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Research Priorities for Complementary Medicine in Australia © National Institute of Complementary Medicine This Work Is Copyright Research Priorities for Complementary Medicine in Australia © National Institute of Complementary Medicine This work is copyright. The Copyright Act 1968 permits fair dealing for study, research, news reporting, criticism or review. Selected passages, tables or diagrams may be reproduced for such purposes provided acknowledgment of the source is included. Permission for any more extensive reproduction must be obtained from NICM. Acknowledgments The NICM wishes to thank the following people for their time and expertise in leading the Working Groups and finalising the reviews included in this report: Dr Monica Robotin, Associate Professor David Colquhoun, Professor Con Stough, Professor Richard Day, Professor Paul Komesaroff, and Professor Marc Cohen. Disclaimer Every effort has been made to ensure the accuracy of this document. However, NICM, its employees and agents disclaim liability for any loss or damage that may arise as a consequence of any person relying on the information contained in this document. New research studies and data on complementary medicine appear on a monthly basis. This ever-developing evidence profile may influence and shift priority areas for investigation in complementary medicine. The work documented in this report was completed at various stages over the last three years so, in some cases, the key data may already be 18 months old. Hence, the recommended research priorities in this report should be taken as a starting point for further discussion and exploration, rather than as a defined, fixed program of recommended research. NICM will continue to update recommended research priority areas and undertake reviews in additional clinical discipline areas. Currency All figures quoted in this report are given in Australian dollars, unless otherwise indicated. Contact For all general NICM enquiries please contact: Administrative Officer National Institute of Complementary Medicine (NICM) UWS – Bldg 3, Campbelltown Campus Locked Bag 1797 PENRITH 2751 Phone: (02) 4620 3284 Fax: (02) 4620 3722 Email: [email protected] ISBN ISBN 978-1-74108-276-0 Date and place of publication: August 2013, University of Western Sydney Edited by Stephen Sheldon of Write to the Point (www.writetothepoint.net.au) Research Priorities for Complementary Medicine in Australia July 2013 Highlighting Complementary Medicine Research NICM IS AN AUSTRALIAN AND NSW GOVERNMENT INITIATIVE HOSTED BY THE UNIVERSITY OF WESTERN SYDNEY WWW.NICM.EDU.AU Director’s message Australians are among the world’s highest users of complementary medicines. Two in three Australians use complementary medicines or therapies each year, many of them on a regular basis, representing an expenditure of over $3.5 billion each year. About half of this use is in relation to the management of major chronic diseases. Increasingly we are finding that complementary medicine has the potential to contribute positively to the management of chronic diseases and improve health outcomes, through increased effectiveness, improved safety or cost-effectiveness of patient care, often when integrated with conventional medical care. Despite this, Australia has one of the lowest rates of investment in research into complementary medicine. This limits the ability of Australian consumers and health practitioners to make informed, evidence-based decisions about the therapies they use. It also opens the door for some medical scientists and practitioners to question the validity of many complementary medicine interventions due to a lack of evidence. As a longstanding advocate of evidence-based complementary medicine, it therefore gives me great pleasure to introduce this report, which articulates a rigorous strategy to guide research in complementary medicine. The report focuses on target areas that have a higher burden of disease, that accord with the Australian Government’s National Health Priority Areas, and that have a greater probability of success. It is a critical step to building our national research effort in complementary medicine for the better health of the Australian community. Professor Alan Bensoussan Director National Institute of Complementary Medicine University of Western Sydney National Institute of Complementary Medicine The National Institute of Complementary Medicine The NICM’s projects have included: (NICM) was established in 2007 with initial seed • An investigation into the cost-effectiveness of CM – funding from the Australian Department of Health and NICM commissioned Access Economics to evaluate Ageing and the NSW Office for Science and Medical the cost-effectiveness of five complementary medicine Research (now part of the NSW Department of Trade interventions. Access Economics