What if there’s no baby in the bathwater? Do we really need a CAM industry?

The marketing is slicker now. Hugh MacLeod's gapingvoid.com

It’s been a pretty tough week for supporters of alternatives to medicine. First up, the Therapeutic Goods Administration (TGA) released a draft for public comment of its much-anticipated consultation document on the evidence required to support indications for listed medicines. This could well be the single most revolutionary consumer protection step in the regulation of non-prescription products since the Therapeutic Goods Act itself.

The draft document outlines a system whereby the manufacturer of a product which makes therapeutic claims would be required to provide the TGA with an “expert report” on the claimed benefits of the product. There are also guidelines as to what constitutes an appropriate “expert”. To the relief of consumer advocates and supporters of scientific healthcare, the TGA has spelled out in detail that the “expert” must be a university graduate of at least a three year bachelor’s degree, with at least five years of clinical work, or a PhD with relevant expertise.

Does this seem excessive? It seems reasonable and sensible to have at least one person with at least a rudimentary amount of training and experience supporting the claims made for products which are making their manufacturers billions of dollars a year. Lord knows, the average punter in the street already thinks this is the case, and they are usually indignant when told it isn’t so.

The reaction from Big Supplement has been predictably apocalyptic. The CEO of the Complementary Healthcare Council of Australia (CHCA), the peak industry body, Ms Wendy Morrow was quoted in one article in the medical press as saying: “If it’s adopted in the way that it’s drafted, there won’t be an industry to worry about. If you don’t have a health degree, according to this, you can’t be an expert.”

If you have a massive industry that is built upon widespread noncompliance with even the shrivelled fig leaf of regulation that currently exists, the public are probably much better off without it. It seems as if this parasitic and lazy behemoth has grown so accustomed to making easy money that even a very reasonable and long-overdue reform looks like a full frontal assault. They seem surprised and offended when their customers get sick of being treated like mugs.

Oh, and I would consider someone with a bachelor’s degree and five years of experience to be just beginning to be reasonably competent in a healthcare-related field. I would be genuinely intrigued to find out what CHCA’s preferred definition of an “expert” would include.

The second hair in the throat for CAM supporters this week is an excoriating exposure of the failures of one of their icons. The National Centre for Complementary and Alternative Medicine (NCCAM) is a huge research establishment founded by the political intervention of a pair of powerful Iowan senators, Tom Harken and Berkely Bedell. It has been around in its current form since 1999 and has an annual budget of $US130m. Its funding has steadily increased over the last decade, despite overall NIH funding declining during the same period. Surely this must mean that it is producing outstanding results? After all, even NASA – the greatest and most undeniably successful organisation in American science – has just had its budget gutted.

In an editorial for the very prestigious Journal of the American Medical Association (JAMA) this month, Dr Paul Offit goes through a litany of negative results and improbable research funded by NCCAM, and by any standard of academic merit, it is impossible to conclude that NCCAM has anything other than ideological value. Unfortunately the full article is behind a paywall, but the following is a fair sample of it…

“many studies funded by NCCAM lack a sound biological underpinning, which should be an important requirement for funding. For example, NCCAM officials have spent $374 000 to find that inhaling lemon and lavender scents does not promote wound healing; $750 000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390 000 to find that ancient Indian remedies do not control type 2 diabetes; $700 000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406 000 to find that coffee enemas do not cure pancreatic cancer. Additionally, NCCAM has funded studies of acupuncture and therapeutic touch. Using rigorously controlled studies, none of these therapies have been shown to work better than placebo. Some complementary and alternative practitioners argue reasonably that although their therapies might not work better than placebos, placebos may still work for some conditions.”

The real problem from a scientific point of view is that if a mountain of evidence shows that improbable therapies don’t work, this fails to result in CAM practitioners abandoning these treatments.

Dr Offit continues: “Several studies have shown that garlic does not lower low-density lipoprotein cholesterol, St John’s wort does not treat depression, ginkgo does not improve memory, chondroitin sulfate and glucosamine do not treat arthritis, saw palmetto does not treat prostatic hypertrophy, milk thistle does not treat hepatitis, and echinacea and megavitamins do not treat colds. Moreover, some studies have found that megavitamins increase the risk of cancer and heart disease. Because the vitamin and supplement industry is not regulated by the US Food and Drug Administration (FDA), negative studies have not precipitated FDA warnings or FDA-mandated changes on labeling; as a consequence, few consumers are aware that many supplements have not delivered on their claims.”

Sound familiar? Pretty similar to here really.

Given the massively funded research effort over more than a decade that has led to no net value to the community, and the determination of the industry to keep flogging their patent cures until the sheriff runs them out of town, I don’t see that there is a baby in the bathwater that we would miss even if it were all to go down the plughole.