Issue 6 / 24 February 2014

THE recent controversy involving the Swisse Wellness company and La Trobe University should surely have us looking at the broader picture and answering some pertinent questions about Australians and wellness.

Without doubt, unhealthy lifestyles cause much of our burden of chronic and complex diseases, diminishing our quality of life and overwhelming the resources of our health system.

Despite all the rhetoric about the importance of prevention and, when well done, its cost-effectiveness, our doctor-centric, illness-focused primary care system continues to lack the infrastructure to provide the continuity and guidance many people need to minimise the development of “lifestyle” diseases.

People seek help from health professionals when they are sick; not to avoid sickness. Government departments of health are in reality departments of sickness.

There is a worldwide trend focusing on the development of integrated primary care practices where people enrol in a program providing access to teams of multidisciplinary health professionals including some who aim to help patients stay well.

Unfortunately, when evidence-based help is not available an information vacuum develops that is quickly filled by the “supplement” industry claiming that their products can help neutralise an unhealthy lifestyle and provide wellness.

Television coverage of the Winter Olympics was swamped with advertisements telling us we need supplements and vitamins, which can even be bought in lolly formulations.

Vitamin supplementation is expensive and usually — but not always — harmless and despite the oft-repeated claims from many suppliers there is no credible evidence that it provides energy, or relieves stress or generally improves health. Most Australians most of the time do not need to supplement their dietary intake of vitamins.

We do not need to detoxify our bodies, or consume “good” bacteria to keep our immune system healthy.

There is no such thing as a “liver cleansing” diet. Research shows glucosamine is no better for our joints than placebo.

We need to hear more respected voices from the health professions and the community speaking up to help consumers understand that the $100 they spend each month on supplements would be much better spent on gym sessions or even saving for a holiday.

One of those voices should be in the local pharmacy — after all, our pharmacists are well trained about evidence-based medicine. But the profession has diminished itself by having shops full of useless medications and supplements from which they no doubt make a high percentage of their income.

Pharmacists are asking government to allow them to play a more significant role in the primary health care system, but they should first become more responsible and not allow false hope to be peddled in their stores just because ill informed consumers will buy it.

Government is performing poorly in its responsibility to protect consumers from fraud. Frustratingly, Health Minister Peter Dutton is planning to reject recommendations from a review of the effectiveness of the Therapeutic Goods Administration that would have allowed it to do more to protect the public from unsubstantiated claims for “listed” products.

The challenge, brought into focus by the recent Swisse-Latrobe controversy, is not only to better protect consumers from health care misinformation and often outright fraud, but also to provide prevention infrastructure.

Most Australians want to stay healthy and have a sense of personal control of their health (a good thing), but they need valid evidence-based information to do that, coupled with continuous encouragement.

This will be best achieved by developing within our primary care system the opportunity for partnerships between patients and health professionals with mutual and shared obligations to maintain wellness.
 

Professor John Dwyer AO is the president of the Friends of Science in Medicine and emeritus professor of medicine at the University of NSW.

This is the second of a two-part series by Professor Dwyer on complementary medicine. Click here to read part one.

21 thoughts on “John Dwyer: Promoting wellness

  1. Julie Baartz says:

    I have always had an interest in preventive medicine. When I started in general practice in 1986 this part of practice was in its infancy but always included lifestyle factors. I am not sure if nutritional medicine is taught at medical school now but I was always taught that in our era and country vitamin deficieny was all but impossible. In 2003 however it was clear to me that although I was not seeing full blown scurvy, I was seeing those on the vit C deficiency spectrum. I thus decided to look into nutrition and in 2006 I graduated from the RMIT with a nutritional medicine degree and understand that vitamins action are more complex than current research papers have taken into consideration. In high doses vitamins can be toxic especially when given out of synergy with all the sub vitamins in its class. Both the beta carotene and alpha tocopherol studies suffer with the same methodological problem, these studies used the most potent sub vitamin of its class as surrogates for the whole class. It should really have been no surprise the outcome was worse, the most potent surrogates drove the most aggressive physiological process without the natural negative feedback of the gamma and delta sub vitamins. Until studies using the natural physiological mix of the vitamin class are performed we do not know for sure whether supplemention is dangerous, beneficial or useless. Lastly no nutritional doctor states that vitamins will work without adequate nutrition but we do know some people have higher vitamin needs than others, needs change depending on health status and we cannot assume all diets these days are vitamin replete. I commend Swisse and Latrobe using their resources to research their products so as to answer the recurrent question whom, when and how to supplement.

