obesity and reproduction The natural medicine workforce Clinical

Transcription

JATMS
JOURNAL OF THE AUSTRALIAN TRADITIONAL-MEDICINE SOCIETY
Volume
17
Number
3
S E P T EMBER
2
0
1
1
Obesity and Reproduction
The natural medicine workforce
Clinical orthopaedic neck massage
Drug nutrient herb interactions in the older patient
The Australian Traditional-Medicine Society
Limited (ATMS) was incorporated in 1984 as a company
limited by guarantee ABN 046 002 844 2333.
ATMS has three categories of membership.
All prices include GST.
Accredited member $170.50
Associate member $66
Plus a once only joining fee of $44
Student membership is free
S TAT E R E P R E S E N TAT I V E S
NSW, Antoinette Balnave, 0418 294 055
VIC, Patricia Oakley, (03) 9974 6394
NTH QLD, Cathy Lee, (07) 4953 3491
STH QLD, June Collard, 0406 467 205
SA, Sandra Sebelis, (08) 8338 1267
WA, Paul Alexander, (08) 9444 4190 F
TAS, Bill Pearson, (03) 6272 9694
ACT, John Warouw, 0418 183 383
M E M B E R S ’ R E P R E S E N TAT I V E
Sandi Rogers
V I C E - P RE S I D E N T Bill Pearson & Maggie Sands
T RE A S URER Allan Hudson
S E C RE TA RY Matthew Boylan
P RE S I D E N T
Patrick de Permentier, (02) 9385 2465
Membership and General Enquiries
ATMS, PO Box 1027
Meadowbank NSW 2114
Tel: 1800 456 855
Fax: (02) 9809 7570
[email protected]
http://www.atms.com.au
Copyright 2005. All rights reserved. The opinions expressed in this journal are those of each author. Advertisements are solely for
general information and not necessarily endorsed by ATMS
MATTERS OF THE HEART
Clinical Measures for Managing Heart Disease
Heart Matters Phonelink Ad print ready.indd 1
130
JATMS
. Volume 17 Number 3 . September 2011
27/06/2011 2:11:13 PM
Contents
September 2011
132
134
L AW RE P OR T
161 The Fair Work Act 2009 and You
President’s Message
Sandi Rogers
Ingrid Pagura
Secretary’s Report
Matthew Boylan
P OL I C Y RE P OR T
163 Atms Official Policies
A R T I C LE S
137 Adoption of the Title ‘Natural Medicine’
by ATMS
David Stelfox
139
The Natural Medicine Workforce: Terms in
Public Use
Sandra Grace, Sandi Rogers & Stephen Eddy
143
Obesity & Reproduction
Reviewed by Penny Robertshawe
Clinical Orthopedic Neck Massage
151
Your Meditation Practice
171
172
Joe Muscolino
Sandra Sebelis
Drug Nutrient Herb Interactions in the
Older Patient
Antigone Kouris
155
Free iPhone Apps for Health Care Professionals
157
Homoeopathy for Tobacco Craving
159
RE C E N T RE S E A R C H
165 Massage Therapy
165 Nutrition
166 TCM
166 Homoeopathy
167 Naturopathy
168 Integrative Medicine
BOO K RE V I E W S
Chi Lim & Nga Cheng
147
153
Matthew Boylan
Sandra Grace
Robert Medhurst
Statin Medications Increase the Risk of
Prostatic Cancer
General Practice: The Integrative Approach
How to Increase your Fertility:
A Practical DIY Guide
173 Medicinal Plants in Australia Volume 1:
Bush Pharmacy
174 Medicinal Plants in Australia Volume 2:
Gums, Resins, Tannin and Essential Oils
175 Mastering Homeopathy 3; Obstacles to Cure:
Toxicity, Deficiency and Infection
NEWS
177 State News
179 Health Fund News
181 Health Fund Update
183 Continuing Professional Education
185 Code of Conduct
188 Simon Schot Education Grant
Stephen Eddey
JATMS
131
D r S andi R o g ers E d . D , N D
A
t the time of writing this report I do not know the
outcome of the proposal to change the structure
of the Board of Directors; however whatever the
membership decides is what the Society will work with.
Over the past two years I have had the pleasure of
working with like-minded people seeking change designed
to offer all members opportunities to be involved with a
vibrant, transparent and innovative organisation.
The organisation has had to move to a more corporate
structure as government rules and regulations demand
and the Board of Directors, in particular the Executive
Management Committee, has worked to make these
changes. The size and structure of ATMS dictates that
we focus on our corporate responsibilities, and we will
continue to do so.
One person that must be acknowledged is Matthew
Boylan, the Chief Administration Officer. Matthew has
faced the difficult task of meeting the standards set by the
previous Company Secretary with great success. He has
taken on the very difficult matters of change and every day
sees him work through difficult challenges. Many would
have found this task too burdensome, yet Matthew has
demonstrated his care for the members and his respect
for ATMS in helping to guide the organisation through
change, and has maintained a steady and caring hand
through the process.
I am very appreciative of the caring, honesty and
integrity that he has demonstrated over this period. As we
enter a new and exciting era for the ATMS, all directors
will be encouraged to work as a cohesive and respectful
group, continuing to guide the Society to a strong and
thriving future.
F U T URE D I RE C T I O N
At this point in time I am preparing for the 2011
AGM and by the time you are reading this report the
direction for our organisation will be better understood, as
you will have had the opportunity to vote on the proposed
changes.
Irrespective of the result of the vote, the future
direction for the organisation will be a focal point for the
2011 – 2012 Board of Directors. As in previous years
132
JATMS
President’s
message
we will definitely continue to communicate with our
members and seek new ways to provide you with more
benefits. We are a members’ association and will continue
to strive to ensure we do our very best for each and every
one of you.
One major area we will be continuing to work in
is regulation of the occupations in relation to natural
medicine. We will continue to keep you informed of the
issues as they arise via the website, Facebook, blogs and
Rapid News.
If you have not enrolled to be on Rapid News please
contact the office to ensure you will receive emails
about the latest information. I encourage you to
visit our social media and exchange your ideas.
RE G UL AT I O N O F T H E O C C U PAT I O N
Over the past two years I have been writing about
regulation and will continue to offer information as it
develops. It is an ongoing subject that affects each and
every one of us.
Two words that form the foundation of the debate
are regulation and occupation. Those two words alone
raise many questions and in fact several books have been
written about these subjects due to their complexity.
RE G UL AT I O N
ATMS has always been in favour of regulation for
the occupations that fall under the umbrella of natural
medicine and therapies. The ATMS position - to recognise
the need for formal regulation of the occupation of
natural medicine and therapies - is due to cynicism that
exists about certain occupations and industries that selfregulate and in which unqualified, untrained and possibly
unethical people are able to set up as practitioners with
no overseeing agency to protect the public from their
practices. As indicated in our booklet Australia Can Lead
the World in Regulation of Natural Medicine there is no
question that some form of regulation is necessary, but the
bigger question that may be posed is which, form is it to
be?
While we have enjoyed self-regulation that has served
us very well for many years we now need to have a more
formalised model where all participants are identified and
are seen to be credible and safe practitioners, providing
quality treatments and service, along with a complaints
mechanism, to the consumer.
ATMS is working with several associations to unite
the occupations and develop a co-regulation model. This
dialogue is progressing very well. Co-regulation calls for
the involvement of all stakeholders in the field of natural
medicine to work co-operatively and collaboratively to
achieve consistency in professional standards such as
education, complaints handling, codes of practice and
codes of ethics.
Initially the name of this group - one you would be
familiar with - is the Inter-Association Regulatory Forum.
The name that has now been agreed on by all participating
associations is the Natural Medicine and Therapies
Registration Board. This NM&TRB is becoming more
formalised as agreements are being reached. As each
meeting proceeds, all can see the strength in working
together for the betterment of our profession, and clearly
demonstrating the care and respect all participants have
for their occupation, their members and the public.
The next step is to form a Public Company, limited
by guarantee, as we need to formalise this group and
demonstrate to all stakeholders and government that we
are serious about our aims and objectives.
All participating associations will take an equal share
in financing this activity. All modalities that fall under the
umbrella of natural medicine are represented.
One key point that must be taken into account is that
some organisations are not participating or have removed
themselves from the group. Some naturopathic and herbal
associations will be seeking the alternative Statutory
Registration as they feel the public will be better protected
if naturopathy and herbal medicine are under this model.
ATMS strongly disagrees with this position.
This leads into to a crucial matter that must be
considered by all naturopaths and herbalists.
The umbrella term Natural Medicine and Therapies
has been agreed to by representatives of associations who
collectively represent approximately 85% of all modalities.
Naturopaths and herbalists are represented within this
group. The debate must now take into consideration
those associations who represent a relatively small number
of herbalists and naturopaths who oppose the regulation
model, opting instead for statutory registration. This
division within out professions is under close consideration
by the NM&TRB.
The recently submitted AHMAC papers are generally
not in favour of a statutory registered model, yet some
of our colleagues still push for it. The existence of this
opposing view is actually a good thing because it makes us
all investigate the best option and keep our minds open to
all possibilities. Over more than two decades ATMS has
investigated many options and it is still considered that coregulation is the one that best suits the unique needs of
our occupations.
The road ahead is long and challenging. We must
stay focused on working toward an outcome that will be
positive for all. Future generations of natural medicine
practitioners rely on us to ‘get it right’, as the decisions we
make today are our legacy to them.
JATMS
MEMBER S ’ RE Q UE S T S
Members have asked me to add a little note on casetaking and business in my reports.
Focus on note-taking
As practitioners are selected by the public as their
health care providers, I would like to remind you all
about the importance of effective note-taking during
your consultations. This aspect of your practice is most
important.
Here are a few tips.
Do you work from a template?
Having a template will remind you to ask important
questions. It will also provide evidence in the event
that you need to offer proof that you asked appropriate
questions during your consultation. All modalities need a
consistent template to work from.
Abbreviations
Do you abbreviate terms? If so, provide a legend of
those terms somewhere in the practice. In the event you
fall ill or have a locum to step in for you these abbreviations
may become important.
Can your writing be understood?
Sometimes writing can become so illegible that even
its author cannot read it after a little time has elapsed.
Check that your writing is legible. Again, you may need
these notes as evidence and if you cannot read them they
may not be of any value.
Fill out a form in the waiting room or do it in the
consultation?
My preferred option is for the client to fill out their
contact details, date of birth and medical practitioner’s
details in the waiting room and for all other health
matters to be obtained by questioning and recorded by
the practitioner. There are several reasons for this, namely:
• You do not know if clients can understand the
questions, or the meanings of some terms. An
example might be the musculo-skeletal system:
some clients may not know what this means no
matter how familiar it is to you
• Many of you would have experienced the situation
where a client has filled out a form but when further
questioned about it offers totally different answers.
Best to ask questions of the client and fill in the
information yourself
• The template should fit within the wholistic
paradigm, covering information pertaining to
the whole person rather than focussing on the
condition they present with.
BU S I N E S S T I P
Several of our members have asked for me to offer
business tips through our social media and reports. In
response to their requests, each time I write I will close
with a business tip:
Wear your business hat 24 hours a day, 365 days a
year, and never take it off.
Find happiness in every moment.
133
Secretary’s
report
M atthe w B oylan
W
elcome to the September issue of the Journal of
the Australian Traditional-Medicine Society
— JATMS. This is the third issue with the new
colour format and extended range of articles. The new
look and feel JATMS has been very well received by many
members, and big congratulations are due to the editor Dr
Sandra Grace and her team.
N E W LO G O
Speaking of things new, I have already written
to members, by email or letter, with advice about the
introduction of the new ATMS logo, and you would have
already noticed it already on the front cover! It is however
now with great excitement and anticipation we at ATMS
prepare to officially launch the new ATMS logo at the
September Annual General meeting.
The feedback from members has been very positive
about the new logo, with the vast majority of comments
received being very much in favour of the new look.
Responding to members’ feedback however, the Directors
have decided to include a variation of the new logo. This
is identical to the first, but with the words Australian
Traditional-Medicine Society added to the side. Members
may choose to use either logo. The new logos are:
Also please do not worry if you have receipts, signs,
merchandise etc with the original logo. Steps have been
taken to protect the original logo by copyright, so you may
continue to use the original logo without any concerns.
FA C EBOO K , T W I T T ER & T H E BLO G
Many members have seen ATMS social media
developing over the past 6 months, and we are thrilled at
how many of you have joined and embraced this initiative.
We see this as a great way to communicate with members
and to encourage your feedback and participation.
You can join ATMS on Facebook via www.facebook.
com/atmsnatmed and on Twitter via www.twitter.com/
atmsnatmed.
The ATMS Blog has also started with good
subscription rates and interaction on our posts. Why not
contribute an article or two for publishing on the blog?
We invite you to submit articles that you have written
about your own modalities and professions. These might
be information-based, research, case studies or general
opinion pieces. The guidelines for article contributions
are available on the Blog www.atmsblog.com.au/articlespecifications/. If you’d like to receive notification of new
articles once or twice a week, please subscribe to www.
atmsblog.com.au.
O F F I C I A L AT M S P OL I C I E S
F OR MEMBER S
Members are aware of the need to follow the ATMS
Code of Conduct. However some members may not be
aware that there is also a short list of official ATMS policies
which members must also apply. This list is published at
page 163 in this issue of the Journal.
The official ATMS policies are under regular review,
and do change from time to time. Consequently all
members are encouraged to read the list of official ATMS
policies list to ensure they are familiar with all current
official ATMS policies.
P RO F E S S I O N A L I N D EM N I T Y I N S UR A N C E
Current professional indemnity insurance is essential
for any practitioner. As well as providing a form of
protection to the public, appropriate and adequate
professional indemnity insurance offers peace of mind
to the practitioner. Even frivolous claims against a
practitioner can be emotionally draining and time-(=
134
JATMS
money) consuming. Adequate professional indemnity
insurance will assist the practitioner in managing all claims
which might unfortunately be made.
Several insurance companies offer professional
indemnity insurance for natural medicine practitioners,
and members should look around to ensure they have
the most appropriate insurance for their needs. ATMS
has however arranged an exclusive arrangement through
Marsh for ATMS members to access excellent professional
indemnity insurance at very affordable rates. To apply,
simply contact ATMS and we can send you an application
form.
Current professional indemnity insurance is one of the
requirements health funds have in order to recognise you
as a provider. Health funds also require that ATMS has a
copy of your current professional indemnity insurance on
your file. So regardless of who you are insured with, please
make sure that your professional indemnity insurance
remains current, and that you have sent a copy of your
current policy to ATMS.
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S I MO N S C H O T AWA R D S
Speaking of Marsh, it is through their generosity
that ATMS is able to offer a total of $10,000 each year
in educational grants via the Simon Schot Education
Grants. These are 10 x $1000 grants provided each
year. Winners are drawn by lot at the March meeting of
the ATMS Directors. It is free to enter, so if you will be
undertaking eligible study in 2012, why not apply? For
more information please see the advertisement at page188
of this issue.
NEW REFLEXOLOGY BOOK now available.
See www.chi-reflexology.com.au or
phone 02 4754 5500
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JATMS
135
ARTICLE
Adoption of the Title ‘Natural Medicine’ by ATMS
David Stelfox, Vice-President
I
nternationally, various terms are used to refer to and
describe the approach to health care represented
and promoted by ATMS. ‘Traditional medicine’,
‘natural therapies’, ‘alternative medicine’, ‘complementary
medicine’, and ‘integrative medicine’ are the most common.
Each carries certain connotations and preconceived
perceptions with both social and political implications.
For the purpose of promoting continued acceptance and
use of our health care approach to the general public,
to governments and other stakeholders, it is vital that
ATMS, as leaders of the profession, employs a title that
clearly reflects the philosophy and nature of what we do.
Consequently ATMS, through its Board of Directors, has
decided to adopt the titles ‘natural medicine’, and ‘natural
medicine practitioner’ when referring to the practice and
the practitioners of our unique holistic approach to health
care.
N AT UR A L T H ER A P I E S
‘Natural Therapies’ was possibly the first
contemporary term of reference for the wide and growing
field of natural health care approaches that appeared in
Western societies during the ‘New Age’ of the late 1960s
and ‘70s. These included natural traditional therapies such
as herbal medicine, massage, natural diet and nutrition,
and folkloric healing methods. However, the term also
embraced more esoteric or non-traditional approaches
to health care such as aura cleansing, chakra balancing,
electromagnetic and electro-acupuncture technology,
vibrational medicine, and polarity therapy. The inclusion
of a number of ‘marginal’ healing approaches provoked
much criticism of and scepticism about natural healing
approaches. Every year new and sometimes highly suspect
approaches to healing or health products are categorised
under the natural therapies umbrella, simply because they
are unconventional.
A LT ER N AT I V E ME D I C I N E
As a response to the broad range of natural therapies
that became popular during the ‘60s and ‘70s (a time when
many Westerners were searching for alternatives to various
aspects of life) the term ‘Alternative Medicine’ became
popular. The implication of the term is that natural
therapies are an alternative to conventional or biomedical
ones, suggesting that the health care consumer chooses
between conventional or alternative (unconventional)
health care services.
C OM P LEME N TA RY ME D I C I N E
‘Complementary Medicine’ then became a more
popularly promoted term. It was felt that natural healing
approaches should be seen to complement conventional
medicine, rather than to offer an alternative. The
downside of this term, however, is that it implies that
JATMS
conventional medicine is the authentic or primary
health care model, and that natural healing methods
may merely complement the biomedical model.
I N T E G R AT I V E ME D I C I N E
More recently ‘Integrative Medicine’ was proposed
as a suitable term to describe an approach to health care
where consumers could benefit from the best of both
approaches, biomedical and natural, to achieve their
health goals. This suggestion of a co-operative health
care model where practitioners of both philosophies and
therapies cross-refer clients when appropriate has much
merit. Unfortunately however, it may be argued that it
has given rise to a number of general practitioners of
conventional medicine, or biomedicine, including some
natural remedies or therapies in their treatment of clients
even though their formal training in natural health care,
and its philosophy and principles, is minimal or absent. In
such instances the client is not necessarily gaining the best
of both approaches and, in many cases, the natural health
care approach that the client experiences may be inferior
to what they would have experienced from a fully trained
natural health care practitioner.
T R A D I T I O N A L ME D I C I N E
‘Traditional Medicine’ is a term acknowledged
by the World Health Organisation and refers to those
approaches to treatment and diagnosis which have origins
in traditional societies or cultures and which are usually
based on unique principles of practice. Unfortunately
conventional medicine, or biomedicine, is also often
referred to as ‘traditional medicine’ and this term may
therefore be misleading to some consumers.
N AT UR A L ME D I C I N E
‘Natural Medicine’ is a term that has been around
for some time. It was coined to project natural health
care approaches as credible, authentic, and serious –
a structured, philosophy-based system of medicine
(medicus: Latin = science and art concerned with curing
and preventing disease and preserving health) that
stands on its own as an independent primary health care
approach, but that also complements and integrates with
other health care management methods and systems.
These may include chiropractic, physiotherapy, dentistry,
psychology and psychotherapy as well as biomedicine.
Joseph Pizzorno, the prominent US naturopath,
author, researcher, bureaucrat, and co-founder of the
Bastyr University of Natural Medicine has said:
One of the challenges of naming our medicine as
‘complementary’ or ‘alternative’ is that, right at
the start, it defines us by what we are not rather
than what we are. The problem is magnified by
defining us by the therapies we use rather than the
137
ARTICLE
philosophies that inform the care we provide. Not
only does this approach define us incorrectly, it
lumps in practices, practitioners and interventions
that have little or no relationship to our systems
of healing, other than being non-conventional,
and often are a public risk. In a perfect world, how
would we be named, how would we be defined?
RE F ERE N C E
I would use the term ‘natural medicine’, not because
Nature is the source of our therapies, but rather because
Nature is the source of our healing philosophies. What
makes our medicine special and appealing to the public is
our profound belief in the powerful healing ability within
each unique individual. When appropriately applied, our
therapies support and enhance each individual’s unique
ability to heal. While all have this unique healing ability,
each manifests it in utterly unique ways. This requires a
high level of personalisation of therapy to effectively
provide natural health care, another of the reasons patients
1
are attracted to us .
C O N C LU S I O N
Natural medicine then may be defined as the science
and art of treating and preventing disease and preserving
health, based on the principle that the therapies used
support and enhance each individual’s innate ability to
self-heal. It is the term for describing and representing
the philosophy and therapies that ATMS represents
and promotes, and it clearly defines the uniqueness of
the natural health care approach. Henceforth, the terms
natural medicine and natural medicine practitioner will
be used in all ATMS documentation.
1. Pizzorno J. Foreword. In: Robson T, editor.
Introduction to Complementary Medicine. Sydney: Allen
& Unwin; 2003.
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138
JATMS
ARTICLE
The Natural Medicine Workforce: Terms in Public Use
Dr Sandra Grace, Dr Sandi Rogers and Stephen Eddey
I N T RO D U C T I O N
A
lthough individual natural therapies and their
scope of practice are increasingly recognised
and understood in Australia,1, 2 the same cannot
be said for the natural medicine workforce itself which
struggles to find a single well-defined and universally
accepted identity. Historically the natural medicine
workforce has been described by various terms including
‘alternative therapists’, ‘complementary therapists’,
‘complementary and alternative therapists’ or ‘CAM
therapists/practitioners’ and more recently ‘integrative
medicine practitioners’. Lack of consistency between
the terms used by the public and those used by members
of health care professions, including natural medicine
practitioners themselves, may hinder public understanding
about natural medicine and contribute to ongoing
disunity within natural therapy professions. Such disunity
would weaken the representation of natural medicine to
government agencies and to public policy development.
