s NICM - An Umbrella for Evidence-Based Complementary Medicine | I2P: Information to Pharmacists - Archive
Publication Date 01/09/2010         Volume. 2 No. 8   
Information to Pharmacists

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Newsflash Updates for September 2010

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Regular updates from the global world of pharmacy.
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Feature Contribution

Pharma-Goss for September 2010

Rollo Manning

Consumer welfare program or small business support program?

This is a controversial question that is sure to invoke hot debate.
It is to be welcomed.
Is the PBS a consumer welfare program as a part of a total National Health Scheme or a small business support program for retail pharmacies?
Where does the balance lie and is the consumer getting the best deal of the arrangements?
That is the question.
How dare such an assertion be made that suggests the Pharmaceutical Benefits Scheme may have lost its way and moved from being a part of a National universal welfare program.

Comments: 1

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Using "Exergames" for Stroke and Falls Prevention

Peter Sayers

"Exergames", like Nintendo Wii, are usually designed for fun, recreation and exercise.
However, they are gradually being transformed into tools to treat depression, assist in stroke rehabilitation and improve mental health-related quality of life.
Currently researchers are exploring the potential of "exergames" to reduce the risk of falls in older adults.
When people walk through their own environment they may be subjected to an occasional "trip" or "slip" that could result in a fall if people are unable to make an adjustment to quickly and accurately to recover their balance.
Stepping is something that few of us think about, yet our ability to step declines with age, increasing our risk of having a fall.
Now the same exergames are set to become medical tools linked to a range of health programs, hopefully connected to the National Broadband Network.
It struck me that this may represent an opportunity for pharmacists to be involved in the supply of this type of equipment and assist in the training and supervision of patients involved in this evolving list of programs.
It also provides a link with aged care and community nursing and may provide a useful service in a pharmacy-style walk-in clinic, providing pharmacists with a "hands on" entry point to patient care.
This lack of "hands on" activity often sees pharmacists ignored in the primary health care practice activities.

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The Road Not Taken

Neil Retallick

The American poet Robert Frost did not have the Pharmacy Guild in mind when he wrote this incisive poem, but I think the decision-makers at the Guild need to read it.
It may help them understand the far-reaching consequences of the choices they are making today.
Frost describes walking through a wood and coming to a fork in the road. He contemplates the two. One seems to be a little more worn, probably the more popular choice. The other is a little more grassy, chosen less often. Neither path showed signs of recent travellers. Frost chooses the less worn road knowing he will never be able to reverse this seemingly trivial decision. He knows that the rest of his life is irreversibly impacted by this simple choice. His history can never be re-written.

Comments: 1

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Social Inclusion

Rollo Manning

“Hey – don’t forget us – we were here first!”
Remote Aboriginals left out of inclusion agenda

Remote living Aboriginals and the cycles of disadvantage which place them at the bottom of the socio economic ladder in Australia must get special treatment from a new Government in Canberra. The fact that Australia’s first people are still living in “Third World” conditions in one of the wealthiest countries of the World is a shameful situation and only special treatment will raise their standards to a point where they can be considered “included” in Australian society.

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Wellness - What is the Pharmacy View?

Staff Writer

Pharmacy, in general. is a destination point for illness.
It has yet to spark consumer interest in the broad concept of wellness, and this is where consumer concerns are being increasingly directed.
An interest in "wellness" used to be something exotic. And to the extent consumers gave any thought to the concept, it was often defined simply as the absence of illness. But "wellness" is now very much a mainstream preoccupation, and one that's viewed more broadly as a marker for quality of life. A report released this month by The Hartman Group, a US-based consultancy/research firm that has made a specialty of analyzing attitudes and behaviors in this area, took a detailed look at what wellness now means to various consumer cohorts and how this affects their engagement with products and services, especially foods.
One only has to look at the Woolworths logo to realise how seriously wellness is being taken in Australia and why that organisation wants to create a health and wellness environment plus leverage the pharmacy destination point of illness.
This would create a model with a strong holistic image, attractive to a majority of consumers.

