Integrative Care
Policy News

Sweden´s drug agency supports US CAMpaign to discuss herbal use

17 September, 2012 by David Finer

Patients and health care staff should communicate more about herbal medicines, says Barbro Gerdén, M.D. at the Swedish Medical Product Agency. Since 2008, there has been an ongoing campaign in USA promoting that message.

The campaign “Time to talk” was initiated by NCCAM (National Center for Complementary and Alternative Medicine), a federal agency whose mission is “to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care”.

The need for more dialogue and integration between conventional and CAM treatment methods is to a considerable degree justified with reference to patient safety.

Risk of interactions
It is well known from the scientific literature that patients frequently hesitate to share information about their use of herbals or other unconventional treatment methods with their conventional health providers.

If physicians remain unaware that the patient is using some CAM treatment, there is a risk that s/he might prescribe a drug which might interact with the CAM treatment in unwanted and potentially harmful ways.

Several examples of the phenomenon are known, e.g., negative effects of combining St. Johns Wort (used against mild depression) with anticoagulants or taking fish oils containing omega-3 together with chemotherapy against cancer.

Some patients do not know that they should tell their health care providers, others say that the physician never asked. Yet again, others perceive the health care staff as being negatively inclined towards alternative treatment modalities or simply do not understand that CAM and ordinary treatment methods might interact in inopportune ways.

Ask and tell

– Patients should tell their doctors if they are taking herbals on their own. Health care personnel should also ask patients seeking care for side effects if they use herbals, says Barbro Gerdén, who is a dermatologist and in charge of plant-based drugs at the Swedish Medical Product Agency.

– In many cases, the hospital staff never inquired about concomitant CAM use, but it may also be the other way around, that patients do not divulge the information, so more openness is required on both sides, Barbro Gerdén says.

NCCAM has not evaluated the campaign in terms of its potential positive health impact. However, the agency has surveyed 106 individuals, who read the campaign material, and compared their answers with answers from a control group of 111 people.

The survey was done in conjunction with two large medical conferences in the USA in 2008 and 2009.  Responses were overwhelmingly positive, reports Alyssa Cotler, public health advisor at NCCAM.

Encourages discussion
Members of the group exposed to the material were clearly more comfortable raising the issue of CAM use in their health care encounters as compared to the controls (56 percent vs 38 percent).

Among consumers who read the material, 85 percent said they would be more or much more likely to bring up the question of CAM with health care staff.

– So we consider that the material has achieved the desired goal to encourage consumers to discuss CAM with their providers, Alyssa Cotler comments.

Check list for health providers
Among health care staff, 361 people were asked to read and respond to the material. Most of them (85 percent of the physicians and 95 percent of the nurses) said that they would integrate the campaign material into their clinical practice.

Here are some tips NCCAM gives health care providers who want to start communicating about CAM use, how and when CAM might be used, and patient expectations.

  •  Include a question about use of complementary health practices on medical history forms.
  • Ask your patients to bring a list of all therapies they use, including prescription, over-the-counter, herbal therapies, and other complementary health practices.
  • Have your nurse, nurse practitioner, or physician assistant initiate the conversation.
  • Ask your patients explicitly about their CAM use when you take their medical history.
  • Ask your patients to also report use of over-the-counter medicines and treatments.
  • Ask your patients where they get their information about CAM methods from.
  • Ask your patients why they are interested in complementary treatment methods.
  • Discuss unconventional methods openly and present the whole spectrum of available evidence for a certain treatment method.
  • Ask your patients on follow-up visits about treatments they have received and how they have reacted.
  • Advise patients about expectations of treatment and cost in terms of time and money, given that CAM strategies require considerable patient commitment.

David Finer


NCCAM (National Committee for Complementary and Alternative Medicine). Time to Talk Campaign.

Pappas S, Perlman A. Complementary and alternative medicine. The importance of doctor-patient communication. Med Clin North Am. 2002 Jan;86(1):1-10.

Koithan M. Let’s Talk about Complementary and Alternative Therapies. Journal of Nurse Practice 2009 March 1; 5(3):214-5.

Finer D. Läkemedelsverket önskar bättre kommunikation kring naturläkemedel. (MPA wants to improve communication around herbals) 2011-08-19.

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