Category Archives: Opinion

“There is only one way to avoid criticism; do nothing, say nothing, and be nothing.” Aristotle

0095_DSC0626I’ve long taken to heart the negative sentiments of critics of complementary medicine – not understanding how anyone could be so narrow-minded as to exclude an entire approach to healthcare that has benefitted countless people for many generations.

 

But I stopped caring about them last week.

 

Last week the Blackmores Institute announced an unencumbered gift to establish the Maurice Blackmore Chair of Integrative Medicine at the Sydney Medical School, University of Sydney, in honour of my late father.​​

 

Both the University and Blackmores Institute professed the necessity for robust governance to ensure the independence of the research and education that would result from the financial contribution.

 

Both the University and Blackmores Institute knew that there were growing numbers of Australians embracing complementary medicines and that this was an area that was underrepresented in medical professional education.

 

According to the NHMRC Research Funding Datasets 2003- 2012, allocations for research funding into complementary medicine have been just 0.2% of total funding over the past ten years, despite use of complementary medicine by the Australian public remaining substantial.

 

Of that, the research funded has, at times, been questionable. Such as a recent NHMRC-funded study claiming the potential harm of vitamin D based on giving rats and mice a dose of vitamin D that would be equivalent to a 60kg human taking 360,000IU of the nutrient daily.

 

It was not unexpected that the critics professed their ‘concerns’ about the Integrative Medicine Chair, though it was certainly ironic. After years of demanding more research, they were unlikely to commend us for our actions.

 

They were misguided though in stating that Maurice Blackmore was not worthy of the honour of the name of the Chair claiming he was not an advocate of ‘evidence-based medicine’ (a concept coined in the 1990s – nearly 15 years after he passed away!).

 

Though the terms ‘evidence-based medicine’ and ‘integrative medicine’ were not used in his time, his life’s work is testament to these principles. His early observations of mineral therapy and his clinical applications of nutritional medicine were the foundation of an approach to health management that is still relevant today.

 

He dedicated his life to sharing his knowledge and published an extensive collection of observations and clinical notes. They are an interesting read given we now have the benefit of nearly 40 years of scientific exploration: sometimes he got it right…sometimes he didn’t. But he had an enquiring mind and a desire to help people, which is the same motivation that led to this Sydney University gift.

 

Somewhat prophetically, when I looked today at one of his journals, he notes his concerns that long-term aspirin use could cause serious gastric depletion (right!), he then states that polar bears are claimed to have the lowest mentality of animals which makes it unlikely that fish is a brain food (wrong!). But the most interesting of his reflections on that page was a quote from EH Chopin:

“Scepticism has never founded empires, established principles, or changed the world’s heart.  The great doers in history have always been men of faith.”

 

It was timely given the commentary of recent days. It’s time for the skeptics and the critics to step off the sideline and engage in furthering healthcare with a focus on prevention and wellbeing. I am proud of the legacy of my father as a pioneer of healthcare, that the Blackmores Group had the courage to contribute to independent research and education, and to play an active role in furthering the health capabilities of our healthcare professionals to the benefit of all Australians.

 

 

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Attack on homeopathy is not evidence-based

Eminent neurologist Dr Raymond Schwartz said it well over dinner one night, “Evidence of itself doesn’t always mean that a remedy works, and conversely, lack of evidence doesn’t necessarily mean that a remedy doesn’t work.”  He went on to explain that at present, the evidence behind the use of stem cells lacks evidence but that is likely to change over time.

The critics of homeopathy and complementary medicine have taken an interim report released by the National Health and Medical Research Council (NHMRC) today on the use of homeopathic remedies and raised questions about pharmacies stocking these products.

In my own experience as a Naturopath, I have mixed views on the use of homeopathic treatments.  I can say that on a recent trip to Italy I was presented with a homeopathic remedy from a homeopathic pharmacy with good results.

However, I have serious concerns that the NHMRC review has not considered the necessary body of evidence to classify this longstanding traditional modality as ineffective and their interim ‘findings’ may have provided a platform for criticism from the skeptics of natural medicine to express their narrow views.

Those questioning the place for traditional medicines in pharmacy should be aware of the limitations of the NHMRC complementary therapy review:

As a ‘review of reviews’ was employed to gather information, the evaluation fails to include any randomised trials or studies that have not been captured by a review.

  • Only papers published in the last five years were considered thereby excluding a lot of evidence.
  • The review only included databases published in English which, considering many traditional modalities have their origin in Europe, excludes some of the most compelling data.
  • The Homeopathy Working Committee has no homeopaths on its panel, though interestingly it did have a consumer advocate (would the NHMRC conduct an enquiry into psychology without having a psychologist on its panel?)
  • The totality of evidence was not also assessed, for example laboratory or animal (vet) studies were excluded.

So, is it fair to say the ‘review’ itself is ‘evidence-based’?

Dr Lesley Braun, Director of Blackmores Institute, reminded me of the words of Sackett, widely considered the chief founding father of modern day evidence based medicine, “evidence based medicine is not “cookbook” medicine. Because it requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patients’ choice, it cannot result in slavish, cookbook approaches to individual patient care. External evidence can inform, but never replace, individual clinical expertise…” (Sackett et al. 1996).

No profession, modality or therapy can claim to be the most effective or safe, however it is the right of the 70% of Australian pharmacy customers taking OTC herbal or natural supplements to access the therapies in which they find benefit particularly when they are well-tolerated and cost-effective.

