Sweeping out the dirt

Being a medical sceptic is a hard gig, these days. Our negativity cops bad press; we lack the faith of traditional healers, the chutzpah of health bloggers and perhaps even the imagination of Donald Trump.

Lift the carpet to scrutinise the evidence for surgical procedures or pharmaceuticals, and detractors will point out that at least western medicine eventually responds to scrutiny – so how about first sweeping out the badlands of alternative medical practices?

But, take a broom to the dust at the foundation of so many complementary medical claims, and devotees will tell you to first get your own house in order.

We critics get used to sweeping criticism.

So, when the RACGP approached me last month to write their official submission to the Senate Report on the TGA reforms, I keenly obliged.

Over the last couple of years I had written the RACGP Choosing Wisely recommendations, aimed at reducing unnecessary procedures and treatments. Or, if some staunch traditionalists are to be believed, conspiratorially aimed at undermining the very basis of our rights as doctors to order whatever we want.

Having disturbed the peace at home, the TGA submission was a chance to kick up some dust over at Alternative House.

“More than a thousand claims…the majority are unscientific”

The issue is the bill before the senate that will allow manufacturers of complementary and alternative medicines to make therapeutic claims for their products without pre-approval. Marketers will be allowed to choose a claim from a selective list.

The problem is that more than a thousand claims have been proposed by this multi-billion dollar industry, and by far the majority on the list are unscientific. Hence the headlines recently about the TGA allowing indications based on traditional use, ranging from the meaningless ‘extinguishes External Wind’ to the completely unsupported ‘improves breast milk production’.

The good news is that my arguments, via the RACGP submission, were extensively quoted verbatim in the senate report – for example:

“Even if a particular product (product X) has no benefit to health at all, the proposed Bill will allow the manufacturer to claim that X nourishes or rejuvenates, or assists weight reduction or jet lag.

“Manufacturers can simply state that X is a traditional product that has at some point been recommended by various alternative practitioners. This justification is so vague that it is hard to see any product failing to meet that low bar.

“It would be extraordinarily difficult to refute the statement that some tradition has recommended product X for whatever therapeutic benefit the manufacturer chooses to advertise. To base the regulation process merely on manufacturer claims about tradition entirely ignores the question ‘Does it work’?”

That’s the good news. The bad news is that, despite support from the Greens, we lost.

After 22 pages documenting all the arguments, the final sentence reads “The committee recommends that the Senate pass the bills.” The bill was passed on 15 February, in full, with no amendments.

So get ready for plenty of post-truth claims on pill bottles. It’s all approved.

Alternative pills with alternative facts.

This article was first published in Medical Observer, February 2018

For further reading, see Prof Ken Harvey’s summation