tag:theconversation.com,2011:/global/topics/fsm-2221/articlesFSM – The Conversation2012-08-29T05:27:19Ztag:theconversation.com,2011:article/91412012-08-29T05:27:19Z2012-08-29T05:27:19ZGP de-registration shows double standard for health practitioners<figure><img src="https://images.theconversation.com/files/14744/original/5wg2sb2t-1346215878.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There is a soft evidence base for spinal manipulations being useful for musculoskeletal problems.</span> <span class="attribution"><span class="source">Michael Dorausch</span></span></figcaption></figure><p>A New South Wales general practitioner, who was de-registered by the NSW Medical Tribunal for claiming he could treat any number of serious conditions by “spinal manipulation”, has <a href="http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/nsw/NSWCA/2012/251.html">lost his appeal to the Supreme Court</a>. But the very same claims are made by numerous chiropractors and the same techniques used without a whiff of disquiet from the <a href="http://www.chiropracticboard.gov.au/">Chiropractic Board of Australia</a>. </p>
<p>Indeed, there’s some support from the Board for spinal manipulation, which is endorsed by the profession’s peak body, the <a href="http://chiropractors.asn.au//AM/Template.cfm?Section=Home1&WebsiteKey=d6b431a0-b077-43d6-af75-74f80487442a">Chiropractor’s Association of Australia</a> (CAA). So it seems we have one government-appointed registration board de-registering a member for practices that are not subject to any restrictions by another!</p>
<p>In September of 1895, the founder of chiropractic, Daniel David Palmer, noted that the janitor who cleaned his office and had been profoundly deaf for 17 years had a vertebra racked from its normal position. He racked it back into position and soon the man could hear as before. </p>
<p>Shortly after this episode, he noted similar spinal distortions in a man with heart trouble and again manipulation provided immediate relief. From these observations came the theory that 95% of what ails man is caused by spinal distortion of an energy flow (innate intelligence), the integrity of which is essential for health. Spinal cord adjustments, thought Palmer, could correct subtle even invisible distortions.</p>
<p>Many chiropractors dismiss this theory and limit their practice to definite musculoskeletal problems. And there is a soft evidence base to support these manipulations. But others endorse Palmer’s theory and use it to greatly broaden the scope of care they offer. Particularly disturbing are the claims being made for spinal adjustments of children to treat conditions such as autism, attention-deficit syndrome, colic, infections, asthma and bed-wetting. </p>
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<img alt="" src="https://images.theconversation.com/files/14746/original/myxdvjnq-1346216083.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/14746/original/myxdvjnq-1346216083.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=734&fit=crop&dpr=1 600w, https://images.theconversation.com/files/14746/original/myxdvjnq-1346216083.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=734&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/14746/original/myxdvjnq-1346216083.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=734&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/14746/original/myxdvjnq-1346216083.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=922&fit=crop&dpr=1 754w, https://images.theconversation.com/files/14746/original/myxdvjnq-1346216083.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=922&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/14746/original/myxdvjnq-1346216083.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=922&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Daniel David Palmer, the founder of chiropractic.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
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</figure>
<p>The CAA describes chiropractic care as an alternative health system distinct from the mainstream that aims to “achieve a fundamental paradigm shift in healthcare direction where chiropractic is recognised as the most cost efficient and effective health regime of first choice that is readily accessible to all people”. Consumers have been warned of the potential dangers inherent in this ambition in a <a href="http://www.choice.com.au/reviews-and-tests/food-and-health/general-health/therapies/can-chiropractors-replace-doctors.aspx">report by Choice Magazine</a>.</p>
<p>The de-registered doctor manipulated spines to treat, among other things, influenza and poor vision. He was furious with the court and claimed to be a whistle-blower exposing the wider medical profession’s unconscionable failure to adopt his techniques. Reading media reports of the case made me wonder if he was somewhat delusional but many a chiropractor would have no such concerns and welcome him and his approach into their club.</p>
<p>The paradox highlighted by this situation is obvious and cause for concern. National registration of practitioners of chiropractic and traditional Chinese medicine was presented as an important advance in protecting consumers, as the new boards would hold members to the highest standards of ethical and credible practice. But when board members accept pseudoscience as ethical and credible, this premise disappears. </p>
<p>Even though modern research shows that (with a few exceptions) acupuncture is no more than a superb placebo, the traditional Chinese medicine board is hardly likely to recommend restricting its current broad and discredited application. </p>
<p>So while the Supreme Court tells a doctor he deserves de-registration, we have a self-serving rather than public-serving government-authorised boards supporting the same practices as if they were good medicine. </p>
<p>It’s time to challenge the Australian Health Practitioner Regulation Agency (APHRA) about registration boards holding members to a standard that rejects approaches to care for which there’s no support from good science or treatments that have been studied and found to be ineffective.</p><img src="https://counter.theconversation.com/content/9141/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Dwyer is President of Friends of Science in Medicine</span></em></p>A New South Wales general practitioner, who was de-registered by the NSW Medical Tribunal for claiming he could treat any number of serious conditions by “spinal manipulation”, has lost his appeal to the…John Dwyer, Founder of the Australian Health Care Reform Alliance & Emeritus Professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/79952012-07-02T00:50:40Z2012-07-02T00:50:40ZTurf war over who can claim the title of acupuncturist<figure><img src="https://images.theconversation.com/files/12462/original/6nxg6bs6-1341188658.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Acupuncture is based on the belief that a vital force (Ch’i) is transmitted along meridians.</span> <span class="attribution"><span class="source">Megan Mallen</span></span></figcaption></figure><p>Acupuncture is popular and no doubt lucrative for its practitioners. The fact that it doesn’t work seems to be of little relevance, and certainly has not curbed enthusiasm for the application of what is, in effect, a superb placebo. </p>
<p>Practitioners of traditional Chinese medicine seem culturally locked into an unshakeable belief in the pre-scientific concepts of a non-existent vital force (Ch’i) transmitted along meridians which, when blocked or imbalanced, cause disease. Trigger spots for acupuncture to correct these problems are said to lie along the meridians. </p>
<p>For anyone who believes that the appropriate standard for modern medicine should be credible scientific evidence of clinical effectiveness, it’s disturbing that so many doctors, trained to understand scientific method, are embracing the technique. It’s not a situation where doctors using acupuncture say, “Well the Chinese theories may be nonsensical but the technique actually works for unknown reasons and is effective in a large number of conditions.” </p>