found that some CMs and Investment, Regional Infrastructure and Services). The University of Western Sydney hosts NICM at its would have a positive impact on the national healthcare Campbelltown campus. system if their integration into daily medical practice were improved. The role of NICM is to provide leadership and support • The establishment of collaborative centres – NICM for strategically directed research into complementary seeded three national collaborative centres in medicine (CM) and translation of evidence into clinical Traditional Chinese Medicine; Natural Medicine practice and relevant policy to benefit the health of all and Neurocognition; and Nutraceuticals and Herbal Australians. Medicine. In doing so, it has built research capacity in The establishment of NICM followed the 2003 the area and supported professional development. recommendation by the Expert Committee on • Integrative care grants – NICM awarded six integrative Complementary Medicines in the Australian Health care grants (two in partnership with the National Breast System that the government has a social responsibility Cancer Foundation) to provide evidence and insight to fund complementary medicine research given the into optimal integrative care for target diseases. high community use of complementary medicines and • Standard operating procedures for clinical trials - While therapies. these procedures were initially designed for use in traditional Chinese medicine, they may be adopted and modified for all complementary medicine sectors and are available on the NICM website. RESEARCH PRIORITIES FOR COMPLEMENTARY MEDICINE IN AUSTRALIA Summary 1 1 | About this Report 4 1.2 Aims of this report 5 1.3 Who should read this report? 5 2 | What is ‘Complementary Medicine’? 6 2.1. International definitions of CM 6 2.2. Classifications of CM 7 2.3 How does CM differ from conventional medicine? 8 2.4 Why invest in CM research? 8 3 | How Priorities were Selected 9 3.1 Overarching research priorities 9 3.2 Research priority areas 9 3.3 Expert groups 10 3.4 Priority-setting matrix 10 3.5 The importance of evidence 11 3.6 Conclusion 12 4 | Cardiovascular Health 13 4.1 Some limitations of conventional treatment 14 4.2 Methodology 15 4.3 Evidence of effficacy 15 4.4 Nutrition and dietary supplements 16 4.5 Bioactive food components 19 4.6 Herbal preparations 21 4.7 Other therapies 24 4.8 Recommended CM therapies 26 4.9 Conclusions and Recommendations 28 5 | Cancer 35 5.1 Prevalence of cancer 35 5.2 Some limitations of conventional treatment 36 5.3 The role of complementary medicine 36 5.4 Methodology 37 5.5 Conclusions and recommendations 40 6 | Arthritis and Musculoskeletal Conditions 43 6.1 Prevalence of arthritis and musculoskeletal conditions 43 6.2 Treatments 45 6.3 Some limitations of conventional treatment 45 6.4 The role of complementary medicine 45 6.5 Methodology 46 6.6 Conclusions and recommendations 50 Contents 7 | Dementias 53 7.1 Prevalence of dementias 53 7.2 Some limitations of conventional treatment 54 7.3 The role of complementary medicine 54 7.4 Methodology 54 7.5 Comparison of CM treatments 55 7.6 Conclusions and recommendations 73 8 | Diabetes 85 8.1. Prevalence of diabetes in australia 85 8.2 The role of complementary medicine 88 8.3 Conclusions and recommendations 91 9 | Wellness and Disease Prevention 95 9.1 Wellness and chronic diseases 96 9.2 Evidence of efficacy 96 9.3 Issues around wellness 99 9.4 How to measure wellness 100 9.5 Wellness and information technology 103 9.6 Conclusions and recommendations 103 10 | Conclusion and next steps 110 10.1 Conclusion 110 10.2 Next steps 110 Appendix A- Developing a Herbal Diabetic Treatment 112 A.1 Requirements for developing a herbal diabetic treatment 112 A.2 Cost implications 113 A.3 Testing procedures and scientific techniques 113 A.4 Process for developing herbal treatments for diabetes 114 A.5 Overarching research program 115 A.6 Summary of suggested plan and timelines 116 Appendix B - Traditional Chinese Medicine 117 B.1 What is TCM? 117 B.2 Traditional chinese medicine in australia 117 B.3 Current evidence for TCM 117 B.4 Research priorities in TCM 122 B.5 Methodological challenges in performing TCM research 123 Glossary ABS Australian Bureau of Statistics AIHW Australian Institute of Health and Welfare ARC Australian Research Council ASMI Australian Self Medication Industry Association CAM Complementary and alternative medicine CHC Complementary Healthcare Council CHD Coronary heart disease CM Complementary medicine CRC Cooperative Research Centre CVD Cardiovascular disease DALY Disability adjusted life year DHA Docosahexaenoic acid DIISR Department of Innovation, Industry, Science and Research DOHA Department of Health and Ageing DHA Docosahexaenoic acid MCI Mild cognitive impairment MI Myocardial infarction mmol/L Millimoles per litre
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