Alternative medicine research must be publicly funded

Research of supplements already in the market has no incentive for robustness. Health Gauge/Flickr

TESTING ALTERNATIVE THERAPIES - La Trobe University’s decision to accept funding from Swisse for a new centre to research alternative medicines has sparked controversy. This article considers the ethical problems with such research and says the only option is for alternative medicine research to be funded by the government.

Ken Harvey, who recently ditched his La Trobe University professorship in disgust at the university’s acceptance of A$15 million from vitamin giant Swisse, is owed a debt of public gratitude. Harvey, named the 2012 CHOICE consumer champion, has made it his business to challenge the misleading claims of drug advertisers.

He is deservedly renowned for his role in the demise of the so-called “diet nasal spray” SensaSlim, and his costly defence of the subsequent lawsuit.

The Swisse money is intended to fund a new research centre to evaluate complementary and alternative medicines and, more specifically, Swisse products. The deal is particularly galling for Harvey because Swisse has, in no small part due to his own efforts, spent much time in the media lowlight.

Most recently, the Therapeutic Goods Administration found the tagline “You’ll feel better on Swisse” was misleading and without evidence.

Marketing or research?

Harvey has a legitimate beef with the La Trobe deal. The dangers of drug company involvement in trials on their products are legion, and well articulated by, among others, Marcia Angell, former editor of the New England Journal of Medicine, in her book The Truth about the Drug Companies.

The chapter “Marketing masquerading as research” details many ways that trials are biased, from enrolling young subjects who are less vulnerable to side effects, to out-and-out suppression of negative results.

La Trobe University has staunchly defended the deal, noting that the Australian Medical Association has called for more research on complementary medicines and therapies and that industry partners with academia all the time.

It also rejects concerns about bias, saying the centre will be independent and at arm’s length from funders. But there remain reasons to be sceptical that a Swisse-La Trobe partnership will add usefully to the research literature.

Reasons for scepticism

First, it’s fair to assume that companies fund university research to advance their bottom line. Spending must be justified to shareholders who expect dividends on any investment. And indeed many partnerships fill industry coffers without compromising universities’ goal of knowledge acquisition.

If a mining company wants a better way of extracting mineral from ore, for instance, the relevant research has a strong incentive for accuracy. A truthful finding is in the interests of both parties, and the robustness of the result is tested by its efficiency, and by the market.

But vitamins and supplements have already been brought to market. On the bottom line rationale, research funding must aim to increase sales by establishing efficacy and building brand associations with the university. Both will no doubt feature prominently in marketing material.

Essentially, the supplement maker lacks the incentive for research accuracy so important to the miner. Given that many alternative medicines have a benign side-effect profile, it is plausible that producers will be partial to positive data on effectiveness, even from research with dubious methodology.

Of course, no one is accusing La Trobe University or Swisse of an overt intention to design flawed trials or produce fudged figures. But conflict of interest can exert influence subconsciously.

And when huge sums are at stake, the need to please one’s master can be adopted as an automatic goal whose operation occurs outside of awareness. This is why the old adage “the best way to reduce conflict of interest is to avoid it” is true.

Is research even possible?

There are further intractable concerns with the research itself. A key goal must be to determine if Swisse products are more effective than alternatives or placebo. The benchmark for this kind of research is a double-blinded trial where neither researcher nor participant knows which option is given or taken.

But a blinded trial can never be a true test of the Swisse product because branding is central to the efficacy of an advertised medicine. Up to 50% of the effects of a drug can be attributed to a placebo response grounded in the consumer’s expectations of a positive effect.

Those expectations are raised by advertiser’s claims and by celebrity endorsement. They are also elevated more subtly by conditioning effects.

Pairing the drug with pleasing imagery and music (so-called evaluative conditioning), for instance, breeds favourable attitudes and inflated beliefs about efficacy. Such is the dramatic force of branding.

If La Trobe University’s research finds in favour of a Swisse product, the result will be indelibly tainted with accusations of bias; if it finds against, the result will lack real world credibility due to the exclusion of Swisse’s brand power.

In the latter case, Swisse would be justifiably miffed at a negative outcome based on a blinded comparison. On each count, the best way forward is to ensure that independently funded research assesses these products, and that the brief doesn’t extend to evaluating brands.

Given the enormous sums Australians spend on complementary medicines, it’s the National Health and Medical Research Council and the Australian Research Council that must foster research in this area so consumers can base their choices on credible and objective data.

This is the second-last article in our series about complementary and alternative therapies. Click on the links below to read the others:

Can we scientifically test herbal medicines?