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ANTONY SCHOLEFIELD THE marketing power of the complementary medicines industry has been highlighted by figures showing that half of Australian women and a third of men are taking dietary supplements.

Supplements are taken predominantly by well-nourished people and often in excess of recommended levels, a national study of almost 5000 people revealed.

Data from the 2011-2012 National Nutrition and Physical Activity Survey showed that dietary supplements use was higher among older people and among more affluent and educated groups who were already meeting recommended nutritional intake targets.

Researchers from Victoria’ s Deakin University noted with concern that intakes of vitamins E, C, B12 and zinc from supplements were, in some cases, in excess of the recommended daily intake“ which may result in toxicity”.

Professor John Dwyer, president of Friends of Science in Medicine, said the findings showed widespread use of dietary supplements with no benefit, which was the result of aggressive marketing by the multibillion-dollar industry.

“ It’ s very difficult to counter the ferocious, celebrity-based advertising. It’ s a very profitable business. Those trying to fight it face an uphill battle,” he said.

GPs should be aware that many of their patients may be spending up to $ 80 a month on multiple supplements that had the potential for adverse events, he warned.

“ We teach doctors to ask patients for all the things they’ re taking, including the supplements.

“ If a doctor doesn’ t know what [ the patients ] are taking and they prescribe orthodox drugs, there can be interactions,” he said.

Nutritionist Dr Rosemary Stanton( PhD) said excess zinc intake could lead to diarrhoea, nausea, abdominal pains, lethargy and interfere with absorption of iron and / or calcium. But excess vitamin E intake was the main concern.

“ The main thing is to warn patients having some types of surgery to stop taking vitamin E several weeks prior to surgery. This is because vitamin E may be associated with increased bleeding and haematoma. This could also apply to herbal and omega 3 supplements,” Dr Stanton added. Nutrients 2017; online.

MICHAEL WOODHEAD MEDICARE is out of alignment with best-practice guidelines for low back pain, making it difficult for patients to access first-line non-drug treatments, Australian experts say.

Recent changes in guidelines for managing low back pain have moved the focus of treatment to non-drug therapies such as physiotherapy, say University of Sydney researchers.

Exercise programs and superficial heat are now the first-line preference for acute low back pain, they note, while for more persistent low back pain, the preferred interventions include CBT rather than NSAIDs or steroid injections.

However, lead author Dr Adrian Traeger( PhD), a researcher at the Musculoskeletal Health Group at the university’ s school of public health, says that under the current Medicare structure, it is difficult for GPs to put the latest recommendations into practice.

“ Health systems in most industrialised countries, including Australian Medicare, are simply not set up to fund the care that is considered the most appropriate for low back pain right now,” he said.

“ It’ s currently much easier and cheaper to provide a prescription for an opioid pain medicine … than a course of treatment with a physiotherapist or psychologist.

“ Without policy changes, it will be difficult for GPs to follow current best practice.

“ However, if Medicare were to make simple changes to improve affordability of alternatives to pain medicines, not only would it make a GP’ s job easier, it could result in a major impact on the lives of many living with low back pain, including those who rely on opioids.

“ This needs the attention of the Federal Government,” he says. CMAJ 2017; online.

Exercise is now first-line treatment for acute low back pain.

YOU should worry for the My Health Record this Christmas— simply because it still has the look of a giant, overfed turkey. Respect to the

Australian Digital Health Agency— it is being open and transparent about what’ s going on.

It could have buried the numbers, as numerous health ministers have done in the past, beneath the statistical irrelevancies of the millions of patients signed up to the system: a number quoted in the media sound bites to disguise the fact that taxpayer dollars are being squandered.

The shared health summaries being created by GPs are meant to be the“ backbone” of the system, a quick, concise clinical overview that

What is being uploaded to the My Health Record system?

100000 hospitals, private specialists, and allied health practitioners can refer to when providing care.

They are about reducing duplication and errors and, when it comes to patients landing in ED, perhaps even saving lives. But that’ s only if someone actually reads them and that, when they do so, they are up-todate. And we still don’ t know whether the summaries, after their creation, are being kept up-to-date.

The My Health Record is more than just these summaries of course, and that is where the system could start showing that it has some sort of a future.

Doctors are( slowly) starting to access pathology and imaging results. There are increasing numbers of event and discharge summaries being uploaded, as well as something genuinely revolutionary— actual information on what medicines have been dispensed. This is probably where hope for this $ 2 billion dollar turkey now lies. It means it has until next Christmas to show it is loved and until next Christmas before someone starts sharpening the knives.

Number of My Health Record documents viewed in hospitals

350

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Health Informatics, said:“ It is easy to say that GPs are wasting their time with these summaries. There is a challenge here, and it is to say to hospitals that this information is now available.

“ I think they have been reluctant to use it in the past because there has been nothing there. Now that has changed.

“ It’ s a chicken and egg problem,” he added.

The Australian Digital Health Agency stressed that it was working with the Australian Commission on Safety and Quality in Health Care to encourage hospitals to engage with the My Health Record.

4 | Australian Doctor | 24 November 2017 www. australiandoctor. com. au