Key Points:

• Scientific studies have found that some complementary and alternative medicines or therapies are effective, but many are unproven or ineffective.  Some can be harmful.
• Complementary and alternative medicines or therapies (CAMs) are used by about two thirds of people in Australia.
• Most CAMs are considered safe when conducted by a trained and experienced practitioner. However, there may be times that a certain therapy may carry higher risks for you, such as if you are receiving chemotherapy
• The Therapeutic Goods Administration (TGA) regulates all medicines in Australia, including complementary medicines and vitamin and mineral supplements.
• Complementary medicines are assessed for the safety and quality of ingredients, but not always for whether they work (efficacy)
• Complementary medicines made in Australia are subject to strict product safety and quality regulations. This may not be the case in other countries.
• You should discuss your complementary or alternative treatments and medicines with your doctor.
• Some complementary therapies interact with conventional medicines, which can make your treatment less effective or harmful.

Complementary and Alternative Medicines

The terms complementary therapy and alternative medicine or therapy are often used as if they mean the same thing. They may also be combined into one phrase – complementary and alternative medicines (CAMs).

Complementary medicines or therapies are used alongside conventional medicines or treatments.

Alternative medicines or therapies are used instead of conventional medicines or treatments.

Examples of complementary and alternative therapies

• Acupuncture
• Alexander technique
• Aromatherapy
• Ayurvedic medicine
• Bowen technique
• Buteyko
• Chiropractic
• Chinese medicine
• Feldenkrais
• Gerson therapy
• Herbal medicine
• Homeopathy
• Iridology
• Kinesiology
• Magnet therapy
• Meditation
•  Myotherapy
• Naturopathy
• Ozone therapy
• Reflexology
• Reiki
• Tissue Salts therapy
• Urine therapy
• Vitamin and mineral supplements
• Yoga, tai chi and qi gong

Do they work?

Scientific studies have found that some complementary and alternative medicines of therapies (CAMs) are effective, but many are unproven or ineffective.

Some complementary or alternative therapies can be unsafe or cause harmful side effects. For example, the herb Feverfew can cause uterine contractions and possible miscarriage in pregnant women[i], and Vitamin C supplements are unsafe for people with haemochromatosis.

Some complementary therapies interact with conventional medicines, which can make your treatment less effective or harmful. For example:

• Vitamin C supplements can interfere with some chemotherapy treatments.
• St John’s Wort can reduce the effectiveness of some pain medications and some chemotherapies (such as tamoxifen). It can also make a wide range of medications less effective or potentially harmful, including contraceptives, antidepressants and HIV treatments[ii].
• Ginkgo and chamomile may increase the risk of bleeding in people who take blood-thinning (anticoagulant) medicines such as warfarin and anti-inflammatory medicines such as aspirin and ibuprofen[iii].
• Echinacea, milk thistle and chamomile can interfere with how the liver processes medications and increase or decrease the effects of some medications[iv].

Complementary therapies and conventional medicine

Conventional medicine is based on rigorous science and evaluation. Historically this has not been the case for complementary or alternative therapies. Some complementary therapies have been tested in good quality scientific trials, but most have not.

Conventional medicine and complementary therapies can often be used alongside each other. However, it is important to tell your doctor and your complementary practitioner about all the medicines, treatments and remedies you use.

Use of complementary therapies

Complementary and alternative medicines or therapies (CAMs) are used by about two thirds of people in Australia[v]. The most frequent users of CAMs in Australia are women with a chronic condition.

Most CAMs are considered safe when conducted by a trained and experienced practitioner. However, there may be times that a certain therapy may carry higher risks for you, such as if you are receiving chemotherapy.

Many people think CAMs are safe because they are based on ‘natural’ products, but this is not always true, particularly if ingredients are used in amounts that are different to what would be ‘natural’.

Complementary herbal medicines and supplements can cause harmful effects in some people.  There have been instances of allergic reactions, heavy metal contamination, poor quality control in production, undeclared active ingredients, and use of toxic or unsafe ingredients.

It is safest not to use herbal medications if you are pregnant or breastfeeding, or trying to become pregnant[vi].

