Adrian Cachia

CIVILISATION may be understood as the gradual march of the scientific method into every nook and cranny of human inquiry.

This has yielded spectacular advances in understanding, but also induced a backlash from those whose world view rejects scientific methodology and its conclusions. The advances and backlash play out on political, economic and social fronts.

One current battleground involves conventional scientific medicine (SM) versus complementary and alternative medicine (CAM).

The outcome of this battle is important because public and private resources are diverted from the loser to the winner, and patients can receive treatments that may be effective, ineffective, or even harmful.

Friends of Science in Medicine (FSM) is a coalition of health practitioners and scientists concerned about the backlash against scientific methodology in Australian health care. Anti-vaccinationists, homeopaths, iridologists and other CAM proponents compete with SM for government recognition, training of practitioners and funding of services, as has been documented by FSM.

FSM is specifically troubled by the increasing proliferation of “pathology tests” that are unsubstantiated by scientific methods, and are marketed to the public by the test providers and CAM practitioners, or via political lobbying to government, to gain funding. Such strategies have been successful.

Some of these tests include “live blood analysis”, hair analysis for “toxins” (non-forensic), “liver detoxification profiles”, “clot retraction tests”, “cancer” tests not performed by National Association of Testing Authority (NATA)-approved laboratories, electrodermal screening devices and food allergy tests not performed by NATA-approved laboratories.

With the support of the Royal College of Pathologists of Australasia, FSM has recently sent an advisory paper, “Recommendations for Pathology Tests in Australia” to the federal Health Minister and other agencies, together with a letter calling for legislation to protect and warn the public of the difference between SM and CAM.

It is essential that scarce public resources are allocated only to pathology tests validated by rigorous scientific methods, provided by accredited laboratories and documented in peer-reviewed scientific literature. Publication of a claim on the internet is not, of itself, sufficient substantiation.

Unsubstantiated pathology testing is bolstered by the use of pseudoscientific jargon, fabricated claims of scientific validity, celebrity endorsements and claims that SM practitioners conspire to oppose CAM merely to protect their supposed lucrative incomes and prestige.

FSM respects the right of all patients to make their own choices in health care. But their choices should be informed.

Government and health care professionals have a vital role to play in informing that choice. When the choice has not passed scientific muster, the individual rather than the public should pay for the choice.

Society also accepts that we should protect children and other vulnerable people who are unable to make autonomous choices, and pathology testing should be no exception.

FSM recognises that the future is, by definition, unknown. SM does not have all the answers.

A claim for any new test should be met with cautious scepticism until it has been scrutinised using scientific methods. If the proponents of a new test are shown to be correct, they are entitled to the financial benefits and recognition from their discovery.

The test will then join other SM pathology tests, and be welcomed by SM practitioners as the latest weapon in the arsenal to investigate disease.

FSM recognises the profound fact that patients seek hope. SM cannot cure all ills, and its practitioners are ethically bound to admit this. Many CAM practitioners do not feel so constrained.

We must be vigilant to ensure that only pathology tests with a sound scientific foundation receive public funding. We must also foster the public’s understanding of the difference between tests that have or lack this evidence.

More generally, we should ask why the distinction between SM and CAM is becoming blurred, and who benefits or is harmed by this loss of distinction.

Health care is fundamentally an ethical endeavour, and that must be the foundation of professional practice.

Dr Adrian Cachia is a consultant pathologist based in Sydney and Professor Graeme Suthers is a pathologist at the University of Adelaide. Both are members of the Friends of Science in Medicine.

Acknowledgement: We are grateful for the advice and energy of Emeritus Professor Alastair MacLennan, vice president Friends of Science in Medicine, on this article.