AMD eBulletin 23 August 2019
How should physicians approach the use of complementary medicines by our patients?
The Medical Board of Australia has recently conducted a consultation into whether there should be changes to the rules for regulating medical practitioners who recommend 'unconventional therapies', which include complementary medicines. The College, in its submission to the inquiry, agreed with the need for rigorous and appropriate regulation of all therapeutic goods, including both pharmaceutical and non-pharmaceutical treatment modalities. It also recognised that the use of complementary medicines in Australia and New Zealand is very widespread. Indeed, studies have shown that over a year up to 65 per cent of Australians use complementary medicines, and that the market for these therapies amounts to roughly $A4 billion.
A difficulty with any discussion of this subject, however, is that the expression 'complementary medicines' refers to a very large and diverse array of therapeutic products. It extends from simple vitamins to well established herbal medicines, some of which have been subjected to extensive research. It includes traditional medicines, such as Chinese medicine, Ayurvedic medicine and Indigenous medicines. And it includes rogue therapies such as misapplied hormonal supplements, protein supplements, untested stem cell therapies, unsubstantiated weight loss treatments and even more marginal practices that have, on many documented occasions, caused serious harm to the vulnerable people who have been drawn to use them.
In some cases, it is clear that proposed treatments are dangerous and inappropriate and there is wide agreement that the practitioners who encourage their use should be sanctioned. In others, however, the circumstances are less clear. Traditional Chinese Medicine, for example, has been used for millennia and is based on a careful and rigorous observational archive. Furthermore, the history of western science from the time of Galileo has shown that different systems of knowledge produce their own criteria of truth and validity, as a result of which it cannot be assumed that just because a treatment approach does not conform to the prevailing, favoured system of knowledge does not mean that it is mistaken or lacks unique and valid insights.
Australia maintains a therapeutic register that allows complementary products to be 'listed' and made available for public use on the basis that they are not associated with significant risks, even if evidence for efficacy is lacking. While this system has worked reasonably well for years it does have its deficiencies. It is still possible, for example, for consumers to choose unproven complementary therapies over proven medical ones; the costs may be excessive and burdensome; and little is known about interactions with conventional medicines, which are often taken in parallel.
A major, ongoing problem concerns the incomplete nature of the research record for complementary therapies in general, and for herbal and traditional therapies in particular. Despite the obvious public interest involved, it is often difficult for herbal researchers to obtain support for their work, including through public research funding agencies. There are fewer commercial incentives in relation to therapies that are ancient, well-established and cheap, even if they remain unproven. The nature of both the substances involved and the practices by which they are applied – which often involve multiple active agents and individualised treatment schedules – pose significant methodological challenges for research design.
In this complex landscape there are contributions that the RACP could potentially make. It is clear that our continuing insistence on ensuring the safety of all therapies available in Australia and New Zealand cannot be compromised. In addition, we must respect the rights of our patients to make their own, properly informed choices about the treatments they themselves take, and it is our responsibility to ensure that they are aware of what is known and what is not known. Practitioners who operate unscrupulously and subject their patients to dangerous and illegal therapies should undoubtedly be subject to rigorous disciplinary processes.
However, there is a large and more difficult project that is yet to be undertaken. This is the construction of a comprehensive, publicly available, authoritative record of the current state of knowledge of individual purported therapeutic agents. This would draw together what is often fragmentary knowledge from multiple sources, themselves commonly partial or incomplete, in a manner that could provide guidance, reassurance or cautions about individual agents, even where conclusive fully funded, large scale randomised trials remain out of reach. The assessments could take into account methodological complexities, cultural factors and the lack of commercial support or incentives for conclusive Phase 3 studies.
Such a record would obviously require support, in relation both to infrastructure and the expertise needed to carry out the assessments. However, it could be initiated on the basis of an 'opt-in' system in which manufacturers and distributors of herbal products could be invited to submit monographs of the products in which they themselves have most confidence. The act of contributing to such an archive would itself be a gesture of good faith and transparency, and may increase pressure for assessment of other products not initially so favoured.
The establishment of such a record could be undertaken as a cooperative partnership with academic, clinical and commercial stakeholders. Perhaps this is an example of how, with the support of its members, the College could demonstrate innovative and imaginative leadership in order to benefit the wider community we serve.
