Issues Magazine

Complementary Medicine Research in the Spotlight

By Dimity Pinto

There needs to be a better balance between Australia’s high usage rates of complementary medicines and the evidence to support its use.

Complementary medicines are very popular in Australia, with up to two-thirds of Australians using some form of complementary medicine products or therapies each year. This is one of the highest usage rates among developed nations. However, Australia has one of the lowest levels of investment in related research.

There is growing evidence that complementary medicine can make a significant, cost-effective contribution to public health in chronic disease management. The key issue is identifying how to best bridge the major gap between the high level of use and a limited and confusing body of evidence.

In 2007 the National Institute of Complementary Medicine (NICM) was established to help address this issue. NICM’s purpose is to provide leadership and support for strategically directed research into complementary medicine and translation of evidence into clinical practice and relevant policy to benefit the health of all Australians. NICM was established in June 2007 with seed funding from the Commonwealth and NSW governments and is hosted by the University of Western Sydney (UWS).

Studies have shown that complementary medicine users are most typically female, well-educated and in the higher income brackets, with the highest proportion of users aged between 25 and 34. Some of the most popular complementary medicines and therapies include vitamin and mineral supplements, chiropractic and acupuncture. The industry is estimated to be worth $2 billion per year in Australia alone.

Disclosure of use is a common issue. Many people fail to let their doctor know they are using a complementary medicine because they don’t see it as being relevant or they are concerned their doctor will not approve. Research has shown that doctors generally don’t ask their patients about their complementary medicine use. This is in part due to their lack of understanding of the complementary medicines and in some cases a cynicism of the field in general.

However, clinicians, pharmacists and other health personnel are increasingly seeking reliable, evidence-based information to catch up with the exponential increase in complementary medicine usage by their patients. They want to know potential benefits, any adverse effects and possible interactions with mainstream pharmaceuticals. They also need to know that information is based on sound, independent scientific testing.

The challenge for the complementary medicine research sector is to develop and implement rigorous scientific methods and quality standards for clinical trials to assess the safety and efficacy of complementary medicines. This requires infrastructure, skilled researchers and funding.

With these things in place there is the potential to develop a high-quality evidence base, which in turn will help in the provision of relevant and accurate information to consumers and medical practitioners. The creation of a larger evidence base may also lead to a better understanding of the cost-effectiveness of complementary medicine interventions, especially in chronic disease management.

Research

Australia has significant strength in complementary medicine research despite the low level of funding. However, there is an urgent need to build critical mass and a better coordinated research effort. International experience shows that an effective strategy to build capacity is to partner complementary medicine practitioners and researchers with mainstream health and science researchers, and to support cross-disciplinary research teams. Building capacity includes increasing the number of complementary medicine researchers, improved investment from industry and optimised use of infrastructure.

The establishment of three NICM collaborative centres earlier this year brings a national approach to complementary medicine research. The collaborative centre model is designed to create cross-institutional partnerships and links to industry and clinicians, and to strengthen the depth of complementary medicine research capabilities in Australia.

The NICM Collaborative Centre program will see over 15 universities across the country participating in a broad range of complementary medicine research covering traditional Chinese medicine, natural medicines and nutraceuticals. The NICM Collaborative Centres will focus on research that:

  • has the potential to impact positively on the health and well-being of all Australians, with emphasis given to areas of high burden of disease where preliminary evidence is strong and demonstrates likelihood of positive impact; and
  • elucidates the safety, efficacy and cost-effectiveness of complementary medicine and translates this into policy and practice.

In addition to the $1.8 million NICM Collaborative Centre grants, the National Health and Medical Research Council (NHMRC) distributed $5 million to fund 13 complementary and alternative medicine research projects earlier this year. These grants fall under the NHMRC’s strategic awards, which support health and medical research in areas that have been identified as a priority and where there is an unmet need for targeted funding.

Education

Over the past 5 years, Australian universities have started to respond to the widespread use of complementary medicine, with many medical schools revising their curricula to incorporate a complementary medicine component in courses including nursing and pharmacy. The level of commitment varies, with some schools simply introducing independent electives while others have created entire research centres such as the Centre for Complementary Medicine Research (CompleMED) at the University of Western Sydney (UWS). Degree courses leading to clinical qualifications in complementary medicines are offered in Australian universities and in private colleges including UWS, RMIT University, Southern Cross University and the University of Technology, Sydney (UTS).

UWS offers undergraduate and postgraduate programs in Chinese medicine and other complementary therapies. Teaching activities at UWS are supported by CompleMED’s research program, which focuses on the safety, efficacy and use of complementary medicine. CompleMED has established state-of-the-art analytical and pharmacology laboratory facilities to research how herbal medicines work.

RMIT’s Division of Chinese Medicine is a designated World Health Organisation-collaborating Centre for Traditional Medicine. It offers a variety of undergraduate and postgraduate degrees in Melbourne, Hong Kong and mainland China.

The Department of Natural and Complementary Medicine at Southern Cross University offers a number of undergraduate and postgraduate courses, including the Bachelor of Naturopathy. The department is active in research in a number of areas, including all aspects of plant chemistry; biochemistry; clinical, sociological and applied aspects of herbal medicine; nutrition; homeopathy; and tactile therapies.

The Faculty of Science at UTS offers an undergraduate course in traditional Chinese medicine over a 4-year period. In addition to the undergraduate degree, the faculty offers a Master of Health Science in Traditional Chinese Medicine.

Regulation

Regulation is also on the national agenda, with the Federal government undertaking a regulatory review of all medical and health practitioners, including complementary medicine fields. Osteopaths and chiropractors are registered practitioners in all states and territories in Australia. Chinese medicine practitioners are registered in Victoria but are also subject to a national accreditation process.

The recent funding boost makes this an exciting time for the complementary medicine research sector in Australia, but a long-term commitment from all levels of government, industry and the education sector is needed to develop a viable and productive research base. By strategically addressing the imbalance between complementary medicine use and evidence to support its use, information will be developed that will impact positively on the health and well-being of Australians.