Notwithstanding, there are currently severe limitations to building a more comprehensive evidence base including:

  • Lack of government funding into well-conducted research
  • Perceived bias against privately-funded research
  • Lack of private investment because of an inability to commercialise and IP-protect findings
  • Debate over methodology that acknowledges the nature of traditional treatments

Hopefully in time, we can overcome these limitations.  However in the meantime we must be cautious about making conclusions based on pseudoscience.

Dr Braun prudently observed that “making public health recommendations based on methodology shaped by inadequate resourcing rather than robust, good science isn’t very scientific at all.”

 
Read the NHMRC press release : http://www.nhmrc.gov.au/media/releases/2015/nhmrc-releases-statement-and-advice-homeopathy

Read Complementary Medicines Australia’s comments: http://www.cmaustralia.org.au/Resources/Documents/16%2012%2014_Fundamental_Flaws_of_the_NHMRC_Homeopathy_Review.pdf

 

Sackett, D.L., Rosenberg, W.M., Gray, J.A., Haynes, R.B., & Richardson, W.S. 1996. Evidence based medicine: what it is and what it isn’t. BMJ, 312, (7023) 71-72 available from: PM:8555924

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The Voice of Reason

This abc.net.au opinion piece titled  The War against Natural Medicine caught my attention  over the weekend.

 

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The Forces Against Health in Australia

Ian Brighthope runs a fantastic company called Nutrition Care. He has been a personal friend for many years and he has written this outstanding article which I wanted to share with you.
Marcus