<p>Acupuncture has been subjected to extensive scientific analysis, particularly in the last decade. Its ability to help with some forms of neck pain is the only benefit that has support from good science and that turns out to have nothing to do with meridian lines, mysterious forces or any of the other mystical propositions cited in support of acupuncture.</p>
<p>Last year a <a href="http://www.ncbi.nlm.nih.gov/pubmed/21440191">review of all published studies</a> in the last ten years examining the effectiveness of acupuncture appeared in the prestigious journal, <a href="http://www.elsevier.com/wps/find/journaldescription.cws_home/506083/description#description">Pain</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=467&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=467&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=467&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=587&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=587&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=587&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Relieving some forms of neck pain is the only benefit of acupuncture that is supported by modern science.</span>
<span class="attribution"><span class="source">Irina Souiki/Flickr</span></span>
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</figure>
<p>An editorial in the same issue featured the headline “Acupuncture’s claims punctured: Not proven effective for pain, not harmless”. The journal recommended that physicians tell patients “although some patients believe that it has helped them, the evidence does not show that it (acupuncture) works any better than placebo”. </p>
<p>So it’s somewhat humorous - if it weren’t symptomatic of the broader problem of the infiltration of pseudoscience into health care in Australia – that doctors and complementary medicine practitioners (particularly traditional Chinese medicine practitioners) are at loggerheads over who can use the title acupuncturist. </p>
<p>This month will see the birth of the Chinese Medicine Board of Australia and it will require practitioners to have completed a three- to four-year accredited course in acupuncture before they can use the title. Under a proposal from the Medical Board of Australia however, doctors who can prove they’ve been performing acupuncture regularly should be able to use the title under “grandfathering” arrangements. In the future, doctors will need a ten-month course to claim the title.</p>
<p>I am one of the founding members of <a href="http://www.scienceinmedicine.org.au/">Friends of Science in Medicine (FSM)</a>, which was established to help minimise the amount of health-related anti-science foisted on poorly protected consumers, and to emphasise the importance of models of care that provide patients with interventions supported by scientific evidence of effectiveness.</p>
<p>Private health insurers are one of our targets because they’ve been subsidising the cost of so called “complementary and alternative medicine” (CAM) practices, including acupuncture. And by doing this, they’re giving totally undeserved credibility to many such practices. </p>
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<img alt="" src="https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Acupuncturists will have to complete a three- to four-year accreditation course under the new Chinese Medicine Board of Australia.</span>
<span class="attribution"><span class="source">Acc Bandido of Oz/Flickr</span></span>
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</figure>
<p>FSM was heartened when the government announced that, in the future, taxpayer dollars subsidising private health insurance would not be available for CAM activities unless the chief health officer confirmed that there was “credible scientific evidence of their clinical effectiveness”. He has been given a year to reach his conclusions. </p>
<p>But we were disheartened when it was announced that acupuncture and chiropractic would be excluded from the practices to be reviewed. They were not included because there will soon be national registration process for practitioners of traditional Chinese medicine, which would include acupuncturists, and there already is a national <a href="http://www.chiropracticboard.gov.au/">registration board</a> for chiropractors. Both are charged with upholding appropriate standards.</p>
<p>This is unsatisfactory because some of the worst offerings of pseudoscience are provided by chiropractors who believe in the “subluxation” theories of their founder (invoking yet another mystical, undefinable and undetectable force), and who are trying to become major players in the delivery of primary care, especially to children. </p>
<p>Chiropractors sympathetic to this nonsense are on the national registration board and executive of the <a href="http://chiropractors.asn.au//AM/Template.cfm?Section=Home1&WebsiteKey=d6b431a0-b077-43d6-af75-74f80487442a">Chiropractic Association of Australia</a>. Similarly, the newly-formed Chinese Medicine Board of Australia is not going to tell Australians that, while acupuncture may be worthy of continuing scientific research, at the moment there is no evidence to support its current use for a wide range of conditions.</p>
<p>FSM has written to all the private health insurers in Australia urging them to abide by the umpire’s decision. All practices that the government finds to be unworthy of taxpayer support should also be unworthy of privately provided insurance dollars. And battles about who can use what title are merely a distraction.</p><img src="https://counter.theconversation.com/content/7995/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Dwyer is one of the founding members of the Friends of Science in Medicine.</span></em></p>Acupuncture is popular and no doubt lucrative for its practitioners. The fact that it doesn’t work seems to be of little relevance, and certainly has not curbed enthusiasm for the application of what is…John Dwyer, Founder of the Australian Health Care Reform Alliance & Emeritus Professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/69562012-05-11T04:21:25Z2012-05-11T04:21:25ZBudget good news: no taxpayer dollars for a ‘bunch of hooey’<figure><img src="https://images.theconversation.com/files/10552/original/hvfkpdrs-1336704930.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Treasurer Wayne Swan delivering the Budget on Tuesday.</span> <span class="attribution"><span class="source">AAP</span></span></figcaption></figure><p>It’s good news indeed that the Federal Budget is providing the chief medical officer with a million dollars to review what works and what doesn’t in the world of “natural” medicine. Professor Chris Baggoley will have one year to report his conclusions. </p>
<p>At the end of that time, <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr12-tp-tp042.htm">says Health Minister Tanya Plibersek</a>, “The Private Health Insurance Rebate will be paid for insurance products that cover natural therapy services only where the Chief Medical Officer finds there is clear evidence they are clinically effective.” </p>
<p>Truth be told, this could be the easiest million dollars the CMO will ever earn for the government. He could have a report ready next month, as there are very few “natural” therapies that have any chance of meeting a requirement of evidence. The government predicts it will save $30 million a year after the review.</p>
<p>So what therapies does the government have in mind? <a href="http://www.smh.com.au/opinion/political-news/razor-gang-targets-natural-therapies-subsidy-20120504-1y47n.html">This recent article</a> tells readers that the government is referring to modalities such as “homeopathy, Reiki, aromatherapy, iridology, ear candling, crystal therapy, flower essences, kinesiology and Rolfing.” </p>
<p>Never heard of Rolfing? Well, according to <a href="http://en.wikipedia.org/wiki/Rolfing">Wikipedia</a> it’s “ a therapy created by The Rolf Institute of Structural Integration (also referred to as ‘RISI’) whereby the alleged manipulation of the fasciae by specific methods is believed to yield therapeutic benefit! Rolfing lacks a solid scientific evidence base.” </p>
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<img alt="" src="https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Ear candling may no longer be coverd by a private health insurance rebate.</span>
