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A system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery. Also called allopathic medicine, biomedicine, conventional medicine, mainstream medicine, and orthodox medicine.

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Today, most Americans live an overly complicated life. There's too much pressure to live up to, and not enough time. Add to that a schedule that's jam-packed with work, family life and unpredictable everyday stressors, it's no wonder it is easy to get run down and eventually, sick.

Adding to that stress, once someone finds themselves sick, comes a decision that many people are facing. Which path does one take to wellness...the western medical approach or the alternative avenue?

The answer to which type of medicine one is more likely to seek can be found in how people perceive their individual worlds. Not so simply, it boils down to spirit vs. science. A more spirit-based individual will look for a holistic approach to health, as alternative medicine treats body, mind, spirit and emotions wholly. A more scientific-centric individual will trust western medicine and the many 21st-century, technology-based advances that have been forged through these type of treatments.

Comparing both western and alternative medicine, there's benefits and drawbacks to both.

Looking deeper into alternative medicine, Livestrong.com notes that rather than determining which genes are responsible, the practitioner considers how individuals contribute to their health through individual beliefs and lifestyle choices. While this burden of responsibility can be difficult for a patient to accept, this individualized view of health care also assumes the patient has the power to cope, rehabilitate, adapt and recover. Alternative medicine offers that ability to heal the entire body during treatments and at home without the use of standardized medication.

The Large Drawback | Alternative Medicine

A large drawback for alternative medicine is the lack of insurance coverage. Holistic health care may not be covered by insurance plans, or treatments may be reimbursed on a case-by-case basis. The standards for care and the quality provided by holistic practitioners may be variable. Although interactions in the traditional Western medical system may be constrained by complications in the health insurance industry, there may be a more consistent standard of care due to federal regulations, according to Livestrong.com. For some, making lifestyle changes, which are often a part of alternative medicine treatment, are difficult. As are multiple return visits for treatment, which are also often a part of alternative medicine.

On the other side, the goal of western medicine is to intervene with effective measures of eliminating the source of disease, thus promoting healing. Medicine in the west breaks down every aspect of the disease or condition that may be occurring in the body, and doesn't fully look at the individual's contribution to said disease. Therefore, it directly targets the disease, encouraging rapid healing. Western medicine also incorporates the use of modern technology and equipment, like the ones found at Mountainside Medical Supplies . With this integration, western treatment has the ability to become more innovative.

According to a study conducted at Milligan College, a drawback of western medicine is that in order for authentic healing to occur, both the logical mind and the intuitive mind must be integrated. It can also be a challenge to find a practitioner of western medicine who will look at the whole body as a unit and not just treat a single ailment. Thus, less time spent with a practitioner, and the less likely you are to form a relationship, which may aid in healing.

Overall, western medicine focuses on pathology and curing disease while alternative medicine focuses on the health and healing of the person.

For both treatments, the majority of concern comes from general misunderstanding and a lack of compromise from both sides.

The Best Treatment for Alternative Medicine

When opting for integration, we're seeking the best alternative for treatment of disease. Collaboration optimizes the outcome for healing. With increased education for both the practitioners and patients, western and alternative medicine could make for a very happy pairing.

Though it may seem daunting for medical professionals to begin integration of western and alternative medicines, it's possible. And this helps, the Journal of the American Medical Association (JAMA) revealed that over half of the 125 medical schools in the U.S. offered classes in alternative or complementary medicine.

Simple steps that practitioners can begin integrating in their treatments according to Livestrong.com, include dietary changes, incorporating exercise, guided imagery or meditation exercises, and direct treatments with acupuncture, herbs, or massage for both western and alternative practices.

Health is universal. It's a human right, not a privilege. Both western and alternative medicine have strengths that would grow stronger when used in harmony. It would prevent disruption during the healing process as the patient wouldn't need to visit many different clinics and doctors, and it would encourage a feeling of safety and true health care for all.

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The Great Debate Between Western And Alternative Medicine

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Today, most Americans live an overly complicated life. There's too much pressure to live up to, and not enough time. Add to that a schedule that's jam-packed with work, family life and unpredictable everyday stressors, it's no wonder it is easy to get run down and eventually, sick.

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The term is most commonly used by promoters of "Eastern" medicine or therapies, such as acupuncture or Reiki, or of other forms of alternative medicine. It may be substituted for other phrases such as "conventional medicine" or "mainstream medicine" by promoters of Western forms of alternative medicine, such as homeopathy.

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Alternative medicine is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine, but whose effectiveness has not been clearly established using scientific methods, or whose theory and practice is not part of biomedicine, or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine.

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About a third of Waitematā DHB staff support Rongoā Māori being made available to patients, a survey has found.

The survey results, published in the New Zealand Medical Association Journal today, found that of the 1181 staff that responded to the survey, 32 percent felt that Rongoā Māori should be available in hospitals.

The survey also found 46 percent were familiar with Rongoā Māori, and 16 percent had used it for themselves or whānau.

Researcher Dr Glennis Mark, who undertook the research alongside surgeon Dr Jonathon Koea, said she was surprised by the results.

"There are a lot of Māori staff in the DHB so that would explain part of it and the other part is that there are a lot of non-Māori who, maybe they have a surface knowledge of rongoā, maybe not a deep understanding, so that will account for the knowledge of it, but for an in-depth real use and provision of rongoā that [was] higher than we expected."

The intention of the survey was to gauge how much support there was for rongoā Māori to know whether there was an appetite for further research, Mark said.

While there has been a lot more collaboration between Māori healers and medical practitioners than has been recorded, Mark said most hospitals were still not open to it so colloborations were only happening at a local level.

"Healers are wanting to ensure their patients are well looked after [and] there are some doctors who are willing to support it but it's not widely accepted within mainstream providers."

"So because of that resistance, healers have just worked with whatever doctor is local and will open to working with them."

Those doctors who were open to rongoā were often of South African descent, Mark said, as they trained alongside healers at medical school in their home country.

While medical treatment was very standardized, Mark said rongoā was specific to each patient, and took a holistic view of their health.

"It will depend on the person what herbs are going to work for them best and whatever other ailments they have, so there's no sort of standard "here take this and it will heal your asthma," she said.

"Not one herb is going to work the same way for everyone and that's why the healers are holistic in their approach and only providing for each individual what that individual needs."

Marks said there was a strong stigma against alternative medicine in general, but rongoā in particular had very little support and knowledge, in part, because of the Tohunga Suppression Act 1907 which forced rongoā Māori underground.

"There's a lot of work to be done about educating people about what the rongoā does and the benefits, [because] you can't really support something you don't know anything about."

She said mainstream medicine was missing the wairua, or spiritual aspect of a person's health, and the holistic view of health.

"Rongoā looks at mind, body, spirit, land, family and the doctor will look at your physical, maybe ask how things are going at home, at then that's it, so we're missing out vital parts of our holisitic health makeup, according to rongoā Māori."

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Waitematā DHB staff open to rongoā Māori traditional medicine

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About a third of Waitematā DHB staff support Rongoā Māori being made available to patients, a survey has found. The survey results, published in the New Zealand Medical Association Journal today, found that of the 1181 staff that responded to the survey, 32 percent felt that Rongoā Māori should be available in hospitals.

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A terminally ill woman is calling for greater access to Māori healing methods saying they've helped to keep her alive for years longer than doctors expected.

When Tanya Filia was first diagnosed with brain cancer in 2013, she went straight into chemotherapy and radiation treatment at Auckland City Hospital.

"It all happened really, really quickly too because the headaches were really massive and the symptoms were unbearable," she said.

Her daughter Willow-Mina was only three-years-old, and the school principal was struggling to come to terms with potentially leaving her.

"The thought of her growing up without a māmā, yeah was really, really hard. That's been the hardest thing."

After a year of chemotherapy and 42 treatments of radiation, Mrs Filia went into remission. But in 2015, her headaches were back.

The whānau was called into a hui at the hospital but she couldn't face the news.

"I left the room and my parents carried that for me. They were told I have two months to live and that my family needed to prepare that I may not make Christmas," Mrs Filia said.

It was then that Mrs Filia took her chances on rongoā Māori and natural therapies - and she hasn't looked back.

She prays, gets mirimiri or spiritual massages and has bathed in kawakawa.

She drinks herbal teas made especially for her by tohunga matakite or Māori spiritual healers, and she gets intravenous vitamic C.

Mrs Filia is still alive two-and-half-years later and her friend and filmmaker Jessie McVeagh has documented the whole thing.

"That footage over time of Tanya and her whānau - you can see on screen the change of what she looks like, her energy levels, compared to how she is now," Ms McVeagh said.

The Ministry of Health says it spends $1.9 million a year funding rongoa Māori services around the country, and has recently renewed rongoa funding contracts for 18 Māori health organisations.

But Mrs Filia says that is not enough, it can be hard to come by and it needs to be an option for healthcare.

"No doctor sat down at that time and said look, you can look at natural therapies, you can look at rongoā, your own healing practices. They just offered a chaplain and a hospice phone number.

"I am not telling people not to go and have chemotherapy or radiation, because it worked for me for two years. But there is a right for people to choose."

Cancer Society chief executive Mike Kernaghan says there is merit in taking a holistic approach to treatment, but clinicians' hands are tied.

"They can only ever really provide options that have a strong evidence base and that's the view that the Cancer Society support as well," he said.

"That is taking nothing away from what has transpired."

But University of Auckland researcher Erena Wikaire, who's doing her PhD on rongoa Māori, says there is demand for it, and the health system needs to be more open.

"Rongoā Māori is not necessarily an option that is readily accessible and affordable and if it was participants in my study have said that they would have a preference of using it."

Mrs Filia has a claim in the Waitangi Tribunal's health inquiry calling for equal recognition of rongoā Māori.

The film about her journey, He Oranga Pumau, will be played to MPs at Parliament on Wednesday evening.

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Calls for equal recognition of rongoā Māori in healthcare

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A terminally ill woman is calling for greater access to Māori healing methods saying they've helped to keep her alive for years longer than doctors expected. When Tanya Filia was first diagnosed with brain cancer in 2013, she went straight into chemotherapy and radiation treatment at Auckland City Hospital.

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Communities and families in the Western Pacific Region use traditional medicine extensively for a variety of health problems, from minor ailments to life-threatening diseases. It is sometimes the only available and affordable option, especially in remote or under-served areas. Thus, it plays an important role in primary health care.

Traditional medicine is a health practice with strong historical and cultural roots. Since it has often evolved as part of a particular cultural heritage, the forms of traditional medicine vary widely across the Region. Some forms are highly developed and well documented. They are based on systematized knowledge, comprehensive methodology and historical experience. A number of less complex traditional medicine practices also exist within small and sometimes isolated ethnic groups, based largely on local experience. The knowledge may not be documented, often being transmitted orally from generation to generation.

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Traditional medicine has a long history. It is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.

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A Tokoroa beneficiary and solo mother of six is aiming to turn her life around, and the lives of others, by exporting traditional Maori medicine.

Qualified rongoa practitioner Karla Crooks is in the process of exporting a line of her topical rongoa (medicine) to Australia as a way of keeping local treatments affordable.

Crooks, who recently opened an holistic wellbeing clinic at the Tokoroa Community Centre in Maraetai Rd called Rakau Rongoa, makes an exclusive line of topical rongoa, used to treat the likes of eczema, pimples, and dermatitis. She also makes internal cleansers for conditions that start in the gut.

While adhering to traditional tikanga (customs) she's adapted the way she makes many of her rongoa through experimentation.

For fear of being copied she wouldn't go into the finer details of how she makes her products but said they are made from mainly locally sourced natural ingredients including mamaku and kawakawa among others.

Despite having limited money she never asks for more than a koha (donation) for treatments at her clinic, believing rongoa should be free for all New Zealands, but she is also aware the clinic needs to be financially viable if it's to continue long term.

"A lot of my clients want to keep paying and it is so hard to take it because I know they don't have any money, "she said.

"I am a solo mum, I am still on a benefit, and I am still trying to get off it but rongoa is also not something you should be profiting from as it is something free, it belongs to the people of New Zealand."

With natural alternative medicines catching on around the world she said exporting seemed like a good solution.

"I've already sent some over to Australia and I have a brother in Perth who said he'll help with the marketing as i'm terrible with it," she said.

"When my children say they want a tablet or a phone I say just wait man," she laughed.

Crooks learnt how to make her medicines, which were used for hundreds of years by Maori before they were oppressed in the early 1900s, while studying towards a level four Certificate in Rongoa Maori Appreciation at Tokoroa's Te Wananga o Aotearoa campus.

- Stuff

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A Tokoroa beneficiary and solo mother of six is aiming to turn her life around, and the lives of others, by exporting traditional Maori medicine. Qualified rongoa practitioner Karla Crooks is in the process of exporting a line of her topical rongoa (medicine) to Australia as a way of keeping local treatments affordable.

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Opinion

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Kathleen McMahon swears by chiropracty. "I come out and I want to dance. You want to jump for joy because everything feels in line."

McMahon, who has been going to chiropractors for 35 years, has good reason to believe chiropracty to be effective.

Over a decade ago, the Christchurch woman had spinal decompression surgery on her back. She didn't want her vertebrae fused, and the surgeon told her she would be coming back four years later in a wheelchair.

She said, "No I won't." It was at this time she met chiropractor Simon Roughan, and has been going to him about once a month ever since. "Just to keep that spine aligned, keep it straight. To make sure I am tip-top."

McMahon is typical of adherents of what is now broadly termed complementary or alternative medicine (CAM). They say that even if they don't always know how it works, it seems to, and often when conventional medicine doesn't. And increasingly, they are us.

Early results from our online Belief survey - completed by at least 5000 respondents - suggest we believe strongly in alternative medicine.

About 68 percent believe acupuncture is effective, 62 percent chiropracty, 54 percent Chinese medicine and 45 percent homeopathy. By comparison, 94 percent had faith in traditional medicine. Women tended to have faith in the treatments more than men.

But do they really work? When it's our stretched health budget and ACC levies that pay for complementary medicine - ACC paid nearly $35m in the year to June towards osteopathy, chiropractic and acupuncture treatments - we have the right to ask hard questions of their efficacy.

Those who have looked hard at the quality of clinical trials have little good to say about alternative medicine. For them, the gold standard is the large-scale, randomised, double-blind, placebo-controlled published clinical trial.

In other words, big trials that randomly assign treatments and allow for the placebo effect with neither patient nor administrator knowing which is the intended treatment. And as Skeptics NZ chair Vicki Hyde says, "If we demand that from our standard medicine then we should demand it from the alternative lot as well."

So, how do alternative treatments stand up to scientific scrutiny? In their recent book Trick or Treatment?, science journalist Dr Simon Singh and Edzard Ernst, a UK professor of complementary medicine, went back and reassessed all the surprisingly numerous clinical trials of all four of the above therapies, ignoring the unconventional theories behind them (see sidebar). They concluded that none of them worked particularly well.

Going to a chiropractor for anything other than a bad back was unwise, they said, and even then you should opt for conventional medicine first or the generally gentler hands of the osteopath.

Acupuncture may have some effect on back pain, headaches and some nausea. However, the latest results, according to Singh and Ernst, suggest that any patient improvements were probably down to the placebo effect.

Homeopathy, which relies on the premise that like cures like by way of dilution, sometimes to the point of the treatment containing none of the original substance, simply doesn't work, they say. One reason homeopathy is a multibillion-dollar global industry, they suggest, is that the public is unaware of the vast body of research that undermines it.

Says Hyde: the idea that water (or sometimes alcohol) can retain a memory of the substance diluted in it is "completely and utterly outside any kind of reality that we know of". As for herbal medicines, Singh and Edzard summarise those that offer some benefit, but note that each substance also carries risk.

While conventional medicine is judged solely on evidence, proponents and fans of alternative therapies often counter that it is results with individual patients over time that matter.

Paddy McBride, the Nelson-based president of the NZ Register of Acupuncturists and in practice for 20 years, says acupuncture can treat anything you might go to your GP for, except for acute conditions and broken bones.

It is particularly effective for chronic conditions, she says, where conventional medicine sometimes falls short. She strongly disagrees with the arguments of Singh and Ernst, saying acupuncturists have no "huge need to prove ourselves to western medical science".

She says acupuncture is difficult to study in the tight frames of clinical trials, such as being double-blind. The clearest results are in patients returning and referring others. The register is looking to put together a comparative database of patient conditions from therapists around the country.

Professor David Baxter, Dean of Physiotherapy at Otago University, says the evidence for pain relief from acupuncture "is quite good".

Likewise, the Chinese movement system of tai chi improves falls as it helps people rethink movement, he says. He also cites the UK BEAM trial, involving chiropractors, osteopaths and physiotherapists, which found that manipulation was a very effective treatment for back ailments when combined with exercise - better than GP care.

Joanne Barnes, associate professor in herbal medicines in the School of Pharmacy at the University of Auckland, says we always need to be cautious about declaring effectiveness of plant derivatives due to issues like interaction, dosage and consistency, but knowledge improves each year.

"Over the last 10 or so years, there has been increased investment and interest in undertaking clinical trials with herbal medicines, so the evidence base is increasing."

Baxter adds that many drugs are based on aspirin and morphine - from poppies and willow bark. Genuine new pain drugs are rare.

Despite the seemingly frosty relations between alternative medicine proponents and hard-nosed scientists, evidenced in recent weeks by the tussle between physicians and chiropractors in the NZ Medical Journal over the use of the title "doctor" (see Doctor doctor), conventional medicine and alternative treatments operate together.

