The concept of self care entails greater personal responsibility for our health, and for smokers, quitting is the ultimate in self care. In many cases, smokers need the support of family, friends, health professionals and cessation aids to make the change. But the change is worth the battle.

Health authorities have put considerable effort into encouraging smokers to quit their deadly habit. Graphic and confronting advertisements have been used to educate the community, and in 2011, the ‘Every cigarette you don’t smoke is doing you good’ campaign has been widely promoted. The Federal Government is also proposing to introduce plain package restrictions on the sale of tobacco in Australia.

Smoking has long been linked to a number of serious health problems, as detailed by Australia’s online health information service, HealthInsite:

“Smoking is an important risk factor for the three diseases that cause most deaths in Australia: heart disease, stroke and lung cancer. It is responsible for around 80% of all lung cancer deaths and 20% of all cancer deaths. Smoking has also been linked to cancers of the mouth, bladder, kidney, stomach and cervix, among others. Smokers are also at increased risk of having reduced lung function from chronic obstructive pulmonary disease. Using tobacco has been linked to a variety of other conditions, such as diabetes, peptic ulcers, some vision problems, and back pain. Smoking in pregnancy can lead to miscarriage, stillbirth or premature birth.”

Smoking continues to be Australia’s largest preventable cause of death. Although the rates of smoking have dropped from more than 30% in the early 1980’s to 18% in 2007, there are still approximately 15,000 deaths per year resulting from smoking. [i]

Several attempts are often needed to quit, and the chances of success are increased by using a combination of approaches.[ii]

So, if you are a smoker who wants to quit, or know one, where do you go for help and what steps do you take?

The ‘quitnow’ website has some useful strategies for quitting.  It recommends preparing a quit plan which will help you to:

• Identify the reasons you want to quit
• Create your quitting plan
• Put your plan into action

Support services

According to quitnow, the best services available to help you to quit include:

Quitline

You can confidentially call the Quitline on 13 7848 (13 QUIT) for professional help and support. Quitline will send you a free quit pack including tools and information to get the best possible start.

QuitCoach

This is an online tool. By answering questions about your smoking habits and lifestyle, QuitCoach will give you ideas and suggestions that will be most useful to you.

GP or pharmacist

Healthcare professionals can help you to determine the best quitting method for you, and give you the advice and support to encourage the best result.

Nicotine replacement therapy (NRT)

Nicotine replacement products, including patches and gum, work by reducing withdrawal symptoms such as cravings, irritability, mood swings and anxiety. NRT is proven to have a significant impact in reducing smoking. A Cochrane review concluded that NRT almost doubles the success rate of long term abstinence.[iii] The use of NRT alongside support like telephone help services is likely to make positive inroads to quitting.

Other medications

There are other medications which reduce cravings while you quit. They are prescription medicines, so consult your doctor for more information.

Cold Turkey

Some people prefer to try to quit ‘cold turkey’; however this is less effective than using NRT.

Whichever path you choose to take on your road to quitting, we hope it gets you across the line.

[i] Preventative Health Taskforce, Tobacco control in Australia: Making smoking history, pg 1

[ii] Preventative Health Taskforce, Tobacco control in Australia: Making smoking history, pg 33

[iii] Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation, Review 2008, Issue 1, Art.No: CD000146. DOI:10.1002/14651858.CD000146.pub3.

In this blog, Ruth talks about the role of complementary medicines in the health system, and shares some tips for using complementary medicines effectively.

Does complementary medicine deserve its place beside conventional medicine?

Complementary medicines are a legitimate and valid part of modern healthcare, despite recent allegations that they lack evidence, or that their popularity is no more than a passing fad.

Traditional complementary medicines have been used all over the world for centuries, and there is a large body of evidence, not only traditional but increasingly scientific, supporting their benefits. Much of this evidence has been scrutinised by respected expert bodies such as the European Commission and the World Health Organization (WHO). Both organisations have produced detailed and authoritative publications on the subject.[1] [2]

In the 20^th Century the science of nutrition and of food components expanded dramatically and the importance of essential nutrients such as vitamins, minerals, and essential fatty acids, is now well established. These play an important role in the prevention, management and treatment of health conditions. Many governments as well as WHO have published information, recommendations and guidelines on specific nutrients, as well as on nutrition generally.[3] [4] [5] [6]

There are many examples of complementary medicines which are supported by good scientific evidence.