Nutritional medicine could save hundreds of millions of lives, but vested interests actively pursue the opposite.
Commentary by Ian Brighthope, M.D.
(OMNS June 25, 2012) Health practice in Australia is still focused on treatment of disease as opposed to its prevention and the optimization of health. Although the scientific literature has recently shown an increasing awareness of the importance of lifestyle factors in preventing disease, mainstream medical professionals continue to be trained to react to disease and pursue drug treatment. This “drug and disease” paradigm is costly, not only in monetary terms but also the human toll of pain and suffering and its impact on productivity and quality of life, and widespread illness and death caused by medical treatment.
Iain Chalmers, director of the UK Cochrane Centre, has said that “Critics of complementary medicine often seem to operate a double standard, being far more assiduous in their attempts to outlaw unevaluated complementary medical practices than unevaluated orthodox practices . . . These double standards might be acceptable if orthodox medicine was based solely on practices which had been shown to do more good than harm and if the mechanisms through which their beneficial elements acted were understood.” Unfortunately, neither of these conditions hold true.
The Australian government has made investment in the prevention of disease a priority in its $7.4 billion comprehensive reform package to the nation’s health system. Yet prevention has been a secondary consideration in most medical schools and practices. A huge amount of disease and death could be prevented by addressing the use of tobacco and alcohol. There remains an enormous void in the government’s health policy because it does not encourage and support the medical profession to practice nutritional medicine.
Changing Attitudes
“Individuals are ceasing to be mindless consumers of drugs and services, becoming more discriminating and aware in their choices. They are also bringing their new options back home to their family physicians, and contributing to an awareness among doctors of the existence and potential of natural therapies.”
Research in the field of nutritional medicine is growing at a phenomenal rate, and now that the human genome has been sequenced, the science supporting nutrition in preventing disease is more impressive than ever. Many general practitioners and academics are open to the use of diet and nutritional supplements as viable alternatives to drugs. However, there are still too few to make a significant impact on public health. There will always be resistance, even hostility from the nutritional “flat-Earthers” – those who believe that “if you eat a balanced diet then you cannot be deficient in essential nutrients” (despite overwhelming evidence to the contrary) – and the academic medical power brokers. But I believe the system will eventually change in line with the accumulating evidence.
Recently, leading economic forecasters Access Economics announced that expanding the use of complementary/nutritional medicines could maintain excellent patient outcomes while saving hundreds of millions of dollars a year in healthcare costs. They studied the cost-effectiveness of common nutritional treatments for common chronic and serious conditions. They evaluated acupuncture for chronic lower back pain, St John’s Wort for mild to moderate depression, fish oils in the prevention of heart disease and for the treatment of rheumatoid arthritis. The director of Access Economics, Lynne Pezzullo, said that analysing each treatment on a case-by-case basis showed patients could save a considerable amount of money by using nutritional medicines. In the case of St John’s Wort, for the 340,000 Australians who are being treated for mild to moderate depression with drugs that don’t work well, she estimated a saving of $50 million per annum. The potential savings from the use of vitamins C, D, and E and fish oils in heart disease is in excess of $2 billion.
The executive director of the National Institute of Complementary Medicine who initiated the study, Professor Alan Bensoussan, commented “I think governments should … look more closely at what implications this might have in the context of national health reform.” I agree wholeheartedly, and have been pushing for similar reforms for many years. I hope this will mark the beginning of a new endeavor to change our overburdened health care system. Politicians and regulators are very cautious about such change for fear of reactions from the medical and pharmaceutical establishment, who may perceive competition for the health dollar as a threat. But there is enough work to do in the goal of optimal health to keep every doctor, hospital, naturopath, and nutritionist busy for decades. That is, unless a miracle occurs and megadose vitamin C and a few vitamins and minerals become widely used. For these supplements can prevent widespread deficiencies that are responsible for many age-related diseases.
The “Wellness Model” of health attempts to prevent disease and optimise health by encouraging people with the proper nutrition and lifestyle tools. This can achieve the maximum level of health, physical and mental, for each individual. It creates an optimal environment for the expression of that individual’s genetic potential. The keys to achieving optimal health include the judicious use of nutrition and nutritional supplements, regular physical exercise, the avoidance of environmental pollutants, and the practice of positive outlook through simple techniques such as meditation. This concept of optimising health for everyone is foreign to most traditional doctors and is glaringly absent from medical school curricula and training.
Lobbying for Disease
In this debate there are insidious influences. A powerful lobby group called the Friends of Science in Medicine (FOSM) is actively discouraging the federal government from supporting universities with funding if they conduct courses in what they personally regard as unscientific. Shamefully, the FOSM don’t have members trained in NM and the nutritional sciences. FOSM is predictably against nutritional supplements, regarding them as expensive and wasteful. Could the money spent on nutritional supplements be better spent in more hospitals by treating the sick with drugs? In effect FOSM insists that universities should only teach what it defines as “correct” knowledge – emphasizing the treatment of disease, not the promotion of health. FOSM and the medical establishment would do well to become aware of the vast literature on nutritional medicine and the clinical experience of scientifically trained nutrition-aware doctors and nutritionists.
Nutritional Supplements in Medical and Pharmacy Practice
Most drug prescriptions are unnecessary, an estimated 80% in Australia. The list is long and includes antibiotics, statins, antidepressants, and many more. Yet through the best education, lifestyle, fitness, dietary change and the proper use of nutritional supplements and herbal medicines, patient health outcomes can be optimised and hospital admissions and adverse drug events significantly reduced. In 2009, government expenditure on the pharmaceutical benefits scheme (PBS) amounted to $6.9 billion and it is estimated that in 2009-10 it grew a further 9.3%. [8] I believe that at least $3 billion could be wiped off the total PBS expenditure and that these savings could be used to promote better nutrition, physical fitness and safe, effective natural therapies. For example, use of more cost-effective niacin or St. John’s Wort as antidepressants could free up more money to psychiatrists for proper counseling and to orthomolecular nutritionists for feeding the mind. Overall this would lead to greater knowledge, more support for the most appropriate research, and an economic benefit to the world’s population.
“There is an angry scornful tone used in leading textbooks of medicine regarding the discussion of micronutrient supplementation; an arrogance and ignorance concerning the evidence for the possible benefit of supplementation.”
Doctors and pharmacists play a major role in informing consumers about the safety, efficacy and correct use of nutritional supplements. A recent Australian study evaluated the use of both nutritional and prescription medicines by pharmacy customers. 72% had used nutritional supplements within the previous 12 months, 61% used prescription medicines daily, and 43% had used both. The most popular nutritional supplements were: multivitamins, fish oil supplements, vitamin C, glucosamine, vitamin B complex, probiotics, Echinacea, coenzyme Q10, Ginkgo biloba and St John’s Wort. The authors of the study explained that customers or patients want more information, ask more questions, and no longer blindly accept the authority of health care providers. This new class of customer differs drastically from the gullible consumer of nutrition supplements often characterized by the mainstream media. According to this study, nutritional supplements were selected by the majority of people themselves, although pharmacists and pharmacy assistants were helpful in this choice. From only a few bottles of vitamins in the 1980s to shelves of vitamins and essential nutrients lining the pharmacy walls, there has been a massive change in the retail pharmacy. The demands of an informed public plus the need for profits drove the pharmacy industry into selling nutritional supplements.
The study also highlighted that some customers currently feel pharmacists are ill-equipped to counsel them about nutritional supplements. Many don’t even refer to pharmacists as an information source. Pharmacists also felt ill-informed about supplements, and experienced frustration when dealing with inquiries about nutritional medicines and natural health products.
“We must act on the facts and the most accurate interpretation of them, using the best scientific information. That does not mean that we must sit back until we have 100% evidence about everything. When the state of the health of the people is at stake, we should be prepared to take action to diminish these risks even when the scientific knowledge is not conclusive.
Unfit to Practice
There is not a single medical school in Australia teaching adequate nutritional science to future doctors to ensure that they are fit to practice in proper health care. This applies equally to general practitioners and specialists. Most of any doctor’s patients are going to die from a nutritionally based disease, yet for years before they die they have formidably obvious nutritional deficiencies that go undiagnosed. Fortunately in Australia, we have highly qualified nutrition-aware health scientists in the profession of Natural Therapists who can help to correct these deficiencies.
Medicine stands on two feet – the science and the clinical art. Take away either one and it is going nowhere. Science on its own doesn’t work because people aren’t widgets; we all have different needs and different strengths, but medical research finds it easiest to treat us all the same. Got arthritis? Take this painkiller. But painkillers may destroy the joints, and in the case of the most common, paracetamol, cause damage to multiple internal organs – while simple things such as changing the diet, movement, vitamins, glucosamine and turmeric, among many others, have been shown to be very safe and effective.
Clinical skills also need to be advised by good science, the constant quest for understanding. In reality nutritional biochemistry holds the answers to most of our health problems, but movements such as FOSM actively seek to censor our knowledge of this.

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Support for complementary medicine courses

Some of Australia’s leading CAM academics and health educators have published an editorial in the 16 July issue of the Medical Journal of Australia (MJA) in support of teaching complementary medicine courses in universities.

Removing complementary medicine courses from universities will not reduce public demand, but it may reduce their educational rigour, say the authors.

“We can see great danger for the public if complementary medicine practice is allowed to develop outside mainstream education”, Professor Stephen Myers and coauthors wrote.

