In her latest sustained attack on Australian complementary medicines, Consultant Pharmacist, Dr Geraldine Moses has misreported several problems that that she says exist with using dietary supplements (complementary medicines).
Surely it is much more helpful to engage in respectful discussion with clinicians, patients, academia, and industry?
Anti-complementary medicines lobby
In the article, published in Australian Prescriber and picked up by other outlets, the comprehensive negative statements are generally incorrect or misleading. Plus, Dr Moses did not disclose that she is a longstanding member of the small but vocal anti-complementary medicine fringe group, Friends of Science in Medicine (FSM).
FSM Group members regularly create and promote hostile slogans about complementary medicines and attack the government's Therapeutic Goods Administration (TGA). The TGA regulates Australian Complementary medicines to the highest standards in the world. This high level of regulation is one reason that Australia's complementary medicines industry is thriving here and overseas.
Confusion, regulation and risk
Australian complementary medicines are the most regulated in the world. We manufacture complementary medicines to the highest pharmaceutical-grade quality; this is not the case overseas. Outside of Australia, especially in the USA, companies can make unsupported advertising claims and generally speaking, there is a far higher risk than that seen in Australian listed complementary medicines.
Who needs supplements?
Geraldine Moses states that for wellness purposes, the risk of taking supplements outweighs the benefit. She adds that most adults don't need supplements.
In an ideal world, the best way to derive nutrients is through diet. But the fact is that the majority of people don't consume enough vitamins, minerals, and other nutrients; there is a myriad of evidence that supports this. According to the AIHW, for example, 50% of adults and 32% of children don't consume sufficient serves of fruit, and 93% of adults and 95% of children do not consume adequate vegetables. Other research shows that only around one out of five Australians consume enough omega-3. Surveys. Many more studies could be cited.
A myriad of evidence supports this existence of nutrient-dietary challenges for Australians ranging from iron-deficiency anaemia to vitamin D and B12 plus many more. Deficiency can result from many reasons such as dietary restrictions, cultural practices, post-gut surgery, lifestyle factors, ageing, the use of certain pharmaceutical medicines and more.
Geraldine Moses says that people who take supplements are wasting their money. The seven out of ten Australians that take complementary medicines regularly would no doubt disagree. Her statement ignores the increasing health literacy of the Australian public who make an active choice.
Research shows that the more highly educated a person is, the more likely to take complementary medicines. The 2011–2012 National Nutrition and Physical Activity Survey examined supplement use within the Australian population; results showed that supplement use was greater among those with higher levels of education.
According to the researchers, supplement users are more likely to participate in healthier lifestyle behaviours, have underlying diets that are higher in many nutrients; they also have a more favourable health status when compared to supplement non-users.
The price of good health
Industry critic Geraldine Moses says that people complementary medicines are expensive. Compared to many pharmaceutical, over-the-counter drugs, complementary medicines are relatively inexpensive. And, health benefits extend to more than just the individual.
One of the most popular supplements in this country is calcium, a macro-mineral well known for its widespread benefits. Deficiency is associated with adverse health consequences, and severe shortage can result in osteoporosis. Treatments can be burdensome to the healthcare system, and of course, the condition is burdensome for the affected individual and their loved ones.
It isn't so straightforward
Complementary medicine is not as straightforward as traditional pharmacology of a single powerful drug effect on one pathway. Complementary medicines are made from either one ingredient or a combination selected to support numerous biochemical pathways. For example, magnesium is integral to more than 300 enzymes; deficiency is highly prevalent worldwide. Yet, in supplementary form, this simple mineral is a powerful, helpful adjunct to pharmaceutical medicine, diet, and lifestyle interventions according to clinical trials.
Look at the label
Geraldine Moses says that, unlike conventional medicines, manufacturers of vitamins and minerals are not required to provide warnings of potential side effects, drug interactions or overdose; another incorrect statement.
In truth, manufacturers of complementary medicines must have strict upper limits on recommended daily doses for higher risk nutrients stated on the label. Appropriate label warning statements on important serious side effects are required; these are designed to inform the public, and they do. Damaging doses are not permitted on recommended directions. Overdosing is also clinically challenging to consume in most cases.
Geraldine Moses warns about drug-nutrient interactions, which are similar to drugs and foods that interact with medications. The complementary medicines sector produces interaction checkers for healthcare practitioners; for example, one of these resources was created by Blackmores Institute. Academics at Sydney University review the interaction checker and provides pharmacists with a dedicated information portal.
Decades of research have shown only a few clinically significant side effects for complementary medicines, and these usually relate to purposeful or accidental improper use. Where reactions for any use occur, they are reported in the Database of Adverse Event Notifications (DAEN), actively monitored and addressed. Further, Australia is the only country in the world to have a Pharmacovigilance inspection program in place for complementary medicine companies.
Complementary medicines make a positive difference to the lives of Australians in a very gentle and low-risk way every day. And, the most severe and damaging adverse events consumers ask for help for are not related to complementary medicines.
After the death of his son from taking a combination of prescribed medicines, Paul Reis and others affected by severe adverse and even fatal events related to pharmaceutical medicines are campaigning for better consumer warnings on prescription medicine labels to protect patients.
The need for consumers to communicate with their doctor and pharmacist when taking any over the counter products, including complementary medicines, is important. Still, pharmacists and medical practitioners require a level of knowledge, respect for, and open-mindedness towards complementary medicines and patients' choices.
Australia's world-leading regulation of quality
Geraldine Moses says, "Most are unaware that complementary medicine labels may not be entirely trustworthy or that natural health products, especially those sourced from overseas, may contain undeclared adulterants." Complementary medicines displaying an AUST L or R number, i.e., Australian products, only contain pre-approved ingredients that must be positively identified and tested. Legal limits on contaminants such as heavy metals, solvents and certain herbal compounds.
Made in Australia
TGA auditors regularly inspect Good Manufacturing Practice (GMP) manufacturing sites and laboratories. While herbal adulteration can be a problem in overseas complementary medicines, the sector uses world-leading laboratories for herbal identification in Australia. And, unlike many pharmaceutical medications, most complementary medicines are manufactured here on our shores, maintaining medical product manufacturing expertise and increasing Australia's national healthcare resilience.
Australians' access to highly regulated listed medicines is not the case for similar supplements purchased from overseas, which have voluntary safety and quality requirements, if any at all. Suppose consumers believed the attack by anti-complementary medicine lobbyists for Australian listed products. In that case, the kinds of concerns stated by Dr Moses may become a reality for the Australian public buying overseas products online.
Cost-effective public safety
Australian consumers' access to high-quality, efficacious ingredients through the listed medicines path is important for public safety and cost-effective access. Regulating ingredients in listed medicines at an economically viable level for Australian businesses to produce such products is also vital – it allows for better health, wellness, and safety for the Australian population.
Towards a better conversation
Just as haematology, endocrinology and dietetics are forms of medicine, so is complementary medicine. There is usually a gentle and lower risk, and thus, importantly, it permits consumers a level of self-determination in their care. It is disappointing that specific well-respected individuals create unbalanced arguments to inflate fear over a valuable and helpful field of medicine. At the same time, other medical experts see countless patients whose health improves by using treatments including complementary medicines specific to the patient's individual needs.
It is much more helpful to engage in respectful discussion with clinicians, patients, academia, and industry to understand the benefits and risks of recognising and advancing the use of complementary medicine through best practice. A positive, mutually respectful approach to engagement and ongoing education is what is needed. This way, all of us can be helped to make the best decisions and deliver the most positive health outcomes for us all.
CEO Complementary Medicines Australia