  2. Garry Egger says:

    Excellent piece John, and spot on in reation to supplementation. However readers should be aware of the big(ger) picture and that is that chronic disease has not only proximal (immediate) drivers of lifestyle like diet, exercise etc., but the big distal driver of the economic system. Only today our Treasurer is delighting in telling us he has convinced the G20 that we must increase economic growth by an extra 2%. But with the system now saturated with ‘needs’, marketers have nowhere to turn but to unnessary ‘wants’, like useless supplements that keep the economy churning. Politicians are unlilkely to touch this until the public becomes aware that the growth model ie. the need to increase (not even just maintain) consumption – of anything, even ‘illth’ products, like supplements, add great value to the economy (as does smoking, car crashes and other unnecessary products/procedures). It should be obvious that exponential ‘consumption’ (v. to eat, drink, over-indulge) is antithetical to good health. Unfortunately, there is little dialogue between economists and health professionals. This is not just idealistic theory, particularly in this current’ end of growth’ era. It needs to be part of any chronic disease epidemiology that can be sprouted by health analysts without being looked at like they have two heads!

  3. Bruni Brewin says:

    Julie makes the point that the research should be there.  We research medication – that doesn’t mean every person goes and buys antidepressants off the counter without being evaluated by a doctor first to find out if there is a ’cause’ that is normal for the person to be depressed.  And if there is, then should that not be dealt with to remove the ‘symptom’, i.e. the cause of the depression, rather than putting a band aid over the ’cause’ (medicating it?)

    And again we are targeting a specific self-medication (vitamins) – we could just as easily target ‘scientific evidence based’ chemical medication couldn’t we? 

  4. Elizabeth Hart says:

    Regarding “promoting wellness” and “looking at the broader picture”, I suggest it’s also time for scrutiny of some lucrative and controversial vaccine products.  For example, HPV vaccination which is pressed upon children around the world.

    In his article published on The Conversation in July 2012, (“Catch cancer? No thanks, I’d rather have a shot!”), HPV vaccine technology co-inventor Ian Frazer acknowledges that the risk of cancer associated with the HPV virus is very low, i.e. “Through sexual activity, most of us will get infected with the genital papillomaviruses that can cause cancer. Fortunately, most of us get rid of them between 12 months to five years later without even knowing we’ve had the infection. Even if the infection persists, only a few individuals accumulate enough genetic mistakes in the virus-infected cell for these to acquire the properties of cancer cells.”

    Given that Ian Frazer has acknowledged that the risk of cancer is low, it is questionable why this still experimental vaccine product is being pressed upon mass populations of children.

  5. Rosemary Stanton says:

    Garry – you make very valid points. Selling supplements may be good for business, but if the diet is inadequate in a country with more than adequate food supplies, the correct course of action is to fix the diet.

    There may still be some Australians who need supplements. The frail aged, for example, may have reduced ability to absorb vitamin B12 and pregnant women may find it difficult to consume adequate amounts of iodine. OVerwhelmingly, however, we have plenty of nutritious foods available that can supply nutrients. In my experience, too many people see supplements as an alternative to good food. For example, many women say it’s easier to give kids chewable vitamin C tablets (some even use them as an alternative to lollies) rather than getting the children to consume vegetables. Dentists will attest to the problems in erosion of dental enamel in children given vitamin C ‘lollies’. 

    For the most part, supplements are bought by the worried well. Indeed, there is evidence that those who take vitamins are least likely to require them.

    Today’s SMH also notes significant the problems with herbal supplements. “Researchers at the University of Adelaide discovered that almost 20 per cent of the herbal remedies surveyed – including vitamins, minerals and fish oils available at supermarkets and pharmacies – are not registered with the Therapeutic Goods Administration, despite it being a legal condition for their sale. And almost 60 per cent had ingredients that did not match what is listed on the bottle or pack.”

