Safety concerns

Warning signs to look out for

Keep the following warning signs in mind about any therapy or medicine you are thinking about using alongside or instead of a conventional  treatment or medicine.

• Any claims that the treatment cures cancer and other illnesses.
• The treatment costs a lot of money, you need to pay in advance for several months’ supply or you can only buy it from the therapist.
• The medicine is not listed with the Therapeutic Goods Administration (TGA).
• The therapist is not qualified in the therapy they provide or not registered with a governing body or professional association.
• The therapist tells you not to use conventional treatment or medicine as it will stop their therapy or remedy from working.
• The therapist suggests changes to your conventional treatment, asks you not to talk to your doctors about the treatment, or won’t tell you what the ingredients are in a herbal preparation they give you.
• The therapist says there are clinical studies showing the effectiveness of their remedy or therapy, but does not show you any articles that have appeared in trustworthy journals reviewed by other scientists.
• The therapist says that the medicine has worked miraculously in other people.
• All potential side effects have not been explained.
• You need to travel overseas to have the treatment.

The Australian Competition and Consumer Commission (ACCC) tracks health and medical scams to help the public spot and avoid scams. To find out more, visit their websites at Scamwatch or the Australian Competition and Consumer Commission (ACCC).

Telling your doctors about using a therapy

Studies show that most people with cancer who use complementary therapies don’t tell their doctors. This is because they worry their doctors will disapprove.

The use of complementary therapies is growing, so many doctors are now better informed about them and are often supportive of their use. Some doctors and nurses have been trained in complementary therapies and are able to give you information about them. Complementary therapies are also available at some cancer treatment centres.

To keep yourself safe, have the following conversations:

Talk to your doctors – It is important to discuss your interest in complementary therapies with your GP, cancer doctors and nurses. Let them know about any specific therapies you are using or thinking about trying.

Talking with your cancer care team allows them to:

• consider your safety and wellbeing
• discuss possible side effects or interactions with conventional treatments and medicines
• suggest other complementary therapies that may help with the issues you have
• refer you to a qualified therapist experienced in working with people with cancer.

Your surgeon, medical oncologist or radiation oncologist may raise specific concerns, such as not using particular creams or medicines at certain times during your treatment. If you are taking herbs or nutritional supplements, they may suggest you stop taking these before, during or after particular treatments.

Talk to your complementary therapist – It is also important to tell your complementary therapist that you have cancer, and inform them of the conventional treatments and medicines you’re having.

Some therapies may need to be adjusted or avoided to prevent interactions with your conventional cancer treatment.

Ask your therapist what information they need from your cancer specialists to help you avoid risky treatment and drug interactions.

Safety of herbs

All herbs should be prescribed by a qualified therapist. Although herbs are natural, they are not always safe. Taking the wrong dose or combination, or using the wrong part of the plant, may cause side effects or be poisonous (toxic). Serious side effects include damage to the liver or kidneys.

Some Ayurvedic and Chinese products have been shown to contain lead, mercury and arsenic in high enough quantities to be considered toxic. Other herbal preparations have been found to contain pesticides and prescription medicines.

There are things you can do to use herbal products safely:

• Buy herbal products from a qualified therapist or reputable supplier.
• If your therapist is making up a preparation for you, ask for it to be clearly labelled in English with your name, date, quantity, ingredients, dosage, directions, safety information (if applicable) and your therapist’s contact details.
• Avoid buying over-the-counter products online. Products from other countries that are available over the internet are not covered by the same quality and safety regulations as those sold in Australia, and may not include the ingredients listed on the label.
• Make sure you know how to prepare and take your herbs. Like conventional medicine, taking the correct dose at the right time is important for the safe use of herbal remedies.
• Check the label for any warnings about side effects and drug interactions. Talk to your doctor and complementary therapist about possible side effects and what you should do if you experience them.
• Report any suspected adverse reactions to any kind of medicine to your therapist or doctor. If the reaction is serious, call Triple Zero (000) or go to your nearest emergency department.

Using herbs and supplements during treatment

Some common herbs and supplements have been shown to cause harmful interactions with cancer treatments, including surgery, radiation therapy and chemotherapy. Talk to your surgeon or oncologist about whether you need to stop taking any herbs or supplements before treatment.

St John’s wort – This popular herb for mild to moderate depression has been shown to stop some chemotherapy drugs and other medicines working properly. It may also increase skin reactions to radiation therapy. If you are feeling depressed, ask your doctor about other treatments.

Black cohosh – Herbalists often prescribe this herb to menopausal women who are having hot flushes, however, it has not been shown to help. While clinical trials show that black cohosh is relatively safe, it should not be used by people with liver damage. There is no evidence to support the use of black cohosh in people with cancer.

Fish oil, ginkgo biloba and garlic – Studies have shown that these products may have a blood-thinning effect, which can cause bleeding. This could be harmful in people with low platelet levels (e.g. from chemotherapy) or who are having surgery.

Green tea – This has been shown to stop the cancer drug bortezomib from working properly.

Keep your complementary therapists and other health professionals informed about any herbs and supplements you use before, during or after  cancer treatment. This will help them give you the best possible care.

For more information on the effects of specific herbs and botanicals, visit the Memorial Sloan Kettering Cancer Center website. You can also download their About Herbs app to your smartphone or tablet.