Professor Myers, director of the natural medicine research unit at Southern Cross University, was responding to an editorial published in the 5 March issue of the MJA by Alastair MacLennan, a professor of obstetrics and gynaecology at University of Adelaide.

In that article, Professor MacLennan, on behalf of a group called Friends of Science in Medicine (FSM), condemned the growth of complementary medicine courses in Australian universities. He said the growth in “pseudoscientific health courses” was undermining the international scientific credibility of Australian universities, and that academics at these institutions should “stand up for science”.

However, according to Professor Myers, “the real benefit of an appropriately mentored and approved university education is the exposure of students to the biomedical sciences, epidemiology and population health, differential diagnosis, safe practice and critical appraisal.

In an article in the same issue of the MJA, Professor Paul Komesaroff, from the Department of Medicine at Monash University, and coauthors wrote that the views in the MacLennan editorial “exceed the boundaries of reasoned debate and risk compromising the values that FSM claims to support”.

Professor Komesaroff said that while there was now an extensive evidence base in relation to complementary therapies, the concept of evidence-based medicine was highly contested and debated within Western medicine itself. It is not appropriate, he argued, for doctors or scientists with a particular view of medicine to impose those views on the whole community; rather, they should respect the rights of individuals to choose the approach to health care they feel is suitable for them.

“It is important that those who seek to be friends of science do not inadvertently become its enemies. We call on the members of FSM to revise their tactics and instead support open, respectful dialogue in the great spirit and tradition of science itself”, Professor Komesaroff wrote.

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A new perspective

Dear Friends,

I have received the following opinion piece from a source who doesn’t want to be identified but has an interesting perspective on this important issue. The author works in the University community and presents a wonderful level on introspection on the current issue with the Friends of Science initiative to write to the University Vice Chancellors attacking natural therapies and to intimidate the government appointed Reviewers within NH&MRC about funding research in Complementary Medicines which they do very little of anyway.  

Now the Gillard government, under the guise of reducing costs, has indicated in pre-budget ‘leaks’ that various practices such as Naturopathy are to be investigated for their evidence when it comes to tax benefits related to private health insurance. In other words we intend to disadvantage those people who look after their own health and in so doing may choose therapies other than those administered by medical doctors or other registered practitioners. Some years ago one of the health insurance companies was able to demonstrate to the then Health Minister Tony Abbott that those people who availed themselves of the ‘alternate’ treatments offered in private health policies, were actually costing the government less per year.

 Also under attack by the government is the Complementary Medicine industry with the recent release of the levels of evidence guidelines from the TGA, even in the words of one of our industry’s main critics Ken Harvey fromLatrobeUniversity, the proposed guidelines “would probably result in 90% of (Complementary Medicine) products disappearing from the market”. Australians already have less access to Complementary Medicines than other countries. How quickly we forget that the Federal Government has now paid out more than $120 million of taxpayer’s money in out of court settlements attributable to the Pan saga to companies in the Natural Products Industry in a veiled attempt to cover up what the court clearly believed was wrongdoing after minutes of meetings were ordered to be destroyed by departmental officers. One could be forgiven in thinking that the Government has a demonstrable bias against Complementary Medicines.

Is there need for regulatory reform? Yes there is. And are some product claims unwarranted? Yes they are, but as in the Pan saga the government needs a tack hammer not a sledge hammer to protect the public. There are good and competent people that work within the TGA and I am hopeful that with the new leadership there will be some positive outcomes under the regulatory reform process which will benefit all Australians. Remember it is the inalienable right of all Australians to choose their therapy and their medicines be they drugs or nutritional medicines. We all need to work collectively to achieve better health outcomes no matter what are belief systems are. 

THE ROLE OF ELECTED GOVERNMENT IS TO PROTECT PEOPLE’S RIGHTS NOT TO PREVENT THEM.

Regards, 

Marcus Blackmore

Universities told only to teach “correct” knowledge.

A group of what seem to be primarily medical academics calling themselves the “Friends of Science in Medicine” recently wrote to all Vice Chancellors concerning Alternative and Complementary Medicine or health degrees.

It’s pretty clear to see that essentially they want University medical and health education to be owned only by traditional western medicine departments (perhaps that they run or work in) and other approaches to be relegated to sub degree level. Not a bad strategy, because then its virtually impossible for alternatives to get funding for research, and in time the alternative approaches can be said to have no evidence! 

They say they are not against Alternative Medicine, but the thinly veiled impression is that they want to ensure it is not taught at Universities apart from by themselves,  from a western perspective as placebo effects.

I’m not pro or against either form of medicine, but I have spent 30 years listening to consumers, including Doctors and health professionals, and doing rather substantial amounts of large scale research, and it seems to me that this FSM is somewhere trapped in the past and really disconnected from the reality of the knowledge economy.

The real threat is that they are saying that one group of prominent people has the right to tell Universities, and through them the public, what can and cannot be taught, and that “they” control “correct” knowledge.

Can you imagine the reaction if Psychologists said sociology and anthropology should not be taught? Or one branch of physics said quantum physics should not be taught. Or climate skeptics said pro climate change courses should not be taught.  Maybe they will be telling Universities not to teach Islamic studies or theology because these are primitive ways of seeing things and don’t have satisfactory evidence.  It’s one thing to debate ideas; quite another to use power groups to restrict higher education and knowledge, and send us back to the inquisition where “ True Knowledge” is controlled by a minority.

In the Internet version of their letter they say:

“we are trying to discourage universities from running pseudo-scientific courses which undermine the scientific credibility of those universities and we hope to influence government and others responsible for funding such courses.”