     

  6. Dr David De Leacy says:

    Ms Julie Baartz and brunibrewin unfortunately just don’t get it do they? Western medicine is totally based on scepticism, the empiral model and the Null Hypothesis, not mumbo jumbo exercises in faith marketing and the compromising of cash strapped Universities by these multinational organisations that flog nothing but unnneccessary ‘consumer products’ to ‘clients’ under the guise of ‘wellness’. It a been hard enough to control the rampant USA style market driven model of ‘Big Pharma’ in recent decades and the vitamin cartel have jumped on that bandwagon but with the added advantage of no regulation or accountablity whatsoever. In truth Julie and brunibrewin, the supplement industry does not need any more research at all! Its ‘market’ research is working really well thank you very much. Forty years of silent acquiesence by western medicine of this vitamin marketing rubbish and so called ‘complementary medicine’ under the mistaken belief the ‘at least it won’t do any harm’ has actually helped create this gigantic monster that can now buy political patronage at will.

    I guess Barnum & Baileys aphorism still holds true: ‘ You never go broke underestimating the taste or intelligence of your audience (market)’.

  7. George Hamor says:

    I agree with John Dwyer’s opinion piece but if people want to spend their hard earned cash on useless supplements, so be it.

    What distresses me more is the govenment allowing private health funds to privide benefits for such useless interventions as naturopathy, homeopathy, osteopathy, etc.

    This drives up the cost of private health insurance and as a result we as a community are all the worse off.

    How can the AMA and other medical bodies allow this to happen?

  8. Julie Baartz says:

    Dr David DeLeacy assumptions are rampant in all fields of medicine and business alike and can I just point out you are no exception. You wrongly assumed I was a Ms purely because I have an open mind and I did not assume automatic credibility by placing Dr before my name. I do have a MBBS qld university of medicine, Diploma of child health, London college of physicians, FRACGP and also a graduate certificate in nutritional medicine RMIT.

    You are absolutely entitled to your opinion and I accept it, but I cannot accept anyone stating I do not get it just because my opinion does not concur with others. My opinion comes from evidence and clinical basis. Perhaps mainstream does does not yet get it?

     

     

     

     

     

     

     

  9. scott masters says:

    Accoring to Professor Graeme Jones, well known Tasmanian rheumatologist and head of Arhritis Australia, glucosamine sulphate is useful for knee osteoarthritis in line with EBM. Perhaps a correction to Professor Dwyer’s article should be published, lest people get the wrong idea.

  10. k.harvey@medreach.com.au says:

    George Hamor said, “What distresses me more is the government allowing private health funds to provide benefits for such useless interventions as naturopathy, homeopathy, etc.”

    There is currently a ” Review of the Australian Government Rebate on Private Health Insurance for Natural Therapies” that is looking at thse matters, see: https://www.health.gov.au/internet/main/publishing.nsf/Content/phi-natural-therapies.

    The first report (on homeopathy by the NHMRC) should soon be in the public domain.

  11. Sue Ieraci says:

    People have been conned by the supplement industry and many ”wellness care” providers that modern diets must be deficient in micronutrients. As Prof Stanton points out, this is rarely the case. Modern diets in wealthy communities may be too high in energy, salt and fat, and low in fibre, but that does not mean they are empty of micronutrients. Manufactured foods can have many disadvantages, but they are frequently vitamin and micro=nutirent boosted. The way to improve those diets is not to take vitamins, but to substitute real foods. Fruit and vegetables do not need to be organically grown to contain vitamins and minerals – people might prefer to avoid pesticides and manufactured fertilisers, but organically-grown foods are no more nutritious – this has been shown in good quality research. According to AIHW, ”Vitamin C deficiency (scurvy) is rarely found in Australia and reported occurrences have been in institutionalised elderly people and infants fed on breast-milk substitutes with low vitamin C levels.”

      

  12. Dr D. M. Cunningham says:

    I could never understand the difference between wellness and good health. I guess I am old fashioned but when practising, I treated sickness, accident and disease. If they were well they had no need of my services.

  13. Max King says:

    My main concern with the placebo-punters, the seekers after eternal youth, the druidic potion quaffers, is that they may impose their nonsensical, neurotic life-style on their children c.f. the anti-vaccination vandals.

