On 7 April 2019, the Minister for Health announced an updated review of natural therapies.[i] The review will be led by the Australian Government Chief Medical Officer (CMO), Professor Brendan Murphy, and be supported by the Natural Therapies Review Expert Advisory Panel (NTREAP). NTREAP membership will be determined by the CMO based on the nominations received. The report will provide recommendations on whether to re-include any of the 16 natural therapies excluded from Private Health Insurance (PHI) benefits under complying private health insurance products by the 2014-15 review.[ii] It will assess any additional evidence of their clinical effectiveness published since the 2014-15 review, or high-quality evidence not included in the 2014-15 review, to be assessed by the National Health and Medical Research Council (NHMRC), including evidence identified by, or submitted to, Panel members.
It is proposed the review will be conducted in two tranches:
- Tranche one: Naturopathy, Western Herbalism, Yoga, Tai Chi, Pilates and Shiatsu; and
- Tranche two: Alexander Technique, Aromatherapy, Bowen Therapy, Feldenkrais, Homeopathy, Iridology, Kinesiology, Reflexology and Rolfing.
Friends of Science in Medicine (FSM) has nominated our President, Assoc Prof Ken Harvey, for membership of NTRAC and provided the following comments:
1. To be comparable with the 2015 review, FSM argues that, in addition to assessing clinical effectiveness, the quality and safety of these alleged ‘therapies’ must also be assessed.
The 2015 review noted the difficulty of evaluating the effectiveness, quality and safety of practitioners with varied training who employed diverse diagnostic and therapeutic interventions.
For example, people calling themselves naturopaths, an unprotected title,[iii] might have undertaken a weekend course, an on-line course, a certificate or a four-year university course. These courses teach subjects lacking an evidence base, e.g. homeopathy, flower essences and iridology.[iv] Other areas, such as western herbalism, are also dubious because of the wide variety of traditional formulations used for various conditions, many of which lack scientific validation. Herbal medicines are often considered safe, but drug interactions and toxicity, including catastrophic hepatic injury, have occurred with their use.[v] [vi]
While natural health practitioners might give useful dietary and lifestyle advice, they might also use discredited or dubious laboratory tests to justify unnecessary or harmful interventions.[vii] Membership of a professional organisation (which are many and varied)[viii][ix] [x] [xi] [xii] [xiii] does not guarantee evidence-based practice. The lack of regulation in naturopathic education has resulted in significant adverse outcomes.[xiv] Finally, a 2019 paper by Myers et al.[xv] purporting to show the effectiveness of naturopathic medicine, fails to address the above concerns about Australian practitioners and has been heavily criticised.[xvi]
2. Other practices, such as yoga, tai chi and Pilates, can improve mobility, physical function, quality of life and minimise symptoms and/or ameliorate chronic disease. However, FSM is unaware that these practices are any more effective than supervised gym activities, weight training, swimming and regular walking.[xvii]
3. Greater government clarity is needed about the purpose and rationale of PHI. For example, if there is good evidence that exercise has health benefits, why should people who can afford extra PHI have some modalities subsidised, whereas those who cannot have to pay the full price? Is this fair or equitable? While this is beyond the scope of this review, this issue is fundamental.[xviii]