Use of complementary and alternative medicines by a sample of Australian women during pregnancy

Background: The use of complementary and alternative medicines (CAM) is growing in Australia, with women higher users than men. Yet, only a few Australian studies have explored the use of CAM during pregnancy.

Aims: To explore the use of CAM, the types of CAM practitioners consulted, physical symptoms/complaints for which CAM are used by a sample of pregnant Australian women, and women's perceptions of the efficacy of CAM in treating those complaints.

Methods: Three hundred and twenty-one pregnant women, who volunteered for a study exploring women's well-being during pregnancy, completed a self-report questionnaire in their late second/early third trimester.

Results: Seventy-three per cent of women had used at least one kind of complementary therapy in the prior eight weeks of pregnancy. Over one-third of the women had visited at least one alternative medicine practitioner during pregnancy. Approximately one-third of the women reported taking CAM to alleviate a specific physical symptom, with 95.7% of these women reporting they either got completely better or a little bit better with use of CAM; one quarter reported planning to use an alternative therapy to assist with labour preparation. Age, number of physical symptoms experienced, income level and level of education were not associated with greater use of CAM (P < 0.05); however, women reporting more physical symptoms were more likely to consult a CAM practitioner.

Conclusion: Findings highlight the substantial use of CAM during pregnancy and the need to have all health professionals adequately informed about such therapies during this life stage.

Generic medicines in Australia : business dynamics and recent policy reform

This article describes the role of generics in the Australian prescription drug market and patterns of business activity in this dynamic market segment. The Pharmaceutical Benefits Scheme (PBS) is the central mechanism for the supply of prescription medicines. PBS prices are arrived at through cost-effectiveness analyses comparing new products against already available products and therapies. In this system, prices do not operate effectively as incentives for consumers or prescribers to choose generics, and their market share was historically marginal. In recent years, generics suppliers achieved a growing market share through discounts (trading terms) to pharmacists. It is estimated that around 30% of PBS scripts, representing around 15% of PBS sales by value, are now filled with generics. Complex changes to the PBS were introduced in 2007, to be phased in over the period to 2012, aimed at increasing the scope for cost benefits to the government, and to lesser extent consumers, from the expanding availability of generic medicines.

Effect of deer velvet on sexual function in men and their partners: a double-blind, placebo-controlled study

The use of alternative medicines and herbal remedies is an increasing trend in Western societies. For years, people have taken products made of deer velvet for their alleged beneficial effects on sexual function. There has been no scientific investigation of the effects of deer velvet powder on the sexual functioning of human males. This study investigated sexual function in men during a 12-week double-blind, placebo-controlled trial of deer velvet. Thirty-two volunteer male participants, aged 45–65 years, and their partners, were randomly assigned to either the deer velvet or placebo study group. The males took capsules containing ground deer velvet or placebo everyday for 12 weeks. Two sexual function questionnaires (the International Index of Erectile Function and the Brief Index of Sexual Function for Women) used at pre- and posttreatment assessed changes in sexual functioning in males and their partners. Blood tests at baseline, and end of study, determined levels of sex-related hormones in male participants. There were no significant differences in the sexual behavior of the men taking deer velvet compared with the men taking placebo capsules. There were no significant hormone changes from baseline to the end of the study in either group of men. We conclude that in normal males there was no advantage in taking deer velvet to enhance sexual function. All alternative health products or nutritional supplements should be subjected to randomized placebo-controlled trials to determine efficacy.

Do high-risk medicines alerts influence practice?

Background: Medicine-related adverse events are prevalent, costly and mostly preventable. The High Risk Medicines Working Party (Victoria) developed and distributed three highrisk medicines alerts – wrong route of administration of oral medicines, subcutaneous insulin and unfractionated heparin – and accompanying audit tools in 2008 and 2009.
Aims: To determine the impact of the three high-risk medicines alerts on Victorian health services; to assess the clinical relevance and utility of the audit tools; to identify barriers to implementing recommendations; and to obtain feedback and suggestions for future alert topics.
Method: A cross-sectional survey was undertaken from 6 to 31 July 2009 using an online questionnaire. The questionnaire was distributed to 90 metropolitan, regional and rural public health services in Victoria and approximately 200 members of the Quality Use of Medicines Network (Victoria).
Results: Most of the 90 respondents were pharmacists (53%) and nurses (31%). 53 (59%) respondents reported making changes as a result of receiving the high-risk medicines alerts – 21 (40%) concerned the wrong route of administration, 12 (23%) subcutaneous insulin and 7 (13%) unfractionated heparin. Barriers to implementation included time constraints, inadequate staff and resources, excessive paperwork and competing priorities. A minority of respondents indicated some alerts were not relevant to small rural services. Suggestions for
improving the audit tools included making them less labour intensive, enabling electronic responses and ensuring their distribution is coordinated with other medicine-related tools.
Conclusion: High-risk medicines alerts and the accompanying audit tools facilitated change but there were some barriers to their implementation, such as time and resource constraints. Not all alerts and audit tools were relevant to all health services.