As part of its mission to be a leader of natural
medicine professions ATMS commissioned its Research
Committee to develop a project to examine nomenclature
used by clients of ATMS practitioners. Although ATMS
members and their clients readily identify individual
natural medicine modalities it is unclear whether there is
unanimity in the use of umbrella terms that collectively
describe the whole natural medicine workforce. The aim
of this study was to explore nomenclature used by clients
of ATMS practitioners to describe the natural medicine
workforce.
ME T H O D
Two research activities were conducted:
Literature Review
A literature review was conducted to ascertain terms
commonly used in print and online media to describe the
natural medicine workforce. Definitions of commonly used
terms and their frequency of use in the popular press and
academic literature were sought. Searches using a keyword
followed by the term ‘practitioner’ often failed to return
results. Consequently searches included a list of terms
both with and without the term ‘practitioner’ appended
(e.g. ‘alternative medicine’ as well as ‘alternative medicine
practitioner’). The following key terms were examined:
‘complementary medicine practitioner’, ‘complementary
medicine’, ‘alternative medicine practitioner’, ‘alternative
medicine’, ‘natural medicine practitioner’, ‘natural
medicine’, ‘holistic practitioner’, ‘holistic medicine’, ‘CAM
practitioner’, ‘CAM’, ‘traditional medicine practitioner’
and ‘traditional medicine’.
Key terms were searched in:
i) Popular media
The use of the keywords in popular media in both
(1)
JATMS
online and magazine media was studied. Searches were
conducted in AdWords, Google’s main advertising
medium, a pay-for-click site-targeted program, and in
Wellbeing Magazine, Australia’s highest circulation
natural and alternative lifestyle magazine. Keywords were
entered into Wellbeing’s online article search.
ii) Scientific literature
The keywords were also searched in the online
databases Medline (via Ovid), a free database of references
and abstracts on life sciences and biomedical topics, and
AMED, a bibliographic database produced by the Health
Care Information Service of the British Library covering
a selection of journals in the three separate subject areas:
professions allied to medicine, complementary medicine
and palliative care.
(2)Survey
The Research Committee developed a short survey
consisting of three closed questions and one open question.
Participants could choose more than one response. The
survey was piloted with 35 consumers of natural medicine
and their feedback was used to modify the questionnaire.
The survey was sent to 11500 ATMS members via an
insert in the September 2010 journal. Seven thousand of
these members subscribe to Rapid News and they were
sent notifications of the survey by this medium. ATMS
members were asked to make copies of the survey and
to invite their clients to complete it. As an incentive for
members to participate, 2 years free membership was
offered to the member whose clients submitted the largest
number of completed surveys.
Data were entered into Statistical Program for Social
Sciences (SPSSv17) for analysis. Finally the results of
the literature review and the survey were collated and
compared.
RE S ULT S
Definitions
Complementary and alternative medicine (CAM)
The
World
Health
Organization
defines
complementary and alternative medicine (CAM) as
health care practices that lie outside the boundaries of
the dominant medical practices in a given society at a
given time.3 Indeed, most definitions of CAM share the
assumption that CAM health care practices are not taught
in Western medical schools4-6 and are not based on the
practices of Western medicine.7 These are definitions by
exclusion: they focus on what CAM is not, rather than
what it is. There is no consensus as to the scope and limits
of the occupations encompassed by the term ‘CAM’. The
term frequently includes all other non-Western forms of
health care, ranging from herbal medicine, acupuncture
and homoeopathy to less mainstream occupations such as
139
ARTICLE
crystal healing and aura balancing.
Other definitions describe CAM as healing practices
that are not based on biomedical science. Aspects of CAM
for which biomedical evidence has been found are often
subsumed under Western medicine,8, 9 adding another
barrier to determining the true scope of CAM.
and traditional Chinese medicine, although these are not
necessarily considered CAM in their country of origin
where they may be part of the dominant medical practice.
When traditional medicines are imported to, or originate
in, countries where Western medicine is dominant, they
are called ‘complementary’ or ‘alternative’.18
Natural medicine
Searches failed to yield results for, or found few
instances of, the association of the term ‘practitioner’ with
any of the keywords. For example, searches using the term
‘alternative medicine practitioner’ in AdWord returned
16 results, whereas ‘alternative medicine’ standing alone
returned 100.
(1) Popular media
In AdWords, ‘natural medicine practitioner’ was the
most used term, followed by ‘holistic practitioner’, then
‘alternative medicine’ and ‘alternative therapies’. Use of
any other term was negligible.
The terms ‘natural therapies’, ‘alternative therapies’
and ‘complementary medicine’ were used as generic article
categories in Wellbeing Magazine, which might indicate
that they are key nomenclature in the judgement of the
magazine’s editors. Of the remaining keywords ‘alternative
medicine’ was the most used term, followed by ‘natural
medicine’ and ‘complementary therapies’.
Frequency of use of terms
‘Natural medicine’ refers to a type of healing that
supports and enhances each individual’s unique ability
to heal. It is customised to suit individual needs and
uses predominantly natural remedies and materials.10
According to Pizzorno’s definition nature is the source
of the healing philosophy. Definitions of naturopathic
medicine appear to be closely aligned to those of natural
medicine.11, 12
Holistic
Holistic practitioners focus on the interconnectedness
of all aspects of a person and the influence of such
interconnectedness on health.13-17 Clients are physical,
emotional and spiritual beings, members of families,
communities and environments.
The harmonious
functioning of all aspects of the individual is considered
essential to maintaining health.
(2) Database searches
In Medline ‘CAM’ was by far the most used term,
followed by ‘complementary therapies’. ‘Alternative
medicine’ is the next most used term, followed by
‘traditional medicine’, ‘alternative therapies’ and
‘complementary medicine’. Use of other terms appears
Traditional medicine
In the literature ‘traditional medicine’ refers solely
to medical practices arising from ancient, indigenous
and pre-scientific-revolution forms or practice-based
healing. CAM includes traditional medicines, such as
Ayurvedic medicine, indigenous Australian medicine,
Table 1 Literature review
POPULAR PRESS
DATABASES
TERM
AdWords**
(25/06/2011)
Wellbeing
Magazine
(25/06/2011)
Complementary medicine practitioner
<10
0
3
3
Complementary medicine
54
*
1337
3426
Ovid - Medicine
(25/06/2011)
AMED via Ovid
(25?06?2011)
Complementary therapies
49
2
12215
3597
Alternative medicine practitioner
16
0
18
1
Alternative medicine
100
7
4380
1380
Alternative therapies
100
*
2397
333
Natural medicine practitioner
140
0
110
0
Natural medicine
27
2
173
75
Natural therapies
48
*
72
54
Holistic practitioner
110
0
211
3
Holistic medicine
19
1
216
55
CAM practitioner
<10
0
49
19
CAM
0
0
13870
968
Traditional medicine practitioner
46
0
6
0
18
1
3166
6507
* In Wellbeing the terms ‘natural therapies’, ‘alternative therapies’ and ‘complementary medicine’ are designated as generic categories
and many articles containing other keywords were subsumed under these three rubrics. Frequencies of the use of these terms as
specific keywords could not be extracted from the available data.
** Data in AdWords reflect the focus of advertising content at any given time. Results are accurate for 25/06/2011.
140
JATMS
ARTICLE
insignificant.
In AMED ‘traditional medicine’ is by far the most
used. However in 100% of cases where articles were read
for the significance of the terminology used the term
‘traditional medicine’ denoted indigenous medicine.
‘Complementary therapies’ and ‘complementary
medicine’ were the next most used terms. The results of
the literature review are also shown in Table 1.
Survey
A total of 1503 completed forms were returned from
clients of ATMS practitioners. Respondents were able
to choose more than one response from the list of terms,
which produced 5120 selections.
Table 2 Survey Results
NUMBER OF
RESPONSES
%
Complementary
practitioner
352
17.71
Alternative
practitioner
294
14.79
Natural medicine
practitioner
382
19.22
Holistic
practitioner
321
16.15
CAM
practitioner
48
2.41
practitioner
451
22.69
None or other
139
6.99
TOTAL
1987
100
Three practitioners filled out surveys on behalf of their
clients. These responses were not included in the results.
‘Traditional medicine practitioner’ was the most
widely accepted term among survey respondents (22.7%),
followed by ‘natural medicine practitioner’ (19.2%).
‘CAM practitioner’ is the term least used (2.4%), although
when the two terms, ‘complementary practitioner’ and ‘alternative practitioner’ were used separately each was better accepted ( 17.7% and 14.8% respectively). The results
are shown in Table 2 and Figure 1.
Complementary
practitioner
Alternative
practitioner
Natural Medicine practitioner
Holistic
practitioner
CAM
practitioner
Traditional Medicine practitioner
None or other
JATMS
There were 139 responses to ‘None or other’. They
were predominantly in favour of using the term for
the individual practitioner’s modality, such as ‘massage
therapist’ (39 responses), ‘kinesiologist’ (29 responses),
‘naturopath’ (8 responses), ‘Bowen therapist’ (5 responses)
and ‘remedial therapist’ (5 responses). ‘Natural therapist’
was the choice of 35 respondents. Other suggestions
included ‘health care practitioner’ (8 responses) and
‘natural health care practitioner’ (9 responses).
DISCUSSION
For the purpose of writing this article the authors had
to choose a consistent term for the phenomenon under
discussion. We chose ‘natural medicine’, for the reasons
given in David Stelfox’s article (see above). This term,
however, was not privileged in any information provided
to participants of the survey and its adoption in this article
is for consistency only.
Response rate for the survey was low. Anecdotal reports suggested that many practitioners did not receive
the survey. The survey was mailed with the September
2010 issue of the ATMS Journal. It appears that at least
some practitioners inadvertently discarded the survey,
which was inserted under the address label. In one instance, 15 out of 17 naturopaths who attended an ATMS
Skills Update seminar reported that they had not received
the survey.
The survey found that 22.7% of respondents reported
using the term ‘traditional medicine practitioners’ as a
title for members of the natural medicine workforce. All
practitioners who assisted in the distribution of the survey
are members of ATMS. It is possible that the appearance
of the word ‘traditional’ in the Society’s name, and on the
ATMS logo and in ATMS literature on display in clinics
contributed to this result. It is also possible that ‘traditional’ is interpreted by the public in its lay sense (e.g. as
‘existing for a long time’) rather than in terms of the World
Health Organisation definition of indigenous medicine.
Two letters were received from people who interpreted the survey as a demonstration of a name change agenda
on the part of the ATMS. Another respondent advised
that their clients thought only in terms of the practitioner’s modality (i.e. massage therapist, acupuncturist, naturopath) and did not use a collective term to describe all
natural medicine practitioners. 139 respondents thought
that none of the terms on the list was appropriate.
C O N C LU S I O N
Results of this study suggest that there is no clear
consensus about nomenclature for the natural medicine
workforce among consumers of natural medicine, academics, practitioners and other authors writing about the
natural medicine workforce. In popular online media
‘natural medicine practitioner’ and ‘alternative medicine/
therapies’ were used most frequently. Wellbeing Magazine
designated ‘natural therapies’, ‘alternative therapies’ and
‘complementary medicine’ as generic categories and used
‘alternative medicine’ most frequently in their articles.
Results of ATMS’ survey suggest that consumers of natu-
141
ARTICLE
ral medicine used the terms ‘traditional medicine practitioner’ (22.7%), ‘natural medicine practitioner’ (19.2%),
‘holistic practitioner’ (16.2%), ‘alternative practitioner’
(14.8%) and ‘complementary practitioner’ (17.7%) to describe the natural medicine workforce. ‘Traditional medicine’ is also commonly found in the scientific literature,
but is used there to refer to indigenous medicine.
In the scientific literature ‘CAM’ is the most commonly used term, but appears to have little resonance with
consumers of natural medicine. The wide use of ‘CAM’ in
the scientific literature reflects the adoption of this term
by Western medical institutions and practitioners to refer
to health professionals practising other than mainstream
Western medicine and may not be a true reflection of nomenclature used by natural medicine practitioners themselves, or by their clients. Further research is needed to
explore the professional identity of the natural medicine
workforce, authentic terms that they use to describe their
own professions, and strategies for their promotion. Consistent nomenclature is likely to be one of the strategies
for effective promotion of natural medicine to the public,
other health care practitioners and government agencies.
Further research is also needed to explore nomenclature
used by consumers of natural medicine beyond the clinics
of ATMS practitioners.
A C K N O W LE D G EME N T
The Research Committee would like to thank all
those practitioners and their clients who participated in
this study. Congratulations to Irene Horvath whose clients submitted the largest number of surveys.
9.Gruner J. The ethics of complementary
medicine. Monash Bioethics Review. 1999;19(3):13-27.
10.
Pizzorno J. Foreword. In: Robson T, editor.
Introduction to Complementary Medicine. Sydney: Allen
& Unwin; 2003.
11.
Vogel H. What is naturopathic medicine?2011: Available from: http://www.naturodoc.com/
cardinal/naturopathy/whatisNM.htm.
12.
Sarris J, Wardle J. Clinical naturopathty:
An evidence-based guide to practice. Sydney: Elsevier
Australia; 2010.
13.
Hassed C, editor. Mind, Body and Meditation. Ninth International Holistic Health Conference: Holistic Healthcare in Practice; 2004; Noosa, Queensland:
Australian Integrative Medicine Association.
14.
Pert C. Molecules of Emotion. New York:
Simon & Schuster; 1997.
15.
Julliard K, Klimenko E, Jacob MS. Definitions of health among healthcare providers. Nursing
Science Quarterly. 2006;19(3):265-71.
16.
Leeder SR, editor. Global Health and the
Future of Academic Medicine. The 2004 Robert Menzies Oration in Higher Education; 2004; University of
Melbourne: The Menzies Foundation.
17.
Park CM. Diversity, the individual, and proof
of efficacy: complementary and alternative medicine in
medical education. American Journal of Public Health.
2002;92(10):1568-72.
18. World Health Organisation. Traditional medicine. 2003 [cited 2006 11 January]; Available from:
www.who.int/mediacentre/factsheets/fs134/en/.
RE F ERE N C E S
1.
MacLennan AH, Wilson DH, Taylor AW. The
Escalating Cost and Prevalence of Alternative Medicine. Preventive Medicine. 2002;35:166-73.
2.
Phelps K. Speech to the Natural and
Complementary Healthcare Summit 2001; 2006(25
January): Available from: www.ama.com.au/web.nsf/
doc/WEEN-5GB44J.
3.
Chen K. Integration of Traditional and Modern Medicine: WHO perspective. Melbourne2002.
4.
House of Lords Select Committee on
Science and Technology. Complementary and Alterative Medicine2000; 2002: Available from: www.
publications.parliament.uk/pa/ld199900/ldselect/ldsctech/123/12302.htm.
5.
Rees L, Weil A. Integrated medicine.
British Medical Journal. [Editorial]. 2001 January 20,
2001;322(7279):119-20.
®
WORKSHOPS : October-December 2011
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02 6672 7985 • [email protected]
Perth:
Mt Martha:
Noosa:
Adelaide:
6.
Zollman C, Vickers A. ABC of complementary medicine: complementary medicine in conventional practice. British Medical Journal. 1999;319:901-4.
Melbourne:
7.Gunstone H, Matthews N, Roy E. Journey
through health & human development. VCE units 1 & 2.
2nd ed. Melbourne: Pearson Education Australia; 2004.
Canberra:
8.
Angell M, Kassirer J. Alternative medicine
- the risks of untested and unregulated remedies. New
England Journal of Medicine. 1998;339:839-41.
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142
JATMS
ARTICLE
Obesity and Reproduction
Chi Eung Danforn Lim
MBBS(UNSW), MMed, MAppSc(Acup), PhD(Bus),
RCMP(CMRBVic), MATMSConjoint Appointee, Faculty of Medicine, University of New South Wales, Kensington Australia
Nga Chong Lisa Cheng
MBBS(UNSW), PhD(Bus), AFRACMA, MRACI, MACNEM, MCMASA. Medical Officer, Sydney Children’s
Hospital, University of New South Wales, Kensington Australia
ABSTRACT
M
any women with reproductive disorders seek
professional help from complementary &
alternative medicine (CAM) practitioners.
Various contributions to the literature have suggested that
obesity has a negative impact on reproductive function.
It is vital for clinicians to understand the link between
obesity and reproduction in order to provide the best
possible care to patients. This article aims to discuss the
role of obesity in reproduction. Beyond defining obesity,
the article focuses on various adverse health outcomes,
particularly in women of reproductive age, and medical
interventions for obesity.
Obesity has become a worldwide epidemic and has
negative impacts on nearly all areas of medicine. Globally,
there are more than 1 billion overweight adults, of whom
at least 300 million are obese.1 Obesity mostly begins in
childhood and becomes more common in teenage years.2
The evidence for the adverse effects of obesity on women’s
health is overwhelming. In the US almost 62% of women
are overweight and 33% of them are obese.3 Women who
are overweight or obese experience adverse psychological
and physical health problems, particularly of reproductive
health. As well as defining obesity, this article focuses on
various adverse health outcomes, particularly in women of
reproductive age, and medical interventions for obesity.
D E F I N I T I O N O F OBE S I T Y
Obesity in its simplest terms refers to the condition
whereby one has extra fat in the body. Weight however is
not acquired from body fat alone, but also from muscles,
body water content and bones.4 According to the World
health Organisation (WHO), overweight is defined as
having a body mass index (BMI) of 25 kg/m2 or higher,
while obesity refers to a BMI of 30 kg/m2 and more.1
It is thought that failure to strike a balance between the
daily consumed calories and the amount of daily physical
activity contributes to overweight or obesity, but there
could also be a genetic predisposition to obesity.
OBE S I T Y A N D G E N ER A L
H E A LT H OU T C OME S
Obesity is associated with the emergence of a number
JATMS
of chronic diseases, including cardiovascular disease,
type 2 diabetes, hypertension, stroke, osteoarthritis, and
certain forms of cancer.1,3 These adverse health outcomes
are more common in women than in men.4 The gender
difference in obesity and related adverse health outcomes
is most likely due to reproductive hormonal fluctuations
across the female lifespan that uniquely predispose them
to excess weight gain.5 Studies have shown that weightrelated risk for all-cause mortality and coronary heart
disease mortality do not differ by race or ethnicity, but do
rise with increasing weight.6-8
OBE S I T Y A N D RE P RO D U C T I V E
H E A LT H OU T C OME S
Truncal or abdominal obesity is central to the
metabolic syndrome and is strongly related to polycystic
ovary syndrome (PCOS) in women.6,9 Underlying insulin
resistance within the body is thought to be the cause of
irregular ovulation and in the long run leads to subfertility and diabetes mellitus, as well as high prevalence
of miscarriage.9-12
For women in pregnancy, obesity increases the rate
of pregnancy complications, such as gestational diabetes
and hypertensive disorders in pregnancy, delivery
complications such as higher rates of caesarean sections
and prolonged time of delivery, as well as adverse foetal
outcomes such as macrosomia, neural tube defects, and
perinatal mortality.10, 13-17 This has resulted in an increase
in socioeconomic burden: for example, the average cost of
hospital prenatal and postnatal care is higher for overweight
mothers, and the infants of overweight mothers more
often require admission to neonatal intensive care units.18
Moreover, maternal obesity may influence the prevalence
of obesity and chronic diseases in future generations.8, 19-20
OBE S I T Y T RE AT ME N T
Weight loss has been demonstrated to improve
menstruation, ovulation, semen parameters, and
reproductive outcomes.21 A slight loss of 5-10% of total
body weight can create up to 30% decrease in visceral
adiposity, leading to normal ovulation and increased
insulin sensitivity.22 The WHO has recommended
a range of long-term strategies for effective weight
management for individuals at risk of developing
obesity, including prevention, weight maintenance,
143
ARTICLE
co-morbidities management, and weight loss.1 The
definition of a diagnosis and the beginning of a weight
reduction programme combined with intense motivating
treatment as well as medical and psychotherapeutic
guidance is thought to be an important preventive
contribution.23
Nutritional challenges are most particularly relevant
to women. Many women today go on unhealthy dieting
routines in order to lose weight. As chronic dieting is not
free of risks women should be encouraged to shift the
focus from weight loss to stabilization and from dieting
to normalizing eating patterns and intake.24 Health care
providers should encourage a high-fibre and low-fat diet
and adequate physical activity.3
Lifestyle modification has not only been found to
improve endocrine profile and cyclicity, particularly of
women with PCOS, but also their pregnancy outcomes.25
A better reproductive or fertility outcome can also be
achieved by combination of lifestyle modification and
ovulation induction, such as administrating clomiphene
citrate.
If lifestyle modification alone fails to result in weight
loss, there is a range of pharmacological therapies available
to aid its success, for instance, Sibutramine (a centrallyacting serotonin-norepinephrine reuptake inhibitor),
Orlistat (an anti-absorptive), and Phentermine (an
appetite suppressant). Moreover, Metformin, when used
together with lifestyle modification, can also induce
weight loss and lower visceral adiposity.26 The use of herbal
supplements have also been reported being used although
it is not well documented.27
A surgical option for those with morbid obesity is
bariatric surgery, which enables weight loss, improves
menstrual pattern and reduces obesity-related medical
complications such as diabetes, dyslipidaemia,
hypertension, and sleep apnoea.28 Compared to obese
women who have not undergone bariatric surgery, obese
women who have are also at a lower risk of complications
during pregnancy.29 Nevertheless, pregnancy is not
recommended until after the first year of surgery because
this is the period in which weight loss occurs. This surgery
may also predispose to anaemia, leading to the death of
both the mother and baby.
