The National Health and Medical Research Council (NH&MRC) is Australia’s pre-eminent provider of advice on science and health to government and the community. Concerned that taxpayer’s dollars might be wasted subsidising private health insurance payments for a range of “Alternative”clinical services, the federal government asked the NH&MRC in 2015 whether there was credible scientific evidence of benefit to support this subsidy.
The seventeen modalities being subsidised were critically reviewed by the council which found no credible scientific evidence of benefit from any of them. Most of the approaches studied were literally anti-scientific in that the concepts supporting each approach could be unequivocally dismissed as nonsense by our modern knowledge of science and medicine. Examples would include Homeopathy, Iridology and Reflexology. Two modalities, Yoga and Tai Chi are in a different category as they can improve general well being and physical fitness but no more so that other forms of exercise ( Gym work-outs, regular swimming, cycling, running etc) and as such they should not attract special funding for the 47% of Australians with private health insurance.
Government was slow to accept the advice that taxpayer dollars should not subsidise the above but recently announced the withdrawal of the subsidy. Australia’s most respected scientists and clinicians applauded the decision, which was much publicised and was important for two reasons. Health dollars are precious and millions more of them would, as a result, be available for evidence-based care. Equally important was the message to Australians that they should be more skeptical about the benefits of the plethora of “alternative” approaches that have so heavily infiltrated our health system in this most scientific of ages. Only 40% of Australians enjoy even minimally adequate levels of health literacy. We waste millions of dollars, having been misled by vitamin and supplement providers that they are needed for us to remain healthy. We have major inadequacies in consumer protection from health care fraud that is supposedly provided by regulators such as the TGA. There has been much publicity of late of the unacceptable anti-scientific practices of many chiropractors, osteopaths and providers of traditional Chinese medicine.
Against this background it was frustrating, to say the least, to learn the Greg Hunt had given in to pressure from “Alternative” medicine lobby groups and ordered a review of the review that led to the subsidy withdrawal. It took just seven days for the withdrawal announcement to be revisited by the minister. Why would he do such a thing? Well there is a federal election looming and the coalition is not travelling well. Angry advocacy from those affected by the original decision has recently been led by Kerryn Phelps, whose support for “alternative” medicine is well known. Now elected to parliament, she is in a position to get her views publicised easily. Hunt excuses his “flip-flop” with his acceptance of the lobby groups argument that since the 2015 NH&MRC review, new evidence is available that might challenge the original findings particularly for Yoga and Tai Chi.
For the truly anti-scientific modalities no number of reviews will ever lead to a different conclusion. Homeopathic preparations contain no active ingredients, there are no specific areas of the foot that are connected to different organ systems in the body (reflexology) and similarly there are no specific areas of the eye that tell us about body-wide health (Iridology). There are new data about Yoga and Tai Chi and they confirm that practitioners of both enjoy health benefits. Last years report on Tai Chi published by the National Institutes of Medicine in the USA concluded:-“the existing clinical studies on various diseases/conditions suggest that the quantity and evidence base of clinical studies on Tai Chi is substantial. However, there is a wide variation of Tai Chi intervention in style, intensity, duration and learning and practicing methods. The reporting of Tai Chi intervention needs to be improved. Though the majority of studies report positive health-related effects of Tai Chi, further studies with better reporting are needed to confirm the effects of Tai Chi”.
As for Yoga, the 2018 report from the authoritative National Center for Complementary and Integrative Health in the US concluded:-
Although much research has been done on the health effects of yoga, many of the studies have included only small numbers of people and have not been of high quality. Therefore, in most instances, we can only say that yoga has shown promise in helping to manage a particular health condition, not that it has been proven effective. Yoga is generally safe for healthy people when performed properly; individuals with health conditions should discuss their needs with their health care providers and the yoga instructor.
So Yoga and Tai Chi are good for you, as are many other forms of physical exercise. If these techniques were to be subsidised by the taxpayer then one could argue such support should apply to all healthy physical activities. Hunt should have asked our Chief Medical Officer, Professor Brendan Murphy, to advise if any 2019 review is needed before making his decision. I am confident that he would have answered “no”.As it is, should Labor win the election, one would hope the new government would cancel this review of the review which will absorb far too many dollars for a useless exercise.
Professor John Dwyer, Emeritus Professor of Medicine, UNSW and founding President of “Friends of Science in Medicine.