5 April 2019
Integrative medicine: so long and thanks for all the dolphins
The Medical Board of Australia’s (MBA) recently released consultation paper on better defining integrative medicine – including some of its less-scrupulous related practices, such as homeopathy – finally hit the rocks of the alternative medicine fraternity this week with vitamin mogul Marcus Blackmore declaring foul play by the board.
In an open letter to the board, and in an article published on the Blackmores website, Mr Blackmore says that by singling out doctors who practise “unconventional” medicine, the board is threatening patients’ freedom of choice.
“Effectively the MBA is proposing one set of rules for ‘conventional’ medical practitioners and another more stringent set for those providing ‘complementary and unconventional medicine and emerging treatments’,” the article says.
“As in any profession there are good and bad practitioners. We can’t have one rule for some practitioners and one rule for others. The key is ensuring regulation is focussed on the health and safety of all Australians. There should be only one set of good practice guidelines that all doctors should follow,” he wrote.
Speaking on ABC radio this morning, the chair of the MBA, Dr Anne Tonkin, said: “Well-performed integrative medicine certainly has its place in our health system”, she said.
“This set of guidelines [if it is adopted] will apply to every medical practitioner in the country. There will not be a two-tier system.”
Dr Tonkin also said that the MBA’s role in seeking a better definition of complementary medicine, unconventional medicine and emerging treatments, was less about limiting patient choices and all about patient safety.
“We don’t want to limit anybody’s choice for safe care,” she said. “ If the care is safe, we have no role in limiting people.”
So what is all the fuss about?
Integrative medical practitioner Dr Mark Donohoe, who along with complementary medicine academic Professor Stephen Myers, has published in defence of complementary medicine on the Blackmore’s site, says that the MBA proposal is “like [trapping] dolphins in a shark net”.
“Stick the shark net out, but don’t catch the dolphins,” he said on ABC radio today.
“Integrative medicine has got no safety issues [and] no risk issues,” he claimed. “It has been practising effectively for 25 years. We take the problems of people and we give them more time to look at other options that fall outside of drug therapies or surgery.”
Dr Tonkin put the current blow up down to the difficulty of defining where integrative medicine stopped and less scrupulous and non-evidence-based practises started.
It should pointed out that the MBA has only released draft guidelines, for which it is seeking the views of major stakeholders to ensure it has got things right.
The discussion paper outlines the issues succinctly though, pointing out that complementary, alternative and integrative medicine all have varying descriptors by a variety of medical and non-medical bodies. And none is particularly clear as far as a patient might be concerned.
For example, complementary healthcare is defined simply by the Medical Council of NSW as “non-evidence-based care”. Complementary medicine has some of the following descriptors:
- Therapeutic good consisting of designated active ingredients (as per Therapeutic Goods Administration (TGA) list) (TGA, 2013)
- A wide range of products and treatments with therapeutic claims that are not presently considered to be part of conventional medicine (Australian Medical Association, 2018)
- Not within the domain of conventional medicine (National Health and Medical Research Council, 2014)
- A broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system … it includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being (National Institute of Complementary Medicine)
The proposed MBA definition is possibly the sticking point for those practitioners who see themselves as the dolphins. It is fairly broad.
Complementary and unconventional medicine and emerging treatments include any assessment, diagnostic technique or procedure, diagnosis, practise, medicine, therapy or treatment that is not usually considered to be part of conventional medicine, whether used in addition to, or instead of, conventional medicine. This includes unconventional use of approved medical devices and therapies.
But the intent of the MBA proposal is much clearer: to define better for consumers what medical practitioners can and can’t do when practising complementary and unconventional medicine and alternative treatments. The list of don’ts is obvious and hardly arguable:
The basic list the MBA proposes for “no go”, which would be articulated and documented in any guidelines that were published with a new definition, include situations where:
- Safety and efficacy of treatments not known (experimental treatments outside clinical trials)
- Unnecessary treatments, or treatments for which there is no clearly demonstrable need
- Risk of harm associated with some treatments (unnecessary exposure to serious side effects)
- inappropriate prescribing – not in accordance with therapeutic guidelines (in particular, hormone therapy and antibiotic therapy)
- unconventional off-label prescribing
- recommending hormone, vitamin and mineral supplements without accepted indications
- Prescribing substances not approved by the TGA without scientifically defensible reasons
- Prescribing substances not approved for human therapeutic use
- Prescribing compounded products:
- where a commercial product is available and suitable
- where there is a lack of evidence to support the compounded product’s use
- that have been manufactured in circumstances that don’t meet expected quality assurance processes
- that have been manufactured in bulk rather than to meet an individual’s needs
- Accepted treatments provided without indications/medical justifications
- Accepted treatments provided beyond the accepted indications
- Risks associated with route of administration of treatments
- Methods used to harvest and administer stem cells
- Varied techniques and lack of standardisation and quality control, e.g. variable numbers of stem cells in the injections
- Variable levels of training, skill and expertise in the administration of treatments and procedures
- the providers offering treatments do not have experience or expertise in treating the underlying condition/disease
Its hard to imagine any real “dolphins” arguing those principles in a set of guidelines.
The deadline for public submissions to the MBA paper has been extended to June 30.