  14. Dr Celine Aranjo says:

    Upon reading the good professor’s second part as well as the first part of this topic, and after reading all the comments on both articles, I am in total agreement with Dr Julie Baartz, albeit I don’t have all her qualifications. Qualifications are regarded as an essential in order to give informed comments. Post-graduate, self taught,  medical graduates who keep up by reading modern text books, good internet sites,etc. seem to be not held in much esteem. I commend Julie on her out-spokeness and commenting on retired Uni professor and the other supporters of his theories. Vitamins and minerals are deficient in many in our good country. Whilst our medical teachers and/or peers wait for diseaes of deficiences to manifest in severe forms, many cases presenting in primary care with mild symptoms AND signs go unsuspected and untreated. Scenario1: an infant brought to ED with fitting, failed to be diagnosed as hypo-calcaemic seizures and not treated with parenteral Cal gluconate as first-line treatment. Scenario 2: osteoporosis in elderly persons treated with strong osteoporosis drugs developing stroke, heart attack, etc..Scenario 3: physical activity presribed in osteoporosis does not address the need for extra calcium as well as iron, due to this added muscle activity.(e.g.gym attendance, 30 min walking).

  15. Julie Baartz says:

    Fortunately the school of sceptics which started back in 320BC and governed Platos Academy for 2 centuries is alive and well. The basic sceptic philosophy that every argument stems from a basis presumed to be true which in turn stems from a prior basis again deemed to be true and so on ad infinitum affirms the important point that certainty is only as certain as the degree of certainty of all the predisposing factors it relies on. It is the Sceptics who have necessitated open, honest, transparent, reliably informed, better designed studies and analyses so as to ensure only evidence of the most rigorous caliber is implemened. Swisse’s conflict of interest is wide open transparent and their research will thus need to be even more rigorous, not to mention that Latrobe unversity is very reputable. This has nothing to do with homeopathy nor naturopathy which I agree should not be subsidised.

    We use vitamins and minerals daily in mainstream medicine, thiamine for alcoholics, folic acid for those with high needs, vit D, B12,  potassium, iodine and calcium. I do not know all the potential gene food/vitamin/mineral interactions but I know the specialty of nutrigenomics with the aid of the human genome project have already discoved many potential beneficial therapeutic interactions.

    We know for starters that Type 2 Diabetes is a polygenic disease and omega-3-fats improves insulin sensitivity through change of gene expression. We know some diabetic genes are turned on by carbohydrates. We have a lot to benefit and Swisse have the fnances and the incentive to help in this needed research .

    If there is anything I do no get its why anyone would want to stop it.

  16. Professor Avni Sali says:

    It is unfortunate that John Dwyer is commenting about an area of medicine where he has very limited knowledge. There should not have been any controversy about any supplement company sponsoring research on non-patent supplements where there is no direct financial return and the community and other supplement companies can benefit cf research funded by drug companies for patent products where there is substantial financial reward to that company if the drug works. Pharmaceutical funded research accounts for approximately two thirds of clinical studies at research institutions in Australia.

    Unfortunately, our governments reward short prescription writing consultations better than long health-orientated consultations by general practitioners. Too many drugs are prescribed eg antibiotics, especially in these short consultations, which are not only highly expensive to the Australian community, but also can be very dangerous. Too much of medicine is involved in drug prescribing, rather than health.

    When people like myself were doing nutritional studies on the eating habits of Australians over 30 years ago, unfortunately there was very little support for this type of research by the medical establishment. As a result of the lack of interest health and prevention of disease, we now face even greater problems.

  17. Dr Ken Harvey says:

    Dr Sali said, “There should not have been any controversy about any supplement company sponsoring research on non-patent supplements where there is no direct financial return and the community and other supplement companies can benefit”.

    First of all, Swisse (and other supplement company) products usually contain a unique mix of ingredients, for example the Swisse Men’s Ultivite F1 contains “52 premium quality vitamins, minerals, antioxidants and herbs”. Results found from trials using Men’s Ultivite F1 cannot be extrapolated to other multivitamin, mineral and herb products (unless they had an identical formulation) and thus other supplement companies cannot benefit from such research.

    Second, supplement companies (including Swisse) have got direct financial returns from using (and abusing) research results on their products in marketing campaigns. For example, Swisse have claimed that a number of their products were “proven”, “clinically proven”, “scientifically shown”, “clinically tested with proven results” and “proven in clinical trials”; claims that the independent Complaint Resolution Panel found breached the Therapeutic Goods Advertising Code, see: http://www.tgacrp.com.au/uploaded/doc/Swisse_Products.pdf.

