Are natural therapies being systematically targeted?
This seems to be the sentiment of many within the complementary medicine industry. Fringe groups and lobbyists are constantly citing that "there's no evidence for complementary and integrative medicine practices". But what are the facts and where can we find them?
Prof Stephen Myers is both a respected academic and passionate advocate of the complementary and integrative medicine industry. Prof Myers has amassed an impressive portfolio of research over the past two decades. He joins us today to discuss the findings from his most recent publication in The Journal of Complementary Medicine; a world first study conducted out of Southern Cross University that shines the light on naturopathy as a clinically significant system of medicine for chronic conditions.
Covered in this episode
[00:58] Introducing Prof. Stephen Myers
[02:08] Prof. Myers' career background
[06:13] Cultivating independent critical thinkers
[08:39] Research: The benefit of naturopathic medicine
[15:48] The NHMRC report on natural therapies
[19:32] The implications for naturopathy
[21:33] Prof. Myers' research findings
[23:47] The economic burden
[25:10] Patients and practitioners suffering at the hands of faulty science
[27:02] What can professionals and public do now to effect change?
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining us on the line today is Prof. Stephen Myers who's the director of NatMed Research Unit based at Southern Cross University in New South Wales. He's one of Australia's leading academics in natural, complementary, and integrative medicine. He has qualifications in naturopathy, Western medicine, and pharmacology. He's raised over $8 million in research funding, managed over 50 clinical trials looking at the pharmacology of natural products in a wide range of conditions. He's supervised 17 higher degree research students, authored 3 books, 10 book chapters, 93 peer-reviewed research papers, and numerous papers for the professional press. He's also acted as a consultant to industry, government, and academia across a broad range of issues. Despite all of this, he has a delightful sense of humour and he's a very down-to-earth and a fundamentally good guy. Welcome to FX Medicine, Stephen. How are you?
Stephen: Good, Andrew. Thank you for that introduction.
Andrew: I have been wanting to podcast with you for years because I think you are one of the most eloquent speakers I've ever heard. So, firstly, I just wanted to ask a little bit about your history. Now you did naturopathy first, is that right?
Stephen: That's right. I have studied at the Southern School of Natural Therapies, the longest-running naturopathic program in the country, back, I started in the 1970s and did a 4-year full-time course.
Andrew: Yes, and then you went on to do medicine and pharmacology as well. What was the draw card there? Why wasn't naturopathy enough?
Stephen: Well, interestingly enough, Andrew, way back in the first year I decided that I actually wanted to study Western medicine as well. And my thinking was something along the lines of I've got half the story I really want to get the other half. I wanted to actually see both sides of the medical coin, so to speak, so I could really make informed decisions. And having decided that, it was a long road to hoe. I made that decision in the first year of my naturopathic practice and one of my colleagues told me that when I graduated from medicine she'd buy me a bottle of French champagne and 10 years later it was very delightful. It was a much easier thing to actually, you know, say, "I'm going to do medicine." It was a much harder thing to actually follow through. But I managed to actually study medicine at The University of Newcastle which was my first choice and I'm very glad that I did. It was a problem-orientated, body system-focused approach to medicine where we were actually in the hospital system from week six and it was a great way to study conventional medicine. And when I finished, my late father was wringing my head that if I managed to do naturopathy and medicine that I should actually do a research degree so that I could actually be a scientist working in this field.
So after a couple of years in the hospital system, I enrolled in a doctoral degree and my supervisor, Prof. Tony Smith, saw that I might end up in academia so he suggested I do both basic and clinical pharmacology which means that he saw that I needed to get into the laboratory so I could see pharmacology at the benchtop and then also do clinical studies so I could actually understand pharmacology in terms of clinical studies and clinical research and I did a component of both of those. I sometimes joke with my own Ph.D. students that my thesis was probably four of what they inevitably will now put in. The amount of work that we used to require for Ph.D. is a lot less these days than we did when I went through.
Andrew: But what I love about it is that you've now, as you say, got both sides of the coin. And I think it's more from a point of knowing, realising both benefits and limitations of natural medicine and benefits and limitations of orthodox medicine. You've got the experience in both having worked in both arenas. So it's not just like you've researched one. You've actually worked in that arena as well.
Stephen: Yes, that's right and, you know interestingly enough, a lot of people ask the question, you know, how did you find studying medicine after studying naturopathy? And I didn't actually find that there was any significant conflict. Naturopathy has got a very rich philosophy while, interestingly enough, medicine starts off with an a priori assumption that disease is the enemy and just fills their up-and-coming student doctors with immense amounts of knowledge. And, you know, I just was a sponge and took all of that knowledge in, but came out the other end with not a significantly different philosophy than I had when I started.