<span class="attribution"><span class="source">Bjørn Bulthuis</span></span>
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</figure>
<p>As the founder of the Skeptics, <a href="http://en.wikipedia.org/wiki/Michael_Shermer">Michael Shermer</a>, noted, Rolfing represents “a bunch of hooey”. Those looking for quality evidence on for natural medicines will find the <a href="http://www.thecochranelibrary.com/view/0/index.html">Cochrane Library</a> invaluable.</p>
<p>The article suggests <a href="http://summaries.cochrane.org/search/site/%22spinal%20manipulation%22%20AND%20pain">chiropractic</a> and <a href="http://summaries.cochrane.org/search/site/acupuncture">acupuncture</a> will continue to be funded, as they are “mainstream” practices. But these modalities are used in ways for which there is certainly no clear evidence of clinical effectiveness. </p>
<p>While there’s weak evidence for conservative chiropractic being effective for helping patients with minor musculoskeletal problems, there’s none to support the more extreme use of chiropractic spinal “adjustments” to treat <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2010.01053.x/full">a wide range of diseases</a> in adults and children. </p>
<p>Using <a href="http://summaries.cochrane.org/search/site/acupuncture">acupuncture to control pain</a> for a very limited number of musculoskeletal problems has been established in clinical trials. But despite many studies, there are no data suggesting it can treat any disease process and the breadth of conditions it’s used for today will not meet the government’s requirement for support.</p>
<p>The initiative announced with the budget papers may well represent the beginning of a more critical assessment of government-funded health programs, with an emphasis on proven effectiveness. This approach would provide a much larger dividend than the anticipated $30 million dollars to be saved after the proposed review. </p>
<p>Australians are, at last, being told by their government that a large number of diagnostic and therapeutic claims made for many so-called <a href="http://www.skepdic.com/tialtmed.html">“complementary and alternative medicines”</a> are without merit and often lead to a delay in correct diagnosis and the start of beneficial treatment.</p>
<p>The process of debunking health services and health-related education involving pseudoscience has surged in recent months in multiple guises. A growing number of articles addressing this issue have appeared in the national press and the matter has been prominent in radio interviews. The t<a href="https://theconversation.com/what-cam-courses-at-universities-should-look-like-5339">eaching of pseudosciences in university</a> health courses has also been questioned. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The evidence base for acupuncture will not be reviewed by the chief medical officer.</span>
<span class="attribution"><span class="source">NYCTCM/Flickr</span></span>
</figcaption>
</figure>
<p>The <a href="https://theconversation.com/does-traditional-chinese-medicine-have-a-place-in-the-health-system-6166">disadvantages of national registration</a> of traditional medical practices has been debated, as has the therapeutic benefits from <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/currentissue-P11000021">homeopathic preparations</a> and other “alternative” therapies. </p>
<p>All this coincides with active <a href="http://www.scienceinmedicine.org.au/">campaigning for the primacy of science-based medicine</a> by a group of scientists, clinicians, lawyers and consumer advocates, (of which we are founding members) now numbering more than 700.</p>
<p>It’s no longer tenable to accuse those concerned with the growing influence of “sciences” not supported by credible evidence of effectiveness to be on a “witch hunt”. Irrefutable worldwide research on homeopathy and many other “natural” therapies shows that they have no more effect than a placebo. </p>
<p>The Government’s commitment to science-based medicine raises a number of interesting questions. Will the private health industry wait for the results of the review before it stops paying for ineffective modalities or at least makes coverage for such treatments an optional extra? If it did, customers could have broad coverage without having to pay for modern pseudosciences. </p>
<p>With international agreement that homeopathy and many other natural therapies are no better than placebo, will Australian pharmacists rid their shelves of homeopathic and other useless preparations? And will the few universities that still prepare people for a career based around these nonsensical therapies stop and recommit to teaching good science? Let’s hope so.</p><img src="https://counter.theconversation.com/content/6956/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors are committed to scientific principles in his academic and clinical careers and are founding member of the Friends of Science in Medicine.
As a member of the Australian Academy of Science, Professor Costa is committed to uphold the highest standard of science in Australian tertiary education and has no other vested interests.</span></em></p><p class="fine-print"><em><span>John Dwyer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s good news indeed that the Federal Budget is providing the chief medical officer with a million dollars to review what works and what doesn’t in the world of “natural” medicine. Professor Chris Baggoley…Marcello Costa, Professor of Neurophysiology, Department of Physiology, Flinders UniversityJohn Dwyer, Founder of the Australian Health Care Reform Alliance & Emeritus Professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/59782012-03-22T19:21:14Z2012-03-22T19:21:14ZEvidence-based medicine v alternative therapies: moving beyond virulence<figure><img src="https://images.theconversation.com/files/8897/original/p65f285p-1332396986.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The answer is not more rigid insistence on the primacy of biomedicine, in spite of its great contribution to saving lives.</span> <span class="attribution"><span class="source">CALI.org</span></span></figcaption></figure><p>More heat than light is being generated by the resurgence of the debate on orthodox evidence-based medicine versus the so-called pseudo-science of alternative therapies. </p>
<p>Unfortunately the voices of medical historians and social scientists, along with those of consumers, seem to be muted. As both a researcher and user of health services, three aspects of the <a href="http://www.scienceinmedicine.org.au/">Friends of Science in Medicine’s</a>’s current <a href="https://theconversation.com/pseudosciences-are-destroying-the-reputation-of-australias-universities-5685">campaign and commentaries</a> on it seem remarkable to me.</p>
<h2>The absent patient</h2>
<p>First, they disregard what is now commonly discussed as the patient experience – so here’s mine. In the early 1970s, I knew little of chiropractic. But when I consulted my local general practitioner about recurrent headaches, I was prescribed anti-inflammatory medication to no useful effect. A friend recommended seeing her chiropractor.</p>
<p>I took her advice and came away absolutely astonished at being asked about diet, constipation, lifestyle and having my eyes and mouth scrutinised as well as my back adjusted. My headaches eased as I was taught to attend more to posture and diet. </p>
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<img alt="" src="https://images.theconversation.com/files/8899/original/wwxmg98m-1332397012.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/8899/original/wwxmg98m-1332397012.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=446&fit=crop&dpr=1 600w, https://images.theconversation.com/files/8899/original/wwxmg98m-1332397012.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=446&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/8899/original/wwxmg98m-1332397012.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=446&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/8899/original/wwxmg98m-1332397012.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=560&fit=crop&dpr=1 754w, https://images.theconversation.com/files/8899/original/wwxmg98m-1332397012.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=560&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/8899/original/wwxmg98m-1332397012.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=560&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">LadyOfProcrastination/Flickr</span></span>
