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THE private health insurance system in Australia came a bit closer to being evidence-based last week when a host of unproven “natural” treatments were removed from the list of services for which consumers could claim a taxpayer-subsidised rebate.
The 16 removed services include naturopathy, homeopathy, reflexology, aromatherapy, iridology and reflexology.
A review by the National Health and Medical Research Council had earlier found there was no clear evidence of efficacy for any of the excluded therapies.
The alternative health industry has been campaigning hard against the insurance changes ever since they were announced back in 2017.
There were online petitions, emotive claims about therapies being “banned”, and an industry-wide “I Support Natural Therapies and I Vote” campaign urging consumers of the various therapies to lobby politicians against the changes.
“I strongly believe that natural therapies, in particular [insert preferred therapy], is crucial to the preventative health strategy of Australia and will significantly reduce the burden on the public health system, especially as our population gets older and larger,” said a template letter for consumers to download and send to their local member.
I’m not sure whether the reference to a larger population means more people or more overweight people, but it doesn’t really matter.
Despite claims from the alternative therapies lobbyists that 25 000 small businesses were under threat, along with a $4.2 billion contribution to the economy, the changes went ahead.
Alternative and complementary therapies are big business. In fact, that might be the one claim made by the industry that is evidence-based.
Personally, I think there would be better ways to spend that $4.2 billion than on a practice such as iridology, which has about as much scientific basis as reading your tea leaves.
Fresh fruit and vegetables come to mind, or a good pair of walking shoes.
But the industry isn’t ready to lie down on the reflexologist’s couch just yet.
The Australian Homoeopathic Association (AHA) is urging devotees to email the Minister for Health asking him to overturn the decision.
The organisation’s “Your Health, Your Choice” campaign aims “to allow democracy to change this ill-conceived policy”, which is a little confusing given it was our democratic system that made the changes in the first place.
A petition on the AHA website calling for a Senate inquiry into “bias against natural therapies and why government-funded reports have ignored positive evidence” has garnered just over 100 000 signatures.
I guess, if you consider “My second cousin took this potion and his [insert condition of your choice] got better” to be high quality evidence, you might well value online petitions above, well, actual evidence.
Let’s be clear, the changes do not “ban” any of these therapies, despite the frequent use of that word by those with vested interests. People have the same right they have always had to spend, or waste, their money in any way they like.
I myself use two of the now-excluded therapies on a regular basis — pilates and yoga. I firmly believe they contribute to my musculoskeletal health, but do I think my personal belief is enough to justify a taxpayer-funded subsidy?
In the absence of evidence, no, I don’t.
In my last column, I wrote about the appalling situation in this country where 2 million people a year are unable to access essential dental treatment because of cost barriers.
If we can’t find public money to address that, we certainly shouldn’t be directing it to homeopathy.
Jane McCredie is a Sydney-based health and science writer.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
There has NEVER been a double blinded RCCT on spinal fusion.
I rest my ca$e.
Then let them go down noisily.
Then let them go noisily.
Right Jane.
Not sure what point Els Bakkar is making in that study of n = 1. I suspect most doctors on this forum would look at the aforementioned important tests with some enthusiasm.
Not sure why those promoting homeopathy are so surprised that our Health Funds (using our money) have stopped supporting homeopathy. It’s been coming for some time now1
Public funding of homeopathy stopped in Britain in August 2018, and as far back as 2009 the WHO warned against its use!
But let’s be clear- no one is stopping people from using homeopathy, or any other variety of “snake oil” or “jungle juice” that they fancy. But, sadly, at the end of the day, amongst the advocates of these so-called remedies, there will inevitably be some who, through not seeking reputable medical care for their symptoms, may be inadvertently delaying the diagnosis and treatment of serious illnesses. in this context, I’ve been advocating for some time that the TGA should not permit the sale of homeopathic products to infants and children, for obvious reasons!
In my opinion, no form of treatment, whether medication, manipulation or surgical, should receive public funds without evidence of effectiveness by means of a properly conducted clinical trial.
My experience, 17 years of research, scientific research only. Yes, their should be education requirements and looked into natural therapies. But this as a small part of my story.
Why is it that my naturopath is so much more knowledgeable in more difficult areas of health issues than my local GP? Why is it that my local GP (not just one) is willing to work together with my naturopath because of her knowledge?
