Speech to Alternative Therapies Seminar, President of the AMA, Dr Kerryn Phelps
Saturday, 16 June 2001, Sydney
"IS THERE PROOF IN THE TOFU PUDDING?"
First of all, my thanks to John Eden for inviting me to speak at this seminar - from one "paradigm challenger" to another.
John made a very compelling presentation via video to the AMA National Conference last month, and he continues to work tirelessly to build bridges between so-called orthodox medicine and so-called alternative medicine.
I'll try to do my bit here today.
The title of my address to you today is "Is There Proof In The Tofu Pudding".
It represents, if you like, the challenge for alternative medicine in Australia today - evidence.
And as Carl Sagan said, "When you challenge paradigms, expect anger to follow".
Before getting into the evidence debate, I'll give you some good news.
The AMA introduced a policy discussion group on Complementary Medicine at our recent National Conference.
Big deal, you might say.
But this was the first time the AMA had held a policy session specifically on Complementary Medicine - and I see that as progress.
That this happened at all indicates the importance of the issues for mainstream medical practice - complementary medicine can no longer be ignored by mainstream medical practitioners.
I'll just briefly run over some facts and figures - things that you in this room will already know - that need to be known and recognised by my medical colleagues and the broader community.
Complementary Medicine is now firmly established in Australia and is a continuing growth area.
It has been estimated that, in 1993, approximately 50% of the Australian population used at lease one complementary medicine per year and that 20% consulted at least one complementary therapist.
It appears likely that spending on both complementary medicines and consultations with complementary therapists will double from the 1993 level by 2001, resulting in a $2 billion industry.
Those who use complementary medicines tend to be professional people, often women, and are used to being able to make their own choices about health care.
Some use complementary medicines and therapies in situations where conventional medical treatments are not able to provide successful intervention.
Others are attracted by the hope of improved well being and by the emphasis placed by the industry on holistic and natural treatments.
It is important for us all to be aware that relatively few - approximately one third - of those using complementary medicines currently inform their medical practitioner of their usage.
And GPs tend to underestimate the extent of use by their patients.
This is something that must change.
And the key to that change - from an alternative medicine perspective - is evidence.
The American poet and mystic, Henry Thoreau, once said that 'some circumstantial evidence is very strong, as when you find a trout in the milk'.
Now, I'm not saying we should take that literally, but from the orthodox medicine perspective growing evidence will lead to more alternative medicines and therapies being embraced by more GPs, for instance.
It is helpful that complementary medicines and therapies are increasingly being evaluated using scientific methodology and these results are being published in mainstream medical journals.
As such research emerges, it will increasingly be possible to take an evidence-based approach to the use of complementary medicines and therapies and to advise patients on this basis.
The evidence needs to address the issues of safety, quality and efficacy of both medicines and therapies.
Such an approach also paves the way for more constructive relationships with complementary therapists.
I believe these relationships must be based on evidence of the effectiveness and safety of particular therapies.
It is crucial that there is an accreditation process based on scientific evidence about particular therapies and recognition of individual therapists on the basis of external accreditation of teaching programs.
In working with complementary therapists, our major concern must be the interests of our patients and the maximisation of their health.
At our National Conference, the policy discussion session was addressed by a carefully selected panel:
- Dr Fiona Cumming from the Therapeutic Goods Administration talked about the unique regulatory framework which has been established in Australia for complementary medicines using a risk based approach;
Professor Basil Roufogalis - Professor of Pharmaceutical Chemistry at the University of Sydney provided extensive information about the issues of quality, safety and efficacy of complementary medicines; and as I noted earlier,
In Professor Eden's absence overseas, we showed a video interview with Professor Eden discussing complementary medicine and its relevance for the medical profession.
First of all, that complementary medicine is firmly established, and is increasingly being evaluated scientifically with evidence emerging that many products have potency.
A second area of major interest is dialogue with patients.
For example, it is clearly important for medical practitioners to encourage patients to talk to them about their use of complementary medicines and therapies so that they know what other medicines patients are taking and what other treatments they are using.
It is also going to be increasingly important for doctors to be sufficiently informed about complementary medicine to enable them to advise patients about potential benefits and any adverse effects, including possible interactions with prescribed medications.
If there is no evidence that a treatment is effective then the doctor is able to point this out. If there is evidence that a product or treatment is potentially harmful then the patient should be informed.
I was pleased to hear Dr Eden note, in our video discussion, that his experience with patients is that this approach is welcomed - patients value this type of advice from their doctor. They are then able to make informed choices.
Medical practitioners must be more involved in the reporting of adverse events associated with complementary medicine.
There needs to be a more coordinated and extensive system of reporting of adverse events in relation to complementary medicines.
There are also situations that give rise to concern - particularly where, for example, patients may forgo a medical diagnosis and best practice treatment in an unfounded belief that a complementary practitioner has the skills to manage a medical condition.
This is of even greater concern where the patient is a child or otherwise unable to make an informed choice of their own.
We must find ways of informing and empowering consumers while respecting their right of choice over health care treatments.
I firmly believe that issues of legal liability will become increasingly important for both practitioners of complementary therapies and the medical profession.
We need to establish what constitutes a duty of care for medical practitioners in relation to complementary medicine.
For complementary therapists, the issue of respecting the boundaries of competency will, I believe, become crucial.
Recently in NSW, the Medical Board has taken action against a complementary therapist for allegedly providing medical advice when not qualified to do so.
Other issues that were raised include the acceptable levels of evidence on the basis of which the medical profession may feel confident in recommending use of complementary medicines and therapies.
As evidence - there's that word again - that the medical profession is serious about building bridges with complementary medicine, you need look no further than the resolutions from the AMA's National Conference.
At National Conference, resolutions are passed which provide advice to the AMA Federal Council for the coming year.
On this occasion, following a very successful session, National Conference recommended that:
- Federal Council acknowledges the widespread use of complementary medicine and therapies in the community, and endorses the need to review these therapies on the accepted basis of evidence of efficacy, safety and quality.
Federal Council emphasises the importance of medical practitioners being fully informed of both potential benefits and potential adverse effects of complementary medicines, including the potential for medication/herb interaction including interactions between different herbs.
Federal Council advises medical practitioners that they cannot afford to ignore the issue of complementary medicine in their practice, and should encourage their patients to inform them of all complementary medicines and/or therapies they are using.
These recommendations will now be carefully considered by Federal Council.
Last year, I established an Advisory Committee on Complementary Medicine within the AMA
It reports to Federal Council through the AMA Public Health and Aged Care Committee.
The terms of reference of the Advisory Committee mean that it will:
- Develop AMA policy in relation to complementary medicine;
- Advocate to government and other organisations in relation to key issues;
- Promote informed debate,
- Investigate key aspects of complementary medicine in mainstream practice;
- Undertake different types of research;
- Explore funding; and
- Provide AMA members with evidence based information about complementary medicines.
This year the Committee will finalise a formal AMA position statement on Complementary Medicine. It will appear on the AMA website.
The Committee will also explore some of the more in depth issues concerning, for example:
- the most appropriate approach to regulation of practitioners;
- issues that arise in terms of the regulation of complementary medicines such as the need for better quality control over the importation and sale of raw herbs; and
- the best way to assist both complementary therapists and medical practitioners to work together on the basis of the evidence and in the interests of patient health.
In this way, the AMA will take a leading role in assisting doctors to work constructively with complementary medicine.
So, we may not want to see the trout in the milk but we would like to know the long term effects of substances like soy, vitamins and herbal preparations.