CAMLAW: Complementary and Alternative Medicine Law Blog

Traditional medicine rocks in Singapore

We call our health care system "traditional," so do they.

Traditional medicine is the preferred World Health Organization term for what we known as "CAM."  It's big in Singapore:

SINGAPORE: Singapore's traditional medicine sector is vibrant. Minister in the Prime Minister's Office, Lim Swee Say, said on Friday that imports grew 63 per cent over the last five years to hit S$49 million last year.

Speaking at the inaugural Traditional Medicine Expo, Mr Lim observed that more traditional medicine products are now produced locally and the industry here appears to be on the uptrend.

He also noted the growing popularity of complementary medicine among younger, English-educated adults, who have come to recognise the legitimacy and effectiveness of combining it with western medicine.

The expo will run till Sunday at the Suntec Convention Centre.

In the UK, Prince Charles speaks on regulation of complementary medicine:


His Foundation for Integrated Health charity says without regulation new EU laws will ban most of the trade, forcing patients to use bogus outlets.

From 2011 EU legislation will permit only statutorily registered professionals like doctors to prescribe manufactured herbal remedies.

The government says it will reach a decision in the new year.

But there are codes under which practitioners use remedies manufactured to recognisable standards.

The EU Directive that will be implemented from April 2011 will restrict herbal medicines that can be supplied over-the-counter to licensed "traditional" medicines used to treat "mild and self-limiting" conditions - basically meaning nothing worse than a cold.

Black market

At the same time, it will become unlawful for anyone except "statutorily regulated" professionals to treat patients with any other herbal medicines, except those that a herbalist prepares personally on his/her own premises.

The Prince's Foundation says this will mean many herbalists will no longer be able to offer remedies to their clients and patients will instead turn to the black market.

The Foundation believes regulation would resolve this, by bringing vetted herbalists within the EU law.

But this is at odds with eminent scientists who sceptical about herbalism and are against statutory regulation on the grounds it would make such treatments "respectable".

Professor George Lewith, a doctor and expert in complementary medicine, said: "Failing to introduce statutory regulation will amount to a Quack's Charter.

"It is the incompetent and the irresponsible we need to stop. Not the well-trained, dedicated herbalists who put their patients first.

"We cannot wash our hands of responsibility for herbal medicine and the patients who use it.

"No-one deserves to die for no better reason than preferring herbal remedies to conventional medicine."

A nurse gives practice tips about advising patients regarding CAM:

Abstract

Mantle F (2009) The risks associated with consumer magazines giving advice on complementary therapies. Nursing Times; 105: 48, early online publication.

Background The increased popularity of complementary and alternative medicine (CAM) has led to increased demand for information on it, giving rise to the concept of “new experts”. However, there is concern about the quality and accuracy of this information, much of which is published in popular magazines and written by contributors with no medical qualifications.  

Aim To examine the extent of CAM product advice in women’s and health magazines, and the potential for adverse drug/herbal interaction.

Method Fifteen women’s magazines were examined over one month.

Results and discussion A total of 150 articles were identified, of which 131 were written by non medically qualified contributors, mainly journalists. Out of the 150, 95 discussed ingested herbs which had the potential for adverse interactions and are contraindicated for certain groups.

Conclusion The findings have legal and ethical implications. The re-evaluation of the journalists’ code of conduct to reflect this new development in journalism should be considered.

Keywords: Complementary and alternative medicine, CAM, Herbal remedies

  • This article has been double blind peer reviewed

Practice points

As a result of these findings, nurses need to be aware of the following issues:

  • Patients may access many and varied sources of medical information;

  • Patients may use CAM therapies either on their own or in combination with concurrent orthodox medication;

  • There is a growing group of “new experts”, who may have minimal or no relevant training.

Introduction

With higher expectations of healthcare provision and general disenchantment with its delivery, many people are turning to complementary and alternative medicine (CAM). This has led to a significant increase in the amount of information about its use being made available in traditional media and on the internet (Ong and Banks, 2003). Giddons (1990) coined the phrase “new experts’ on health and wellbeing (old experts being proponents of orthodox and mainstream knowledge). For those who are dissatisfied with their current healthcare system, these modalities can provide a welcome source of information.

