Natural health for the well-heeled
When Australians feel under the weather, two in three of us will turn to some form of complementary medicine to get back on our feet. But a new government review into the complementary medicine could mean some of those treatments get a lot more expensive for us soon. May Slater reports.
The $1 million review, announced with the recent federal budget, will put popular therapies like homeopathy, kinesiology, aromatherapy, naturopathy and herbal medicine under the scientist’s microscope. Those treatments found to be ‘clinically ineffective’ will lose their private health rebate status.
Emeritus Professor, John Dwyer of the University of New South Wales said: “The government is sending a signal that there’s a current credibility gap that needs to be looked at… they’re focusing on those therapies that are based on a belief system that is more metaphysical than physical and which are actually an affront to our modern knowledge of how the body works.”
Dwyer is founder of the Australian Healthcare Reform Alliance and more recently, President of ‘Friends of Science in Medicine’ (FOS); a group of doctors, scientists and researchers who are lobbying for stricter regulation of the natural health industry in Australia and overseas. He says the science is stacked against natural therapies.
“If you apply the definition the government uses: ‘credible scientific evidence of clinical effectiveness’ — none of them will pass the test and there will be a big shake up in terms of private health insurance,” he says.
The Department of Health and Aging says services that are already regulated with national accreditation schemes and subsidized under Medicare will not be affected by the review. These include things like acupuncture, Chinese medicine, chiropractic, osteopathy and physiotherapy.
But Marcus Blackmore, Chairman of natural health and vitamin company Blackmores, says the review could be “devastating” for the complementary health industry as a whole and for consumer choice. He has little confidence natural therapies will be fairly represented.
“The government’s track record in appointing people to review natural therapies is nothing short of disastrous,” he says. “Unless they put clinicians there with practical experience with complementary medicine, the outcome will be disastrous. They’ve got to have the right people sitting in judgment.”
Blackmore says this is part of a broader push against natural medicine in Australia.
“Why is there that push? The principle underlying reason is one thing which dictates so much of our lives and it’s unfortunate – it’s money,” he says. “One in three of all medical consultations in Australia are now with an alternate health practitioner. We’re massive competition.”
The government has given its chief medical officer, Professor Chris Baggoley, eight months to determine what is, and what is not, good medicine. This will involve consultations with consumers, service providers, professional bodies and health insurers, with any changes to private health rebates expected to come into play in January 2014.
John Dwyer says this will be easiest one million dollars the government has spent.
“We think the chief medical officer could finish that in three weeks because there’s such an abundance of literature and good science debunking these techniques that we’re talking about,” he says.
Dwyer’s group, Friends of Science in Medicine, came together last year to lobby Australian universities to stop teaching complementary health courses.
“For years we’ve been concerned with the amount of misinformation being given to consumers. The amount of health care fraud and pseudoscience that is out there in this most scientific of ages is distressing,” says Dwyer.
“And even more distressing is the fact that a number of universities are giving quite undeserved credibility to some of these ‘pseudo-sciences’ by teaching them as part of their science program.”
Dwyer says natural therapies are a threat to public health and he is now calling on private health funds to “abide by the umpires decision” and reject them when the review findings come through next year.
“There is a section of the community that, in this postmodern world, want a simpler, less harsh version of science. They like the idea of panaceas and an almost magical approach to health, but of course this is a dangerous delusion,” he says.
“The danger for most of them is that there’s a significant risk of a lack of diagnosis, a missed diagnosis or a delay in getting effective treatment.”
But Marcus Blackmore says there are centuries of traditional knowledge behind most natural remedies, and solid research is being conducted in universities around the country.
“Where’s the evidence for the Aboriginal herbal medicine? Kept them alive on the planet for a long time before white man came along and fed them all this crap and gave them all of our diseases, didn’t it?”
“John Dwyer is critical of reflexology, he’s critical of homeopathy and acupuncture, he’s critical of traditional Chinese medicine,” he says. “But just about every medical hospital in China has a reflexologist, certainly has an acupuncturist and they all use traditional Chinese medicine. And have been doing so for 5,000 years at least.”
Blackmore says people are now better informed about their health than they’ve ever been. The Internet, he says, has changed the whole practice of medicine.
“With my generation the doctor tells you to go and eat crap – then you go and eat crap! You had blind faith in him,” he says. “But we don’t have that anymore because we’re better educated about those things and there is a desire for us to take control of our own health.”
There are many ways people satisfy their health requirements, says Blackmore, but they must have the right to choose how they do so. In terms of safety, he says all medicine carries a degree of risk.
“The underlying doctrine of orthodox medicine, of Hypocrates, is ‘do no harm,’” says Blackmore. “Who are the best people in our community to measure harm and risk? Not your doctor — your insurance company. They’re experts at it.”
“A naturopath will pay $300 a year in professional indemnity insurance, while a GP will pay up to $20,000. If that’s not a measure of risk and harm, I don’t know what is.”