A Cochrane review of 28 randomised, double-blind controlled trials of the herb St. John’s Wort found that this herb is superior to placebo and equivalent to standard anti-depressants in the treatment of clinical depression. The reviewers also found that subjects treated with St. John’s Wort experienced fewer adverse reactions.[7]

More than 120 clinical trials have been published on the herb Ginkgo biloba. The great majority, including double-blind placebo-controlled trials, showed benefit in several conditions: intermittent claudication, tinnitus and mild dementia due to cerebral insufficiency or early Alzheimers disease. Once again, use of the herb was found to be similar in effect to standard drug treatment, with fewer adverse effects.[8] [9]

Vitamin D is essential in calcium metabolism, bone health, and other metabolic roles including immune function. It is produced in the body as a result of sunlight falling on the skin. Although the vitamin is found in small quantities in some foods, with current patterns of eating it is almost impossible to obtain sufficient vitamin D from the diet alone.[10] In recent years the risk of melanoma has led to national campaigns to use sunscreens and to avoid direct sun exposure. As a result, vitamin D deficiency is a growing problem and supplementation is frequently recommended, for example an article by a group of Sydney medical professionals says:

Australia is well known for its abundance of sunshine. Hence, it is perhaps surprising that vitamin D deficiency is a common condition affecting a large proportion of Australians. A recognised consequence of low vitamin D is osteomalacia in adults. It also contributes to osteoporosis, that is fragility fractures, in part through increased risk of falls. Vitamin D deficiency has also been implicated in other conditions including cardiovascular disease, increased cancer risk and mortality, falls, diabetes, multiple sclerosis, osteoarthritis, epilepsy and cognitive dysfunction.[11]

It is worth bearing in mind that substances like digitalis, codeine, quinine and aspirin were developed from traditional herbal medicines, based on traditional knowledge, and subsequently demonstrated by modern science to be highly effective.

Much progress has been made to develop the evidence base for complementary medicines but those who wish to invest in research face major challenges. The lack of appropriate IP protection provisions is a major disincentive. The vast majority of complementary medicines are based on well known ingredients, which make it very difficult to patent them. High-quality research is extremely costly and without patents companies cannot protect the investment required to run large trials. Despite this unfavourable regulatory environment many companies invest millions of dollars each year in the development of products and the evidence to prove their efficacy.

The growth in our understanding and acceptance of health and wellness, and of complementary medicines of all kinds, complements the body of medical knowledge. The important contribution of complementary medicines to the wider health system should be acknowledged and appreciated.

Consumers have made it very clear that they see a definite role for complementary medicines as part of an integrated approach to personal health and self care. Today’s consumers seek information, and have the tenacity to weigh up their options before making choices. All the evidence suggests that the majority of complementary medicine users in Australia are well educated, and use these products and services in combination with existing orthodox treatments; and they want GPs, pharmacists and other healthcare professionals to assist them in making the right choices.

Many GPs have embraced evidence-based complementary medicines as an important aid to wellness and recovery, and hold dual qualifications in both conventional and complementary medicine. These GPs should be commended, and there should be an enhanced role for the medical professions in helping consumers to make informed choices evidence-based alternative medicine.

So, in answer to the question I posed at the outset of this blog: Yes, evidence-based complementary medicines fully deserve their place alongside conventional medicines in the health system. With the industry moving in leaps and bounds to develop and innovate, consumers will only continue to benefit from quality health outcomes.

To get the best results with complementary medicines there are a few rules to follow:

• Consult a qualified natural health practitioner, doctor or pharmacist to ensure that the complementary medicine is safe and effective, and to identify any possible reactions with other medications.
• Read the label instructions carefully and know the active ingredients of the product so you can make informed choices.
• Always check the use-by dates on the labels.

For more information about using complementary medicines wisely visit NPS

For more information about complementary medicines generally, visit Healthinsite and EBSCO Health Library .

[2] The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council.1999.

