Issue 29 / 3 August 2015

EARLIER this year, the University of Sydney announced the establishment of a Chair in Integrative Medicine, raising many questions about the rights and wrongs of such an undertaking. 
The chair is named after the late Maurice Blackmore, who trained in naturopathy and established the well-known vitamin and herbal remedy business, now headed by his son, Marcus. Blackmores has contributed $1.3 million to funding the Chair. 
While much debate has focused on whether a university department should be endowed by industry, other discussion has considered the significance of the entity “integrative medicine” and the overall quantity and quality of research into existing alternative remedies and supplements. 
There are many reasons given as to why the evidence base for so-called alternative remedies is very lean in comparison to pharmaceutical medicines. But while it’s easy to blame the motivations and practices of so-called Big Pharma, what are the dynamics within the alternative and supplement industry itself? 
Why don’t big multinational alternative medicine providers spend more on research and development like Big Pharma?
First, it’s worth understanding the requirements for Therapeutic Goods Administration (TGA) listing. In contrast to TGA-registered medicines, for which evidence of efficacy and safety must be provided, TGA-listed remedies are over-the-counter products that are generally considered safe. The TGA does not evaluate the manufacturer’s claims of efficacy, and research into efficacy is not required for a product to be listed.
Second, the claim is frequently made that there is “no money” for research into alternative products. But does this claim stand up to scrutiny? Is there simply no money made in the manufacture of these products, or is research into these remedies not institutionally funded?
Close scrutiny of the purveyors of non-mainstream medicines produces some revealing findings. A search of financial details for homeopathy, vitamin, herbal and supplement companies reveals some large profits with little expenditure on research. 
Complaints and class actions about unsubstantiated claims for a product that is essentially a sugar pill resulted in a French-based homeopathic multinational paying out millions of dollars in settlements.
What about independently-funded studies of alternative remedies? Both the UK and the NHMRC have recently released exhaustive literature reviews of homeopathic remedies. Neither review found any high-quality evidence for their efficacy in any medical condition. 
In the US, the National Institutes of Health incorporates the National Center for Complementary and Integrative Health, which has spent almost $2 billion on more than 3000 studies and the maintenance of an information clearing house. 
The NHMRC has provided more than $85 million in funding for complementary therapy research since 2000.
Despite all this, when study after study fails to find convincing evidence of efficacy, there are the predictable cries of “more research is needed”, “the studies were flawed/biased”, “science just hasn’t caught up yet” or even “conventional science doesn’t apply”. This is often followed by vague assertions involving the words “quantum”, “vibrations” or “vitalistic”. 
While it is to be hoped that the proposed new academic department at the University of Sydney will provide high-quality evidence, it is not true to say that previous research has been somehow blocked.
Back to the beginning, then — what is integrative medicine? Is it ethical to integrate practices without evidence within conventional medicine? 
All proposed new therapies should be tested for both efficacy and safety. If good evidence is found, isn’t this just medicine?
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 also a member of the Friends of Science in Medicine executive.

8 thoughts on “Sue Ieraci: Find the evidence

  1. daman langguth says:

    What do you call alternative medicine that works? Medicine

    The TGA’s approach is unique in the commercial setting. Nowhere else are people allowed to sell a product (homeopathy) that can not work and still make millions. Perhaps the MBS review might want to remove accupuncture as that doesn’t work.


  2. randal williams says:

    One of the problems is that complementary- type medications are stocked in pharmacies, giving  the imprimatur of respectability and scientific credibility when there is little or no evidence for effectiveness apart from placebo effect.. Have a look at the rows and rows of vitamins, supplements, herbal remedies, weight loss products, arthritis relief etc etc that you will find in any pharmacy. These obviously are very remunerative for the pharmacist, and there is an inherent conflict of interest in pharmacists recommending them. Radio and TV stations love to have naturopaths and similar ” natural ” therapists promoting these products, with a quite uncritical acceptance, and no acknowledgent of the placebo effects involved.

