Medicandus

Medicandus

PathoLOLgical testing. Actually it’s not so funny.

Friends of Science in Medicine (to whose goals I am a signatory) has gotten together with the Royal College of Pathologists of Australasia (RCPA) to produce some excellent and sensible advice about dodgy health tests. I applaud the RCPA for being involved in defending the borders of its professional responsibilities as the ‘learned college’ responsible for pathology testing. It is heartening to see a professional body whose mission is largely the training and ongoing maintenance of standards for pathologists take on more of a consumer protection role in this way.

Some tests that get abused are legitimate tests which may be done by unaccredited laboratories with poor quality control, and with misleading interpretations of the results. Much of the online genetic testing that is available falls into this category. Respectable genetic testing involves trained genetic counsellors who explain the ethics and ramifications of doing the tests beforehand, and help to interpret the result afterwards. Overly simplistic ideas about genetic influences of disease are superficially appealing, but cheap and cheerful genetic testing is an ethical and legal minefield that needs an experienced guide. I was pleased to see there is advice about this in the document.

Ersatz sciencey-looking tests are a potentially excellent money spinner for alt-medders. They are advertised to the ‘professionals’ concerned (usually but not exclusively naturopaths) as such. Many of the testing devivces are completely discredited but continue to be sold and used by people who are either too lazy or too poorly trained to find out the truth about them. One excellent example of this category is Vega testing. This is a device which had its origins in made-up quackery and was widely marketed with claims about its ability to diagnose allergies amongst other problems. It was actually put into clinical trials, and was unable to tell those with allergies from those without. It has been debunked and condemned for more than 20 years by the medical experts in the field. In 2010, the importer of Vega devices into Australia finally had its listing withdrawn from the Australian Register of Therapeutic Goods (ARTG). This meant it could no longer be sold in Australia for healthcare purposes.

It did NOT however mean that it couldn’t still be used, or that retractions of all the claims had to be made. It’s as if a magic yeti tooth importer got busted for selling cow teeth and just agreed to no longer import them. The magic yeti tooth retailers are still free to go around continuing to report the miracles their products have performed, and people keep getting fooled into buying them. Check out what happened in the comments section when The Conversation’s own Dr Rachael Dunlop blogged about it (a full year before the ARTG cancellation in 2010) if you want to see for yourself the level of mistaken belief Vega supporters have in their equipment.

It’s now clearly a breach of the TGA Advertising Code to make any claims at all for the Vega machine, given that its sponsors couldn’t provide any supporting evidence of effectiveness when TGA asked them to. Product sponsors affirm when registering with the ARTG that they hold evidence that their product can do what it claims to do, by the way. Despite this minor regulatory hurdle, I found a friendly local practitioner just a couple of streets away from my office who could sort me out for some Vega testing action. You can take it from me that the secondhand Vega market seems pretty healthy as well, based on my browsing of some of the professional natural therapy classifieds.

Vega testing is just one example of the sort of flaky testing that many naturopaths espouse. Live blood analysis is another popular pseudoscientific test at the moment. According to my search of one of the larger natural therapy sites, there are at least 66 practitioners in Melbourne alone offering it. Amount of valid research supporting it as a diagnostic service? None. Have a look at the Wikipedia page. It has been scientifically debunked, and practitioners have been disciplined for making the sort of claims you see any day on the internet. One wonders how such a thoroughly discredited service could possibly be offered by any practitioner in good faith.

I think I know how it can happen. First, you need to create an environment where credible, sensible advice such as that offered by FSM and RCPA (or by Sense About Science in the UK) can be construed as propaganda in a turf war. Do this by producing testimonials. Fictional or not, a breathless story is always compelling. It helps to have toothless regulators whose legal powers have been carefully constrained by lack of money and staff. No matter how forbidding they look on paper, they won’t have the resources to pursue any more than a couple of fringe operators, while the rest of the industry pretend that nothing has happened. If pushed, blame the scapegoats as ‘rogue operators’ but under no circumstances should any natural practitioner attempt to address the logical and scientific howlers that underpin the whole enterprise. Finally, get sympathetic academics to write wordy papers which claim that trying to stop consumers getting ripped off and harmed is actually just a medico-fascist activity carried out by a powerful yet shady cabal trying to suppress free speech and ‘patient choice’. Stop me if any of this sounds familiar….

So my advice is to insist that any blood test you may have should be covered by Medicare, unless it is a highly specialised test that a relevant specialist recommends. If it’s not Medicare rebatable, the test should at least be done by a laboratory that is accredited by RCPA and the National Association of Testing Authorities (NATA). The logo should be on the test request slip.

It’s challenging enough to wisely order lab tests and interpret them without having pseudomedical wannabes stealing the lab coats and performing zombified versions of them.

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