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NICM - An Umbrella for Evidence-Based Complementary Medicine

Peter Sayers

The National Institute of Complementary Medicine (NICM) is an organisation established to provide leadership and support for strategically directed research into complementary medicine, and the translation of that evidence into clinical practice and relevant policy, to benefit the health of all Australians.
It is an organisation that generates much needed credibility for the complementary medicine area and will do much to temper improper use of these medicines and moderate unwarranted criticism.
Polarisation of these two extremes has occurred, generating confusion among health providers.

Comments: 2

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The Right to Die

Neil Johnston

For the last decade, Australians have been talking about their average age increasing, to the extent that at least 25% of the population will be over the age of 64 within twenty years.
With that increase in age comes an increase in lifestyle illness and the need to invest in aged care facilities and to provide funding for medicines on the PBS that will increasingly be utilised.
It seems demand will outstrip available resources.
But another social/ethical issue accompanies the ageing process and lifestyle illness, and that is quality of life.
What purpose is there to living a long life if it has no quality or becomes too unbearable and draining for the individual and their surrounding family?
So when somebody decides they wish to die ahead of schedule because of unbearable pain and suffering they suddenly find that right has been taken away from them by politicians.
Euthanasia is a subject that has been kept under the radar for a long time but containment now appears impractical as evidence of suffering will simply increase with the volume of aged persons.

Comments: 3

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UK Walk-In Clinics Gain Traction

Staff Writer

Walk-in clinics in pharmacy is an idea that is now gaining traction around the world.
Long established in the US, they are now appearing in the UK - with one great difference - the UK model is staffed mostly by pharmacists with only a small number of nurse-led clinics.
All are funded by government.
If this type of clinic was to gain sufficient traction in Australia, plus receive government funding, an easing of the oversupply of pharmacists in some parts of Australia would possibly result, as well as ease pressure on GP's.
Boots, a chain pharmacy group in the UK is providing walk-in services during extended hours to ease pressure on GPs and hospitals.
Pharmacists at a Boots store in Edinburgh have started to provide walk-in services during extended opening hours this month as part of the Pharmore pilot project funded by the Scottish Government.
It's really just a more professional and properly resourced version of the old style counter prescribing, but this time in privacy, plus being paid for the service.

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Promising climate research awarded

Staff Writer

Dr Deanna D'Alessandro has been recognised for her promising research into climate change.
A University of Sydney researcher has won recognition for her groundbreaking work into capturing carbon emissions, which has the potential to significantly impact climate change.
Dr Deanna D'Alessandro, a postdoctoral fellow based in the School of Chemistry, is one of three female researchers to be awarded a L'Oréal Australia For Women in Science Fellowship.

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New therapy could combat the weight loss and muscle wasting experienced by cancer patients

Staff Writer

Deakin University medical researchers are working on a treatment for cancer cachexia, the debilitating weight loss and muscle wasting condition that affects patients with cancer.
Cancer cachexia has a major impact on quality of life for cancer patients. It can also inhibit the effectiveness of cancer treatments such as chemotherapy and radiotherapy.
There is currently no effective treatment.

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Prevention Saves Money and Lives

Staff Writer

University of Queensland and Deakin University researchers have  released a report with dozens of recommendations that strongly support more spending on prevention, but also warn that not all prevention measures are wise investments.
The Assessing Cost Effectiveness of Prevention (ACE-Prevention) project is the result of five years of research, funded by the National Health and Medical Research Council.
It is believed to be the most comprehensive evaluation of health prevention measures ever conducted world-wide, involving input from 130 top health experts.

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FIP Professional Innovation Grant

Staff Writer

Jonathan Penm, a PhD candidate at the Faculty of Pharmacy has just been awarded the Young Pharmacists Group (YPG) Grant for Professional Innovation 2010.
The announcement was made by the International Pharmaceutical Federation (FIP) Board of Directors during the 70th FIP World Congress of Pharmacy /Pharmaceutical Sciences in Lisbon, Portugal, which ran from 28th August to the 2nd September 2010.

