Key principles No drug or alternative therapy is cheap No cost effectiveness if not effective, not safe if not evaluated Ingredients vary, as does quality, price and consistency Patients love natural, organic, home-remedy, old-fashioned ‘cures’ Beware the well meaning (daughter/son) or ‘HCP’ next door Best approach is: Get patient to report these alongside other meds (“bring the shopping bag”) Outline what is known / harmful from what is unknown Have patient do the homework – websites, labels, ingredients Trust is everything – don’t ignore

What is Complementary / Alternative Medicine? “Complementary” and “alternative” are not interchangeable “Complementary” generally refers to using therapy together with conventional medicine. “Alternative” refers to using a therapy instead of conventional medicine. In Canada, use of alternative medicine is not common The boundaries between complementary and conventional medicine overlap and change with time.  NCCIH: https://nccih.nih.gov/health/integrative-health

CAM includes Systems of care: Traditional Chinese medicine Ayurvedic medicine Natural health products / functional foods Minerals, vitamins, herbs, lotions, potions, cocktails Practices Mindfulness, massage Heterogeneity in quality Multiple species, Growing conditions, Plant part, Extraction method Characterization, not standardization NNHPD: Good Manufacturing Practices and “truth in labeling” Pharmacology and mechanisms of action largely unknown

NHP and Safety NHP-drug interaction tool Kutt et al. Can Pharm J. 2016 Clinical AE Absence of information In vitro or in vivo Theoretical Emerging clinical evidence Clinical evidence documenting the lack of interaction after concurrent use Kutt et al. Can Pharm J. 2016

Synthesized information Articles PubMed www.ncbi.nlm.nih.gov/pubmed/ Use the Complementary Medicine limit Cochrane (systematic reviews) www.cochrane.org Browse by the topic of Complementary Medicine Synthesized information Natural Medicine (available from UofA Libraries) Natural Medicines Comprehensive Database (available from UofA Libraries) NCCIH: https://nccih.nih.gov/health/integrative-health