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Complementary Medicine: Exploring the Issues U3A Short Course (3 of 3 Sessions), Nov 2014

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Complementary Medicine: Exploring the Issues U3A Short Course (3 of 3 Sessions), Nov 2014 Complementary Medicine: Exploring the Issues U3A Short Course (3 of 3 sessions), Nov 2014 Complementary Medicine: Exploring the Issues Dr Ken Harvey and Grace Jackel and Aaron Kovacs (SPH&PM Summer Research Program students) Short Course (3 of 3 sessions), Nov 2014, Multicultural Hub Issues that could be explored • What is complementary &/or alternative medicine? • Who uses it, why and what for? • Regulation of products and practitioners; • The current review of the private health insurance rebate for natural therapies; • How do we know if it works: what is evidence? • Evidence for and against specific products &/ or therapies for certain conditions; • Sources of good information about complementary medicine, and • Using complementary medicine wisely. 2 Dr Ken Harvey Page 1 Complementary Medicine: Exploring the Issues U3A Short Course (3 of 3 sessions), Nov 2014 Recap: TGA list of evaluated registered CMs • Of the 25 products on the list most are unremarkable: Iron, Calcium, Vitamin D, Psyllium fibre and Ispaghula husk for constipation, Clove oil for toothache. • More innovative products are: – IBEROGAST (Flordis). A specific nine herb mixture, “for the treatment of functional dyspepsia and irritable bowel syndrome”. – KALOBA (Schwabe) containing a specific extract of Pelargonium sidoides (EPs 7630) for “for the treatment of acute bronchitis and sinusitis” (an alternative to prescribing an antibiotic). – FLEXAGIL (Blackmores). A specific extract of Symphytum officinale (Comfrey) for topical application for the “relief of lower back pain, painful joints and strains”. http://www.tga.gov.au/industry/cm-basics-regulation- evaluation.htm 3 Specific products &/or therapies: Evidence? 4 Dr Ken Harvey Page 2 Complementary Medicine: Exploring the Issues U3A Short Course (3 of 3 sessions), Nov 2014 You wanted to know about: Product / therapy Condition Glucosamine / Turmeric (curcumin) / Osteoarthritis Evening primrose oil Omega‐3 fatty acids (fish oil / krill oil / Preventing cardiovascular disease; cod liver oil / Chia seeds) arthritis; immune boosting Calcium & Vitamin D Osteoporosis Vitamin C / Garlic / Echinacea Colds (prevention and symptom relief); immune boosting Magnesium (Nigari flakes, etc) Health & rejuvenation; muscle cramps; restless legs syndrome Acupuncture Pain / General well being 5 Sources of good information about CM • Summarised evidence: – National Center for Complementary and Alternative Medicine • http://nccam.nih.gov/health/decisions – Medline Plus • http://www.nlm.nih.gov/medlineplus/ – The Cochrane Library • http://www.thecochranelibrary.com – PubMed Health • http://www.ncbi.nlm.nih.gov/pubmedhealth/ – Healthdirect Australia • http://www.healthdirect.gov.au/ • Original clinical trials – PubMed • http://www.ncbi.nlm.nih.gov/pubmed/ 6 Dr Ken Harvey Page 3 Complementary Medicine: Exploring the Issues U3A Short Course (3 of 3 sessions), Nov 2014 Glucosamine: Who uses it? • The 45 and Up Study is the largest study of healthy ageing ever undertaken in Australia. • It involved self‐reported data on over 265,000 participants aged 45 and over. • The study found that 58,630 (22%) participants reported using glucosamine in the 4 weeks prior to the survey. • Use was higher for those who were female, non‐smokers, residing in inner/outer regional areas, with higher income and private health insurance. • Use was associated with a reported condition of osteoarthritis. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0041540 7 Glucosamine for osteoarthritis • Nature’s Way Glucosamine 1500 mg contains the clinically recommended daily dose of glucosamine in just one convenient tablet. • Glucosamine is considered the most important nutrient for the protection, renewal and building of joint tissue and in forming the ‘cushioning’ effect of the joints and surrounding tissues. • Glucosamine promotes the protection, repair and rebuilding of damaged joints and cartilage in the fingers, hands, wrists, knees, back, neck, hips, ankles and feet. • Clinical trials and research show that glucosamine helps: $30.99 (180 tabs) – Provide temporary relief of the pain of osteoarthritis, SAVE $9.00 – Reduce joint inflammation and swelling, RRP $39.99 – Increase joint mobility, Dose: 1 tab per day – Keep all the joints in the body lubricated and supple. (17 cents per day) http://tinyurl.com/lppbv6f 8 Dr Ken Harvey Page 4 Complementary Medicine: Exploring the Issues U3A Short Course (3 of 3 sessions), Nov 2014 Glucosamine for osteoarthritis • Cenovis® Glucosamine 750 helps to maintain the structure and function of cartilage in joints, while also helping to repair and rebuild damaged cartilage. – May assist in