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New Drug a Potential Treatment for Type 2 Diabetes

Staff Writer

Australian scientists, in association with US pharmaceutical company DiaKine Therapeutics, have shown that a drug candidate, Lisofylline, could be useful in treating Type 2 diabetes.
Drs Georgia Frangioudakis and Carsten Schmitz-Peiffer from Sydney’s Garvan Institute of Medical Research, tested the anti-inflammatory drug which is undergoing clinical trials for other diseases, on mice being fed high-fat diets.
Their findings are published in the journal Endocrinology, now online.

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Mobile Phone Technology - A Need to Integrate for Patient Benefit

Staff Writer

Mobile technology is advancing at a rapid pace and mobile phones in particular are now beginning to overtake fixed landline phones.
Some technology companies are now providing physical platforms to handle both mobile phone calls and fixed landline calls in a more integrated fashion, distributing all calls throughout the home or office using "hands free" extension phones.
The new platforms include other applications such as electronic diaries, Internet connection, Facebook and other social media extensions, weather displays, latest news displays, personal or other photo albums - the list is becoming very extensive.
Health technology developers now need to factor this expanding "tool" into their various architectures to ensure that they too are able to "keep in touch".
The mobile phone is now cemented into all age demographics, including "seniors", where it is regarded as an essential tool for keeping in touch with family and friends, and more importantly, for connection to their health professionals for emergencies.
I also notice that health professionals, particularly GP's and dentists, are using the telephone to remind patients of their appointments, usually a day or so in advance.
Health telephone systems need to become more intuitive to handle emergencies to bypass the normal blockages to a health practitioner in the event of an emergency.
A recent survey published in Retail Clinician indicates to what extent consumers would currently engage in an integrated and interactive system.

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Drug-herb interactions information available to all healthcare professionals

Staff Writer

MIMS Australia and IMgateway recently signed a Memorandum of Understanding (MoU) with the intention of delivering a unique Australian developed, evidence based drug-herb interactions database directly to a healthcare professional's desk top.
This database has been developed by researchers from the Faculty of Pharmacy at The University of Sydney.

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Health sector treats almost 6 million in flood-affected Pakistan

Staff Writer

The objective of WHO and health partners in Pakistan is to reduce avoidable death and illness
In a massive health relief effort underway in the flood-affected parts of Pakistan, nearly six million people have been treated for health conditions since the floods began in late July; but there are urgent needs to prevent further health crises or food insecurity caused by large-scale damage to crops and agricultural land.
"Increasing cases of communicable diseases, like diarrhoea and malaria, fears about children being malnourished, the massive disruption to healthcare, crop systems and rising food insecurity are the main health threats facing Pakistan's flood-affected people," says Dr Guido Sabatinelli, WHO's Representative to Pakistan.

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Kidzcomics-empowering kids (and possibly their parents)

Staff Writer

Children affected by serious diseases and medical conditions either personally or in their families often don't really understand those illnesses or the treatments required to fight them. New Zealand-based Kidzcomics aims to change all that with a series of comic books designed to explain medical information for children.
The Medikidz series features five superheroes by the same name, each of them a specialist in a different part of the body. With stories designed to be fun and appealing, the comics aim to entertain as well as educate children about serious medical issues. Conditions covered in the Medikidz line so far include leukemia, epilepsy, diabetes, HIV and ADHD, among many others; rather than “sugar-coating” the topics, Kidzcomics' books aim to empower and educate children for better self-management and less fear. All content is written by professional medical writers and doctors and then peer-reviewed.
And while the comics attract children they also serve to educate parents who sneak the occasional look.

There are currently more than 50 million children afflicted by illness in English-speaking countries.

Website: www.kidzcomics.com

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Water-Based "Artificial Leaf" Produces Electricity

Staff Writer

A team led by a North Carolina State University researcher has shown that water-gel-based solar devices – “artificial leaves” – can act like solar cells to produce electricity.
The findings prove the concept for making solar cells that more closely mimic nature.
They also have the potential to be less expensive and more environmentally friendly than the current standard-bearer: silicon-based solar cells.

