Ensuring the Healthy Sustainable future of Complimentary and Alternative Therapies beyond April 1st

Why we need to take a more collaborative approach in substantiating Complimentary and Alternative Medicine use and treatment outcomes in future. And what is required of all of us to better serve the 80% of the world and the two thirds of Australians actively utilising Complimentary and Alternative Medicine.

In the interest of contributing something constructive to the current public discussion on safe Natural Therapy  (otherwise defined as "Complimentary and Alternative Medicine, or CAM for short) usage and truly committing to best practice and doing what is in the best interest of the world population and the Australian public i'm a part of, i put my Biological Science Degree hat back on this week and got to digging through some primary resources that we could all be using to make a case right now for why it's more important than ever now that we double down on investing in the further development of CAM, not withdraw support from it in the coming month, and why it's essential to ensure the safe, human-centred, evidence-based, ethical future of this industry.  


A quick reminder: What is Complimentary and Alternative Medicine and How Do We Define It?

Firstly, Complementary and alternative medicine (CAM) is a blanket term used generally to describe a very wide variety of treatments, modalities and therapies, ranging from herbal medicine and supplements, to practitioner-based therapies [6][20] that are used to treat the whole person to create holistic wellbeing and a healthy lifestyle, not just to treat the disease [21]. Which Dr Matthew Leach, during his work with the University of SA, had been quoted as suggesting are definable in 5 main areas:
  
• System-based therapies, such as Naturopathy and traditional Chinese medicine
• Manual therapies, such as Chiropractic and Massage
• Energetic therapies, such as Reiki and Therapeutic Touch
• Mind and body therapies, such as Yoga, Tai Chi and Meditation
• Biological therapies, such as Herbal Medicines and nutritional supplements. [10]

The International Institute for Complimentary Therapists has one of the widest lists in the world of modalities considered to come under the heading of CAM (and approved by them for membership and insurance purposes) viewable here [22].  



Why we need to keep researching, developing and funding CAM (Natural or Alternative Therapies and Medicine) and best practice

Firstly, "it is estimated that up to four billion people (representing 80% of the world’s population) living in the developing world, rely on herbal medicinal products as a primary source of healthcare. And traditional medical practice, which involves the use of herbs, is viewed as an integral part of the culture in those communities" [1][2][3][4][5]. 

As it stands in 2019, "CAM has well and truly become an established part of healthcare for many Australians" [6][7]. "CAM is estimated to be used by up to two out of three Australians, and accounts for $3.5 billion in expenditure every year"[6][8]. "With the annual patient expenditure for CAM exceeding expenditure on Pharmaceutical Benefits Scheme (PBS) medications by $1.8 billion" [7].

Yet, despite

a) their growing popularity

b) repeat usage and

c) despite the fact that there are numerous Universities in the country, who've been a part of conducting a wide range of evidence-based research on the efficacy of various CAM's [1][8][10][12][19] as fast as they can manage AND departments at Universities like the Faculty of Health Sciences at RMIT [15], the Australian Research Centre in Complementary and Integrative Medicine at the University of Technology Sydney [14], Western Sydney University’s NICM Health Research Institute [19], the School of Nursing at the University of SA [10] and School of Science at Charles Sturt University [1], teaching CAM in combination with the exact same units of study that Western medically recognised Practitioners like Physiotherapists, Nurses, and GP's and Specialists being trained by the University are required to be trained in [1];

d) who have been actively contributing to policy development on the safe use of CAM's, and

e) despite the fact that, the world over, since 2004 and my Science Degree training, i have seen, literally thousands of university trained, PhD holding Scientists and Medical Professionals the world over who've written literally thousands of papers, and books full of evidence based research on the quantitative and qualitative benefits of CAM's falling under the above-mentioned 5 classifications


A large portion of government funding and support is set to be withdrawn from 17 of the available modalities on the 1st April and apparently, 400 of the world's highest profile Medical Professionals and Scientists who are part of a group called Friends of Science in Medicine, are lobbying to have all CAM related research, study and government funding withdrawn from the very Universities and Experts that are among the best placed in Australia to continue to lead the healthy, safe, ethical, evidence based research into and training of Practitioners who will be able to best serve the needs of the 80% of the world who are crying out for our care. 


Following the review that was undertaken by the National Health and Medical Research Council (NHMRC), chaired by the former Commonwealth Chief Medical Officer, which was tasked with reviewing scientific literature examining the effectiveness and, where available, the safety and cost effectiveness of the 17 natural therapies they examined, it has been reported back to the Australian Government's Department of Health that "there is no clear evidence demonstrating the efficacy of the [excluded] natural therapies"[9]. Which, as per the Department of Health website, is the basis on which, on the 1st April 2019, 17 Natural Therapies are now going to be removed from Private Health Coverage to "ensure taxpayer funds are spent appropriately and are not directed to therapies that do not demonstrate evidence of clinical efficacy"[9].


