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Letters to the Editor
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Natural therapies
Government should invest more in alternative therapies
From Mr H. M. Dowdalls, MRPharmS
With regard to Ian Jackson’s letter (PJ, 17 July, p83), I firmly
believe there will come a time when integration between “alternative
medicine” and “mainstream medicine” will not only happen
but both “strands” augment the other so much that the benefits
for the future would, I suggest, be undeniable.
I would, meekly, suggest that this Government, or the next, if not willing
to invest more on alternative medicine in the NHS should perhaps, with
the instigation of the Royal Pharmaceutical Society, at least spend some
money on investigating the benefits accrued by its use in other countries.
H. Dowdalls
Cupar,
Fife
What about the end service user?
From Mr I. Jackson, MRPharmS
Christopher Anton and Anthony
Cox express surprise at my disdain for
conventional medicine (PJ, 24 July, p114). Actually, I am an advocate
for conventional medicines such as simvastatin 40mg with firm primary
endpoint data, eg, reduction in cardiovascular death.1
My argument is that many conventional medicines have no such evidence
but are being pushed remorselessly by “big pharma”. Thanks
to the new general medical services contract (points make prizes) there
is a danger that conventional drugs without robust outcome data will
be increasingly used as GPs chase Department of Health targets. If they
require natural therapies to have a robust evidence base then the same
rules should apply to conventional therapies. There would not be much
left on the pharmacy shelves.
They admit that large numbers of patients are harmed by conventional
medicines but the majority are avoidable by better medicines management.
So have many hospital admissions have been prevented by the medicines
management collaborative? Do I need to do a PDSA (Plan, Do, Study, Act)
to find out?
They question my example of mistletoe injections in the treatment of
cancers. It is a shame they have failed to include the latest studies.
The largest study involved 10,266 cancer patients in treatment centres
across Germany. A pool of 396 matched pairs was formed in which one arm
used conventional treatment and the other conventional plus mistletoe
injections. The main outcome measure was survival time. The mistletoe
group had a survival time 39 per cent greater (P<0.001). Those that
used mistletoe for between 80–100 per cent relative to survival
time saw a doubling in survival time from 3.48 years in the control group
to 7.08 years in the mistletoe group (P<0.001).2 This adds some weight
to the comment I made that “mistletoe works with the body’s
immune system, rather than against it”.
They expressed concern over adverse drug reactions with mistletoe. A
study (which is being considered for publication) may ease their concerns.
A group of 1,442 patients with early stage breast cancer used either
conventional therapy only or conventional plus mistletoe injections.
It was found that 16.2 per cent of the mistletoe group and 54 per cent
of the control group developed ADRs attributed to the conventional therapy
(P=0.001).
Rather than reflecting on our competencies a really useful way of spending
our time could be to read an excellent article in this month’s
New Zealand Pharmacy called “Effectiveness of hawthorn extracts
for heart complaints”. It discusses an ongoing study in 2,600 New
York Heart Association class 2 to 3 heart failure patients with hawthorn
extract or placebo alongside conventional therapies. They are looking
at primary outcomes of cardiac death, non-lethal myocardial infarction
and admission to hospital because of the progression of heart failure.
The article ends with the phrase “this may change the attitude
towards use of hawthorn extract in general”. Not in the UK — we
are busy being amused by cupping!
At the end of the day, might it be a good idea to ask the patient (sorry,
end service user) how he or she feels. As one drug representative said
to me: “I’m so glad I can ask you about natural medicines
for my family”.
Ian Jackson
Mansfield, Nottinghamshire
References
1. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection
Study of cholesterol lowering with simvastatin in 20,536 high-risk
individuals: a randomised placebo-controlled trial. Lancet 2002; 360:
7–22.
2. Grossarth-Maticek R. Use of Iscador, an extract of European mistletoe
(Viscum album), in cancer treatment: Prospective non randomised and randomised
matched-pair studies. Alternative
Therapies, May/June 2001;7:57–78. |
The
Pharmaceutical Journal