Andrew: But I've got to say the students under your tutelage are a different ilk. They are a different breed. They are the epitome of critical thinkers. They are the epitome of passionate care for their patients as well but responsible care, and this is something that I just see as really different. They are fierce. They are fiercely for their patient.
Stephen: Well, that's fantastic, because the first graduate outcome we wanted for students of naturopathy at Southern Cross University is that they become independent critical thinkers. And I'm bemused by the story especially of an anecdote of one of our graduates being in a health food shop and picking up a bottle and saying, "What's the evidence for this being used in such and such?" And the person looking at them and saying, "Did you come from Southern Cross University?" Because that's the sort of graduate we wanted. We wanted a graduate that was actually armed with modern science, armed with a traditional knowledge of naturopathic medicine, and able to critically understand the differences and distinctions and the need, the modern need, that we actually had for evidence.
And, secondly, in terms of being advocates for the people that they actually work with, certainly, it was part of my approach to healthcare that you always see the person in front of you as potentially related. You know, that this person could be my mother, my father, my brother, my sister, my son, my daughter, you know, my grandparents. And that you do for them exactly what you would do if you were related to them. And that's why I think actually therapy in general, not just modern medicine, but therapy in general can actually fall into a routine when you see the next person as just..and anybody coming through the door and don't give everything that you've got to give to them as though you were, you know, seeing the first patient that you've ever seen and wanting to do your absolute best. Therapy should always be practiced on the basis that the person that you see in front of you is the person that you need to give your all to. And if you can't do that you're better to find a different occupation.
Andrew: Now, you've been involved, as I said, in over 50 clinical trials. You've recently published another paper looking at the benefit of naturopathy with chronic care. Can you give us a run over of what that paper went through, how it was designed, please?
Stephen: Well, this is what's called a systematic scoping study, Andrew. There had been a previous paper in 2015 by a group of U.S. researchers but they kept the scope of the paper to North America. And it was cited by the NH and MRC (NHMRC) reviewer’s naturopathy, and erroneously decided because the scope of practice in North America was perceived to be different from the scope of practice in Australia, that that study shouldn't be actually interpreted as a benefit of naturopathy in the Australian context. And that was an erroneous assumption. The World Naturopathic Federation considers that Australian naturopathic education and U.S. or North American naturopathic education to be on a similar level. And at Southern Cross University when our degree was operating, we actually did an exchange, a senior student clinical exchange with Bastyr University and we found our students actually held their own at Bastyr and the Bastyr students actually held their own at Southern Cross.
So from the educational interface, there was no real difference between graduates from North America and graduates from Australia. So that 2015 study should have actually been considered adequate evidence that there was benefit of naturopathic medicine. Because it didn't, it actually made me, I suppose, angry was the first emotion that I actually felt that the NH and MRC has done such a poor job and I'm happy to elaborate on that. But what I asked my research group to do was to actually work with me to do the job properly. In other words, to ask the question of what was the benefit of naturopathic medicine practiced in the whole context? And that's called whole system or whole practice research.
We decided to put a caveat on that and we decided that we would assess multi-modality whole system naturopathic medicine, and by multi-modality, I simply mean that there were more than one modality practiced. So we didn't report on naturopathic medicine if all they did was to give one particular supplement or one particular type of therapy. We looked for studies where they had undertaken approach that combined at least two modalities in the delivery of the naturopathic medicine because we thought that that was more indicative of pragmatic or whole world approach to naturopathic medicine. So we scoured the world's literature and after we went through all the titles and abstracts and we ascertained that the research was done by naturopaths about naturopathic medicine, we found 33 studies. And part of a scoping review, what we did was that we abstracted that information and we then reported what we've seen in that body of literature.
Andrew: Okay, well, what were the key findings of the paper?
Stephen: Well, firstly, we actually found that naturopathic medicine in a range of studies, there was a range of clinical trials and there were a range of observational studies, showed that it was beneficial across a wide range of chronic conditions. So that included cardiovascular disease. It was demonstrated to be beneficial for hypertension and lowering cholesterol, musculoskeletal pain, specifically chronic lower back pain, type 2 diabetes, it was found to lower blood glucose, and the more long-term marker, the haemoglobin A1c. It was beneficial for polycystic ovarian syndrome, a range of mental health issues, depression, anxiety, and bipolar disorder. It was found to be beneficial in hepatitis C, in menopausal symptoms, in asthma, and one interesting study that demonstrated that it was beneficial in increasing cancer survival time. So the research demonstrated that naturopathic medicine was beneficial across this wide range of chronic conditions. And when people say that there's no evidence for naturopathic medicine, this paper stands as a wall against that particular comment to say, "There most definitely is evidence for naturopathic medicine and it no longer can be denied."
Andrew: Would I be right in assuming that this sort of paper would be a corollary with, say, a general medical practice paper looking at, say, the opioid abuse in Australia and how that's handled by general medical practitioners?
