Chapter 4 - Complementary and alternative therapies
Cancer is a chronic condition. In order to get the best result,
you need to be able to use every possible resource.[219]
4.1
Although the terms of reference refer to less
conventional treatments, this chapter will refer to the more commonly used
terms complementary and alternative therapies and distinguish between them. It
will outline the current approaches to complementary and alternative cancer
treatments, paying particular attention to efficacy and research. The role of government
in this field is also discussed. This chapter also considers what is required
to progress the acceptance of complementary therapies by mainstream medical
practitioners, improve the information available for health professionals and
patients on complementary therapies and describes a model of integrative
medicine for the health system to work towards.
The great divide: conventional and complementary treatment
4.2
From the evidence presented, there is no doubt that
there is a division in Australia between conventional cancer treatment services
and the health professionals who work in them and the complementary therapies
offered, most often by practitioners outside the conventional system. The
Brownes Cancer Support Centre at Sir Charles
Gairdner Hospital
summed up this divide by commenting that 'in the minds of many mainstream
healthcare practitioners all less conventional therapies are tarred with the
same brush of being alternative'.[220]
Definitional issues
4.3
It was clear from witnesses that terminology is a very
important issue to take into account and the terms currently in use must be
clearly defined. In Australia,
the proposed Therapeutic Goods Administration (TGA) definition of complementary
medicine is:
Complementary medicines (also known as 'traditional' or
'alternative' medicines) include vitamin, mineral, plant or herbal,
naturopathic and /or homeopathic preparations and some aromatherapy products.[221]
4.4
The definition of complementary therapies and
complementary medicines used in the report Complementary
Medicines in the Australian Health System was:
'Complementary therapies' include a diverse group of
health-related therapies and disciplines that are not considered to be part of
mainstream medical care in Australia.
'Complementary medicines' include herbal medicines, vitamin and mineral
supplements, other nutritional supplements, traditional medicines such as
Ayurvedic medicines and traditional Chinese medicines, homoeopathic medicines,
and aromatherapy oils. [222]
4.5
The Gawler Foundation stated that 'the definition of
key terms as they apply to cancer medicine has been the subject of some debate.
There are many terms that are used to describe this area and there is a
pressing need for agreement on what these terms actually mean'. Based on
definitions used by the USA's
National Centre for Complementary and Alternative Medicine (NCCAM), the Gawler
Foundation offered the following clarification:
- Complementary medicine or therapy is used together with
conventional medicine. Another interpretation is a medicine or therapy that is
used in addition to mainstream medicine or complements health or specific
therapies or treatment; and
- The term alternative medicine is used in place of
conventional medicine.[223]
4.6
Overseas, complementary and alternative medicine and
therapies tend to be grouped together. The definition proposed by the National
Centre for Complementary and Alternative Medicine at the US National Institute
of Health, is used by the National Cancer Institute (NCI) and reported in
scientific literature:
Complementary and alternative medicine is a group of diverse
medical and health care systems, practices and products that are used to
diagnose, treat and/or prevent illness and are not used in conventional
medicine...The term complementary represents those taken in addition to generally
accepted practice, while alternative therapies are those undertaken instead of
conventional medicine.[224]
4.7
Complementary and Alternative Medicine (CAM) was
explained by Mr Lerner
in the following way:
Terminology is a floating issue but I can offer the following
rough guide. Alternative therapies tend to refer more to the hard therapies
that I spoke of: alternative pharmaceuticals and things like that.