However, the quality of advice given and the qualifications of “new experts” cannot be guaranteed. Of particular concern is the plethora of lay advice available about CAM in popular magazines. Some are specifically devoted to CAM while others, primarily focusing on women’s issues, often contain information about using CAM for medical conditions. This may take the form of readers’ contributions, celebrity endorsement, feature articles promoting CAM, product placement in response to specific conditions and information about therapies in general. A common format is columns in which new experts offer advice about CAM interventions for medical problems, ostensibly sent in by readers.

Observation of a selection of these magazines indicates that, although some of this information is written by medically qualified writers, the majority is by contributors whose key remit appears to be new product placement. This raises legal, ethical and safety issues regarding the potential use of CAM by uninformed members of the public and its sequelae in terms of latent harm to both adults and children.

One side effect of the increase in health information via the media is the worrying trend towards self medication, either with orthodox medication or with CAM.

The scope of self medication

Proprietary drugs sold over the counter (OTC) include analgesics (including those containing codeine), antihistamines, vitamins, tonics, antacids, statins and cough medicines. The World Medical Association (2002) stated that individuals have primary responsibility for using OTC products, but if they choose to self medicate, they should be able to:

  • Recognise the symptoms they are treating;

  • Determine that their condition is suitable for self medication;

  • Choose a suitable product;

  • Follow the directions for use.

Self medicating for a diagnosis of cold or flu is well within most people’s capability. However, the seriousness of other symptoms may be less obvious and result in delays in seeking appropriate treatment.

Sihvo and Hemminki (1999) highlighted the dangers of self medication, in this instance, to treat dyspepsia. This research discussed a common remedy for a common problem but indicated the potential for serious misdiagnosis. A survey conducted on 50 consecutive customers in 10 pharmacies (response rate 53%) showed 88% were self medicating for heart burn, 31% for gastrointestinal pain, and 32% for acid regurgitation. Of these, 75% had been using the drugs for over a year, while 6% had symptoms which contraindicated self medication but had not consulted a doctor. Although this was a small study, the level of continuous self medication was high and could indicate cause for concern.

More recently, Bardia et al (2007) conducted a survey among 30,600 adults, finding that 3,315 used herbs to treat a specific medical condition and, of these, two thirds did not do so in accordance with evidence based indications.  

Risks related to self medication with CAM products include:

  • The appropriateness of the intervention for the condition;

  • Failure to appreciate the significance of the presenting symptoms and incorrect self diagnoses being made;

  • The possibility of a delay in seeking orthodox treatment, or the refusal of more appropriate orthodox treatment.

One perennial problem regarding safety and CAM is the enduring perspective that, since these medicines are perceived as “gentle” and “natural”, they are intrinsically safe and have no side effects. This can be wrong but may it prove difficult to change patient perceptions.

Mintel (2003) noted that annual retail expenditure on homeopathic remedies, herbal remedies and essential oils was £126m.

Thomas et al (2001) noted that the purchase of OTC remedies was highest in the 18-44 age bands for both men and women, and that in every age band women were twice as likely as men to use OTC products.

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Michael H CohenMichael H Cohen
Founder
The Los Angeles / San Francisco / Bay Area-based Michael H Cohen Law Group provides healthcare legal and FDA legal & regulatory counsel to health & wellness practices and ventures, including health technology companies (medical devices to wearable health and nanotech), healthcare facilities (from medical centers to medical spas), and healthcare service providers (from physicians to psychologists).Our legal team offers expertise in corporate & transactional, healthcare regulatory & compliance, and healthcare litigation and dispute resolution, in cutting-edge areas such as anti-aging and functional medicine, telemedicine and m-health, and concierge medicine.Our Founder, attorney Michael H. Cohen, is an author, speaker on healthcare law and FDA law, and internationally-recognized thought leader in the trillion-dollar health & wellness industry.
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