Issues Magazine

Complementary Medicines: Integral to the Australian Health System

By Trixi Madon and Kristy Roberts

Complementary health care is an important part of Australian preventative health care.

Preventative health care is well-recognised as the key to an efficient health system within Australia. Many diseases and conditions can be prevented, yet existing healthcare systems do not always make best use of resources that could support this process. Complementary medicines play an important role in maintaining wellness and preventing illnesses, which impacts on productivity, reduces avoidable hospitalisations and readmissions into hospital, and could significantly reduce overall healthcare costs in Australia.

Complementary Medicine in Australia

Complementary medicines cover a diverse range of products such as vitamins, minerals, nutritional supplements, herbal and homeopathic medicines. The use of complementary medicines in Australia, and around the world, has grown rapidly over the past few years. Some theories suggest that this increase is because of disappointing medical outcomes, dissatisfaction with doctor–patient relationships, changes in views and beliefs about health, an increase in access to health information via the Internet, and the growing research-based evidence supporting the effectiveness of a wide range of complementary medicines .

One 2005 study by Cardinal Health found that over 70% of Australians had taken one or more complementary medicines in the previous year, and Alistair Maclennan and colleagues (Medical Journal of Australia, 2006) estimated that $1.3 billion was spent on complementary medicine products in a 12-month period alone. Further, the “estimated number of visits to complementary practitioners by adult Australians in a 12-month period (69.2 million) was almost identical to the estimated number of visits to a medical practitioner (69.3 million)”, according to Charlie Xue and colleagues in 2007 (Journal of Alternative and Complementary Medicine).

Complementary Medicine: Safety and Effectiveness

The Therapeutic Goods Administration (TGA) is responsible for regulating therapeutic goods, including complementary medicines, in Australia. The TGA ensures that complementary medicines meet set safety and quality standards so that these products will not pose a safety concern within the general population.

Complementary medicines are generally considered to be of low risk due to the high standards of manufacturing practices. However, some identified complementary medicine ingredients may interact with other herb or pharmaceutical products when taken in conjunction. For this reason, patients should always advise their healthcare practitioner if they are taking a complementary medicine and take note of all advisory warnings on product labels.

There is a range of evidence that demonstrates whether a medicine is effective, ranging from proof of traditional use to scientific data. It is generally accepted that clinical trials are the gold standard for scientifically assessing the safety, efficacy and other aspects of particular complementary medicine ingredients and/or products.

There has been much debate about the effectiveness of complementary medicines because of “lack of scientific evidence to support their use”. However, it has recently been reported that the number of clinical trials conducted on complementary medicines alone has increased to almost 4000 (at 2005), and in some cases the trials are of a higher quality than those conducted on synthetic drugs.

There is a perception by many consumers that a product is 100% effective if it has undergone a clinical trial. A clinical trial is a statistical assessment of how effective, and often how safe, a substance is for a particular condition or subgroup of a population. Does the absence of a clinical trial to test the effectiveness of an ingredient or product necessarily mean that it does not work? The simple answer is “no”.

There is no medicine that works for everyone. Researchers in a new branch of science called pharmacogenetics are investigating the reasons for this.

Complementary Medicine and Healthcare Costs

The inclusion of complementary medicine options in the delivery and promotion of healthcare will improve the health of the Australian community and the health budget. The Department of Health and Ageing’s 2002 report, Returns on Investment in Public Health, showed substantial returns for each dollar spent on health prevention. For example, for every $1 spent on measles prevention $155 was saved, and in the case of coronary heart disease $11 was saved for every $1 spent. A healthier community would make available resources to spend on other issues such as education, research and other services or infrastructures.

Numerous studies demonstrate the importance of complementary medicines in the prevention of preventable illnesses that are burdening our health system. Three such conditions – osteoporosis, mild depression and osteoarthritis – are described below.

Although a number of clinical trials have been used to assess the safety and efficacy of complementary medicines, there is still a critical need for more quality data that demonstrates the clear health and economic benefits of taking such products.

Osteoporosis

Approximately 1.4 million Australians have osteoporosis (fragile and brittle bones), with consequent direct and indirect healthcare costs of about $18.7 billion per year. The Australian Institute of Health and Welfare reported in 2000–01 that pharmaceutical services (i.e. prescriptions and drugs) constituted the largest component of expenditure for osteoporosis, followed by high-level residential care.

Good-quality data suggest that calcium and vitamin D supplements prevent and/or delay the onset of osteoporosis. Calcium is one of the biggest selling mineral supplements in Australia.