the management of osteoarthritis. – Temporarily relieves pain and enhances joint mobility. – May help reduce the joint inflammation, swelling and tenderness associated with arthritis. – May assist in the maintenance of proper joint function. – May provide temporary relief of joint pain. – May enhance joint mobility. – Maintains structure and function of joint cartilage. $30.19 (200 tabs) – May help reduce joint inflammation, swelling and tenderness associated with arthritis. Dose: 2 caps daily 30 cents per day http://www.cenovis.com.au/glucosamine-750/ 9 Glucosamine for osteoarthritis • Blackmores Glucosamine 1500 offers a convenient, one a day dose to help reduce joint inflammation and swelling, and help relieve the pain caused by osteoarthritis. • Supplementary glucosamine sulfate helps reduce cartilage wear, increase joint mobility and decrease joint stiffness in osteoarthritis. – Effective for osteoarthritic pain relief – Helps reduce cartilage wear – Contains the most scientifically validated form of glucosamine; glucosamine sulfate sodium chloride complex – Results expected after 2‐4 weeks • Clinical trials have shown that 1500 mg glucosamine sulfate as $59.49 (180 tabs) sodium chloride complex significantly improves pain and Dose 1 tab per day functionality in osteoarthritis. In addition, glucosamine sulfate 33 cents per day may have a long‐term protective effect, acting to reduce cartilage wear. http://www.blackmores.com.au/products/glucosamine-1500 10 Dr Ken Harvey Page 5 Complementary Medicine: Exploring the Issues U3A Short Course (3 of 3 sessions), Nov 2014 Glucosamine for osteoarthritis • DONA® Glucosamine is a patented formulation of glucosamine sulfate clinically proven to reduce the pain and assist in the management of osteoarthritis. • DONA Glucosamine may also help to maintain joint health and rebuild cartilage that has been worn away by progressive age or injury. • It is manufactured using a patented process by one of the leading natural medicine companies in the world, Madaus/Rottapharm. • DONA Glucosamine was developed following many 750 mg (120 tabs) years of research and has been the subject of 25 Dose: 2 daily clinical trials. $1.00 per day http://www.flordis.com.au/product/dona-glucosamine 11 Glucosamine for osteoarthritis Brand Formulation Daily Daily Dose Price Nature’s Way Glucosamine hydrochloride 1 tab $0.17 1500 mg Cenovis Glucosamine hydrochloride 2 caps $0.30 750 mg Blackmores Glucosamine sulphate sodium 1 tab $0.33 chloride complex 1500 mg Flordis Glucosamine sulphate 2 tabs $1.00 (Rottapharm DONA) 750 mg Glucosamine is sold by itself in the form of glucosamine hydrochloride or sulphate or in combination with other supplements (such as chondroitin). 12 Dr Ken Harvey Page 6 Complementary Medicine: Exploring the Issues U3A Short Course (3 of 3 sessions), Nov 2014 Glucosamine for osteoarthritis • Major studies of glucosamine for osteoarthritis of the knee have had conflicting results. – A large National Institutes of Health (NIH) study, compared glucosamine hydrochloride, chondroitin, both supplements together, celecoxib (a prescription drug used to manage osteoarthritis pain), or a placebo (an inactive substance) in patients with knee osteoarthritis. Most participants in the study had mild knee pain. Those who received the prescription drug had better short‐term pain relief (at 6 months) than those who received aplacebo. – Overall, those who received the supplements had no significant improvement in knee pain or function, although the investigators saw evidence of improvement in a small subgroup of patients with moderate‐to‐severe pain who took glucosamine and chondroitin together. – In several European studies, participants reported that their knees felt and functioned better after taking glucosamine. The study participants took a large, once‐a‐day dose of a preparation of glucosamine sulfate (Rottapharm) sold as a prescription drug in Europe. – In general, research on chondroitin has not shown it to be helpful for pain from knee or hip osteoarthritis. http://nccam.nih.gov/health/glucosaminechondroitin 13 Glucosamine for osteoarthritis • A few studies have looked at whether glucosamine or chondroitin can have beneficial effects on joint structure. Some but not all studies found evidence that chondroitin might help, but the improvements may be too small to make a difference to patients. There is little evidence that glucosamine has beneficial effects on joint structure. • No serious side effects have been reported in large, well‐conducted studies of people taking glucosamine, chondroitin, or both for up to 3years. • However, glucosamine or chondroitin may interact with the anticoagulant (blood‐ thinning) drug warfarin (Coumadin) and also the way your body handles sugar, especially if you have diabetes or other blood sugar problems, such as insulin resistance or impaired glucose tolerance.
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