In many countries, considerably more activity is required regarding: qualification and licensing of providers; proper use of products of assured quality; good communication between TM/CAM providers, allopathic medicine practitioners and patients; and provision of scientific information and guidance for the public.
Table 11. Key needs in promoting sound use of TM/CAM by providers and consumers
At national level:
• Training guidelines for most commonly used TM/CAM therapies.
• Strengthened and increased organization of TM/CAM providers.
• Strengthened cooperation between TM/CAM medicine providers and allopathic medicine practitioners.
• Reliable information for consumers on proper use of TM/CAM therapies and products.
• Improved communication between allopathic medicine practitioners and their patients concerning latter's use of TM/CAM.
Education and training
Challenges in this area are at least twofold (Table 11). Firstly, ensuring that the qualifications and training of TM/CAM providers are adequate. Secondly, using training to ensure that TM/CAM providers and allopathic medicine practitioners understand and appreciate the complementarity of the types of health care they offer. The first involves establishing, where possible, examination and licensing systems legislation so that only those who are qualified can practice TM/CAM or sell TM/CAM products. The for TM/CAM, and second requires modifying training programmes for TM/CAM providers to include basic elements of primary health care and public health, and ensuring that pharmacy, medical and public health degrees include a component on TM/CAM.
Proper use of products of assured quality
Proper use of products of assured quality can also do much to reduce risks associated with TM/CAM products such as herbal medicines. However, regulation and registration of herbal medicines are not well developed in most countries. Products may be contaminated or vary tremendously in content, quality and safety. Garlic, for example, often claimed to have cholesterol-lowering effects, may fail to produce such effects if processed in certain ways.54 At the same time, standards to control labelling of and publicity for herbal medicines are few. Moreover, many are sold as over-the-counter or dietary supplements, with little advice offered on their appropriate use. Consumers may then be unaware of potential side-effects, and how and when herbal medicines can be taken safely. Reversing this situation will necessitate much more stringent control of TM/CAM products and greater efforts to educate the public in this area.
Information and communication
Use of TM/CAM is increasing rapidly. But appreciation of its risks and how to avoid those risks has not kept pace. As a result, consumers may not understand why they should seek treatment only from suitably qualified and trained providers, or why they should exercise caution when using TM/CAM products. It is not commonly understood, for example, that side-effects following reactions between herbal medicines and chemical drugs can occur. On its own, for example, ginseng has few serious adverse effects. But if combined with warfarin, its antiplatelet activity risks causing overanticoagulation.55 Similarly, use of St John's wort as an antidepressant has been shown to compare favourably with a standard antidepressant, imipramine. But if St John's wort is taken by subjects who are also taking indinavir, an HIV protease inhibitor, levels of indinavir in the blood are reduced below the level required to block HIV multiplication.56,57
Without knowledge of the possibility of such interactions, patients may fail to inform their allopathic doctors about the TM/CAM products they are using, while allopathic doctors may fail to ask. In the USA, for both 1990 and 1997, less than 40% of CAM therapies used were disclosed to a physician.13 At the same time, allopathic doctors, nurses and pharmacists, all of whom may be used as information sources by the general public, may not be informed about CAM and therefore unable to answer patients' queries about CAM treatment options.
Information, education and communication strategies could overcome some of these problems, and raise awareness of the potential benefits of TM/CAM.