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<p>In late 1979, I became ill with what was (once they had a name for it) chronic fatigue syndrome (CFS). Over the years, I consulted several fine doctors known to be interested in managing CFS with whatever medication seemed to work for particular individuals. Success was limited.</p>
<p>In 2002, I first attended an extraordinary medical doctor. Over time his detailed diagnosis, strict dietary regime, vitamins and homeopathic treatments worked. Evidence-based? Friends and colleagues commented on my transformation. I lived the evidence, but not in the eyes of the mainstream medical profession. </p>
<p>This doctor had been a suburban GP for some 20 years but was frustrated with not making people with today’s lifestyle and chronic conditions really well. Instead, as he puts it, he was being an unpaid salesman for the pharmaceutical industry.</p>
<p>So one day he just walked out and started again, retraining in several alternative modalities. His very busy practice is now based on a quite different ontology and epistemology than those of orthodox biomedicine.</p>
<p>Rather than a “curing disease” perspective, it aims to support the intrinsic energy system of a living body, just like chiropractic, to make people better. This is in stark contrast to the paradigm underlying modern medical science.</p>
<h2>Lack of critical reflection</h2>
<p>The second problem with recent debates, then, is the lack of critical reflection on philosophies of health and the politics of medicine. As medical philosopher Drew Leder has <a href="http://press.uchicago.edu/ucp/books/book/chicago/A/bo3622735.html">pointed out</a>, historically, medicine’s model of knowledge was based on a dead rather than a living body, that is, on studying cadavers.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/8896/original/cvfym6zn-1332396804.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/8896/original/cvfym6zn-1332396804.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=492&fit=crop&dpr=1 600w, https://images.theconversation.com/files/8896/original/cvfym6zn-1332396804.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=492&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/8896/original/cvfym6zn-1332396804.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=492&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/8896/original/cvfym6zn-1332396804.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=618&fit=crop&dpr=1 754w, https://images.theconversation.com/files/8896/original/cvfym6zn-1332396804.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=618&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/8896/original/cvfym6zn-1332396804.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=618&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Rafal Kiermacz</span></span>
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<p>Following <a href="http://plato.stanford.edu/entries/descartes-works/">Descartes</a>, the mind and body were largely seen as separate. The goal of modernist or <a href="http://plato.stanford.edu/entries/enlightenment/">Enlightenment</a> science was to seek truth through objective (read mental) and systematic knowledge. </p>
<p>But most modern scholarship asks critical questions about what knowledge is, and who defines evidence – as well as in what context and in whose interests the answers are. </p>
<p>Gaining and maintaining medical power is clearly a highly political process of “shoring up the troops” and fighting off other contenders. <a href="http://www.e-contentmanagement.com/special-issues/24/medical-dominance-revisited">Evan Willis</a> has documented such struggles and exactly how the Australian medical profession achieved public legitimacy in spite of internal conflicts. Doctors’ organisations either subordinated (nursing and midwifery), limited (physiotherapy, optometry) or discredited other forms of clinical practice (homeopathy, chiropractic). </p>
<p>Other scholars, such as <a href="http://catalogue.nla.gov.au/Record/2931826">James Gillespie</a> and <a href="http://books.google.com.au/books/about/The_social_transformation_of_American_me.html?id=FK4pBXGvQzoC&redir_esc=y">Paul Starr</a>, have demonstrated that professional self-interest and corporate influence as well as altruism have been at work in the rise of modern medicine.</p>
<h2>Evidence-based medicine</h2>
<p>The third issue is critical analysis of the evidence-based medicine movement itself. Lively debates about the movement’s claims continue among medical philosophers, such as <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2753.2008.01094.x/full">Andrew Miles</a>, in publications, such as the <a href="http://www.blackwellpublishing.com/journal.asp?ref=1356-1294">Journal of Evaluation of Clinical Practice</a>. </p>
<p>The peer-reviewed journal Social Science and Medicine even published a <a href="http://www.sciencedirect.com/science/journal/02779536/62/11">special issue</a> on the topic in 2006.</p>
<p>These critics argue that simplistic over-emphasis on the evidence generated within the experimental, quantitative paradigm of Enlightenment science is inadequate because it diminishes clinical practice. <a href="http://www.springerlink.com/content/452u6227qwt29642/">Waymack</a> and <a href="http://www.jstor.org/discover/10.2307/20079651?uid=3737536&uid=2&uid=4&sid=55932560353">Charon</a>, for example, point to the importance of patients’ subjective narratives and the “biopsychosocial” processes involved in interactions with care givers. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/8895/original/2gy7zym4-1332396798.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/8895/original/2gy7zym4-1332396798.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=318&fit=crop&dpr=1 600w, https://images.theconversation.com/files/8895/original/2gy7zym4-1332396798.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=318&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/8895/original/2gy7zym4-1332396798.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=318&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/8895/original/2gy7zym4-1332396798.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=400&fit=crop&dpr=1 754w, https://images.theconversation.com/files/8895/original/2gy7zym4-1332396798.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=400&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/8895/original/2gy7zym4-1332396798.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=400&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Tony Dowler</span></span>
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<p>The randomised-controlled trials and systematic reviews espoused by evidence-based medicine are also increasingly recognised as inadequate or inappropriate for many aspects of health care. And some medical practitioners (such as <a href="http://www.bmj.com/content/323/7313/625.short">Greenhalgh</a>) have moved on from the dominant scientific paradigm, emphasising new understandings of human bodies as complex adaptive systems.</p>
<p>Humanistic medical approaches support a holistic understanding of the dynamic human body more compatible with the claims of alternative modalities. They’re also consistent with the <a href="http://174.120.202.186/%7Epickerin/wp-content/uploads/2011/06/Luxford-etal-Promoting-patient-centered-care-20111.pdf">growing strength of the patient-centred</a> or, more radically, person-centred care movement in quality improvement circles.</p>
<p>Finally, critics such as <a href="http://onlinelibrary.wiley.com/doi/10.1525/maq.2007.21.2.218/abstract">Claire Wendland</a> and <a href="http://www.sciencedirect.com/science/article/pii/S0277953605006131">Helen Lambert</a> go further. Why do some findings, such as the now discredited obstetric term breech trial, get taken up rapidly while others do not? And how does medicine interface with the interests of the corporate sector?</p>
