essay: Complementary Health Care

 

COMPLEMENTARY HEALTH CARE IN AUSTRALIA, and its relationship to western scientific medicine:
Introduction
Health care choices can seem complex in a wealthy country like Australia. Broadly, there are two systems:
– mainstream western scientific medicine: GP’s, specialists and associated allied health providers like physios, podiatrists, dietitians, dentists etc
– complementary medicine: naturopaths, homeopaths, chiropractors, iridologists etc.  Asian approaches reflect a very different cultural history.
Mainstream medicine is supported by Medicare and private health insurance cover. With a few exceptions, complementary medicine is only supported by some private health funds. This comparison of the two systems goes to the nature of what ‘healing’ means.

Is it legitimate science?
Mainstream western medicine is largely evidence-based, and backed up by government bodies who assess and license medical treatments. Complementary medicine follows some good ideas, and a fair amount of unproven, pseudo-scientific mumbo-jumbo.  Some examples:
Naturopathy:  talks about imaginary illnesses like ‘pyroluria’, unheard of in mainstream science. This has the effect of making people think they have a disease when they haven’t.  ‘Monilia’ is another imaginary illness often diagnosed by naturopaths.  Naturopathy incorporates many reasonable ideas found in mainstream preventitive health care, but imperils its legitimacy by using pseudo-scientific claptrap, presumably to impress.

Chiropractic:  manipulation can relieve back pain temporarily (like pills), but some of the concepts are wacky, such as claims that manipulation can be used to treat diseased organs.

Homeopathy: The idea that effective treatments for disease can be achieved by taking substances so diluted that they are effectively just water, is pretty silly.

Iridology: again, the idea that you can make accurate diagnoses of health problems by examining the iris is pretty silly – certainly without any scientific basis.

Is it legitimate practice?

Any system of healthcare can be abused eg by doctors who practice ‘5-minute medicine’ to maximize their income under medicare, and by chiropractors who persuade clients to have their spine ‘adjusted’ every month, to build regular secure income.  It’s a moot point whether treating people for imaginary diseases is legitimate practice or quackery, if the naturopath truly believes in those ‘diseases’; it certainly doesn’t offer much benefit to the patient, other than by a placebo effect.  A few doctors combine mainstream and naturopathic practice – this looks very much like an attempt to capture a wider market.

Does all this matter, and what is a healer anyway?

It may be argued that in a wealthy society like this people can spend their money on whatever they wish to – nobody suffers.  However not all people who pay for complementary medicine are wealthy; and it seems that some insurance funds provide a rebate for complementary health care to improve their market position, rather than because the services offered have proven benefit.  Health care providers of whatever type are in a strong position to influence and persuade clients, especially if they are plausible ‘experts’ skilled at communication.  Healing could be simply defined as ‘making the patient feel better’, whatever the cause of their symptoms.  Often a healer is just someone who listens with a sympathetic ear and gives the client time.  Arguably mainstream medicine with its heavy emphasis on technology rather than just time spent listening carefully has become less attractive to some clients, opening up a market for complementary health care not driven by either medicare or the burden of scientific validity.  However the question of whether unvalidated approaches should have the backing of taxpayer funded Medicare support is another question completely.

 

Having a bone to pick with natural medicine

by  AMY CORDEROY (Insight, Saturday Age, 9/3/13)

THE women sat perched on the edge of their seats, desperate to hear more. ‘‘ Many were bald, one even had tubes coming out of her breast, all were cancer survivors,’’ remembers Loretta Marron . ‘‘ Some would be dead now.’’