Complementary therapies tend to refer to therapies that are used in combination
with mainstream therapies. The term of art in the field these days is 'CAM
therapies' - complementary and alternative medicine.[225]
4.8
Mr Lerner spoke of making a distinction between 'soft'
and 'hard' therapies, describing soft therapies such as massage, visualisation,
imagery and support groups as working on psychological, physical and spiritual
levels and hard therapies being such things as alternative pharmaceutical
intervention, and alternative herbal intervention. He stated that 'the hard
therapies are looked at with much more questioning – and with good reason,
because the soft therapies intrinsically enhance quality of life'.[226] He suggested that the 'soft
therapies do not require that kind of evaluation because they intrinsically
enhance quality of life, and that is reasonably associated, to some degree,
with life extension for some people with some cancers'.[227]
4.9
Cancer Support UK,
based at the Royal Marsden
Hospital defines complementary therapies
as a range of therapies based on holistic treatment. They are not seen as an
alternative to conventional treatment but help to live with cancer and to cope
with the side effects of treatment.[228]
Dr Kohn,
Complementary and Alternative Medicine Adviser from Macmillan Cancer Relief in London,
supported this definition but added that patients now want to know if there are
any therapies that apart from making them feel better, may have an effect on
the cancer. She said the problem with any alternative cancer cell killing
therapies such as alternative diets and alternative immune therapies is that
there is currently no robust evidence for their effectiveness.[229]
4.10
Some witnesses recommended that the Committee
distinguish between complementary and alternative therapies by the claims being
made and the way they are being promoted. If the claim being made was that the
treatment would treat or cure cancer then it was classed as 'alternative'. If
the treatment was used to support the patient undertake conventional cancer
treatment then it was termed 'complementary'.[230]
Dr Cassileth,
Chief, Integrative Medicine Service, Memorial Sloan-Kettering Cancer Centre, New
York, commented that there are no viable alternatives
and that 'if they were useful and beneficial, they would not be alternatives;
we would all be using them in cancer practices. Dr Cassileth was also of the
view that if 'something is promoted as a cancer treatment, as a cancer cure, as
something that is as good as or better than surgery, chemotherapy and
radiation, and we know that that is not viable, that it is bogus'.[231] A similar view was expressed by Professor
Currow who stated 'cancer is a diverse group
of illnesses under one umbrella term, and the person who has the 'universal
cure' does concern me'.[232]
4.11
The NSW Cancer Institute recommended to the Committee
that the TGA definition of complementary medicine be adopted nationally but that
it be adapted to make reference to the USA
and UK
definitions in order to further clarify terms.[233]
Conclusion
4.12
Witnesses from the USA
and UK emphasised
the value of developing a shared language between mainstream and complementary
therapists and the Committee believes that this should start with terminology.
The Committee received evidence that the definition of key terms, while
similar, are not standardised and this could promote confusion and distrust. While
complementary and alternative therapies are often talked about together, the
Committee believes it is important to make the distinction between them to
facilitate greater understanding between mainstream and complementary
therapists.
4.13
For the purpose of this report, the Committee accepts
that complementary therapies and complementary medicines are used alongside
mainstream cancer treatments. Research has been undertaken and there is either
scientific evidence to support their use or it is widely accepted that they do
no harm. Alternative therapies and medicines are used in place of conventional
treatments, are generally unproven and may cause harm. However, the Committee
recognises that some cancer patients choose not to use hospital-based
conventional services or for whom conventional treatment options have been
exhausted and that in their circumstances alternative therapies are a valid
choice.
4.14
There are a diverse range of complementary therapies which
according to NCCAM can be grouped into five categories:
- Alternative Medical Systems: including
naturopathy, Traditional Chinese Medicine, Ayurveda and homeopathy;
- Mind-body interventions: including patient
support groups, cognitive-behavioural therapy, meditation, prayer, mental
healing and therapies that use creative outlets such as art, music or dance;
- Biologically based therapies: including herbs,
vitamins, minerals and dietary supplements;
- Manipulative and body-based methods: including
therapeutic massage, chiropractic and osteopathy; and
- Energy therapies: including acupuncture,
therapeutic touch, reiki, qi gong, therapeutic touch, electromagnetic fields,
magnetic fields.[234]
Prevalence and cost of
complementary therapies
4.15
The acceptance and use of complementary therapies is increasing.
People want to be more active participants in their own healthcare and this is
evident in the increasing use of complementary therapies in Australia
and overseas. A systematic review conducted in 13 countries found that between 30
to 64 per cent of people have used complementary therapies. Other studies have
found prevalence rates of up to 83 per cent depending on the definitions of complementary
therapies used.[235]
4.16
Witnesses confirmed that complementary therapies are
being extensively used in Australia, with research showing that about 60 per
cent of the population use complementary medicines at least once a year.[236] The 2002 Datamonitor Survey covering
the United States
and Europe indicates that 80 per cent of cancer patients
use alternative or complementary modalities.[237]
The use of complementary therapies by cancer patients in Australia
is reported to vary widely between
seven to 83.3 percent.[238] These figures are significant and
cannot be ignored by the health system or health professionals.
4.17
The amount spent on complementary therapies confirms
the extent of their use with CAM being a billion dollar
business in Australia
and a multibillion dollar business globally. Between 1990 and 1997, expenditure
in the United States
doubled from $US14b to $US28b and this situation is likely to be mirrored in Australia.[239] The Gawler Foundation noted that:
A South Australian Survey in 2000, estimated that approximately
52 per cent of the Australian population used complementary medicines and 23
per cent consulted practitioners of complementary medicine. This represents an
estimated out of pocket spending of $2.3b which is a 62 per cent increase since
1993 and four times the out of pocket spending on pharmaceutical drugs.[240]
4.18
Estimates provided by industry suggest that the current
retail turnover of complementary medicines in Australia
is approximately $800m.[241] In 1993
the figure was $621m with $309m spent on visiting complementary practitioners.[242]
What motivates people to use
complementary therapies
...As orthodox physicians, complementary therapies are helping us reassess
the basic tenets of good care, such as the value of things like good healing
partnerships. This is not just about compliance. Patients will often say they
have a wonderful therapeutic relationship with their complementary therapy
practitioner. So there is a lot that orthodox medicine can lean from this too.[243]
4.19
The reasons behind the growth in complementary
therapies include: patients receiving greater individual attention from
practitioners, holistic values, dissatisfaction with medical outcomes, a desire
for improved health, increased access to health information as well as a growth
in research based evidence supporting the effectiveness of complementary
medicine.