<p>Investigations such as those by <a href="http://www.randomhouse.com/book/185984/deadly-monopolies-by-harriet-a-washington#synopsis">Harriet Washington</a>, <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050001">Marc-André Gagnon and Joel Lexchin</a>, and <a href="https://www.mja.com.au/journal/2005/183/2/pharmaceutical-advertisements-prescribing-software-analysis">Ken Harvey</a> (among others), into the politics of research funding and publication, make it clear that modern medicine is not squeaky clean. Rather, in line with the history of modern medicine, they show the insidious effect of Big Pharma’s influence. </p>
<p>Most of us want health care that has been critically scrutinised by accountable institutions and shown to work rather than cause harm. Some alternative treatments no doubt can be found wasteful or otherwise wanting. But mainstream health care also has significant problems, such of drug utilisation and medical error. </p>
<p>The answer lies not in more rigid insistence on the primacy of biomedicine, in spite of its great contribution to saving lives (including those of two members of my family recently). Instead, more attention to history, politics and philosophy, along with a large dose of humility, would allow us to move beyond outdated forms of professional territorialism and provide better care that responds the needs of patients.</p><img src="https://counter.theconversation.com/content/5978/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kerreen Reiger has received funding from the Australian Research Council and the Canadian Institute of Health Service Research.</span></em></p>More heat than light is being generated by the resurgence of the debate on orthodox evidence-based medicine versus the so-called pseudo-science of alternative therapies. Unfortunately the voices of medical…Kerreen Reiger, Honorary Research Associate, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/58492012-03-15T04:11:03Z2012-03-15T04:11:03ZNo need for an alternative medicine crackdown<figure><img src="https://images.theconversation.com/files/8639/original/ts6y65b8-1331783920.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Treatments should be based on how well they make people feel rather than how scientific or traditional the medicine is.</span> <span class="attribution"><span class="source">By Wikidudeman</span></span></figcaption></figure><p>Homeopathy is a combination of tradition, art and a science that has been used for centuries. Does it really matter if its effect is placebo if it makes people feel better and regain good health? </p>
<p>And why do we have to prove something that’s been working for over a hundred years? Homeopathy is not the same as medicine, and it shouldn’t be measured by the same yardstick. Medicine is not 100% evidence-based itself but it still does wonderful things for people.</p>
<p>Homeopathy uses plant, mineral or animal substances to stimulate the body’s ability to heal itself. The choice of the remedy to use in a particular case is based on the “Law of Similars”: a substance capable of producing a certain set of symptoms in a healthy individual can remove these same symptoms if given to an unwell individual. In other words, what a substance can cause, it can cure (Similia Similibus Currentur). </p>
<p>This is a natural law observed as far back as 400 BC by Hippocrates. This law was developed into a system of therapeutics 200 years ago by the German physician <a href="http://books.google.com.au/books?hl=en&lr=&id=EGphHjIE2U4C&oi=fnd&pg=PR6&dq=samuel+Hahnemann&ots=zU87Gt5r4D&sig=WSdLXXg1g_MW4pUDvTb-6uhnppA#v=onepage&q=samuel%20Hahnemann&f=false">Samuel Hahnemann</a> who is considered the father of homeopathy.</p>
<p>In 2005, the World Health Organisation (WHO) <a href="http://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&codcol=15&codcch=614">estimated that homoeopathy was used</a> by around 500 million people worldwide, and constituted the largest complementary and alternative medicine regime. And there are <a href="http://www.ncbi.nlm.nih.gov/pubmed/20674839">studies</a> showing the effectiveness of homoeopathy at a large scale.</p>
<h2>Case study: Cuba</h2>
<p>In Cuba, outbreaks of the tropical disease Leptospirosis is recorded by an efficient national surveillance programme. Its incidence correlates closely with heavy rainfall and subsequent flooding. </p>
<p>In response to a developing epidemic in late 2007, and with only enough vaccines to treat 15,000 high-risk people, the government decided to treat the entire population of the region over the age of one with homeopathic medicine. </p>
<p>The medicine was prepared from the inactivated causative organism provided by the Cuban National Vaccine Institute. It was a highly diluted preparation called homeoprophylaxis.</p>
<p>This medicine was given to the 2.3 million people living in the provinces usually worst affected. Within a few weeks the number of infections had fallen from 38 to 4 cases per 100,000 per week. This was significantly fewer than the 38 forecast based on historical figures for those weeks of the year. And the 8.8 million people from other provinces who did not receive homeopathic treatment suffered the forecast infection rate.</p>
<p>The <a href="http://www.sciencedirect.com/science/article/pii/S1475491610000585">effect appeared to be sustained</a> – there was an 84% reduction in infection in the treated region the following year (2008) when, for the first time, incidence did not correlate with rainfall. In the same period, incidence in the untreated region increased by 22%.</p>
<h2>Local scene</h2>
<p>Yesterday’s <a href="http://www.theage.com.au/opinion/political-news/alternative-medicine-crackdown-20120313-1uyiw.html#ixzz1p9IL3W6Q">article</a> in the Fairfax papers – Alternative medicine crackdown – suggested the National Health and Medical Research Council (NHMRC) might declare homeopathy baseless and unethical. This statement would be based on a 2010 evaluation of homeopathy by the British House of Commons science and technology committee which declared homeopathy was no more efficacious than a placebo.</p>
<p>In contrast to the UK government’s stance, the Swiss government’s <a href="http://www.huffingtonpost.com/dana-ullman/homeopathic-medicine-_b_1258607.html">2011 report on homeopathic medicine</a> represents the most comprehensive evaluation of homeopathic medicine ever produced by a government and has just been published in English.</p>
<p>The report says homeopathic treatment is both efficacious and cost-effective and recommends homeopathic treatment be reimbursed by Switzerland’s national health insurance program. </p>
<p>Insurance companies are very particular about which practitioners they cover and rightly so. A homeopath, for instance, needs to belong to a particular association that has a high minimun standard of education to be able to have clients receive private insurance rebates. </p>
<p>All health practitioners can cause harm. Medicine can cause serious harm and even death; there are <a href="http://health.vic.gov.au/ruralhealth/downloads/dla-phillips-fox.pdf">many medical mishaps</a> and deaths every year. According to the former Australian Council for Safety and Quality in Health Care, the rate of adverse events in Australian hospitals is around 10%.</p>
<p>But there have very few deaths from homoeopathy. </p>
<p>All deaths are sad but as a <a href="http://health.vic.gov.au/ruralhealth/downloads/dla-phillips-fox.pdf">Victorian report</a> says: “It is important to recognise that human error is inevitable for even the best trained and best-qualified healthcare providers.”</p>