OBE S I T Y A N D T RE AT ME N T I N
P RE G N A N T W OME N
Pregnancy is thought to be a key time to target a
weight control strategy to curb the obesity epidemic, as
women tend to be more motivated to adopt a healthy
lifestyle for optimum health of their offspring.20 Prior to
conceiving, women should be advised to lose weight, as
high pre-pregnancy BMI poses a higher risk of foetal birth
defects such as anencephaly and spina bifida.12,30 Weight
gains of no more than 6.7-11.2 kg in overweight or obese
women and less than 6.7 kg in morbidly obese women
are associated with a reduced risk of adverse pregnancy
outcome.31
Nevertheless, pregnancy itself seems to play a
significant role in the development of obesity in many
144
JATMS
women. Excess weight retention following pregnancy
is thought to be associated with various factors, such as
weight gain during pregnancy, ethnicity, diet, and interval
between pregnancies. Hence, it is essential to tailor energy
intake recommendations to each individual pregnant
woman.5
In brief, preconception counselling, pre-gravid weightloss programmes, close monitoring of gestational weight
gain, repeated screening for pregnancy complications
and long-term follow-up can minimize the social and
economic consequences of pregnancy in overweight
women.16
C O N C LU S I O N
Obesity has been found to have a significant impact
on women’s general and reproductive health. Treatment
options for weight management include dietary
intervention, physical activity, behaviour modification,
pharmacotherapy and surgery. However, the complexity
of this chronic condition necessitates a coordinated
multidisciplinary team approach to care for obese patients
who fail to control their weight. The long-term duration of
the treatment and the necessity of monitoring compliance
and effectiveness should be considered.
RE F ERE N C E S
1.World Health Organization Fact sheet:
Obesity and Overweight. Retrieved on 12th November,
2010, from http://www.who.int/dietphysicalactivity/
publications/facts/obesity/en/
2.
Kanagalingam, M.G., Forouhi, N.G., Greer,
I.A., Satter, N. Changes in booking body mass index
over a decade: retrospective analysis from a Glasgow
Maternity Hospital. BJOG, 2005;112: 1431-1433.
3.
Morin, K.H., Stark, M.A., Searing, K.
Obesity and nutrition in women throughout adulthood. J
Obst Gyne Neonatal Nurs, 2004;33 (6): 823-832.
4.
Nelson, S.M., Fleming, R.F. The
preconceptual contraception paradigm; obesity and
infertility. Hum Reprod, 2007;22: 912-915.
5.
Love, J.C. The influence of sex hormones
on obesity across the female life span. J Womens
Health, 1998;7 (10): 1247-1256.
6.
Hu, F.B. Overweight and obesity in women:
health risks and consequences. J Womens Health
(Larchmt), 2003;12(2), 163-172.
7.
McTigue, K., Larson, J.C., Valoski, A.,
Burke, G., Kotchen, J., Lewis, C.E., Stefanick, M.L.,
Van Horn, L., Kuller, L.Mortality and cardiac and
vascular outcomes in extremely obese women. JAMA,
2006;296(1): 79-86.
8.
Ryan, D. Obesity in women: a life cycle
of medical risk. Int J Obs (Lond), Suppl 2007;2:S3-7,
discussion S31-2.
9.
Rachon, D., Teede, H. Ovarian function
and obesity--interrelationship, impact on women’s
reproductive lifespan and treatment options. Mol Cell
Endocrinol, 2010; 316 (2): 172-179.
10.
Linne, Y. Effects of obesity on women’s
reproduction and complications during pregnancy.
Obes Rev, 2004;5 (3): 137-143.
ARTICLE
11.
Smith, G.C. First trimester origins of foetal
growth impairment. Semin Perinatol, 2004; 28: 41-50.
12.Waller, D.K., Shaw, G.M., Rasmussen,
S.A., Hobbs, C.A., Canfield, M.A., Siega-Riz, A.,
Gallaway, M.S., Correa, A. Pre-pregnancy obesity as
a rick factor for structural birth defects. Archives of
Paediatrics & Adolescent Medicine, 2007;161(8): 74550.
13.
Smith, G.C., Smith, M.F., McNay, M.B.,
Fleming, J.E. First trimester growth and the risk of low
birth weight. NEJM, 1998; 339: 1817-1822.
14.
Siega-Riz, A.M., Laraia, B. The implications
of maternal overweight and obesity on the course of
pregnancy and birth outcomes. Matern Child Health J.,
2006; 10 (5 Suppl): S153-6.
15.
Bringer, J., Galtier, F., Raingeard, I.,
Boulot, P., Renard, E. Pregnancy and overweight:
underestimated consequences? Bull Acad Nat Med,
2008;192 (4): 673-687.
16.Galtier-Dereure, F. Choice of stimulation in
polycyclic ovarian syndrome: the influence of obesity.
Hum Reprod, 1997;12: 88-96.
17.
Yogey, Y., Catalano, P.M. Pregnancy and
obesity. Obstet Gynaecol Clin North Am, 2009; 36 (2):
285-300.
18.Galtier-Dereure, R., Boegner, C., Bringer, J.
Obesity and pregnancy: complications and cost. Am J
Clin Nutr, 2000;71 (5 Suppl): 1242S- 248S.
19.
Catalano, P.M., Ehrenberg, H.M. The shortand long-term implications of maternal obesity on the
mother and her offspring. BJOG, 2006;113 (10): 11261133.
20.
Birdsall, K.M., Vyas, S., Khazaezadeh,
N., Oteng-Ntim, E. Maternal obesity: a review of
interventions. Int J Clin Pract, 2009; 63 (3): 494-507.
21.
Loret, D., Mola, J.R. Obesity and its
relationship to infertility in men and women. Obstet
Gynaecol Clin North Am, 2009;36 (2): 333-346.
22.
Jensen, M.D. Medical management of
obesity. Semin Gastrointest Dis., 1998;9: 156-162.
23.
Wolf, A.S., Sterzik, K. Obesity--significance
in adolescence and for reproduction. Zentralbl Gynakol,
1998;120 (5): 210-222.
24.
Ciliska, D. Women and obesity. Learning to
live with it. Can Fam Physician, 1993;39: 145-152.
25.
Haslam, D., Sattar, N., Lean, M. Obesity
time to wake up. BMJ, 2006;333: 640-642.
26.
Alberti, K.G. The metabolic syndrome: a
new world wide definition. Lancet, 2005; 366: 10591062.
27.
Pasquali, R., Gambineri, A. The impact
of obesity on reproduction in women with polycyclic
ovarian syndrome. Intl J 2002;26: 883-896.
28.
Sattan, N. Pregnancy complications
and material cardiovascular risk: opportunities for
intervention and screening. BJOG Intl J Obstetric
Gynecologic, 2006;113: 1148-1159.
29.Galtier, F., Raingeard, I., Renard, E., Boilot,
P., Bringer, J. Optimizing the outcome of pregnancy
in obese women: from pregestational to long-term
management. Diabetes Metab, 2008;34 (1): 19-25.
30.Willis, L.H., Slentz, C.A., Houmard, J.A.,
Johnson, J.L., Duscha, B.D., Aiken, L.B., Kraus,
W.E. Minimal versus umbilical waist circumference
measures as indicators of cardiovascular disease risk.
Obesity, 2007; 15: 753-759.
31.
Crane, J.M., White, J., Murphy, P., Burrage,
L., Hutchens, D. (2009). The effect of gestational
weight gain by body mass index on maternal and
neonatal outcomes. J Obstet Gynaecol Can, 31 (1),
28-35.
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ARTICLE
Clinical Orthopedic Neck Massage
Joe Muscolino, DC
Joe Muscolino is a Doctor of Chiropractic. He has been an instructor in the world of massage therapy for over 25
years. He runs CPE classes in clinical orthopedic massage therapy techniques and will be in Australia in March
2012. For more information, visit his website: www.learnmuscles.com; or contact him at [email protected].
T
he human neck is a marvel of biomechanical
engineering. Through a precise functional
interplay of cervical vertebrae and their associated
soft tissues, the neck functions to orient the head in
whatever positions are needed to interface with the
world. However, the postures we assume in our lives
often place great stress on the musculature of the neck,
especially the posterior extensor musculature. Therefore,
clinically oriented orthopedic massage is often indicated
and necessary. One aspect of clinical orthopedic massage
therapy is deep tissue work.
Although deep pressure is not always indicated as the
optimal treatment technique or even desired by the client,
when it is the appropriate treatment choice it is critically
important that it is performed safely for the client and
with the least effort by the therapist. This article explores
techniques to work the neck with deep pressure when the
client is in the prone, supine, and side-lying positions.
It also explores the underlying body mechanics that are
needed to efficiently perform these techniques.
F U N D A ME N TA L BO D Y ME C H A N I C S
Before presenting specific techniques for each position,
let’s discuss a few fundamentals of body mechanics for
creating and delivering pressure. These fundamentals are
using body weight and working from the core, keeping
joints stacked, and directing pressure perpendicular to the
contour being worked.
B O D Y W E I G H T A N D W OR K I N G
F ROM T H E C ORE
Pressure generated into the client can come from
two sources: body weight and muscle contraction. Of
these two, body weight is free in that it takes no physical
energy expenditure on the part of the therapist, therefore
it should be utilized whenever possible. But using body
weight does require that the table is low enough so that
the therapist’s core can be positioned over the area of
the client’s body that is being worked. The proper table
height for this varies depending on the size of the client,
the positioning of the client, the part of the client’s body
that is being worked, and the part of the therapist’s body
that is being using to contact the client. As a general rule,
if the therapist is contacting the client with the pads of
the thumbs or other fingers, or even the palms, the top of
the table should be no higher than the therapist’s patella.
However, if the therapist is using the elbow or forearm
as the contact, the table can be higher and should be
positioned so that the top of the table is approximately at
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the mid-thigh of the therapist.
When body weight cannot be used, or it needs to
be supplemented, the therapist needs to generate force
with muscular contraction. To minimize effort, fatigue
and injury on the part of the therapist, it is always best to
generate this force using the largest muscles possible. This
usually means generating force from the core musculature
of the body and/or generating force from large musculature
of the lower extremities that is then transferred through
the core of the body. In either case, it is essential that the
therapist work from the core.
Given that the therapist ultimately uses some part of
the upper extremities to contact the client, it means that
the therapist needs to orient their upper extremities close
to and in front of their core. In effect, the therapist needs
to work from inside out. This is accomplished by keeping
the elbows in toward the midline as much as possible. A
good way to visualize this is to think of placing the elbows
inside of the anterior superior iliac spines (ASISs). For
therapists with a lot of soft tissue in front (large-breasted
therapists or therapists with large abdomens), it may not
be possible to perfectly attain this posture, but the closer
the elbows can be brought in, the better.
Electric Lift Tables
The optimal height of the table can vary during
the same session for many reasons. Therefore, having
a table whose height is easily adjustable is critically
important. Although at first many therapists view an
electric lift table as extravagant, it is likely one of the
best investments that a therapist can make, both in their
business from increased revenue from satisfied clients,
and in the longevity of their career by remaining injuryfree.
Stacked Joints
Another fundamental of body mechanics is that
forces should be directed in a straight line. This means
that joints should be stacked, in other words extended as
much as possible. This is important to generate maximum
pressure into the client. For example, when working
with flexed elbow joints, leaning in often results in loss
of force because we further flex, in other words collapse
at the elbow joints instead of pressing into the client.
Working with stacked joints is also important to prevent
injury to the joints through which the force is being
transmitted. Transmitting force through a bent joint
places a tremendous torque force into it. This is especially
prevalent for wrists and thumbs, and often the cause of
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ARTICLE
injuries that drive massage therapists out of business.
Working Perpendicular to the Contour of the
Client’s Body
Maximal pressure for the effort expended occurs
when pressure is exerted perpendicular to the contour of
the body part being worked. Given the curvature of the
neck it is important to pay attention to this and adjust
from the lower to the upper cervical region.
Caution: Avoid the transverse processes!
The techniques shown here involve deep tissue
massage to the posterior laminar groove musculature.
When working this musculature, it is extremely
important not to veer too far anteriorly and press too
deeply over the transverse processes. They are sharp
and pointy. Deep pressure here is not only unnecessary,
it would also be very uncomfortable for the client.
W OR K I N G T H E N E C K
Although massage is beneficial to all muscles, certain
musculature, given its layers and depth, require more
attention and deeper work. In the neck, this is true of the
laminar groove musculature located over the vertebral
laminae between the spinous processes and articular
processes (facets). This is where much of the muscular
tightness that clients experience in their neck occurs.
P RO N E P O S I T I O N
Because the client’s scapular and upper back regions
are worked with the client prone, it seems a natural
extension to continue working into the neck with the
client positioned this way. One advantage to neck work
in the prone position is that it allows the therapist to use
body weight to create pressure. The downside to prone
neck work is that if the therapist is not careful with the
angle that the force is directed, the client’s face can be
uncomfortably pushed down into the face cradle. For this
reason, the key to prone neck work is adjusting the angle of
pressure from the lower neck to the suboccipital region. In
the lower neck, pressure can be directed anteriorly, down
toward the floor. However, as the stroke progresses up the
neck, it is important to gradually transition the direction
of the stroke to be more cephalad (superior). By the time
we reach the suboccipital region we should be pressing
nearly directly cephalad (Figure 1). In effect, the stroke
is a scooping motion that matches the lordotic curve of
the neck. Whenever possible, it is important to work with
the hands in concert. In this case the thumb of the contact
hand is braced (double supported) by the other thumb.
If the base of the neck (top of the trunk) is worked,
then the therapist should instead stand toward the head
of the table so that the base of the neck can be approached
at a perpendicular angle. Strokes should be short, ranging
from 2.5 to 10 centimetres in length.
Another stroke that can be performed in the prone
position is cross-fibre stripping to the laminar groove
musculature. This is accomplished by standing to the side
of the client, curling the finger pads of the index, middle,
ring, and little fingers to hook around the laminar groove
musculature on the other side of the body (be sure to not
reach too far onto the transverse processes). Force into
the musculature is then exerted by simply using core body
weight to lean back and away from the client (Figure 2).
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SUPINE POSITION
Massaging the neck with the client supine is usually
done with the therapist seated. Because maximal pressure
is exerted by pressing perpendicular to the contour of
the area being treated, it is important when working
the neck for the therapist to change the location of the
seated position. When working the base of the neck the
therapist is seated at the head of the table, toward the
centre. However, as the work is done progressively higher
up the neck, the therapist needs to move the stool around
the side of the table. By the time the therapist reaches the
suboccipital region, they will be seated 90 degrees or more
around the side of the table (Figure 3). Because the optimal
position from which to work changes, strokes should be
short, ranging from approximately 3-6 centimetres. Work
further up the neck is performed from the next seated
position.
Because force is transmitted horizontally into the
client, the supine position does not allow for body weight
to be used as the prone position does. However it is still
possible to use large musculature and work from the core.
To do this the therapist needs to bring the elbow in and
tucked as close as possible inside the ASIS. By doing this,
when the therapist rocks forward with the pelvis, the force
of the core moving forward transfers directly through the
elbow, forearm and hand, and into the client (Figure 4).
The most common error made is that instead of keeping
the spine vertical as the pelvis rocks forward, the therapist
collapses downward toward the client; this causes the
elbow joint to further bend. To make sure that the core
force is correctly and fully transferred into the client, make
sure that the angle of the elbow joint does not change. For
each degree that the elbow joint bends, a corresponding
amount of core force is lost.
An advantage to the supine position is that the
therapist’s other hand can be effectively used to supplement
the work, both by increasing the depth of work or by
positioning the client’s neck to be worked on stretch.
To increase pressure the therapist gently, but firmly
and securely, supports and cradles the client’s head in their
other hand, making sure to not cup over the client’s ear
and not to press on the client’s temporomandibular joint.
The therapist can now increase the pressure by not just
pushing in with the treatment hand’s thumb pad contact,
but by also pulling the client’s head and neck into the
thumb pad contact (Figure 5). In fact, pulling the neck
into the treatment hand contact is often biomechanically
easier than pushing in with the treatment hand contact.
ARTICLE
To work the neck on stretch in the supine position,
the therapist can reposition the other hand to be on the
side of the client’s head, pushing it into opposite side
lateral flexion as the treatment stroke is performed.
Figure 1 When working the upper neck/suboccipital region
with the client prone, the force should be applied in a cephalad/
superior direction.
Caution: Keep the thumb stacked and close to the
palm!
In the supine position, the easiest contact to use
is the thumb pad. However, it is extremely difficult in
this position to brace the thumb with the thumb (or
any other part) of the other hand. Therefore, to avoid
injury to the thumb, it is critically important to keep it
stacked and in line with the forearm and hand, and as
close to the palm as possible.
S I D E LY I N G P O S I T I O N
Side-lying position to work the neck is probably the
least utilized position, but it can offer many advantages for
deep work. As with prone work, the therapist can stand
and use body weight, and if the thumb pad or finger pads
are used as the contact, they can be braced (Figure 6).
Further, depending on the relative sizes of the client and
therapist, it is also possible to use the elbow in this position.
To optimally expose the laminar groove musculature
superiorly toward the therapist, the client should actually
be positioned not perfectly side-lying, but slightly rotated
down toward the table. This is accomplished by rolling
the client slightly onto their anterior shoulder as seen in
Figure 6.
Another advantage of the side-lying position is that
gravity can be used to facilitate working the laminar
groove musculature on stretch. Position the client with
the head off the end of the table. Be sure that the client’s
head is far enough off the table that when she is laterally
flexed toward the floor, her head will not hit the table
(this is especially important if the end of the table has any
hard surfaces or clasps of any sort). The therapist can now
use his body weight to slowly and carefully lean down
into the client’s musculature. Finger pads, thumb pads, or
even the elbow can be used (Figure 7). As with all neck
work, be sure to stay off the transverse processes. Because
of the position of the client’s head in this technique, it is
generally contraindicated for elderly clients and should
also be avoided for anyone who would become dizzy with
the head down or anyone who is predisposed to stroke
or glaucoma. However, when performed appropriately,
this side-lying work performed on stretch is an excellent
technique, and one that is often loved by clients!
Deep work into the neck is a valuable tool to have in
your toolbox of techniques, and when it is applied safely
and appropriately, it can be extremely effective. Being able
to do this work with good fundamental body mechanics
will also increase the efficiency of your work and the
longevity of your career. And being able to perform this
work with the client in any position will also increase the
versatility of your work. With practice, these techniques
can be great additions to your clinical orthopedic practice.
JATMS
Figure 2 Cross-fibre stripping is performed by curling the finger
pads around the opposite side laminar groove musculature and
then leaning back with core body weight.
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ARTICLE
Figure 3 When doing supine neck work, the therapist needs
to adjust where the seated position is to work perpendicular to
the contour of the area being treated. Here, the therapist sits
at the side of the table to work the upper neck / suboccipital
region.
Figure 5 The therapist’s other hand can be used to increase the
pressure by pulling the client’s neck into the treatment hand
contact.
Figure 4 To transfer force from the core into the forearm and
client, the therapist rocks the pelvis forward while keeping the
spine vertical. Note: The elbow should not bend any further
when rocking into the client.
Figure 7 Side-lying technique can also be done on stretch with
the client laterally flexed away. Here, the elbow is used as the
contact. (Note: This is an advanced technique and should be
performed with caution.)
Figure 6 Side-lying work into laminar groove musculature.
Double supported thumb pads are being used as the contact.
Reprinted with permission from Muscolino J. Advanced Treatment Techniques for the Manual Therapist: Neck. Baltimore, MD: Lippincott
Williams & Wilkins. In press. Photography: Yanik Chauvin.
150
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ARTICLE
Your Meditation Practice
Sandra Sebelis
A
t some moment in our lives we have all experienced
a period of intense peace and joy – it may have
been in listening to a piece of music; watching a
sunset, a rainbow, or snow falling in the forest; or it may
have been after a delicious meal. These too rare moments
will have seemed timeless and so, to recapture the sources
of peace, happiness, or creativity, we meditate, for through
meditation we come in contact with our True Selves, our
Inner Being or Source. It is said that in meditation, we “go
home”.
Meditation is simply “being in the here and now”,
totally absorbed in the moment, practising what is
known as “awareness” or “mindfulness”. It involves the
establishment of a “watcher” or “witness” through whom
we observe our own internal thoughts and processes.
Meditation brings about inner peace and calmness,
which is important, for if we as individuals do not ourselves
know peace, how can we help others? How can we create
world peace? Inner peace comes from the practice of
self-awareness, concentration, relaxation, perseverance,
patience and meditation.
Through meditation comes “insight” or “wisdom”.
When we meditate, it is as if we were looking into a mirror.
We see our thoughts, feelings, our emotions, and gain
inner strength, security, fearlessness and peace. When the
mind is calm and still, the body is also relaxed. When the
mind is happy, the body is healthy, for body and mind are
dependent, serving each other. Regular meditation will
increase energy and efficiency, and resistance to disease;
reduce high blood pressure; normalise weight; reduce
nervousness, anxiety, depression, neuroticism, feelings of
inadequacy, and irritability. It will improve self-esteem,
creativity and productivity; enhance the ability to love
and to express love; and strengthen religious affiliations.
Yet there are also occasions when meditation may be
inappropriate, upsetting or even medically ill-advised.
Not everyone experiences a quietening of the mind: some
people report experiencing anger, panic and anxiety,
tension, a worsening of depression or other emotional
problems, or the surfacing of pain and emotions that
have been blocked prior to meditation. Difficulties
encountered appear to merge when meditators come in
touch with their “dark” or “shadow” self. While such selfexploration may be painful at the time, it may also lead
to new personal growth, heightened awareness, deeper
compassion and sensitivity to suffering in general. I would
suggest that in such events advice and support be sought
from a teacher or therapist.
