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.
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.