[3] Australian Government Dept. of Health and Aging. 2006. Nutrient Reference Values for Australia and New Zealand including Recommended Dietary Intakes.

[4] WHO and FAO. 2004. Vitamin and Mineral Requirements in Human Nutrition. Second Edition.

[5] Food and Nutrition Board (USA). Dietary Reference Intakes for Energy, Carbohydrate, Fibre,  Fat, Fatty Acids,  Cholesterol,  Protein, and Amino Acids (Macronutrients) (2005). The National Academies Press.

[6] U.S. Department of Health and Human Services. U.S. Department of Agriculture. 2005. Dietary Guidelines for Americans. 2005.

[7] Linde K, Berner MM, Kriston L. St John’s Wort for major depression. Cochrane Database Syst Rev. 2008.

[8] Blumenthal M. 2003. The ABC Clinical Guide to Herbs. American Botanical Council/ Thieme.

[9] WHO,2003. Monographs on Selected Medicinal Plants. World Health Organisation.

[10] Australian Government Dept. of Health and Aging. 2006. Nutrient Reference Values for Australia and New Zealand including Recommended Dietary Intakes.

[11] Joshi D, Center J, Eisman J. Vitamin D deficiency in adults. Aust Prescriber 2010;33:103–6)

Medicines play a useful, and sometimes critical role in our health, however we must take care to use them responsibly.

NPS, the independent, government-funded organisation behind MedicineWise, says there are five important questions that everyone should ask when using a medicine, whether it is an over-the-counter or prescription medicine:

1. What is the medicine for?
2. What is the active ingredient?
3. How do I take or use this medicine correctly?
4. What are the possible side effects and what can I do about them?
5. What should or shouldn’t I do while taking this medicine?

There are other simple steps that you can take before using medicines to ensure the greatest level of safety.

Check that the container is not damaged
When you buy a medicine, check that it has not been opened. Most medicines come in tamper-evident packaging. Check that the barrier/seal is not broken before you buy.

Read the medicine label carefully
Read labels and any leaflets in the pack. The labels give you important and essential information about how to use the products correctly.

Sometimes product names appear similar but may contain different ingredients. This is called ‘umbrella branding’. Sometimes different brands may contain the same ingredients. Therefore, it is important to always read the label and to follow instructions.

Look for “change flags”
Note special “change flags”. They tell you about a change in the formulation or dose. Don’t assume a product is the same as the last one you bought. A change in formulation can affect how the product looks, e.g. colour, or how much you should take.

Check information about the medicine
Watch out for any special warnings. Check what ingredients are in the product. Check on the right dose for you – how much, how often, how long. Some medicines should not be used if you are already taking other medicines. Or a product may not be suitable for people with certain medical conditions. The label will usually tell you.

Make sure the product you choose is the right one for you and your family. Ask your pharmacist or doctor if you are not sure.

Follow directions
Do what the label says. Never use a medicine more often or in larger doses or for longer than recommended on the label. Only use the medicine for the indications shown on the label. Taking more than the recommended dose or taking it more frequently than recommended could be harmful.

Keep medicines secure
Keep all medicines out of the reach of children. Some products look attractive to children. Always keep medicines well away from them. It is a good idea to lock these products in a cupboard above the ground.

If the container has a child resistant cap, make sure you put it back on properly and tightly.

Don’t store for later
Check the ‘use by’ or ‘expiry’ date. All medicines lose their strength and effectiveness over time. Don’t assume a medicine you bought some time ago is still suitable. Ask your pharmacist to dispose of your out-of-date or unwanted medicines.

Talk to a health professional
Ask and you’ll get the answers you need. If you still have questions after reading the label, talk to your pharmacist or doctor. They can help you use your medicines safely and effectively.

For more information about the safe and effective use of medicines, please visit the ASMI website.

Following on from this, we had the pleasure of hearing John’s European counterpart, Professor Ian Banks, President of the European Men’s Health Forum, who was in Australia for the Australian Self-Medication Industry (ASMI) 2010 Conference in Sydney. 

Professor Banks, is one of the world’s leading experts on men’s health and the official spokesman on men’s health issues for the British Medical Association, along with being a GP.