The most common barrier to meditative practice
is trying, which always increases internal dialogue and
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muscular tensions, and then assessing, asking oneself such
questions as “What is meditation?” “Where will it lead
me?” “How will I know if I am doing it correctly?” All that
is necessary is to relax – to let go, and to let meditation just
happen, for it is a simple, natural function, not so much
an activity but a state of being. Remember there are no
rules, no levels, no right or wrong. Ultimately, you will be
able to bring the meditative state into your daily activities
and the periods of “simply sitting” evolve so that whatever
you are engaged in becomes a meditation – walking in the
park, gardening, washing dishes, ironing, chopping wood,
etc. This is to say that your mind has become one-pointed,
totally absorbed, in whatever you are engaged in, that your
concentration is total.
Remember: “we are much more than our mind.” Your
mind will try to wander and distract you as you meditate.
It is not necessary to fight or analyse what is happening,
just be aware and return gently to the object or idea that
you were focusing on or, the empty space. Let thoughts
come and go, simply witness them. You may get “pins and
needles” in your legs – if this happens, simply move your
leg, massage it gently and change your sitting position. If
you feel the need to scratch you may do so but generally
this only serves to increase the irritation. Instead, take your
mind to the spot and repeat to yourself, “itching, itching”,
and the itch will generally disappear. You may find your
body begins to rock or to sway – this is caused by your
energies moving or the fact that you are becoming one
with the energies around you. This is fine, let it happen.
You may see white or a blue light depending on the
intensity of your meditation; rather than attempt to “hold
onto this light” – simply enjoy it while it is there. Unless
you are meditating in the Himalayas or in the centre of
a desert, there will be sounds going on around you that
will appear to be intensified when you meditate. Be aware
of these sounds, acknowledge them and let them go, and
you will find in doing this that you become oblivious to
them. Experience meditating with family or with a group;
you will find this very different. Practice meditation with
faith and sincerity and you will achieve all things; and
remember, meditation is a very personal experience, it is
your experience.
So, to summarize, the seven attitudinal factors of
mediation practice are
• non-judgment, assuming the stance of an impartial
witness;
• letting go/non-attachment to experiences;
• acceptance, seeing things as they are in the present
(which does not mean taking a passive attitude to
everything and abandoning your own principles);
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• no striving;
• trust, both yourself and your feelings;
• having a “beginners mind”, seeing everything as if for
the first time;
• patience, being open to each moment, accepting it in
its fullness, knowing all will unfold in time.
There are many techniques or “vehicles” to help
you concentrate and to lead you into the actual state of
mediation, when you let go of all thoughts and images and
just sit, observing and enjoying the inner peace and quiet.
You may be familiar with some of these techniques under
a different name: the name is unimportant. Probably the
best known-practice, which is followed by schools such as
Transcendental Meditation and Siddha Yoga, is the use of
a mantra. A mantra is a sacred word or phrase, repeated
over and over, that may be practised silently or out loud
(when it is known as chanting). Mantra meditation
is often used in conjunction with counting a string of
beads such as a Mala or rosary, or the fringes of a prayer
shawl. Inspirational passages similar to the mantras are
learned by heart and repeated over and over. They are
drawn from varied sources such as psalms, outstanding
poems or inspirational speeches e.g. The Lord’s Prayer,
the prayer of St. Francis of Assissi, or Kahlil Gibran’s verse
on “Marriage” from “The Prophet”. Tratka meditation
involves gazing at an object – a flower, a crystal, a symbol
or candle flame, keeping the gaze fixed and steady until
the eyes water, then closing them, imprinting the image
on your mind until it fades, then reopening the eyes
and again gazing. A mandala is a Tibetan form of art, a
symmetrical design with all points emanating from the
centre. A yantra is formed from geometrical forms and
often used in association with the Chakras or energy
centres of the body. Both these techniques help the visual
mind to focus and become still and may be used as in
Tratka meditation. Designing, drawing and colouring
in a mandala is a meditative practice in itself. Sound is a
valuable meditative tool, the vibrations having a beneficial
healing and calming effect on the body. These can be
gongs, bells, an Indian raga, a relaxation tape or simply
sitting by a gurgling stream. Movement can also lead you
into a deep, meditative state – shaking the body, Sufi-style
dancing or simply walking, aware only of placing your
feet and of your breath. An excellent group meditative
practice is to follow literally in the footsteps of a leader.
With visualisations or Guided Imagery, one is taken on a
beautiful journey that often affects the subconscious with
a positive lesson or learning experience. A Reflective,
Constructive or Analytic meditation involves reflecting
upon or analysing a word, phrase, concept, quotation
or passage from a well-known work. This enables the
meditator to relate strongly to their own belief system or
experiences. The person themselves or a section from their
own life is very often the subject reflected upon. Working
with awareness on the breath is one of the simplest and
most powerful techniques that will lead you directly into
meditation.
For your actual meditation practice, choose a time
and place where you will be undisturbed. Ensure you have
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not eaten for at least one hour, that your bladder is empty,
clothing comfortable and that your previous activities have
been appropriate. The ideal time to meditate is just before
sunrise or sunset. It is a good idea to choose the same place
and same time, ideally 10 – 20 minutes when beginning.
You may meditate inside or outside, but be sure that you
will be warm, dry and not bothered. If suddenly disturbed
when in a deep state of meditation, the mind can register
shock because of the sudden, altered state of consciousness.
It is for this reason when we end our period of meditation
that we open the eyes slowly, and move the body very
gently. The use of incense is conducive to meditation as
are special objects, such as a crystal, flowers, a candle or
other personal symbols. We never meditate in a lying
position as this would induce sleep too easily. You may sit
in a chair or against a wall. The actual sitting position is
unimportant; ensure only that you have a steady base and
a straight spine. If sitting in a chair, have legs uncrossed
and feet resting on the floor or an appropriate support.
Hands are cupped either in the lap with thumbs touching
or are placed on the knees in what is known as a “mudra”,
where the thumbs and index finger are joined to seal in
the energy. It is very important that you are comfortable
and that your body is relaxed before starting your actual
practice, so take your time in working from the crown of
the head down, and briefly going over the different parts
of your body, with the out breath releasing anything you
need to let go of, and with the in breath feeling successive
parts of your body relax deeply.
Then, to centre yourself before each practice and once
you are relaxed, focus your awareness on your breath, the
breath being the bridge between mind and body. You may
take your awareness to the tip of the nose, the point where
the air enters and leaves your body, feeling the coolness as
you breathe in and then the warmth as you breathe out.
You may also focus on the centre of your being, seated just
below the navel, and become aware of the rise and fall of
your belly as you breathe in and out. Be aware of your
rhythm of breathing and know that this rhythm is your link
with the Universal Rhythm. Feel also that as you breathe
in you are receiving a very precious gift, life itself, and that
when you breathe out, in turn you are giving, sharing part
of yourself with the universe. Our next and third step is
withdrawing our senses, focusing inwards, and then we
move to the technique or concentration tool we have
chosen, e.g. repetition of the mantra, gazing at a candle,
etc. The final step, that of actually meditating, is when we
let go of our concentration tool or technique and, moving
inwards to an even deeper level, begin the observation or
witnessing of our own internal spontaneous process.
Remember, when we meditate we can connect with
other beings whom otherwise we would never meet.
Recommended further reading:
• Harvey A. The Direct Path. London: Rider, 200
• Goleman D. The Meditative Mind. New York: Tarcer,
1988
• Volin M. The Quiet Hour. Carlton VIC: Pelham,
1980
• Easwaren E. Meditation. New York: Arkana, 1986
ARTICLE
Drug Nutrient Herb Interactions in the Older Patient
Dr Antigone Kouris PhD Nutrition (Monash), Grad Dip Diet (Deakin),
Grad Dip Botanic Medicine (Newcastle)
BSc (Biochem/Micro) (Melb), Bsc Hons (Nutrition) (Deakin)
Adjunct Senior Lecturer, Dept Dietetics, Latrobe University
Accredited Practising Dietitian in Private Practice, 22/488 Neerim Rd,
Murrumbeena Vic 3168, [email protected]
Reprinted with permission from the Journal of Geriatric Medicine in General Practice 2009; 2: 26-27.
P
harmaceuticals have both beneficial and adverse
effects, although there is a strong focus on the
benefits. Furthermore, drug-drug interactions are
generally integral to decision-making yet the impact
of drug-food and drug-nutrient interactions are rarely
acknowledged or mostly deemed clinically insignificant.
However, even though a patient has an adequate amount
of vitamins/ minerals, they may be tipped into nutritional
deficiency due to their medications. The elderly are at
particular risk of nutritional deficiencies due to reduced
appetite/food intake compounded by the use of multiple
drugs
A concise ready reckoner for drug nutrient herb
interactions has recently been compiled by the author as
a stand-alone book (hard copy and e-book) and as a peerreviewed appendix to a text book on integrative medicine
(see references).
Some common drugs contributing to nutritional
problems:
1) Proton pump inhibitors (PPIs) and histamine
receptor antagonists (HRAs)
• These drugs shut down production of acid, which
affects absorption of: Ca, Fe, Mg, Zn, Se, Vitamins
B1, B12, C, D, E, Folate. A multivitamin is usually
recommended with these drugs.
• They can alter taste, impair appetite and cause
anaemia through reduced absorption of these
nutrients.
• PPIs are linked to increased risk of fractures.
• Mg/Ca, magnesium hydroxide and calcium
carbonate supplements require acid for digestion –
citrate versions are preferable (except if taking oral
hypoglycaemic medication – see below).
• Antacids containing magnesium hydroxide (e.g.
Mylanta) can block absorption of PPI and HRA
consumption must be separated by 2-4 hours.
• PPI and HRA may not be tolerated by patients with
fructose intolerance/irritable bowel syndrome.
2) Antacids
• Neutralise stomach acid and their high levels of
calcium can interfere with the absorption of Fe, Zn,
Cr, Cu, Vitamins A, B1, B12, Folate, D, E, K.
• They can alter taste and impair appetite.
• Aluminium in some antacids (e.g. Mylanta) can bind
JATMS
dietary phosphates, leading to calcium depletion
and osteomalacia. Ca/Mg citrate, vitamin C
supplements, citrus juices and milk can increase
aluminium absorption so should be separated from
drug consumption by at least two hours.
• Fe/Zn/fibre supplements and foods high in oxalates
(e.g. tea, wheat germ) and phytates (e.g. bran, oats)
can reduce absorption of antacids.
• Long-term use of antacids can increase serum
magnesium levels.
Tip: elderly patients should not take antacids at meal
times or with other dietary supplements.
3) Loop and thiazide diuretics
• Increase the excretion of K, Mg, Zn, Vitamins B1,
B12, B6, Folate
• They can alter taste and impair appetite.
• High K foods/supplements are frequently prescribed
but long-term use >6 months might lead to Mg
deficiency, which in turn can increase loss of K and
B1. B1 deficiency can aggravate congestive heart
failure, oedema, muscle pain, poor appetite, mental
confusion and risk of falls.
• Thiazide diuretics can increase blood levels of calcium
by decreasing excretion and, indirectly, by affecting
vitamin D metabolism, therefore calcium and
vitamin D supplements should be used with caution.
Tip: it may be prudent to check red blood cell Mg along
with serum K and prescribe a supplement if low (eg
magnesium orotate/chelate/citrate).
4) Laxatives
• Can cause steatorrhoea with chronic use, which
reduces absorption of fat-soluble vitamins (A, D, E,
K) and increases excretion of K and Mg. Milk/Ca/
Mg/medication are not recommended within two
hours of the laxative.
• It may be prudent to recommend a multivitamin with
chronic use of laxatives.
5) Aspirin
• Can reduce the absorption of B12, folate, vitamin C,
Fe, Zn, Ca.
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ARTICLE
• Can increase the risk of gastrointestinal bleeding and
anaemia with chronic use
• Can reduce appetite.
• A high intake of omega 3 EPA/DHA (>3000mg/
day) from fish oil or flaxseed oil (>30g/day) or
evening primrose oil (>1g/d) or vitamin E (>100IU)
with aspirin may increase risk of haemorrhagic
stroke. Other blood thinning herbs/foods that have
the potential to increase the blood thinning effects
of aspirin, warfarin or clopidogrel, if taken at high
supplemental doses include: aloe vera, carnitine,
chamomile, chondroitin, cinnamon, CoQ10,
cranberry, devil’s claw, dong quai, feverfew, garlic,
ginger, gingko, ginseng, glucosamine, goji, grape seed
extract, green tea, krill oil, policosanol, saw palmetto,
turmeric, willow bark.
6) Metformin/Pioglitazone/Sulfonylureas
• Can decrease absorption of vitamin B12, folate.
Magnesium supplements can increase the absorption
of these drugs. They can alter taste and impair
appetite.
• Patients taking supplements containing vitamin E,
Mg, Cr, CoQ10, lipoic acid, inositol,aloe vera juice,
bitter melon, cinnamon, fenugreek, garlic, ginger,
gymnema, ginseng, bilberry, guggul, gingko, milk
thistle, guar, green tea, olive leaf extract, psyllium and
turmeric may result in reduced blood glucose and/
or insulin levels requiring adjustment of diabetic
medication.
• The therapeutic effect of these drugs may be reduced
by K/Mg Citrate supplements.
• Sulfonylureas can affect thyroid function (and cause
weight gain) by reducing the uptake of iodine by the
thyroid.
7) Ace Inhibitors and Angiotensin II antagonists
• Attach to Zn and can cause zinc deficiency, which
may account for side effects (impaired appetite,
altered taste, skin numbness/tingling).
• Garlic, hawthorn, olive leaf and fish oil supplements
may increase the antihypertensive effect, requiring
adjustment of dose.
• K supplements/high K foods are contraindicated due
to risk of hyperkalaemia.
• These drugs contain Mg so high-dose Mg
supplements (>300mg/day) should be used with
caution.
8) Thyroxine (T4)
• Does not cause nutrient deficiencies but its
absorption is reduced by food and mineral
supplements. Thyroxine should be taken on an empty
stomach, ideally one hour before food or two hours
after food. Meals high in fibre and/or soy should also
be separated from thyroxine by several hours. Any
supplements or fortified foods (e.g. Anlene milk)
containing minerals, especially Ca, Fe, Zn, Se should
be taken with a gap of 4 hours from thyroxine.
• Secretion of TSH, production of T4 and conversion
154
JATMS
of endogenous or exogenous T4 to T3 in the thyroid,
liver and other tissues requires an adequate intake of
I, Fe, Se, Zn, Mg, omega 3 fatty acids, vitamin A and
tyrosine. Correcting deficiencies of these nutrients
may have an additive effect on thyroid function that
may result in a need for a reduced dose of thyroxine.
This may be desirable since thyroxine therapy can
have side effects, e.g. potentiates glucose intolerance.
Mild iodine deficiency has re-emerged in Australia
over the last 10-15 years, with 43% of the population
having inadequate iodine intakes. Good food sources
of iodine include kelp/seaweed, fish and iodised salt.
Iodine deficiency can be detected by way of several
fasting urinary iodine tests (iodine/creatine ratio).
If iodine deficiency is identified, low dose iodine
supplement (100mcg/day) approaching the RDI of
150mcg daily may be necessary with a concomitant
reduction in thyroxine dose.
• High dose iodine supplements should be avoided as
they can block thyroid hormone synthesis and create
an underactive state. A T4:T3 ratio >3 may suggest
selenium deficiency. However, since both I and Se
deficiencies can co-exist, iodine deficiency must be
corrected first to enable the thyroid to respond to
selenium supplementation.
• Foods/ supplements that may have an additive effect
on thyroid function include low dose iodine/ kelp/
seaweed, Fe, tyrosine and withania.
• Foods/supplements that may reduce thyroid function
or the effects of thyroxine include high dose iodine/
kelp/seaweed, isoflavones, lemon balm, bugleweed,
red rice yeast extract, SAMe, carnitine, celery seed.
Goitrogenic foods include broccoli, cauliflower,
cabbage, garlic, onion, linseed, rapeseed, lima beans,
soy, peanuts, swede, sweet potato, millet; can reduce
utilization of iodine by the thyroid and may only be
important when iodine intake is low.
9) Grapefruit juice and pomegranate juice
• Can inhibit drug metabolising intestinal and
hepatic cytochrome p450 enzymes, especially
CYP3A4, for up to 72 hours. This significantly
increases the bioavailability of many drugs (e.g.
statins, antidepressants, beta blockers, calcium
channel blockers, HRT, warfarin, anticonvulsants,
antipsychotics) and can raise their blood levels into
toxic ranges.
C O N C LU S I O N
• Separate vitamin/mineral supplements from
medications by about 2-4 hours.
• Clinical symptoms of nutrient deficiency combined
with laboratory data are needed to verify changes in
nutritional status.
• A nutrient-dense diet, and in some cases a low
dose senior multivitamin, makes an important
contribution to the health of medicated patients.
• Health professionals need to be knowledgeable and
vigilant of nutrition-related clinical symptoms that
may be caused by pharmaceuticals.
ARTICLE
RE F ERE N C E S
Kouris-Blazos A. Medications: Good and Bad
Interactions with Foods, Herbs and Nutrients.
2011. Purchase from www.lulu.com (ebook and
hard copy)
Kouris-Blazos A. Drug-nutrient-herb interactions
for commonly prescribed medications. Appendix
2. in: Kotsirilos V, Vitetta L, Sali A. A guide to
evidence-based integrative and complementary
medicine. Elsevier, Sydney 2011; 901-922.
2.
Lave J, Wenger, W. Situated Learning.
Legiitimate Peripheral Participation, 1991, Cambrindge, Cambridge University Press.
Isn' t it time you discover the Benefits of Craniosacral Therapy
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· Reduces strain on your body yet provides
effective light-touch techniques
Free iPhone Apps for Health
Care Professionals
· Increases your earning power
· Combines well with other therapies
· See our website for seminar dates.
Sandra Grace
H
usain, Wodajo and Misra1 published their list of
the top 20 free iPhone Medical Apps for health
care professionals in December 2010. Here are
some of their selections:
Medscape – a clinical reference tool for information
about diseases and drugs. It contains over 7,000 drug
references, more than 3,500 disease references and over
2,500 clinical images and procedure videos.
Micromedex – a drug reference and dosage tool
New England Journal of Medicine – access to this
prestigious medical journal is unlikely to remain free for
long
Epocrates Rx – contains drug monographs and
information about drug interactions, medical news and
some clinical articles Radiology 2.0: One night in the ED
– a teaching tool based on clinical cases
Skyscape: RxDrugs and Outlines in Clinical Medicine –
Skyscape produce a great range of Apps, not all are free
(e.g. Netter’s Atlas of Human Anatomy $14.95)
Prognosis: Your Diagnosis – a clinical case simulation
game for physicians, medical students, nurses, and
paramedics
An increasing number of online ‘communiities of
practice’2 are emerging. These are interactive sites where
patients and healthcare professionals discuss health care
issues and learn from each other. Sites such as Organized
Wisdom and PatientsLikeMe are popular with patients
with serious illnesses.
JATMS readers are invited to send details of their
favourite Apps or other online sites to share with ATMS
readers.
ACADEMY OF AUSTRALIA
Call 1800 101 105
or visit our website
www.craniosacraltherapy.com.au
A Ne
Vib
RE F ERE N C E S
1.
Husain I, Wodajo F, Misra S. Top
20 Free iPhone Medical Apps For Health Care
Professionals2010: Available from: http://www.
imedicalapps.com/2010/12/bes-free-iphonemedical-apps-doctors-healthcare-professionals/18/.
JATMS
155
A NEW Benchmark in
Herbal Medicine
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Health Co Pty Ltd
Sydney 1300 882 849
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Victoria and TAS
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Queensland
Natural Remedies Group
P 1300 138 815
South Australia and NT
BettaLife Distributors
P 1300 553 223
Western Australia
Rener Health Products
P 1300 883 716
ARTICLE
Homoeopathy for Tobacco Craving
Robert Medhurst, B.Nat. D.Hom
Y
ou’d probably have to have been living in another
solar system over the last 10 years not to be aware
of the risks associated with tobacco smoking.
There’s no longer any doubt about the risks associated
with this activity but in 2007 Australia still had the
eleventh highest rate of smoking in the world. There’s a
huge range of solutions for people seeking assistance to
disconnect themselves from the desire to smoke. Some
of these proffered solutions work, some don’t and some,
such as nicotine replacement, for most seem to offer
only limited relief and having a few notable limitations
including break-through cravings and contraindications
such as pregnancy.
The nature of tobacco craving and the physical
and psychological factors that motivate it, modify it or
enhance it mean that its characteristics are usually quite
individualised. Therefore the more therapy is tailored to
those individual characteristics the more successful it is
likely to be. Homeopathy is perfectly positioned to meet
these requirements and what follows are some of the more
notable homeopathic medicines that have found favour
with prominent authorities in this area.1, 2, 3, 4, 5, 6, 7
A C O N I T UM N A P ELLU S
Aconite is a wonderful remedy for acute stress and
has also been used for anxious dreams and nightmares,
vertigo, headaches (with an associated boiling sensation),
red inflamed eyes, dry mouth and throat, intense thirst,
vomiting, a short dry croupy cough, tickling in the throat
and chest pain brought on with coughing. Symptoms are
worse at night and after midnight, dry cold winds and
warm rooms and better for open air.
A R S E N I C UM A LBUM
The Arsenicum type displays restlessness, anxiety,
constantly shifts, fearfulness, is easily exhausted, emaciated,
and pain in any area that has a burning character. Also
seen here may be an unquenchable thirst, burning eyes,
respiratory catarrh and lung pain. Symptoms are worse for
wet weather or cold, and better for heat and warm drinks.
C A L A D I UM
One of the great tobacco craving remedies, Caladium
promotes a dislike for tobacco, often to the point of nausea
or vomiting if used when smoking. A keynote symptom
for this remedy is a dread of motion. Headaches, memory
loss, dyspnoea and catarrhal asthma may also be noted
here. Symptoms are worse for motion and better after
sleep.
are worse at night and from motion, and better from
warmth.