They appear to be attacking the base of the freedom of Universities to pursue knowledge and diversity in disciplines of knowledge. It’s like going back to a time when people were burnt at the stake for their hypotheses, or had to hide because intellectuals of any persuasion apart from the totalitarian one, were hunted and imprisoned. Every academic in every discipline should fear the potential impact of a group such as this. It’s much bigger than Western versus alternative medicine.

Lets consider why. They want evidence to be at the base of teaching. Nothing wrong with that.  But on four levels their argument fails.

First the funding of research into Complementary and Alternative Medicine (CAM) is substantially lower than all the government grants and pharmaceutical funding globally over decades to Western medical faculties.  Its quite early days since controlled trials were established in the CAM fields and whilst FSM seems to say there is nothing proved, many writers claim they are ignoring anything other than that which supports western Medicine or Placebos.

By removing CAM degrees the chance of developing a strong evidence base by CAM research, which is starting to get off the ground, will disappear, apart from that run in Western medicine disciplines under their paradigms.

Second is the “throwing stones in greenhouses” effect.  This group ignores the fact that much Western medical research has many evidence-based problems. Even a cursory read on the web convinces one that the academic medical worlds research is sometimes very questionable.  Search subjects like: “problems with medical research”;  “fraud in medical research;”  “can you trust the medical journal research?” “Can you trust evidence based research in medicine?”   Three Million deaths in the US due to prescription medicines is enough to say “get your own house in order”.

 Problems with Medical research include removal of data or cases in medical research, and a huge range of issues from data, sample, method, controls through to choice even of subject.  Some articles even suggest that a large number of medical research controlled trials are questionable.

They have been using restricted repertoires of research methods for so long now that they think their restricted scientific paradigm is the only paradigm that can be used.  Go to other disciplines and there are a wide variety of ways of producing evidence. Western medicine is a pseudo science also, compared to pure sciences such as physics and engineering where the majority of variables can be included, observed over a definable period, and controlled?

It is locked into one research paradigm; a pseudo-science one that ignores numerous variables as it tries to simplify life and living into sets of measureable elements, with often little understanding of the range of other factors that may impact life. It is a pity, because Western Medicine has achieved huge breakthroughs in many areas; but it has also had little impact overall on many of the so-called modern day diseases where it has stuck to its singular pseudo science paradigm for evidence.

As such this group has a great chance of damaging further the reputation of scientists in general in the eyes of consumers, at a time when we hear many young people are not inclined towards science.

Third, when we listen to consumers they talk about Pharmaceutical companies who removed data on the side effects of some drugs; they talk about their own choices in treatment; they are suspicious of the links between academic researchers and commerce. They prefer however properly trained and graduated Western and CAM professionals, they respect their GP’s, Nurses and CAM professionals. They want choice and they want all of these to have the benefits of University education, rather than to just “fall into it”.

When we listen to the academic medical fraternity, its easy to see that the closed shop works like this. A Doctoral candidate chooses a subject, which will fit with the supervisor’s interests.  They start their work from the body of knowledge (within the square); they research, often controlling certain variables, they publish and get their PhD and the eminent supervisor gets their name on the publications.

This adds to the academic supervisors citations. As the citations build they get higher up in the medical academic system. Then they are invited onto grant awarding panels. And of course we now have the “square” locked in mind judging who should be funded and who should not be funded.

So knowledge is developed within a set of minds that have to perform within a narrow tunnel of what is considered to be evidence-based knowledge.

Fourth these academic silos are a long way from the day-to-day work of the dedicated front line GPs, Nurses or others who interact with consumers and see the variability of treatment and conditions and lifestyles.  For the FSM, controlled randomized trials (which are often no more than pseudo science) are the reality. For everyone else, the human in society, with the variability that indicates,  is also the reality.  The communiqué from academic research comes only if you pay to read the journal articles (which you don’t have time for), or you hear through the pharmaceutical reps.

Connection with reality would help these academic medics to realize that in many of their pieces of research so many variables are omitted to do with life and living, that many of the claimed and publicized results are laughable. It does not help us to know that in a tiny sample of people there was minor differences in a certain prognosis on say liver damage in those who snore versus those who don’t (just because the statistical method shows that !)

However, it’s very clear that Western medical research has by lucky chance sometimes, sequences of research at others, and the many incredibly talented scientists, made massive breakthroughs. Many academic medics have done this. That is something they should be proud of.  But theirs is just one paradigm of research-pseudo scientific controlled randomized samples. There are many other paradigms of research, used across countless disciplines, and it is gross arrogance to try to prevent these being taught and utilized.

Reading blogs following this group, its interesting that they grab on to the most extreme examples of CAM, or things from way back in the past…and ignore the thorough health, science and biological training that takes place in CAM courses. One hopes they are a little better in how they approach evidence in Western medicine, but this does not give great confidence !

And overall, FSM and similar groups just are so out of touch with the general consumer. Consumers are choosing many forms of alternative medicine, complementary medicine, vitamins and minerals, nutritional advice and ways to try to improve their health.  The gradual erosion of trust in academic medical research and the way that it is now servant of commercial needs, academic careers , journal articles, and similar rather than the servant of the consumer, the GP and the nurse, is widely understood. 

This type of arrogance makes the consumer think that all these people are doing is trying to protect their turf by removing other choices for the consumer. This little world of academic medics who have been schooled through the same institutions, lived at the same colleges, joined the same elites, purchased the same brands of cars and suburbs, and gradually seen their “brand” lose face among consumers are now running scared. Lets see how fast they run once they whip up enough opposition to make serious statisticians and others start to pull apart and publicise their research paradigms and methods. They are picking of one at a time- homeopathy, then chiropractors , then who next. So the opposition will easily pick off different disciplines and show how their so called academic medical research has huge failings.

