This is the text of a letter sent to new Minister of Health Pete Hodgson in November 2005 by Keith Garratt, as a follow-up to his submission to the MACCAH committee in 2003.
Dear Minister
In mid-2003, I made a submission to the Ministerial Advisory Committee on Complementary and Alternative Health (MACCAH). I also sent a letter to your predecessor, the Hon. Annette King. MACCAH provided its advisory report to the Minister in June 2004. I understand that no policy decisions have been made as a result, but that the question of possible integration and public funding of complementary and alternative health practices (CAM) is still open.
A key recommendation of the MACCAH committee was:
“Where there is evidence of safety, efficacy and cost effectiveness, specified CAM modalities should be considered for public funding.”
The requirement for evidence sounds reasonable. However, elsewhere in the report MACCAH recommends that:
“Recognition should be given … to the relevance and importance of research at different levels of evidence for the efficacy and safety of CAM.”
In context, it is clear that the intention is that something less than the ‘gold standard’ systematic reviews, meta-analyses and randomised control trials usually required of mainstream medicine should be accepted as sufficient evidence.
Recent Green Party statements have referred to integration of “recognised” or “selected” CAM modalities, but I have seen no indication of how such a selection would be made. I also note the appointment of the Green Party health spokesperson as Chair of the Health Committee.
All this gives me concern that serious consideration may yet be given to the integration and funding of unproven pseudo-medical procedures and treatments within the national health system. As I noted in my letter to your predecessor, this would be a very major and probably retrograde step, and would bring grave danger of a serious downgrading of the quality and credibility of the system.
In a recent statement about a successful prosecution of the seller of phoney weight-loss pills, David Russell of the Consumers’ Institute commented: “It sends a clear signal to the peddlers of hope with no substance that if they get caught the penalties are going to be very severe.” The term “peddlers of hope with no substance” exactly describes the great majority of alternative health practitioners and the marketers of alternative health products. It would be a paradox indeed if the Government was to enter into the support and funding of such unproven practices and products, thereby becoming by proxy a ‘peddler of hope with no substance’.
It may be that, among the scores of alternative pseudo-medical practices and the hundreds or thousands of alternative remedies, a few may have some actual or potential benefit. Unfortunately, none of the 75 or so CAM modalities identified by MACCAH have met the stern requirements of objective research, investigation and substantiation that would enable them to be accepted as part of ‘mainstream’ medicine. Unless and until the practitioners and marketers of CAM are prepared to submit to and accept the same standard of research and evidence required of ‘mainstream’ medicine, there should be no suggestion that they deserve integration or public funding. It is only this level of research and proof that could be considered to provide the ‘evidence’ mentioned in the MACCAH recommendation quoted above. The paradox is that, if the safety and real efficacy of any of these practices had been proven in this way in the past, they would no longer be classed as CAM, and would in fact have already become part of mainstream medicine. Another paradox is that CAM practices are often claimed to be valid because they are ancient and/or derive from cultures other than our own. The irony here is that they derive from times and places where life expectancy was dramatically lower than that which we experience in our time and culture because of the benefit of modern medicine.
There is reference in the MACCAH report to the often-repeated claim that CAM is more ‘holistic’ than mainstream medicine. Again, this is paradoxical. A feature of mainstream medicine is the team approach, with patients being referred to and attended by a range of specialists and technical experts as required to give the total diagnosis and care required. In contrast, CAM is very fragmented, with practitioners often acting in isolation, each offering so-called ‘holistic’ care. There is little evidence that the various CAM practitioners act together in an integrated manner, or that they necessarily believe in the validity of modalities other than their own. In my submission to MACCAH, I suggested that each committee member should be asked to nominate CAM practices, other than his or her own, that they believed deserved integration and public funding. I suspect that this did not occur.
The proliferation of CAM is already a major concern to many people, because of its exploitation of people’s gullibility, the waste of money by people who can ill-afford it, the diversion of people from conventional care, and the potential for tragic disappointment (such as in the Liam Holloway case.) At present, it is a matter for private choice. Those of us that recognise CAM for what it is can choose not to use it. However, any move to give it public recognition and to divert scarce public health funding would certainly bring a storm of protest and ridicule from rational-thinking members of the tax-paying public.
Yours sincerely
Keith Garratt