My question to you reading this: knowing that 80% of the world is reliant on types of CAM and that 2/3 of Australian's alone are continually accessing CAM already, is the Australian Government and are the 400 Experts making up Friends of Science in Medicine [23], really acting in the best interest of the world population or the Australian population, by calling for withdrawal of funding from a large section of the Holistic Health Industry and calling for the shut down of the leading hubs of CAM teaching and research? Where some of the most reliable evidence based research we've got so far has been and is still being studied by some of the most qualified experts in the world to lead it?


Given that 80% of the world and 2/3 of Australian's are consumers of CAM's, how can the Australian Government justify putting through these legislation changes, without giving the Australian public a chance to vote on the future of their own wellbeing and the use of their tax dollars? When clearly, 2/3 of them have been happy to spend their hard earned money on CAM's? Given that Health and Hospitals are on the top 3 concerns list of numerous Australian voters polled at the end of 2018, surely this too is worth putting to the people to find out why and what those 2/3rds accessing CAM's are getting out of it? The very people, let's not forget, who's wellbeing the government and all of us in the entire health world, mainstream and alternative, are meant to be representing the wellbeing and best interests of?
 

Objectively speaking, does the removal of funding and support for CAM's on the 1st April represent what you personally want? And reading the Friends of Science website, does the stance accurately represent what you're seeing in your world as a consumer of CAM's or a Provider of CAM's? Does it accurately represent the quality of care you're receiving in the traditional health care system? What do you personally want and need of the CAM's world and the mainstream medical system? What's your vision of a healthcare system that works better for all? And for your unique needs too?


Have you expressed it, to the health system? And to the government? Maybe now it's time, at this, the 11th hour, for all consumers and holistic practitioners to get just a bit more honest about their experience of both paradigms (mainstream and alternative health) and what they really wanted and needed, and still want and need, instead, while we still have the chance?


Personally, i share everybody's concerned about wellbeing, safety, best practice and collecting tangible evidence of the benefits (and, just as importantly, limitations) of what we do.  I'm personally doing my best to try and operate with respect to bridging the requirements of both worlds (mainstream medical and alternative). But i really feel like this is a matter of time. We need more time to gather reliable evidence and develop more comprehensive policy ensuring the safe and ethical use of CAM's in compliment to traditional medical care in the modern day, we need more time to collaborate on better training CAM's and Mainstream medical professionals, and working out how we can best support each other. We need more time to hear from the 2/3rds and the 80% of the world accessing CAM's what the long term benefits (and drawbacks) are of the treatments and therapies they're utilising. And most importantly, we need more time and acknowledgement of the tremendous wealth of knowledge and qualitative, not just Western Science and Medicine qualified quantitative evidence, that already exists, and in some cases, has already existed for multiple millennia.  Is it not WAY to premature to call it?

And the next logical question, for Practitioners, for all kinds of Practitioners: 



How can we do better at bringing these two worlds together?


1. It's time to realise all the ways in which we share the same vision and unite over all we have in common.

For me personally, having a Mainstream Medical and Science background, as well as having worked in the CAM world,  i think we all have more in common than we might think we do, in wanting the best for our clients and wanting to be better at what we do. But it's time to start seeing what unites us and how we can work together, over what makes us two separate parties, on either side of some metaphorical battlefield, constantly pointing the finger of blame at each paradigms incompetence and lack of sensitivity. it's time to get out of our heads, out of our wounding, judgement and the condescension of "knowing it all", and get back in our hearts and start REALLY listening to each other, really SEEING each other, really feeling each other, human to human, from a place of mutual love and respect for the people we're talking to. Expecting the best of each other and acknowledging that each and every person on this planet has a valid opinion and their own unique body of wisdom and talent from which to speak, no matter how many qualifications they do or don't have. if we can communicate and relate from that place more often, i think we'll get something truly constructive, done. And it's also the place from which the 80% of the world, and the approximately 67% of Australian consumers of CAMs might just feel a little more safe to open up to all of us about the true extent of their CAM usage.



2. We as Practitioners need to make it safer for patients to report their CAM usage to all parties involved in their care and feel safe to talk about what they really need, so that both parties can better collaborate towards their evidence-based, best practice, ethical care and here's the evidence why.