This “war” started by FSM  is the last thing that we need in an overstretched health system, and one hopes that young medical academics and practitioners will say enough is enough-we have to learn from many approaches to health and medicine.  Its time for the old men dominated academic medical profession to have a significant change so we can have a better future.

So what do we need to do?

First every academic in every discipline should be talking to their Vice Chancellors about this fundamental attack on the freedom of Universities to decide what they consider to be knowledge and research.

Second, if some of the signatories of the FSM letter are on grant making committees, it appears they are not supportive of research into CAM apart from in medical faculties as placebos or similar.

In fact the internet version of the email that was sent to potential signatories seems to have targeted people who advise on the award of grants- an interesting issue of the independence of such advisers to the Government. It says:

“We  are  writing to  you,  as  you  have  been  trusted  by  the  NH&MRC  to review applications  to   the  council  for  support.  Obviously you  will  only  support  good science  and  may  well  be  as frustrated as we are that “pseudoscience” is flourishing.

They then ask their support for the petition which seems to be against CAM courses in Universities.

They should be required immediately to state conflict of interest and remove themselves from any grant making  or similar committees that hear proposals for CAM research in Non medical faculties. Further to this, all political parties should institute an enquiry into whether health and medical research is silo-ed or fully represents the spread of opportunity for both preventing ill health and treating ill health. The consumer is demanding with their feet a better deal.

Third, to get real evidence based medicine, the Government should require that on any grant making committee there are equal numbers of expert representatives from Western Medicine and CAM, and that there are also non-medical statisticians and non medical research methodology experts to ensure that both fields have to come up to non medical statistical standards and also are open to a range of research paradigms for creating evidence, not just the overriding pseudo scientific paradigm used in much western medicine research.

Fourth, Western medicine has to get to grips with why so many consumers turn to CAM.  I suspect this is the fear driving this old style thinking. A preservation of the old ways.  This sort of strategy is going to alienate more people again. When I read of FSM, as someone right out of this field, I could not believe that this type of arrogance still existed.

Fifth, those who signed the FSM letter. Did they really understand what they are doing in restricting knowledge?  I cannot believe that among them there are not lots of very dedicated sincere people. They can’t all be this narrow minded and blind to what is going on in society?  Perhaps many of them will want to consider whether they signed up for what they think they signed up for. FSM seems to indicate it is not against CAM, just does not want it to be seen as legitimate by allowing Universities to train people properly in it. That seems to be incongruous.

FSM is part of a campaign orchestrated from overseas. Read about it on the Internet. I think the ordinary consumer would feel that some strategy worked out somewhere in the UK or USA to attack CAM practitioners and exported here, is not acceptable. It is an attack on the choice of the consumer, the GP’s who are open to many forms of prevention and treatment, and the CAM specialists.

Sixth, every consumer out of the huge percentage who use a combination of western and CAM Medicine, should phone or email their MP and the Vice Chancellor of any local Universities, and request that the rights of CAM academics and practitioners are supported, and that no one has the right to stop people being properly trained in both. And the 40% (or less?)  of us who don’t use CAM, but still believe in the great benefit of freedom of knowledge and education, should do the same as this sets a very dangerous precedent.

More important than any of this, is that those intelligent, dedicated and open minded people in academia and practice from both western and CAM approaches should be working together to find the best combination of techniques to promote health and treat illness and to share their education and research. FSM seems to be asking for the exact opposite of such collaboration, an outdated notion of society and the knowledge economy.

GP’s, Nurses and CAM’s  are working together, so why can’t you?  That’s what a large percent of consumers expect for what they pay in tax for your salaries, careers, departments, conferences, benefits and fame through citations.

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The author is a businessperson who has conducted very substantial amount of research, trained many researchers, and regularly is amused by the lack of variables, the claims, and the restriction in research paradigms, included in some medical research.  He believes medical research should be much better quality and evidence based in a broader sense than for instance commercial research on doughnuts or bumper bars.

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Alternative medicine in universities debate heats up

The debate about whether Alternative Medicine should be taught in Universities continues. One of our most ardent critics, Prof Alister MacLennan, has written an editorial piece in the Medical Journal of Australia.

Some would remember his public statements at the time of the Pan crisis, commenting “how much snake is in the snake oil”. Sadly he was somewhat quiet when the Australian government paid out $120 million of taxpayers money to resolve the subsequent court actions.

Of course in a democracy we are entitled to our own views and, dare I say, our choice of medicine. I know where I stand on these issues.

Regards

Marcus

The McLennan article is at mja.com.au and the response from Dr Kerryn Phelps, President of the Australian Integrative Medicine Association is copied below.

Medical Journal of Australia Undermining Australia’s International Credibility, and its Own Credibility as a National Medical Journal

As a Past President of the Australian Medical Association and an active member for over thirty years, I am shocked at the latest publication of the Medical Journal of Australia with its accompanying press release “Pseudoscientific health courses threatening Australia’s International Credibility” which cites the teaching of courses in Naturopathy, Traditional Chinese Medicine and Herbal Medicine as examples. The AMA’s own current position statement on complementary medicine was developed during my time as AMA President a decade ago and states:

“Increasingly, medical practitioners will require a basic understanding of Complementary Medicine and should receive sufficient training in their undergraduate, vocational and further education to enable them to discuss such issues with their patients on an informed basis. This training should also enable medical practitioners to incorporate complementary therapies into their practice if they so decide following due consideration of the evidence. As with any developments which impact on medicine, information about Complementary Medicine should be included in continuing education.