    Finally, there is no community benefit when research is misused in such fashion; hence the controversy about the Swisse – La Trobe MOU.

  18. Julie Baartz says:

    Thanks Dr Harvey for the link. It is true that Swisse have pushed the boundaries of truth in their advertising but ALL PHARMA are guilty. In fact any company who uses celebrity and states their product is scientifically proven are guilty: skin cream, hardware and kitchen products are all major culprits!

    Surely the responsibility lay with the consumer but I agree it is the medical professions responsibility to bring deliberate misleading advertising of medical products to everyones attention. I commend Dr Harvey for doing this.

    The real issue however is: Is La Trobe university necessarily compromising their research by having Swisse backing? All researchers have a conflict of interest, one’s desire to prove one’s hypothesis resulting in publication bias has created much controversy. As we know major journals today not only ask about potential conflict of interests but request for all research both positive and negative to be published. Provided Swisse-La Trobe does this the potential for conflict of interest reducing reliability will be significantly reduced.

    With Universities struggling and BIG PHARMA making massive profits why not solve both problems by putting Swisse’s capital into beneficial rigorously performed peer reviewed research. Nutrigenomics for example has the potential to reduce the major impact Type 2 Diabetes has on resources today.

    Lastly it’s worth thinking about who has the capital, the incentive and the will to research nutrigenomics? La Trobe has given Swisse a chance, what is there to lose if the main goal is to get closer to certainty.

  19. Dr Yaacov (John B.) Myers says:

    I co-authored a “low salt cookbook” in 1980s as there was nothing out there. I agree with Dr Baartz that research based science is to be encouraged, rather than have unresearched claims used in campaign marketing. It would be an educational exercise, if the studies were meaningful and the conclusion subject to accountability and methods transparent etc. The third party effect is only significant if it impacts on the trust of the doctor-patient relationship. Third party involvement must be based on “honesty and accountability”, no matter what or who. Educating consumers and professionals to objectively appraise evidence and make informed choices is preferred over blanket restriction and campaigns (dogma) in support of abstinence, methods which abet ignorance, remove discretion and opportunity to make responsible choices. Wellbeing is an attitude, good health is what one has. The aim of medicine is to help ensure both.

  20. k.harvey@medreach.com.au says:

    I applaud complementary medicine companies that provide capital to enable universities to undertake research in important areas of clinical interest, such as exploring the efficacy of traditional medicines (from which many useful active pharmaceuticals have been derived).

    But that is not what the Swisse – La Trobe MOU proposed; rather the aim was for La Trobe researchers to specifically assess the efficacy of Swisse products.

    Do we really want University researchers to spend their time assessing if, for example, Swisse Men’s Ultivite which contains 52 “premium quality vitamins, minerals, antioxidants and herbs” in a potpourri of ingredients many of which lack logic (and are present in non-standardised, sub-therapeutic amounts) but presumably are included in the hope that “more is better”, has marketing appeal? What about Swisse “Liver detox” and “Ultiboost Hunger control” (the subject of a 2013 ABC Checkout program)?

    See: http://www.youtube.com/watch?v=12ww26sQF7E&feature=youtu.be

    I reiterate, there are many worthwhile complementary medicine questions to be researched but I do not believe the Swisse – La Trobe MOU (as announced) would have elucidated them.

  21. Brad McEwen says:

     

    I believe the main issue is that more research is needed. There are some good studies out there but the funding may not have been enough to sustain the length and numbers required to get the statistical P Value of <0.05. The much needed funding could help solve this issue by providing researchers with the resources required to produce high quality studies with larger numbers, wider population and ages of participants, greater length, and the possibility of including a placebo arm or even with the design of double-blind placebo-controlled cross-over trial.

    Some good points have been made in this thread. These include:

    • A wide and varied diet containing energy-dense and nutrient-dense foods.
    • Increasing lifestyle factors such as exercise, physical activity, rest, recreation and sleep.
    • Noting that supplements are required for certain people with particular health conditions, e.g. the elderly, frail, people with chronic disease…

    I think the focus should be on promoting optimum health, using the above points, promoting more research, and educating the public to access qualified practitioners (and possibly verifying their credentials) for information on their health and treatment options.

     

          

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