A repeat study done by Foley, H, Steel, A, Cramer, H, Wardle, J and Adams, J., referenced by the Australian Research Centre in Complimentary and Integrative Medicine, goes a long way to help us understand why the current government and traditional healthcare system still doesn't have the full picture of how widespread CAM usage really is. Which, after having spoken to several thousand Holistic/Alternative Practitioners of both camps (mainstream medical and alternative) and patients within both systems since 2004, i would say represents what i've also seen and heard first-hand, and that is that "2/3rds of all complementary medicine users do not disclose their CM use to their [mainstream] medical providers" [18].


Why do people not accurately report their usage? The study found that "disclosure of CM use to medical providers is influenced by the providers’ communication style" [18] And, "perceived provider knowledge of CM use was reported to be a barrier to discussions about CM use in clinical consultations [18]." In other words, if they feel like it's not their mainstream medical providers cup of tea, or they pick up on the slightest indicator that the Professional they're seeing is not supportive of CAM', they wont disclose. And from what i've seen, they often wont go back and tell the professional why, or tell them that they never filled the script/s they were given or used half of the interventions suggested, because they think, if the Professional is not open to discussion of the complimentary use of CAM's with Western Medical care, what's the point?

That says two things to me. 1) Holding onto a negatively biased and highly subjective viewpoint on CAM is not truly serving at least 2/3 of clients' wellbeing and apparently (just as much as the reverse scenario is also true of a negative bias against mainstream medical care) and 2) We've still got some work to do on "Soft Skills, as people in the the corporate world might know them," Counselling and Communication Skills and "bed-side manner" as Practitioners of all kinds might know them, to help make it safer for our clients, as well as our colleagues to be honest, without fear that they'll be crucified and mocked if they do.
 


3. It's time recognise more of the existing forms evidence based research that already exist and acknowledge that we're riding the wave of a paradigm shift, that requires new forms of scientific measurement and analysis, to keep up with the shift in consciousness that the implementation of many CAM's are creating. And if we're on the verge of another realisation that the world is in fact round, instead of flat type moment, hanging onto the old is just going to delay the whole inevitable evolutionary process


There are 3 things i believe to be the case from my personal training and professional experience:

i) Many aspects of CAM i think are explainable by the known laws of Biology, Chemistry and Physics, testable and measurable via existing scientific means, used widely in mainstream medicine. For one example, the "energy field  many CAM practitioners claim exists" [23] in and around a human being, is not pseudo-science. The electrical activity a Neuroscientist measures via an EEG or Cardiac Nurse measures via an ECG every day of her working life in a cardiac ward is evidence of it's existence and measuring just a part of it's activity. In my 3rd year Muscle Physiology class, we were literally also measuring part of it's activity every single day. Which is precisely why Reiki and many Energy Medicine and Bodywork Practitioners pretty much had me at "hello' on the possibility of their existence. 

ii) There are also literally thousands of critically analysed, peer-reviewed, published, evidence-based studies on both the Physiological aspects of bio-electrical activity and alternative energy medicine alone.  I could be here for a month trying to site the numerous one's i've seen over the last decade, but here's where you can find at least 126 i've read over the last 10 years [24][25][27].

iii) To say that there is no credible scientific evidence validating Homeopathy or the use of thousands of different kinds of herbal medicine the world over, i believe very premature and dare i say it, actually insensitive to and dismissive of the countless Indigenous cultures who originally discovered it and have been the custodians of it since long before Western Medicine and Science came into existence. 

On one level, some of the herbal medicine practices have endured throughout the ages because Indigenous cultures did the research already and passed the knowledge forward largely orally. And they're well aware of what was toxic and dangerous. WE could learn a lot from listening to their wisdom. In other respects, to fully come to scientifically understand how certain CAM's like homeopathy and various aspects of energy medicine work, a paradigm shift in understanding, not unlike that time the world's leading brains believed the world was flat, only to be later disproved by the first people to circumnavigate the globe, is very much required. I believe we're in the midst of such a shift. We just need more time to quantify and substantiate the findings on what we're intuitively already seeing. That's going to require a little patience of all of us. Because proper research takes good time, and if a well qualified university Professor can collaboratively turn out 99 published, peer-reviewed journal articles in the space of his career, that ought to tell us, collectively speaking, as it comes to the whole of the CAM spectrum, we've got some waiting and a lot of work yet to do yet before Western Medicine and Science fully documents the how and the why of it all.



All of this being said though, i whole-heartedly agree with the concerns of the government and Western Medical paradigm about the safety of CAM's and the need for greater focus on personal accountability and ethical, evidence based best practice, before clients everywhere jump any further off the deep end with every herb or supplement out there, without understanding at exactly what point, they could become toxic, or toxic in combination with something else. I agree we need to lift our game on that. 


