17 traditional medicine modalities discriminated against

The 2016 federal elections are really about the control of Australia’s health system.
And many special interest groups are using the elections to further their agendas at a time when the election polls are showing a “neck and neck” result between the major parties.
One little drama played out recently was the Victorian legislation enacted after a review of 17 natural health services that attracted a government rebate through health funds.
When you realise how stacked the committee was, you cannot have confidence in the outcome.

The Natural Therapies Review Advisory Committee was comprised of the following people:
Membership
Chair Prof. Chris Baggoley Chief Medical Officer, Department of Health Members
Mr Jim Olds Australian Natural Therapists Association
Ms Eta Brand Australian Naturopathic Practitioners Association
Dr Raymond Khoury Australian Traditional Medicine Society
Mr Trevor Le Breton Australian Traditional Medicine Society
Dr Ken Harvey Consumers Health Forum of Australia
Ms Alison Marcus Consumers Health Forum of Australia
Dr Brian Hanning Health Insurance Restricted Membership Association of Australia
Mr Greg Kovacs Private Healthcare Australia
Mr Glenn Ruscoe Technical Expert Physiotherapy
Prof. Paul Glasziou Technical Expert Medical
Ms Debbie Rigby Technical Expert Pharmacy

Observers
NHMRC
Department of Health
Prof. Alan Bensoussan Technical Expert Complementary Medicines

Although the Friends of Science in Medicine (FSM) were not officially on the committee, there are at least six (possibly more) FSM members involved there, representing other organisations.
FSM as an organisation carries a strong bias against natural medicine and works to destabilise, disrupt or destroy natural health modalities.
It has an extreme agenda and is thought to have links back to global pharma’s and works to preserve a monopoly position for global drug companies through doctor controlled organisations.

So the strategy employed within this committee is almost identical to that employed by the NHMRC when it held its investigation into homeopathy i.e an FSM chairman in a supposed non-biased committee, and no research papers allowed that were not published in English.
However there were some modest advances over the original NHMRC homeopathy committee investigation in that at least some experts were able to present their case, but given the NHRMC was there in oversight with its already proven bias already established for the 17 modalities under review, it was simply an exercise in window dressing.

That government is wasting time and money on targeting harmless and helpful natural health services is simply irrelevant and pointless, particularly when it is known that medical error is now the third most frequent cause of death causing distress, and with an excessive cost that makes the natural modalities under attack seem insignificant

The best analysis of this legislation was prepared by the Australian Integrated Medicine Association (AIMA) which published the following statement:

Response to the Review on Private Health Insurance Rebates for Natural Therapies

“In the 2012/2013 Budget, the previous Government tasked the Chief Medical Officer, Professor Chris Baggoley AO, with undertaking a review of certain natural therapies to determine whether or not these therapies should continue to attract the Australian Government Rebate on private health insurance.
The Office of the National Health and Medical Research (NHMRC) assisted the Department with the review in the assessment of submissions and also by supervising the evidence reviews of the in scope natural therapies.
The purpose of the Review was to ensure that natural therapies are underpinned by a credible evidence base that demonstrates their clinical efficacy, cost-effectiveness and safety and quality.

Submissions were sought and AIMA provided both a written submission and a presentation to the Advisory Committee.

To view the many publicly available detailed submissions provided to the review, see here.

The final report was released in November and can be viewed here.

Unfortunately, it is impossible to properly appraise the findings and conclusions made by the Natural Therapy Review Advisory Committee because the methodology and results were inadequately described.

The report acknowledges the following methodological weaknesses:

‘1.  Literature searches were restricted to systematic reviews (SRs) published within the last 5 years (see page 21)

2. The searches were limited to SRs published in the English language databases, although these SRs may have included primary studies published in other languages.
For some disciplines there is potentially a body of literature published in languages other than English, which may have reduced sources of evidence from being considered (Editor’s Note: this was the method also employed by the NHMRC when it conducted an earlier investigation into homeopathy).

3. There was considerable variation in the therapies that were reviewed and this necessitated some variation in the methodological approach.  An alternative and more feasible approach in some circumstances was to consider the ‘health service’ delivered by the therapist, particularly for herbalism, naturopathy and myotherapy.”

4. The report also fails to meet the internationally recognised PRISMA statement for reporting systematic reviews. In particular, it is frustrating that the search terms that were used to search the literature are not reported, because this prevents anyone from critically appraising the systematic reviews for bias and quality. It is perplexing that clinical trials published before 2008 were excluded, particularly since there was a paucity of recently published research for many therapists and unlike pharmaceuticals, the therapeutic approach of traditional therapies changes little over time.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009, 339:b2700.

5. It is also nonsensical to only include research evaluating the healthcare practice rather than the therapeutic interventions such as herbs, nutraceuticals, acupressure, lifestyle modifications etc that are used by the practitioners. Across the board, the majority of published medical research examines the safety, efficacy and cost effectiveness of specific interventions rather than the practitioner or health service. It would be interesting to apply the same limited methodology used in this report to other allied healthcare practitioners and medical specialists.

6. In addition, the method chosen which was to search for systematic reviews (level 1 evidence), to accept any RCTs (level 2 evidence) published after the systematic review and ignore all research with lower levels of evidence. The logic is that the systematic review should capture all the previous RCTs.
It is worth noting however, that the NHMRC is possibly the only body to still use an evidence hierarchy. WHO, Cochrane, GRADE, NIH, NICE, SIGN, USPSTF and others have all stopped using this approach because amongst other things, people are then more likely to inappropriately ignore lower levels of evidence, as has been the case in this instance.
The trend to stop using an evidence hierarchy began in 2006.
The NHMRC is now well behind international standards.

