Complementary therapies - safety and legal issues

Many people believe that complementary therapies are safer than conventional medical treatments because they are more “natural”. This is not always true. There are a number of safety and legal issues to be aware of before using them.

What complementary therapies are#

Complementary therapies are used alongside conventional medical treatments to help improve a person’s health and wellbeing. Examples include acupuncture, aromatherapy, traditional Chinese medicine, herbal medicine, yoga, meditation and massage. These treatments are sometimes known collectively as “complementary and alternative medicine” (CAM), and their use appears to be increasing.

Complementary medicines can include:

• medicinal products that contain herbs, or certain vitamins or minerals
• nutritional supplements
• homoeopathic medicines
• certain aromatherapy products
• traditional medicines, such as traditional Chinese medicine and Ayurvedic medicine

How complementary medicines are regulated#

In many places, complementary medicines are regulated by a government body responsible for therapeutic goods. Regulation typically assesses a medicine for the safety and quality of its ingredients, but not always for efficacy (how well it works). Often only products considered “high risk” are assessed for efficacy, using clinical-trial data supplied by the manufacturer. Regulators may also oversee the recall of faulty or dangerous products.

Where products are regulated, approved medicines usually carry a code or marking on the label that shows they have been assessed. Lower-risk products may be assessed for safety and quality, while higher-risk products are also assessed for how well they work. Standards and labelling vary from country to country, so a product made or bought elsewhere may not meet the same requirements.

Why clinical trials matter#

Without clinical trials, we cannot know for sure whether a complementary therapy actually works, and the short- and long-term risks of the treatment may also remain unknown. A lack of scientific evidence does not necessarily mean that a therapy does not work — it may simply mean there is little research, or that the available research does not meet recognised standards for clinical trials.

How complementary therapists are regulated#

Regulation of complementary therapists varies. In some places certain practitioners must be formally registered, while in others the industry is largely self-regulated and laws differ from one area to the next. Many therapists belong to a professional association. Membership may require a certain standard of care, but it is usually voluntary, so there may be no legal obligation. Where misconduct occurs, police, the courts or a health review body may investigate a therapist’s activities.

Health and safety risks of complementary therapies#

Complementary therapies can cause harm if used incorrectly or by someone for whom they are unsuitable:

• Poor standard of care — without regulation, there is no legal requirement that a therapist is qualified, trained or experienced, and an unqualified therapist can harm a patient.
• Indirect harm — relying on complementary therapies alone may delay diagnosis and medical treatment. With serious illnesses such as cancer, a delay can lead to serious complications or death.
• Side effects — complementary medicines can cause unwanted and potentially dangerous side effects. For example, the herb feverfew can cause uterine contractions and possible miscarriage in pregnant women.
• Drug interactions — they can interact with over-the-counter and prescription drugs. For example, ginkgo and chamomile may increase the risk of bleeding in people who take anticoagulant medicines such as warfarin, or anti-inflammatory medicines such as aspirin.
• Financial harm — you waste your money if a complementary medicine is not effective or appropriate.

There may be little protection under the law if a product is bought from overseas.

Issues for you and your doctor#

Doctors are expected to advise patients on complementary therapies, but there is no clear standard for how much a doctor should know about them. There are many different therapies available, and it is not realistic to expect any one doctor to be familiar with all of them. A doctor’s knowledge may depend on their specialty — for example, a cancer specialist (oncologist) may know about therapies relevant to cancer but little about others.

Many patients do not tell their regular doctor about their use of complementary therapies, often incorrectly assuming the doctor will be judgemental or will not understand. It is very important to tell your doctor if you are receiving or planning to receive complementary therapy.

Your doctor may have genuine misgivings about the safety of complementary therapies. Without regulation, standards of care differ from one therapist to the next, and the evidence on a particular medicine’s efficacy, risks and benefits may be unclear. A doctor may also be cautious about referring you, because in some cases a doctor can be legally liable if a referral results in harm.

General safety suggestions#

Be guided by your doctor. General suggestions include:

• If you are concerned about your health, always see your doctor for diagnosis. Don’t self-diagnose or seek diagnosis from a complementary therapist.
• Always consult your doctor before taking a complementary medicine or starting a complementary therapy.
• Choose regulated complementary medicines that carry an approved label or marking where this applies.
• Be an informed consumer. Medical misinformation, or “cyberquackery”, is rife on the internet, so use reputable sources for information about complementary medicines and therapies.
• Be wary of complementary medicines for sale online. Products may be out of date, poor quality or fake. Consult your doctor before buying any healthcare product online, especially a complementary one.
• If poisoning or suspected poisoning occurs, seek urgent advice from a poisons information service.

Key points#

• Complementary therapies are not automatically safe just because they are “natural”.
• Where they are regulated, complementary medicines are usually assessed for safety and quality, but only higher-risk products are assessed for how well they work.
• Without clinical trials, the benefits and short- and long-term risks of a therapy may be unknown.
• Complementary medicines can cause side effects and interact with prescription and over-the-counter drugs.
• Always tell your doctor about any complementary therapy you use or plan to use.

Where to get help#