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12 Professor hosen kiAt, heAd of mediCine And CArdiology At mACQuArie university hosPitAl A CAll FoR SUPPleMeNTARY KNoWleDGe The complementary and alternative medicine industry in Australia is now worth $2 billion annually. Most supplement use is largely self-administered or recommended by natural therapists – rather than by a medical doctor. When patients begin taking dietary supplements, how they effect the action of prescription medications a patient might be taking is generally not considered. Concern about what doctors do not know about supplement use by cardiology patients – and how alternative medicines interface with the biotherapeutic action of prescription medications – led Professor Hosen Kiat, Head of Medicine and Cardiology at Macquarie University Hospital and School of Advanced Medicine, to examine the issue more closely. Professor Kiat and PhD student Dr Yu Sun Bin conducted a systematic literature review using international bibliographic databases – including Medline, eMBASe, CINAHl, Allied and Complementary Medicine (AMeD), Australian Medical Index (Meditext), Health and Society (H&S) and International Pharmacy Abstracts (IPA). They focused on the prevalence of dietary supplement use in people with cardiovascular risk factors or proven cardiovascular diseases – a population already at increased risk of acute lifethreatening events. They also looked at the rate of disclosure of this information to a patient’s treating physician.
A COMPREHEnSiVE liTERATuRE REViEw finDS THAT PHYSiCiAnS knOw SuRPRiSinGlY liTTlE AbOuT THEiR CARDiAC PATiEnTS’ DiETARY SuPPlEMEnT uSE – A SiTuATiOn THAT COulD COMPROMiSE THE EffECTiVE TREATMEnT Of SERiOuS HEART COnDiTiOnS. over 500 articles were retrieved and 20 studies met the criteria for the review. Their meta-analysis revealed that while the use of dietary supplements is common – with up to 64 per cent of cardiac patients taking supplements – most treating physicians (40 to 95 per cent) are not aware of their patients’ supplement use. The research found that when patients were asked why they did not disclose supplement use to their doctors, they placed the responsibility with their doctors, saying that they thought their doctors would ask if the issue was of significance. “This has profound implications,” said Professor Kiat. “For more than half of all doctors never to ask about medications other than prescription medications is potentially troubling.” Professor Kiat’s concern lies in the fact that supplements could potentially interfere with the effectiveness of prescription medications or produce clinically important drug interactions. “A typical example is blood thinners, which are widely used in cardiology,” said Professor Kiat. “Warfarin, aspirin and clopidogrel, for example, are potent drugs in themselves. “Many patients, however, take additional supplements that have blood thinning properties – such as ginkgo, fish oil, vitamin e, ginger, garlic and glucosamine. Alternatively, some patients take vitamin K or St John’s wort, which could reduce the blood thinning effect of warfarin. either way, these supplements and possibly others may result in deleterious effects for a patient. “We have not yet had robust clinical studies evaluating the impact of supplements on prescription medications, so this situation is further complicated. “even if patients did disclose their supplement use – and many patients might be taking three to five different types of supplements – then it is still difficult for a doctor to control or adjust the prescription medication accordingly.” Because of the potential for negative effects, Professor Kiat says change is needed. “It is very important that doctors ask specifically what complementary medicines their patients are taking, in addition to their questions about prescription medication,” explained Professor Kiat. “The key is that doctors must actually ask this question in order to give patients a window of opportunity to disclose pertinent information.” But this alone is not enough. In addition to more research on the interaction between alternative and prescription medicines, pharmacology training around this is important. “even if the research exists, if a doctor doesn’t know what fish oil does, then that is an impediment to his or her practice,” explained Professor Kiat. “education in at least the most commonly used supplements, the top ten – such as ginkgo, ginseng, folic acid, vitamin e, evening primrose oil and fish oil – would make a difference.” Ideally, this education would form part of pharmacology training in medical schools, but it could also be available as continuing education for doctors already practicing. There are also cultural differences that doctors need to be aware of. The Chinese community might make extensive use of ginseng, but a patient from the Arab community may never have heard of this supplement. Doctors must be able to address different communities’ habits. education and awareness training could target doctors working in specific communities to make sure they have culturally relevant knowledge. Professor Kiat says that some advanced and informal training is already happening. For example, the complementary medicine and education group (CompleMeD) at the University of Western Sydney, to which he belongs, is comprised of scientists and doctors undertaking robust research into complementary medicine and promoting awareness and education to GPs and specialists. “Whether we like it or not, our patients are taking complementary medicines,” noted Professor Kiat. “We may agree or disagree, but it’s happening and it’s our duty as physicians to know what a patient is taking and how to respond effectively.” 13
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reconstructive plastic surgery - Macquarie University Hospital

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