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Reflections on the Unexpected Depth of a Problem

By John Dwyer

Professor John Dwyer reflects on changes to Australia’s health climate and the continuing influence of complementary and alternative health practices.

In 2011 several colleagues and I, concerned that in this most scientific of ages a number of Australian universities were providing undeserved credibility for approaches to health care based on “pseudoscientific” concepts of physiology and pathology, formed Friends of Science in Medicine (FSM). The organisation would promote the need for health care in Australia to be underpinned by credible scientific evidence of clinical effectiveness. I have recently finished my term as the Foundation President of the organisation and have had some time to reflect on the learnings and challenges for FSM as it continues its advocacy.

In 2011 some universities were supporting courses providing credibility for homeopathy, “energy medicine”, “healing touch” therapies, chiropractic subluxation and acupuncture for a myriad of conditions as well as pre-scientific concepts integral to modern “traditional Chinese medicine”. Our concern was twofold: the obvious threat to the highest standards of scientific endeavours in our universities, and the need to protect consumers from fraudulent, often dangerous health care. This latter concern soon had us examining the broader consumer protection landscape and the effectiveness of government-established regulatory agencies charged with this responsibility in health-related areas.

Eight years later, two outstanding primary weaknesses are obvious. Consumers would be best protected if their acquisition of health literacy provided the skills that would minimise their susceptibility to health care fraud. The reality is, however, that among OECD countries health literacy in Australia scores poorly. Only 40% of Australians possess minimally adequate health literacy. This needs urgent redressing, of course, but the status quo makes it all the more important that health-related regulatory agencies are effective in protecting the public. It’s self-evident that if they were effective they would be minimising the occurrence of health care fraud, but we have found that most of the time their consumer protection efforts involve reacting to reported episodes of violations to the National Law as it is applied to health care.

Neither of the two major agencies involved, the Australian Health Practitioners Regulatory Agency (AHPRA) or the Therapeutic Goods Administration, have a culture that provides any passion for consumer protection. Neither recognises that, while fraudulent health care is not always directly harmful, there may be serious consequences when accurate diagnosis and effective treatment are delayed while individuals are robbed and experience psychological harm associated with dashed expectations.

Today we have billions of dollars being generated for companies that market vitamins and supplements, shamelessly making false claims for efficacy by promoting the concept that unhealthy lifestyles can be neutralised with something from a bottle. This is taking place in a country where we have a tsunami of citizens developing avoidable diseases that consume the majority of our health budget and cause many to suffer from their illnesses. We are served by a generation of pharmacists who have abandoned professionalism for profit as they focus on selling Australians products they don’t need.

We have hundreds of registered health professionals making false claims for efficacy, such as: chiropractors treating autism; traditional Chinese medicine practitioners advertising that they can diagnose serious diseases by examining the tongue and pulse, and using acupuncture to improve a women’s fertility; and doctors offering chelation therapy to avoid heart disease. We have AHPRA so hamstrung by legislation that its Board can tell registrants what they may or may not advertise but have no power to limit what they actually do to patients through their “scope of practice”. Throughout Australia, state agencies charged with protecting consumers from unregistered health practitioners are repeatedly ineffective, being under-resourced and underpowered for the job.

The depth of the problem FSM has encountered was unexpected. Our efforts continue to expose the problems and suggest strategies for improvement.

The reality is that business rather than consumer interests seem to prevent our politicians from strengthening consumer protection. Some of these concerns are to be addressed at the next COAG Health Council meeting. FSM and partnering organisations will continue to urge our community to demand remedial action from our politicians to sweeten what is currently a very bitter pill.

Professor John Dwyer AO, FRACP, FRCPI is Emeritus Professor of Medicine at UNSW, and was the Foundation President of Friends of Science in Medicine.