<p>People have a right to choose the treatments they want and decide how to manage their health issues. All health professionals including homeopaths should be qualified so the public has appropriate treatment. Treatments should be based on how well they make people feel rather than how scientific or traditional the medicine is.</p><img src="https://counter.theconversation.com/content/5849/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sandra Lucas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Homeopathy is a combination of tradition, art and a science that has been used for centuries. Does it really matter if its effect is placebo if it makes people feel better and regain good health? And why…Sandra Lucas, Lecturer in Nursing, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/53392012-02-21T04:33:23Z2012-02-21T04:33:23ZWhat CAM courses at universities should look like<figure><img src="https://images.theconversation.com/files/7603/original/ymc97c6s-1329109827.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Appeals to popularity and ancient traditions are insufficient to establish vocational courses.</span> <span class="attribution"><span class="source">Michael Flick</span></span></figcaption></figure><p>While drizzling treacle on your porridge or spreading it on your toast, you might consider the time when the calorie-laden condiment was an antidote for poison. Of course, these days the crushed vipers that supposedly gave theriac or theriacle (as it was known) power are off the ingredient list, but treacle’s fall from favour illuminates an important aspect of the debate around teaching courses in complementary and alternative medicine (CAM) at university.</p>
<p>This <a href="https://theconversation.com/alternative-medicine-can-be-scientific-say-besieged-academics-5058">debate started</a> when the newly formed Friends of Science in Medicine (FSM) called for universities to not teach CAM courses. But the <a href="https://theconversation.com/why-universities-should-teach-alternative-medicine-5159">articles that followed</a> and the comments they’ve attracted reveal some confusion about the aims of the group. Their call is not to end research into the various modalities under the CAM umbrella; they’d like universities to not set up programs giving CAM vocational degrees.</p>
<p>This difference is the same as the one between teaching <em>about</em> astrology, and teaching a vocational course to <em>produce</em> astrologers. I don’t introduce astrology as a distraction. Astrology was once one of the four pillars of western medicine, and one of Galileo’s duties as a mathematician at Pisa was to teach it to medical students. </p>
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<img alt="" src="https://images.theconversation.com/files/7886/original/pgf8sqbb-1329798030.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/7886/original/pgf8sqbb-1329798030.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/7886/original/pgf8sqbb-1329798030.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/7886/original/pgf8sqbb-1329798030.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/7886/original/pgf8sqbb-1329798030.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/7886/original/pgf8sqbb-1329798030.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/7886/original/pgf8sqbb-1329798030.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Echinacea is known to be ineffective against colds and flus.</span>
<span class="attribution"><span class="source"> LadyDragonflyCC</span></span>
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<p>Those same students would prescribe medicinal treacles, and Venetian treacle (comprising of more than 50 ingredients, including crushed vipers) was particularly prized. Although it was meant to treat the poisoned, treacle was enjoying a renaissance as a treatment for plague at the time.</p>
<p>Astrology is no longer part of modern medicine, despite it being very popular and many people swearing by astrological predictions. Similarly, treacles are no longer part of medicine despite nearly 2,000 years of enthusiastic use and testimonies by famous physicians of antiquity.</p>
<h2>No law of similarity</h2>
<p>Herbal medicines are often used as a justification for teaching CAM in universities. Undoubtedly, many herbal medicines work – willow bark for headaches; foxglove extract for heart failure and; artemesinin for malaria. There is, in fact, an entire branch of medicine dedicated to finding active pharmaceuticals from natural sources (pharmacognosy) and about one in four current medicines are based on natural products.</p>
<p>But while there are many herbal medicines that work, there are many others that don’t. The medicinal treacles are a historical example, but there’s very strong evidence that <a href="http://summaries.cochrane.org/CD000530/echinacea-for-preventing-and-treating-the-common-cold">echinacea</a>, a herb used for preventing colds and flus, doesn’t work. But it’s still recommended by many complementary medicine practitioners.</p>
<p>This brings us back to what universities should teach. Universities have a variety of goals, one of the most important being to make their graduates capable of critical, independent thought. This is true of the vocational courses such as medicine, dentistry and nursing. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/7887/original/8yyywbfp-1329798227.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/7887/original/8yyywbfp-1329798227.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/7887/original/8yyywbfp-1329798227.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/7887/original/8yyywbfp-1329798227.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/7887/original/8yyywbfp-1329798227.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/7887/original/8yyywbfp-1329798227.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/7887/original/8yyywbfp-1329798227.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our ancestors were completely wrong about medicinal uses for treacle.</span>
<span class="attribution"><span class="source">mudge</span></span>
</figcaption>
</figure>
<p>So what would a vocational course in CAM look like if they applied this principle? CAM consists of a variety of modalities, from herbalism, which has reasonably strong evidence for some of its treatments; to acupuncture, which has very weak evidence that <a href="http://dx.doi.org/10.1016/j.pain.2010.11.004">it might work in very limited circumstances</a>; to practices such as reiki and <a href="http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4502.htm">homeopathy</a>, where there’s strong evidence they do nothing at all. </p>
<p>A true university course in CAM should look critically at these modalities, and the evidence for them, rather than just reiterating traditional teachings. In the end, there’d likely be very little left to teach because the fact that some herbs are therapeutic doesn’t justify other modalities.</p>
<h2>Revealing hidden harms </h2>
<p><a href="http://www.nps.org.au/news_and_media/media_releases/repository/complementary_medicine_usefirst_findings_from_nps_survey">More than half of all Australians</a> use a CAM modality in any given year, and as most people don’t tell their medical practitioners about it (they don’t see herbal medicines as drugs). This can have a serious impact on patient health. </p>
<p>The classic example of such harm is from St. John Wort, a herb that’s an effective antidepressant, but can <a href="http://www.umm.edu/altmed/articles/st-johns-000931.htm">interact with other drugs</a> to cause failure of HIV therapy and anti-rejection drugs (for organ transplants) among other serious side effects. We should make those studying health care aware of these issues, but this is <em>very</em> different to teaching a vocational course in CAM.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/7890/original/b799nr7q-1329798564.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/7890/original/b799nr7q-1329798564.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/7890/original/b799nr7q-1329798564.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/7890/original/b799nr7q-1329798564.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/7890/original/b799nr7q-1329798564.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/7890/original/b799nr7q-1329798564.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/7890/original/b799nr7q-1329798564.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">St John’s Wort may be effective against depression but interacts adversely with other medicines.</span>
<span class="attribution"><span class="source">Barry Cornelius</span></span>
</figcaption>
</figure>
<p>At the heart of this debate is our desire for autonomy in health-care decisions, but appeals to ancient traditions and popularity are not sufficient to establish vocational courses. Remember treacle? Its use was a 2,000-year-old tradition, and it was highly popular, with extensive testimonials. But it didn’t work for curing the plague or venomous bites.</p>