GPs often do acupuncture or recommend it. Physiotherapists sometimes do therapeutic massage, which is considered by some to be alternative, says Baxter. Chiropractors and osteopaths sometimes use similar techniques to physios. And health consumers, hard evidence or not, seem to want it that way.

They recognise, suggests local medical doctor and pharmacist Shaun Holt in a new book, Natural Remedies that Really Work, that western medicine has limitations, in that it is conservative by its nature, and it can take 10 years for a successful therapy to become widespread.

He acknowledges, however, that this open-mindedness lets in some sloppy thinking around health.

"At the other extreme, the archetypal New Ager will tell you that all natural health products work all the time and are safe because they are natural."

So what if we took the hard scientific line and presume that no positive effect can be proven beyond placebo from complementary medicines?

Would we demand the ACC stop paying - and effectively endorsing since 1989, as Hyde points out - alternative treatments by paying $12.4m a year to acupuncturists, $10.2m to osteopaths and $11.9m to chiropractors? Probably not.

British arch-sceptic Rose Shapiro suggests in her recent book Suckers that the youth culture of the 1960s was where support for alternative medicine took root. They questioned everything, including medicine, she says.

They wanted to reconnect to nature and take a "holistic" view of the world. There was distrust of the pharmaceutical industry, and the feeling arose that, despite living longer and healthier than ever, we weren't as fit and happy as we should be. We became the worried well.

However, as Shapiro notes, the keenest consumers "see it as the answer to a range of much less clearly defined conditions ... allergies, anxiety, back pain, fatigue, depression, digestive problems, food sensitivities, headaches, insomnia, skin disorders, stress and overweight".

Just the kind of chronic and elusive conditions that conventional medicine finds hard to treat. Shapiro suggests that alternative therapy fills a psychosocial role patients used to time-poor and bottom line-focused conventional medicine appreciate the time and attention they can buy from an alternative practitioner.

This observation was made to the Star-Times by practitioners and patients on all sides of the complementary medicine debate.

UK-born physiotherapy professor David Baxter is one. He has a healthy scepticism, having worked with Ernst in the past, but one of his research areas is alternative medicine.

Acupuncture is taught to physio postgrads. Chiropractors, he says, have a narrower focus than physios but can offer treatment similar to some forms of physiotherapy in terms of manipulation and joint treatment.

He personally finds their theories very hard to believe and says that and their more extreme claims, such as being able to treat asthma, probably fuel deep scepticism (chiropractors, for their part, say positive research on asthma from Macquarie University is imminent).

"Setting the theory aside, if medicine works, whether it's a tea leaf boiled up or a drug that's taken a pharmaceutical company millions to develop, if it actually works, and the evidence shows it works, then that's an effective medicine."

Says Kathleen McMahon: "The whole thing needs to come together. It needs to be part of the mainstream. I think we all need to get together and sometimes where there's something going wrong, maybe you've got cancer or something, you need to use more than one thing. There's more to us than just the body. There's the spirit and the mental and the physical. They are all parts of us."

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Kathleen McMahon swears by chiropracty. "I come out and I want to dance. You want to jump for joy because everything feels in line." McMahon, who has been going to chiropractors for 35 years, has good reason to believe chiropracty to be effective. Over a decade ago, the Christchurch woman had spinal decompression surgery on her back.

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Every Green Herb - 100's of tips for using medicinal herbs, essential oils, and home remedies

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Hippocrates believed in scientific reason -- and natural healing. Hippocrates, a physician during Greece's Golden Age, had one foot in science and the other in tradition. He believed that the task of the physician was to help the healing process along rather than to take it over. His beliefs continued until the 19th century (for 2,300) years. He was a smart man.

© Andrey Kiselev | Dreamstime Stock Photos
Doctors, herbalists, and alternative medicine professionals should work together to heal the patient.

Conflicts between alternative and western medicine

Throughout history, the art of healing as been influenced by religion, politics, philosophies, and vested interests (money). The conflicts between alternative medicine and "western" medicine are nothing new. From traveling medicine shows to modern day hospitals, "western medicine" has always been based on physical science. Other methods such as acupuncture, herbal medicine, and aromatherapy have concentrated on healing the mind, body, and spirit as one entity.

Is diagnosis the key to healing?

During the second century, Galen, another Greek physician, was the first to promote diagnosis as the key to healing and soon every health problem was fit in to a classification (as it is today). His ways were rigid and only doctors were allowed access to healing knowledge.

Herbal pharmacies were busy during the Dark Ages.

During the Dark Ages, natural healing came back into favor for a time. The Arabs brought alchemy and pharmacy into western medicine. They introduced many new ointments, elixirs, pills, tinctures, suppositories, purgatives, cathartics, and inhalations to the masses. From the 12th century on, apothecaries (herbal pharmacies) were common in every neighborhood.

Isolated properties verses whole plants as medicines

In the 16th century, Paracelsus taught that alchemy and chemistry were a way to unlock the secrets of nature. He began the distillation of isolates. Both the alchemists of his day, and the chemists of our day, adhere to the belief that these chemicals are more potent and effective than the whole plant (while still being safe to use). This may be true, but during the process of isolating one chemical, many good ones are lost.

Isolates can be patented.

Even though big pharmaceutical companies have been proven wrong countless times, isolates remain popular because their manufacture can be patented and rigorously controlled enabling huge profit margins. Isolates are useful, and in many situations they save lives (but so do natural herbal remedies which are inexpensive and don't cause overdoses).

Culpepper and the practical use of herbs

In the 17th century, Nicholas Culpepper, tired of expensive imported drugs, created his own herbal handbook called The English Physician. Culpepper wrote about the practical use of herbs. People once again started looking to home remedies for help when disease struck.

People thought herbal medicine was old-fashioned.

Early in America's history, the colonists relied heavily on imported medicines (although there are accounts of Native Americans providing natural remedies to the newcomers). By the 1800's, both American and European medical schools favored prescription medicine and it was the only thing they taught. Herbal medicine was considered old fashioned (although many country folks still relied heavily on herbs).

Medical industry promotes synthetic chemicals as best choice.

The American Medical Association was formed in 1847, partly in response to renewed interest in herbal medicine and the popularity of alternative medicine schools. The newly formed organization soon became underwritten by pharmaceutical companies who had a great deal to gain. Before long, the whole medical and pharmaceutical industry turned its back on the plant world and looked to synthetic chemicals as the best choice. By the 20th century, overwhelmed by the growth of the AMA, herbal medicine went into severe decline.

Great technical advances

Chemists learned to synthesize active plant components and modern laboratories began to produce standardized and readily available drugs. After the discovery of antibiotics, surgical techniques were improved and modern medicine accomplished great technical advances.

By the 1950's, people were accustomed to taking a pill for everything.

Instead of looking at diet, lifestyle, and environment, most doctors and their patients addressed individual symptoms instead of causes.

Combining modern medicine with alternative methods

People are finally starting to combine modern medicine with alternative and holistic methods of healing. There is clearly a rebirth of herbal medicine and natural healing in today's society.

Rebirth of herbal medicine and natural remedies

Herbal medicine has always recognized that individual body parts are components of the whole being. Herbalists have not only looked at symptoms, but also at social, emotional, and spiritual health (along with diet, exercise, and stress levels) before making decisions regarding treatments.

Herbalists have also recognized the need of a loving touch and compassionate ear. Sometimes a warm embrace can do more to help a patient than any medicine or procedure.

Combine modern medicine with holistic approaches for best results.

Modern medicine and the holistic approach are slowly starting to come together. People still depend on doctors, but they are also relying more on diet, exercise, and herbal remedies as a way to prevent and reduce severity of sickness and disease.

Herbal medicines work differently than prescription drugs.

Herbs are nutritional substances that help promote healthy bodies. There is an old herbal saying, "One month of healing for every year of the problem." As an example, If a patient has been suffering from acne for three years, it will probably take three months to get clear skin.

Herbal remedies are not always a quick fix.

When using herbal remedies, many times the condition worsens before getting better. Just like another old saying, "It is darkest just before the dawn." During healing, poisons and toxins are released into the system and must be flushed away before the patient will feel better. Herbal healing takes time.

Herbs work best when combined with a good diet.

That means lots of fresh fruit, colorful vegetables, whole grains, and clean water should be consumed every day. It is hard for herbs to do their jobs if they are fighting against preservatives, artificial food colorings, added chemicals, rancid fats, pollution, and other junk.

Herbal remedies help the body to heal itself.

Herbs and essential oils help break up toxins, help cleanse the tissues, speed digestion, regulate the glands, and do other amazing things. Herbs are living medicines. They are easy to use, gentle, safe, inexpensive, and can handle most problems. Herbs offer people another choice. Herbs help bring caring people together to care for each other. Herbs and essential oils can help bridge the gap between modern medicine and individual responsibility.

* Always consult with your healthcare provider before using any herbal remedy especially if pregnant, nursing, or taking other medicines.

"The only way to really learn about herbal medicine is to touch and smell herbs, taste them, use them daily, and grow them if possible. Herbal medicine is a way of life. It is not a quick fix." ... Janice Boling , herbalist, web designer, writer, photographer

"Ointment and Perfume Rejoice the Heart." Proverbs 27:9
© 2005-2018 website and all content by Janiceboling
* Note - the information on this website has not been evaluated by the Food and Drug Administration.

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weatern medicine or alternative medicine

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Western medicine vs herbal medicine - a short history

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Hippocrates believed in scientific reason -- and natural healing. Hippocrates, a physician during Greece's Golden Age, had one foot in science and the other in tradition. He believed that the task of the physician was to help the healing process along rather than to take it over.

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Is it ethical for pharmacies to sell medicines with no scientific evidence that they actually work?

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Pharmacists want more freedom to sell homeopathic and herbal treatments, even when there is no evidence they will help patients.

A proposed tweak in the Pharmacy Council's code of ethics on complementary medicines, such as homeopathy or health supplements, has sparked vigorous protest from doctors.

The debate focuses on whether the obligations to protect patients from bogus remedies trumps the patient's rights to decide their own treatment.

The changes proposed by the Pharmacy Council would remove the obligation for pharmacists to only sell complementary medicine where there "is credible evidence of efficacy", in other word where there is substantial evidence showing the medicine does what it says on the box.

Instead, pharmacists would only have to provide customers with information about a medication's "risks and benefits" and whether better alternative treatments are available. Pharmacists should still not "promote" ineffective complementary medicine, and needed to be confident it was safe, but they could sell it.

"Pharmacists must ... respect patients' rights to freedom of choice or autonomy in relation to their treatment options."

But Dr Kate Baddock, chairwoman of the New Zealand Medical Association's GP council, said pharmacists were health professionals and shouldn't be offering products they knew didn't work.

"I think its a fine line between selling these products and promoting them," she said.

"If you're selling something with credible evidence and right beside it you're selling something without credible evidence, the edges are always going to blur."

The proposed changes would send a signal to pharmacists that it was ethically acceptable to sell ineffective products, resulting in more of them on the shelves, she said.

"It ups the ability to sell more products, whether there is a commercial imperative there, you'd have to ask pharmacists."

But Pharmacy Council chairman Dr Andrew Bary said the rules as they stood were "unworkable" and many pharmacists, including himself, were already selling complementary medicines, even if they didn't believe their claims.

The proposed changes would strengthen pharmacists' obligation to tell the patients if a pill, supplement or ointment didn't work while retaining patients' right to choose it anyway.

"There seems to be some anxiety that pharmacists will be prescribing homeopathy and herbal remedies but that's just not the case," he said.

"What we [the council] can't do is direct which products are fit for the shelves."

Ann Privett, partner at the Unichem Pharmacy in Miramar, Wellington, said she sold homeopathic remedies and herbal supplements with no scientific evidence proving they worked.

Any customers requesting these products were told they wouldn't do anything medically. However, some chose to buy them anyway and still believed they worked.

"Some people find a particular product works for them even though the science isn't there," she said.

"If it makes them them think they feel better, and it's not doing any harm, that is still a benefit."

Removing complementary medicines from pharmacies would just drive customers to less reputable sources, paying too much for mythic cures that could actually put them at risk.

"At least in the pharmacy they get the right information."

Submissions on the proposed change close on Thursday.
WHAT ARE COMPLEMENTARY MEDICINES?
Complementary medicines cover anything intended to be taken alongside conventional medicines. They include homeopathy, naturopathy, Chinese medicine, mineral or herbal supplements, and active therapies such as acupuncture.

By definition, complementary medicines have not been through the same randomised trials that conventional medicine must pass before being approved for use and, for many, the evidence of their effectiveness is contested.

In March, an Australian National Health and Medical Research Council review of 1800 studies of homeopathic therapies, sold in many pharmacies here, found there was "no good quality evidence to support the claim that homeopathy works better than a placebo".

Detractors of complementary medicine claim that not only do they not work but they are dangerous. They can interfere with conventional medicines' effectiveness and, in extreme examples, can be used as an ineffective substitute, leading people to forego potentially life-saving treatment.

Supporters counter that in practise complementary medicine do help individuals' health, without the side effects associated with invasive conventional treatments, and clinical trials are an inappropriate was to measure their effectiveness.

Even if they don't work, it has been argued complementary medicines are harmless and their positive "placebo effect" have a legitimate place in the treatment of some patients.

- Stuff

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Doctors and pharmacists clash over complementary medicines

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Pharmacists want more freedom to sell homeopathic and herbal treatments, even when there is no evidence they will help patients. A proposed tweak in the Pharmacy Council's code of ethics on complementary medicines, such as homeopathy or health supplements, has sparked vigorous protest from doctors.

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Maori healer in Northland combines her nursing skills with traditional Maori herbs to assist people in quitting smoking

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Gabrielle Sexton-McDevitt works as a nurse and Maori healer. She lives in Koutu in the Hokianga, with her husband John, a sales project manager, three dogs, a cat, a mini horse and 22 chooks.
I tell people I was called here by the wairua, spiritually led. I'm from the East Coast, but for years I lived in Auckland and I'd come up here - I'd bring my children - and I felt that something was pulling me here. I felt an inner-strength and safety here.

John and I bought a section, an acre, and I knew a change was coming.
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I was training in Maori healing. It was time for me to be free of Auckland, to be separated from the clutter and the noise of the city so I could be focused on what I was learning.

My husband has commuted between here and Auckland for five years - he's a fabulous support, an awesome husband.

Living in the Hokianga is a powerful experience. The first Maori explorer, Kupe the navigator, landed here. It's a privilege to be a part of that history.

I've become more independent up here. I had to learn to live by myself for 80 per cent of the week.

I work for an iwi provider as a traditional Maori healer, a registered nurse and a smoking cessation coach. It's my dream job.

Nursing is law, and traditional Maori healing is lore. My main role is stopping people smoking. I use my nursing skills and, if people want it, I use traditional Maori herbs as well.

I have seen people who've been smoking since they were 11 give up. I call my clients my superheroes.

We bought the house up from Auckland. I wanted a house that you don't really see, that just blends with the outside. The outside comes in, the inside goes out.

Having the ocean right there gives me a constant feeling of change. A flow and ebb. It's always fresh.
Sexton-McDevitt and two friends have a business sharing indigenous products and skills, sistersindigenous.com.
- Sunday Magazine

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At home with Gabrielle Sexton-McDevitt, a Maori healer and nurse in Northland

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Gabrielle Sexton-McDevitt works as a nurse and Maori healer. She lives in Koutu in the Hokianga, with her husband John, a sales project manager, three dogs, a cat, a mini horse and 22 chooks. I tell people I was called here by the wairua, spiritually led.

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Five years ago, Bronnie Ware was diagnosed with rheumatoid arthritis.

The then 45-year-old decided to take a "natural" approach to healing.

For two and a half years, Ware tried a variety of alternative remedies, including herbs from naturopaths and an alkaline-based diet, to manage the autoimmune disease that causes pain and swelling of the joints.

Her well-intentioned approach only saw her deteriorate.
READ MORE:
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* Five natural remedies for skin dryness
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* 7 herbal remedies for urinary tract infections
"It got to the point where my one-and-a-half-year-old daughter was helping me get dressed," explains the single mother and internationally best-selling author of Five Regrets of the Dying.

She struggled to walk more than 30 metres at a time and couldn't get up and down from the floor.

"I was in horrific pain," Ware says. "I was exhausted."

Eventually she was forced to admit that her rigid resistance to conventional medicine was backfiring. She went to a GP who also practised alternative therapies including acupuncture and Ayurveda (India's traditional medicine system which incorporates nutrition, yoga, acupuncture, massage and herbal medicine).

"He said, 'OK, I understand where you're coming from but your body is in too much trauma to come back on its own now - it's too far gone, you really need to try these immuno-suppressant drugs'," Ware recalls. "Reluctantly I did."

Despite her reluctance, the medicine helped.

"They gave me a lot of mobility back and freedom and it gave me a sense of hope again," she says.

"It's been a huge journey of surrendering my very rigid beliefs that this is the only way to go. The pharmaceutical medicines did have a lot of side effects but they also had a lot of other benefits that brought me back to a place where I could actually heal from."

Up to 70 per cent of Australians use complementary and alternative medicines (CAM) and about 24 per cent of adults with a chronic health condition regularly use complementary medicines to help them treat their condition, in particular for arthritis and osteoporosis.

With each year, the $4 billion industry grows. In fact, the number of people visiting a complementary health professional (most commonly a chiropractor, naturopath or acupuncturist) has increased more than 51 per cent in 10 years.