And no matter what kind of Practitioner we are, mainstream medical or CAM, we can all benefit from a health dose of self-reflection, frequent peer review (from people who aren't afraid to give it to us straight) and supervision in the work that we do. And that can become potentially hazardous at times; we can miss our own flaws or flaws in our practice in the absence of that kind of support. 

That's part of the reason learning to do Western Scientific analysis is so very beneficial and complimentary to alternative practice and more needed than ever, at this late hour. Which brings me to my final point.



4. In order to better demonstrate the positive outcomes many of us have repeatedly seen from our CAM Practice, It's time for more Holistic Practitioners to learn how to do and report upon evidence-based research and be proactive in the research, development, regulation and improvement process, as it relates to your craft.

Given that it takes a good 3-10 years to get trained in mainstream medical and scientific, and the obvious reality that, while i've supervised my share of Coaches, i didn't go on to do that PhD in Muscle Physiology to be able to supervise others in A level evidence based Scientific Practice. So, especially given events of recent weeks,  i'm very reluctant right now to go any further beyond my comfort zone of expertise. But what i will say from a Scientific standpoint is:

Please do check out how outstanding Australian researchers, who've made an incredible contribution to the furthering of Integrative, Complimentary and Lifestyle Medicine, that i've referenced below, to get a feel for how they do it. And if you're not already connected with a Mentor for Supervisory got Practice Development purposes, maybe have a think about who that might be going forward. For the sake of this whole industry, it's time we got over our fear of truly being seen and scrutinised for what we do and don't know, and boldly dare to go out there where not enough Practitioners have dared to go before. You're needed now more than ever.  


My final suggestion, make some time to (if you're not already) familiarise yourself with what mainstream Science and Medicine considers Primary Research to be and get all over it. it consists of:

- The journals for your industry and others, the kind you'll find listed on search engines like PubMed
-The professional associations governing your modality and others like yours
-The universities, colleges and hospitals who are doing research on your area's of interest
-The government organisations, departments or government funded organisations contributing to your specific area of CAM, and their publication channels (this is usually considered a little more secondary in nature) and
-Take note of the full range of other experts in the industry on your particular area of interest and their preferred channels of sharing their content.

Any time that you're communicating with government departments or the mainstream medical healthcare system or other important stakeholders about what you do going forward, that way, you'll be able to back up your observations of what you're already seeing, with reliable evidence-based research, to make a case for your course of treatment. Being able to do that, at this point in time, is now more important than ever.

Simultaneously, as someone close to me once said, and i think Homer Simpson once famously remarked as well, "you can use evidence to prove anything that's even remotely true." Anyone in Science can tell you, he's actually not far off. Pretty much, two parties can find a whole world of evidence based research to support what they want to see [28] and keep making a case to stay at odds with each other, forever if they chose to. Part of the health care and CAM systems are obviously playing that game right now.

But i think, for the benefit of the 80% of the world, and the 2/3 of Australian's who need continued access to CAM as well as reliable, safe traditional medical care beyond the 1st April, it would better serve them right now if we all looked at all that unites us and how we can work together to truly serve the greater good of humanity. Raise a hand with me if you agree.

Until next time....

Nat xx

REFERENCES:
​
1. Schwager, S. War against natural medicine, https://www.abc.net.au/news/2012-02-21/schwager-war-against-natural-medicine/3840682, 21 Feb 2012

2. Mukherjee P. W. (2002). Quality Control of Herbal Drugs: An Approach to Evaluation of Botanicals. New Delhi, India: Business Horizons Publishers, 
https://www.elsevier.com/books/quality-control-and-evaluation-of-herbal-drugs/mukherjee/978-0-12-813374-3

3. Bodeker C., Bodeker G., Ong C. K., Grundy C. K., Burford G., Shein K. (2005). WHO Global Atlas of Traditional, Complementary and Alternative Medicine. Geneva, Switzerland: World Health Organization
https://apps.who.int/iris/bitstream/handle/10665/43108/9241562862_map.pdf?sequence=1

4. Bandaranayake W. M. (2006). “Quality control, screening, toxicity, and regulation of herbal drugs,’’ in Modern Phytomedicine. Turning Medicinal Plants into Drugs eds Ahmad I., Aqil F., Owais M., editors. (Weinheim:Wiley-VCH GmbH & Co. KGaA; ) 25–57 10.1002/9783527609987.ch2

5. Martins, E. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety, Front Pharmacol. 2013; 4: 177.
​https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887317/