As always, feedback on the Presidential Posts is welcomed. Please send comments to:
Adult Medicine Division
Telephone: +61 (0) 417 55 26 59
The 2020 AChSHM Annual Scientific Meeting (ASM) will be held on Saturday, 21 March 2020 in Sydney – please save the date in your calendars. The 2020 ASM is guaranteed to be an excellent event with Dr Vincent Cornelisse as Lead Convenor, supported by an Organising Committee including myself and:
- Dr Rosalind Foster
- Dr Massimo Giola
- Dr Manoji Gunathilake
- Dr Melissa Kelly
- Dr Phillip Read
- Dr Daniel Richardson
- Dr Rick Varma
The 2020 Trainees' Day will be held on the Friday before the ASM on 20 March 2020. All AChSHM trainees are encouraged to attend this invaluable educational and networking activity with their peers.
Nominations for the award for Best Postgraduate Thesis in Sexual Health Medicine have opened. Fellows and trainees who have been awarded a doctoral or masters by research thesis within the last five years are eligible to nominate. AChSHM members can nominate another person or can self-nominate.
The Chapter Committee will next meet via teleconference on Thursday, 5 September 2019. If you have any feedback or issues you would like to raise with the Committee, please don’t hesitate to contact us through our secretariat at email@example.com.
Associate Professor Catherine O’Connor
Australasian Chapter of Sexual Health Medicine
The AChPM Committee will meet in the coming weeks with key items for discussion including work on a strategy to advocate for improved GP education in opioid prescribing for palliative care patients, and the potential development of a Chapter award through the RACP Foundation.
I would like to remind all Chapter Fellows of the new MyCPD Framework which came into effect in January 2019. The new framework changes the CPD activities you need to record to meet CPD requirements, and is designed to help members to prepare for future regulatory requirements to be introduced with the Medical Board of Australia’s Professional Performance Framework.
I encourage Chapter members to familiarise themselves with the new requirements and continue to update their MyCPD throughout the year to minimise their stress at deadline time. The RACP’s CPD team have developed useful FAQs, and are also able to respond to any queries directly if you need support or assistance at MyCPD@racp.edu.au or 1300 697 227.
If you have any feedback or comments for the Committee, please do not hesitate to contact us through our secretariat at PallMed@racp.edu.au.
Professor Greg Crawford
Australasian Chapter of Palliative Medicine
Each year the Chapter awards a prize for the best Addiction Medicine advanced trainee research project. The prize is full registration to the recipient’s choice of the 2021 International Medicine in Addiction Conference in Sydney or RACP Congress 2020 in Melbourne in May 2020. The prize also includes up to $500 funding for travel. Trainees are encouraged to review the AChAM Research Project webpage to determine their eligibility and enter.
I recently attended a reception at Government House with some of the Victorian members of the Chapter. The reception was hosted by the Honourable Linda Dessau AC, Governor of Victoria and Mr Anthony Howard AM QC to express appreciation of those working in the field of addiction. It was heartening to have our field recognised by the Governor.
The Chapter will meet next week to discuss a number of matters in the policy and advocacy space, including finalising its Evolve list and continuing work on a Prescription Drug Monitoring System position statement.
The Chapter Committee will meet next Friday, 30 August 2019 via teleconference. If you have any feedback, questions or comments for us, please get in touch via our secretariat at AddictionMed@racp.edu.au.
Dr Martyn Lloyd-Jones
Australasian Chapter of Addiction Medicine
We’re excited to announce the training settings that will be the first to adopt the new Basic Training program.
We will be working with the Gold Coast University Hospital, Starship Children’s Hospital Auckland, The Townsville Hospital and Women’s and Children’s Hospital Adelaide to start rolling out the new Basic Training programs from 2020.
Thank you to everyone who submitted an expression of interest to become an early adopter of the new program.
We are also seeking expressions of interest
for additional training settings to join those listed above as early adopters of the new Basic Training programs from 2021.
Key changes coming to the Basic Training programs
Watch our video
to learn more about RACP's Basic Training curricula renewal.