Mild Depression

Mild depression has been identified by the Australian Bureau of Statistics (2005) as the leading contributor to non-fatal disease burden in Australia. Without treatment it is estimated by beyondblue that a single Australian worker with mild depression equates to $10,000 per year in lost revenue, or $4.3 billion in total lost productivity. Beyondblue has created a national program to assist in overcoming the condition and alleviate some of the burden on the health system.

St John’s wort is supported by beyondblue as an alternative treatment for individuals with mild depression. Research shows that St John’s wort is beneficial not only for mild depression but also for mild anxiety.

Sales in Australia are estimated to be around $6.1 million per year for products containing St John’s wort.

Osteoarthritis and Joint Pain

Access Economics (for the Arthritis Foundation of Australia) found that osteoarthritis, particularly knee osteoarthritis, was the fourth largest contributor to years lost due to disability in 2001. The health expenditure for osteoarthritis in the same year was around $1.2 billion, with hospital services making up the largest component ($567 million), according to the Australian Institute of Health and Welfare. It has also been estimated that for every procedure associated with osteoarthritis (such as hip and knee replacements), between $13,600 and $30,600 was spent per patient, with an estimated 42,000 procedures carried out in 2003–04.

Clinical studies have shown that glucosamine, taken each day, can be a safe and effective treatment for osteoarthritis by alleviating pain in the joints. Leonie Segal and colleagues, in an article in the Medical Journal of Australia (2004), noted that “taking glucosamine sulfate [one form of glucosamine available on the Australian market] was found to be cost-effective at less than $5000/QALY [quality adjusted life years]. These medicines had equivalent efficacy to non-steroidal anti-inflammatory drugs, with no evidence of excess morbidity [rate of disease cases each year] or mortality [death rate].” This finding suggests that taking glucosamine supplements could potentially reduce the burden on our current health system.

Complementary Medicine and Health Policy

“Mainstream” healthcare is vital, with hospitals and general practitioners having a crucial role in delivering healthcare. However, preventative and appropriate self-care options could be promoted more heavily. The National Medicines Policy (2000) recognises complementary medicines as a “medicine” just like a prescription or over-the-counter product. They are also recognised in other Australian policy documents. Despite this policy recognition, complementary medicines may not be being used optimally.

Increasing the information base of complementary medicine efficacy and usage could make a positive contribution to Australian health policy. Access to such information may not only improve the health budget but also increase acceptance within the community that complementary medicines can provide suitable alternative prevention and treatment options.

There is general acceptance of the role of substances in food (e.g. folic acid) for preventative health, including the associated flow-on to reduce public health expenditure and improving productivity. Not only is this acceptance at a government level, but also by the public, medical profession and the media at large. However, this is in contrast to the experience of complementary medicines.

A recent example is the voluntary and mandatory fortification of bread with folic acid to reduce the incidence of neural tube defects in newborn babies. The Australian government supported and funded the assessment of the public economic impact of neural tube defects and the likely improvements in the incidence of the condition within the community if this policy was implemented. Information used to support the ministerial decision included the dated National Nutritional Survey. A 2006 report commissioned by Food Standards Australia New Zealand to assess the cost–benefit of fortifying our food supply noted that supplement health education campaigns had not been taken into account during the assessment process. It was estimated that the addition of folic acid to bread would result in an overall fall in the incidence of NTD and would deliver benefits of up to $126 million per year.

A second report was commissioned to assess the cost-effectiveness of policy options, one of which included promoting folic acid supplement usage. The report recommended that a policy of promoting supplement use may be the better policy option. However, even with these findings, fortification of food was adopted.

In short, what hadn’t been taken into account was the contribution that folic acid supplements were already having in the community. In 2004–05, almost 270 million tablets containing folic acid were manufactured in Australia. These supplements are already marketed as formulations for general health, for pregnant/lactating women, and for children, and would therefore be contributing quite substantially to a better health economy.

Complementary medicines are becoming increasingly important in the prevention, health maintenance and healthcare of all Australians. Although a healthy diet and exercise regime are the basis for good health, well-being and disease prevention, complementary medicines also have a role in helping people meet their health needs.

With healthcare costs anticipated to escalate significantly in the coming years, now is the time for bold and innovative thinking in healthcare policy. Ensuring that complementary medicines are better integrated into mainstream health policy is the only realistic and intelligent way to support the Australian community in their pursuit of wellness.