6. Bonney, A, von Conrady, DM. Patterns of complementary and alternative medicine use and health literacy in general practice patients in urban and regional Australia, Volume 46, No.5, 2017 Pages 316-320
https://www.racgp.org.au/afp/2017/may/patterns-of-complementary-and-alternative-medicine-use-and-health-literacy-in-general-practice-patients-in-urban-and-regional-australia/

7. Complementary Medicines Australia. In good health: 2014 Complementary medicines industry survey. Mawson, ACT: CMA, 2014.
www.cmaustralia.org.au/resources/Documents/Reports/CMA%20Industry%20Audit%202014.pdf

8. Xue CCL, Zhang AL, Lin V, Costa C, Story DF. Complementary and alternative medicine use in Australia: A national population-based survey. J Altern Complement Med. 2007;13(6):643–50. 
https://www.ncbi.nlm.nih.gov/pubmed/17718647

9. Private health insurance reforms: Changing coverage for some natural therapies
http://www.health.gov.au/internet/main/publishing.nsf/Content/9BF149856FD5AF22CA2581BB007C0CEB/$File/Natural%20Therapies%20-%2019%20Oct%20with%20SR%20updates.pdf

10. Galvin, R. From fringe to mainstream: the future of alternative medicine, News from the University of South Australia, November 2014
http://w3.unisa.edu.au/unisanews/2014/November/story10.asp

11. Smith, A. Health and hospitals top priority for NSW voters, Sydney Morning Herald, Dec 10 2018
https://www.smh.com.au/politics/nsw/health-and-hospitals-top-priority-for-nsw-voters-20181209-p50l5n.html

12. Cohen, Dr M, Academic Papers, Articles 1-99, https://drmarc.co/papers-academic-listing/

13. Cohen, Dr M, About Dr Marc Cohen, https://drmarc.co/about-dr-marc/

14. Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney.https://www.uts.edu.au/research-and-teaching/our-research/complementary-and-integrative-medicine

15. The School of Health Science, RMIT University, https://www.rmit.edu.au/study-with-us/health-science/complementary-medicine

16. Leach, Dr M, The Integrative health care Model development & Evaluation Project, https://www.time-project.net/

17. Study reveals complementary medicine use remains hidden, 8th Feb 2019,  https://www.uts.edu.au/research-and-teaching/our-research/complementary-and-integrative-medicine/news/study-reveal

18. Foley, H, Steel, A, Cramer, H, Wardle, J and Adams, J. Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis, Nature Scientific Reports, 7 Feb 2019,   
​
https://www.nature.com/articles/s41598-018-38279-8.epdf?author_access_token=URyylsD38S2yEhg3UR3LmtRgN0jAjWel9jnR3ZoTv0Pny5WDa16-mtOV-bC73fjnbzzx-2qXIB5UmW6mO8bFlR43X5WhQgP1JrrEphIZpBKJEMfTY5YXlikqosf-TOYpoYYTPtiYwhUzhzYJIzguFg%3D%3D
​
19. Western Sydney University’s NICM Health Research Institute (NICM), About NICM, 2019
https://www.nicm.edu.au/about_us/about_NICM

20. Understanding Complementary and Integrative Medicine- Definitions, 2019
https://www.nicm.edu.au/health_information/information_for_consumers/understanding_cm

21. Complimentary Therapies, Better Health Channel, Department of Health and Human Services, State Government of Victoria, Australia, 2018
 https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/complementary-therapies

22. Approved Modalities, international Institute of Complimentary Therapists
https://myiict.com/approved-modalities/

23. ​Position Document, Friend of Science in Medicine, 2019, https://www.scienceinmedicine.org.au/what-do-we-stand-for/position-document/#PDMP10

24. Jonas, WB & Alternative therapies in health and medicine 9(2):56-61 · March 2003,  https://www.researchgate.net/publication/10841809_Science_and_spiritual_healing_A_critical_review_of_spiritual_healing_energy_medicine_and_intentionality

25. Baldwin, A.L. & Trent, N.L., An Integrative Review of Scientific Evidence for Reconnective Healing, Complement Med. 2017 Aug 1; 23(8): 590–598
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26. Electromagnetic fields (EMF), The World Health Organisation, What are Electromagnetic fields, definitions and sources, https://www.who.int/peh-emf/about/WhatisEMF/en/

27. Benor, Dr D.J. Spiritual Healing: Scientific Validation of a Healing Revolution, Vision Publications, 2001, https://books.google.com.au/books/about/Spiritual_Healing.html?id=DnEUAQAAMAAJ&redir_esc=y​

28. Observer Bias/Research or Experimenter Bias: Definition, Examples, How to Avoid, Statistics How To, 2019
https://www.statisticshowto.datasciencecentral.com/observer-bias/