More information on the new Basic Training programs is available on the Basic Training curricula renewal pages
Each trainee is responsible for completing their own research project. Trainees can learn about conducting a research project by enrolling in our Research Projects online course. It’s designed to support trainees through a detailed walk-through of the research process.
A trainee’s experience can be greatly enhanced by a supportive and informed supervisor. The Research Supervision online course helps supervisors who want an update on research project requirements and the research process in general.
RACP Online Learning Resources are free for members and count towards Continuing Professional Development requirements.
We are seeking the views of trainees and Fellows who have had experience of the Training Support Pathway.
Your feedback about your past experiences of the Training Support Pathway will help us identify what improvements can be made.
This short survey is open to:
Your participation will take approximately 10 to 15 minutes and is anonymous.
If you have questions about the research project, please contact the lead researcher, Gillian Lucas at firstname.lastname@example.org.
Nominations are closing soon for prizes which acknowledge outstanding contributions and achievements made by Fellows and trainees. Submit your nomination for the prizes below by Monday, 16 September 2019.
- The John Sands Medal recognises a Fellow who makes a significant contribution to the welfare of the RACP and its members.
- The College Medal recognises a Fellow who makes a significant contribution to medical specialist practice, healthcare and/or community health through physician activities.
- The RACP International Medal recognises a member who has provided outstanding service in developing countries.
- The Medal for Clinical Service in Rural and Remote Areas recognises a Fellow who has provided outstanding clinical service in rural and remote areas of Australia or New Zealand.
- The Mentor of the Year Award presented to a Fellow who has made an outstanding contribution to mentoring or providing a high level of support and guidance throughout training.
- The Trainee of the Year presented to a trainee who has made an outstanding contribution to College, community and trainee activities.
Details about these prizes are available on the RACP Foundation webpage.
Trainees are encouraged to apply for the RACP Trainee Research Awards. This is an opportunity to present your research at regional events. Representatives will be selected from each event and invited to present at RACP Congress 2020 in Melbourne in the ‘Research and Innovation Showcase’. Applications are due Saturday, 31 August 2019.
Details about this prize are available on the RACP Foundation webpage.
Register today for Aotearoa New Zealand Trainees’ Day 2020. This event is developed by trainees for trainees and will be held on Saturday, 4 April 2020 at The Heritage Hotel in picturesque Queenstown.
If you are an RACP trainee, this event is for you. Whether you are a basic or advanced trainee, adult medicine or paediatrics, the Trainees’ Day will be inspiring and relevant for wherever you are in your training journey. Offering a variety of big picture topics and professional skills building, every NZ trainee should attend Trainees’ Day at least once during Basic Training and once during Advanced Training.
Trainees' Day offers professional development and community building opportunities for all trainees at any stage of training. It is supported as a recognised skills day by New Zealand District Health Boards and attendance costs are reimbursable and earlybird registration is open now.
Trainees’ Day is an opportunity to connect with the wider trainee community, take time out to think broadly and strategically about your career, and hear practical wisdom from experienced physicians and other professionals.
Register now for the RACP Aotearoa New Zealand Trainees’ Day 2020.
For more information email the RACP New Zealand team.
The Australian Medical Council Aboriginal, Torres Strait Islander and Māori Committee invites interested Aboriginal, Torres Strait Islander and Māori members to nominate for the position of Committee Chair. Closing date for nominations is 5pm Friday, 6 September 2019.
We are finalising the College’s submission to the Royal Commission into Aged Care Quality and Safety. We have received very good input on this significant issue of health reform and improving patient health care. This is pertinent to many RACP specialties and subspecialities. Here are the Terms of Reference. Due date for contributions is Thursday, 29 August 2019. Please contact RACPconsult@racp.edu.au for a copy of the penultimate draft if you wish to contribute.
Monday, 26 August 2019, 6pm to 7pm (AEST) Webinar
Join Dr Rosalie Schultz, Associate Professor Nick Buckmaster and Carey Doolan from the Australian Digital Health Agency next Monday for an interactive panel discussion on the opportunities My Health Record has for Indigenous health, integrated care and more.
