2. 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

3. 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:

4. 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

5. 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

6. Synthesized information
Articles
PubMed
Use the Complementary Medicine limit
Cochrane (systematic reviews)
Browse by the topic of Complementary Medicine
Synthesized information
Natural Medicine (available from UofA Libraries)
Natural Medicines Comprehensive Database (available from UofA Libraries)
NCCIH: