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OUR health care system is a bit like our system of government: it’s not perfect, but it’s way ahead of the alternatives.
It’s not uncommon for conventional health care providers to be accused of being under the influence of Big Pharma, of continuing to provide ineffective treatments and, sometimes, of causing harm. We hear accusations of doctors just handing out prescriptions, prioritising treatment over prevention, and not providing holistic care. We can be portrayed as arrogant and paternalistic.
What, then, of the alternatives?
Providers and purveyors of so-called natural therapies often try to take the higher moral ground. Are these remedies actually natural? Are their purveyors treating their clients with honesty and respect? Do they treat the whole patient?
It’s important to understand the role of the Therapeutic Goods Administration, and the difference between registered and listed substances. In contrast to registered medicines – like most pharmaceuticals – listed medicines are considered to be of less risk to the public, and are not evaluated by the Therapeutic Goods Administration for efficacy or safety.
Another important difference between so-called natural therapies and pharmaceuticals is the widespread advertising of supplements and other remedies, often making claims that cannot be substantiated and using popular celebrities to represent the brand. A recent complaint has been lodged by Public Health academic and consumer advocate Professor Ken Harvey about unsupported claims from supplement manufacturers – spruiked by celebrities.
Then, there are claims made by alternative therapies providers. While criticising the medical profession for not being open about informing patients, they often provide simplistic, directed advice and, frequently, directly market the products that they recommend.
Finally, there are no forms of health care more holistic than conventional medicine. We provide preventive and therapeutic care, from smoking cessation to major surgery, from birth to death, for patients of all walks of life, all ages and for all conditions. We can assist people with both acute and chronic conditions, and work in collaborative teams with our nursing colleagues as well as physiotherapists, dietitians, podiatrists, and speech and occupational therapists. Sometimes modern medicine delivers such miracles that it is seen as particularly tragic when the miracle fails. We are human, after all, and can’t deliver perfection.
We must continue to be a self-reflective profession, always looking to improve services for patients, and always prepared to question current practice and habit. We must be open to new information, and better ways of understanding what our patients need. We must be good custodians of public funds and of the trust placed in us, and do our best to avoid conflicts of interest. At the same time, we must hold all health care providers to the same standards, being prepared to call out deceptive and conflicted behaviour where it occurs.
“Big Vita” is neither natural nor pure.
Dr Sue Ieraci is a specialist emergency physician with 30 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. She is an executive member of Friends of Science in Medicine.
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Anonymous Poster #1 may not have noted that I used the terms “often” and “frequently”, and there is abundant evidence that this is true. Homeopaths, for example, almost universally directly sell the products they recommend. Naturopaths also commonly sell supplements – it is one of their core roles. The very existence of so-called “Practitioner Only” supplements services as further evidence. The article posted by “anonymous” does not contradict this.
Well written Sue, and I agree with you fully in relation to natural therapists. The problem with your arguments, however, is that Big Pharma and Big Vita are to a large extent two heads of the same beast. Several of the pharmaceutical companies make more money out of vitamins and minerals than they do out of pharmaceuticals.
Thanks, Kay. I work very productively with my pharmacy colleagues in public hospitals, and value their expertise. It;s a pity that the financial model of retail pharmacies seems to require the inclusion of so many supplements and even homeopathic “remedies” on the shelves.
Sue I agree with you. It is very easy to criticise and be negative about Big Pharma but what is easily forgotten is that without the pharmaceutical industry there would be no new medications introduced. The pharmaceutical industry takes on significant risk to develop and test numerous products and only a few make it through to registration with the TGA let alone being listed on the PBS. While treatments may have adverse impacts in most cases they are preferable to the disease they treat or prevent. Big Vita does not have to meet the same rigorous standards of efficacy as Big Pharma and natural does not equate with safe. However the disincentive for Big Vita is that many substances cannot be patented hence there is little incentive for research. Many members of the community like to feel that they are proactive in managing their own health by using products developed by Big Vita, sometimes this is ill advised and even dangerous and health professionals have an important role in ensuring accurate advice in relation to these products. For many consumers use of these products can give them a sense of control which they may feel is missing with conventional medicine and we must ensure that when providing conventional medicine we are patient focused at all times to try to remedy this. Although Big Vita marketing is very persuasive and can be inaccurate there is also a consumer driven demand for Big Vita products and we must consider why this has occurred and reflect on our own care and consider if we are contributing to this. I believe that patient centred care will assist in reducing the demand for Big Vita products.
When you talk about working in collaboration to manage acute and chronic conditions do not forget your pharmacist colleagues, we collaborate with you in many areas such as medication reconciliation, supporting adherence, providing counselling to consumers about medication as well as responding to the prescriptions you write.
“they often provide simplistic, directed advice and, frequently, directly market the products that they recommend.” – actually there is evidence to the contrary of this statement for naturopathic practitioners – for example http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0048549 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680587/
If the author wishes to make sweeping statements regarding all CM practitioners surely some evidence must be sited rather than relying on an authorative position?