Complementary medicine, exercise, meditation, diet, and lifestyle modification for anxiety disorders : a review of current evidence

Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity and exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our review found that in respect to treatment of generalized anxiety or specific anxiety disorders, CAM evidence revealed support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the management of anxiety disorders.

EU-India free trade negotiations threatening access to medicines

Indian firms are major global producers of relatively affordable generic medicines. Access to such drugs makes the difference between life and death for billions of people in the Global South. The Economist noted recently that ‘America should not use trade deals to swaddle drugmakers in excessive patent protections’. Nor should the European Union (EU) impose obstacles to the supply of generic drugs by Indian firms beyond those already mandated by the Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Free trade negotiations between the EU (reported to be close to completion) constitute a clear threat to the role of India as the ‘pharmacy of the developing world’.

The politics of the pharmaceutical industry and access to medicines : world pharmacy and India

The Pharmaceutical Industry presents one of India’s most successful stories of economic expansion and improvements in public health. Indian firms have made access to quality medicines possible and affordable in many developing countries. Indian pharmaceuticals are also exported on a large scale to the United States and other highly regulated markets. A wave of mergers, acquisitions and tie-ups point to growing integration between Indian firms and global pharma multinationals.

The Politics of the Pharmaceutical Industry and Access to Medicines: World Pharmacy and India examines this important industry from different economic, social and political perspectives. Topics covered include the implications of TRIPS-compliant intellectual property rights, the role of flexibilities under TRIPS, the market regulation system, the role of Indian firms in exporting HIV/AIDS medications to Africa, the issue of free trade agreements, the power and reach of foreign pharmaceutical multinationals in India’s domestic market, and the sustainability of India as a major generics supplier.

The Pharmaceutical Industry and Access to Medicines in India

Pharmaceutical policy in India as elsewhere is shaped by conflicting economic and social interests and opposing values and priorities. Tensions can be understood as revolving around the contradiction between use value and exchange value in the production of medicinal drugs as commodities, as per Marx’s original analysis. The use value of medicines – if safe and efficacious, of good quality, and prescribed and consumed appropriately – is the prevention, cure or alleviation of ill-health and disease. Health policy is – or should be – aimed at optimising the use value of medicines. For this purpose government agencies administer regulatory oversight of the manufacturing, marketing and distribution of medicines. Drugs made available to patients are expected to meet adequate safety, quality and efficacy standards, but regulation to ensure such standards is subject to controversy in most countries. This is a domain where definition and interpretation of scientific-technological principles and criteria is infused by partiality and bias grounded in social and material interests, as evidenced by recurrent debates about industry ‘capture’ of regulatory agencies, including the world’s most regulator, the US Food and Drug Administration (Angell 2005; Law 2006). In India, a Parliamentary Committee Report in 2012 depicted the Central Drugs Standard Control Organisation (CDSCO) as dysfunctional and influenced inappropriately by the exchange value perspective of manufacturers (Parliamentary Standing Committee on Health and Welfare 2012). The clash between use and exchange value perspectives is starkly illustrated by cases of products known to cause more harm than good, particularly common in poorly regulated markets such as India’s, as shown by Srinivasan & Phadke.

The pharmaceutical industry, intellectual property rights and access to medicines in Pakistan

The pharmaceutical industry in Pakistan is worth around US$ l.18 billion, with annual growth in 2010 approaching 10 per cent (Khan, 2012). There are more than 650 registered companies, including 31 multinationals, which in 2006 had a market share in value terms of 53.3 per cent, with national firms controlling the remaining 46.7 per cent (IMS Health, 2007). In 2007 medicines worth about US$100 million were exported. Medicines are a vital component of healthcare, and Pakistan spends around three-quarters of its healthcare budget on medicines (WHO, 2004). This chapter provides an overview, from a public health perspective, of the national pharmaceutical market and the development of drug policies and regulation. Pakistan adopted a Trade Related Aspects of Intellectual Property Rights (TRIPS) compliant patent regime in 2000, and the intersection between patents and public health is a central policy challenge. This chapter highlights key issues related to intellectual property, Free Trade Agreements (FTAs), and production and access to medicines.