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Exploring New Horizons

Neil Johnston

A message delivered to delegates attending the International Pharmacy Federation (FIP) Congress in Lisbon Portugal was for pharmacists to explore new horizons.
One can sense and appreciate this message because pharmacy does seem to be stuck in a time warp without a unified sense of purpose for the future.
Our two major peak bodies, the PSA and the PGA have not closely worked together, with open warfare being declared on occasions.
There does not yet seem to be a coherent positive theme running from either organisation that the "troops" can align with, although there are signs of positivity developing in PSA and a slightly lesser aggressive stance being taken by PGA.
But what's on your horizon and what is your future vision?
To help kick off a discussion, i2P asked Mark Coleman to comment on the media item reported in Pharmacy News on the 31 August 2010

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NICM - An Umbrella for Evidence-Based Complementary Medicine

Peter Sayers

articles by this author...

Peter Sayers is vitally concerned about pharmacy professional practice - its innovation, its research and development, and its delivery to create an ongoing revenue stream. Delivery of healthcare is increasingly involved with Information Technology systems. All perspectives in IT must be considered for the impact on pharmacy practice and its viability.

The National Institute of Complementary Medicine (NICM) is an organisation established to provide leadership and support for strategically directed research into complementary medicine, and the translation of that evidence into clinical practice and relevant policy, to benefit the health of all Australians.
It is an organisation that generates much needed credibility for the complementary medicine area and will do much to temper improper use of these medicines and moderate unwarranted criticism.
Polarisation of these two extremes has occurred, generating confusion among health providers.

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NICM has been backed by government and was established with seed funding provided by the Commonwealth Department of Health and Ageing and the NSW State Government (NSW Office of Science and Medical Research) and is hosted by the University of Western Sydney
It will do much to promote confidence for consumers and practitioners alike while at the same time provide a “softer” and mostly “safer” alternative to conventional medicine.

Lower cost may also prove to be a fringe benefit.

A recent NICM study into the cost effectiveness of complementary medicine in Australia has found millions in healthcare costs could be saved without compromising patient outcomes, if complementary medicine is more widely used.

NICM commissioned Access Economics to undertake a series of cost effectiveness studies of selected CM interventions where a reasonable body of scientific evidence for efficacy and safety of the intervention was available (the full report can be found here).
An expert Reference Group was convened and from a range of CM interventions that were considered for analyses, five were chosen.
These included:

* Acupuncture for chronic non-specific low back pain;

* St John's wort for mild to moderate depression;

* Omega-3 fish oils for secondary prevention of heart disease;

* Omega-3 fish oils to reduce non-steroidal anti-inflammatory drug use in rheumatoid arthritis; and

* A proprietary herbal medicine for pain and inflammation of osteoarthritis called Phytodolor which is a combination of three herbal extracts, from aspen, golden rod and common ash that has been used in Europe for more than 40 years and has been studied in 43 clinical studies. These herbs work together to provide proven pain relief with fewer side effects than usually experienced with other synthetic anti-inflammatory agents.

Four of these interventions proved cost-effective or cost-saving under particular scenarios.

Australians spend over $3.5 billion each year on complementary medicines and therapies, most commonly to assist in the management of chronic disease and improve health and wellbeing.

Over the last twenty years, there has been a growing body of scientific knowledge on the efficacy of complementary medicine; understanding of mechanisms of action; and advances in processes to ensure quality and standardisation of materials and products.

Research partnerships have increasingly focused on high burden of disease areas where mainstream medicine has yielded relatively poor results, particularly in the prevention and management of chronic disease, and towards enhanced results using a combination of complementary and mainstream interventions.

Once safety and efficacy have been established, a critical issue for consumers, practitioners and governments alike, is understanding the cost effectiveness of medical interventions, whether mainstream or complementary.

Complementary medicine is a field that pharmacists have an ability to develop expertise in, particularly when integrated with orthodox medicines.
A body of knowledge has been steadily building in the interactions and side effects mechanisms, and with NICM providing the confidence factor, Australians may now begin to access this health extension.