Professor Ian Banks, President, European Men's Health Forum

Listen to Professor Banks talk about men’s health in an interview on Melbourne radio here

Professor Banks believes that a better understanding of profound gender differences could hold the key to improving men’s health, and that women may play a pivotal role in the health of men in the community.

He says that, for better or worse, most of the responsibility for men’s health falls on women in the family because they are more acutely aware of their own health and are often the ones that encourage a man to visit the doctor.

Professor Banks has also found that many men actually avoid going to the doctor because they are fearful of the diagnosis. This explains why for a range of conditions including melanoma, where men have a lower incidence than women, they actually suffer a higher mortality rate because they delay diagnosis and treatment.

He agrees with Professor Ian McDonald that health services are geared towards women, and are not effectively encouraging men to seek help. He uses the example of the many posters around a doctor’s surgery that are targeted at women, or the overwhelming amount of women’s products in pharmacies to demonstrate this.

Professor Banks said we still have a long way to go to improve the state of men’s health worldwide.

Guest blogger, John Baxter, is the President of the National Herbalists Association of Australia and a practising herbalist and naturopath. Here he explains the importance of balancing the right foods and supplements for optimal health.

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John Baxter

It almost goes without saying that nutrition is the key to health.

We have all heard many times the saying “you are what you eat” and in one sense this is true.

The food we eat provides the nutrients that we use to build, repair and maintain our bodies. Food provides the chemicals that the sophisticated, biochemical factory we call our body, needs to function.

Whether awake or asleep our bodies are continuously taking chemicals, nutrients and minerals and converting them into energy, building new cells, creating hormones and neurotransmitters which our body utilises to maintain the balance that keeps us functioning.

There are literally thousands of these processes occurring in any given moment to create this balance known as homeostasis. When we get our balance “right” we feel alive, full of energy, ready and willing to face the challenges life offers.

The types of foods we choose has, to a large degree, a direct effect on our biochemical functioning. There is no real single formula or diet for every person; there are however some very good guidelines available to help in the choices we make. A very good starting place is the food pyramid.

Image from: www.foodscope.com.au

The food pyramid is a pictorial representation of the types and amounts of foods required for good health. This picture suggests that cereals & grains, fresh fruits and vegetables form the major food sources in your diet with protein from dairy and meats to support this choice and to use oils and sweets sparingly.

The ‘Human Interference Factor’ must also be considered when selecting foods. As a general rule, the more a foodstuff is processed the less nutritional value it will have. So selecting fresh, nutritious foods is best.

Other considerations that must be taken into account when designing your nutritional requirements include the following:

Gender – Women tend to have different nutritional requirements as their life cycle includes menstrual cycles, pregnancy, breast feeding and eventually menopause. Men’s needs vary as they age, but not so much as women.

Exercise – increased exercise calls for higher levels of calories to support the energy output and different nutrition to repair and restore muscles that are working hard. People in sedentary work need fewer calories to prevent excessive weight gain but they also need to consider engaging in some moderate exercise.

Health – Our state of health may cause us to need extra nutrients to fight off infections, repair tissue, to help regain wellness and to protect against further damage.

Medications – medications can affect our body’s nutritional status as it uses nutrients to metabolise them and the medications may also affect the way nutrients are processed.

Alcohol, smoking and drugs – use of alcohol, tobacco and recreational drugs will affect our nutritional status. Our body must use nutrients to detoxify and protect against any damage caused by any of the toxic by-products produced during detoxification.

Stress – living and working in stressful situations will cause our body to use up more nutrients as it strives to maintain its equilibrium in these situations.

Environment – the environment we live in influences how our body responds nutritionally. If we live in an environment where we are continually exposed to pollutants or radiation our nutritional requirements change.

As can be seen, because of the many factors that affect our nutritional requirements, it is possible that sometimes our diet may not supply all the nutrition we need. This is where well-chosen nutritional supplements come into play.

Depending on our circumstances it is likely at some stages during our lives we will need to supplement the food we eat with nutritional supplements. The good news is, in Australia there are high quality products available over the counter in health food shops, pharmacies and even supermarkets.

In health food shops and pharmacies some information and advice on the supplements can be obtained from the assistants on duty. This advice is obviously not available in supermarkets.

