Page 68 - RP-AUGUST-2020

66 COMPLEMENTARY MEDICINES FROM PAGE 64 recommended intakes of the food groups,” she said. “Where supplements might be indicated is for some people who may be unwell, not eating properly because they’re going through something, like cancer treatment, which is causing them side effects such as sore mouth or nausea and they’re just not maybe able to get enough nutrition in. “So, in those instances it could be prudent to top up the diet with some sort of multivitamin and mineral supplement. But as someone who works in cancer treatment, sometimes the antioxidants \\\\\\\\\\\\\\\[found in vitamin and mineral supplements\\\\\\\\\\\\\\\] can interact with treatments like chemotherapy, and dilute their potency. “In those instances it’s very important that people do talk to their doctor, oncologist or dietitian, whoever they’re working with, to let them know that they were thinking of taking these supplements and just making sure everybody knows and is happy with it – so there’s no interactions that could impact on the treatment outcomes.” Ms Freeman adds that for most people, it’s important to remember that putting more nutrients in doesn’t necessarily “equate to better or improved health”, and that in some cases – for example, vitamin A – excess levels can, in fact, be toxic. “The water-soluble vitamins B and C will just get excreted in your urine \\\\\\\\\\\\\\\[if excessive amounts are consumed\\\\\\\\\\\\\\\],” she said. “So, you’re just going to end up with expensive, colourful urine.” Tapping into the potential When thinking about complementary medicines, be they vitamins, minerals, supplements, aromatherapy or herbal medicines, what comes first to mind as the best place to buy these products? For many, this may be natural health food shops. However, the complementary medicine space represents untapped potential in many community pharmacies. According to Mr Quigley, the reason many pharmacists may not engage with the complementary space, other than perhaps using it as a place to make an extra dollar, is the fear of not knowing. “I think the biggest problem is that everybody expects... every person believes that they need to know everything about everything, and it’s not possible,” he said. “My suggestion is always that you look at a reliable source. Every pharmacy is required to keep a Braun and Cohen \\\\\\\\\\\\\\\[authors Lesley Braun and Marc Cohen\\\\\\\\\\\\\\\], which is called Herbs and Natural Supplements: An Evidence Based Guide. “If they had that handy and they were willing to... look at a section at a time, their confidence in using these things \\\\\\\\\\\\\\\[would increase\\\\\\\\\\\\\\\].” Mr Quigley says he encourages pharmacy students and pharmacy staff to “develop a prescribing personality”. “Select something and learn about it,” he said, adding that this will open up the opportunities to help and “make a difference to a person’s life”. “It’s not about \\\\\\\\\\\\\\\[just\\\\\\\\\\\\\\\] making the sale,” Mr Quigley added. “It’s about fixing the potential problem and guiding the person into a regime of treatment that they might be mixing in with their medications as well. “The opportunities are endless... but sadly it’s \\\\\\\\\\\\\\\[often\\\\\\\\\\\\\\\] looked at \\\\\\\\\\\\\\\[as\\\\\\\\\\\\\\\] making a sale. \\\\\\\\\\\\\\\[But\\\\\\\\\\\\\\\] there’s got to be a reason for it \\\\\\\\\\\\\\\[the complementary medicine\\\\\\\\\\\\\\\] and the reason has to make sense to both the person recommending it and the person who is accepting it.” skills of communication. Secondly, the skills of patience, and thirdly, the skills of guidance where you might move the person away from something into something else. But it’s got to be done with respect and with common sense and with an obviously better outcome.” Ms Freeman adds that it’s “about having a conversation with the customer to understand what they’re trying to achieve by the various supplements that they’re looking at”. “And perhaps if they know that it’s a person on a lot of other medications, suggest to them that they chat to the pharmacist or their doctor ... possibly a dietitian – just to make sure that there’s no interactions or issues,” she said. “If they’re struggling and losing weight, hence why they might be on something like Sustagen, then yes, of course, it’s worth talking to the GP and getting a referral to see a dietitian.” Where does medicinal cannabis fit? While technically medicinal cannabis, in particular cannabidiol or CBD, is not defined as a complementary medicine (due to it being a scheduled medicine – currently schedule 4) there may be some confusion here, as even Mr Quigley suggests that, in some forms, “it could be”. “\\\\\\\\\\\\\\\[However\\\\\\\\\\\\\\\], at the end of the day, CBD and all the developments there will probably be managed by the TGA,” he said. “So, I think we’re getting a little ahead of ourselves and what role pharmacists will play, who knows? But if they play their cards correctly and if the professional organisations align themselves with patient safety, health and outcomes, there will be a big role to play in using CBD products.” References 1. IBISWorld,AustraliaIndustry(ANZSIC)Report X0015, ‘Alternative Health Therapies in Australia’, Report by: Arna Richardson, December 2019. 2. World Health Organization, ‘Traditional, Complementary and Integrative Medicine’, who. int/health-topics/traditional-complementary-and- integrative-medicine#tab=tab_1 \\\\\\\\\\\\\\\[Accessed 8/7/20\\\\\\\\\\\\\\\] 3. NICM Health Research Institute, The Science of integrative medicine, ‘Understanding Complementary and Integrative Medicine’, nicm.edu. au/health_information/information_for_consumers/ understanding_cm \\\\\\\\\\\\\\\[Accessed 8/7/20\\\\\\\\\\\\\\\]. 4. TGA, ‘Complementary medicines overview’, tga.gov.au/complementary-medicines-overview \\\\\\\\\\\\\\\[Accessed 6/7/20\\\\\\\\\\\\\\\]. While homeopathic preparations are included within the TGA definition of complementary medicine, the issue of whether homeopathic preparations should be sold within retail pharmacy has been hotly debated over the past few years. Advising on complementary medicine Education and professional development are key when it comes to dispensing advice around complementary medicine. However, effective healthcare provision goes beyond the theory. There’s a human element to effective practice. “The first thing \\\\\\\\\\\\\\\[pharmacists and pharmacy staff need to know\\\\\\\\\\\\\\\] is... how to communicate with a person,” Mr Quigley said. “Seventy per cent of Australians use some sort of complementary medicine \\\\\\\\\\\\\\\[but\\\\\\\\\\\\\\\] most people don’t spread that news. They’re frightened they’re going to get told off by their doctor. And they’re often dismissed as well – ‘it won’t do you harm but why would you bother?’ – by some pharmacists. We’ve got to show people a lot more respect. “So, they need to know firstly the For more on medicinal cannabis, turn to page 68. RETAIL PHARMACY • AUG 2020