Health Care Advertising and Consumer Protection
There are far more irritations than pearls available currently to those of us trying to champion the importance of having our health care underpinned by credible scientific evidence of clinical effectiveness. Though we live in the most scientific of all ages it is cause for concern that practices based on “pseudoscience” remain so entrenched in our community. Consumer protection from misleading often-fraudulent advertising and unscientific ineffective practices is distressingly inadequate.
For those concerned about this situation, the pleasure from watching the Australian Open Tennis championship on TV is diminished by the plethora of advertisements telling Australians that better health is available from vitamins and “supplements” that in fact offer no benefit to the average citizen. Swisse and Blackmores make a fortune selling a promise of a healthier you if you regularly consume their products. To prove this is so they have the likes of Lleyton Hewitt and Ricky Ponting telling you how they have benefitted from such consumption. I doubt that either of these fine athletes have independently pursued evidence to make sure what they are saying is true. What about all those fraudulent advertisements for painless quick weight loss products? You cannot watch the Sky News channel for very long before you are asked if you have had your “Inner Health” today! While there are definite indications for treatment with probiotics (“good bacteria”) to suggest that everyday everyone needs these good guys is indefensible.
The truth is that with health literacy in short supply for many of us it is easy and convenient to believe that an unhealthy life style can be neutralised by pills from a bottle. Of course there are people in the community who do need vitamins and supplements for various conditions but such use should be planned and supervised by doctors and nutritionists. There has been much quality research that confirms the lack of benefit and occasional harm associated with excessive vitamin and “supplement” intake. Although companies marketing products for which they make a therapeutic claim are meant to hold evidence that their claim is supported by credible evidence, many just label their product with an “as traditionally used” label even when scientific studies have contradicted those traditional claims. This is big business with Australian’s spending at least three billion dollars a year on products that for the majority provide no benefit.
Our universities are not doing enough to make sure that they do not give undeserved credibility to pseudoscience. Courses in Chiropractic, Osteopathy and Traditional Chinese medicine often include concepts that could be considered to represent pre-scientific beliefs. At a recent Open Day for a major university’s Traditional Chinese Medicine program, participants had the ancient art of “cupping” demonstrated and touted as a technique for countering lung disease and all who attended left with a artefact to place on a specific spot behind the ear to prevent depression.
Two related matters received much mainstream publicity recently. The first involved the extraordinary decision of the University of Wollongong to award a PhD to a candidate who for the last decade or so had been a very public spokesperson for the anti-vaccination movement. She enrolled in a higher degree program in the Humanities and Social Science faculty with a supervisor who, as a champion of free speech, courted controversial students who had been criticised for their publicised opinions. The “research” for the thesis would focus on the safety or otherwise of our current vaccination policies.
The candidate concluded that vaccines did far more harm than good, were not necessary and would not be forced upon an ignorant community if an international conglomeration of companies with a vested interest in the vaccine industry had not coerced the WHO into lying to the public about vaccine safety. Many with the appropriate expertise examined the thesis and found it to be riddled with errors particularly when discussing immunology and epidemiology. The official reviewers of the thesis were social not biological scientists. There has been a major effort both inside and outside of the University to have the thesis re-examined but to date the University maintains it is comfortable with the decision to grant the PhD. Meanwhile the supervisor has labelled criticisms as an attack on free speech seemingly dismissive of the fact that a PhD thesis is not a vehicle for opinion but rather a vigorous search for and presentation of verifiable facts.
The second issue which provoked Editorials in the Fairfax and Murdoch media concerned reports that hundreds of Chiropractors across the nation were claiming to be able to assist patients with numerous problems beyond their traditional focus on musculoskeletal problems with one’s back and neck. Particularly objectionable is the targeting of care for neonates, children and pregnant women. Involved chiropractors support the totally discredited suggestion of their 19th century founder, that there is associated with the spinal column an invisible but potent energy force (“innate energy”) the integrity of which is essential for whole of body health. Even slight distortions of the bony spinal column (“subluxation”) can interfere with this energy flow and cause problems remote from the spine. Chiropractors can make “adjustments” to the spine to correct the defects. Some of the problems that can be addressed in this way include Autism, Asthma, bed-wetting, developmental delay and colic. Parents are advised to have all neonates see a chiropractor soon after birth so that any distortions that occurred during the birthing process and that could cause long-term problems are addressed. Some chiropractors claim that their pregnancy care can prevent the need for Caesarean births, others say they can cure cancer.. This in 2016!
How can this be I hear many of you thinking? The previous government decided that consumers would be better protected if chiropractors, osteopaths and traditional Chinese Medicine practitioners were required to seek national registration and have their professional activities monitored by a federal Board for their specialty under the auspices of the Australian Health Professional Registration Agency (AHPRA). This organisation reports to the COAG Health Council set up Australia’s Health Ministers who appoint Board members. AHPRA and the Chiropractic Board of Australia have been totally ineffective in protecting consumers from fraudulent activities described above. The Board has even been populated with members who practiced subluxation chiropractic. It has taken up to two years to investigate complaints made to the Board and AHPRA claims they do not have the legislative power to limit the scope of practice of the profession. AHPRA claims that only a few chiropractors fail to modify their advertising and practises after a warning. This is not true and this week the Friends of Science in Medicine sent images from 400 chiropractic websites targeting children to the CBA, AHPRA and Minister Jack Snelling who heads the COAG Health council. I should emphasise that the chiropractic profession is polarised with many chiropractors that stick to an evidence based form of practice distressed by the behaviour of colleagues who bring the profession into disrepute.
The government is not helping. When our NH&MRC concluded that homeopathy and 18 other “Alternative” practices (Iridology, Reflexology, Reiki etc.) were not supported by any evidence of effectiveness one would have expected the government to stop allowing tax-payer dollars to be used to subsidise such treatments. Not so! While Homeopathy has been declared to be of no value, despite protests, students studying Homeopathy at colleges of Natural Medicine receive an annual $6000 handout from the government.
There are many other anomalies that compromise consumer protection in this area that we could discuss and in so doing acknowledge that there are some medical doctors who engage in health care fraud, but to summarise, our approach has been and continues to be one where the emphasis is on having after the fact complaints dealt with rather than legislating and organising to prevent the incidents that generate so many complaints from happening in the first place. True consumer protection must be based on the primacy of such a strategy.
John Dwyer is Emeritus Professor of Medicine, UNSW.