Just a small example. My daughter was ill, suddenly bedridden at 14. Normal blood tests and all checks normal. I could see the GP was confused by the results as she was obviously very ill. But shrugged his shoulders and said I am sorry. So for the first time we saw an experienced and highly qualified naturopath. She requested further tests and the GP was willing to work with her. Co-Q-10 levels were tested, this was then new and done at a special lab for unusual and new tests (now taken over by ST V’s as they have become mainstream). Level Co-Q-10 – ZERO, required for heart function ), magnesium low, zinc low, (tested because of red stretch marks on her body, apparently a sign), iron low etc etc. All basic tests not yet mainstream in the medical profession. Supplements were given. She managed to go back to school, but not enough energy for extracurricular activities. Vomiting and allergies started to appear. It took the naturopath, with doing research, to get her intestinal permeability tested ( her case was extreme). Again this test is now more well known. Again with supplements and special diet we plodded along. Now we have dietitians who do what my naturopath did years ago
Another example, vomiting increased to nearly a daily basis, her food did not seem to get digested as normal. First gastroenterologist’s answer, see a psychiatrist ( this disbelief, not the first by the medical profession) eventually caused psychological damage. The second was more aware, and at at least acknowledged her illness, he said she was in the worst 10% of cases he had seen, but there were no answers. Next a visit to one of those frightening (to the medical profession) Integrated Medicine clinics. A new test was done, again seemingly outside the realm of the medical profession. It returned with results of a major overgrowth of streptococci bacteria in the gut and a lack of ecoli . She was treated, and for the first time in 10 years the vomiting has stopped, food is being processed and allergies are lessened. She is still really unwell, with ME, also know as Chronic Fatigue Syndrome. Finally ME/CFS is becoming accepted as a real illness. ( research has been available for years, but no one seems to be reading it.Also it was classified as a neurological illness by WHO in 1969.) But by all means, get rid of these untrustworhy practitioners, because the medical profession in its wisdom thinks they know all. My opinion of the medical profession, when they are good they are very good. My daughter was also one of the early children born via the Epworth/QueenVic IVF. Brilliant doctors with open minds, willing to listen and try something out of the box. So I have seen both sides and there a valid points for both. An open mind is required. Supplements I never use without prescription from the naturopath and she uses practitioner only brand ( not available in the chemist). She also tells me to go and see my GP for a check up. . I just wish that people making decisions listened more and read more widely, but that seems to be a problem in all facets of politics. And I learned that the medical profession is highly political, so disappointing. The medical profession ” Hippocratic Oath” , ” First do no harm ” I wish that was remembered more often. One question, aspirin has been used in its natural form from the time of the early Egyptians. Would you be using it it now, 2,000 later it wasn’t “scientifically proven”, synthesised and sold by “Big Pharma”? Finally, be careful, do not throw the baby out with the bath water
these alternative therapies should never have been covered by private health insurance but the idea was to attract the younger “New Age” generations who are main users. It is part of a wider issue of unproven treatments. The owner of Blackmores is a billionaire even though there is no evidence base for the majority of the products sold to a gullible public. Such companies are careful to make only vague claims for products such as ” may help support’ or “may assist ” , almost impossible to disprove. Patients are looking for a quick and easy fix, and Pharmacists are complicit in stocking and promoting these products.
You neglected to mention that the NHMRC review was seriously flawed and a new review has been ordered by the Health Minister, which will include much of the evidence which the original review failed to include. The Alternative Health Professions (not “Industry” – your bias is showing) are not “going down” or going away at all. According to a review conducted of 3,000 medical interventions by BMJ Clinical Evidence only 11% of interventions were established as beneficial, 24% likely to be beneficial and 50% simply “unknown”. The fiction that 100% of current medical practice is supported by robust evidence has too long been used to criticise non-mainstream therapies. This is actually not a negative reflection on current medical practice, but merely a little reality check, that new innovations in medicine do not come with a pedigree of robust evidence. It is only older therapies which have been used for long enough to accumulate the research that can boast of their robust evidence base. Given the limited research funding which has been available to non-mainstream therapies, the evidence base which does exist is impressive. The other important point which you failed to make is that government funding which encourages people to make healthy lifestyle choices pays off massively in the long term, with reductions in the chronic disease burden in older citizens. Of course these long term cost savings from preventive measures are challenging to demonstrate by research as they involve very costly long-term studies, but this does not mean they are not real. While evidence is useful to inform clinical decision-making, Sackett’s original definition placed equal weight on the patient’s preferences, the clinician’s clinical judgement and the “best available” evidence (regardless of whether that is high, moderate, low or very quality evidence). This model of shared decision-making is precisely the form of EBM practised every day by alternative health care professionals. The suggestion that what motivates these practitioners to do what they do is their desire to financially exploit their patients is a disgusting slur.
Like you Jane, I use and recommend yoga for my ageing and stiffening frame, but I “youtube” my lessons for free and certainly don’t expect the taxpayer to pay for me.
The altmedders are feeling threatened, but as they are by default part of the entertainment industry, the latter isn’t under any threat of extinction either. The defunding measures don’t even extend to the thorny issues of public endangerment and delayed diagnosis, just to public funding.
The altmed entertainment industry and the earnest customers obediently signing the generic petitions though should be careful what they wish for. Labor’s policy on altmed de-funding is significantly more developed and extensive than that of the Coalition. Their best tactic would be to keep their heads down and stay quiet, rather than draw attention to themselves.
By the same token, it is an indictment that acupuncture (‘Chinese medicine’) is an AHPRA-registered ‘profession’.
I can sympathise with the alternative health care industry when I see that the scientifically discredited and ineffective practice of “dry needling” so-called myofascial trigger points has escaped critical assessment by the National Health and Medical Research Council. There is great potential for saving precious health care dollars by removing this form of treatment from the list of publicly funded services.
Well said Jane. The costs go further than the 4.2 billion mentioned- how often do GPs see patients saying ” my naturopath says i have a toxic (insert condition of choice) , and the Gp ends up ordering pathology tests to demonstrate to the patient the true nature of their condition. The naturopath often ignores that the patient is diabetic, overweight, hypertensive, alcoholic and demands the GP order a serum rhubarb or such. ( my response now is to say to the patient – get your naturopath to write me cogent reasons for this exotic test and I will consider it)
Legalised quackery has now got to the point where it is almost mainstream and no-one bats an eyelid. The vitamin Giants(Swiss’s, Blackmores, Inner Health etc.) are advertising, lobbying and their shares change hands for absurd prices. This is long before Chiropractic, naturopathy and the extremes like colonic therapy etc. We have election campaign built on curing cancer or second best, removing all gap expenses. People believe this nonsense. Who will regulate properly ?