"There are some conditions where medical treatment is, in my view as a GP, non-negotiable. I think rheumatoid arthritis is one of those examples," says Dr Kerryn Phelps, who adds that delaying treatment can cause irreparable joint damage.

"Cancer treatments are another situation where I quite often have people saying 'I'm just going to battle this with the power of my mind and diet' when they've literally got no chance of surviving without chemotherapy."

Phelps, the author of The Cancer Recovery Guide, adds that there is a place for 'adjunctive therapies' as she prefers to call them. "There are many instances where recovery can be enhanced by adjunctive treatments."

There are also instances where pharmaceuticals are not the best option.

"There are lots of conditions where pharmaceutical treatments can be minimised or even eliminated if people take the right lifestyle measures," Phelps says, pointing to Type 2 diabetes, cardiovascular risk factors and osteoarthritis.

"The thoughts around pharmaceutical and medical treatments changes with time and as we understand more about side effects."

Those wanting to explore different treatments should find a doctor who has an understanding of "a broad range" of options, Phelps advises.

"Someone who can direct them to appropriately trained allied health practitioners ... and who has an understanding of when medicine is the most appropriate treatment and how to combine those things."

Along with conventional treatment, Ware continued to care for her diet and use CAM, including a "prescription" from an Ayurvedic doctor to do something "really fun" each week.

"She said that stress is far more detrimental to our body than anything we can do with our diet so it's much better to eat a chocolate when you're happy than have a green juice every day when you're stressed," Ware says. "We have so much pressure and stress we sometimes lose the fact that life is to be enjoyed. We need joy and lightness to balance the stress and pressure on ourselves."

Ware, who details her journey in her new book Bloom, says she now has a very different attitude to health, one that embraces both the conventional and CAM.

"I was very rigid that 'I'm going to find the natural path to this' and it was just causing me so much stress so I've let go of all that nonsense now," she says.

"I went to some pretty low places with RA and I still live with RA but I'm jumping on a trampoline now and riding a pushbike and travelling and I've got my life back."

- Sydney Morning Herald

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'I was in horrific pain': Alternative remedies for rheumatoid arthritis backfire

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Five years ago, Bronnie Ware was diagnosed with rheumatoid arthritis. The then 45-year-old decided to take a "natural" approach to healing. For two and a half years, Ware tried a variety of alternative remedies, including herbs from naturopaths and an alkaline-based diet, to manage the autoimmune disease that causes pain and swelling of the joints.

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Making use of healing plants found in the backyard or nearby forest is experiencing a revival.

There are a surprising number of plants with health giving properties out there, something Maori have known for many years.

Rongoa is traditional Maori medicine made from plants, and using mirimiri [massage] and prayer [karakia]. It's becoming increasingly popular in Northland.

Te Tii couple Rawi Pere and Ngawati Hei Hei use Rongoa in their Healing Hands practice at Te Whare Wairua Healing Centre in Kerikeri and in their daily lives.

They visit Puketi Forest regularly for native plants Kawakawa and Tupakihi.

"Kawakawa is a universal plant; you can eat it, drink it and bathe in it," Pere says. "You can use that to cleanse your body as well.

"We [Maori] used to use it [Rongoa] all the time before pharmaceuticals. It's good to have it daily. It's good to get back to nature."

Design artist Robert van der Touw has spent more than 20 years studying, teaching and researching the medicinal properties of native plants in Holland and New Zealand.

Though he's not strictly practicing Rongoa, his practice and beliefs are in line with it, he says.

"It's developing a relationship with nature, where nature is respected and seen as being part of us, and being a healer for us.

"When you learn to connect to nature in a deep sense and strengthen our sense of belonging we have less and less need for making medicine out of nature as our relationship with nature is the medicine itself."

According to Te Ara, Maori traditionally used more than 200 plant species for medicinal purposes.

There are also plenty of weeds that are useful, including Oxeye Daisy, for whooping cough, calming nerves and soothing conjunctivitis, and Cleavers which is a good cleansing tonic for the blood and lymphatic system. A weed called Self-Heal, also known as Woundwort, has been used for healing cuts, bruises and minor burns.

Van der Touw, a classical homeopath, moved to NZ in 1990, and headed up North in 2002.

He holds courses about native plants every year, taking groups of people for guided walks through Puketi Forest.

He's developed a new way of learning, which involves letting people connect to and work with plants they are naturally drawn to.

"When I came to NZ I was teaching homeopathy and I taught all the medical uses overseas.

"When I went into the forest here I was so inspired by the atmosphere, with the energy in the forest...there were all these plants and a lot have never been thoroughly researched. I thought 'why use these overseas remedies when we have got these ones here'? I believe that nature provides everything, particularly in our own environment."

But before you head for the nearest forest armed with secateurs - van der Touw says there's no need to take the foliage.

He recommends simply taking a bottle of water and holding it near a plant to retrieve its properties then taking the water home.

Here are some of his top healing plants:

Rewarewa Good for self esteem. Used for people with illness related to depression or patterns of abuse. Kawakawa Good for the heart and blood. Traditionally, the leaves and bark were used for stomach pains and cuts. Puriri Good for poverty consciousness; for those who feel they haven't got enough. Totara Beneficial for male confidence and leadership. Kawaka and Kauri Gum Good for grief. Flax Multi-purpose plant useful for flexibility, including joints and ligaments, and skin. In traditional Rongoa, flax leaves or roots were used for skin infections. Tea Tree/ Manuka Helps heal wounds. Maori also used the ashes to rub on the scalp to cure dandruff and drank tea made from leaves for a fever. Karaka Related to fear, anxiety.

- Stuff

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Making use of healing plants found in the backyard or nearby forest is experiencing a revival. There are a surprising number of plants with health giving properties out there, something Maori have known for many years. Rongoa is traditional Maori medicine made from plants, and using mirimiri [massage] and prayer [karakia].

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"Researchers have found significant evidence that music interventions help alleviate symptoms of anxiety, pain and fatigue in cancer patients while also booting their quality of life."

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Laughter may not be the best medicine - it may actually be music.

Researchers have found significant evidence that music interventions help alleviate symptoms of anxiety, pain and fatigue in cancer patients while also booting their quality of life.

A US study of more than 3700 cancer patients says music interventions of all kinds resulted in moderate-to-strong effects in reducing patients' anxiety.

There was also a large benefit for treating pain, while a small-to-moderate treatment effect was found for fatigue.
READ MORE:
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* Hopes of new immune-boosting cancer 'vaccine'
* Auckland woman determined to survive terminal cancer
Small reductions in heart and respiratory rates as well as lowered blood pressure were also linked to music interventions, according to the study.

Lead author Associate Professor Joke Bradt from Drexel University says these are important findings as these outcomes play an important role in the overall well-being of patients.

"The results of single studies suggest that music listening may reduce the need for anaesthetics and analgesics, as well as decreased recovery time and duration of hospitalisation, but more research is needed for these outcomes," according to Bradt and her co-authors.

In light of the benefits to cancer patients' quality of life, and specifically their levels of anxiety, pain and fatigue, the researchers hope music interventions will become more widespread.

"We hope that the findings of this review will encourage health care providers in medical settings to seriously consider the use of music therapy in the psychosocial care of people with cancer," Bradt said.

Sally Francis has seen firsthand the benefits of music and the arts in cancer care.

She runs the Arts in Health program at Flinders Medical Centre, which offers a broad range of performance, music and visual arts activities that support patient recovery.

Francis says not only does music act as a vital distraction, it also boosts a patient's self confidence at a time when control has been lost after such an arresting diagnosis.

"It takes them out of the place they're in and provides for a position of reflection or even emotional expression.

"Often if you are playing music, it taps into a part of you that maybe other things don't and often when you are having treatment you're in a hospital coping with the clinical imperatives that are necessary. To some extent you lose a lot of your independence because you're handing over decision-making to medical staff," said

It provides emotional and psychological support, she added.

"Music can come in and just provide a space to let go and relax."

- AAP

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Why music is good medicine for cancer patients

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Laughter may not be the best medicine - it may actually be music. Researchers have found significant evidence that music interventions help alleviate symptoms of anxiety, pain and fatigue in cancer patients while also booting their quality of life.

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Seriously ill patients seeking medicinal cannabis to ease their symptoms will no longer have to take their cause right the way to the top, but access to the drugs will remain tightly controlled.

From today, authority to approve applications for non-pharmaceutical grade medicinal cannabis products no longer resides with the Minister.

Instead the Ministry of Health has ultimate sign-off for all applications, Associate Health Minister Peter Dunne announced.
READ MORE:
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* Helen Kelly on cancer, dying and bad access to good medicine
* Peter Dunne approves cannabis product for Tourette's patient
* Woman wins legal victory for medicinal cannabis
"Last week I wrote to the Director-General of Health, advising him that as of February 8, 2017, applications from specialists to the Ministry to prescribe non-pharmaceutical cannabis-based products will no longer need ministerial approval," Dunne said in a statement.

The Ministry of Health already had the power to sign-off on a specialist's application to prescribe pharmaceutical-grade drug Sativex, and in December last year, that need for approval was removed for clinicians wanting to prescribe the drug to people suffering multiple sclerosis.

Dunne has hinted more changes could be on the way, to further loosen prescribing rules for specialists wanting to prescribe Sativex for conditions other than multiple sclerosis.

It may have been this, that Health Minister Jonathan Coleman was referring to in comments he made on Tuesday, suggesting more prescribing authority could be placed with specialists.

Dunne said Wednesday's changes recognised that application procedures had been tested to a level where he could feel confident he wasn't throwing officials under the bus, by delegating them approval authority.

"As I stated in my delegation letter to the director-general, when applications first began to be received it was my view that the final decision appropriately lay at ministerial level, rather than exposing officials to risk, given the complicated and contentious nature of the issue - that is to say the buck stopped with me".

The Green Party has welcomed the change as a "step in the right direction", but said it did not go far enough.

"Peter Dunne has removed one hoop New Zealanders have had to jump through to get access to medical cannabis, but there are still many more that need to go before people can get the medicine they need," said party health spokesperson Julie Anne Genter.

"With the advice and support of their doctor, New Zealanders should be able to access medical cannabis as easily and as cheaply as they do any other prescription drug - the announcement today doesn't allow that to happen."

Professor Paul Smith, professor of neuropharmacology at Otago University said it was a positive step forward, while taking a cautious approach in an emerging area of medicine.

"The evidence that they work for some conditions like neuropathic pain is not entirely consistent or convincing, but they do appear to help some people. So, it is a question of benefit versus burden for a particular condition.

"In the case of terminal illness, there is not much reason to have concerns because the harm will be minimal and the patient may benefit," he said.

Dunne has been carrying out a review of the regulations around medicinal cannabis for more than a year, and the announcement follows a string of high-profile cases in which terminal patients have died fighting for the drugs to ease pain or seizures.

Most recently, Trade Unionist Helen Kelly died in October last year, after a lengthy battle with lung cancer. In the months before her death, she detailed how tumours had broken her back, but medicinal cannabis was the only thing keeping the pain away.

Kelly applied for a medicinal cannabis product outside the approved New Zealand schedule but the application was later withdrawn from the Ministry of Health. Both Dunne and Health Minister Jonathan Coleman had expressed comments at the time, that Sativex would have been appropriate.

Kelly said it left her with little choice but to take her own products illegally.

Nelson teen Alex Renton died in July 2015 after being hospitalised in "status epilepticus", a kind of prolonged seizure. It was not known what caused the seizures.

Dunne approved a petition to the Government from Alex's family to allow him to be treated with a medicinal cannabidiol oil, Elixinol. Renton's seizure stopped and he regained consciousness shortly before his death.

But it emerged afterwards that Renton's mother had administered the drug to her son before approval was given.
* Comments on this story are now closed.
- Stuff

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Victory for medicinal cannabis campaigners as laws are loosened

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Seriously ill patients seeking medicinal cannabis to ease their symptoms will no longer have to take their cause right the way to the top, but access to the drugs will remain tightly controlled. From today, authority to approve applications for non-pharmaceutical grade medicinal cannabis products no longer resides with the Minister.

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My grandmother used to believe you could cure a cold by soaking a sliced onion in a cup of honey overnight, then taking liberal spoonfuls.

I'm not saying it doesn't work - it has to be said she kept remarkably good health - but it's just one of a number of remedies you can grow to combat winter sniffles, and some are more palatable.
Citrus & Honey Cough Syrup
Ingredients: * 1 lemon or orange * 1/2 cup honey * lemon balm leaves

Chop up a lemon or orange, then put in a jar and cover it with half a cup of honey, preferably untreated. In a pot, cover a handful of lemon balm leaves in water, simmer until reduced to half a cup. Cool slightly, strain, add to the lemon and honey and mix well. Store in fridge.
Thyme & Aniseed Cough Drops
Ingredients: * 6-8 tablespoons chopped thyme leaves * 4 teaspoons aniseed * 400ml cold water * 400g sugar * icing sugar

Put thyme and aniseed into a saucepan and cover with water. Bring to the boil, remove from heat and leave to infuse for 15 minutes. Strain and add sugar. Bring back to the boil, stirring occasionally, and boil until mix is thick enough to leave a thread coming off the spoon. Drop teaspoonfuls of the mixture into a pan of cold water to form the cough drops. Remove immediately and leave to dry on a clean tea towel. Roll in icing sugar and store in a sealed container. Will keep for up to two years.
Horehound & Aniseed Tea
Ingredients: * 30g fresh or dried horehound leaves * 1 tablespoon aniseed * 600ml boiling water

Put horehound leaves and aniseed in a large teapot, add boiling water, put the lid on and leave to infuse for 15-20 minutes. Strain and store in a glass jar. Take 150-200ml lukewarm tea 3-4 times per day. Sweeten each cup with 1 teaspoon honey.
Thyme Cough Syrup
Ingredients: * 1 cup chopped onion * ½ cup honey * ¼ cup fresh thyme

Place ingredients in a stainless steel or glass saucepan. Heat gently over low heat for 20 minutes, ensuring honey doesn't burn. Remove from heat, let honey cool, then strain out onion and thyme. Bottle and store in the fridge. Take 1 teaspoon to relieve coughs.

Note: Use all of these remedies in moderation. Avoid if you're pregnant, have high blood pressure, or are taking other medication. Only use plants when you are sure you have identified them correctly.

- NZ Gardener

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Homegrown herbal remedies for coughs and colds

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My grandmother used to believe you could cure a cold by soaking a sliced onion in a cup of honey overnight, then taking liberal spoonfuls. I'm not saying it doesn't work - it has to be said she kept remarkably good health - but it's just one of a number of remedies you can grow to combat winter sniffles, and some are more palatable.

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Over the last 10 years, the epidural has changed dramatically, explains William Camann, MD, coauthor of Easy Labor and director of obstetric anesthesia at Brigham and Women's Hospital, in Boston. The medicine is no longer delivered through one hefty shot that leaves you completely numb. Instead, it's given via a slow continuous drip so you can't run out, and you should feel enough pressure to be able to push. In fact, most hospitals now use patient-controlled epidural anesthesia, which keeps the baseline epidural low but allows you to press a button for more if you need it.

Studies show that you're not at a higher risk for having a c-section or a prolonged labor (an epidural adds one hour, on average). Spinal headaches, caused by the leakage of spinal fluid through the tiny hole the needle makes, are now exceedingly rare, occurring in just 1 percent of patients. And you don't need to worry about missing a small window of opportunity to get the epidural, says Benito Alvarez, MD, codirector of obstetrics and gynecology at the Cleveland Clinic. In general, you can get an epidural anytime after starting active labor, and, Dr. Alvarez adds, "it's really only too late if the head is popping out." A few medical conditions could prevent you from getting the epidural, like certain blood clotting disorders, scoliosis or past back surgery, or severe infections like sepsis. But for the vast majority of women, it's fine. All of which adds up to a lot of satisfied patients.

"When I first arrived at the hospital, I was in such pain and so disoriented, everything was like a blur," recalls Erika Scott, of Minneapolis, mother of two. "But a half hour after the epidural, I felt no pain, just pressure -- and more than that I felt totally like myself, really present in the experience."

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Over the last 10 years, the epidural has changed dramatically, explains William Camann, MD, coauthor of Easy Labor and director of obstetric anesthesia at Brigham and Women's Hospital, in Boston. The medicine is no longer delivered through one hefty shot that leaves you completely numb.

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MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.

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MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.

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Complementary medicine has received a lot of attention in the past couple of weeks. First, a study focused on potential safety concerns about taking herbal products. Second, ABC's Four Corners looked at the need for better regulation of product claims, and questioned the credibility of the pharmacy industry for endorsing and selling these products.

Both of these are particularly relevant, considering complementary and alternative medicines are widely used by different populations and by more than half of all people. People like complementary medicines often because they find such natural alternatives to be more in line with their values and beliefs, and desire to lead a more "natural" life.

However, in many instances complementary medicines have no added benefit when compared to placebo, or weak evidence. These include dietary supplements such as vitamin C and echinacea for the common cold, and weight-loss supplements.
READ MORE:
* Five natural remedies for skin dryness
* Homegrown herbal remedies for coughs and colds
* Three herbal remedies to beat insomnia
On the other hand, there is evidence for complementary medicines in preventing or managing a range of conditions. Some examples include improvement in mental health conditions, managing menopausal symptoms, and for healthy outcomes during pregnancy.
HOW COMPLEMENTARY MEDS END UP ON OUR SHELVES
In contrast to pharmaceuticals (otherwise known as conventional "Western" medicines), government typically does not subsidise complementary medicines. Therefore, the cost burden is shifted to consumers. While this is good news for government budgets, consumers need to have confidence the products they're spending their money on are safe and effective.