Stephen: Well, this sort of research is called pragmatic research so it's about the whole of the practice. And interestingly enough there are not a lot of studies in general medical practice that actually looks at the whole of the practice. Generally, medicine accepts that research on their tools of trade is adequate to support the practice of medicine. So if there's a paper on a particular drug or a paper on a particular surgical technique, medicine would consider that to be a valid piece of evidence about the practice of medicine. Interestingly enough, the NH and MRC didn't take that approach to the way that they assessed naturopathic medicine.
It was clear from their literature review that they'd seen what is known as the La Trobe Report which was a report that was commissioned by the Victorian Government in 2005 that I was very honoured to take part in. And one of the things that we did as part of that report was we looked at the benefits of naturopathic medicine. At that particular point in time, there wasn't a lot of this pragmatic clinical research available. So we actually looked at the tools of trade and we did a review of systematic reviews in the major areas that naturopaths worked in and found that there was first class evidence in all of the major body systems that supported the tools of trade that naturopaths actually use, and Western herbalists for that matter, and concluded that if the tools of trade were effective that it's highly likely that naturopaths were actually effective clinicians.
The NH and MRC report, by comparison, looked at a 5-year period from 2008 to 2013 of systematic reviews. No health profession in their right mind would consider that to be an appropriate way for their profession to be assessed and for any determination of government policy to be based on such an incredibly limited review.
Stephen: I think it's a shame that our peak medical research body couldn't demonstrate the most effective way to actually undertake research to be able to come to a conclusion whether a profession was effective or not. I mean the health department, based on the NH and MRC's finding has said, "No evidence was found to the effectiveness of naturopathy, therefore, we are not going to fund it. No evidence was found for yoga, therefore, we are not going to fund it. No evidence was found for tai chi, therefore, we are not going to fund it. No evidence was found for Buteyko, therefore, we are not going to fund it."
Well, I’d actually really challenge the health department and the NH and MRC to actually justify those statements. Because it's really clear that there is evidence that they have ignored. And their report is fundamentally flawed and should never be used as a basis for any determination of the benefit of a whole therapy as a judgment point. You either have to do the science correctly and you have to do it objectively and you have to do it thoroughly or you shouldn't do it at all. You know, at worst, it was a very sloppy piece of work. Well, I suppose at best, it was a very sloppy piece of work. At worst, it was a demonstration of bias.
Andrew: To me it smells rank. It smells of they are either stupid or there's mischief.
Stephen: Well, the NH and MRC have a set of guidelines about how you write guidelines. They've got another set of guidelines about how you develop evidence. And one of those things that the NH and MRC says is that you actually really need to make sure that you have covered all of the major shareholders within a particular area to be able to understand whether you have a complete handle on the topic that you are actually working with. And the one thing that didn't occur in the NH and MRC review is they didn't go out to the major stakeholders and ask them for their input about how they would go about justifying the evidence base for naturopathy or yoga or tai chi.
The whole process was done in-house and it is not the first time that the Australian government bodies have failed to actually go out to stakeholders to actually ask them about areas within complementary medicine or integrative medicine. It seems to be a pattern of government to not ask the people that are actually involved, to even go out to the academics in the field. Myself or other professors working in the field weren't asked to comment on the methodology let alone to actually be involved in the development of evidence. It seems like they...you know, it was the blind leading the blind.
Andrew: And claiming that they are knowledgeable.
Stephen: Yes, and what they got was a report that is blinded. You know, it's blinded of good science.
Stephen: Well, the first thing is that the government is set to take naturopathy off health insurance rebates on the 1st of April, and they are doing so under a false premise that there's no evidence to support it. So that's actually completely untrue. Even the evidence that we have demonstrated about whole practice is enough evidence to say that that's untrue. The 2005 findings from the Victorian inquiry is enough evidence to say, on the tools of trade, that there's evidence to support naturopathy. So, firstly, the government is going to take naturopathic medicine off the health insurance rebate on the basis of a false claim. And, you know, one of the things about that, which is actually really interesting, is that they've written the regulation in such a way that if even somebody includes naturopathy or yoga or tai chi in any series of integrated healthcare provision, then none of it can actually be funded.
They've nearly put a black mark against naturopathy and these other natural therapies so no one can ever use them that wants to actually get health insurance rebates. They've not just banned them individually, they've banned them collectively and they've banned them as a component of everything used in a mix with therapies. You know, there's obviously some pattern of activity here that we really need to come to the bottom of to clarify why the government is actually being misled by the NH and MRC, why they are basing a decision on incredibly poor science, and why they have written the regulations in such a way that is quite draconian.
