The Role of Complementary and Alternative Medicine in Pharmacy

Pharmacists are often the most accessible health care professionals, and for many Americans, their expertise can be particularly valuable when it comes to counseling on complementary and alternative medicines (CAM).

CAM is an umbrella term encompassing a wide variety of treatments and practices that can range from supplements to vitamins to herbal products. Thanks in part to the COVID-19 pandemic, the popularity of these products has risen dramatically in recent years.

According to the Nutrition Business Journal,1 the supplement market added $4.15 billion in sales in 2021 and came in more than $5 billion higher than pre–COVID-19 projections. Despite CAM’s commercial growth, more can be done to better inform pharmacists about this field, which will, in turn, help patients achieve their own individual health goals, experts say.

“We certainly in pharmacy education in general could do much better with teaching these treatment modalities,” said Alice Scaletta, PharmD, an associate professor of clinical pharmacy at Philadelphia College of Pharmacy at St Joseph’s University in Pennsylvania. She noted that this lack of education creates a domino effect: “My professors were never trained in it, [so] then they aren’t going to be able to teach us, and then it just keeps going,” she said.

In her role, Scaletta offers an elective course on herbal products, natural medicines, and dietary supplements to all professional-year pharmacy students—a crucial elective, given that a 2020 study of national consumer survey data show that individuals want pharmacists to have a better understanding of these medicines.2

That 2020 study also found that respondents had a positive perception of these medicines vs Western medicines.2 Based on this finding, researchers concluded, “It is important for pharmacists to be more prepared to provide consultation to patients using CAM about proper use, [adverse] effects, and interactions with other remedies.”

When it comes to furthering pharmacists’ and patients’ education on these treatments, keep several things in mind. For one, it’s important to be mindful of how the terms are defined. For example, substituting alternative medicines with integrative medicines can be a more accurate and inclusive way of discussing treatment with supplements, herbal products, and other medicines.

According to Scaletta, most of the time patients aren’t using just conventional or nonconventional medicines; they’re using both. Therefore, complementary refers to patients using conventional and nonconventional approaches at the same time—sometimes without the knowledge of all their health care providers—whereas “integrative medicine is when there’s actually a coordination of care between all their treatment modalities, including conventional and nonconventional,” she said.

What’s more, using the term CAM can imply these treatments are “second tier to traditional allopathic approaches,” said Lara Zakaria, PharmD, CNS, IFMCP, an integrative pharmacist and a nutritionist in New York, New York. Zakaria typically uses the term nutraceutical to describe these types of therapies.

Moving away from the alternative label can also enable pharmacists to discuss the medicines in a more granular way, with a focus on basic biochemistry and metabolic function. “Pharmacy has the opportunity to step in [and be] the patient’s chemistry expert and be on their clinical team,” said Kathy Campbell, PharmD, a clinical community pharmacist in Owasso, Oklahoma. “What pharmacists have to realize is, it’s all basically chemistry—and pharmacists are the chemistry experts in medicine. Nobody gets trained to the depth of chemical interactions at the cellular level like a pharmacist does. We have a very curated point of view when it comes to medicines and metabolic function.”

Being open-minded about these medicines and conveying accurate information to the patient in a nonjudgmental manner is also crucial, especially when the treatments may be doing more harm than good. Campbell noted that, at the end of the day, “what I know doesn’t matter. It’s what the patient knows and what the patient can do every day that actually create outcomes.”

What’s more, patients may hesitate to ask pharmacists about these medicines because they fear judgment or worry that they will be immediately shut down, Scaletta said. “For us to have a patient actually open up to us about these things is actually a huge privilege [because] they’re opening up this door and an opportunity for us to educate them. So it’s really important to recognize that and to approach them in a nonjudgmental way no matter what your viewpoints are.”

It’s estimated less than 40% of patients who use herbal supplements disclose it to their health care providers.3 Creating a trusted environment where patients feel comfortable consulting with their pharmacists about their use of these medicines can also help prevent negative herb-drug interactions. For example, using St John’s Wort with a selective serotonin reuptake inhibitor could lead to a potentially life-threatening interaction, according to the National Center for Complementary and Integrative Health.4

“As that person [who’s] responsible for checking for medication interactions or appropriateness of therapy, it’s really important that pharmacists are educated in this realm,” Zakaria said.

When it comes to regulation, supplements fall under the food branch of the FDA, receiving far less scrutiny and oversight than pharmaceuticals. This can pose a problem when proprietary blends are marketed with labels that don’t disclose every ingredient in the product. Supplements also do not need to be proven safe or effective before being brought to market.

One source that pharmacists can turn to for information is NatMed Pro, a subscription-based service complete with a drug interaction and effectiveness checker—all backed by scientific evidence.

Providing counsel to patients that is evidence based as opposed to opinion can help foster that trusted relationship. Dispelling misconceptions that these treatments have no proven use is also important. “You don’t [want to make a] blanket statement saying things like, ‘If it’s an herbal product, if it’s not conventional, then you shouldn’t take it,’” Scaletta said.

Drug-induced nutrient depletions are just 1 instance in which supplements can be beneficial to the patient. “Every day, pharmacists would not dispense a thiazide diuretic without a potassium supplement,” Campbell noted. Some patients could also be deficient in certain vitamins or minerals due to an underlying disease or injury.

“It’s not about choosing sides. It’s about recognizing that our patients are using both sides,” Scaletta said. “And if I am going to be the most helpful to them, I need to be a trusted, nonjudgmental source of education for them—and not an adversary—for the approach that they’re choosing for their lives.”

References
1. Supplement market more than $5B higher than pre-pandemic expectations, according to Nutrition Business Journal’s 2022 Supplement Business Report. News Release. Nutrition Business Journal. June 7, 2022. Accessed August 23, 2022. news-releases/supplement-market-more-than-5b-higher-than-pre-pandemic-expectations-according-to-nutrition-business-journals-2022-supplement-business-report-301563200.html
2. Cernasev A, Gomaa B, Hager K, Schommer JC, Brown LM. Use of national consumer survey data to explore perceptions of complementary and alternative medicine. Innov Pharm. 2020;11(2):10.24926/iip.v11i2.2263. doi:10.24926/iip.v11i2.2263
3. Fasinu PS, Bouic PJ, Rosenkranz B. An overview of the evidence and mechanisms of herb-drug interactions. Front Pharmacol. Published online April 30, 2012. doi:10.3389/ fphar.2012.00069
4. St. John’s Wort and depression: In depth. National Center for Complementary and integrative Health. Updated December 2017. Accessed August 23, 2023. nccih.nih.gov/health/st-johns-wort-and-depression-in-depth

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