All herbal medicines (these are products derived from plant sources and fall under the complementary medicines umbrella) must be listed on the Australian Registry of Therapeutic Goods before they are made available for sale. This gives them an AUST-L number. However, this still relies on the manufacturer's honesty with respect to its effectiveness.

This stands in stark contrast to pharmaceuticals. These have high up-front development costs, go through rigorous registration processes and have no guarantee of approval. Once pharmaceuticals are approved they are given an AUST-R number, which is different to the AUST-L number.

Natural or herbal medicines do not face the same regulatory scrutiny as pharmaceutical drugs because of their origin from "natural" sources.

However, as the recent piece in the Medical Journal of Australia points out, some products (particularly traditional Chinese medicines) often inaccurately list ingredients and may contain undeclared products (including DNA from endangered animals such as the snow leopard) or toxic and pharmaceutical contaminants.

Similar findings have been reported previously for traditional Chinese medicines.

If a complementary medicine product does not have an AUST-L number you should not buy it: you are putting yourself at risk.
NOT ALL BAD EGGS
It's often the poor compliance of a few companies tarnishing the industry as a whole. One example is "Hydroxycut". Not only has the product been banned in the US several times, it has put consumers' health in serious jeopardy.

Other dietary supplements have led to questions being asked of the industry due to case reports of liver damage from taking products containing, for example, green tea extract. It's the concoction of different ingredients in these supplements that often makes it difficult to pinpoint the exact root of concern. Therefore, tighter regulation of the industry is needed.

But many companies are meeting regulatory requirements and performing good-quality research to support their product claims. One recent example is an extract from the green-lipped mussel for those with attention deficit hyperactivity disorder (ADHD) or learning difficulties. This supplement showed some benefits in reducing hyperactivity and inattention, and improving memory in children and adolescents. Similar studies with other products are under way.

Regulatory reform is needed to protect those companies performing good-quality research from other companies "piggy-backing" off this evidence for their similarly marketed product, perhaps with the same or similar ingredients. The Therapeutic Goods Administration should require manufacturers to have independent testing performed on their products before marketing to ensure the ingredients listed on the packet are accurate.

However, this still doesn't stop people purchasing complementary medicine over the internet, despite clear warnings against this.

We need to encourage and better incentivise research and development of complementary medicines. And we need to give adequate resources to a relevant body capable of more closely regulating the listing of complementary medicines to ensure patient safety.

Until this happens, make sure you only purchase supplements with an AUST-L number to ensure it's safe - and do some research into the efficacy to ensure you're not wasting your money.
Nicholas Fuller is a Research Fellow in Clinical Trials Development & Analysis at the University of Sydney. - theconversation.com

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Do you know what's in the herbal medicine you're taking?

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Complementary medicine has received a lot of attention in the past couple of weeks. First, a study focused on potential safety concerns about taking herbal products. Second, ABC's Four Corners looked at the need for better regulation of product claims, and questioned the credibility of the pharmacy industry for endorsing and selling these products.

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The Act contains provisions enabling the scope of the Act to be extended to cover other practitioners and professions that provide health services.

The document link on this page discusses these provisions. Before you begin the process for regulation under the Act we recommend discussing this with Health Workforce New Zealand (HWNZ).

The need for regulation is based on criteria regarding public safety, under the Act. The process for a profession to become regulated is lengthy and is outlined below as follows.

1. The prospective applicants meet with HWNZ in the Ministry of Health (the Ministry) to discuss issues when considering applying.

2. The Ministry receives an application from the professional body or bodies.

3. The Ministry undertakes a preliminary assessment of the application and seeks further information if required.

4. If the Ministry accepts that the application makes a robust case, it convenes an expert panel to consider the application. This includes an independent assessment of whether the public is at risk of harm and whether it would be in the public interest to regulate the health service.

5. If necessary, discussions may be held between the professional bodies and existing responsible authorities to seek agreement on whether the proposed new profession can be included in an existing authority.

6. Subject to the Minister of Health's agreement, the Ministry undertakes a consultation process and analyses submissions.

7. The Ministry provides advice to the Minister regarding whether the profession should be regulated and the appropriate responsible authority to regulate it. If agreement has not been reached regarding an appropriate responsible authority, the Minister may assign the new profession to an existing responsible authority.

8. If he agrees with the proposal, the Minister seeks agreement from Cabinet. If the policy for the proposal is agreed by Cabinet an Order in Council is prepared by the Parliamentary Counsel Office. This Order in Council will be considered by Cabinet and if agreed the Minister will recommend to the Governor-General that the profession is designated under the Act.

9. The profession joins a responsible authority.

If you are considering applying to become a regulated profession we suggest that you contact us for a preliminary discussion. If you have any queries about the criteria or application process, please email info@healthworkforce.govt.nz.

Current applications

There are several professions who have applied to become regulated under the Act. Applications for regulation under the Act have been received from:

clinical physiologists (July 2010, with renal technicians subsequently expressing interest)

practitioners of traditional Chinese medicine (TCM) (October 2010)

paramedics (October 2011)

perfusionists (November 2014)

Western medical herbalists (May 2015)

oral health therapists (January 2017)

physician associates (February 2017).

Traditional Chinese Medicine (TCM) practitioners

In 2011, the Ministry consulted on the proposal to regulate the TCM profession which outlines the reasons for regulating a profession, a brief background on the profession and invited comments on the proposal.

Since then, there have been a number of meetings with the profession to identify suitable governance options.

Clinical physiologists (with renal dialysis technicians)

Clinical physiology includes clinical cardiac physiology, clinical respiratory physiology, and clinical sleep physiology.

A preliminary assessment was undertaken and further information requested and supplied. However, this application has not yet been formally assessed by an expert panel.

Paramedics

The Minister of Health has agreed that Ambulance New Zealand's application for regulating paramedics under the Act can proceed to the next stage of the application process.

In April 2016, the Ministry of Health convened an expert panel to review Ambulance New Zealand's application. The expert panel advised that the paramedic profession meets the criteria for being considered for regulation. The Minister reviewed the expert panel's advice in May 2016 and agreed that the Ministry of Health should undertake targeted stakeholder consultation about Ambulance New Zealand's application.

Perfusionists

A preliminary assessment is underway.

Western medical herbalists

We have made a preliminary assessment of the application and met with the applicants to discuss next steps.

Oral Health Therapy

The Dental Council of New Zealand has applied for oral health therapy to become a regulated profession under the HPCA Act.

Designation under the Act would reflect current practice and competencies of recent graduates graduating as "oral health therapists". Oral health therapists have been graduating since 2008 and are currently registered by the Dental Council under two scopes: dental therapy and/or dental hygiene. No new dental hygienists or dental therapists have graduated in New Zealand since the changes were made to the undergraduate qualifications.

The Ministry has consulted on the proposal and is preparing advice on our analysis of the consultation.

Physician Associates

This application has not yet been assessed.

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The Act contains provisions enabling the scope of the Act to be extended to cover other practitioners and professions that provide health services. The document link on this page discusses these provisions. Before you begin the process for regulation under the Act we recommend discussing this with Health Workforce New Zealand (HWNZ).

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Forest therapy is literally healing people.

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Caroline was always someone who ran on nervous energy. But when a man began stalking her last year, harassing her for 10 months, the lawyer and mother of two developed a new kind of cell-deep fear that took over her mind.

"It has sucked so bad. More than anything," she says, referring to the nine months of anxiety that followed. "I didn't even know things could suck as bad as it sucked."

It came on in stages. She'd have a day where she suddenly felt very disoriented, as though someone had put something in her drink. The next day she'd be fine.

"I felt my throat tightening, so I went to the doctor, and then to the ENT surgeon, but there was nothing.
READ MORE:
* What it's really like to pop 'happy pills'
* My anxiety is called Walter
* Being anxious makes it hard to identify others' emotions
"It was terrifying and strange and then it all fell apart and I got this crippling panic disorder: rolling panic, panic attack followed by panic attack, that went on for six weeks. When it came on it was like full alert: it was front line of the Iraqi special forces in Mosul. It was like that, but you're just in your house."

The stalker has stopped now, but he left behind a full-blown generalised anxiety disorder, something Caroline* now realises she'd caught glimpses of throughout her life. She says the symptoms are hard to describe - a staticky crackling in her ears, for one.

"It's a terrible, unnerving, unending fear, something every molecule in your body experiences. My brain is fried.

"It's not like just being nervous about exams - it's a very powerful inability to calm down," she says. "But it's a difficult illness to communicate to the world. The number of times that people popped in and said: 'You look fine! You look great!'"

Anxiety is a growing modern affliction. Although, whether that's due to greater awareness, or because we really are experiencing a higher incidence of clinical-level panic than usual, is uncertain. Anxiety New Zealand estimates that a whopping one in four New Zealanders experience anxiety, panic attacks, and phobias every day.

Alongside that has come a well-documented rise in demand on a struggling national mental health system, as well as an international increase in pharmaceutical treatment. One in 10 adults in the developed world now takes an antidepressant. In June it was reported that the number of New Zealand children and teens on them has doubled over the past 10 years, with nearly 15,000 prescribed them last year.

Psychiatric medication can be lifesaving. Ruby*, in her early 30s, says it saved her life. Diagnosed with anxiety, depression, obsessive compulsive disorder, and post-traumatic stress disorder, she had reached desperation point. She's tried about a dozen on the anti-psychotic, anti-depressant, and anti-anxiety spectrum, and says they're a tool you use in tandem with a host of other approaches to mental health.

"I have no doubt that I wouldn't be here without them," she says. "They saved my life."

But medication can be tough on the body and mind - and it can be hard to get right. Caroline's doctor prescribed her Prozac, which her psychologist supported. She was reassured - but once she started taking it she felt worse, with more extreme panic.

Her doctor doubled the dose, which she says was "a whole new type of hell".

After six weeks she stopped taking it - which medical professionals agree is highly inadvisable - but in Caroline's case the panic subsided. Later, she went on Mirtazapine, but the side effects were "extraordinary". (Think weight gain, foggy thinking, memory loss, erratic periods, loss of libido and all the while the anxiety appeared to increase.) Again, she went against her doctor's advice and stopped taking it.

"One week off that now and I'm almost back to normal," she says.

She's been told she's one of a handful of people who react badly to the happy pills, but there is growing evidence that they're not the only solution.

The Mental Health and Nutrition Research Group in the Psychology Department at the University of Canterbury has been investigating the link between micronutrients and mental health, and has stacked up a pile of research to demonstrate the benefits in children and adults, including earthquake victims.

Since 2010, when the group's first study was published, UC clinical psychologist Julia Rucklidge has been a frequent face in the media, including presenting a TEDxChristchurch talk, The Surprisingly Dramatic Role of Nutrition in Mental Health, which had more than 600,000 views online.

One of the research group's most recent publications, in the Journal of Child and Family Studies, investigated anxiety and stress in children following the Christchurch earthquakes. It found symptoms of anxiety improved when they were supplemented with specialist formulations of micronutrients (see sidebar).

"We saw such robust changes in the anxiety levels of the children in that study," Rucklidge says. "Certainly the research is suggesting it's a viable way forward, with virtually no side effects."

The children's sleep improved. They were less anxious about going to school. They seemed easier to reason with, and were better self-regulated.

"In our studies with kids, they often have multiple problems, not just anxiety. We see kids with encopresis [soiling themselves], bedwetting, a lot of irritability, oppositional behaviour, temper tantrums; and we have found with our research that those types of behaviours can also be well managed with the nutrients.

"Our experience of the nutrients over 10 years is that when it works - and I have to always be careful to say it doesn't work for everyone - but when it does work we see a broad range of symptoms getting better."

When 10-year-old Sam joined one of UC's micronutrient studies, he wasn't taking them for his tics and anxiety; he was taking them to see what effect they'd have on his ADHD. But a couple of weeks after he started on the specialist vitamins and minerals, his parents began to notice a difference.

"His anxiety had gone down and his tics had reduced, which go hand in hand," his mother Karen says. "When he finished the programme, we took him off the micronutrients and we noticed within two days it all came back. He was quite anxious and had his head shake going on, clicking his fingers, doing all the things he used to do."

They put him back on the pills. Six months on, Sam is still taking them, his parents buying the product direct from the distributor in Auckland when the study supply ran out.

"My message to other parents would be: don't be scared to try them," Karen says. "Even the smallest changes can make all the difference."

The positive effect of nutrition on mental health is hardly a new idea. There are multiple studies showing the brain benefits of a better diet, but much of the discussion around junk and processed foods has been centred on obesity, not brain health.

Rucklidge believes that our current approach to mental health isn't working very well. Many people don't improve, even if they can access treatment, which would be a cause for outcry in any other field of medicine, she says.

"When it comes to mental health there's this assumption that what we are actually offering, if everyone could get it, works. And that's the wrong assumption," she says.

"There's this talk that we just need more resources. I would say we need to change what we're doing, not just add more of the same.

"Even if you get the best treatment, many people don't get better. That's a hard thing for me to say, but the message has to get through."

Pharmaceutical medication and psychotherapy certainly have their place, she says. But micronutrients have no side effects, and no street value. Why not try them before drugs, which can knock around already vulnerable people?

"We're fine about all the people being on antidepressants, even though the long-term evidence for that approach is questionable and the side-effect profile can be concerning."

But she says there's difficulty getting buy-in from professionals. "There's a lack of saying: 'Why don't you try some B vitamins first? Or change your diet?'"

She has lobbied for UC's research to be considered in national care plans, but says there's frustrating inertia.

Medsafe general manager Chris James says he's aware of Rucklidge's work and the organisation has approved the use of the micronutrient products in her clinical trials only.

"Due to the inclusion of certain ingredients or levels of certain ingredients and the conditions for which the products are used in Prof Rucklidge's work, these products are currently considered to be unapproved medicines," he says.

But after the trials that UC runs, the families have often found such relief with the products that they want to keep using them. In a convoluted workaround, they're able to buy the micronutrients with the permission of their GP or prescriber, which essentially means they are sold as an off-label medicine.

For the treatment to enter the mainstream and be prescribed as easily as Prozac, these micronutrients would need to become approved medications. Rucklidge would prefer they be approved as part of the Natural Health Products Bill and allowed to be sold as such.

But that's difficult, as the vitamins and minerals in the products Rucklidge and her team use to achieve therapeutic results differ vastly from your standard supermarket multivitamin. They are sometimes present in high amounts many times over the recommended daily intake (RDI), and are therefore declared to be medicinal - but the cost and difficulty of registering them as medicine would put most natural health companies out of business.

The RDI is not an upper limit of safety, Rucklidge says. A handful of Brazil nuts can put you over the RDI for selenium, for example... "We have lots of evidence that there are very minimal safety issues, if any."

The entire issue of what natural health products can be sold, and what they can claim, is currently before the Government as the Natural Health Products Bill, and Rucklidge has been lobbying against some of its wide-ranging restrictions.

The process for bringing a product into clinical care is extensive, and James says the Ministry of Health hasn't received any application - including from Rucklidge - for consent to distribute the micronutrient products in New Zealand.

Rucklidge says that's not her role, and she needs to stay at a distance from the products. It's why she's reluctant to mention brands.

"I am a researcher, not a salesperson or distributor of medicines," she says.

"I find it frustrating as I need to stay impartial to do the research but also feel I have to advocate for people we have helped and for the vulnerable, people who are mentally ill.

"It would be nice if the Ministry recognised the benefits of the nutrients and actively worked with me and others involved to make access to them for New Zealanders simpler and affordable."

She did apply to Pharmac to have them funded, but was turned down.

"I only did that because I am saddened when we help someone get better through our trials and they switch to medications because they can't afford the nutrients. If the Ministry of Health really had the health of New Zealanders at heart, they would be proactive about it, they would find a way."

James says the Ministry is considering the ingredients and conditions to determine their suitability under the upcoming Natural Health Products regime, and the work is ongoing.

In the meantime, Rucklidge finds herself sought out by thousands of people looking for help when everything else has failed. She replies with a form email, outlining the nature of her work and from where the micronutrients can be obtained.

Otherwise, her basic advice to improve mental health is, of course, to eat less processed food and more fruits and vegetables. But in the lab, she and her team don't talk much about diet at all. Besides, basic lifestyle changes involving brisk walks in the fresh air and carrot sticks can seem impossible to someone in the clutch of depression or anxiety. It's only when the dark moods lift that they become simple.

"We give nutrients to people and they get better," she says.

"When people who aren't eating very well start to feel better when getting additional nutrients in pill form, they start to make dietary changes. They don't crave sugar and carbs as much, and we start to see improvements down the road.

"Once they see the simple effect of the pill and the impact it can have on their behaviour, a light bulb goes on."
WHAT ARE MICRONUTRIENTS?
Micronutrients - as opposed to macronutrients carbohydrate, protein, and fats - are the regular vitamins and minerals that the body needs in trace amounts: B-complex vitamins, selenium, iodine, zinc, magnesium, iron, copper, etc. The World Health Organisation calls them "magic wands", enabling the body to produce enzymes, hormones and other substances essential for proper growth and development.

We should be able to get enough from a healthy diet, but that's in increasingly short supply these days because of an increased intake of processed foods, soil deficiencies, and certain farming practices.
GETTING THE MEDS RIGHT
Diagnosing and prescribing for psychiatric illness isn't an exact science; people slip through the cracks and struggle to access help but they can also struggle with treatment itself.