<p>Our ancestors weren’t stupid, and were keen observers of the natural world. Yet they were completely wrong about medicinal treacle. Treacle recipes could be very different (not all contained crushed vipers, for instance), but they all contained opium, sometimes in heroic amounts. While opium had no effect on the plague bacillus or viper venom, it did <a href="http://www.ncbi.nlm.nih.gov/m/pubmed/18175463/">provide symptomatic relief</a>, fooling generations. </p>
<p>What this shows is humans can fool themselves very easily, especially when faced with intractable conditions, where hope can blind us to reality. Conventional medicine has spent centuries developing ways to reduce the chances of fooling ourselves – <a href="http://www.sciencebasedmedicine.org/?p=8198">the double-blind placebo-controlled trial</a> being one important (but not the only) way. CAM avoids these measures.</p>
<p>So as you eat your breakfast, you may reflect that promoters of teaching vocational CAM courses in universities should be careful what they wish for. A rigorous, evidence-based university course would be devoid of the majority of CAM modalities – like your treacle is devoid of vipers’ flesh. </p><img src="https://counter.theconversation.com/content/5339/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Musgrave receives funding from the Australian Research Council and the National Health and Medical Research Council.</span></em></p>While drizzling treacle on your porridge or spreading it on your toast, you might consider the time when the calorie-laden condiment was an antidote for poison. Of course, these days the crushed vipers…Ian Musgrave, Senior lecturer in Pharmacology, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/52422012-02-10T03:34:16Z2012-02-10T03:34:16ZCoffee enemas don’t cure cancer: reviewing the remarkable claims of Ian Gawler<figure><img src="https://images.theconversation.com/files/7548/original/c3skz3y4-1328843538.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gawler claims to have cured himself of advanced cancer by a series of unorthodox treatments including herbal remedies, meditation, coffee enemas and diets.</span> <span class="attribution"><span class="source">Nick Olejniczak</span></span></figcaption></figure><p>It’s not often that a scientific article in a learned medical journal becomes front page news but that was the case recently when <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1445-5994.2011.02686.x/abstract">a paper I co-authored with Dr Ian Haines</a> of Melbourne’s Cabrini Hospital was published in the Internal Medicine Journal (IMJ) just before the new year. </p>
<p>In very prominent “exclusives”, Fairfax newspapers, including <a href="http://www.theage.com.au/national/cancer-experts-challenge-gawlers-cure-20111230-1pfns.html">The Age</a> in Melbourne, called our paper explosive. What was the fuss about? Ian Haines and I are experienced cancer specialists and had published <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1445-5994.2011.02686.x/abstract">a paper with the rather unexplosive title</a> “Hypothesis. The importance of a histological diagnosis when diagnosing and treating advanced cancer. Famous patient recovery may not have been from metastatic disease.” </p>
<p>In this technical report, we analysed the very public case of Melbourne cancer guru Ian Gawler whose claims to have cured himself of advanced cancer by a series of unorthodox treatments have passed into Australian folklore. His methods included herbal remedies, meditation, coffee enemas and diets. </p>
<p>After careful evaluation of the publicly available case details (mostly made public by Gawler himself), we came up with an alternative theory. We suggested that rather than suffering from advanced cancer, Gawler had been afflicted by tuberculosis, which was appropriately treated with antibiotics and cured.</p>
<p>Gawler vigorously disputes our theory and there will undoubtedly be a lively series of exchanges in the correspondence pages of the IMJ. Both Ian Haines and I have received a number of unpleasant communications from Gawler supporters for having gone public the way we did, often with questions about our motives. Although, to be fair, we also received a considerable number of supporting messages from colleagues.</p>
<p>The obvious question – why did we do it? Why put our reputations on the line to query the diagnosis of a man who is seen by many in the community almost as a saint, as someone who (according to one correspondent) “has helped thousands of cancer patients”. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=915&fit=crop&dpr=1 600w, https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=915&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=915&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1149&fit=crop&dpr=1 754w, https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1149&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1149&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ian Gawler in September 2000.</span>
<span class="attribution"><span class="source">AAP</span></span>
</figcaption>
</figure>
<p>Although we didn’t appreciate it at the time we prepared our report, the publication of our paper coincided with increasing stirrings amongst scientists and orthodox medical practitioners against what’s seen as promotion of “<a href="https://theconversation.com/pointing-the-bone-at-chiropractic-quackery-lessons-from-the-uk-5021">pseudoscience, anti-science, dodgy science, bogus science, balderdash, claptrap…</a>”. This description comes from Dr Simon Singh, a British science journalist who recently successfully defended himself in the United Kingdom against a libel action mounted by the chiropractic fraternity for harsh criticism of their philosophy.</p>
<p>So our work hasn’t occurred in a vacuum. The newly formed Australian organisation, Friends of Science in Medicine, is currently campaigning strongly against universities that are seen as sullying their scientific reputations by running courses in alternative and evidence-poor philosophies of medical practice, such as chiropractic and homeopathy. In only a few weeks since their launch in late 2011, FSM has attracted hundreds of supporters and <a href="http://www.nytimes.com/2012/02/06/world/asia/australian-universities-defend-alternative-medicine-teaching.html">garnered international attention</a>.</p>
<p>Although alternative practitioners have always been with us, they became much more prominent during the 1970s and 1980s. Initially, at least, the attitude of the orthodox medical profession was to ignore them and hope they would go away. Orthodox clinicians often adopted an attitude of “at least their treatments can do no harm”; an attitude has been shown to be mistaken in many cases.</p>
<p>But the increasing emphasis in medical teaching and practice on a solid “evidence base” for everything clinicians do is starting, finally, to encourage the profession to challenge the proponents of these alternative philosophies and indeed to be harsher in their criticisms of treatments considered bogus or worse.</p>
<p>So to return to the Gawler story. Ian Haines and I, and many of our medical colleagues, have been distressed over the years to see large numbers of our cancer patients adopt some of his unproven ideas – often to the exclusion of proven orthodox treatments. </p>
<p>We asked the question, how well supported by evidence are Gawler’s claims? We based our enquiries on a quote from the late Carl Sagan that “extraordinary claims require extraordinary evidence”. Gawler’s claim to have cured his cancer by meditation, herbs, coffee enemas and a vegan diet is surely extraordinary by anyone’s interpretation. </p>
<p>If cancer sufferers and other ill people are to follow his advice, which is not an easy thing to do, they need to be sure that it is based on rock solid evidence without there being a possible alternative explanation. </p>
<p>Our motive, pure and simple, was to point out that there’s at least one other highly plausible explanation for his survival. Cancer patients should think carefully before following down the path that Gawler has mapped out.</p>