The AMA calls on educational institutions and professional colleges to ensure that medical education provides basic information about Complementary Medicine in relevant areas such as pharmacology and evidence based therapies.”

What really has the potential to undermine the international credibility of the Australian medical profession is the publication of such a deeply biased, unchallenged and divisive editorial.

It is an insult to our learned colleagues in China and other countries in the region where many universities, research institutes and public hospitals are dedicated to theresearch and teaching of herbal medicine and acupuncture and where the majority of hospitals offer an integrated care approach, with herbal medicine and acupuncture being offered along side western medicine.

This is also a year when our own Australian Traditional Chinese Medicine practitioners will achieve national registration.

I have been in contact with many colleagues internationally over recent days.
Over fifty major medical schools in the United States and Canada offer courses in complementary and integrative medicine to prepare their doctors and other healthcare professionals of the future for the multi-cultural and mixed-philosophy environment they will encounter professionally.

What should unite us all is the desire to do what is safest and most effective for our patients, which includes respecting their choices and preferences for safe and effective complementary therapies.

Our Australian universities provide teaching of the highest quality, with a sound evidence-based approach in complementary medicine, Traditional Chinese Medicine and Western herbal medicine. The standard of teaching provided is acknowledged and admired the world over and indeed Australia will lose all international credibility unless these modalities are included, as supported by AMA policy, in the teaching of our new generation of doctors and other healthcare professionals.

Professor Kerryn Phelps, President, Australasian Integrative Medicine Association

Statement from Prof George Lewith, Professor of Health Research at Southampton University in the UK:

“In the UK we offer statutory regulation and university-funded courses in chiropractic, osteopathy and more recently in herbal medicine, including Chinese herbal medicine. Worldwide many medical practitioners have developed integrated medical practices that involve these techniques and feel they are able to offer safe, patient centred and effective interventions. The UK General Medical Council advises ALL UK medical schools to teach familiarisation courses in CAM and majority of UK medical schools offer this option.

The UK National Institute for Health Research (www.nihr.ac.uk) and the National School for Primary Care Research (www.nspcr.ac.uk) currently support and fund a number of Russell group University based research projects and research fellowships into a range of complementary medical interventions including herbal medicine and acupuncture. The Royal College of Physicians (London) has also supported conferences and currently funds research work in this field. The situation across Europe is governed by diverse national legislation but many countries such as Germany support and fund clinical practice in CAM (herbs, homeopathy and acupuncture) as well as funding university based research groups.

Destroying good quality CAM courses will only place vulnerable patients at risk from untrained and potentially unscrupulous practitioners. All the Western industrialised nations must recognise that we need to respond to patient choice and ethnic diversity in these matters and strive to provide safe, evidence based, professional practice and training within these fields of legitimate medical practice.”

Prof George Lewith http://www.cam-research-group.co.uk

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The responsibility to teach natural medicine in Australian universities

A group of scientists has launched a campaign against the teaching of certain ‘alternative’ health modalities in Australian universities and a passionate debate is underway.

With 6 million Australians regularly taking Complementary Medicine it is a responsibility to ensure that health care professionals have access to the highest level of education to understand different approaches for managing their health.

To simply discount the practices such as Naturopathy and Chiropractic as being ‘quackery’ is unscientific to say the least. Science is about observation and deduction and most of the medicines and practices of CAM have existed in some cases for hundreds, if not thousands, of years.

Clearly the allopathic dogma of these scientists is being challenged by the prevalence of well researched peer reviewed papers that are appearing at increasing levels in many of the world’s prestigious medical journals. It is surely an anathema to the detractors of ‘alternative’ medicine that more than one in three of all medical consultations in Australia is with an alternate medical practitioner driven no doubt by consumer acceptance.

There is an urgent need to do more research which given the lack of substantial support from government, is largely dependent on the institutional support that universities can and are undertaking given the fact that 70% of the Australian population are users of complementary medicine.

I urge this group of scientists to open their minds; they may well find that the practices of Complementary Medicine and allopathic medicine can co-exist in our community and that our patients will be the benefactors.

University education provides important training for Complementary Medicine practitioners. These courses are renowned for their ability to create research literate practitioners who are able to provide high quality evidence-based therapies to the three quarters of Australians who take complementary medicines regularly. In addition, university education adds to the ability of Complementary Medicine to continue its vital role in contributing to the improvement of global health outcomes.

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The case for a National Health Policy…not a national disease policy

Complementary Medicines are a significant component of healthcare.

They are largely funded out of individuals own pockets.

However, the contribution of complementary medicines is rarely recognised by Government. Any economic benefit they could bring is not acknowledged in the current health budget.

There is a growing body of evidence that complementary medicines can reduce the incidence of chronic disease, such as age related eye disease, bone loss and osteoporosis and that they are a lower risk and a more cost effective option for government.

 This was recognised in 2004 by an Expert Committee on Complementary Medicines in the Australian Health System, established by Government following the Pan recall.

 The Committee concluded;

 “Compared with other medicines, some complementary medicines may offer lower risk and more cost effective options for the prevention and treatment of some diseases, conditions and disorders”.