However, there might soon be a better treatment answer than trial and error. University of Otago neuroscientist Neil McNaughton is developing one of the first methods to biologically test for any mental disorder, by measuring the brain response in a special test. The project, which has $1 million in funding from the Health Research Council, will run until the end of 2018, and investigates a particular brain rhythm that is reduced by anti-anxiety medication.

The study tests if the brain response is high in subjects with anxiety disorders. If it is successful, it should allow development of clinical tests that will be able to show who is more likely to have success with some types of medication and who is more likely to respond to others.

"This should help, particularly with the problem that - even when medication works - it can take weeks to have its full therapeutic effects, and so finding the right treatment can be a very long, drawn-out process," he says.

The work should also lead to development of other biomarkers for mental illness, which means that multiple diagnoses at once will be possible.
* Names have been changed. Anxiety New Zealand: anxiety.org.nz. Helpline 0800 ANXIETY (0800 269 4389)
- Sunday Magazine

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Are micronutrients the answer to NZ's mental health crisis?

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Caroline was always someone who ran on nervous energy. But when a man began stalking her last year, harassing her for 10 months, the lawyer and mother of two developed a new kind of cell-deep fear that took over her mind. "It has sucked so bad.

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Every week, when Ian Hanley sits down with his therapist, he goes through a list of depression treatments he's been researching online. The best-known treatments at the top of the list-half a dozen antidepressants and known combinations of those drugs-are all crossed out.

"My therapist says he's never had this much difficulty with somebody," says Hanley, "which is sort of a dubious honor."

Hanley is only 21 years old, but he's already six years into his search for something, anything, that can help him feel better for more than a few weeks at a time. "I've heard people describe it as sadness, and that's not specific enough," he says. Numbness is closer, but it's not like depression inures you to suffering. "It's like not quite being alive," he says, "but still having to go through all the crappy parts of being alive."

When he was in the 10th grade, Hanley basically lost all desire to get out of bed in the morning. He started seeing a psychiatrist and a therapist-the same one he sees today-and went on Zoloft. "I wasn't catatonic anymore," he says. But the positive effects soon disappeared, like they would with every medication he's tried since.

This year, Hanley quit college and put on ice his ambitions to become a screenwriter. Now he spends most of his time waiting to start a new treatment, trying that new treatment or waiting to see if he feels better.

Most diagnoses do not come with 20-plus medicines approved by the Food and Drug Administration to treat it-and yet with depression, more options don't always mean better outcomes. Ever since the first antidepressants were introduced 60 years ago, doctors have had patients like Hanley-people who don't seem to get better even after they've worked their way through the lengthy list of available drugs. About 30% of all people with depression don't respond adequately to the available treatments. That's a dismal failure rate for a class of drugs designed to improve a person's basic ability to function.

Not that it has hurt the market. At last count, about 12% of Americans took antidepressants. Global revenue for antidepressants was about $14.5 billion in 2014 and is projected to grow to nearly $17 billion over the next three years. Clinical depression affects 6.7% of U.S. adults, or about 16 million people, and a growing number of children and teenagers too. It's the leading cause of disability in the world, costing the U.S. economy alone $210 billion a year in lost productivity, missed days of work and care for the many physical and mental illnesses related to depression, like anxiety, posttraumatic stress disorder, migraines and sleep disorders.

There hasn't been a major depression-drug breakthrough in nearly three decades, but a number of factors are conspiring to change that. Scientists are gaining a more nuanced picture of what depression is-not a monolithic disease, but probably dozens of distinct maladies-and they're getting closer to learning what works for which kind of ailment. With suicides in the U.S. at their highest number in 30 years, experts agree that patients need faster ways to feel better, without waiting the typical four to eight weeks it takes for antidepressants to kick in. And as old drugs have gone off patent-making them less lucrative for drugmakers-companies are eager to find new revenue streams.

The biggest development has been the rediscovery of a promising, yet fraught, drug called ketamine. It's best known as a psychedelic club drug that makes people hallucinate, but it may also have the ability to ease depression-and fast. In a race to shape the next generation of antidepressants, Johnson & Johnson and Allergan are fast-tracking new medicines inspired by ketamine. The FDA could be reviewing new drug submissions by as early as next year. Researchers, too, are exploring how to harness big data and even genetic testing to come up with new ways of treating depression for the 30% of people who don't respond to the current standard-of-care treatment options.

All of this has psychiatrists, long frustrated with their menu of available treatments, hopeful for the first time in years. Finally, they say, their field is on the cusp of a much-needed breakthrough. "At this point, any new depression treatment that makes it to the finish line is a huge win," says Dr. George Papakostas, director for treatment-resistant depression studies at Massachusetts General Hospital. "It's going to have a major impact." The question is, which method will prove to help the most people in the safest way possible?

Doctors have always seen depression as something that's distinct from ordinary sadness, but what causes it and how best to treat it has changed wildly over the years. In the 5th century B.C., Hippocrates believed the body was made up of four humors and that too much "black bile," the humor secreted by the spleen, resulted in melancholia. Melancholia as described by the Greeks looked a lot like depression today: persistent dark moods with a deep, lasting fear or sadness that isn't based on reason. The Greeks prescribed lifestyle treatments like diet, exercise, sleep, bathing and massage as well as rougher approaches like vomiting and bloodletting. In later ancient times, sex was also considered a helpful remedy.

By the Middle Ages, depressive-like behavior was believed to be a disease of the spirit-the result of demonic possession. Many depressed women were thought to be witches, and the cure for them was to be burned alive.

The idea that depression is rooted in the brain-and not a bodily fluid or possessed spirit-didn't take hold until the 17th century, when a neurologist named Thomas Willis decreed that melancholia was "a complicated Distemper of the Brain and Heart." Although he had little else to offer patients besides the lifestyle remedies of the Greeks, melancholia was finally thought to be at least partly biological. In subsequent years, everything from herbal remedies to opium to music therapy to spinning stools designed to make people too dizzy to feel pain fell in and out of vogue.

Beginning in 1938, electroconvulsive therapy was thought to be the only effective modern treatment for depression, but the procedure sometimes caused memory loss, among other side effects.

It wasn't until the 1950s that doctors hit upon the idea that certain chemical cocktails could be used to treat depression. The first, called iproniazid, was found by accident when it was being tested as a treatment for tuberculosis. Doctors noticed that the TB patients taking the drug transformed from miserable and near death to euphoric, energetic and social. Newspaper articles of people "dancing in the halls tho' there were holes in their lungs" captured the popular imagination, and in 1957 scientists decided to try it on a small group of psychiatric patients.

According to that study, 70% of them became happier and more social. By the end of the decade, about 400,000 people with depression were on the drug. The high was short-lived, however: scientists soon discovered that the pills caused liver damage, and it was pulled from the market in 1961.

Another experimental drug, imipramine, was supposedly an antipsychotic, but scientists discovered in 1957 that it worked much better on people with depression. It became the first in a class of what's called a tricyclic antidepressant, so named for its three-ringed chemical structure.

By studying how those early drugs worked, scientists were able to hit on a new idea about what caused depression in the first place: depleted levels of the brain's neurotransmitters, namely serotonin, norepinephrine and dopamine. Those early drugs may have come with nasty side effects, but they ultimately gave rise to selective serotonin reuptake inhibitors, the drugs most widely prescribed today.

Eli Lilly released the first one, Prozac, in 1987. It was an immediate hit; in just three years, 2 million people around the world were taking it, and pharmaceutical companies began churning out their own only slightly different versions of the drug soon after. SSRIs are still the field's proudest and most profitable achievement, but they're far from perfect. They can make people feel worse before they start feeling better several weeks after treatment begins. When the drugs work, they're life-changing. But they don't work for everyone. On SSRIs, about 35% of people taking them experience full remission.

"We have no idea, after many decades of studying these drugs, why some people get better and some people don't," says Dr. Roy Perlis, director of the Center for Experimental Drugs and Diagnostics at Massachusetts General Hospital. "We desperately need truly new interventions."

The largest, longest study conducted on depression treatments, called the STAR*D trial, found that after people tried four antidepressants over the course of five years, about 70% of them were free of depressive symptoms. That's a lot of trial and error to end at a place where 30% of patients don't experience remission at all.

The STAR*D trial ended in 2006, and despite a clear hole in the market-and a clear patient need-a golden age of new depression treatments still hasn't arrived. Drug companies do not want to spend their money developing yet another SSRI-there are already a dozen approved by the FDA. "The drug companies basically shut down a lot of their brain research when it comes to psychiatry," says Dr. Richard Friedman, director of the psychopharmacology clinic at Weill Cornell Medical College.

"In my opinion, it wasn't necessarily a lack of interest-it was just that people had felt that they'd gone as far as they could with things like Prozac, and they weren't sure what the next targets were going to be," says Husseini Manji, global head for neuroscience at Janssen, the pharmaceutical arm of Johnson & Johnson.

Now, many experts-and drug companies-believe that target is ketamine hydrochloride, the only legally available psychedelic drug in the U.S.

In large doses, anesthesiologists use ketamine to put people under before surgery. In smaller doses, clubgoers use "Special K" to trip and hallucinate; it's one of the top drugs of abuse in Asia. However, its newest application, discovered serendipitously in the late 1990s, opened ketamine up to a whole new audience: those looking for a fast-acting drug for stubborn depression.

There are two drugs, one from Allergan and one from Johnson & Johnson, that work similarly to ketamine and are in late-stage clinical trials. As of now, ketamine is not FDA-approved for depression. So far, clinical trials on ketamine for depression have been small, and there aren't many of them. Only about 400 people have participated in such studies, and many had fewer than 100 people. (By comparison, the STAR*D trial had almost 3,000 participants.) Still, the results are promising enough to excite a number of prominent researchers in the field.

"In the past 20 years, I've not seen anything like this," says Dr. Cristina Cusin, a clinician and researcher who runs the ketamine clinic at Massachusetts General Hospital. Studies have shown that 60% to 70% of people with treatment-resistant depression respond to ketamine.

Ketamine has also shown promise in putting an end to suicidal thoughts. "We have patients saying, 'I'm exactly as depressed as I was before, I just don't want to kill myself anymore,'" says Cusin. "This was very surprising. We can't explain it."

Barbara Reiger, who's 59 and lives in San Diego, says she tried nearly everything to lift her out of the depression that had plagued her since childhood and sometimes rendered her suicidal. When she learned about ketamine in 2015, she decided to try it at a ketamine clinic in her hometown. Since ketamine is FDA-approved as an anesthetic, physicians can legally prescribe it off-label for any condition they believe it may help, including depression.

Since then, every six weeks or so, she shows up at a private ketamine clinic, where she'll put on an eye mask in a dim room, sit back in a recliner and have a needle full of ketamine plunged into her deltoid. It doesn't make her feel high, exactly, but she remembers that the first time she tried it, a grin and happy tears spread across her face. "I felt I was putting things in order, moving pieces of a puzzle around to make it all make sense," she says.

Ketamine trips are known to help people disconnect from their bodies and their thoughts, and it worked that way for Reiger. After her first trip, she remembers feeling better than she had for years. "I immediately felt relief ... a lightness of the depression kind of lifting," says Reiger. And it all happened in less than an hour.

"It's been a paradigm shift, that now we can achieve rapid antidepressant effects," says Dr. Carlos Zarate, chief of the experimental therapeutics and pathophysiology branch at the National Institute of Mental Health and one of the foremost researchers of ketamine. "Now we know there's something radically different."

Experts aren't sure exactly how ketamine works, although they agree it doesn't target the standard antidepressant route of serotonin, norepinephrine and dopamine. Instead, they think it stimulates a series of receptors in the brain, kick-starting something called synaptic plasticity-the ability of parts of the brain to grow and change. While antidepressants have been shown to also increase plasticity, ketamine seems to do it much more quickly-and much more powerfully.

How it works is one of the drug's many unknowns. Doctors also don't know the consequences and potential side effects of taking tiny doses of ketamine over and over again. People can become dependent on it, and long-term use of the drug has been linked to bladder toxicity and cognitive problems in those who abuse it recreationally. And although ketamine has been shown to be safe as an anesthetic, "you get anesthesia once," Cusin says. "You don't get anesthesia for months or a year. We have no idea what it does."

Ketamine's effects are temporary; depression reliably creeps back, so people need infusions every few weeks or more to keep their symptoms at bay. It's also costly. The treatments are rarely covered by insurance and run from $400 to $800 per infusion. On a biweekly schedule at the high end of going rates, that adds up to more than $15,000 out of pocket per year.

When Reiger first started taking ketamine, she quickly drained the funds she had set aside for treatments. She was on an every-six-weeks schedule, not including doctor's visits, but at $500 a pop it was adding up fast. "It was cutting too much into our budget," she says.

She thought she'd have to stop treatment, but she got lucky: another of her doctor's ketamine patients heard about her plight and volunteered to pay for her treatments. "I'm grateful," Reiger says. "But a donor can only be so generous, and I know someday I'll probably have to face these demons again."

As many as 5 million people in the U.S. have treatment-resistant depression, and to capture such a huge potential market, private ketamine clinics run by psychiatrists or anesthesiologists have popped up across the country in recent years. These clinics have pitched themselves to doctors as get-rich-quick side businesses and to patients as a ray of light in the darkness. But there are no rules governing how these clinics administer ketamine or whether they monitor blood pressure, heart rate, psychological changes or substance-abuse risk in patients who are taking it. "There is pretty large variability in what one clinic is doing compared to another," says Dr. Gerard Sanacora, director of the Yale Depression Research Program at Yale School of Medicine and a longtime ketamine researcher, who surveyed 57 of these clinics in a July paper.

This year, a task force from the American Psychiatric Association (APA) concluded in an issue of the medical journal JAMA Psychiatry that ketamine wasn't ready to be widely used as a medication for treatment-resistant depression.

"I still think it's the most exciting treatment to come in mood disorders, probably of the last 50 years," says Sanacora, who worked on the APA statement. "But the reality is, there's still a lot we don't know about the treatment."

Other scientists are skeptical that ketamine is a good long-term solution to depression. "I think a lot of the hope on ketamine may prove to be misplaced," says Friedman, of Weill Cornell Medical College. "People may be disappointed." One problem, he says, is that in addition to enhancing neuroplasticity, it may also stimulate an opioid receptor in the brain. "If you stimulate that receptor-which is what Percocet and oxycodone and morphine and heroin do-you'll relieve pain and make people feel high and euphoric," says Friedman.

But that can also come with risk of habituation and abuse. Scientists already know that ketamine can be addictive. Now a clinical trial is under way at Stanford to test if ketamine acts like an opioid. Results are expected by the end of 2018.

Until recently, ketamine proved to be a tough drug to imitate. Because it has widespread effects in the brain and doesn't act neatly in just one spot, many of the drugs developed in its likeness-including those from pharma giants like AstraZeneca and Roche-were simply not as effective as the original. But now a few new drugs are showing promise.

Last year, Zarate at the National Institute of Mental Health and his colleagues keyed in on a part of ketamine's chemical structure that they think is responsible for the drug's antidepressant effects. Now they're working on developing it as a treatment for depression. Early research in mice suggests that, unlike ketamine, the compound they've identified does not appear to be addictive.

Janssen, part of Johnson & Johnson, has developed and patented a version of ketamine called esketamine that doctors would be able to give their patients through the nose like a nasal decongestant, making it a more convenient alternative to an IV. The FDA has designated esketamine a "breakthrough therapy," which means it can speed through the typically lengthy drug development process and get to market more quickly. If the ongoing efficacy trials prove successful, Janssen could file esketamine for FDA approval in 2018.

Rapastinel, an intravenous depression drug under development by Allergan that acts on the same receptor as ketamine, can be given in just 30 seconds and doesn't seem to cause the hallucinogenic effects ketamine is known for. "So far in our clinical trials, the incidence of anything like hallucinations or psychosis has been incredibly low," says David Nicholson, chief R&D officer at Allergan. That drug also received breakthrough status by the FDA and is in the final phase of clinical trials, which are expected to finish in 2019. Once those trials are done, Allergan will petition the FDA for approval to market the drug for major depression. They're also working on an oral version of rapastinel.

Other new approaches to treating depression are on the horizon. For instance, researchers are testing drugs that target altogether different potential biological roots of depression-including chronic inflammation.

And at Perlis' lab at Massachusetts General Hospital, a team of scientists is trying to use big data to uncover whether any other existing FDA-approved medications-including drugs for completely different issues, like high cholesterol, pain and even acne-could have any mood-lifting side effects. Finding a medication that can be repurposed for depression would have huge advantages over traditional drug development: they are already proven to be safe, they don't cost a fortune to create from scratch and they're available for people to use now.

A revolution in genetics also offers promise for treating depression. "After lots of years of really not going anywhere, suddenly there's a lot to be excited about," says Perlis. In a landmark 2016 study, he collaborated with the genetics company 23andMe and Pfizer Pharmaceuticals to analyze the genetic profiles of nearly 460,000 people. For the first time, they discovered 15 different regions of the human genome associated with the development of depression.

Understanding what these depression genes do in the body makes it easier for scientists to find new drugs and interventions that have the opposite effect, which will make the search for treatments ever more precise. "It essentially gives us a target to aim at," Perlis says.

For those who are suffering without hope, these new innovations, whether they stem from ketamine or whatever compound scientists will stumble upon next, can't come soon enough.