DAPHNE INDICA
Like Caladium, Daphne is one of the most frequently
used remedies for tobacco craving. The symptoms that
correspond to it include insomnia, a bursting headache,
shooting pains in the extremities, twitching, a burning
pain in the stomach and foetid breath.
EU G E N I A
The primary characteristic linking Eugenia with
smoking is nausea that is improved by smoking.
Occasionally practitioners will encounter a patient whose
attempts at smoking cessation are constantly thwarted by
nausea that is relieved by smoking and in this instance
Eugenia can be very effective.
I G N AT I A
Ignatia is a remedy frequently used for anxiety
linked with tobacco craving and it is often associated
with excitability and a marked sensory hypersensitivity.
Other symptoms may include mood swings, depression,
headaches, a sour taste in the mouth, sour eructations, a
dry spasmodic cough, cramping pains in the abdomen,
neck or back, as well as insomnia. Symptoms are worse in
the morning, aggravated by coffee or smoking and relieved
by sitting or changing position.
KALI PHOS
Kali phos should be considered where the primary
issue is anxiety associated with tobacco withdrawal.
The signs and symptoms that may help to confirm its
applicability include prostration, mental weakness,
irritability, dry mouth, tinnitus and dyspnoea. Symptoms
are worse from any exertion and in the early morning, and
better with warmth and rest.
LOBEL I A I N F L ATA
One of the interesting symptoms that may indicate the
need for Lobelia is that, despite a craving for tobacco, the
sufferer can’t stand the smell of it. Lobelia’s main sphere
of action in this area is on the lungs. There is marked
dyspnoea association with constriction. Emphysema or
asthma with a characteristic ringing cough may complicate
this presentation. Respiratory symptoms are worse from
exertion, tobacco smoke and cold and are better for rapid
walking.
N U X V OM I C A
C A M P H OR
Icy coldness is characteristic here, often accompanied
by a throbbing, occipital headache, insomnia, a weak
bradycardia and a violent dry hacking cough. Symptoms
JATMS
The predominant mental symptoms here as it relates
to tobacco craving is irritability. Some also claim that Nux
vomica assists in the detoxification of the toxic material
absorbed from tobacco smoke. Guiding symptoms
157
ARTICLE
include headache, vertigo, insomnia, nausea, food craving,
constipation and dyspnoea. Symptoms are worse in the
morning and from mental exertion, and better from a nap
(if they’re able to complete it) and from rest.
P L A N TA G O
Plantago is indicated for “nicotinism”, the historical
term applied to tobacco craving, and in its mother tincture
form, has been found to produce an aversion to tobacco.
The presence of depression, insomnia, constipation or
diarrhoea, as well as nocturnal enuresis, may indicate a
need for its use.
S TA P H Y S A G R I A
The guiding symptoms for Staphysagria include
irritability, hypersensitivity, insomnia, stupefying
headaches, a desire for stimulants (this obviously includes
tobacco) and itchy skin. Symptoms are worse from
emotional disturbance and the touch of other on affected
parts, and better from warmth and rest after sundown.
TA B A C UM
As with Nux vomica, some say that tabacum assists in
the elimination of the toxins carried by tobacco smoke.
This is yet to be proved but it certainly does appear to
have a significant effect on tobacco craving, where it’s
indicated. The symptoms that may be used to confirm
this include cold extremities, sick headaches in the early
morning, indigestion, palpitations or vertigo, prostration,
hypertension, dizziness, nausea, confusion and lack of
concentration. Symptoms are worse at night and better
during the day and with slow motion. Use may also be
158
JATMS
made of a variation of this remedy, Tabacum fumar,
the remedy manufactured from tobacco smoke, in low
potency as an emergency measure for acute cravings.
T H ER I D I O N
This remedy, made from the little orange spider, can
be extremely useful where the symptom constellation
consists of nervousness, hyperaesthesia from all sources
but particularly audio, vertigo and a headache that is
accompanied by nausea or vomiting. The symptoms here
are worse with touch, pressure or jarring.
RE F ERE N C E S
1. Das RBB. Select Your Remedy. 14th ed.
New Delhi: B Jain, 1992.
2. Clarke JH. A Clinical Repertory to the
Dictionary of the Materia Medica. England: Health Sciences Press, 1979. ISBN 0 85032 061 5.
3. Dewey WA. Practical Homoeopathic Therapeutics. 2nd ed. New Delhi: B Jain, 1991.
4. Bouko Levy M. Homeopathic and Drainage
Repertory. Editions Similia. France, 1992. ISBN-2904928-70-7.
5. Raue CG. Special Pathology and Diagnostics with Therapeutic Hints. 4th ed. New Delhi: B Jain,
1896.
6. Kalvin KB. Repertory of Hering’s Guiding
Symptoms of our Materia Medica. New Delhi: B Jain,
1997. ISBN 81-7021-241-3.
7. Lilienthal S. Homoeopathic Therapeutics.
3rd ed. New Delhi: Indian Books and Periodicals, 1890.
ISBN 81-7021-000-3.
.
ARTICLE
Statin Medications (Cholesterol lowering drugs) Increase the
Risk of Prostatic Cancer
Stephen Eddey
MHSc, BCompMe., DipAppSc(Nat0, AssDipChem, CertIV(Workplace
Training and Assessment), ATMS Head of Nutrition
A
s our population ages and the nation gains
weight, men are at increased risk of developing
prostatic cancer, which is a particularly dangerous
malignancy. Now we learn from the scientific evidence
that common medications that many middle-aged take
regularly (cholesterol lowering medications) also increase
cancer risk. This summary of the literature draws on recent
medical studies published this year (2011) that highlight
these dangers.
T H E P ROBLEM W I T H S TAT I N S
Middle age men are being urged to reduce cholesterol
levels by medical doctors. The number one weapon
against cholesterol used by doctors are the statin drugs
(e.g. Lipitor, Simvastatin etc.). While they reduce
cholesterol levels, common the side effects of statin drugs
include peripheral neuropathy; paraesthesia; GI upset;
pancreatitis; dizziness; myalgia; muscle cramp; pruritus;
alopecia; rash; gynaecomastia; anaemia; asthenia;
insomnia; memory impairment; hypotension; depression;
and sexual dysfunction1. Recently, prostatic cancer has
been added to this list.
S TAT I N S I N C RE A S E P RO S TAT E
C A N C ER B Y 5 5 %
In a recent population study, researchers examined
388 prostate cancer cases and 1,552 controls. They
found that every use of any statin was associated with a
significant increase in prostate cancer risk (OR = 1.55,
95%CI = 1.09-2.19). This equates to a 55% increase of
cancer rates. Unfortunately, the study also found that the
higher the dose, the higher the risk of prostatic cancer.
In this study, the researchers concluded that “statins may
increase the risk of prostate cancer”.2
S TAT I N S S U P P RE S S P S A Y E T I N C RE A S E
P RO S TAT E C A N C ER
An even more disturbing study found that while statins
increased prostatic cancer, they suppressed the common
prostatic cancer blood test (the P.S.A. test). In this study, a
total of 1261 patients who had had their prostates removed
due to cancer were examined. There were 281 (22%) statin
users. The average age was 60 years and median follow-up
was 36 months (average 43 months). Interestingly, statin
users had lower preoperative PSA levels (6.4) than nonusers (7.1) (P < 0.05). In all, 80% of statin users had a
pathological Gleason sum ≥7 compared with 67% of nonJATMS
users (P < 0.05). After the data had been analysed statin
use was found to be an independent predictor of prostatic
cancer (hazard ratio 1.54, P < 0.05). This equates to a 54%
increase of cancer rates in statin users.3
N AT UR A L C H OLE S T EROL M A N A G EME N T
S U P P LEME N T S RE D U C E C A N C ER R I S K
Natural medicine practitioners use Red Rice Yeast
extract, which is a commonly used natural medicine, to
reduce cholesterol levels in middle-aged men. Interestingly,
animal studies have found that this substance reduces
prostatic cancer growth.4
C O N C LU S I O N
The latter study is a worrying find because while the
evidence clearly points to statin drugs increasing prostatic
cancer risk, taking statins suppresses P.S.A. levels, which
is the front line diagnosis blood test for prostatic cancer.
Another very worrying point is that earlier studies have
shown that statins reduce prostatic cancer because they
cause a fall in P.S.A. levels (and thus presumably cancer
rates).5 This false assumption has led to the belief that
statins do not increase prostatic cancer and may even
reduce it when the recent evidence has found that in fact,
prostatic cancer rates are increased with regular statin use.
RE F ERE N C E S
1.
eMIMS August 2011. Available from http://
www.mims.com.au/index.php?option=com_content&tas
k=view&id=113&Itemid=143
2.
Chang CC, Ho SC, Chiu HF, Yang CY.
Statins increase the risk of prostate cancer: A population-based case-control study. Prostate. 2011 Apr 7.
[epub ahead of print]
3.
Ritch CR, Hruby G, Badani KK, Benson
MC, McKiernan JM. Effect of statin use on biochemical
outcome following radical prostatectomy. British Journal of Urology International. 2011 Mar 31. [epub ahead
of print]
4.
Hong MY, Henning S, Moro A, Seeram NP,
Zhang Y, Heber D. Chinese red yeast rice inhibition of
prostate tumor growth in SCID mice. Cancer Prev Res
(Phila). 2011 Apr;4(4):608-15.
5.
Murtola TJ, Tammela TL, Maattanen L,
Huhtala H, Platz EA, Ala-Opas M, et al. Prostate
cancer and PSA among statin users in the Finnish
prostate cancer screening trial. Int J Cancer. 2010 Oct
1;127(7):1650-9.
159
L AW R E P O R T
The Fair Work Act 2009 and You
Ingrid Pagura
BA, LLB
Ingrid is a part time teacher in the Massage Department at Meadowbank College of TAFE and a trained lawyer.
She also works for a legal publishing company.
A
s an employer it is important that you know and
keep up to date with the law that affects your staff.
As this area changes regularly, it is often a difficult
task. Just trying to work out what law applies to you can
be difficult. In this article I’ll cover some recent changes.
In coming articles I’ll cover dismissals, harassment and
bullying policies.
During the mid 2000s industrial relations law
changed. Legislation looked at industrial law as it related
to a corporation, rather than whether an award was state or
federal. It now meant that any employee who worked for
a corporation (an entity established with a view to making
a profit) would be covered by federal rather than state law.
This meant that employees other than state government
ones came under the Work Choices legislation, and that
all the changes it introduced applied to them.
Since 2009 the Fair Work Act 2009 (Commonwealth)
has been in force. The Fair Work Act (FWA) 2009 kept
the approach of a corporation as the factor determining
which legislation covered which worker. Most Australian
workers are now covered by the FWA. Most states have
kept industrial laws for state government workers though
some have handed over their industrial relations powers to
the Commonwealth.
The FWA came into force over a period of time but
many elements started on 1 January 2010. A new body
called Fair Work Australia was established to cover
aspects of industrial relations such as contract issues and
termination, among other things. Further changes were
made on 1 January 2011. Some changes included:
MO D ER N AWA R D S
All awards have been rewritten and simplified to include
10 points:
• Minimum wages
• Type of work: full time, part time, casual
• Hours of work
• Overtime rates
• Penalty rates
• Annualised wages or salary arrangements
• Allowances
• Leave
• Superannuation
• Consultation, representation and dispute settling
procedures
U N I O N S ’ R I G H T S O F E N T RY
Unions can only enter a workplace to hold talks or
to investigate breaches of FWA or OHS legislation if
they give the employer 24 hours notice and have an entry
permit.
JATMS
N AT I O N A L EM P LO Y ME N T S TA N D A R D S
The FWA provides a safety net of enforceable
minimum employment terms and conditions. These
10 National Employment Standards (NES) apply
to employees covered by the FWA and replace other
standards. They set out the minimum standards that apply
to the employment of workers. The 10 NES are:
1. Maximum weekly hours
• Generally for a full time employee this is 38 hours.
Part-timers work a proportion of this
• An employee may refuse to work additional hours if
it is unreasonable or without sufficient notice
2. Request for flexible working arrangements
• An employee who is a parent, or has responsibility
for a child, can request a change in working
arrangements to assist in the care of the child. The
child must be under school age or under 18 with a
disability
• An employee must be employed at least 12 months
before making the request
• An employer must let the employee know of
their decision within 21 days and not refuse on
unreasonable grounds
3. Parental leave and related entitlements
• An employee must have completed 12 months of
continuous service immediately before the date of
their leave
• An employee is entitled to 12 months of unpaid leave
for the birth or adoption of a child
• They have a guaranteed right to return to their preleave job or if it no longer exists, then a comparable
one
4. Annual leave
• Employees are entitled to 4 weeks of paid leave per
year and 5 weeks for shift workers
• They can take leave at a time as agreed by the
employee and employer who cannot reasonably
refuse
5. Personal/carer’s leave and compassionate leave
• Employees are entitled to 10 days of personal/carer’s
leave per year Employees can take personal leave if
they are not fit for work due to illness or injury
• Employees may take carer’s leave to provide care to a
family member who has an illness or injury
• Employees may take 2 days compassionate leave
for every occasion where a family member dies or
sustains life-threatening injuries
6. Community service leave
• An employee on eligible community service leave may
be absent from work
• An examples of such leave is jury duty
161
L AW R E P O R T
7. Long service leave
• This section refers back to state laws or Awards that
better state laws
8. Public holidays
• An employee is entitled to be absent on a public
holiday and be paid
9. Notice of termination and redundancy leave
• This standard sets out the minimum requirement for
employers giving notice of termination
• Redundancy of a job is defined as are the amounts
paid per years of service
10. Fair Work Information Statement
• New employees must receive a Fair Work Information
Statement
Sydney Institute of Traditional
Chinese Medicine
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U N FA I R D I S M I S S A L
Under previous legislation many people were
excluded from making an unfair dismissal claim. Under
the FWA this has changed. A small business is viewed
as having fewer than 15 employees since 1 January 2011.
Previously it was 15 full time equivalents. Small business
employees are now able to seek compensation. Guidelines
for understanding what constitutes an unfair dismissal are
provided by the Small Business Fair Dismissal Code.
Now is the time to review all your employment
contracts and make sure they fall into line. In the next
issue I will cover dismissals in more detail as this is an area
of concern and confusion.
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POLICY REPORT
Atms Official Policies
Matthew Boylan
A
s well as complying with the ATMS Code of
Conduct all ATMS members, including student
and associate members are required to comply
with official ATMS Policies as determined by the ATMS
Board of Directors.
The following are the official ATMS policies in effect
as at January 2011. Additionally ATMS members must
ensure that any staff they employ are aware of these policies
and also comply with them where applicable.
I N T ER N A L E X A M I N AT I O N S
As the practice of natural medicine does not in any
of its forms require an internal examination, any internal
examination by a member, even if the patient consents, is
regarded as indecent assault, which is a criminal offence.
BRE A S T M A S S A G E
It is ATMS policy that members do not massage the
mammary glands of patients, and that only professional
techniques be applied to surrounding tissue.
INGESTION OF ESSENTIAL OILS
It is ATMS policy that members do not prescribe the
ingestion of essential oils.
H E A LT H F U N D RE C E I P T S
Under no circumstances may an ATMS member use
someone else’s membership number for purposes of issuing
receipts for health fund rebate. All information provided
on a receipt must be completely true and correct. ATMS
members are required to take all reasonable steps to ensure
that receipts for their services are not improperly issued.
the Society’s Code of Conduct and its Constitution.
Information to help members comply with their Privacy
obligations is available on the ATMS website and from the
ATMS office.
STUDENTS PRACTISING
Student members may not practise outside of
supervised clinical practicum. As students are not fully
qualified nor completely trained, they pose a risk to the
public and therefore to the interests of the profession and
the Society.
O C C U PAT I O N A L H E A LT H A N D S A F E T Y
It is the ATMS Policy that members will be aware of
and comply with all the applicable Occupational Health
and Safety requirements of their practice.
T ELE P H O N E & N E T C O N S ULTAT I O N S
A telephone or internet consultation must not be
conducted without a prior face-to-face consultation.
Without a face-to-face consultation a correct diagnosis
would not always be possible and inappropriate medicine
could be prescribed resulting in harm to the patient.
A failure by an ATMS member or a member of their
staff to comply with any of the above policies is a breach
of the ATMS Code of Conduct, and sanctions, including
termination of ATMS membership, may be imposed by
the ATMS Complaints Committee.
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C O N T I N U N I N G P RO F E S S I O N A L
E D U C AT I O N P RO G R A M
All accredited members must fully participate in
the ATMS Continuing Professional Education (CPE)
program. This is a requirement even if the member is not
currently in active practice. Accredited members’ CPE
activities are subject to a yearly audit. If audited, a member
must provide satisfactory evidence that applicable CPE
activities were undertaken. Details of the CPE program
are found on the ATMS website www.atms.com.au.
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U S E O F T H E T I T LE D O C T OR
ATMS members may not use in the clinical setting the
titles of Dr or Doctor unless they are a registered medical
practitioner within Australia.
PAT I E N T C O N F I D E N T I A L I T Y
Members are required to abide by Australian Privacy
Laws. Wrongful disclosure of personal information in
respect of a patient by a member of the Society, or a member
of his or her staff, is considered to be a serious breach of
JATMS
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163
NE
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patient’s levels of free radicals and heavy metals using an easy to read colour chart.
TEST KITS AVAILAbLE:
• General Heavy Metal Test Kit: Tests for the presence of 8 elements in solution. Elements tested in this
kit include; cadmium, cobalt, copper, lead, manganese, mercury, nickel and zinc.*
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including; aluminium, arsenic, cadmium, chlorine, chromium, cobalt, copper, iron, lead, manganese,
mercury, molybdenum, silver, tin and zinc.*
*The above tests can be applied to detect the presence of heavy metals in mediums including saliva, urine,
water, dust, soil, food and drink.
• Free Radical Test Kit: A simple and reliable test to measure the level of free radicals or “oxidative stress”
within the body. This test measures malondialdehydes as a marker of free radical stress. The lighter the
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Email: [email protected]
RECENT RESEARCH
M A S S A G E T H ER A P Y
Munk N, Zanjani F. Relationship between massage
therapy usage and health outcomes in older adults.
Journal of Bodywork and Movement Therapies 2011;
15(2):177-185
Physical and emotional decline in older adults
is a serious issue affecting not only quality of life but
also susceptibility to injury. Non-pharmacological
interventions addressing the needs of older adults are
important for reducing medication burden and possible
drug interactions. This study (N = 144) examines the
potential of massage therapy as such an intervention for
older adults by comparing self-reported health outcome
scores among adults 60 and older who have and have
not utilized massage therapy in the past year. When
controlling for age and cumulative morbidities, older
adults who reported massage therapy usage in the past
year had significantly better health outcome scores in the
following domains: 1) emotional well-being, 2) limitations
due to physical issues, and 3) limitations due to emotional
issues. Because previous massage therapy research has not
included or focused on older adults, studies examining
massage therapy and emotional health, specifically among
this population, are warranted.
Lamas K. Using massage to ease constipation. Nursing
Times 2011;107(4):26-7
Background: Constipation is a painful and serious
condition that patients often find difficult to talk about. It
is usually treated with laxatives alone. Aim: To determine
whether abdominal massage is an effective treatment for
constipation. Method: Of 60 people with constipation,
half received 15 minutes of abdominal and hand massage a
day, five days a week, for eight weeks, as well as prescribed
laxatives. The rest received prescribed laxatives only.
Interviews with participants were also conducted. Results:
Abdominal massage used with laxatives reduced abdominal
pain, increased bowel movements and improved quality
of life compared with laxative use alone. Patients reported
positive experiences of abdominal massage but it did not
reduce their laxative use. Conclusion: Abdominal massage
was seen as a pleasant treatment that can be offered as an
option in constipation management.
Western herbal medicine
Mohamed ME, Frye RF. Effects of herbal supplements
on drug glucuronidation. Review of clinical animal,
and in vitro studies. Planta Medica 2011;
77(4):311-21
The use of herbal supplements has increased steadily
over the last decade. Recent surveys show that many
people who take herbal supplements also take prescription
and nonprescription drugs, increasing the risk for
potential herb-drug interactions, While cytochrome
P450-mediated herb-drug interactions have been
extensively characterized, the effects of herbal extracts and
constituents on UDP-glucuronosyl transferase (UGT)
JATMS
enzymes have not been adequately studied. Thus, the
purpose of this review is to evaluate current evidence on
the glucuronidation of phytochemical and the potential
for UGT-mediated herb-drug interactions with the topselling herbal supplements in the United States and Europe.
In vitro and animal studies indicate that cranberry, Ginkgo
biloba, grape seed, green tea, hawthorn, milk thistle, noni,
soy, St. John’s wort, and valerian are rich in phytochemicals
that can modulate UGT enzymes. However, the in vivo
consequences of these interactions are not well understood.
Only three clinical studies have investigated the effects of
herbal supplements on drugs cleared primarily through
UGT enzymes. Evidence on the potential for commonly
used herbal supplements to modulate UGT-mediated
drug metabolism is summarized. Moreover, the need for
further research to determine the clinical consequences of
the described interactions is highlighted.