 Blackmores is keen to contribute to the development of health policy as we are of the view that health policy needs to focus not just on the treatment of disease but on health optimisation.  It should ensure public access to affordable complementary medicines that are safe, efficacious and of high quality while respecting freedom of choice and philosophical and cultural diversity.

•          Over 70% of Australians have embraced complementary medicines as part of an integrated strategy of preventative health by using supplements with vitamin, mineral and herbal, natural medicines.

 •          In the last twelve months, 90% of doctors and almost 100% of community pharmacists have recommended vitamins, minerals, fish oil and glucosamine.

 •          Over 50% of Australians would prefer to use a complementary medicine product rather than a pharmaceutical drug.

 •           In 2000, individuals using their own money spent nearly four times as much on complementary medicines and health practitioners as they did on pharmaceuticals.

 •           50% of all healthcare professional visits in 2010 were estimated to be with a complementary healthcare professional.

 •           In some regions of Australia, people visit a complementary healthcare specialist more often than a GP or medical specialist.

 •           Australians spend over $3.5b each year on complementary medicines and therapies, most commonly to assist in the management of chronic disease and improve health and wellbeing.

   •           92% of doctors say they want a better understanding of complementary medicine.

 The cost benefits of complementary medicine – some examples

In 2006 the USA Lewin Group report estimated that if people over the age of 65 increased their daily intake of Omega-3 fatty acids to 1800mg they would reduce the occurrence of heart disease. They also estimated that over a four year period, net savings in hospital expenditure and physician charges would be in the order of US$3.1 billion. The report suggested approximately 384,303 hospitalisations would be avoided.

 In 2010, an Access Economics report from The National Institute of Complementary Medicine (NICM) on the cost effectiveness of complementary medicine reviewed five complementary medicine interventions that each had a reasonable body of evidence for safety and efficacy.  Overall, the review showed complementary medicine to be highly cost effective and highlighted the important role of these products in managing the health of all Australians.  For example, nearly 1.5 million Australians were prescribed antidepressants in 2007-08 at a cost to the government of about 57¢ a day. By comparison St John’s Wort cost consumers an estimated 17¢ a day. 

The health benefits of complementary medicines – some examples

There is a large amount of research now available that shows the use of dietary supplements is effective in preventing and/or treating diseases.

Scientists have found that folic acid supplementation can substantially reduce neural tube birth defects, and a regime of vitamins and zinc can slow the progression of the age-related eye disease, macular degeneration.

A large number of clinical trials have shown that calcium and vitamin D supplements have been found to be helpful in preventing and treating bone loss and osteoporosis and users of cod liver oil were significantly less likely to have depressive symptoms.

The total expenditure for osteoporosis in Australia in 2000-2001 was $221m with $32m contributing to hospital admission costs.

A total of $1.2b was spent on osteoarthritis in 2000-2001 with $567m being spent on hospital services. Procedures associated with osteoarthritis i.e. hip/knee replacements cost between $13,600 and $30,600 per person (and there were 42,000 such procedures carried out in 2003-2004). Scientific evidence has demonstrated that glucosamine sulphate plus chondroitin supplements are able to reduce pain and delay the progression of this condition.

The Government is to be commended for its commitment to refocusing the health system towards prevention. For too long the system has focused on treating people after they become unwell, and this has resulted in vast social and economic costs associated with chronic disease.

By June 2050, 23% of Australians will be aged 65 or more. As the population ages, the cost of healthcare will become the single largest impost on Government.

We applaud the work that has been done recently on the development of the National Preventative Health Strategy. We note its initial focus is on obesity, tobacco and excessive consumption of alcohol and we fully support the goal of Australia becoming the world’s healthiest nation by 2020.

However …

Despite development of the National Preventative Health Strategy and the goal of becoming the world’s healthiest nation by 2020, and despite the widespread and growing use of complementary medicines, there is currently no recognised role for complementary medicine in current health policy development.

Government already recognises and supports supplement use in the context of nutritional intake in food policy and the contribution this makes to the health of Australians and the economy (for example the mandatory fortification of food with vitamins). The government is also committed to research into the potential benefits of ‘nutraceuticals’ and ‘functional food’.

We now call on Government to recognise that complementary medicines provide effective and low-risk prevention/treatment options for healthcare institutions, practitioners and consumers and we welcome the opportunity to engage with Government to pursue true health policy reform.

What we would like Government to support us in achieving

•           CM representation on the Australian National Preventative Health Agency Advisory Council.

•           Greater training of doctors, pharmacists and healthcare professionals to better understand the benefits of complementary medicine and inclusion of developments in complementary medicine as a component in continuing professional development programs.

•           Establishment of an industry consultative committee to advise the Minister for Health and Ageing on the development of Complementary Health Policy.

•           Funding support by Government to continue ongoing research into complementary medicines particularly in relation to its clinical effectiveness and economic contribution.

•           Complementary medicines that have a demonstrable public health outcome and are shown to be cost effective should be made available on a subsidised basis.

•           Removal of GST on those complementary medicines which have a demonstrable public health benefit (such as fish oil, vitamin D and co-enzyme Q10) as has happened with folic acid through inclusion in the GST-free Supply (Health Care) Determination.

•           Inclusion of Blackmores products on the Electronic Health Record in community pharmacies.

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Welcome to my blog

After 50 years in the natural healthcare industry, I’ve got a strong opinion on the role of natural healthcare in the national healthcare system.  Some of the brightest, most passionate and innovative minds in how best to maintain health and treat disease are advocates of natural health.  These are people I meet every day.  Through my work I have access to all sorts of interesting information and in this blog I’d like to share that with you.

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