For his part, Ian Hanley is waiting to see if ketamine, which he recently crossed off the list of treatments he has tried, will be a success or just another failure. His first IV infusion left him dazed and, after a long nap, uncharacteristically energetic. The night of his first trip, he shocked his parents by cleaning his room and going for a walk for the first time in ages. But about half of his subsequent treatments sent him on bad trips. He was consumed with worries that he'll stay depressed, that ketamine won't work for him and that, if it doesn't, he won't know what to do next.

Hanley says ketamine has given him a bit of hope, but that hope is tempered by the skepticism of a patient who's been excited-then crushed-many times before.

Drug-free treatments backed by science

MANY PEOPLE WITH DEPRESSION FIND RELIEF WITHOUT PRESCRIPTION drugs. These methods have all been scientifically proven to help ease symptoms of depression. Here's what the research recommends:

EXERCISE

One of the most-studied natural approaches to treating depression, regular physical activity may lift mood in part by increasing certain neurotransmitters. Of course, embracing an exercise habit isn't easy for most people-especially those with depression. "In my experience, the last thing depressed people want to do is move," says Dr. Andrew Weil, founder of the University of Arizona Center for Integrative Medicine. "But it has a striking effect."

Plus, it's free.

COGNITIVE-BEHAVIORAL THERAPY

CBT, a type of talk therapy, focuses on changing negative thought patterns, and then learning how to home in on specific problems and find new ways to approach them. It typically lasts for 10 to 20 sessions. Some studies have shown it to be as effective as medication.

BEHAVIORAL-ACTIVATION THERAPY

People with depression often withdraw from the world, and this therapy seeks to bring them back in. Treatment involves helping people identify activities that add meaning to their life, like reading, volunteering or hanging out with friends, and encourages them to do these things without waiting for their mood to lift first. In a recent study published in the Lancet, this kind of therapy was shown to be as effective as CBT. And it costs much less, because practitioners don't need as much training.

MINDFULNESS TRAINING

"Thoughts and images are often the source of sadness and fear, and if you have no training in getting your attention away from them, you're helpless," says Weil. One such program, an eight-week small-group treatment called mindfulness-based cognitive therapy, trains people to be aware of the present moment through mindfulness practices like gentle yoga and daily meditation. It was shown in a 2016 study in JAMA Psychiatry to help people with recurrent depression avoid relapses even better than antidepressants.

TRANSCRANIAL MAGNETIC STIMULATION

In TMS, a large magnetic coil is held against the scalp near a part of the brain believed to be important for mood. Magnetic pulses painlessly pass through the skull to stimulate nerve cells, and though how it works is still a mystery, it's thought to help normalize brain circuits involved in depression. TMS is not invasive, and people receive it when they're awake, without anesthesia. It typically requires sessions several times a week for four to six weeks and seems to have few serious side effects. In 2008, the FDA approved it as a treatment for people with major depression who hadn't responded to at least one antidepressant.
This appears in the August 07, 2017 issue of TIME.

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Every week, when Ian Hanley sits down with his therapist, he goes through a list of depression treatments he's been researching online. The best-known treatments at the top of the list-half a dozen antidepressants and known combinations of those drugs-are all crossed out.

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Farah Hancock is a Newsroom reporter based in Auckland who writes on education, conservation and technology.

Newsroom

A new pharmacy code of ethics will clear the way for pharmacies to sell homeopathic products.

The Pharmacy Council's previous code required that credible evidence of efficacy exist for any products sold at pharmacies, however, this rule was often ignored by pharmacists.

The new code, which comes into effect March 12, does not require credible evidence for what it refers to as complementary and alternative medicines, but does require pharmacy staff tell customers if a product lacks scientific evidence of efficacy.

Homeopathy is based on the belief that extremely diluted amounts of active ingredients are effective against ailments. The more diluted the active ingredient, the more potent homeopaths believe treatment is. Homeopathy's effectiveness has been rejected by many scientists, and by large government reviews conducted in the United Kingdom, Australia and Europe.

The Code of Ethics 2018 update came after consumer advocacy group, the Society for Science Based Healthcare (SSBHC), complained when they discovered homeopathic products were being sold in pharmacies in an apparent breach of the industry's own code of ethics.

The Society's chairperson, Mark Hanna, said a parent contacted him after realising they had been sold "crap" by the pharmacy and had thrown the homeopathic product in the bin.

"In 2014 they had a rule which basically was - you can't sell quackery - but they didn't want to enforce you can't sell anything in particular."

Hanna said he believes the entire code was reviewed because the Pharmacy Council did not want to tell pharmacies what they can and can't sell.

The Pharmacy Council was established under the Health Practitioners Competence Assurance Act. It's primary role is to protect the health, safety and wellbeing of the public. Chief executive, Michael Pead said the code was updated to recognise the changing health sector.

"The real issue here is you can have what is a regulated medicine, say for example omeprazole sitting on the shelf next to shark oil. What happens is the presence of the omeprazole gives legitimacy to the shark oil."

"It's a much more patient-centric, integrated health care model in New Zealand and we felt it was more appropriate to have a more principal-based code of ethics."

The code is now simplified into principles, and much of the detail of what was in the previous version is now set out in separate standards and statements documents.

When asked if products with no scientifically-proven benefit should be removed from pharmacy shelves Pead said: "The pharmacy council has not taken a position of that in its case, once again we look to the pharmacist to make those judgments in helping to make sure they are dealing with informed patients fundamentally."

The New Zealand Medical Association's (NZMA) chairperson, Dr Kate Baddock, made a submission to the Pharmacy Council against pharmacies selling complementary and alternative medicines during the code's review process.

She said the Pharmacy Council has created a document the NZMA is disappointed with.

"The real issue here is you can have what is a regulated medicine, say for example omeprazole [a medicine for heartburn] sitting on the shelf next to shark oil. What happens is the presence of the omeprazole gives legitimacy to the shark oil.

"As long as you have pharmacists stocking products like that side by side you're going to have an unsuspecting public believing them to be equally important, equally effective, equally efficacious and equally having scientific basis for them being used."

Baddock said she is concerned how the codes requirement for pharmacy staff to inform customers of a product's lack of efficacy will translate to real-life situations.

"I think there is going to be great difficulty in ensuring that whomever you may see when you walk into a pharmacy is going to give the prospective buyer the amount of detail that is being stipulated, even more - to ensure that everybody in the pharmacy does that."

Understanding what enforcement measures there will be when pharmacy staff do not adhere to the requirement to let customers know a product may be ineffective is difficult.

Pead said complaints to the council are a basis for action and the code of ethics is a base to assess whether a pharmacist was fit and competent.

"All our standards, guidelines and statements from there give us more and more specific places to say 'Hey, you didn't quite meet the expectation, you need to reconsider your position on those matters'."

Hanna said SSBHC members would be checking to see if the new measure requiring customers be informed when there was a lack of evidence supporting a product was being adhered to. He said the society would be making complaints to the Pharmacy Council if pharmacies were not following the new code.

"Ideally, I think pharmacists shouldn't choose to stock these products. If that can't be enforced, I think that this is the next best way to go, to make sure they are not misinformed about them."

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New code of ethics makes way for homeopathy

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Farah Hancock is a Newsroom reporter based in Auckland who writes on education, conservation and technology. Newsroom A new pharmacy code of ethics will clear the way for pharmacies to sell homeopathic products. The Pharmacy Council's previous code required that credible evidence of efficacy exist for any products sold at pharmacies, however, this rule was often ignored by pharmacists.

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All you need to know

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Click on the country flags to view the latest translations for that language.

Regular 2-3 minute whiteboard patient animations to share with your practice members. To view, click on their respective links below:

Understanding Chiropractic Series

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Chiropractic Animations Our whiteboard animations help explain the benefits of Chiropractic care. They are easy to understand and based on the latest chiropractic evidence informed research, deciphered and delivered to you and your patients. Email videos to your patients Click on the country flags to view the latest translations for that language.

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CNN news article

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Pay Attention: How "forest bathing" clears the mind and body

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New studies say no, but reduce sugar and cream

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The boy sits there, his head down. He feels stink; he knows all the adults are there to talk about him, about what's wrong with him.

He's always been told off for being so fidgety, for not paying attention. He knows it's a bad thing.

But when the talking begins, it's not about how to fix him. They're telling a story about atua, the gods, and one of them sounds exactly like him! He's called Uepoto, and he's always curious. He's full a mischief, a tutū.

The boy looks up.

"That's where the healing starts, with an exchange of words," says Poutu Puketapu, 25, a mental health worker at Gisborne service Te Kūwatawata. Only, that's not his title here - in this space he's a Mataora, or change-maker.

And the boy isn't a patient, or client, or even a consumer. He is simply whānau.

"Instead of labelling them and making them feel like they are part of the mental health system, we reach them with these narratives. When they hear the pūrākau (stories) you see a little spark in them."

Mahi a Atua is a form of narrative therapy that focuses on recovery from the trauma of colonisation. Māori creation stories are used as a form of healing, connecting alienated Māori to their whakapapa.

The pilot programme began in August last year as a response to the disproportionate mental health issues among Māori, and is backed by the Ministry of Health's innovation fund and Hauora Tairāwhiti District Health Board.

Māori youth are two-and-a-half times more likely than non-Māori to commit suicide. Māori in general are more often underdiagnosed, and once in the mental health system are more likely to be secluded and imprisoned.

Mahi a Atua is driven by Dr Diana Kopua, an Otago University Māori health academic and clinician who is Head of Psychiatry at the DHB, and her husband Mark Kopua, a tohunga and Tā Moko practitioner.

And in Gisborne, it's seeing change. Since Te Kūwatawata opened six months ago, the number of urgent callouts to the traditional psychiatric and assessment treatment team has halved.

And referrals to the DHB's child and adolescent mental health team, a specialist service, have dropped from an average of 70-90 a month to between five and 10. "This is because we are seeing families without the need for any wait time, and seeing them intensely and supporting them to overcome their problems without the need to refer them," Kopua says.
DECOLONISING HEALTH
After graduating from her first degree at Whitireia Polytechnic in 1993, Kopua became the first Māori mental health nurse employed in Porirua.

"I saw Māori being bought to hospital for admission in police cars, it was almost like they had lost their physical existence they were so broken," Kopua, who is Ngati Porou, says.

"I saw the system use up its Māori workers being that bridge to get them into the hospital. I was seeing, and still am, Māori being overmedicated. If one doesn't work, let's add another one, and another one. I saw complacency."

After taking a year out to learn Te Reo Māori, Kopua began developing Mahi a Atua. Working with troubled teenagers, she would re-tell them pūrākau, the stories of various atua, or gods.

Whānau were involved in these sessions, where it was discovered which atua the teen related to, and the challenges they shared. With a role model from their own genealogy to compare to, the teen could anchor themselves to a positive identity.

"You can't know your identity if you don't know your whakapapa. When we used stories, I wasn't imposing my Western beliefs," Kopua says.

"With something like ADHD, Western medicine isn't looking at historical and social determinants, poverty - when there's an obvious link between these and mental health problems. The solutions lie in looking at the history of colonisation and that impact, guided by a humanistic response in that room."

Everything Kopua has done since then - attending medical school, becoming Otago University's Associate Dean for Tairāwhiti - has been working towards establishing her narrative therapy.

Two years ago, the Ministry agreed to a trial backing of Kopua's local initiative. In August last year, she and her husband opened the Te Kūwatawata clinic.

The therapy flips the Western format on its head. Instead of a one-to-one diagnosis focusing on the diseases' cause, Kopua and her Mataora focus on helping the person and their whānau find culturally relevant meaning.

"We use Māori knowledge systems to give Māori a different lens and language to understand problems. We aim to get a lot of feedback when we're in the room, and we don't ever talk about that whānau without them present."

Te Kūwatawata doesn't look like a mental health service. It looks like an art gallery, and some of the Mataora, like Puketapu, are artists. They will pair up with a qualified clinician to work in a session with a whānau, breaking down the power dynamic of a typical client-doctor relationship.

Puketapu, at work on a Tā moko.

For many Māori, Kopua says, traditional mental health settings are intimidating. "It's almost like mental health services are way of colonising people again. You come in, you're disconnected from your land, your culture, and your language. You can't articulate values that are part of your ancestry."

Professor David Tipene-Leach, an outside clinician who helped to co-author a paper about Mahi a Atua in the New Zealand Medical Journal published on Friday, will lead a study into the outcomes of the programme.

"My underlying sense is there is a lot in here we need to take notice of. They are dealing with a group of people who have not previously been well catered for, and they are doing it better and at a lower cost."
'MY BABY WAS HURT'
Tama* was four when he told his mum, Erena, that he had been sexually abused. For several years she was bumped around mental health and rape crisis services, each one unable or unwilling to help.

"I was referred to a lot of people, but I was getting the run around. My baby came to me and told me this at 4-years-old, but I couldn't find anyone to help. I felt disheartened," Erena says.

"He wanted answers - 'Why did this happen to me, what did I do wrong?' and and I didn't have those."

Rape Crisis offered sand and art therapy sessions, but Erena felt it wasn't what the whānau needed.

"I wasn't allowed in the room with my son when he was doing his art therapy. He was getting taken away from me and I felt like I was being treated like I was the abuser."

With "Doctor Di", the whole family are involved. Her son, previously withdrawn and angry, has shown more progress in five sessions than the past five years, Erena says. Whiro, the god of anger, is his favourite.

"My son loves it. He says 'I love getting told the stories mum, I understand my feelings'.

"He can relate them back to characters, and realise he's not the only one out there who has to go through these things. He said to me: 'I like Whiro, because he's in a dark place like me'.

"It was sad for me as a mum, but it was healing for me to hear my son start letting some things go. He's bubbly, he's starting to be more outgoing, his confidence is lifting, he's more engaged with the family."

Puketapu was working as a beekeeper when he was asked by Mark Kopua to train as a Mataora. At first, he just figured it would help him get him closer to Kopua.

"Mark has been my idol since I was really young, along with a lot of young males my age. I eventually got to rub shoulders with Uncle Mark and he introduced me to a needle and applying moko on skin. That was probably the biggest thing I ever achieved for myself," Puketapu says.

"After applying my first moko he thought it would be a good idea I come to these wananga [training courses] and I was like 'Oh keen, sweet!'."

After a few, he was hooked. "I was being enlightened every week with pūrākau and these sophisticated words I've never heard about like institutionalised racism and meritocracy. I just kind of got addicted to it."

He doesn't feel like it's a job. Often, once a whānau is ready to leave the service, they will request a moko. For Puketapu, it is an honour.

"It's like this friendship you've built with them, a trust, you don't want to say goodbye but it's good because they're well.

"For me, marking them with moko is a way of healing, and acknowledging what they've been through."
*Names have been changed.
- Stuff

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In narrative therapy, Māori creation stories are being used to heal

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The boy sits there, his head down. He feels stink; he knows all the adults are there to talk about him, about what's wrong with him. He's always been told off for being so fidgety, for not paying attention. He knows it's a bad thing.

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Medicinal cannabis bill should take account of Māori traditional healing | NZ Drug Foundation - At the heart of the matter

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The regulation and production of a cannabis market could have wide-reaching economic benefits for Māori communities. We need to ensure that big business and large pharmaceutical companies do not dominate this space, as they have with the alcohol industry, increasing the challenges associated with local alcohol policies.

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Osteopathy is a type of alternative medicine that emphasizes manual readjustments, myofascial release and other physical manipulation of muscle tissue and bones. Practitioners of osteopathy are referred to as osteopaths. Its name derives from Ancient Greek "bone" ( ὀστέον) and "sensitive to" or "responding to" (-πάθεια).

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The Accident Compensation Corporation (ACC) spent $54m on alternative therapies last year despite a lack of scientific evidence the treatments work.

Alternative therapies included chiropractic, osteopathy and acupuncture, and payouts have increased by more than $36m since 2003.

Although physiotherapy cost the ACC $109m last year and remains the most popular therapy choice, acupuncture has surged in popularity since 2004. The ACC paid out $26m for acupuncture last year, an increase of $21.9m since 2004.

Society for Science Based Healthcare chairman Mark Hanna said the ACC was spending tens of millions of dollars each year on treatments that weren't supported by evidence.

READ MORE:
* Doctors at war with chiropractors over treatment of babies and children
* Walmsley trial: Alternative medicine tapping technique in the spotlight
* Ins and outs of acupuncture

"Everyone has the right to make informed choices about their own healthcare. But when it's public money that's being spent, it's important that we have a good reason to expect the treatment to help," he said.

"We're disappointed that ACC will pay for treatments that aren't supported by the available evidence."

Hanna said the ACC carried out reviews on the scientific literature on alternate therapies such as acupuncture and most of their findings were negative or inconclusive.

New Zealand Medical Association (NZMA) chairman Dr Stephen Child said there was a global increase in the use of alternative therapies. One reason for this was doctors over-diagnosed patients.

Alternative therapies are not regulated or credible because they haven't been scientifically verified.

"Worldwide, one of the fastest growing business is the alternative healthcare industry," Child said.

"Thirty years ago you were a little bit stressed, now we have a name for it. Thirty years ago your blood sugar was a little bit high, and now you're a pre-diabetic.

"EFT (emotional freedom therapy) and reiki are not regulated by the government and there is insufficient evidence available to show effectiveness of those therapies."

But Acupuncture NZ president Paddy McBride said there was growing scientific evidence acupuncture worked.

"I think it's here to stay. It's been around for a very long time and it's a very sophisticated system of health care," she said.