Safety of oils used in bodywork

Concentrated oils extracted from plants, such as lavender or tea tree, are called essential oils. Before being applied to the skin, essential oils need to be diluted by being mixed with a base oil. Base (or carrier) oils are usually made from kernels or nuts, such as almonds. Sometimes mineral oil is used instead as it is odourless.

Allergic reactions to oils are rare, but some people find they irritate the skin, or the smell makes them feel nauseous or gives them a headache. Let your therapist know if you have had reactions to oils in the past, or if you find certain smells unpleasant.

Regulation of medicines

The Therapeutic Goods Administration (TGA) is an Australian Government department that assesses and monitors (regulates) all therapeutic goods and medicines sold in Australia. This includes complementary medicines such as herbs, vitamins, minerals, nutritional supplements, homeopathic remedies and some aromatherapy products.

The regulation of complementary medicines helps to protect the public. It helps ensure that therapeutic goods are produced to an acceptable standard of safety and quality (good manufacturing practice) and that any adverse reactions can be investigated.

Most therapeutic goods supplied in Australia – whether made in Australia or overseas – must be included on the Australian Register of Therapeutic Goods (ARTG). Some homeopathic preparations are exempt from this requirement. Visit the Australian Register of Therapeutic Goods (ARTG) to search the ARTG for a specific medicine.

To be included on the ARTG, medicines will be given one of the following codes depending on the level of risk. This code must be displayed on the medicine label.

AUST L (listed) – These products make low-level health claims and contain pre-approved low-risk ingredients. They are reviewed for safety and quality only, not for how well they work. Products in this category include sunscreen, vitamin and mineral supplements, and herbal medicines. These products are available at supermarkets, health food stores and pharmacies, and you don’t need a prescription.

AUST L(A) (assessed listed) – These products make higher-level health claims than other listed medicines and contain pre-approved ingredients. The TGA assesses them for safety, quality and whether the scientific evidence shows that the product does what it says it does. These products may include the “TGA assessed” symbol on the label and are sold at pharmacies, supermarkets and health food stores.

AUST R (registered) – Because these products are considered higher risk, they are evaluated by the TGA for safety, quality and whether the scientific evidence shows that the medicine does what it claims. They include all prescription medicines, most over-the-counter medicines and some higher-risk complementary medicines. Registered complementary medicines may include the “TGA assessed” symbol on the label.

Many pharmacies and health food stores sell herbal preparations. For more information on the safety, labelling and regulation of these medicines, visit the Therapeutic Goods Administration.

Regulation of complementary therapists

Some complementary therapists are required to be registered and accredited, but most are unregistered.

Registered health practitioners – The Australian Health Practitioner Regulation Agency (AHPRA) and 15 National Boards regulate certain types of health practitioners, such as doctors, nurses, dentists, pharmacists, psychologists, physiotherapists and Chinese medicine practitioners (including acupuncturists).

Health practitioners must meet certain standards before they can be registered and accredited with a National Board. This helps ensure that only trained and competent health professionals practise within these professions. It is unlawful for a person to pretend to be a registered health practitioner. If you have concerns about the performance or conduct of a registered health practitioner, you can contact AHPRA.

Unregistered health practitioners – Some health practitioners are not legally required to be registered with a National Board. They are known as unregistered health practitioners or general health service providers. They may join a professional association that sets minimum standards, but membership is voluntary. In some states, unregistered health practitioners are required to follow a Code of Conduct, which must be displayed in the premises. If you have an issue with an unregistered practitioner, talk to them first. If you’re not satisfied, you can lodge a complaint.

The following complementary therapy providers that are not registered with AHPRA have set up their own regulatory bodies:

Naturopaths and Western herbalists – Most naturopaths and herbalists are members of the Australian Register of Naturopaths and Herbalists (ARONAH). This is a self-governing body that sets minimum standards of practice for both professions.

Homeopaths – The Australian Register of Homoeopaths (AROH) represents homeopaths who are qualified to practise in line with government standards. The AROH outlines the necessary professional standards for registered homeopaths, who must meet continuing education requirements each year.

Because they are not regulated in the same way as doctors, nurses and other registered health practitioners, standards of care may differ from one complementary therapist to another.

What can I do if something goes wrong?

If you experience any side effects that you think are from a complementary therapy, stop the treatment and talk to your therapist about your options. These may include adjusting your treatment, stopping the treatment permanently, seeking a second opinion, or seeing another qualified therapist. You can also talk with your doctor or pharmacist about your concerns. If you have a serious reaction, call Triple Zero (000) or go straight to your nearest hospital emergency department.

If you are concerned that a therapist has been negligent, incompetent or unethical, consider the following options:

• If they belong to a professional association, contact the association with a formal complaint.
• Contact the health care complaints commission in your state or territory.

Health care complaints commissions

These organisations protect public health and safety by investigating and resolving complaints about health care providers. They can also prosecute
serious complaints.

ACT – ACT Human Rights Commission ph: 02 6205 2222

NSW – Health Care Complaints Commission ph: 1800 043 159

NT – Health and Community Services Complaints Commission ph: 1800 004 474

QLD – Office of the Health Ombudsman ph: 133 646

SA – Health and Community Services Complaints Commissioner ph: 1800 232 007

TAS – Health Complaints Commissioner Tasmania ph: 1800 001 170

VIC – Health Complaints Commissioner ph: 1300 582 113

WA – Health and Disability Services Complaints Office ph: 08 6551 7600 or 1800 813 583