4.20
People who experience limited success with conventional
medicine will turn to complementary medicines and complementary therapies and
this includes people with illnesses such as cancer. Some are dissatisfied that
medical practitioners do not allow sufficient time to discuss their health
concerns or provide adequate explanations. Complementary practitioners
generally have longer consultation times and focus on a patient's lifestyle as
well as symptoms. There is a shift towards a more holistic view of health,
encompassing mind, body and spirit as well as an increased interest in health
prevention strategies such as diet and stress management.
The mental state of mind as well as the physical strength of the
body are two major areas of neglect in traditional medicine. Strength of body
and mind can only improve a person's overall ability to fight this disease.[244]
4.21
There has also been a growth in evidence based research
into the safety and effectiveness of complementary medicines and complementary
therapies which means that more general practitioners are referring their
patients to complementary health practitioners, with some undertaking training
to provide it in their practice.[245]
If these therapies are helping them to get through the
uncertainty, to live better with their cancer, then there is no doubt that
there is something that is of great importance.[246]
Comparisons with overseas practises
4.22
What happens in 2005 in terms of complementary
therapies is very different to the attitudes and hostilities during the 70s and
into the 90s. There has been a softening in attitude by most areas of the
medical profession due to some complementary therapies beginning to be used in
the conventional sector, especially in palliative care; the support of
complementary therapies by a few conventional practitioners who sought out
scientific evidence to back up the application of complementary therapies; a
surge in the adoption of these therapies in overseas cancer centres and an ever
increasing consumer demand.
4.23
In Europe, complementary
medicines have a long tradition and have been routinely used side by side with
conventional cancer treatments for many years. In the USA
and the UK,
complementary therapies are also widely accepted and used to assist patients
with mainstream cancer treatment. However, from the submissions received and evidence
heard by the Committee, Australia
would seem to be a long way behind the USA,
UK and Europe
in terms of the acceptance of complementary therapies by medical practitioners and
their automatic inclusion in the treatment plan for a cancer patient.
4.24
In Australia,
complementary therapies are not used in most settings as a primary treatment of
cancer and this was heavily emphasised by several complementary therapies
witnesses representing professional organisations.[247] Primary treatment is provided in the
conventional setting by orthodox medical practitioners and complementary
therapies are provided to involve and empower the patient, reduce side-effects
and contribute to their well being. Witnesses also said that complementary
therapy could help the patients extend survival time.[248] Dr
Cassileth, Memorial Sloan-Kettering Cancer
Centre, New York, reported that
the many kinds of pain, side-effects and symptoms associated with cancer cannot
be well addressed by mainstream treatments.[249]
Complementary therapies are also used to help prevent cancer in healthy people,
especially those who may have a genetic predisposition, or to prevent cancer
re-occurring in patients who have been successfully treated.
4.25
The view of Nutritional Medicine Doctors and the Australasian
College of Nutritional and
Environmental Medicine (ACNEM) is that the nutritional status, from a
biological perspective, of cancer patients is not taken into account in the
Australian health system. It is their view that many patients suffer nutritional
deficiencies and metabolic imbalances as a consequence of their disease and
sometimes because of the severity of the treatment. Dr Peter
Eng stated that these patients need to be managed
nutritionally and with diet and appropriate supplements. Dieticians in
conventional hospitals do not have the time and, in general, are not trained in
the practice of nutritional medicine as utilised by nutritional doctors trained
by ACNEM. Also, very few doctors in Australia
have had any training in nutritional medicine or have had specific training in
the management of cancer patients using diet, nutrients, micronutrients etc to
either improve the outcome of orthodox management (drugs, surgery and
radiotherapy) or reduce the impact of the cancer on the individual patient and
thus improve the prognosis.[250] Examples
of research supporting this argument were provided by Dr Eng.[251]
Evidence for complementary
therapies
My belief and my experience in doing research is that
complementary and alternative treatments are going to provide us with much
better ways of dealing with chronic cancer than we had before.[252]
4.26
The Committee heard conflicting statements by witnesses
regarding whether sufficient scientific evidence for complementary therapies is
available. There is continuing criticism by conventional doctors that there is
a lack of hard scientific evidence to support the widespread use of complementary
therapies in the health system. However, witnesses from Australia
and overseas expressed surprise at this view, indicating that many
complementary therapies have been studied and scientific evidence of their
efficacy have been published. Indeed, a number of submissions included
extensive bibliographies of published evidence.[253]
4.27
Mr Lerner
advised that there is a very substantial research literature showing that some
of these therapies can enhance quality of life. He commented that evidence is
well established in psychosocial therapies for cancer such as meditation,
support groups and relaxation. Dr Cassileth emphasised that many people have
published randomised clinical trials at the highest levels of science on the
merits of acupuncture, music therapy, yoga, tai chi massage therapy, meditation
and others.[254] 'There is evidence
from randomised trials supporting the value of hypnosis for cancer pain and
nausea; relaxation therapy, music therapy, and massage for anxiety; and
acupuncture for nausea'.[255]
4.28
Mr Michael
Lerner, offers a scientific appraisal of complementary
therapies in his book Choices in Healing:
Integrating the Best of Conventional and Complementary Approaches to Cancer. When
speaking to the Committee he stated that 'it was the first book on integrative
cancer therapies to be well reviewed in the scientific literature as well as
the lay press'.