Yarnell E, Abascal K. Herbs for gastroesophageal
reflux disease. Alternative and Complementary
Therapies 2010;16(6):344-6
Herbal medicines offer many potential ways to help
people with gastroesophageal reflux disease (GERD),
including by treating the underlying transient lower
esophageal sphincter relaxations (TLESR), helping
relieve symptoms, and reducing inflammation. Fumaria
officinalis (fumitory-of-the-wall) and Chelidonium
majus (celandine) are two among many cholagogues
that empirically seem to be helpful. Another cholagogue,
Artemisia asiatica (Asian wormwood), has been shown
experimentally to reduce GERD-related symptoms. Atropa
belladonna (belladonna, deadly nightshade) and other
anticholinergics may also correct TLESR. Demulcents,
such as alginic acid, Ceratonia siliqua (carob), U/mar
rubra (slippery elm), A/thaea officinalis (marshmallow),
and Aloe vera (aloe) leaf gel can reduce acute symptoms
and heal acid-damaged tissues. Inflammation modulators,
such as deglycyrrhizinated licorice, Calendula officinalis
(calendula), Curcuma longa (turmeric), Zingiber
officinale (ginger), Rosmarinus officinalis (rosemary), and
Symphytum officinale (comfrey) may also help with tissue
repair and symptom control. Herbal medicine has much
to offer patients with GERD but more clinical research is
needed.
NUTRITION
Kligler B, Homel P, Blank AE, Kenney J, Levenson
H, Merrell W. Randomized trial of the effect of an
integrative medicine approach to the management of
asthma in adults on disease-related quality of life and
pulmonary function. Alternative Therapies in Health
and Medicine 2011;17(1):10-5
Purpose: The purpose of this study was to test the
effectiveness of an integrative medicine approach to the
management of asthma compared to standard clinical
are on quality of life (QOL) and clinical outcomes.
Methods: This was a prospective parallel group repeated
165
RECENT RESEARCH
measurement randomized design. Participants were
cadults aged 18 to 80 years with asthma. The intervention
consisted of six group sessions on the use of nutritional
manipulation, yoga techniques, and journaling.
Participants also received nutritional supplements: fish oil,
vitamin C, and a standardized hops extract. The control
group received usual care. Primary outcome measures
were the Asthma Quality of Life Questionnaire (AQLQ).
The, Medical Outcomes Study Short Form-12 (SF-12),
and standard pulmonary function tests (PFT’s). Results:
In total, 154 patients were randomized and included in
the intention-to-treat analysis (77 control, 77 treatment).
Treatment participants showed greater improvement than
controls at 6 months for the AQLQ total score (P < .001)
and for three subscales, Activity (P < 0.001), Symptoms
(P = .02), and Emotion (P< 001). Treatment participants
also showed greater improvement than controls on three of
the SF-12 subscales, Physical functioning (P = 003); Role
limitations, Physical (P < .001); and Social functioning (P
= 0.03), as well as in the aggregate scores for Physical and
Mental health (P = .003 and .02, respectively). There was
no change in PFTs in either group. Conclusion: A lowcost group-oriented integrative medicine intervention can
lead to significant improvement in QOL in adults with
asthma.
Murtaugh MA, Filipowicz R, Baird BC, Wei G,
Greene T, Beddhu S. Dietary phosphorus intake
and mortality in moderate chronic kidney disease:
NHANES III. Nephrology Dialysis Transplantation
2011; epub ahead of print
Background: Dietary phosphorus intake is usually
restricted in dialysis patients but the associations of
dietary phosphorus intake with mortality in moderate
chronic kidney disease (CKD) are unknown. Therefore,
we examined these associations in National Health and
Nutrition Examination Survey III.
Methods: Dietary phosphorus intake was estimated
from 24-h dietary recalls administered by trained
personnel. CKD was defined as estimated glomerular
filtration rate (eGFR) <60 mL/min/1.73 m(2). Time to
mortality was examined by Cox regression models taking
into account the complex survey design.
Results: 1105 adults with CKD were studied.
Phosphorus intake was 1033 ± 482 mg/day (mean ±
SD), eGFR was 49.3 ± 9.5 mL/min/1.73 m(2) and serum
phosphorus was 3.5 ± 0.5 mg/dL. Compared to those in
the lowest tertile of phosphorus intake (mean 532 ± 161
mg/day), those in the highest third (1478 ± 378 mg/day)
had similar serum phosphorus levels (3.6 ± 0.5 versus 3.5
± 0.6 mg/dL, P =0.113) and modestly higher eGFR (50.0
± 8.1 versus 47.5 ± 12.0 mL/min/1.73 m(2), P = 0.014).
After adjustment for demographics, comorbidity, eGFR,
physical activity, energy intake and nutritional variables,
phosphorus intake was not associated with mortality
[hazard ratio (HR) 0.98 per 100 mg/dL increase, 0.931.03].
Conclusions: High dietary phosphorus intake is
166
JATMS
not associated with increased mortality in moderate
CKD, presumably because serum phosphorus levels
are maintained in the normal range at this level of
GFR. Interventional trials are needed to define optimal
phosphorus intake in moderate CKD.
T R A D I T I O N A L C H I N E S E ME D I C I N E
Jiamei Z. Treatment of ‘Water illnesses’ (shuibing)
using the zue. Chinesische Medizin 2011;
26(1):29-35.
In this article the author looks at the treatment of
‘Water illnesses’ (shuibing) using the xue for which the
foundations were already laid down in the ‘Synopsis of
Prescriptions of the Golden Chamber’ ( Jinkui yaolue).
He introduces the subject by explaining the role of the
xue and ‘Water’ in the human body and the effects of
their interaction. After mentioning the most important
conditions that must be present for the treatment of ‘Water
illnesses’ (shuibing) and especially for the treatment
of oedemas and swellings using the xue, he describes
the successful therapy of four patients suffering from
cardiac oedema, hepatic oedema, nephrotic oedema and
depletive oedemas. In each case he analyses the mechanics
of the illness and the symptoms which appear and gives
recommends principles on which therapy should be
carried out. For each case study he presents the formulas
and medicines which were used indicating the exact
dosage required and he describes the therapy procedure.
Legge D. The jingjin - a 21st century reappraisal.
Journal of Chinese Medicine 2011; (95):5-8
The jingjin are a network of secondary channels that
form part of the channel system of Chinese medicine.
Although described in contemporary texts, they have
received relatively little attention since their introduction,
and are rarely used as tools of diagnosis or treatment in
contemporary acupuncture practice. This article surveys
the source texts that originally described the jingjin, and
explores the clinical utility of these channels from the
perspective of modern anatomy and physiology.
H OMOEO PAT H Y
Oberbaum M, Samuels N, Ben-Arye E, Amitai Y,
Singer SR. Apparent life-threatening events in infants
and homoeopathy: An alternative explanation. Hum
Exp Toxicol. 2011 Jul 29. [Epub ahead of print]
Background: A recent report showed increased
frequency of apparent life-threatening events (ALTEs) in
infants treated with the homeopathic medication GaliColBaby (GCB). The premise was that the ALTEs resulted
from toxic effects of the drug’s components. We examine
an alternative explanation. Method: The toxicological
literature was searched for known reactions to the various
GCB components, noting doses and reported symptoms.
Dosage quantities and severity of reaction to the GCB were
ranked independently by two groups of physicians, and a
RECENT RESEARCH
dose-response curve was generated. Reported toxic doses
and symptoms were compared with those of the GCB
series. The homeopathic literature was searched as well
to determine the propensity of the GCB components to
cause ALTE symptoms, when given in homeopathic doses
to healthy volunteers (proving). Results: Doses ingested
in the GCB series were 10-13 orders of magnitude smaller
than those reported to cause toxic reactions in humans.
There was poor correlation between symptoms with GCB
and toxic profiles of the components. A nonsignificant,
inverse relationship between dose and severity of reaction
was observed. Conversely, four GCB components (in
homeopathic doses) had a high propensity to produce at
least one of five symptoms which define ALTE, two of
which had intermediate to high propensity to produce
three symptoms. Conclusions: It is unlikely that the
ALTE following ingestion of GCB was a toxic reaction to
any of the drug’s component. Homeopathic theory may
explain this linkage, though further research is needed
to understand the pathogenic effects of highly diluted
homeopathic compounds.
Taylor JA, Jacobs J. Homeopathic ear drops as an
adjunct to standard therapy in children with acute
otitis media. Homoeopathy 2011; 100(3):109-15
Objective: To assess the effectiveness of a homeopathic
ear drop for treatment of otalgia in children with acute
otitis media (AOM).
Methods: Children with AOM were enrolled in the
study at the time of diagnosis and randomized to receive
either standard therapy alone or standard therapy plus
a homeopathic ear drop solution that was to be used
on as needed basis for up to 5 days. Parents of children
in both treatment groups rated the severity of 5 AOM
symptoms twice daily for 5 days in a symptom diary. A
symptom score was computed for each assessment with
lower scores denoting less severe symptoms. Parents of
children randomized to receive ear drops also recorded
information regarding symptoms being treated and
response to treatment.
Results: A total of 119 eligible children were
enrolled in the study; symptom diaries were received
from 94 (79%). Symptom scores tended to be lower in
the group of children receiving ear drops than in those
receiving standard therapy alone; these differences were
significant at the second and third assessments (P=0.04
and P=0.003, respectively). In addition, the rate of
symptom improvement was faster in children in the ear
drop group compared with children in standard therapy
alone group (P=0.002). The most common reason for
administration of ear drops was ear pain, recorded for
93 doses; improvement was noted after 78.4% of doses
for this indication. There were no significant side effects
related to use of the ear drops.
Conclusions: This study suggests that homeopathic
ear drops were moderately effective in treating otalgia
in children with AOM and may be most effective in
the early period after a diagnosis of AOM. Pediatricians
and other primary health care providers should consider
JATMS
homeopathic ear drops a useful adjunct to standard
therapy.
N AT URO PAT H Y
Hawk C, Ndetan H, Evans MW. Potential role of
complementary and alternative health care providers
in chronic disease prevention and health promotion:
An analysis of National Health Interview Survey
data. Preventative Medicine. 2011 Jul 13. [Epub
ahead of print]
Objective: To make a preliminary assessment of the
potential role of the most frequently used licensed or
certified United States complementary and alternative
medicine (CAM) providers in chronic disease prevention
and health promotion.
Method: This was a secondary analysis of the
2007 United States National Health Interview Survey
(NHIS), the most recent to include CAM use. The Adult
Core Sample, Person and Adult Complementary and
Alternative Medicine data files were included. NHIS’s
complete survey design structure (strata, cluster and survey
weights) was applied in generating national population
estimates for CAM usage.
Results: Chiropractic or osteopathic manipulation
(8.4%) and massage (8.1%) were most commonly used;
acupuncture was used by 1.4% and naturopathy by 0.3%
of respondents. Substantial proportions of respondents
reported using CAM for wellness and disease prevention,
and informed their medical physician of use. Fifty-four
percent were overweight or obese, 22.0% physically
inactive, and 17.4% smokers; 18.0% reported hypertension,
19.6% high cholesterol, and 9.1% prediabetes or diabetes.
Conclusion: CAM users present with risk factors
which are priority public health issues. This implies a
need to train CAM providers in evidence-based health
promotion counseling. CAM encounters may provide
opportunities to coordinate health promotion and
prevention messages with patients’ primary care providers.
Braun LA, Spitzer O, Tiralongo E, Wilkinson JM,
Bailey M, Poole S, Dooley M. The prevalence and
experience of Australian naturopaths and Western
herbalists working within community pharmacies.
BMC Complementary and Alternative Medicine.
2011 May 23;11:41
Background: Naturopaths and Western herbal
medicine (WHM) practitioners were surveyed to
identify their extent, experience and roles within the
community pharmacy setting and to explore their
attitudes to integration of complementary medicine
(CM) practitioners within the pharmacy setting.
Method: Practising naturopaths and WHM
practitioners were invited to participate in an anonymous,
self-administered, on-line survey. Participants were
recruited using the mailing lists and websites of CM
manufacturers and professional associations.
Results: 479 practitioners participated. 24% of
167
RECENT RESEARCH
respondents (n = 111) reported they had worked in
community pharmacy, three-quarters for less than 5 years.
Whilst in this role 74% conducted specialist CMs sales,
62% short customer consultations, 52% long consultations
in a private room and 51% staff education. This was
generally described as a positive learning experience
and many appreciated the opportunity to utilise their
specialist knowledge in the service of both customers and
pharmacy staff. 14% (n = 15) did not enjoy the experience
of working in pharmacy at all and suggested pharmacist
attitude largely influenced whether the experience was
positive or not. Few practitioners were satisfied with the
remuneration received. 44% of the total sample provided
comment on the issue of integration into pharmacy, with
the main concern being the perceived incommensurate
paradigms of practice between pharmacy and naturopathy.
Of the total sample, 38% reported that they would
consider working as a practitioner in retail pharmacy in
future.
Conclusions: The level of integration of CM into
pharmacy is extending beyond the mere stocking of
supplements. Naturopaths and Western Herbalists are
becoming utilised in pharmacies.

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
Skill Update
Weekend Workshop

Conducted By Master Zhang Hao
B.Phy.Ed. D. TCM (China)
Found/Director of Chi-Chinese
Healing College
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
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 
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
Checking our website for other courses may be interested you too!
Chi-Chinese Healing College
I N T E G R AT I V E ME D I C I N E
Thede C, Poetzsch V. The use of Western medicinal
herbs within the system of Chinese herbal medicine.
Chinesische Medizin 2011; 26(1):1-14
The use of herbs in the treatment of illness has as
long a tradition in the Occident, just as it has in Asia. The
oldest written works about medicinal herbs have been
handed down to us from ancient times, and some even
from before the Common Era. Indeed Galen of Pegamon
gave us the first theoretically-based descriptions of the
qualitative effects of medicines in the second century AD,
yet in contrast to herbal theory in China, Galen’s initial
treatises were not continuously developed. In view of the
plentiful availability of local medicinal herbs, it would
seem obvious to apply the universal system of classification
standards provided by the Chinese paradigms to Western
herbal medicines. A project of this kind requires a
thorough knowledge of Chinese phytopharmacology
together with the knowledge of the clinical effects of the
herbal medicines to be evaluated by this classification
system. This article describes how herbal medicines can be
classified according to an evaluation of their clinical effect
based on the Chinese paradigm. A number of examples
are given of a description of the effect of western herbs
in terms of Chinese medicine as well as a description of
an example of treatment. In summary, it can be said that
therapy using Western herbal medicines within the context
of practical Chinese medicine provides an enrichment of
the therapy spectrum and offers a multitude possibilities
for development, bearing in mind that in some cases the
assessment of Western herbal medicines according to
the Chinese paradigm must be considered to be only of
a provisional nature because of the limited experience
available.
168
JATMS
www.chihealing.com.au
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BOOK REVIEW
P E N N Y R O B E R T S H AW E
General Practice: The Integrative Approach
Phelps K, Hassed C.. Chatswood, NSW: Elsevier Australia, 2011. ISBN 978-0-7295-3804-6. $150.00. Available
from Elsevier Australia, telephone 1800 263 951 or <shop.elsevier.com.au>.
T
his tome was written for general practitioners who have an interest in integrating ‘orthodox’ medicine with complementary medicine. However, it could just as well be viewed in the reverse i.e., as a reference about general medical
practice for complementary therapists. It has been organised into seven parts.
Part 1 introduces the general principles of integrative medicine and discusses some of the modalities and their evidence
bases. This is followed by an overview in Chapter 2 about the principles of general practice such as practice management,
communication and the check-up.
Part 3 is the largest section and it examines different systems including blood, allergies, pain management, obesity, sleep
disturbances and much more. The disorders associated with each of these systems, their causes, means of diagnosis, and the
pharmacological and integrative strategies that are used to manage them are covered.
Parts 4 and 5 focus on health issues that specifically affect men and women consecutively; and Part 6 concentrates on the
typical health-related concerns that occur during different stages in a person’s life cycle. Part 7 deals with social conditions
that impact on health such as domestic violence, sexual health and substance abuse.
Pedagogical aids such as tables, diagrams, photographs and break-out boxes are plentiful and there are references and
resources listed at the end of each chapter. The text concludes with an appendix of herb/nutrient-drug interactions and an
index. Moreover, access to an online version is available for those who have purchased the book. It includes a search facility,
an image library and the option to add bookmarks and notes.
MEDICINAL PLANTS IN AUSTRALIA
Volume 1: Bush Pharmacy by Cheryll Williams
$69.95, 328 pages over 300 colour illustrations ISBN 9781877058790
These books are designed to enhance our appreciation of the
medicinal history of Australia’s flora, its unique contributions to
everyday life and its extraordinary future potential
CONTENTS OF VOLUME 1
1 Plants of the Pioneers: first impressions
and improvisations
2 Herbal Inspiration: remedies from
the bush
3 Sarsaparilla and Sassafras: old remedies
in a new colony
4 Xanthorrhoea: grass-tree medicine
5 Floral Emissaries
ORDER FORM – Postfree to readers of this journal
6 Bush Beverages
7 Bush Tucker Bugs
8 A Sweet Surprise: Medicinal
and toxic honeys
9 Uniquely Australian: flowers, flavours
and fragrance
10 Sandalwood: the aromatic export
11 The Famous Australian Gum-tree
Volume 2: Gums, Resins, Tannin and Essential Oils
by Cheryll Williams
Please supply ….. copy/copies of Medicinal Plants in Australia Vol 1 @
$69.95 and .......copy/copies of Medicinal Plants Vol 2 @ $69.95 (including $69.96, 344 pages over 300 colour illustrations ISBN 9781877058943
GST and postage). I enclose a cheque/money order for $……...Or please CONTENTS OF VOLUME 2
6 Tannin and Trees: Native Floral
charge my credit card: Mastercard/Visa Expiry date………………….
1 Oleum Eucalypti
Resources
2 Kino: The Natural Panacea
3 Resinous Resources
4 The Native Pines: Copal, Dammar
and Sandarac
5 The Myrtaceae: Hidden Chemical
Treasure
7 Wattle: Tales of an Australian Icon
8 The Medicinal Mulga
9 Tea-trees: Modern Investigations of an
Ancient Remedy
10 Melaleuca: The Prosaic Paperbark
Signature……………………………………Phone No...................................
Name…………………………………………………………………………
Address................................................................................................................... Volume 3 will be published in 2012, Volume 4 in 2013
…………………………………………………………Postcode………… Cheryll Williams has over 25 years of clinical experience in
Send to: Rosenberg Publishing Pty Ltd, Box 6125 Dural Delivery herbal and nutritional medicine, homeopathy and acupuncture.
She holds a diploma in Herbal Medicine and post-graduate diPhone: 02 9654 1502 Fax 02 9654 1338 ploma in Nutritional Medicine, two diplomas in homeopathy
Centre NSW 2158
email [email protected]
www.rosenbergpub.com.au,
and a Bachelor’s Degree in Acupuncture.
ABN 88 085 426 81
JATMS
171
BOOK REVIEW
How to Increase your Fertility: A Practical DIY Guide
Stephens J. Blackheath, NSW: Verand Press, 2011. ISBN 978-1-9215-5616-6. $29.95. Available from Macmillan
Publishers Australia, telephone (02) 9285 9100 or ‹http://www.macmillan.com.au›.
W
ith twenty years in general practice as a complementary therapist, and the past ten years
specialising in natural fertility, this book’s author used her practice notes as well as her
personal experience as the basis for this work.
The text is divided into thirteen chapters—each designed as a distinct ‘consultation’ that deals
with specific aspects of increasing fertility. Readers are encouraged to follow these in their given
order for the most favourable outcomes.
Chapters 1 to 3 begin with examining the male and female reproductive systems and how they
function during conception. They then move on to general lifestyle considerations that should be
taken into account when planning a baby. Chapters 4 to 6 ensue with discussions about food intake.
Various aspects of food such as food types, allergies, nutritional values, and modes of production
are covered as well as buying, storing and cooking foods.
In Chapters 7 to 11, readers are introduced to different therapeutic applications for increasing
the potential to conceive. These applications include astrology and lunar ovulation, acupuncture and acupressure,
homoeopathy and flower essences, herbal medicine, and aromatherapy. Case studies from the author’s own clinic illustrate
how these therapies have helped her clients.
In Chapter 12 there are some last words of advice to prepare for fertility such as allowing flow and practising acceptance
as well as some ‘age-old secrets’. The final chapter offers a four-week planner to put all this guidance into action.
Charts, tables and diagrams enrich the text. Additionally, there is a list of useful contacts and websites, a bibliography
and an index. This book offers inspiration, empowerment and focus to those who are planning a family.
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JATMS
BOOK REVIEW
Medicinal Plants in Australia Volume 1: Bush Pharmacy
Williams C. Kenthurst, NSW: Rosenberg Publishing Pty Ltd, 2011. ISBN 978-1-8770-5894-3. $69.95. Available from Rosenberg Publishing, telephone (02) 9654 1502 or ‹http://www.rosenbergpub.com.au›
M
edicinal Plants in Australia: Bush Remedies is the first of four volumes in
the study of Australian plants. It follows the story of early European settlers
to Australia and their quest to discover the potential of the unfamiliar native
flora of its vast land. Original quotes from these explorers’ journals unveil the determined
and at times courageous experiments they conducted with the available vegetation—
experiments that were integral to the survival of the new colony.
The nineteenth century saw many new remedies being discovered from natural
sources in Australia. Knowledge of many of these remedies was already established in the
Aboriginal population and much of what became known about Australian bush remedies
can be attributed to their contribution. Over time however, carefully written and
illustrated documentation allowed specific knowledge to become more widely available.
As readers, we make our own discoveries about how the now well-known Australian
plant remedies extracted from plants such as Eucalyptus, Tea Tree and Lemon Myrtle
became recognised. But perhaps more intriguingly, the histories of lesser-known remedies
such as those extracted from native orchids, banksias and grass trees are also brought alive in this text.