Quick tips:

• If you are concerned about your health, see your General Practitioner for diagnosis and treatment. Don’t self-diagnose or seek a diagnosis from a complementary or alternative therapist.
• Talk to your doctor before taking a complementary medicine or embarking on a complementary therapy.
• Buy Australian-made complementary medicines that are labelled ‘Registered Aust R’ or ‘Listed Aust R’.  This means they have been tested for their safety by the Australian Therapeutic Goods Authority (TGA).
• Be informed. Use trusted health websites and sources of information – you can find some on the Finding Good Health Information page.
• Don’t buy medications or herbal remedies on the internet. The product may be poor quality, contaminated or fake. Many medications, vitamins and supplements that come from other countries do not meet Australia’s standards for safety and quality.
• Don’t take a remedy that is not licensed or approved by the TGA.

Clinical trials are important

Without clinical trials, we can’t know whether a CAM actually works and if there are any short and long-term risks with the treatment. Sometimes the research that has been done doesn’t meet Australian standards for clinical trials so the treatment can’t be shown to be effective or safe.

The safety and effectiveness of CAMs continue to be studied, by places like the National Centre for Complementary and Integrative Health at the National Institutes of Health, part of the US Department of Health and Human Services.

Regulation of complementary medicines in Australia

The Therapeutic Goods Administration (TGA) is part of the federal Department of Health and regulates all medicines in Australia, including complementary medicines and vitamin and mineral supplements. A branch of the TGA, called the Office of Complementary Medicines, oversees the recall of faulty or dangerous CAMs.

Under Australian law, complementary medicines are assessed for the safety and quality of ingredients, but not always for whether they work (efficacy). Only complementary medicines that are deemed ‘high risk’ are assessed for efficacy. The TGA does this by looking at data from clinical trials supplied by the manufacturer.

The TGA considers complementary medicines to include:

• Medicinal products that contain herbs, certain vitamins or minerals
• Nutritional supplements
• Homoeopathic medicines
• Certain aromatherapy products
• Traditional medicines such as traditional Chinese medicines, ayurvedic medicines and Australian Indigenous medicines.

Some naturopaths, herbalists or Chinese medicine practitioners make their own herbal preparations. These preparations are not checked by the TGA and it is not possible to be sure what is in them, or in what amount, and most importantly, whether they are safe.

Regulation of complementary therapists

In Australia, State and Territory governments regulate complementary therapists. This means that the laws differ between the states. If a consumer complains about the care they receive from a CAM therapist, the police, the courts or a health review board can investigate.

The complementary therapy industry in Australia is largely self-regulated.  Many complementary therapists are affiliated with a professional association which usually have minimum training and professional standard requirements. However, membership is usually voluntary, which means there is no legal obligation and little regulation of the claims made by practitioners or the treatment they provide.

How to choose a complementary therapy provider

It is a good idea to choose a therapist who is registered with a regulatory body or professional association. This means that they will have met the standards of practice and education required by that organisation.  Either before or during your first visit with your practitioner, ask about their training and qualifications.

Be cautious of any complementary or alternative therapy practitioner who advises you to abandon your conventional medical treatment.

Some ways to find a reputable practitioner include:

• Contact the professional association for your chosen therapy and ask for a list of members in the ACT. For example the Australian Acupuncture and Chinese Medicine Association is the peak body for Chinese medicine, acupuncturists, herbalists and traditional remedial massage practitioners in Australia.
• Ask your doctor for a referral.
• Check the Australian Health Practitioner Regulation Agency (AHPRA) website to see if the therapist you want to see is registered.

Health and safety risks of complementary therapies

Most complementary and alternative therapies (CAMs) are considered to be safe when conducted by a trained and experienced practitioner. However, there may be times that certain therapies may pose higher risks for you, such as if you are pregnant, undergoing chemotherapy, or taking antidepressants.

Many people believe that CAMs are safer than conventional medical treatments because they are more ‘natural’. This is not necessarily true. Complementary therapies can cause harm and be unsafe. For example:

• Standards of care – because there is little regulation of complementary therapists in Australia, there is no legal requirement for complementary therapists to be qualified.
• Indirect harm – relying on CAMs could delay getting a formal diagnosis and medical treatment. In the case of serious illnesses, such as cancer, a delay can mean that you need more serious treatment, have serious complications or receive treatment too late.
• Side effects – CAMs can cause unpleasant or potentially dangerous side effects. For example, the herb Feverfew can cause uterine contractions and possible miscarriage in pregnant women.
• Drug interactions – CAMs can interact with over the counter and prescription medications. For example, St John’s Wort increases the risk of dangerous side effects with some antidepressants.
• Financial harm – you are wasting your money if the complementary medicine isn’t effective or actually harms you. The TGA and the Australian Competition and Consumer Commission (ACCC) regulate health claims made by Australian companies, but there is no protection under Australian law if the product is bought from a company or individual outside Australia.