Marron survived her cancer, but she will never forget the presentation from a naturopath who had been invited to the 2005 breast cancer support group meeting. ‘‘ She was just attacking doctors from the beginning to the end, saying they were funded by drug companies and you can’t rely on them,’’ says Marron, now chief executive of Friends of Science in Medicine. The experience spurred her to spend the next eight years exposing the worst practices in alternative medicine. Complementary and alternative medicine varies widely, but is often not supported by scientific theory and research. From multivitamins to acupuncture, it’s a growth industry. By some estimates, two-thirds of us use some form of complementary or alternative medicine every year– spending up to $1.8 billion. And national registration has led chiropractors, Chinese medicine practitioners and osteopaths– and, perhaps soon, naturopaths and others– to be registered by the same federal body that covers doctors and nurses. Universities are running courses, and government funding for treatments has skyrocketed. In 2005, Medicare paid out just over $22,000 annually on chiropractic and osteopathic treatments– last year it paid $15 million. But Marron wonders if bringing alternative medicine inside the mainstream has brought muchneeded oversight, or simply given operators undeserved respectability . ‘‘ People are told that chiropractors and osteopaths, for example, are registered, but they’re not told they are self-regulated ,’’ Marron says. And the self-regulation looks loose. Even the federally mandated Chiropractic Board of Australia allows chiropractors to make up the entirety of their annual 12.5 hours of formal education – which they must undertake in order to practise – from known antivaccination proponents. ‘‘ Once they are regulated, that legitimises them, but it comes witha responsibility to consumers ; they can’t have it both ways,’’ says Marron, who has spent hours trawling through the courses and documenting those promoting unscientific claims. She is particularly critical of universities for offering courses in alternative medicines, giving an example of a former lecturer at Macquarie University who on her personal website says she can use naturopathic treatments to ‘‘ enhance the efficacy of chemotherapy’’ , and ‘‘ alter the ‘terrain’ of the patient to be nonsupportive of tumour cells’’ . Other lecturers claim to be able to use chiropractic for children with repeat infections, or mothers with problems breastfeeding. Macquarie University says it only offers rigorous, high-quality courses. ‘‘ Our students are taught to understand that science proceeds only on the basis of evidence. They are taught only those techniques that are known through science to be beneficial,’’ a university spokesman says. But Marron argues that such courses give a veil of respectability to unscientific beliefs. ‘‘ It’s only when you scrape back to look at what is in the courses that you think something is quite wrong,’’ she says. Former AMA head Professor Kerryn Phelps says in the end it’s nota matter of deciding whether or not to let alternative treatments into the mainstream. ‘‘ It just reflects real life,’’ she says. ‘‘ There is a consumer-led movement … people are looking for different ways to manage their illnesses’’ .

Her recent book, Ultimate Wellness, argues doctors should practise ‘‘ integrative medicine’’ , adopting complementary treatments or referring patients on to practitioners. But even Phelps says she would hesitate before referringa child to a chiropractor, considering the potential for harm. Yet she also calls Friends of Science in Medicine an ‘‘ ultraconservative’’ force with ‘‘ an alarming and far-reaching agenda’’ .

Simon French, from the Melbourne School of Health Sciences at the University of Melbourne, has researched the practices of Australian chiropractors, and says within modern chiropractic there is a continuum of practice.

Some very fringe practices exist at one end and evidence-based practice at the other, according to French. But he believes the chiropractors’ board is trying to bring the profession into the mainstream , by doing things such as commissioning reports on evidence-based practice– adevelopment he calls ‘‘ promising’’ .

Yet the practice of some harks back to the oldest traditions of the therapy. Chiropractic was founded in 1895 by an American, Daniel David Palmer, after what sounds likea miracle. ‘‘ Chiropractic began when a deaf guy got his hearing back when he got his spine adjusted, and that doesn’t happen very often, but it happened,’’ says Tony Croke, anational director of the Chiropractors’ Association of Australia.

The early chiropractors believed subluxations, or (often painless) misalignments in the spine, could lead to almost any health problem. As medical technology advanced and subluxations could not be found using X-rays or other imaging techniques, many chiropractors abandoned the theory.

In 2010, the British General Chiropractic Council announced: ‘‘[ Subluxation ] is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.’’

But the Chiropractors’ Association of Australia is still committed to subluxation . Croke says the concept includes things such as inflammation, stiffness or poor function, which is then thought to have an impact on the nervous system.

‘‘ Diagnostic imaging is not particularly helpful for diagnosing [this type of] dysfunction,’’ Croke says.

But the question remains how apainless reduction in joint function, invisible on medical scans, could change the signals sent by our nerves. Research papers supporting the theory are filled with references backing the claim, but when Fairfax Media examined them, most studied people with chronic pain or arthritis . Others documented uncontroversial facts about the central nervous system, but did not support the broader claim that a spinal joint with no pain or obvious symptoms could change nerve functions, and lead to asthma, infections or other childhood conditions.

‘‘ This is the hallmark of pseudoscience ,’’ says Chris Del Mar, aprofessor of public health at Bond University. ‘‘ The way to do it is to churn out lots of this stuff, which is impressive to someone who doesn’t understand it, and to do it with the imprimatur of the universities.’’

Del Mar, like every sceptic of alternative medicine, is keen to point out that he has no trouble with chiropractors who seek to treat musculoskeletal conditions such as back pain. (Although research reviews have found it is only marginally effective, just no worse than anything else offered for the condition.)

‘‘ When they start professing they are paramount and start saying you should do this and not that, it makes me narrow my eyes,’’ he says. ‘‘ It is no longer complementary medicine, it’s oppositional.’’

Copyright © 2013 Fairfax Media

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