John Dwyer. Pseudoscience and health care.

Current Affairs 

The catalyst for my need to share with you frustrations associated with the penetration of pseudoscience into Australian health care and the poor protection of consumers from same, was generated by the release of the details of the long awaited Free Trade agreement between Australia and China.

We now know that Chinese medicine was the subject of a side letter from Australia’s Trade Minister, Andrew Robb, to the Chinese government, which outlined plans to strengthen cooperation on traditional medicine, which among other things, could open the door for hundreds of contractual service providers from China to be officially registered to work here. The CEO of the Acupuncture and Chinese Medicine Association was delighted by the news, “We do know that the Chinese government has set globalisation of traditional Chinese medicine as a major priority and they’ve invested a lot of funding into this process”. Minister Robb also noted the opportunities that would be available for Australian manufacturers of supplements and “Complementary” medicines to penetrate the huge Chinese market.

The above association has dismissed concerns raised by this policy noting that practitioners of Traditional Chinese Medicine (TCM) in Australia must be registered by the Australian Health Practitioners Regulatory Agency (AHPRA) which has established a TCM board to protect consumers from inadequate practitioners. AHPRA has, however, been distressingly unsuccessful in protecting consumer from pseudoscience. What do I mean by “pseudoscience”? Concepts that, in reality, are pre-scientific “belief” systems. They are not supported and could never be supported by any credible scientific evidence. Such concepts are an affront to our understanding of physiology and pathology. Homeopathy is a good example.

The previous federal government made a big mistake in deciding that practitioners of Chiropractic, Osteopathy and Traditional Chinese Medicine should be nationally registered as was required of many other health professionals. Intense lobbying saw Tanya Plibersek agree that chiropractors could call themselves doctors. Hard to believe but as constituted neither AHPRA nor its subspecialty boards have any authority to limit the scope of practice of registrants. They can only respond to complaints about individuals and even that takes many months to resolve. This is a major problem as pseudoscientific beliefs and practices dominate all three of these newly registered professions.

The chiropractic profession is polarised. About 30% of chiropractors limit their care to evidence based treatments for definite muscle and bone problems particularly those effecting the back and neck. However recent research found that 70% of chiropractitioners’ websites claim to be able to help patients with many conditions not associated with any discernible musculo-skeletal problems. They make these claims based on their acceptance of the reality of “subluxation” theory as espoused by their founder in 1895. The belief is that there is associated with the spinal cord an invisible but vital energy the integrity of which is essential to health and the functioning of body systems remote from the spinal area. Minor, indeed undetectable, distortions of the normal spinal cord anatomy, (”subluxation”) interfere with this innate energy causing disease. Subtle “adjustments” of the spinal cord anatomy by chiropractors can correct the flow and restore health. The executive of the professions peak body, the Chiropractic Association of Australia, supports this concept. There is no credible scientific evidence to support this theory.

Particularly disturbing is the harnessing of this theory and its implications to bring chiropractic into paediatrics. Hundreds of registered chiropractors claim to be able to assist children with Autism, Asthma, bed-wetting, developmental disorders, colic, fever and over 60 other conditions. Many chiropractors combine their adjustments with a range of naturopathic treatments such as homeopathy and a nonsense called “Applied Kinesiology” wherein palpation of muscles can allow one to diagnose a range of diseases. One feels sorry for the chiropractors trying to stick to evidence based care.

There are also major concerns regarding the practices of many registered Osteopaths. Many osteopath’s websites talk about “Osteopathy of the Cranial Field” and the wonders of “Visceral Manipulation”. The former involves feeling for pulsations in the head associated with the propulsion of cerebro-spinal fluid around the brain, the nature of which diagnoses a disease process and subsequent cranial manipulation is used to fix the problem. The latter involves pushing around the contents of one’s abdomen to set up a chain reaction of pulsations that corrects remote, disease producing distortions.