President of the National Herbalists Association of Australia, Leah Hechtman, says there is strong modern science underpinning many popular natural therapies.
“Countless herbal medicines have gone through numerous clinical trials and shown impressive evidence and efficacy for use. It’s very rigorously studied,” she says.
Hechtman thinks the review is positive if it can improve the information and quality of care available to the public. Not all therapies, though, are equal in the eyes of modern science.
“We think it’s a good thing if it allows complementary medicine to be split into specific modalities; to ensure that they don’t group us all together and incorporate fringe modalities when looking at the very effective therapeutic things that we do,” she says.
“Each have their benefit and each have their merit, however you can’t compare oranges and apples, you can’t compare herbal medicine with crystal therapy for example – there’s a very distinct difference with the evidence base behind it.”
Australians spend about over one billion each year on natural health, and at the moment, we can claim back 30 per cent of the costs of most of those treatments through our private health insurance.
Naturopath Lizzie d’Avigdor says the majority of her patients claim private rebates when they come to see her. How might changes to private health affect her patients?
“It will exclude people coming to me who would otherwise be able to afford it,” she says. “I think scrutiny is good. Every industry – including the medical profession – needs constant scrutiny and I welcome it, but I don’t understand why groups like Friends of Science appear to want any complimentary medicine completely banned off the list and not available as a matter of choice for our patients.”
“I think we need to have a little respect for the intelligence of our clients,” she says.
Leah Hechtman is also a practicing naturopath and herbalist, with qualifications in iridology, Bach flower remedies and energetic healing.
“I really doubt that the health funds will no longer fund herbal medicine and naturopathy specifically, but if they did, a large percentage of my patients would be disadvantaged,” she says. “When you look at complementary medicine in Australia though, it’s a billion dollar industry, it would be highly unlikely that they would disadvantage that many people.”
But Professor John Dwyer says people who want to use a bunch of “nonsense” that is “no better than a placebo” should pay for it themselves.
“Of course there are naturopaths and alternative therapists who limit themselves to giving perfectly sensible advice to people about lifestyle and nutrition, and not all these practitioners are either dangerous or useless,” says Dwyer.
“Those people that are being helped with good advice – nothing’s going to interfere with that – but the government I think is saying; ‘look we’re not going to be using tax payer’s dollars to pay for things that clearly cannot be of benefit, could never be of benefit’ — the scientific evidence is in that this is totally a non-science, a nonsense.”
The popularity of natural medicine suggests otherwise: 72 per cent of people surveyed as part of a 2010 study into complementary medicine use in Australia rated the products they had used as ‘effective’ or ‘very effective’. Dr Sandi Rogers of the Australian Traditional Medicine Society asks: ‘If natural medicine didn’t work, then why do consumers keep coming back for more?’
Proponents of complementary medicine say these therapies are an essential part of our healthcare system and actually save the government money.
“The way conventional medicine has evolved, unfortunately, it is no longer preventative,” says Leah Hechtman of NHAA.
“But our medicine — naturopathy, complimentary medicine, herbal medicine – is all about preventative medicine. It’s about understanding your body and if we can prevent diseased states, the health of the wider population can only benefit.”
The Australian Bureau of Statistics notes that people who visit a complementary health therapist are significantly more likely to exhibit healthy lifestyle behaviours than people who consult any other health professional. Healthy behaviours include eating the recommended serves of fruit and vegetables, exercising at high or moderate levels, and not smoking. And rather than it being and either/ or choice – the majority of people who see a natural therapist also visit a doctor.
With so many Australians choosing natural and alternative therapies to keep a healthy body and soul, greater investment in research of those medicines can only be a good thing.
“The reality is you need more and more science,” says Blackmore. “We need to develop new methods to evaluate some of these therapies but the right place for that to happen is at the universities — to cut that off, is seriously, seriously stupid.”
Blackmore says the problem for his industry is that the research money is going into the study of pharmaceutical drugs.
“You can’t patent a herb,” he says “we’re very dependent on research organisations that aren’t looking for a new chemical entity that never existed on the planet before.”
John Dwyer concedes modern medicine is full of treatments that have come from the natural world and says some traditional Chinese medicines and plant extracts are worthy of further study.
“But science, good modern science can, and must, see a convergence so that anything that is useful in the alternative and complementary world shouldn’t remain alternative – there shouldn’t be a parallel health system,” he says.
What could come out of the review then is a more integrated Australian health system and better information about all the treatments available to us when we’re feeling poorly.
Blackmore says there is now a growing trend within orthodox medicine to treat people more holistically, with many doctors and hospitals choosing to integrate natural remedies into their practice and surgery.
“They’ve started to realize, that if you put bad fuel in the car — the body— it still goes, it just doesn’t go so well. They’re starting to understand that things as simple as an apple a day does keep the doctor away. That maybe what you eat determines how you feel.”
The naturopathic concept of treating the body as a whole is an art, says Blackmore. “What many people in this world don’t understand is that medicine is as much an art as it is a science.”