For specific advice on our personal health needs it is best to consult with a trained health care provider. Naturopaths and herbalists are specifically trained in nutrition as it affects disease states and can assist with selection of appropriate supplements for particular situations.

According to a recent report by the Australian Bureau of Statistics (ABS), men are more likely to engage in risky behaviours, and have a higher incidence of many conditions, than women.

The ABS says that men are expected to live 4.5 years less than women, with young men more likely to die from external causes, and as age increases, cancers and diseases of the circulatory system are the main causes of death.

So what can be done to improve the health of Australian men?

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Our guest blogger Professor John MacDonald, Director of the Men’s Health Information and Resource Centre, University of Western Sydney, gives his view on the state of men’s health in Australia.

Professor John MacDonald

Male health: Self care, but it takes two to tango!

There has been a growing interest in male health. The women’s movement has brought attention to the issue of gender and health and the benefits to women are there to be seen in the health programs designed specifically for them. Unfortunately, one result has been that “gender and health” often refers exclusively to women’s health. Women have rightly struggled with the danger of ‘women’s health” being reduced to concerns for the reproductive health of women, likewise,  male health has been dominated for some time by concerns around the prostate and more recently, erectile dysfunction, both, in themselves important aspects of male health, but only part of the bigger picture. This medicalisation of men’s health has often been accompanied, not by regular screening for men as there is for women, but by repeated assertions that “men don’t take care of themselves”, “men don’t get in touch with their feelings” and the like. Generally this has been in a blaming tone, compounded by another stream of concern about “men behaving badly” and male violence. Of course, we must accept that good male health is a matter of the engagement of the individual male with his total environment, including the health services which are there and are sometimes underutilised by men (though not as much, as we see from the ABS statistics, as the stereotype would have us believe). And no one, including men, should get away with violence, but there is more to men’s health than that.

But change is on the way! This negative approach to male health has been offset more recently by what can be seen as a more rational and compassionate view of male health. This has come about in part by a growth of interest in the “social determinants” of health, a movement spearheaded by WHO. The Australian National Male Health Policy, launched this year, (www.health.gov.au/malehealthpolicy)  tells us that this approach is the way forward. Sure, we have to exercise and watch alcohol intake etc but if a man’s context is one where he commutes two hours in the morning and two at night, let’s get real – “self care” must be adapted to his life situation. Work, stress, the social gradient (where we fit in the ladder of society), social inclusion and exclusion are all examples of the social determinants of health and influence our resistance to illness and disease and provide a useful entry point to looking at male health.

One example is that of work, employment and unemployment: men working to support their families and anxious not to be made redundant, men working in health-threatening jobs, not by choice or carelessness, men finding the adjustment after retirement hard and stressful. All these issues are legitimate and in fact essential factors to look at when dealing with men’s heath. What does “self-care” mean for each of these groups? The shift involved in adopting a social determinants of health approach allows us, for all populations, including men, to acknowledge the importance of personal behaviour (including violent behaviour) but to see this in the broader environments of men’s lives. The Male Health Policy talks about men going more to the doctor but doesn’t say it’s all up to the men. It talks of “male-friendly” health services. Wow! That is a change. Check out what your local Community Health or GP does for young dads, for commuting men (e.g. surgery hours), for isolated older men who are the group most at risk of suicide. I am afraid you won’t find much.

Some Australian circumstances may have relevance for the wider world. National male health conferences have been run in conjunction with Indigenous, Aboriginal and Torres Strait Islander Male Health Conventions and we see there is much to be learned from Aboriginal approaches to health, including male health: a more holistic view of health underpins Aboriginal philosophy and there is a respect for “men’s business” as separate from women’s business. In a globalised world there is much to be learned from other cultures, helping us towards a more rational and compassionate view of men’s health.

2010 has seen the proclamation of an Australian Male Health Policy, only the second country in the world after Ireland to have one. The preparatory documents have stressed the social determinants of male health and also the importance of “male-friendly” health services. Both these elements allow us to move away from the narrow clinical perspective of men’s health (or rather illness), as well as from the blaming men approach. We can now think of building the health of men and boys across the life span as well as changing our perspective about men and health services. Instead of asking, Why don’t men come to services?, we should now be asking, What can services do to make themselves more accessible to men and boys? It takes two to tango!