RACP has been engaged by the Australian Digital Health Agency (ADHA) to help promote and encourage the adoption and use of the My Health Record (MHR) system. We are looking for trainees and Fellows who have used MHR to share their experience.
We’re keen to understand and build a suite of real-life practical vignettes, highlighting the use and benefits of MHR by specialists, working in a range of settings. Your contribution on how the MHR may be embedded in current specialist workflow is extremely valuable. RACP and the Agency may use the information provided in a variety of ways (e.g. print and social media, educational resources etc.) and as per the process, we will consult with the author for review & approval. We may also contact you to present your cases for educational webinars/podcasts.
If you are interested in being involved, please complete the RACP Clinical Use Case Template and provide to email@example.com. Please do not hesitate to get in touch if you have any questions.
Since 2015, Evolve has been a flagship initiative of the RACP. Evolve enables physicians to be leaders in high-value, high-quality care. The importance of this initiative was recognised in recent government reviews including the Productivity Commission’s 2017 Shifting the Dial Five Year Productivity Review. Consultation for our 2019-21 strategy is now complete. We thank our members for their valuable insights which contribute to the ongoing development, delivery and evaluation of Evolve. We look forward to sharing the outcomes with our members in the coming weeks.
The Haematology Society of Australia and New Zealand (HSANZ) Council is pleased to call for
applications for the Haematology in Obstetrics & Women's Health Collaborative HSANZ Clinical Fellowship to be taken up in 2020.
This year, the HOW Collaborative and HSANZ will award one Clinical Fellowship to an Australian or New Zealand applicant of outstanding merit and whose work aligns with the aims of the HOW Collaborative and HSANZ. The HOW Collaborative Clinical Fellowship is funded to a total value of $60,000 for a period of one year only and must be taken up in 2020.
The Australian Commission on Safety and Quality in Health Care has invited the College to comment on its draft Peripheral Venous Access Clinical Care Standard. If you wish to help the College develop a response to this draft, please send your comments on the draft standard to firstname.lastname@example.org by close of business Monday, 9 September 2019. You are also welcome to make your own submission.
Conjoint Committee for the Recognition of Training in Peripheral Endovascular Therapy
Expressions of interests are sought from one Australia-based Fellow for RACP representation on the Conjoint Committee for the Recognition of Training in Peripheral Endovascular Therapy.
The Committee is constituted by three parent bodies; RACS, RACP and RANZCR, and will work to formulate training guidelines in Peripheral Endovascular Therapy and to assess the training of persons seeking recognition of their training in this area.
If you’re an Australia-based Fellow and interested in applying, please see the RACP website for further details.
The Specialty Society Webinar Series is now live. The webinar series is being undertaken by RACP in partnership with its affiliated specialty societies. Please see below for information on upcoming webinars.
Associate Professor Tomas Kalincik – Relapsing Multiple Sclerosis
Monday, 19 August 2019, 6pm (AEST)
Dr Janet Cheung – Over-the-counter and complementary sleep aids for insomnia: The implications of self-medication for insomnia in the real world
Tuesday, 20 August 2019, 6pm (AEST)
Dr Cherie Chiang – Bone turnover markers in clinical practice – when to order and how to interpret
Monday 26 August 2019, 6pm (AEST)
Professor Mark Parsons – Stroke
Tuesday, 27 August 2019, 6pm (AEST)
Professor Renuka Visvanathan – Nutritional Frailty
Tuesday, 27 August 2019, 5pm (AEST)
Dr Harry Ball – Oral appliances for snoring and OSA
Monday, 2 September 2019, 6pm (AEST)
Dr Tony Sammel & Dr Claire Owens – Polymyalgia Rheumatica and Giant Cell Arteritis
Wednesday, 11 September 2019, 6pm (AEST)
Dr Andrew Lim – CPD credits using a peer discussion (for rheumatologists)
Monday, 16 September 2019, 6pm (AEST)
The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses.
Regional Nephrology Weekend
The Regional Nephrology Weekend is an opportunity for general medicine and nephrology advanced trainees to learn about a variety of nephrology practices, clinic set up options and management of general medical and nephrology cases. See event flyer for more details.
Go to the events list at any time to see what other events are coming up.
Opportunities at Tamworth Hospital