Buy Australian-made complementary medicines

Complementary medicines made in Australia are subject to strict product safety and quality regulations. This may not be the case in other countries.

Look for Australian-made products that are marked ‘Listed Aust R’ or ‘Registered Aust R’, which means these product were manufactured in a laboratory licensed by the TGA:

• Listed – this means the product is considered low risk and has been assessed for safety and quality.
• Registered – this means the product is considered higher risk and has been assessed for safety, quality and how well it works. The TGA assesses efficacy and safety by looking at data that is provided by the manufacturer.

Warning signs

If you are thinking about using a CAM instead of or alongside an evidence-based mainstream medical treatment, it is important to discuss it with your health care team first. And watch out for these warning signs:

• Be suspicious of any treatment that says it can cure cancer or other difficult-to-treat diseases (such as chronic fatigue, multiple sclerosis, HIV/AIDS, etc.).
• Be suspicious of any treatment that claims to have no side effects. Even herbs and vitamins have possible side effects.
• Be suspicious of those who attack the medical or scientific community or who tell you not to use standard medical treatments.
• Beware of treatments you can get in only one clinic or online, especially if the source is a country with less strict patient protection laws than Australia.
• Beware of terms such as “scientific breakthrough,” “miracle cure,” “secret ingredient,” or “ancient remedy.”
• Beware of personal stories that claim amazing results but provide no credible evidence. Remember – anecdotes are not evidence – even if there are lots of them!
• Find out whether scientific studies or clinical trials have studied this treatment in people (not just animals), and what side effects have been reported. Have the findings been published in academic journals, or have they only been promoted ontelevision, social media, books, magazines, and the internet?

Resources:

Cochrane Summaries: Independent high-quality evidence summaries for health care decision making summaries.

The ANU has information about alternative therapies for the treatment and management of depression.

The Clinical Oncology Society of Australia (COSA) Complementary and Integrative Therapies Group have released a comprehensive position statement on the use of complementary and alternative medicine by cancer patients. You can download a copy here (pdf, 263kb).

CAM Cancer provides health professionals with high-quality, evidence-based information about complementary and alternative medicine (CAM) for cancer. It provides evidence-based information on a wide range of therapies.

The Medical Journal of Australia – Narrative Review – What risks do herbal products pose to the Australian community?

The Cancer Council of NSW has information and resources on Complementary therapies.  This includes a downloadable guide to Understanding Complementary Therapies.  

Health Direct has information on CAMs.

The Quackwatch website looks at the evidence and issues relating to different therapies.

The Department of Health Therapeutic Goods Administration website has information on complementary medicines

The Memorial Sloan-Kettering Cancer Centre in the United States has information on specific herbs, botanicals and other products.

References:

[i] https://www.webmd.com/vitamins/ai/ingredientmono-933/feverfew

[ii] https://www.webmd.com/vitamins/ai/ingredientmono-329/st-johns-wort

[iii] https://www.mskcc.org/cancer-care/integrative-medicine/herbs/

[iv] Australian Society of Clinical Immunology and Allergy, 2019, Adverse reactions to alternative medicines.  https://www.allergy.org.au/patients/drug-allergy/adverse-reactions-to-alternative-medicines

[v] Steel, A., McIntyre, E., Harnett, J. et al. Complementary medicine use in the Australian population: Results of a nationally-representative cross-sectional survey. Sci Rep 8, 17325 (2018). https://doi.org/10.1038/s41598-018-35508-y

[vi] Muñoz Balbontín, Yolanda MD, MSc; Stewart, Derek PhD; Shetty, Ashalatha CCST; Fitton, Catherine A. MSc; McLay, James S. FBIHS Herbal Medicinal Product Use During Pregnancy and the Postnatal Period, Obstetrics & Gynecology: May 2019 – Volume 133 – Issue 5 – p 920-932 doi: 10.1097/AOG.0000000000003217