All of us need medical advice at some point, whether it’s for a minor cough or a more serious concern. But do we need to always visit the doctor?

In order to provide better access to healthcare, there is a growing trend to give pharmacists a greater role in the treatment of minor ailments. Pharmacists would act as the first point of call for patients who need advice for non-serious or chronic ailments.

This not only gives patients better access to health advice, it also eases the pressure on GPs and gives them more time to address more serious ailments and preventative health.

Some in the medical profession have reservations, while others are more supportive. A recent survey undertaken by research company, CDS on behalf of the Australian Self-Medication Industry canvassed the view of 150 GPs.

It found that 29 per cent of GPs believed it would be better if patients with minor ailments such as coughs and colds were encouraged to visit a pharmacist as a first port of call for such ailments. Some 71 per cent disagreed, indicating there is still a way to go to gain the full support of the medical community.

Pharmacists are a well-established part of local communities throughout Australia. They are highly qualified, trusted and accessible, and are well-placed to provide advice on the most common minor ailments – such things as upper respiratory tract infection, back pain, diarrohea and gastroenteritis, joint pain, coughs, viral infection, malaise and fatigue, headache and constipation.

This doesn’t mean replacing the role of GPs who continue to play a vital part on the frontline of primary healthcare. Rather, it opens up a new avenue for GPs to help promote improved health literacy – giving them the time to educate patients on the best ways to take greater responsibility for personal health through appropriate self care and preventative measures.

It also means that GPs’ time will be freed to focus on patients who most need their attention, including those with serious health concerns or illness.

A 2008 study by international health industry consultants, IMS, found that 15 per cent of all GP consultations involve the treatment of minor ailments.  When projected nationally, the study suggests that a total of 25 million GP consultations annually, or approximately 96,000 consultations per day involve minor ailments.

No one wants to feel rushed during their GP consultation because of a backlog of people, some with coughs, colds and other minor ailments that could be managed through a pharmacist or appropriate self care. Neither do GPs want to feel pressured to rush their consultations due to time pressures.

Clearly there is a need to look at ways of better utilising our highly trained health workforce. It makes sense to use the skills of the Australia-wide community pharmacy network.

With support from government, the health sector and the community, pharmacists could play a valuable role in helping to improve health outcomes for all Australians.

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Vote in our Facebook Poll:

Would you be prepared to visit your pharmacist as a first point of call for a minor ailment (eg: coughs, colds, gastroenteritis, headaches)? Click here to vote.

World Health Day 2010 is run by the World Health Organisation (WHO) and this year it is all about creating healthier cities. According to WHO, more than 50 per cent of the world’s population lives in cities, and by 2030, that number will reach 60 per cent. So it is important to recognise the impact that high-density dwelling has on infrastructure, resources, and inevitability, health.

As part of World Health Day, groups in cities all over the world are taking to parks and streets to spread the word on the importance of health. Even if you are not involved in a World Health Day activity or event, or don’t live in the city, you can still use this opportunity to think about the actions that would make your life healthier.

Are you eating a healthy diet, engaging in an exercise regime, getting enough sleep, and taking appropriate self-medication? For tips on nutrition and exercise, visit the Healthy Weight website, for information about self-medication visit the Medicines Line website.

Through taking greater personal responsibility for health, and engaging in healthy living, we can each make a contribution to preventing illness and disease.

Recently we have heard from the Federal Government about the need to fix our hospitals, and this is indeed the case in many areas of Australia. But in terms of the healthcare spectrum, hospitals are essentially the last step for people to visit when ill. So shouldn’t much of the focus be on preventative healthcare to stop many of these problems occurring in the first place?

Public health campaigns including the ‘Quit’ smoking campaign, the ‘Measure Up’ weight campaign and the drink driving campaigns are all aimed at providing the public with the information they need to get healthy and stay healthy. Many of these campaigns have been wide-reaching and very successful; however at the end of the day, it is the individual that has to make the choice to follow this advice.

So, on this 2010 World Health Day, whether you are in the bustling city, or the wide open spaces of the country, take a moment to think about the contribution you are making to your own health. What improvements can you make?