The NZ School of Acupuncture was currently running a masters course in the treatment and two members of Acupuncture NZ had completed their PhD studies in acupuncture.

The ACC said it contributed a set rate towards the cost of a range of different treatments and recognised clients' rights to have a choice about what treatment will best meet their rehabilitation goals.

ACC Minister Nikki Kaye said acupuncturists, chiropractors and osteopaths were all defined as treatment providers under ACC legislation.

"In deciding whether to fund a particular treatment, ACC takes into account a number of factors, including the advice and clinical experience of health professionals who have referred the client for treatment, and the client's view on what they believe is the best treatment for them," Kaye said.

"To provide some context, ACC spent around $1.5 billion on treatment costs overall last year."

Labour declined to comment on the ACC payout.
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- Stuff

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ACC paid out $163 million on alternative therapies and physiotherapy in 2015

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The Accident Compensation Corporation (ACC) spent $54m on alternative therapies last year despite a lack of scientific evidence the treatments work. Alternative therapies included chiropractic, osteopathy and acupuncture, and payouts have increased by more than $36m since 2003. Although physiotherapy cost the ACC $109m last year and remains the most popular therapy choice, acupuncture has surged in popularity since 2004.

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Good article about Type II diabetes

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bpac nz advocates for best practice in healthcare treatments and investigations across a wide range of health service delivery areas, and we are recognised nationally and internationally for our expertise and innovation.

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Best Practice Advocacy Centre New Zealand

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bpac nz advocates for best practice in healthcare treatments and investigations across a wide range of health service delivery areas, and we are recognised nationally and internationally for our expertise and innovation.

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Managing pain in osteoarthritis: focus on the person - bpacnz

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6. - Rongoā - medicinal use of plants - Te Ara Encyclopedia of New Zealand

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The approaches of modern-day tohunga have some common features. The use of wai rākau (plant-based medicines) is virtually universal, although the actual method depends on the practitioner. Spirituality is usually emphasised - or at least acknowledged. Many healers also see the Māori language as an important part of their practice.

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We must handle antibiotics with care so they remain effective for as long as possible.

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Living in time with the environment

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An ancient system that aligns daily activities with the natural world, moon, sun, stars and planets could help improve Māori health inequities. Carmen Parahi explores how maramataka is being revived across Aotearoa, and why the Ministry of Health is helping pay for it.
When Davina Thompson was a child, she grew up learning how to gather kai from the land and sea, trap eels and fish in Matatā near Whakatāne. These practices were handed down through generations and are being continued by her whānau.

Since 2013, Thompson has applied what she learned from her grandmother and father at Matatā into an ancient Polynesian system called the maramataka. It's known by other names throughout the Pacific.

Thompson orders her time according to the maramataka, its many phases and natural indicators, the moon, sun, stars and planets, traditional knowledge, her own observations and scientific data to synchronise her everyday life with nature.

She knows there will be critics of the system but said it is applied knowledge, similar to science. She poses a hypothesis and tests it.

"They think it's hocus pocus," said Thompson. "This is how we survived, adapted and became resilient as a people. We adapted to the environment."

READ MORE:
* Manutīmori and the giant bird
* Gardening in Taranaki using the maramataka
* Māori need to be consulted over climate change
* Science and mātauranga Māori of equal value

TEMPLATE FOR SURVIVAL

The maramataka is a complex system traditionally used for sourcing food and fresh water.

"It's the template for survival," said maramataka expert Rereata​ Makiha.

"If you understand the maramataka you'll understand how to move with the changes in the environment. If you understand that you can live. You can survive anywhere."

The maramataka came to Aotearoa with the first Polynesian migrants who arrived 800 to 1000 years ago. The first people would later become the indigenous Māori.

By the time of the first Europeans arrived, every tribal group had developed its own unique maramataka based on the environment they lived in. But its use diminished with the introduction of Western systems through colonisation.

Maramataka synchronised the daily activities of people with the natural world (taiao), moon, sun, stars and planets. Nature was personified into different levels of deities (atua) and they were connected to humans through genealogy (whakapapa). This kinship instilled a sense of respect or reverence for nature. It created a duty of guardianship (kaitiakitanga) so food sources were sustainably managed.

In recent times the maramataka has been called the Māori calendar. It noted generic Māori lunar names but incorrectly applied it to the Gregorian calendar, said Thompson.

It's not a calendar, she said. Maramataka uses cycles and phases instead of counting days, weeks and months. Thompson only uses the western calendar out of necessity. "It's the way it is. We've all got to pay our bills, live by the Gregorian calendar to get to work."

Particular natural indicators or signs (tohu) have to be present to determine each phase.

There are many maramataka with varying names specific to different tribal groups and the environments they live in. Its use is widespread across the Pacific.

Makiha said there are hundreds of tohu to be aware of including the different meanings of bird sounds, behaviour of insects, and weather patterns. In Hawaii, he said, when certain crabs come to the surface it's a warning of a volcanic eruption or earthquake.

Makiha cautions the use of the maramataka if people don't connect with the environment. He said it's important to retain the whakapapa links to nature through the atua.

"A lot of people are using it without tuning in properly. If you look at winds our tupuna (ancestors) had over 750 names for different winds, 200 names for different types of rain, 300 names for snow."

Traditionally, it was the experts or tōhunga who knew the many names of nature. The rest of the population knew the basic maramataka principles and common atua.

Thompson said it's not only Māori and other Pacific cultures who are learning the maramataka, others are interested too.

"They're pretty attuned to Papatuanuku. It's not exclusive," she said. "It just makes life better."

A SOLUTION FOR INEQUITY

The Ministry of Health agrees. It's backing the use of maramataka through its Healthy Families initiative to help them deal with health inequities particularly for Māori.

In a written statement, the ministry said, "We encourage its use by local providers who, in partnership with communities, are reviving this traditional practice."

Since 2014, Healthy Families has operated in 10 centres across the country at an approximate cost of $9 milliona year.

The ministry defended its funding of Healthy Families, which will continue until June 2022. It said the initiative aligns with international best practice.

Each site works with communities struggling with preventable chronic diseases and poverty by finding innovative long-term solutions to improve nutrition, increase physical activity, decrease smoking and reduce alcohol-related harm.

"The work of Healthy Families NZ is part of the growing movement to place indigenous knowledge and practices on an equal level with western epistemologies," said the ministry.

But Makiha is concerned about the maramataka going mainstream and being applied to health systems without careful consideration. "What they don't do is they don't tune into the environment and don't see how it's always shifting," he said.

Makiha believes maramataka should go through kura Māori (schools), marae and Māori communities first.

"I don't want in 100 years from now to come back and to listen to a German professor teaching our mokopuna (descendants) the maramataka," said Makiha. "It's the danger of letting it go out, their version of it.

"They're taking that knowledge base out of its comfort zone and putting it under a Pākēhā lens. Why the hell would we want to put our mātauranga (knowledge) under that lens for? Bloody crazy."

The ministry has commissioned two evaluation reports since the initiative began. The last report released in November 2018 found its strong Māori worldview encouraged greater Māori participation, legitimises community perspectives of health and found some evidence of long-term prevention.

It recommended the ministry continue the initiative by prioritising and resourcing Māori-led solutions and participation.

"This is a recommendation we fully support," said the ministry. "The approach of Healthy Families NZ recognises that innovative practice (that is embedded in cultural knowledge and concepts of well being) is required to achieve health equity, particularly for Māori."

INDIGENOUS RENAISSANCE

Healthy Families Rotorua Manager Mapihi Raharuhi said the initiative is working and worth the millions being spent on it.

"It certainly is value for money, bang for buck," said Raharuhi. "We have statistics and evidence telling us there is certainly a small shift happening."

In 2017, the organisation decided to use maramataka to help reduce risk factors like obesity, smoking and alcohol to prevent chronic illness such as diabetes and heart disease.

The team began promoting its use and encouraging people to return to a healthy lifestyle by using a maramataka developed specifically for Te Arawa tribal groups based in the Bay of Plenty.

"We've influenced over 200 people I believe in Te Arawa to apply maramataka in a series of settings not only growing kai," said Raharuhi.

The use of maramataka has grown to include schools, community groups, whānau, marae and businesses. It's use is also being promoted by other Healthy Families organisations.

In Rotorua, Te Rangihakahaka Centre for Science and Technology is using the maramataka as a planning tool for teachers and students. Te Pākārito, an early childhood centre has normalised the use of maramataka into its everyday operation and learning.

Social enterprise Kai Rotorua, a community garden was set up based on the maramataka supported by Dargaville kūmara experts.

"There's a renaissance of traditional knowledge across the world," said Raharuhi. "It can tell us so much. What I believe in is kaupapa Māori, Māori systems, Māori thinking."

"If we eat our kai as fresh as we can get it, all the nutrients, minerals, all the goodness in that kai will help our tinana (body) to be well. We can use the maramataka to guide and plan what we do."

Jade Kameta has been teaching his colleagues at Healthy Families how to apply maramataka at work and in their own lives. He said it has changed his life and helped him manage his stress levels.

In Te Arawa maramataka, the orange days are the highest energy, navy blue is high energy, green is moderate, grey is low and light blue, the lowest energy.

"Track those observations and once you've got enough data you can start testing and trialling," said Kameta.

But warns the maramataka is not something that can be learnt overnight.

"Before I learnt maramataka I thought I had a Māori worldview but until I learned maramataka I knew nothing. This knowledge has helped me with my own wellbeing and bring balance to my life."

Kameta is keeping a diary of everything that happens including historical events he has linked to a maramataka timeline. He was not surprised by the Whakaari/White Island eruption.

"It happened on a day called Atuaheihei, where our environments are battling each other. It's a day where our minds are in a battle too," he said.

Kameta said humans are the only living organism out of sync with nature, but the environment still affects us whether we realise it or not.

"Maramataka can definitely help us. It does change the way we think and challenges how we live today. It challenges the whole western paradigm of health and wellbeing," he said.

THE CHALLENGE AHEAD

Thompson, a mother of five, uses the maramataka to understand her own fertility and has helped other women too. She estimated her advice to them has resulted in three babies being born so far.

"I couldn't do any other forms of contraception I used to get horrible side effects," she said. "Rākaunui (the full moon), I knew that was my high fertility day."

She managed the conception of her last three children using the maramataka. Her youngest son, Aramakaraka Te Ora Tangaroa was conceived on Rākaunui and born during the high tide of Tangaroa-ā-mua, a waning moon, she said.

Since his birth in 2018, Thompson has kept a detailed log of her son's daily activities and environmental conditions to establish if there are any observable patterns or links.

"I was able to determine on Rākaunui he would all of a sudden get a burst of learning coordination and things like that," she said.

Thompson was diagnosed with depression about 15 years ago. Since turning to the maramataka, Thompson claims she's been able to manage her depression without prescription drugs.

"I tried to take medication once but I went all koretake (useless)," she said. "I know when I'm going into manic, in Rākaunui. I know my kai has to be more denser, ground me more."

The moon phases aren't the only factors helping Thompson manage her mental health.

The former national touch rugby representative also eats food she grows, gathers or catches with her whānau. She is very active, fit and healthy. She works with the environment and connects with it in her personal time. All aspects of using a maramataka, she said.

Medical studies have proven the benefits of an active lifestyle, eating whole foods and connecting with the environment for mental wellbeing and overall health.

Thompson monitors the many lakes in the Rotorua district for the Te Arawa Lakes Trust. Her job is to apply cultural practices around catfish monitoring and aquatic weed spraying. She is also an environment science researcher with ESR, the Crown research institute.

For her Masters thesis, she is investigating how maramataka can be used as a survival template for climate adaptation and resilience.

"There has been a conscious shift. People are seeking the traditional ways of learning," said Thompson.

"It's time, especially with our climate emergency. We've got to band together to help Papatuanuku (earth) and Ranginui (sky) otherwise we've had it."

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The ancient Maori healing system that is making waves

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An ancient system that aligns daily activities with the natural world, moon, sun, stars and planets could help improve Māori health inequities. Carmen Parahi explores how maramataka is being revived across Aotearoa, and why the Ministry of Health is helping pay for it.

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+ Full Transcript

Rosemary Pennington: When people think of what it takes to get a new drug approved, they likely think of the various trials a drug has to be run through, then the production and marketing of a drug once it's ready for release. What they might not consider fully is the scope and impact of statistics in the production and manufacturing of drugs in the pharmaceutical industry. That's the focus of this episode of Stats and Stories where we explore the statistics behind the stories and the stories behind the statistics. I'm Rosemary Pennington. Stats and Stories is a production of Miami University's Departments of Statistics and Media, Journalism and Film, and the American Statistical Association. Joining me in the studio are regular panelists John Bailer, Chair of Miami's Statistics Department and Richard Campbell former Chair of Media, Journalism and Film. Our guest today is Steven Ruberg. Ruberg was involved in the drug industry for almost 40 years working in all phases of development and marketing. At his last ten years at Eli Lilly he formed the advanced analytics hub for which he was the scientific leader, and eventually distinguished research Fellow. He now runs analytics thinking which he founded to promote good statistical principles and to help organizations come up with analytical strategies. Steve thank you so much for being here today.

Steve Ruberg: Rosemary it's a real pleasure to be here. looking forward to the conversation.

Pennington: Great so I guess my first question for you is just how you got involved in- and I guess as a statistician in manufacturing of drugs.

Ruberg: Yeah so I didn't know I wanted to do this I actually went to Miami University to get a master's degree in statistics.

Bailer: Oh yeah baby.

[Laughter]

Ruberg: No let me take that back. I actually went to Miami University to get a masters degree in mathematics, but when some astute professors noticed that I appeared to be more interested in applied mathematics they suggested taking some courses in statistics, which I loved and converted to a masters degree in statistics which I got, and I was just totally captivated by the whole field of statistics and applying quantitative thinking to real world problems and I went on to get a PhD in biostatistics. I went to work for a small pharmaceutical company in Ohio because that's the job offer I got and [Laughter] and interesting and I thought it was good, I like biology, you know I got this PhD in biostatistics from the University in Cincinnati, so I was hanging around the medical school and doing stuff related to that. So, it was kind of a natural transition, but I can tell you it didn't take too long for me to realize or to feel that I was part of a noble cause. That I was using my quantitative skills to help scientists and physicians figure out how to cure disease or how to relieve symptoms or how to improve quality of life, and that felt very good and rewarding and enriching to me, and over the course of my 38-39 years now hanging around the pharmaceutical industry I'm very proud of the contributions that I have made, and I have seen many statisticians that play a very impactful role in bringing new drugs to the market that help cure or ameliorate disease. So that's what kept me engaged and really totally motivated to press on in the field of statistics and drug development.

Bailer: So, are there particular diseases or concerns that you focused on in your early work that really led you to this thought or this realixation that you were a part of this noble cause as you describe it?

Ruberg: You know, I think I just saw the pharma company that I work for which merged with some others and kind of grew into a really big pharma company, I just saw people in all different aspects on this. I spent some early years in research, and I was so thoroughly impressed with the depth of knowledge that these people had about cellular mechanisms of the human body, and how passionate they were about trying to tear apart a cell and figure out what's going wrong in this cell, what proteins have been mis formed or aren't being produced so that this cell can operate in a reasonable way. And I saw the same things with clinicians who were trying to figure out what's the right dosage for these patients or what are the right patient characteristics for this drug that might be best for a person to take this drug etc.. So everywhere I looked I saw people passionate, committed, really smart, and had invested their entire lives and careers into this scientific enterprise, or maybe even one specific niche. The beauty for me as a statistician is data is everywhere and I got to play, as some folks have said as a statistician I got to play in a lot of people's sand boxes, and so I got to learn a lot of biology and chemistry and medicine and that satisfied my inherent need of curiosity to learn more, and I just really enjoyed learning more statistics, learning more methods, doing more research on more statistical methods or algorithms or approaches, while also learning more about these other scientific disciplines, and how I could be more part of the team that would bring a new drug to the market. So, John the beauty of- to answer your question is no I felt as a statistician I wasn't pigeonholed into one area. I've worked in allergy and oncology, diabetes, neuroscience, Alzheimer's and cardiovascular disease and on and on and on. So, it's been a really fun and exciting way to apply my inherent interests in quantitative things.

Richard Campbell: Very good. Steve this is Richard, can you talk a little bit about as a statistician when you worked for Eli Lilly, what were your biggest challenges? What does a statistician have to do to explain what it is that you do to get people to understand data and the numbers that you work with?

Ruberg: Good question. So, in some respects because regulatory agencies like the Food and Drug Administration and you can imagine there are international counterparts in Europe and Japan and China and other places in the world, because they require clinical trials that are adequately designed and sufficient sample size and analyzed appropriately etc., statisticians are viewed as a necessary and important part of clinical development. But even then, I would say one of the hardest problems, maybe the hardest problem human beings face, is inference. That is, we observe things in the natural world, and we try to infer what is the true natural phenomenon going on behind it. That is, we observe patients have certain responses to a drug and we try to infer does this drug really work or not? Or am I just seeing some random chance or spurious favorable outcomes in a few patients, or whatnot. So I think that inference is a very difficult thing conceptually, and I think that's probably the hardest thing to communicate to others who aren't trained in statistics, and I guess I'd even say it's hard for me who spent a lifelong career in statistics to try to figure out what is true based on this limited view of mother nature that I have, whether it's 100 patients in this clinical trial or one experiment done in rats in this laboratory, what general inferences can I make? And it's a very difficult problem. We all have human biases, there's random variation in nature, there's assumptions and analyses and models, and so trying to pull that all together in a way that you can help scientists understand I'm here to help, but because statisticians deal with uncertainty and variability and probability, I may not give you a yes or no answer that you're looking for, I may say something like the probability that this drug at this dose works in these patients is maybe 67%, do we want to do more research on this or do we want to call it quits? Well that involves a bunch of other business decisions etc., but that I think is the hardest thing to communicate- is this notion of inference and the inherent uncertainty that comes with it and that we deal with probabilities and not certainty. So that's where I think scientists and clinicians who appreciate statistics, to a certain level, enjoyed working with me and other statisticians because they said you guys think differently than the rest of us, and we need that different kind of thinking, but boy it's hard to think like you guys or could you just tell me yes or no? [Laughter] And it's like golly, I wish the world were as easy as black and white and yes and no, but we don't deal with zeroes and ones, we deal on the continuum of zero to one, in terms of probabilities.