<p>It’s time science fought back.</p><img src="https://counter.theconversation.com/content/5242/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ray Lowenthal does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s not often that a scientific article in a learned medical journal becomes front page news but that was the case recently when a paper I co-authored with Dr Ian Haines of Melbourne’s Cabrini Hospital…Ray Lowenthal, Professor of Oncology, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/51592012-02-03T02:54:13Z2012-02-03T02:54:13ZWhy universities should teach alternative medicine<figure><img src="https://images.theconversation.com/files/7368/original/qz64kg4q-1328236484.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Linking research and teaching, universities are best placed to teach evidence-based CAM.</span> <span class="attribution"><span class="source">Tulane Publications</span></span></figcaption></figure><p>Most readers would know of <a href="https://theconversation.com/alternative-medicine-can-be-scientific-say-besieged-academics-5058">the current debate</a> about universities teaching complementary and alternative medicine (CAM). A core question not being addressed in this debate is what other institution is better placed to deliver evidence-based knowledge of CAM. </p>
<p>The latest controversy started when a group called Friends of Science in Medicine (FSM) wrote to vice chancellors across the country asking them to review their health science courses. FSM rightly says that rigorous academic standards and evidence for scientific conclusions and health-care practices are of the essence and should be the basis of all university teaching. </p>
<p>I’m sure that any university lecturer would agree with these principles; most would consider themselves as friends of science in medicine. But it’s a matter of concern when the debate and terminology become simplistic, generalised and uninformed. </p>
<p>CAM is a term for <a href="http://nccam.nih.gov/">many different practices and medicines</a> and there’s scientific evidence for a number of them. Some of the modalities are derived from ancient sciences, for instance, and have a very long history of successful traditional use. FSM mentions acupuncture as a therapy it considers pseudo-scientific and argues that it shouldn’t be taught at university. But this isn’t entirely true. </p>
<p>There’s clinical evidence for acupuncture as effective treatment for various conditions, including <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001218.pub2/abstract">migraines</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007587/abstract">tension-type headaches</a> and <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001351.pub2/abstract">chronic low-back pain</a>. What’s more, there’s a <a href="http://www.medicareaustralia.gov.au/public/claims/what-cover.jsp">Medicare rebate</a> available for acupuncture if it’s part of a doctor’s examination. Why <em>shouldn’t</em> medical practitioners learn about the evidence for this treatment option at universities to increase consumer choices and improve patient outcomes? </p>
<p>The National Prescribing Service’s <a href="http://www.nps.org.au/__data/assets/pdf_file/0005/69656/CMsInfoSummary.pdf">“Review of the Quality of Complementary Medicines Information Resources”</a> can be used to identify which CAM information resources are of high quality, evidence-based, unbiased and well structured. The use of such high-quality resources is available and encouraged at universities.</p>
<p>In Australia, complementary medicines are <a href="http://www.tga.gov.au/industry/cm-basics-regulation-overview.htm">regulated</a> as medicines by the Therapeutic Goods Administration (TGA). The TGA’s ambit includes homeopathic and traditional medicines, such as Traditional Chinese Medicines. According to the TGA’s <a href="http://www.tga.gov.au/pdf/cm-evidence-claims.pdf">guidelines</a> general and medium-level claims (such as the temporary relief of minor self-limiting conditions) for complementary medicine’s efficacy can be based on certain traditional use evidence. The guidelines allow the use of such medicines until high-level evidence, that would allow for high-level claims, is available.</p>
<p>A balanced view in this debate is particularly important because about <a href="http://www.ncbi.nlm.nih.gov/pubmed/20646290">70% of Australians already use CAM</a>, mostly alongside conventional medicines and treatments.</p>
<p>So the community expects health professionals to be able to provide information and guidance about the quality use of <em>all</em> medicines, which, according to <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/National+Medicines+Policy-1">Australian’s National Medicines Policy</a>, includes complementary medicines. To be able to do that, health professionals need to be knowledgeable, at least, about the principle, paradigm and available evidence for all complementary medicines, including <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Where%20Does%20Homeopathy%20Fit%20in%20Pharmacy%20Practice%3F">homeopathic </a>and traditional medicines. </p>
<p>And where else would health professionals gain this knowledge if not at university, during their degree? One of the advantages universities have is the close relationship between research and teaching – students are more engaged and inspired by research-led teaching, and research is informed by queries from students while teaching. Many universities research CAM to generate an evidence base or prove their lack of efficacy.</p>
<p>So why support research but exclude teaching of CAM from universities? Aren’t we obliged to translate our research results into practice – starting by teaching new practitioners? </p>
<p>At Griffith University, evidence-based CAM education is integrated throughout the whole pharmacy curriculum. Our teaching research has shown that pharmacy students perceive education about CAM as a core part of their professional degree. We found that CAM research and education had a moderating effect on <a href="http://www.ncbi.nlm.nih.gov/pubmed/18221569">students’ attitudes</a> towards CAM. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19002274">The training</a> also encouraged students to look at and evaluate evidence and make informed decisions in the best interests of their patients.</p>
<p>We also offer a specifically designed “<a href="http://www.integramedshortcourses.com/">Short Course in Integrative Medicine for Pharmacists</a>,” which has been accredited for continuous professional development. The course addresses the shortage of CAM knowledge among practicing Australian pharmacists as identified in a recent Pharmacy Guild-funded project, which <a href="http://www.degruyter.com/view/j/jcim.2010.7.1/jcim.2010.7.1.1411/jcim.2010.7.1.1411.xml?format=INT">surveyed Australian pharmacists nationally</a>. </p>
<p>The survey found most pharmacists supported undergraduate CAM education (76%), and the majority (85%) were interested in additional CAM education themselves. </p>
<p>Research also suggests that CAM education may also teach practitioners greater <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Hirschkorn%2C%20Sociol.%20Health%20Illn.%2C%202006">self-awareness, improved core competencies</a> (such as evidence-based practice), enhanced cultural competency and <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Gaylord%20et%20al.%2C%20Acad.%20Med.%2C%202007">patient-centred care</a>. </p>
<p>So should we turn our back on the consumer-driven trend toward holistic and integrative healthcare, or should we work together to understand, research and teach different principles, practices and evidence to improve health outcomes for customers and patients? I, for one, would prefer the latter.</p><img src="https://counter.theconversation.com/content/5159/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evelin Tiralongo does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most readers would know of the current debate about universities teaching complementary and alternative medicine (CAM). A core question not being addressed in this debate is what other institution is better…Evelin Tiralongo, Senior Lecturer, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.