The “Friends of Science in Medicine”, of which I am the current president, has been established to fight this penetration of pseudoscience into our health care delivery system. More than a thousand leaders in science and clinical medicine in this country support us. We have had a voluminous correspondence with the AHPRA executive team and the appropriate Boards in an attempt to have these regulatory authorities protect the public from such misleading claims and practices, which is their statutory obligation one would have thought. The task is that much more difficult as many members of the regulatory boards actually practice such pseudoscience. We have made no progress as AHPRA does not have the authority, (or the in house expertise), to issue directives re the acceptable scope of practice for its registrants.

Which brings us to TCM, a tradition founded on pseudoscientific principles. The theoretical basis of acupuncture for example, is pre-scientific and involves imaginary structures and vitalistic forces. An undetectable, immaterial life force, “qi”, is said to flow through channels (meridians) on the body. Disease occurs when the flow of qi becomes blocked. Inserting needles at specific acupoints on those meridians somehow restores the flow of qi. No such structures and forces have ever been identified by anatomists or physiologists. The World Health Organisation has recently taken down its Acupuncture website for revision after intensive analysis of all the credible research on the subject concluded that Acupuncture was no more than a superb placebo. Interestingly the number of TCM practitioners in China has plummeted in recent decades while the number of doctors trained in the “Western” tradition has soared.

Recently the National Health and Medical Research Council, our peak clinical science body, working with a committee set up, on government instructions, by the Chief Medical Officer, analysed the scientific data available for 18 popular “Alternative” practices (Homeopathy, Reflexology, Iridology, Applied Kinesiology Reiki etc.) The investigation found no credible scientific evidence that any of them were effective. Unfortunately the equally implausible antiscientific practices described above for Chiropractic, Osteopathy and TCM were excluded from the review because their practitioners now had national registration and therefore must be practising evidence based care!

Apart from pseudoscience, Australian health consumers are disadvantaged by misinformation from the very profitable Complementary and Alternative Medicine (CAM) industry. The vast majority of Australians get no benefit from taking vitamin supplements, probiotics, detoxification regimens etc. The impression given by advertising is that you can neutralise an unhealthy lifestyle with something out of a bottle. We spend three billion dollars a year as a result of this misleading urging. Now we will see those marketing these supplements urge middle class Chinese to use products that most will not need. In return our government will actively support the further penetration of TCM into our health system.

None of the above implies that we should not subject strong anecdotal and plausible evidence of a possible beneficial effect of a traditional herb or concoction to rigorous scientific evaluation. After all that is how much of our modern drug repertoire was developed. Research dollars and health care dollars are precious and in short supply so despite the cries of the alternative industry that their practices would be found to be beneficial after more research, not a further penny should be spent on the pseudosciences. In fact billions of dollars have been spent because of the widespread use of CAM justified attempts at validation.. The National Institutes of Health in the USA has spent more than 2 billion dollars on CAM in recent years and found very little that was useful.

There are many barriers to further protecting consumers from fraudulent and misleading health care claims and practices. General health literacy is inadequate for a modern society, the Therapeutic Goods Authority is a “toothless tiger” and lacks the authority, resources and political support to adequately protect the public and our pharmacists, men and women trained in, and promising to adhere to, evidence based medicine have stores full of products that they know lure buyers with false or exaggerated claims. A number of our universities give undeserved credibility to pseudoscience. At a recent open day for the TCM course at one university, visitors were shown by faculty how “Cupping” could be used to treat disease and all who attended went on their way with a clip to put on a certain spot on their ears to prevent depression!

Sharing my frustrations has been cathartic but there is one more I will document before stopping. After the NH&MRC report on the uselessness of Homeopathy the government announced that it would no longer allow taxpayers dollars to be used to supplement private health insurers coverage for homeopathy. FSM wrote to Christopher Pyne requesting that the more than $6000 subsidy paid to students studying to be Homeopaths in tertiary colleges should be withdrawn. After all how can you justify taxpayers supporting students training to implement treatments you accept are worthless? Minister Pyne replied that he was confident the homeopathy course met required academic standards.

Why is it that governments of all persuasions will not give regulatory agencies the resources and authority to better protect the public and contribute to efforts to insure that our health care is cost effective? The only evidence-based conclusion is that the political power of vested interests is outweighing the imperatives provided by modern science.

John Dwyer is Emeritus Professor of Medicine, UNSW.

 

 

 

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