Bailer: So, Steve you mentioned the idea of clinical trials, I was wondering if you could just sketch out the workflow from the discovery of a promising compound to the investigation of that compound, to finally marketing in this pharmaceutical compound?

Ruberg: I'll give you a general overview, but I hope along the way I can give you a couple specifics statistical stories that I think are very fascinating and compelling about the value of statistics in drug development. So basically, in the research arena scientists are looking for what are known as targets for disease. So, a patient has Alzheimer's disease and the scientists are trying to figure out what is it that's going on in the human brain that has gone awry so that a person has cognitive decline and functional decline? And so, they're looking at the neurons and synapses in the brain to say what's gone wrong, and if you can identify what's gone wrong, that's called a target. We say we think this is what's gone wrong in this cell that's our target, we have to repair that or change that or regulate it with something along the way. The next step is to design a molecule that interferes with that target in the way you'd like. So, let's say that target is something to do with the production of a protein and your cells aren't producing enough or too much of that protein. The scientific community says let's find a molecule or an antibody or something that will go in and stop the overproduction of that protein or will enhance the production of that protein whatever the case may be and that's called a lead compound. Generally, there are a number of lead compounds that are generated because biology is very complex and it's not always sure which one might be best. You then proceed to testing those things in animals and animal models to see if they actually do what you think they should do. And if they're tested in animals and they seem to be producing more of this protein in the rat brain or the dog brain, and you think that's relevant to humans, then you go on and do safety testing in animals, so-called toxicology work, to make sure that this thing for all intents and purposes looks like it's safe. So, years of toxicology researching to make sure that this thing doesn't do anything bad in animals, so therefore now we think it's safe to take in humans. And so the first trials in humans that are done are safety trials, very small numbers of people; 6-8 people get a single dose of the drug, and they're watched for a week or two to make sure nothing goes haywire and that the drug is safe, and you gradually increase doses in subsequent cohorts of patients, and once you determine it's safe and say gee it's safe up to 200mg a day, then you begin efficacy testing in phase two trials where you start to test on people with the disease, say Alzheimer's disease, and you might try 25-50-100-200 milligrams of the drug, and you might study it for six months or a year or some period of time. And you do all that testing to say does the drug look like it's really having an effect? And if it looks like it's having a positive effect and it looks like it's still safe, these trials tend to be hundreds of patients for longer periods of time, then you go to phase three confirmatory trials where you say alright we're going to do a very large long term trial, we've picked the dose that works, we know the kind of patients we want to enroll in our trial, and you do this very extensive, very long term international clinical trial- usually involves dozens of countries hundreds of doctors and investigators from around the world and at the end of that trial you conclude whether you've generated, in regulatory language, they say substantial evidence of efficacy and safety of this drug as it is intended to be used in the intended population for Alzheimer's disease etc.. Then you submit it to a regulatory agency or multiple regulatory agencies all over the world you submit all your data your preclinical data, tox data, clinical trial data and they review all that stuff and essentially say yes it is approved for marketing, or no it's not. If it's approved for marketing the company is in the background investing lots of money to build manufacturing facilities to produce this, so there's a lot of upfront investment, and when they get the approval they manufacture the drug and they put the sales force out to start informing doctors around the country and around the world to say here's our new drug, it's used, here's the doses, here's the patients etc.

Pennington: You're listening to Stats and Stories and today we are talking statistics and pharmaceuticals with Steven Ruberg of Analytics Thinking.

Bailer: Steve that was a great summary. That was really nicely done.

Campbell: So, it's complicated right?

Bailer: You know, the thing that is always striking to me when thinking about this is just the pyramid that you have here of starting with so many potential lead compounds, and ultimately what ends up coming to market so two questions: One is what fraction of these lead compounds get approval and make it to market? And what is the cost of bringing something from promising lead compound to market pharmaceutically.

Ruberg: Yeah so, from the lead compound area I would say the numbers I've seen are anywhere from 1 in 1,000 to 1 in 10,000 lead compounds actually make it all the way to the market as a drug. The process for discerning all that and finding that one compound and getting it to the market- average numbers anywhere from 9 years on the low side to 12 or 13 years. And the cost can be as much as two and a half to three billion dollars of investment to make that all happen. Now of course there's exceptions where the scientific world is advancing rapidly and there have been breakthrough therapies that have been accelerated for rare diseases, and gene therapies that have gotten through the process in a shorter period of time, maybe five or six years, maybe with as little as a one billion dollar investment but still the time scales and the dollar amounts are quite considerable.

Campbell: So, one of the ways the general public learns about this very complicated process is through journalism. So, and they often- you know the kind of process you described is complicated, and what journalists usually focus on is the more dramatic parts of it, and if you could talk a little but about what journalists could do better? Because I'm thinking the general public today probably thinks- when they think big pharma they think opioid crisis, and all of those stories that have come out in recent years, and you're reding the newspaper stories on your work, and the work going on, what do you think that the general public needs to know that they're not getting from journalists on a daily basis?

Ruberg: It's a very interesting question because I just heard an interview this morning listening to National Public Radio of drug pricing. It's a very big issue, and this person said it costs a trivial amount of money to manufacture such and such a pill, you know? And yet a pharmaceutical company will charge $500 for a month's supply of maybe 60 pills, where you maybe take this pill twice a day or something like that, and it literally only costs them 3 or 4 or 5 cents to take that pill, one pill. They say that's outrageous, that's crazy and the pricing markup and they're gouging the public. Well, without getting into all the details and the nuances of pricing and that stuff and the complexities, you know I think what the public needs to know you're not paying for the manufacturing of that pill, you're paying for the ten or twelve years of research that went into that pill. There's a lot of knowledge and intelligence into how that chemical is constructed in that pill, and how the safety of it was documented etc. etc. and the effectiveness, so what you're really paying for when you buy a bottle of that medication is the billions of dollars and the decade of research and all the smart intelligent people who worked very very hard to bring that deep expertise to bear in terms of a medicine that helps you with your disease. And so, I think that's one of the things that I see it played out once in a while, but it's frequently dismissed by people. Yeah yeah yeah, it's expensive to develop a drug and all that kind of stuff, but I still want it for a dollar a day to treat this very complicated disease called diabetes, or breast cancer, or whatever the case may be. So anyway I think people hear that but it's still there's still an emotional aspect- what I just gave you is a very intellectual argument, the emotional argument is man, I struggling to make ends meet with my family and now I have to pay a lot of money for my drug.

Bailer: So in one of your roles when you were working in the industry you were in charge of all things analytical at a large pharmaceutical company, and that spans the clinical trials and preclinical research that you talked about earlier, can you talk about some of the other areas where statistical insights or careful study was required for everything from manufacturing to marketing to post market surveillance all the other thigs that might have been in the scope or practice of your office?

Ruberg: Yeah John, I'm going to give you-you mentioned manufacturing, so I'm going to give you a manufacturing story here very quickly. So, some drugs are dosed based on body weight. These are injectable drugs, especially in the oncology and cancer treatment areas, and so everyone gets a different dose depending on how much you weigh, and the question is well how do you do that? Well what we do is make vials of the solution of the drug say a 10 mg vial, so here's a small vial with some fluid and it's got 10miligrams of the drug in it. So let's say a small person needs to get this drug, say they only need 4 milligrams, what happened is you extract the 4 milligrams from this vial and then since you've punctured the seal, the 6 milligrams cannot be used again because of all sorts of concerns about sterility and everything else. And so, 6 milligrams get wasted. Let's say a larger person needs 11 milligrams, what they have to do is take two vials and take 10 milligrams out of one and only one out of the next vial, and nine milligrams is unused from the second vial. Now, oncology drugs are very expensive. And in fact, the excess has to be destroyed usually by special means to inactivate them, so that's expensive. So traditionally to reduce waste, a company might create a smaller vial and say let's use a 5-milligram vial, that will help us reduce waste. But if a patient needs 6 milligrams, they get one 5 milligram vial and the other 5 milligram vial they get only one milligram and there's still 4 milligrams of waste. So, the question is what is the optimal set of vial dosage strengths that you can use to minimize waste, while also minimizing the number of dosage vials and minimizing the number of vials used for any given patient, right? You can't just say well let's make one milligram vials, and then a person who needs 13 milligrams just gets 13 vials. In a hospital, in a pharmacy, in a practical setting that will never work. Usually there is a constraint of a maximum of four vials per patient. So anyway, so suppose you have a drug that has to cover a range of 2 milligrams to 15 milligrams. That's kind of peoples normal body weights from the smallest female maybe to the largest male gets - well with a little bit of thought you can probably understand that 10 milligrams and 5 milligrams are very bad choices because that combination are multiples of each other, and in fact if you go through a formal optimization process you can find that actually a 3 milligram vial and a 4 milligram vial works best because they can cover almost any of those doses with virtually no waste whatsoever. So if you need 2 milligrams, you get a 3 milligram vial and only 1 milligram waste but a 3 milligram or 4 milligram, you can see the combinations of 3 or 4 milligrams gives you no waste, it's less than 4 vials per patient etc.. That's an example where some folks in my group came in and said hey why are we doing all these dosages in multiples of each other? And we went through a formal mathematical optimization process, the objective function to minimize waste constraints, there's also manufacturing constraints so we had to build in certain other aspects to this, but we did an optimization across all of this, and Lilly started producing vials that had these really odd dosage numbers, you know like a 7 milligram vial and a 23 milligram vial for stuff like that, and it reduced waste considerably. The bottom line as one of our manufacturing people told us that over the course of 5-10 years that this drug would be on the market the amount of waste we would minimize would probably accumulate somewhere in the vicinity of 200-300 million dollars.

All: Wow.

Ruberg: Right? So I can tell you that story caught the attention of our C.E.O. and some others in the company said we want the statisticians involved any time we're developing a new drug that is an injectable where we have these options of different vial dosage strengths, we want the statisticians involved in the conversation in helping to truly mathematical optimization that minimizes waste for all parties involved. Lower cost for us, lower cost for the patient, lower waste for the hospital, it has to be destroyed etc. everybody wins. It's a great example of not just statistical thinking but quantitative thinking.

Campbell: Steve I was interested in you know you talked about the processes as the drug is going to market and I know Lilly was one of the very few companies that was involved in non-opioid pain medication studies, and I wonder if you had any or were doing any of that at Lilly, and you know where that research stands today- the non-opioid pain medications?

Ruberg: Yes its important research are given the recent opioid crisis and yes I was still at Lilly we some of that research was going on, and to be honest I've actually done some consulting with Lilly who has a joint venture with Pfizer, but I can't give you any insights.

Campbell: I thought I'd try.

Bailer: For future episodes Steve.

Ruberg: I can only tell you what's in the public domain some trials have shown success in some pain areas. They're studying back pain knee pain lower back pain post-surgical pain some of these other areas there have been some successes and some not as much, so the jury I think is still out and people are trying to figure out what is it about these new mechanisms of these new molecules besides using opioids that could help manage pain but ill tell you if a company could unlock that key it would be an important addition to the medical arm of treating pain.

Pennington: Well Steve that's all the time we have for this episode of Stats and Stories, thank you so much for being here today.

Ruberg: Thank you for having me I've enjoyed the chat and keep up the great work with Stats and Stories, I find it interesting and invaluable.

Pennington: Thank you very much. Stats and Stories is a production of the Miami university's Departments of Statistics and Media, Journalism and Film, and the American Statistical Association. You can follow us on Twitter or Apple podcasts or other places you can find podcasts. To share your thoughts on the program send your email to statsandstories@miamioh.edu or check us out on statsandstories.net and be sure to listen for future editions of Stats and Stories where we discuss the statistics behind the stories and the stories behind the statistics.

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The Math Behind Prescription Drugs | Stats + Stories Episode 127 - Stats + Stories

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Dr. Stephen Ruberg was in the pharma industry for 38 years where he worked in all phases of drug development and commercialization - from R&D to Business Analytics.

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Ngangkari healers were considered the treasure of Aboriginal communities, and now their 60,000-year-old tradition has made its way to South Australia's Royal Adelaide Hospital and rural clinics.

Eighteen registered Ngangkari healers set up the Anangu Ngangkari Tiutaky Aboriginal Corporation (ANTAC) more than seven years ago.

Chief executive Francesca Panzironi heads a team visiting major hospitals and rural clinics in Victoria, New South Wales, South Australia and Western Australia.

"It all started with friendly chats, a cup of tea and kangaroo tails," she laughed.

More recently they have been working in regional clinics across country SA and the new Royal Adelaide Hospital.

"I think about 95 per cent of the Australian population doesn't know this knowledge system exists," Ms Panzironi said.

Getting recognition in mainstream health

ANTAC's objective is to provide a platform for Aboriginal healers to be recognised in the mainstream healthcare system as a form of complementary alternative medicine.

External Link https://twitter.com/twitter/statuses/978135650137358336

While she was a university lecturer, Ms Panzironi identified a gap in literature on Australian Aboriginal healing.

She said the most comparable form of alternative medicine to Ngangkari healing was reiki, a Japanese technique for stress reduction.

Depending on a client's problems, Ngangkari healers offer three main techniques - a smoking ceremony, bush medicines or spirit realignment.

"The healer identifies where the issues are and, through a specific method of healing, which is called panpooni, they take away whether it's pain, a blockage, or some kind of obstruction, with their hands," Ms Panzironi said.

"The most unique method of healing they use is the realignment of the human spirit.

"They see the spirit as the core component of the human body.

"If it's not in the right place it can cause problems, whether physically, emotionally, mentally. With their healing touch they push it back in the right place."

Complementary treatment for clients

The Ngangkari healers are popular with clients of all backgrounds.

Ms Panzironi said some people who used the healing technique for pain management experienced relief of their symptoms.

But for Indigenous people especially, the healers have been making a world of a difference by improving attendance rates at medical appointments.

Ms Panzironi said the treatment did not replace the role of mainstream medicine, but it could be used in conjunction with other treatments.

"I remember once the manager of the hospital said to me 'Oh my god, I have never seen so many Aboriginal people in the hospital smiling and being so happy to be here'," she said.

Riverland Community Health has been inviting the Aboriginal healers to its clinic for only a few months, and the results have been life-changing for some.

Aboriginal health consultant Kelly Matthews said before the healers' involvement, it was a struggle to get Indigenous clients to see a conventional doctor.

"It's a fear. It's how a doctor communicates. The first thing is to listen and not be judgemental," she said.

"Sitting in the sitting room they feel self-conscious. I hate it myself and my skin is pale.

"I'd rather go to the Aboriginal clinic where you sit back, can have a yarn, catch up with family and friends."

Since the healers have been involved with the clinic, appointments have been completely booked.

Respect between healer and client

Lyn Ackerman has had more than nine heart attacks, and after one occasion she contracted an infection from the surgical supplies used to unblock her arteries.

The Darumbal woman lives in Berri, miles away from her Queensland mob, and said the distance left her feeling spiritually empty.

She said the healers' power for Indigenous people lay with their ability to reconnect them to culture, the lifeblood of their spiritual being.

Ms Matthews believed traditional medicines were a pathway to improving Aboriginal health.

"They're more open. Because they are traditional they're respected. The healers also respect the clients," she said.

Making hospitals culturally acceptable

Ms Panzironi has been advocating for mainstream doctors to better understand the role Aboriginal healers can play in complementing other treatments.

It is an opinion shared by Jon Wardle, a senior lecturer in public health at the University of Technology Sydney.

He said having the Ngangkari healers in a hospital setting would educate other staff about how Aboriginal healers could make the space culturally acceptable.

"A lot of GPs don't understand traditional medicine, so automatically they have to be sceptical of something they don't understand," Dr Wardle said.

"This gives a good insight into how effective these treatments can be."

He said including healers in a hospital setting could also reduce the risks alternative medicine could have, such as physical trauma caused by under-qualified therapists, or interactions with prescriptions drugs if a patient was offered herbal medicine.

The Ngangkari healers have their own form of registration, which Dr Wardle said would reduce these potential harms.

"Really people shouldn't expect a miracle cure, they shouldn't reject other treatments," he said.

"The important thing is to have all options on the table, so if those other options are needed, they are available."

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Ngangkari healers: 60,000 years of traditional Aboriginal methods make headway in medical clinics

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Ngangkari healers were considered the treasure of Aboriginal communities, and now their 60,000-year-old tradition has made its way to South Australia's Royal Adelaide Hospital and rural clinics. Eighteen registered Ngangkari healers set up the Anangu Ngangkari Tiutaky Aboriginal Corporation (ANTAC) more than seven years ago.

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Get access to files anywhere through secure cloud storage and file backup for your photos, videos, files and more with Google Drive.