitis, for nasal and throat catarrh, and for its cardiovascular protection from blood clotting, atherosclerosis and related conditions.

• Very often taken as a prophylactic