7. Unfortunately, due to these various concerns with the chosen methodology and substandard reporting of the methodology in the published report, AIMA is unable to make any credible conclusions about the therapies which were reviewed. We do support the call for further research included in the report, and their acknowledgement of the shortcomings of a report with such limited assessment of the available evidence.

“The absence of evidence does not in itself mean that the therapies evaluated do or do not work. Natural therapies emerged in an environment where there was not a premium on rigorous evidence base. Where there is limited evidence in some modalities, there is value in conducting more research. It is also possible that there is a lack of evidence because the therapies are not effective, but it is also possible that further research may identify clinical conditions for which particular therapies are effective.”

AIMA holds to its core mission and values which are:

*  To act as the peak medical body promoting the practice of evidence-based integrative medicine, research and education as the gold standard for optimising wellbeing, prevention and management of disease in Australasian health care systems.

* To encourage a holistic attitude amongst doctors and medical students and enhance skills in whole person medicine.

* To encourage the ‘wellness’ paradigm amongst medical practitioners by fostering an attitude of Prevention and Health Promotion as a fundamental cornerstone in primary care.

* To foster an attitude of respect for the rights of patients to exercise choice, and ownership of their treatment and management, and doing so with the giving of proper information, both mainstream and complementary to assist patients with their decision towards consent or refusal of specific treatments.

What we do know is that there are high levels of evidence regarding good patient – reported evidenced outcomes as reported at a recent Australian Commission on  Safety and Quality in Health Care consultation. We know the inherent benefits of ‘patient-centred care”.
We also know that we have the support of the IM profession and the public, who will always of course, vote with their feet… and they are.”

I have selected the AIMA position statement, because it is an excellent and balanced version for adoption by pharmacy, particularly as we are yet to see an official response from pharmacy.
It also clearly shows that there is no evidence or reason for attacking the modalities under review in the first place.

However, there does appear to be some contamination of some of pharmacy’s policy settings because after the findings by the NHMRC re homeopathy, there was a rush to ban homeopathy in any form within pharmacy by the Australian Liaison Pharmacy Forum (APLF), with no debate or discussion available for individual pharmacists.
PSA also made similar statements.
I simply find this state of affairs appalling and undemocratic, and appears to follow a “party line” established by FSM.
To add to this toxic pool of activity there have been ongoing criticisms of pharmacy like the one that recently appeared in Australian Doctor under the headline “NHMRC boss slams pharmacists over homeopathy”.
In the article, a speech is described as being made by Professor Warwick Anderson, (CEO of the NHMRC) and it is reported he takes issue with pharmacists who continue to sell non-evidence based homeopathic products to patients.
His argument against homeopathy is that it lacks high quality evidence for its effectiveness.
He says nothing about how a biased NHRMC committee manufactured a result that distorted an appropriate finding.
But he does go on to note that while pharmacists are an evidence-based profession, why are they selling products which are unproven, this blurring the boundaries between what is evidence based practice, and what is not?
He further stated:
“Pharmacy … is a profession based on and trained in science,” he said.
“So it comes as a shock to walk into some pharmacies to see them urging products on customers where there is no evidence base of effectiveness.
“If you’re providing advice and care to patients, you should be clear about the evidence for the treatment.”

And the above is a reasonable statement if the umpire is not skewing the evidence base and changing the rules of patient engagement to restrict or eliminate their choices.

Well, Mr Anderson, i2P can assure you that it comes as a shock when the NHMRC allows filtered evidence to be presented by your investigators that excludes valid evidence that would support the natural health modalities and that your homeopathy committee allowed for biased control and management of your recent findings against homeopathy.
That your hierarchy of evidence system was abandoned in 2006 by the rest of the world illustrates how far you have fallen behind world standards.
That you purport to represent the highest level of arbiter for health evidence in Australia is simply ludicrous.

Professor Anderson made claims that Australians spend more money on complementary and alternative treatments than was being spent on the PBS for what he described as “ethical treatments”.
And this is the crux of the matter – patients are marching with their feet and spending more on natural health than global pharma’s and their medical allies can bear.

Professor Anderson further amplifies his bias when he states:
“This becomes an even more ethical dilemma when non-evidence based homeopathic treatments are chosen instead of evidence based pharmaceuticals to the detriment of both the patient and the public at large.”
“Some of these [private health insurance] rebates are [paying] for what we tend to call traditional medicine where they might not have a good evidence base,” Professor Anderson said. “Removing … public or private reimbursement of these treatments that have no evidence would save heaps, including on your private insurance.”

Well it might come as a surprise to you Professor Anderson, that it is the general public that is marching with its feet because of the shoddy standards of “ethical treatments” causing them not to work.
Why?
Because of the falsified evidence manufactured to launch these drugs causing death and injury – with mainstream medicine now being documented as the third major cause of death globally – and that statement is evidence-based.
You may receive more credibility for your endeavours if you focused on that problem rather than divert attention to natural health.
You might also have cause for regret if after eliminating some or all of natural health modalities that Australian health system costs will run out of control having to rely on so called “ethical treatments”.

Health consumers are told they should take responsibility for their conditions and their treatment.
They are told to indulge in “self care” – and they do.
Yet you assume that pharmacists are pushing homeopathic remedies rather than supplying perceived consumer need?
That is clearly a nonsense and a clear lack of understanding of what constitutes care in the eyes of a consumer.
And when Australian pharmacists are accused of not having a proper evidence base when selling various products, we are science-based enough to recognise shoddy standards and inputs.
Don’t ask us to lower our standards to the level of NHMRC!