The book is extensive in its coverage of Australian flora and its uses as medicine. It is also abundantly illustrated with
colour photographs of various plants, insects and extracts from early records. Break-out boxes offer supportive information
to the main text and tables summarise details for easy reference. Furthermore, textual references are provided throughout
and there is also a list of resources and an index at the end of the volume.
ii
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BOOK REVIEW
Medicinal Plants in Australia Volume 2: Gums, Resins, Tannin
and Essential Oils
Williams C. Kenthurst, NSW: Rosenberg Publishing Pty Ltd, 2011. ISBN 978-1-8770-5894-3. $69.95. Available from Rosenberg Publishing, telephone (02) 9654 1502 or ‹http://www.rosenbergpub.com.au›
M
edicinal Plants in Australia: Gums, Resins, Tannin and Essential Oils is the second of
four volumes in the study of Australian plants. It highlights the potential of Australia’s
rich natural plant resources and the long-standing conflict that occurs between using
trees for timber and conserving them for their medicinal value.
With the advent of antibiotics, medicinal plants became undervalued in many societies;
but with rising incidences of drug-resistant bacteria, viruses and fungi, plant-based medicines
are once again gaining their place as effective remedies. As a result, research into these remedies
has taken on greater significance and this book follows the developing expansion of knowledge
in this area.
The ten chapters in this book cover in detail the chemical constituents, medicinal applications
and growth patterns of species such as Melaleuca, Acacia, Eucalyptus, Grevillea, Canarium and
Araucaria. Of particular note is Chapter 2 which investigates the healing potential of resins
such as those that seep from the trunk of the River Red Gum; and Chapter 4, which considers the screening of native pines
for their possible anti-cancer compounds.
There is a visual feast of colour photographs peppered throughout the text as well as enlightening extracts from keen
observers of the Australian landscape—some date back to colonial times; others are more recent but no less revealing in
their insights. Textual references and a vast list of resources at the end of the volume emphasise the depth and breadth of
research that has gone into this work. An index is provided.
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174
JATMS
BOOK REVIEW
Mastering homeopathy 3; obstacles to cure: toxicity,
deficiency and infection
Gamble J. Mittagong: Karuna Publishing, 2010. ISBN 978-0-9752-4733-4. $79.00. Available from Karuna
Publishing telephone (02) 4872 1063 or <www.homeopathyorks.com.au>
T
his book would make a valuable addition to any practising homoeopath’s professional
library. It is the third volume in the Mastering Homeopathy series and uncovers many of the
mysteries as to why patients don’t respond to homoeopathic treatments.
The author speaks candidly of his own experience and frustrations in his first ten years of practice.
During this time he was often baffled by unsuccessful responses to his remedies. These frustrations
led him to delve further into the aphorisms of homoeopathy’s founder, Fredrick Hahnemann, to
discover the obstacles to treatment.
Two key concepts to be understood when considering treatment obstacles are to uncover
what is to be cured and to be aware of the causes of disease. These concepts establish the basis of a
differential diagnosis from which practitioners can treat the fundamental issues. Once these issues
are addressed, practitioners can then consider the sum of the presenting symptoms and treat them
with homoeopathic remedies, if appropriate.
Issues that create obstacles to cure stem from three categories: deficiency, infection and toxicity.
These categories of obstacles are addressed in the first three parts of the text by looking at the
symptoms, causes, and types of treatment available for associated diseases. Part 4 puts theory into practice by presenting
genuine case histories from the author’s homoeopathic practice.
To enhance understanding there are tables as well as examples of mineral hair analyses interspersed throughout. There
are also four appendixes: pathology tests and resources, hair tissue and mineral analysis, treatment summaries: how to remove
obstacles to cure, and contents of chemical protocols. The text concludes with references, a bibliography and an index.

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ATMS Journal Specials*
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

S TAT E N E W S
From Victoria
PAT R I C I A O A K L E Y
V
ictoria has been buzzing along the past few
months with our highlights being two graduation
ceremonies, our breakfast meeting on 13th July
and Sandi’s discussions about the proposed changes to
the ATMS Articles of Association to allow for election of
members to the ATMS Executive Board, as proposed in
the insert in theJune issue of JATMS.
ATMS was proud to support Melbourne graduates
from Endeavour College of Natural Health with two
awards: the first, for Clinical Excellence in the BHSc
(Naturopathy) was awarded to Elspeth Vines, and the
second, for Clinical Excellence in HHSc (Western
Herbal Medicine) to Stephanie Craze. The Melbourne
Graduation Ceremony was held on 13th May 2011 at the
Melbourne Town Hall with over 300 students graduating
in various Bachelor of Health & Science degrees. The
evening opened with an address by Dr Nicholas Vardaxis,
Director of Education at Endeavour College of Natural
Health, followed by presentation of the graduands. A
reception for staff, graduates and their guests followed and
the evening was a happy and exciting one which celebrated
the hard work and effort of so many.
I also had the honour of attending Southern School
Graduation on Saturday 21 May at Melbourne University.
It was wonderful to see happy excited graduates in their
caps and gowns presented with their well-earned degrees.
A lovely reception followed on the terrace overlooking the
university gardens.
At our breakfast meeting on July 13th Sandi
provided everyone with an update on registration issues
and information on some of the changes to look for in
our forthcoming AGM, to be held in Melbourne this
September, and told us how important it is for members
to vote even if they are unable to attend. Attendance at the
AGM will allow members to make an informed decision
so we are hoping for a record attendance. Our new logo
was discussed, along with some of the proposed changes,
including those to the ATMS Articles of Association to
allow for election of members to the ATMS Executive
Board as proposed in the insert in the June issue of the
journal over the next twelve months, making it a very
exciting time for ATMS members.The ATMS blog will be
used to let members know what is happening with views
on Practitioner Only products’
availability over the counter at health food stores and
pharmacies and an article on Preventative Medicine,
which can be viewed online, and there is to be a
brief Webinar included in a new computer setup due for
completion in September - all part of an ongoing longterm plan to challenge the availability of Practitioner Only
products without professional consultation to ensure that
a patient history is taken before deciding which herbal
products are to be dispensed to patients.
Our next breakfast meeting will be held on September
7th 2011 and any members wishing to attend and discuss
JATMS
ATMS business are very welcome. There will be a 7.30am
start for breakfast and an 8am start for the meeting at 134
Durham Rd Sunshine. Victorian Seminars this semester
include Lower Back Pain on 27 & 28 August and Heart
Health on November 6th 2011 – check ATMS website
for further details.
From New South Wales
A N T O I N E T T E B A L N AV E
D
id you attend the International Natural Medicine
Summit 2011 held at Olympic Park Homebush
Bay in May? If you didn’t you missed the best
speakers, discussion groups and workshops I have attended.
Congratulations to the organisers. Sandi Rogers closed
the event with information on our forthcoming AGM
and how any ATMS Member can stand for positions.
Please attend the AGM in Melbourne. Remember that
this is your Association.
Forthcoming Seminar Series :
• August 6 & 7 at North Gosford – Lower Back &
Pelvic Pain
• August 21 at West Ryde – Homeopathy Skills
Training (this is a very important NOT TO BE
MISSED seminar to attend, especially with all the
negative publicity on homeopathy that is current.)
• September 11 at Coffs Harbour – Natural Medicine
Solutions for Children’s Health & Wellbeing
• September 18 at Newcastle West – Mental Health
(please note that this is also the date of the AGM)
• September 25 at Richmond – ATMS Herbal
Medicine Day
• October 2 at West Ryde – Understanding & Treating
the Alzheimer’s Riddle
I have had a lot of calls from NSW practitioners
expressing how upset they were that doctors, pharmacists,
physiotherapists, chiropractors etc who have little or
no training in nutrition have been allowed to prescribe
Practitioner Only products. Your thoughts on this can be
sent to my email: [email protected] .
I look forward to catching up with you at the next
seminar.
From South Australia
SANDRA SEBELIS
W
e have been blessed with a particularly
exceptional winter – blue skies and sunshine,
daily temperatures averaging 12-15 degrees
with only very occasional showers – great weather to be
active outdoors. Following on from our last and most
successful seminar, “A Healthy Heart”, we again had the
good fortune to receive Alan Hudson and Raymond Smith
177
S TAT E N E W S
from NSW to present a very interactive and dynamic twoday workshop on April 30 and May 1 entitled “Lower
back and pelvic pain”. Booked out well in advance, there
was discussion, demonstration and then the practice
of basic assessment, palpation and massage techniques
for the pelvic girdle and lower back, and the causes and
mechanisms of pain.
On 19 June we cheered ourselves up enormously
with our seminar, “Anxious about Depression”. Our three
speakers from different backgrounds and experience
were able to enhance our understanding of depression
and its origins. Adrienne Jefferies gave us a very clear
and informative introduction to the day and the subject,
focusing on Interpersonal Therapy and Mindfulness
techniques. Thomas Dellman introduced the use of
Cognitive Behaviour Therapy (CBT) and Acceptance and
Commitment Therapy (ACT) as tools to help our clients
deal with anxiety and depression. We then spent the
afternoon with Marta Lohyn, a psychologist with many
years of clinical practice and of conducting assessments
for The Family Court. Marta’s focus was on the use of
hypnosis as a tool to strengthen our outcomes.
Our next seminar, “Arthritis and Osteoporosis”, is
scheduled for 14 August. On Saturday 23 July I participated
in a Japanese Cultural Day organised by my local Burnside
Library by demonstrating the traditional Japanese therapy,
Shiatsu. The large audience was very mixed and attentive
and, as an ex-librarian, I found it quite ironical to unroll
my futon and get down on my hands and knees – to shelve
library books. And next week again down in the Burnside
Library, I will be participating in a “Health and Well-being
Day”, teaching Yoga class.
In closing, a must read: “I’m Over All That and
Other Confessions”, by Shirley Maclain. This is a wise,
witty and fearless collection of observations and big
picture questions, plus recollections of people she had
met, and the state of Hollywood, past and present. The
honesty and humour is irresistible. She closes the book by
saying: “Our own perfection is yet to be reached, but that is
what gives us a purpose in being alive. I will not get over
this.”
From Tasmania
ust be cold down there”! A line that
everyone seems to say when I tell them I live
in Hobart. Well not from where I’m sitting
and by that I don’t mean but a few centimetres from a
heater. Perhaps many of them don’t watch the national
weather forecasts that show that Tasmania too is subject
to global warming. That on so many days we are but a few
degrees behind most mainland states and indeed on some
days actually in front on the ‘how warm is it in your area’
scale. Gone are the days when … oh you don’t want me to
regale you with stories about how cold it used to be.
178
JATMS
If you don’t remember reading that somewhere
(everywhere) then maybe you’re not taking your hawthorn
and ginkgo!
At the ATMS AGM in September in Melbourne you
will be given the chance to see, discuss, debate and vote
on some of the innovations that are being put in place
to ensure that this association leads the way with a new
image. If you cannot be part of this day ensure you have
your proxy nominated so your voice can be heard.
Some years ago, actually it was the day before the
AGM, we were having a board meeting and a football
final was being held close by. I remember watching the
thousands walking to the stadium which took them right
by where we were meeting. I commented “Those arriving
early for the AGM”.
Perhaps this year!
Oncology Massage (OM) Training ...
Dispelling myths
Eleanor Oyston
02 6236 3008 | 0417 259 026
[email protected]
Massage for a person with cancer, or a history of cancer,
needs mindful touch.This can be given to everyone by a trained
massage therapist who knows the adjustments needed for each person’s
unique situation. A powerful tool for wellbeing in our hands.
BILL PEARSON
“M
With a bit of imagination I can draw a parallel
between the growing temperature throughout the world
and the growing temperature within our profession.
Registration of TCM by July 2012. The government call
for the regulation of non registered health practitioners.
Two prime examples of why the debate is fluctuating
between two often disparate points of view.
You may remember that the ATMS viewpoint on the
regulation of the profession is that
1. We certainly need it
2. Self regulation has served its purpose and we
need to move up to the next step
3. Co-regulation would better serve us than
statutory registration
Oncology Massage offers a moment when peace and relaxation can
blossom. It provides an opportunity for the individual to reconnect with
their physical, emotional and spiritual self.
Do you have Clients living with Cancer?
Oncology Massage Training gives you the knowledge and skills to work
safely with clients who are challenged with issues that arise from cancer,
and the treatment of it. There is always a way to apply skilful, mindful touch!
Course dates, minimum qualification requirements, module
content and registration information are posted on our website.
For enrolments contact Kylie Ochsenbein
07 3378 3220 | 0410 486 767
[email protected]
www.oncologymassagetraining.com.au
H E A LT H F U N D N E W S
AUSTRALIAN
(AHM)
H E A LT H
M A N A G EME N T
Names of eligible ATMS members will be automatically
sent to AHM each month. ATMS members can check
their eligibility by telephoning the ATMS on 1800 456
855.
A U S T R A L I A N RE G I O N A L H E A LT H G ROU P
(ARHG)
This group consists of the following health funds:
• ACA Health Benefits Fund
• Cessnock District Health
• CUA Health (Credicare)
• Defence Health Partners
• GMF Health (Goldfields Medical Fund)
• GMHBA (Geelong Medical)
• Health Care Insurance Limited
• Health Partners
• HIF (Heath Insurance Fund of WA)
• Latrobe Health Services
• Lysaught Peoplecare
• MDHF (Mildura District Health Fund)
• Navy Health Fund
• Onemedifund
• Phoenix Welfare
• Police Health Fund
• Queensland Country Health
• Railway and Transport
• Teachers Union Health
• St Lukes
• Teachers Federation
• Transport Health
• Westfund
When you join ATMS, or when you upgrade your
qualifications, details of eligible members are automatically sent to ARHG by ATMS monthly. The details sent
to ARHG are your name, address, telephone and accredited discipline(s). These details will appear on the AHHG
websites. If you do not wish your details to be sent to
ARHG, please advise the ATMS office on 1800 456 855.
Remedial massage therapists who graduated after
March 2002 must hold a Certificate IV or higher from a
registered training organisation. Please ensure that ATMS
has a copy of your current professional indemnity insurance and first aid certificate.
The ARHG provider number is based on your ATMS
number with additional lettering. To work out your
ARHG provider number please follow these steps:
1. Add the letters AT to the front of your ATMS member number
2. If your ATMS number has five digits go
to step 3. If it has two, three or four digits,
you need to add enough zeros to the
front to make it a five digit number
(e.g. 123 becomes 00123).
3. Add the letter that corresponds to your
accredited modality at the end of the
provider number.
JATMS
AAcupuncture
C Chinese herb al medicine
HHomoeopathy
M Remedial massage
NNaturopathy
OAromatherapy
R Remedial therapies
W Western herbal medicine
If ATMS member 123 is accredited in Western herbal medicine, the ARHG provider number will be
AT00123W.
4. If you are accredited in several modalities,
you will need a different provider
number for each modality (e.g. if ATMS member 123 is accredited for Western
herbal medicine and remedial massage, the
ARHG provider numbers are AT00123W and
AT00123M.
AUSTRALIAN UNITY
Names of eligible ATMS members will be automatically sent to Australian Unity each month. ATMS members can check their eligibility by telephoning ATMS on
1800 456 855.
BU PA ( i n c l u d i n g H B A a n d M u t u a l C o m munity)
Names of eligible ATMS members will be automatically sent to BUPA each month. ATMS members can
check their eligibility by telephoning ATMS on 1800 456
855.
C B H S H E A LT H F U N D L I M I T E D
On joining ATMS, or when you upgrade your qualifications, the details of eligible members are automatically
sent to CBHS each month. The details sent to CBHS are
your name, address, telephone and accredited discipline(s).
These details will appear on the CBHS website. If you do
not want your details to be sent to CBHS, please advise
the ATMS office on 1800 456 855.
Please ensure that ATMS has a copy of your current
professional indemnity insurance and first aid certificate.
D O C T OR S H E A LT H F U N D
Names of eligible ATMS members will be automatically sent to Doctors Health Fund each fortnight. ATMS
members can check their eligibility by telephoning ATMS
on 1800 456 855.
G R A N D U N I T E D C OR P OR AT E
To register with Grand United Corporate, please apply directly to Grand United on 1800 249 966.
HBF
To register with HBF, please contact the fund directly
on 13 34 23.
179
H E A LT H F U N D N E W S
H C F A N D M A N C H E S T ER U N I T Y
Names of eligible ATMS members will be automatically sent to HCF and Manchester Unity each fortnight.
ATMS members can check their eligibility by telephoning
ATMS on 1800 456 855.
MB F A LL I A N C E S
Names of eligible ATMS members will be automatically sent to MBF Alliances each month. ATMS members
can check their eligibility by telephoning ATMS on 1800
456 855.
ME D I B A N K P R I VAT E
Names of eligible ATMS members will be automatically sent to Medibank Private each month. ATMS members can check their eligibility by telephoning ATMS on
1800 456 855.
NIB
NIB require Health Training Package qualifications
for naturopathy, Western herbal medicine, homoeopathy,
nutrition, remedial massage, shiatsu and Chinese massage.
Australian HLT Advanced Diploma qualifications are the
minimum requirements for acupuncture and Chinese
herbal medicine. Names of eligible ATMS members will
be sent to NIB each week. NIB accept overseas qualifications which have been assessed as equivalent to the Australian qualification by Vetassess or and RTO college.
All recognised provides must agree to the NIB Provider Requirements, Terms and Conditions as a condi-
tion of NIB provider status. The document is available
at http://providers.nib.com.au. Alternatively, a copy can
be obtained by emailing [email protected] or calling
NIB Provider Hotline on 1800 175 377. It is not necessary for ATMS members to complete the application form
attached to NIB Provider Requirements, Terms and Conditions.
ATMS members currently recognised by NIB and
who have not submitted their renewed professional indemnity insurance and/or first aid certificate to ATMS
must do so immediately, or they will be removed from the
NIB list.
Documents needed for members to remain on the
health fund list
To remain on the health funds list, members must
have a copy of their current professional indemnity insurance and first aid certificate on file at the ATMS office and
must meet the CPE requirements. Please ensure that you
forward copies of these documents to the ATMS office
when you receive your renewed certificates.
Lapsed membership, insurance or first aid will
result in a member being removed from the health
funds list. Upgrading qualifications may be required to be re-instated for some health funds.
C H A N G E O F D E TA I L S
The ATMS office will forward your change of details
to your approved health funds on the next available list.
Health funds can take up to one month to process change
of details.
Review of the
Understanding
Knee & Associated
the
Dysfunctions
Iliopsoas
16th October
23rd October
Greg Morling and Patrick de Permentier
Anatomy dissection room in the morning and
practical massage session in the afternoon for both
workshops at the University of NSW, Kensington.
These workshops are very popular and places fill quickly.
Book online at www.mostlymassage.com or email [email protected]
Call 02 9713 9256 for flyer & more information
180
JATMS
JATMS
181
 Therapy covered by Fund
* Need to Apply directly to Fund
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^ BUPA includes MBF, NRMA Health Insurance, HBA, Mutual Community, SGIC Health Insurance, and SGIO Health Insurance
# Manchester Unity no longer accepting new providers after merge with HCF
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HCF
Manchester Unity#
Medibank Private
NIB
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Queensland Country Health
Railway and Transport
Reserve Bank Health Society
St Lukes
Teachers Federation
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Navy Health Fund
Onemedifund
Peoplecare Health Insurance
Phoenix Health Fund
Police Health Fund
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Health Care Insurance Limited
Health Partners
HIF (Health Insurance Fund of WA)
Latrobe Health Services
MDHF (Mildura District Hospital Fund)
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BUPA^
CBHS Health Fund
Doctors Health Fund
GU Health (Grand United)*
HBF*
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3
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Teachers Union Health
Transport Health
Westfund
Australian Unity
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Cessnock District Health
CUA Health (Credicare)
Defence Health Partners
GMF Health (Goldfields Medical Fund)
GMHBA (Geelong Medical)
2
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ACA Health Benefits Fund
Health Fund
Australian Health Management
Australian Regional Health Group
H E A LT H F U N D U P D AT E J U N E 2 0 11
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19
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20
Traditional Chinese Massage
Traditional Thai Massage
Reflexology
Remedial Massage
Remedial Therapies
Shiatsu
Sports Massage
Hypnotherapy
Iridology
Kinesiology
Naturopathy
Nutrition
Chinese Herbal Medicine
Counselling
Deep Tissue Massage
Herbal Medicine
Homeopathy
Acupuncture
Alexander Technique
Aromatherapy
HICAPS do not cover all Health Funds nor all
modalities. Please go to www.hicaps.com.au
for further information.
Rebates do not usually cover medicines, only
consultations. For further rebate terms and
conditions, patients should contact their health
fund. Policies may change without prior notice.
ATMS accreditation in a modality does not
guarantee provider status as all funds have
their individual set of strict eligibility
requirements. Please see our website
www.atms.com.au or contact our office for
current requirements.
Please note that this table is only a guide to
show what funds cover ATMS accredited
modalities. If the modality that you are
accredited for is not listed, this means that no
health fund covers the modality. The only
exceptions are Chiropractic and Osteopathy.
19
20
14
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4
5
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1
2
3
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C O N T I N U I N G P R O F E S S I O N A L E D U C AT I O N
C
ontinuing professional education (CPE) is a structured program of further education for practitioners in the professional occupations.
The ATMS CPE policy is designed to ensure its practitioners regularly update their clinical skills and professional knowledge. One of the main aims of CPE is keep
members abreast of current research and new developments which inform contemporary clinical practice.