  3. Mark O'Connor says:

    Interesting move by UoS; one that is sure to receive further criticism from the mainstream academic community.

    Still, lets hope that this new research group can demonstrate high-quality output that will clearly demonstrate the effect, or lack thereof, from these widely utilised ‘remedies’.

    Still agree with the inferred point that the TGA need to set a level playing field for all medicines/ remedies with a period of grace (time to catch-up with their research) for the likes of Blackmores. Perhaps they could start with a ‘whitebox’ warning that ‘there is no evidence of efficacy for this product’

  4. Ian Cormack says:

    A problem I see is that some of us make sweeping generalizations, lumping things together that should not be lumped togrther. eg vitamins, minerals, and homeopathy. All are called “alternative”, and yet we know we cannot survive without an intake of B12, B1 and C (for eg) and we don’t know what the optimum intake is for any.

    Another problem is our credibility suffers from inconsistency.  On one discussion site today a Doc was complaining that all he had been taught at Med School has been negated by research. I wouldn’t say “all”, probably no more than 70% in my case (need examples?  you must be young, but this article was written by a specialist in ED so how about: : I was taught within the last 10 y when resuscitating you had to do mouth to mouth. Also when doing ECM the aim was to keep the brain alive. In 2015 I was told mouth to mouth is out the door, ECM only thanks, and that is done to keep the heart alive.)

    I know this makes me more credible now than I was 30 y past, but not every one will see it that way. It also makes me more wary about broadly condemning others for lack of proof. I doubt homeopathy will ever be proven as having more than placebo value, but I am confident many other mixtures will be proven. And nor am I about to knock placebo, having had benefit from that myself.

    So GOOD LUCK to Blackmores and UoS. I am confident that nothing that cannot be proven will be proven.

  5. Dr. Mark McGovern says:

    Sue, you are throwing the baby out with the bathwater. Sure, homeopathy and iridology are scams. However, there is a vast amount of research documenting the efficacy of numerous non-prescription supplements – it just doesn’t appear in clinician’s journals, but rather in basic science journals.

    For example, the data demonstratng that vitamin D deficiency (or to be precise, suboptiimal levels) is an excellent predictor of death from all causes, and that optimal levels in an adult require supplementation with approximately 7,000 IU daily in the absence of significant sun exposure, has been there for years. Yet most general practitioners prescribe a 1,000 IU dose…

    Suggest having a long look at the position statements of the Life Extension Foundation as a starting point –

  6. Sue Ieraci says:

    Hi, Mark. I don’t see vitamin replacement for identified deficiencies as “alternative” or “unproven” – it is part of rational medicine. I am referring to the multitude of “supplements”  that are marketed to people with no evidence of deficiency or – even worse – people with “deficiencies” that are (mis)diagnosed by scam tests.

  7. Richard Middleton says:

    Anything using the words “quantum”, “vibrations” and my favourite “molecular memory” or variants there of, is labeling itself as bogus.   Such assertions fly in the face of common sense and the fundamental laws of physics. Simple as that.  Now we have a new branch appearing, Metagenics…. which is basically about eating a sensible diet .. but with expensive advice and personal attention. If people are prepared to be parted from their money in order to over come the vicissitudes of their “busy lives” by being scammed in this way, who are we to stop them or tell them otherwise? Perhaps we should rebrand!!!

  8. Sue Ieraci says:

    Hi, “Anonymous” – “expensive advice and personal attention” is essentially what people are paying for – and therefore what they value, along with validation of their concerns. If only we all had the time to provide these things within a medical framework! Unfortunately, the responsibility for effective medical care, including both acute and chronic, gets in the way, along with the expectation that expert medical care isn’t worth a lot of money. We are also expected to be honest with out patients, and not provide unsupportable claims for “remedies”. Ironically, the constraints imposed on a regulated profession, together with the responsibiilities, create a service that is less “popular” with the community than much of the sCAM practice, but also under much greater scrutiny and expectation.

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