Stephen: My research points to the fact that naturopathic medicine is effective especially in chronic disease, which is something that we’ve actually always suspected. My research group is going to go on and do further work looking at this body of evidence and also looking at the tools of trade and publishing further about the effectiveness of naturopathic medicine. And we'd also like to do some work that actually highlights the role that naturopathic medicine plays in healthcare delivery. You know, one of the things that I think is a great shame is that there's a hidden workforce in Australia that is actually working towards the health of Australians that's actually not only not acknowledged by government but now is actually being penalised by the government.
It is one thing being not acknowledged but it is actually even worse that the government has actually decided to actually penalise the practice of naturopathic medicine. Given the fact that we have found that naturopaths are actually effective at what they do, they do contribute significantly to the welfare of Australians and if they are doing so, they need to actually be acknowledged as a component of the workforce. One of the issues which was raised by the La Trobe Report in 2005 is that there needs to be occupational regulation of naturopaths. You know, currently at the moment, as an unregulated group of people, people can call themselves naturopaths without appropriate education and cause significant harm to individuals by prescribing nutrients or herbal medicines without knowing exactly what they do. They really should be used only in the hands of people that have actually done a thorough training, who've put the time in, done the education, and know what they are actually prescribing.
Andrew: You know what? I just see this as such a short term gain of the health department. If they are wiping away with one broad brush stroke all of that, as you say, the hidden workforce that's healing Australia, this is not just going to have severe impacts on those individuals that, as you say, suffer from things like chronic pain but it's going to have a major impact in the future on economics. So this is what I just don't understand, where there is some evidence, wouldn't you want to try and see how much money that can save you?
Stephen: I would suspect, you know, that that, you know, should be the case. We should actually have health policy that's transparent and based on evidence. And, you know, currently, you know, the interesting thing is that the rebates to natural therapies don't amount to a large amount of money in comparison to the amount that the hospital system swallows up in health insurance. We are talking of very, very small amount of money but we're talking about the fact that it may actually have significant impact on the livelihood of a lot of natural therapists whose patients depend upon getting health insurance rebates. And the reality is that those individuals who depend on that may not be able to afford to get effective care in future.
And, you know, so you've got both the professional and their patient suffering because of a decision that's actually based on faulty science. And when I say faulty science, it's the logic behind the science. You know, they, having set the methodology, they did their science appropriately but the methodology that was set was faulty.
Andrew: So you choose a wrong parameter and follow it through to its obvious conclusion.
Andrew: So what needs to happen? What needs to change to get the right outcome for the benefit of the Australian public?
Stephen: Well, the first thing is that the government needs to actually review this whole decision of taking these natural therapies off the health insurance rebate scheme. And they also need to look at the way that it's actually being written so that they are actually put on an exclusion list which is literally draconian. They actually need to actually stop and say, "Did we get the right advice from the NH and MRC? You know, is there individual evidence that we should have taken into account in regard to Buteyko and asthma, in regard to tai chi and musculoskeletal pain, in regard to yoga and back pain, for instance?" Because, you know, they don't have the full story in regard to evidence and especially in the field of naturopathic medicine, they are completely off the mark in terms of, you know, stating that there's no evidence to support it when we have done the study the NH and MRC at least should have done first up and demonstrated without a shadow of a doubt there's evidence that naturopathic medicine is beneficial in a range of chronic conditions and therefore deserves health insurance rebates.
Andrew: Okay, so what can naturopaths, natural therapists do, and indeed, what can the public do? What pressure can be brought to bear on Australia's government and the health department to bring about change to a correct conclusion?
Stephen: Well, I think we need to actually lobby. We need to write to Greg Hunt, the health minister. We need to write to our local members. We need to actually say, "This decision was based on false evidence." One of the things that's important for people to be aware of, Andrew, is that the paper that we produced which is actually called "The State of the Evidence for Whole-System, Multi-Modality Naturopathic Medicine: A Systematic Scoping Review" is available open access. So it's free for anyone to get. And for any natural therapist, you can actually give a copy to any of the patients that you see and again ask them to contact their health minister if they disagree with the concept that naturopathic medicine should be taken off the health insurance rebate. We have to take the argument to the government and say, "This decision was not a good one."
Andrew: Prof. Stephen Myers, these are worrying words and salient words. We'll certainly get as much information as we can up on the FX Medicine website. I'd like to give a call out to everybody out there you need to really lobby now if you want change to be effected. But I'd like to thank you personally for your previous work with the naturopathic community and indeed healthcare in Australia. Thank you so much for joining us on FX Medicine today.
Stephen: My absolute pleasure, Andrew.
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. The FX Medicine team would like to thank the enormous generosity of all our guests who have graciously donated their time, their expertise, and their stories of both triumph and adversity. Most of all, we'd like to thank you, our listeners, for your continued feedback and support and for giving us direction and purpose as we move forward together into the future.