The ATMS CPE Policy is based on the following
principles:
• Easily accessible to all members, regardless of geographic location
• Members should not be given broad latitude in the
selection and design of their individual learning programs
• Applicable to not only the disciplines in which a member has ATMS accreditation, but also to other practices that are relevant to clinical practice which ATMS
does not accredit (e.g. Ayurveda, yoga)
• Applicable to not only clinical practice, but also to all
activities associated with managing a small business (e.g.bookkeeping, advertising)
• Seminars, workshops and conferences that qualify for
CPE points must be of a high standard and encompass both broad based topics as well as discipline-specific topics
• Financially viable, so that costs will not inhibit participation by members, especially those in remote areas
• Relevant to the learning needs of practitioners, taking
into account different learning styles and needs
• Collaborative prSetocess between professional complementary medicine associations, teaching institutions, suppliers of therapeutic goods and devices and government agencies to offer members the
widest possible choice in CPE activities
• Emphasis on consultation and co-operation with
ATMS members in the development and implementation of the CPE program
• Muscolino J. Clinical orthopedic neck massage
• Kouris A. Drug nutrient herb interactions in the older
patient
• Medhurst R. Homoepathy and tobacco craving
• Pagura I. The Fair Work Act 2009 and you
As part of your critical reflection and analysis, answer
in approximately 100 words the following questions for
each of the three articles:
1. What new information did I learn from this
article?
2. In what ways will this information affect my
clinical prescribing/techniques and/or my
understanding of complementary medicine
practice?
3. In what ways has my attitude to this topic changed?
Record your answers on a separate sheet of paper for
each question. Date and sign the sheets and attach to your
ATMS CPE Record. As a condition of membership, the
CPE Record must be kept in a safe place, and be produced
on request from ATMS.
ATMS members can gain CPE points through a wide
range of professional activities in accordance with the
ATMS CPE policy. CPE activities are described in the
CPE policy document as well as the CPE Record. These
documents can be obtained from the ATMS office (telephone 1800 456 855, fax (02) 9809 7570, or email info@
atms.com.au) or downloaded from the ATMS website at
www.atms.com.au.
It is a mandatory requirement of ATMS membership
that members accumulate 20 CPE points per financial
year.
Five 5 CPE points can be gained from each issue of
this journal. To gain five CPE points from this issue, se
lect any three of the following articles, read them carefully
and critically reflect how the information in the article
may influence your own practice and/or understanding of
complementary medicine practice:
• Grace S, Rogers S and Eddey S. The natural medicine
workforce: Terms in public use
• Lim C and Cheng N. Obesity and reproduction
JATMS
183
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most advanced work. NST incorporates the
philosophy of DeJarnette's, Sacro Occipital
Technique and is validated according to the
principles of Applied Kinesiology.
NST allows you to access Bowen's astonishing
intuitive powers via the philosophy and
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techniques you will learn at this workshop.
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Non-invasive and generally a lighter touch
compared to similar bodywork therapies.
NST results are usually instantly noticeable and 5 day workshop convenor Ron Phelan is a
Remedial Masseur, Bowen therapist and
generally long lasting.
NST educator with many years of professional teaching and therapeutic experience.
He is committed to spreading the benefits
of this world-renowned mode of therapy.
Find out more about all NST workshops.
Call Ron yourself on 03 5255 5229.
Note : Both NST Basic and NST Introductory courses
are accredited for CPE points
(Continuing Professional Education)
Presenting the new NST 2 day
Introductory course team
Marianne Grainger (Perth), Michael Howse(Wodonga) and Robert Monro
(Brisbane) have joined Sylvia Callander (Melbourne) to form the Australian
NST Introductory course team. Together they provide quality NST
Introductory courses across Australia. All are qualified in NST and have many
years experience as both remedial massage, teaching and as NST practitioners.
The NST Introductory Training is a two-day workshop designed for both
beginners and the experienced alike. The main objective is to provide an
introduction into the basic philosophy and practice of NST.
Participants will learn a powerful Integrated Body Balance (IBB) essentially
an extract from the NST Basic Workshop famous Dynamic Body Balance.
2011 NST Introductory class dates
Marianne - Perth (WA) Nov 5th/6th, Michael - NSW
- Canberra, Victoria. Robert - Brisbane - November
To run a class in your area, contact us now
Marianne : 0407036047 Michael : 0417047412
Robert : 0400705190 Sylvia : 0417368100
to
2011 5 day Basic level dates
Geelong area Nov 24th-28th
Sydney
Dec 2nd -6th
2012 March - Melbourne, Perth
Plus 2 new innovative courses
3 Day Physical Assessment Skills course
November 5th-7th
3 Day Biochemical and Emotional
assessment and balancing techniques
November 11th-13th
Sunshine coast, Queensland
NST
NeuroStructural
NeuroStructural
Integration
Integration
Technique
Technique
For
For bookings
bookingsor
or further
further
information,
information, phone
phone
Ron
Ron Phelan
Phelan on
on
03 5255 5229
or
or email
email
[email protected]
CODE OF CONDUCT
PREAMBLE
C
omplementary medicine is a holistic approach
to the prevention, diagnosis and therapeutic
management of a wide range of disorders in the
community. Complementary medicine practice is founded
on the development of a therapeutic relationship and the
implementation of therapeutic strategies based on holistic
principles. Complementary medicine encompasses a
diversity of practices to improve the health status of the
individual and community for the common good.
The aim of the Code of Conduct is to make it easier for
members to understand the conduct which is acceptable
to ATMS, the complementary medicine profession and
to the wider community, and to identify unacceptable
behaviour. The Ethical Principles underpin the standards
of professional conduct as set out in the Code of Conduct.
The intention of the Code of Conduct is to identify
ethical dilemmas and assist ATMS members in resolving
them. ATMS members are accountable for their clinical
decision making and have moral and legal obligations for
the provision of safe and competent practice.
Where an ATMS member encounters an ethial
quandary, it is advisable to seek appropriate advice. If this
action does not solve the matter, the advice of ATMS
should be sought. The purpose of the Code of Conduct
is to:
• Identify the minimum requirements for practice in the
complementary medicine profession
• Identify the fundamental professional commitments
of ATMS members
• Act as a guide for ethical practice
• Clarify what constitutes unprofessional behaviour
• Indicate to the community the values which are
expected of ATMS members
The Code of Conduct was established as the basis
for ethical and professional conduct in order to meet
community expectations and justify community trust in
the judgement and integrity of ATMS members.
While the Code of Conduct is not underpinned in
statute, adoption and adherence to it by ATMS members
is a condition of ATMS membership. A breach of the
Code of Conduct may render an ATMS member liable
for removal from the Register of Members.
ETHICAL PRINCIPLES
• Practitioners conduct themselves ethically and
professionally at all times.
• Practitioners render their professional services in
accordance with holistic principles for the benefit
and wellbeing of patients.
• Practitioners do no harm to patients.
• Practitioners have a commitment to continuing
professional education to maintain and improve their
professional knowledge, skills and attitudes.
• Practitioners respect an individual’s autonomy, needs,
values, culture and vulnerability in the provision of
complementary medicine treatment.
• Practitioners accept the rights of individuals and
encourage them to make informed choices in relation
JATMS
to their healthcare, and support patients in their
search for solutions to their health problems.
• Practitioner treat all patients with respect, and do
not engage in any form of exploitation for personal
advantage whether financial, physical, sexual,
emotional, religious or for any other reason.
DUTY OF CARE
• The highest level of professional and ethical care shall
be given to patients.
• The practitioner will exercise utmost care to avoid
unconscionable behaviour.
• The patient has the right to receive treatment that is
provided with skill, competence, diligence and care.
• In the exercise of care of the patient, the practitioner
shall not misrepresent or misuse their skill, ability or
qualifications.
PROFESSIONAL CONDUCT
• Practitioner members must adhere to all of the
requirements of this Code of Conduct and State,
Territory and Federal law within the scope of their
practice.
• The title of Doctor or Dr will not be used, unless
registered with an Australian medical registration
board.
• Under no circumstances may a student, staff
member or another practitioner use someone else’s
membership number or tax invoice book for the
purposes of issuing a health fund rebate tax invoice.
The member is responsible for the issue of their own
tax invoices.
• The practitioner shall not provide false, misleading or
incorrect information regarding health fund rebates,
WorkCover, ATMS or any other documents.
• The practitioner shall not advertise under the
ATMS logo any discipline(s) for which they are not
accredited with ATMS.
• The practitioner shall not denigrate other members of
the healthcare profession.
• The practitioner shall be responsible for the actions
of all persons under their employ, whether under
contract or not.
• The practitioner shall not engage in activity, whether
written or verbal, that will reflect improperly on the
profession of ATMS.
• In the conveying of scientific or empirical knowledge
to a patient, the practitioner shall act responsibly, and
all personal opinions shall be highlighted as such.
• Students shall not engage in clinical practice
other than as part of supervised training. In all
other student obligations, students must identify
themselves as such and not charge a fee.
• In the clinical setting, the practitioner shall not be
under the influence of any substance capable of
impairing professional judgement.
• The medicines and medical devices used by the
practitioner must be in accordance with therapeutic
goods law.
185
CODE OF CONDUCT
• Telephone or Internet consultations, without a prior
face-to-face consultation, must not be conducted.
• The fee for service and medicines charged by the
practitioner must be reasonable, avoiding any excess
or exploitation,
R E L AT I O N S H I P B E T W E E N
P R A C T I T I O N E R A N D PAT I E N T
• The practitioner shall not discriminate on the
basis of race, age, religion, gender, ethnicity, sexual
preference, political views, medical condition,
socioeconomic status, culture, marital status, physical
or mental disability.
• The practitioner must behave with courtesy, respect,
dignity and discretion towards the
• Patient, at all times respecting the diversity
of individuals and honouring the trust in the
therapeutic relationship.
• The practitioner should assist the patient find another
healthcare professional if required.
• Should a conflict of interest or bias arise, the
practitioner shall declare it to the patient, whether
the conflict or bias is actual or potential, financial or
personal.
another healthcare professional.
• The patient has a right to be adequately informed as
to their treatment plan and medicines, and access to
their information as far as the law permits.
ADVERTISING
• Advertisements, in any form of printed or electronic
media must not:
• Be false, misleading or deceptive
• Abuse the trust or exploit the lack of knowledge of
consumers
• Make claims of treatment that cannot be
substantiated
• Make claims of cure
• Use the title of Doctor, unless registered with an
Australian medical registration board
• Encourage excessive or inappropriate use of
medicines or services
• List therapies for which the practitioner foes not have
ATMS accreditation if the ATMS logo or name is
used.
PROFESSIONAL BOUNDARY
• The practitioner will not enter into an intimate or
sexual relationship with a patient.
• The practitioner will not engage in contact or gestures
of a sexual nature to a patient.
• Mammary glands and genitalia of a patient will
not be touched or massaged and only professional
techniques applied to surrounding tissue.
• Any internal examination of a patient, even with the
consent of the patient, is regarded as indecent assault
which is a criminal offence.
• Any approaches of a sexual nature by a patient must
be declined and a note made in the patient’s record.
TCM LIQUID EXTRACT – DISPENSARY SERVICE
traditional values & modern solutions
P E R S O N A L I N F O R M AT I O N A N D
CONFIDENTIALITY
• The practitioner will abide by the requirements of
State, Territory and Federal privacy and patient
record law.
• The practitioner shall honour the information given
by a person in the therapeutic relationship.
• The practitioner shall ensure that there will be no
wrongful disclosure, either directly or indirectly, of a
patient’s personal information.
• Patient records must be securely stored, archived,
passed on or disposed of in accordance with State,
Territory and Federal patient record law.
• Appropriate measures shall be in place to ensure that
patient information provided by facsimile, email,
mobile telephone or other media shall be secure.
• Patient records must be properly maintained with
adequate information of a professional standard
• The practitioner must act with due care and obtain
consent when conveying a patient’s information to
186
JATMS
For more information
or free samples
call 03 5956 9011
www.safflower.com.au
[email protected]
fax 03 5956 9344
LEARN N EARN WITH OUR ONLINE
STUDY MODULES
Build on your Continuing Education points from home via
our Centre for Learning website, where you can, at your
convenience, simply log on, pay for your Study
Module, sit the quiz and instantly receive your
3 CPEs per m
odule
Our New Release Study Modules are fully interactive,
making the learning experience both fun and increasing
your knowledge retention.
Go to www.comphs.com.au and click on the ‘Nav Bar’ here
and you’ll be a few steps away from gaining 3 CPE points.
Certiﬁcate of Completion.
Complementary Health Seminars PO Box 5086, Alphington, VIC 3078 W: www.comphs.com.au E: [email protected] T: 03 9481 6724
JATMS
187
AUSTRALIAN TRADITIONAL MEDICINE SOCIETY
The ATMS Simon Schot
Education Grants ($10,000)
Proudly sponsored by Marsh
What is the Purpose of the Grants? The purpose
of the grants is to encourage and assist 10 ATMS accredited members to undertake further education in
natural medicine. The grants will subsidise an ATMS
accredited course at an ATMS recognised course, or a
research project in natural medicine at an appropriate
tertiary institution.
How Do the Grants Work? The grants consist of 10
prizes of $1,000 each. The grants will be paid directly
to the institution. The ten winners will be decided by a
draw to be held in March 2012.
How To Apply for the Grants? The grants are open
to all ATMS Accredited and Student members. To apply simply send a letter to ATMS with your name, address, telephone number, ATMS membership number
and the name of the ATMS accredited course or the
research project you wish to undertake if successful.
The winners must generally commence studies no later
than July 2012.
Send your letter to:
Simon Schot Education Grant, ATMS, PO Box 1027
Meadowbank NSW 2114;
Or by Fax to (02) 9809 7570; Or by email to
[email protected]
Your Source for Massage DVD
We have the largest &
best collection of
massage books & DVDs
Advance Your Knowledge!
Approved CPE Points
More than 200 DVD titles in stock
Myofascial Release, Deep Tissue Massage, Anatomy,
Trail Guide to the Body, Neuromuscular Therapy,
Anatomy Trains, Myoskeletal Alignment, OrthoBionomy,
Positional Release, Craniosacral, Polarity Therapy,
BodyReading, Visceral Manipulation, Stretching,
Orthopedic, Lymphatic Drainage, Sports, Esalen,
Nerve Mobilization, Stone, Pregnanc
Pregnancy, Infant,
Reiki, Lomi Lomi, Equine, Canine, Fibromyalgia,
Chair, Ayurvedic, Shirodara,Shiatsu, Acupressure,
Thai Massage, TuiNa,QiGong, Tai Chi, Reflexology,
Zen Shiatsu, Yoga, Spa, Beauty Therapy and more
Visit www.terrarosa.com.au
Or Call 0402 059570 for a free catalog
The deadline to apply for the Education Grants is 2 March 2012.
188
JATMS
AUSTRALIAN TRADITIONAL MEDICINE SOCIETY
Free Website and Email Entries in ATMS Internet Directory
I
n an average month, the ATMS website receives 300,000 hits. To take advantage of this large public exposure, members can now have their websites and/or email addresses included in the ATMS Internet Directory.
H O W D OE S I T W OR K ?
When a consumer searches for a practitioner on the ATMS Internet Directory, the search search result page currently
shows your name, membership number, suburb or town, telephone number(s), qualifications and language(s) spoken.
With this free service, your website and/or email address(es) will also be shown.
EM A I L A D D RE S S O N LY
It is a free service to have your email address included in the ATMS Internet Directory but we need your written permission to release your information into the public domain.
W EB S I T E A N D EM A I L A D D RE S S E S
It is also a free service to have both your website and email addresses included in the ATMS Internet Directory, and
your written permission is also required
W EB S I T E A N D EM A I L RE G I S T R AT I O N
To obtain a copy of the registration form, telephone the ATMS office on 1800 456 855, send an email to: info@atms.
com.au or send a fax to (02) 9809 7570 and request a copy of the registration form.
Important News For New South Wales Members
T
he NSW Government Commission for Children and Young People requires that from 1 May 2011 all self employed persons who have direct unsupervised contact with children in their employment must hold a Certificate
for Self Employed People issued by the Commission. To hold a Certificate for Self Employed People, a self employed person needs to first undergo a police check.
This requirement applies to all NSW ATMS members who have unsupervised contact with children in their practice.
In order to gain the Certificate, the Commission’s application form must be lodged with a police station. There is an application fee of $80.
The police check may take some time, so do not delay lodging the application. Fines and other penalties may apply if
after 1 May 2011 a self employed person has unsupervised contact with a child while undertaking their employment,but
does not hold the Certificate.
Information about applying for the Certificate may be found on the Commission’s website:
https://check.kids.nsw.gov.au/#self-employed
If you require further information after checking the Commission’s website, please telephone Matthew Boylan on
1800 456 855.
JATMS
189
Canonical Chinese Medicine is the style of Chinese
Medicine practiced along the tenets codified in the
Western and Eastern Han dynasty medical classics
or canons.
The seminar will introduce multiple foundational
aspects of the Shanghan Lun - Jingui Yaolue and its
relationship to the Yellow Emperor's Inner Canon
Huangdi Neijing, the Canon of Difficulties Nanjing,
the Devine Farmer's Canon of Materia Medica
Shennong Bencao Jing, and the Yiyin Decoction
Canon Yiyin Tangye Jing.
TOPICS TO BE DISCUSSED:
 Canonical Characteristics of the Shanghan Zabing
Lun
 Five Flavours Dynamics in Formula Design
 Cosmological Formula Attribution of the Tangye
Jung
 Zhang Zhongjing formulas organised by Seven
Formula Structures
 Pulse Diagnosis Integration in Pattern Recognition
 Shanghan Zabing Lun Acupuncture & Moxibustion
 Advanced Clinical Work Flow: Disease-PulseFormula
 Tian Lineage Shanghan Lun Style
 Five Phase and Six Qi School of Shanghan Lun
 Five Spirit School
 Advanced Pulse Understanding
Registrations: CHINA BOOKS 1300 66 1484
  & ICEAM
Elementary Aspects of Canonical
Chinese Medicine
Melbourne: Sep 24-25 Clinic Sep 26-27
Sydney: Oct 1-2



 


This seminar will change the way you practice!



Email: [email protected]
A comprehensive Practice Management Solution
ASSIST© is a computer software solution developed for the alternative &
complementary medicine practitioner.
ASSIST© is a must for every practice, implementing ASSIST© will increase your
productivity and enhance your professional image.
With ASSIST© information is at your fingertips. Easily create, access and update;
ASSIST© incorporates an
easy to use electronic
library, including the
capability to add or
update references.
Employ ASSIST© to help
take care of your business
and patients.
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Appointments
Patient History
Clinical Notes
Photographs / Images
Prescriptions
Invoices
Taking Care of Business & Patients.
ASSIST© by
escientia
190
email [email protected]
phone 1300 729 866
www.esci.com.au
JATMS
ATMS members may find the following information useful to share with their clients. It has been kindly provided by
Garry Lavis, National President of Australian Association of Massage Therapists. (AAMT)
Arthritis and Massage Therapy – Improving Mobility and
Managing Pain
D
id you know that massage therapy can help
alleviate some of the symptoms and reduce pain
of arthritis?
The benefits of massage vary on an individual level,
depending on a person’s condition. Generally speaking,
research has shown that massage therapy can help reduce
swelling, improve circulation, reduce muscle tension, alleviate pain, and improve flexibility.
I S M A S S A G E S U I TA BLE F OR Y OU ?
To ensure remedial massage therapy is an appropriate
treatment option for you, talk to your GP and find out
how massage can complement your arthritis management
plan.
Remedial massage therapy treatment goals for people
with arthritis generally focus on decreasing pressure or
tension on joints, decreasing pain, increasing range of motion, increasing circulation and promoting relaxation.
W H AT T Y P E O F M A S S A G E I S N O T
S U I TA BLE F OR P EO P LE W I T H
ARTHRITIS?
Massage therapy may not be appropriate when joints
are inflamed, check with your GP or rheumatologist.
Qualified and accredited massage therapists are trained to
identify these conditions and adapt their treatment techniques based on an individual’s needs.
W H AT T O T ELL Y OUR M A S S A G E
T H ER A P I S T P R I OR T O T RE AT ME N T
It is important that your therapist is aware of your diagnosed condition, as there are many forms of arthritis,
each with its own particular needs for appropriate treatment. You’ll need to advise them of your medical and
paramedical treatments, general health status and your use
of medications, vitamins and supplements. If you have allergies, also mention these. In follow-up consultations, be
sure to update your therapist about the effects of the previous treatment and of any changes to your condition. And,
if you experience any discomfort during your treatment,
let your massage therapist know.
C H OO S I N G A Q U A L I F I E D
M A S S A G E T H ER A P I S T
Massage therapists may have different levels of training depending on the type of massage they practice. To be
assured that your therapist has formal, accredited qualifications and adheres to a code of ethics, check that they are
a member of a recognised professional association. When
JATMS
choosing a massage therapist, check that they are also experienced with working with arthritis.
Four facts about massage therapy for people with
arthritis:
• Remedial massage can help alleviate pain, improve
flexibility and reduce muscle tension
• It is common for hand and knee areas to benefit from
massage
• Massage is not appropriate when joints are inflamed
• Massage therapists can work with your GP to complement your treatment plan.
JATMS is a quarterly publication of the Australian
Traditional Medicine Society. It publishes
information and peer-reviewed articles of interest
to the practitioners of all branches of natural
medicine and healing who constitute the nationwide membership of the Society. The Journal is
produced by AdVerba Editing Services. The Editor
is Dr Sandra Grace and the Assistant Editor is
Stephen Clarke. Layout is By Sarah Craig.
All ATMS members are encouraged to contribute
to their Journal. Scholarly articles will be submitted
to the Peer Review Board and should conform to
the Guidelines for Authors, which can be found on
the Society’s website: http://www.atms.com.au/
journal/Journal_Instructions.asp
Letters to the Editor are also welcomed.
For further information please send emails to the
Editorial Board: [email protected]
JATMS is distributed free to all ATMS members. If
you are not a Society member and wish to subscribe
to JATMS, Associate Membership is available
for an annual fee of $66 plus a once-only joining
fee of $44.
191