Speech to the Natural and Complementary Healthcare Summit Canberra, 1 March 2001
President of the AMA, Dr Kerryn Phelps

Good afternoon. I come in peace.

One of the conclusions the AMA would like to see come out of this Summit is a better relationship between so-called 'orthodox' medicine and so-called 'alternative' or 'complementary' medicine.

I have been pursuing this goal for some considerable time.

The AMA acknowledges the influence of complementary medicines and therapies.

We acknowledge also the growth in the use and consultation of complementary medicines and therapies.

With 60 per cent of Australians using at least one complementary health care product each year, it is a development that consumers are clearly pursuing.

And with Australians spending more than $900 million a year in the complementary medicines sector, it is a growth industry.

It is a development the medical profession cannot afford to ignore, and indeed has a growing interest in.

But there is nothing to be achieved through continuing the past adversarial approach between the orthodox and complementary advocates.

It is a time to build bridges - and all bridges must be built on trust and understanding.

A good starting point is being clear about what we have in common - best practice, health outcomes and patient welfare.

Of course, there are hardliners on both sides who just won't budge. But that doesn't have to hold us back.

You need to show evidence that alternative or natural therapies work.

If the evidence is there, they will be embraced by orthodox medicine.

The key to acceptance of complementary medicines and therapies is having an evidence base.

And there are lots of examples:

like acupuncture for post-operative pain

massage for headache, backache and stress relief

and vitamins like anti-oxidants that slow the progress of macular degeneration.

This should not just be the bottom line for doctors. It should be demanded by practitioners of complementary therapies.

There must be proof that what they are administering works and is safe.

Is the patient - the consumer - getting the desired outcomes and value for money? That's the first issue.

The second issue relates to the very real medico-legal ramifications of the therapist-client relationship in complementary medicine.

As you all know, medical indemnity is a growing problem for medical practitioners.

It is also a problem for nurses and hospitals.

I predict that within ten years indemnity will be a major issue for complementary practitioners - and this is something your industry will need to come to grips with.

Which raises the matter of regulation - regulation affecting products, practitioners and training courses.

And the Government has turned its attention to your industry.

I am aware of the regulatory framework put in place by the TGA.

I am aware also of the efforts that have been made to make this framework appropriate to the nature of the industry by separating out the low risk products from the high risk.

The framework uses a risk management approach to the management of information. There is also a need for provision of clear information. I welcome the requirements for the reporting of adverse outcomes relating to complementary medicines.

We need to counter the common belief out there that anything herbal is safe. This is artifice.

Adverse outcomes must be reported.

One of the most worrying stories to emerge over the last ten years is aristolochia.

Throughout the 1990s, the use of this herb was associated with a spate of adverse outcomes in Belgium, Spain, Taiwan and the United Kingdom.

It is now known that this herb can cause renal failure and cancer.

There is a danger that aristolochia may still be contaminating some herbal preparations on sale today in Australia, despite its banning last year by the TGA.

Another issue is efficacy of treatments.

A case in point is the use of herbs in treating menopausal symptoms.

As Associate Professor John Eden wrote in a recent Medical Journal of Australia:

"phytoestrogens are largely safe, however they have little if any beneficial effect on bone metabolism. If there is an effect on menopausal systems it is mild and not much better than a placebo".

Similarly, negative results have been found in trials of evening primrose oil and wild yam cream.

The Chinese Medical Association has been critical of these trials on the basis that they didn't test the herbs in the right conditions or in the right way.

The Association's concerns to accurately reflect the therapeutic treatment in a trial are legitimate.

However, the Association must go beyond criticism of the trials - they must work more closely with the researchers to get it right.

To get evidence. And then abide by the results.

Such an approach could then be applied to other conditions and other treatments.

If there is clearer, more available evidence available it will assist complementary medicine practitioners and GPs to come together in constructive dialogue.

Many GPs have recognised the evidence that is emerging and are moving to a dialogue with complementary medicine and therapy practitioners, and this is healthy.

To work constructively with complementary therapists, doctors need good information - evidence-based information - on complementary medicines.

They need to know the potential benefits and the potential adverse effects of any medicine or treatment.

They also need to know of any possible problems that may result from drug/herb interactions.

We know that St John's Wort has potential in treating mild to moderate depression, but there are dangers if it is used with HIV therapies or prescription anti-depressants.

Saw Palmetto has been useful for benign prostatic hyperplasia.

Let me turn to consumers.

Just as medical practitioners need documented evidence on complementary medicines, so too do the consumers - and preferably from independent sources.

Evidence is the umpire.

As well, consumers need to be confident in talking about their treatments - orthodox or complementary.

It is important that medical practitioners encourage their patients to discuss with them any complementary medicines or therapies they are using.

It is essential that patients feel confident to discuss these issues with their doctor if the best outcomes are to be achieved.

For this to happen, doctors need to give out signals. They need to be informed and show that they are informed.

In the same way, natural therapists should be fully aware of the medical history of their patients.

So, where is the AMA going in its policy position on complementary medicine?

As you know, I established the AMA Advisory Committee on Complementary Medicine to provide advice to our Federal Council on complementary medicine policy.

Guided by this Committee, the AMA will:

review and develop AMA policy in relation to complementary medicine

advocate to government in relation to key issues

promote informed debate on an evidence basis

investigate the role and place of complementary medicine in mainstream practice, and

provide AMA members with evidence-based information about complementary medicines and therapies.

If we can be clear about the areas of agreement between us - which need to be about patient outcomes, clear and accurate information to both doctors and consumers, and the crucial role of evidence - then we can look forward to a more constructive relationship and partnership.

Both sides need to stop stereotyping the other.

Orthodox medical practitioners could usefully stop talking about complementary medical practitioners as 'quacks' and 'leaf eaters'.

Similarly, complementary therapists must stop stereotyping orthodox medicine.

The view that orthodox medicine is simply disease-based, non-holistic and dependent on technology is simplistic and misleading.

Medicine has moved on.

There is growing emphasis on community based care and growing emphasis on the role of GPs.

General Practice now has its own vocational training, continuing education and standards.

Increasingly it has a focus on prevention and early intervention on both a systematic and an evidence basis.

Its aim is to integrate biomedical, psychological, social and environmental understandings of health.

It also coordinates more with other health practitioners to maximise health outcomes.

And even in the area of hospital care many hospitals are now investigating how to broaden their treatment to include areas of complementary medicine and therapies.

There is evidence, if you like, that so-called orthodox medicine has taken on board many of the criticisms that have been levelled at it by alternative practitioners.

Complementary medicine, too, must move forward.

I invite you today to join us in constructive dialogue based on respect for evidence, respect for patient outcomes, and respect for each other.

Thank you.

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