Pharmacies may also enjoy marketing complementary medicines utilising the NCIM umbrella, thus avoiding criticisms by some media and public interest organisations.

Return to home

Submitted by Dr Ken Harvey on Tue, 14/09/2010 - 22:00.

There were some important points made in the Access Economics report that Peter has ignored.

In particular, "If St John’s wort was to be sold in Australia with ‘depression’ as a therapeutic indication, a higher level of regulatory approval would be required".

My own comments follow.

The authors found that acupuncture as a complement to standard care resulted in significantly better pain outcomes than standard care alone. However, acupuncture alone as an alternative to standard care alone provided a significant improvement in pain only for a short period. No statistically significant benefit of acupuncture over sham was found when all patients received standard care (implying that the benefit observed was probably a placebo effect).

The cost effectiveness of fish oils, as a complement to current preventive therapies for reduced death and morbidity among people with coronary heart disease (CHD), was compared with no fish oils for people who have had a myocardial infarction within three months and who are unable to eat sufficient amounts of oily fish to meet the recommended intake of eicosapentaenoic acid (EPA) and decosahexaenoic acid (DHA). Where dietary changes cannot be made (or sustained) the use of fish oil supplements was shown here to be a cost effective intervention to prevent future cardiovascular mortality in Australia. However, no evidence was presented as to the cost-effectiveness of people without CHD taking fish oil for "heart health" in the hope of preventing disease (which is where much promotion and use occurs with no good supportive data).

Fish oils as an adjunctive treatment with non‐steroidal anti‐inflammatory drugs (NSAIDs), to reduce a patient’s reliance on NSAID treatment, were not found cost effective.

Finally, the report found two herbal medicines cost-effective when compared to conventional medicines: PhytodolorTM (a proprietary standardised mix of populus tremula (aspen), fraxinus excelsior (ash) and solidago virgaurea (goldenrod or woundwort) was found to be more cost-effective than Diclofenac and other NSAIDs in the treatment of osteoarthritis while St John’s wort was found to be cost-saving relative to standard anti‐depressants.

However two important caveats were listed.

First, the literature review on PhytodolorTM was relatively sparse.

Second, complementary medicines available on the Australian market, including products containing St. John’s wort, are neither standardised by the TGA or assessed for clinical efficacy. The active components of such products are known to be variable; thus different products allegedly containing the same ingredients are unlikely to be equally effective. Access Economics noted that, "the results of this review apply only to the preparations tested in the studies included, and possibly to extracts with similar characteristics".

The report also noted that, "If St John’s wort was to be sold in Australia with ‘depression’ as a therapeutic indication, a higher level of regulatory approval would be required".

In addition, the multiple interactions that occur between St John’s wort and many other drugs highlight the need for its use for its potential use for depression to be supervised by health professionals rather than being available over-the-counter as currently occurs.

In short, while this report notes the potential of some complementary medicines to replace and/or complement conventional medicines this potential will only be realised if a higher regulatory standard can be applied to separate out products that have clinical evidence of effectiveness from the rest. This was the purpose of suggesting an opt-in system, funded by an additional fee, that would independently evaluate the effectiveness of specific complementary medicines. A product with reasonable evidence of effectiveness could be awarded a symbol similar to the National Heart Foundation “red tick”. Implementing this measure, together with other recommendations put forward in the literature would assist consumer choice and provide a market advantage for the sponsors of evidence-based, ethically promoted CMs. An alternatively (but more costly regulatory path) is for sponsors of evidence based CM to get their products registered by the Therapeutic Goods Administration (AUST R) rather than Listed (AUST L). Unfortunately, a number of studies show that the public have no idea of the difference between these two labels!

Submitted by Peter Kennedy on Tue, 14/09/2010 - 16:47.

"Four of these interventions proved cost-effective or cost-saving under particular scenarios."
If this is true, then these products would be eligible to be Registered under the ARTG and would no longer be "complementary".

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