4.29
In support of complementary therapies, Mr
Lerner described the benefits of a healthy
body and mind in living with cancer:
Any human being who starts taking care of themselves physically,
mentally, emotionally and spiritually tends to become a healthier human being.
That means you are a healthier human being with cancer. That means you have
what oncologists call better functional status. Functional status in drug tests
is reliably associated with longer survival, which is why they control for
functional status when they test pharmaceuticals, otherwise they cannot figure
out to what degree you are living longer because you are in good shape and to
what degree you are living longer because of the new pharmaceutical.[256]
4.30
Some witnesses suggested that natural and traditional
therapies should not be judged according to the paradigm of mainstream
medicine.[257] Supporters of complementary
therapies pointed to the overwhelming influence of the pharmaceutical industry
in the conventional health sector and claimed that it is in the best interests
of this industry that complementary therapies do not gain a foothold in Australia's
public health system.[258] This
negative attitude within mainstream medicine was taken a step further, with some
submissions arguing that alternative cancer therapies are being suppressed as
they challenge the prevailing cancer paradigm and serve the vested interests of
the status quo.[259] Several witnesses
commented on this viewpoint. Mr Lerner
indicated that:
In the course of studying complementary and alternative cancer
therapies over the last 25 years I have reached a number of conclusions that I
think have stood the test of time. The first is that I have seen no clear-cut
cure for any form of cancer among the complementary and alternative cancer
therapies in the sense of any treatment that reliably reverses any form of
cancer. This is a very important statement, because there are many people in
the field of these therapies who claim that there are cures out there that are
being suppressed. I have never seen that phenomenon.[260]
Dr Kohn
commented:
The difficulty lies in the fact that most of those (alternative)
therapies today remain unproven rather than disproven. So as physicians we feel
that to justify their use we want to see more robust research evidence, to make
sure that they work and that they are safe.[261]
4.31
Conventional practitioners to their credit are vigilant
in the context of potential harm to their patients, especially when therapies
are offered as a primary alternative to conventional cancer treatment,
sometimes at an exorbitant cost and with unrealistic promises of positive
results. Negative interactions with conventional chemotherapy and/or
radiotherapy were also of concern to conventional practitioners. Dr
Kohn from the UK
agreed that better information needed to be provided on whether some complementary
therapies might interact with orthodox therapies and negate their effects. She
mentioned encouraging studies to be available through the mainstream
information sources so that clinicians are alerted. She also mentioned looking
for more ways to educate physicians and make the information easily accessible
to facilitate a dialogue between patients and medical practitioners.[262]
4.32
To improve the information available on complementary
therapies and ensure safety, Professor Maher
suggested three steps. First, an information strategy to get information to health
professionals and patients by making use of information, studies and research
produced by other countries, backed up with information on safety. Second, a
national research program and third, an exemplar centre that is associated with
a very highly respected cancer centre.[263]
Research into and regulation of Complementary
Therapies
If we can take a message away from some of this it is not to be
unquestioning in our examination of the evidence but that at the same time we
need to invest a lot more time and resources into the research which can be not
only effective for quality of life, mental health and emotional health, but
also potentially can save large amounts of resources for the system itself in
that it supports people and helps to prevent or make more simple the management
of various complications as well.[264]
4.33
The vast majority of research on complementary
therapies and medicine has been conducted in the USA
where a significant effort has been made with research primarily funded by
government. In the USA,
the Office of Cancer Complementary and Alternative Medicine (OCCAM) was
established in 1998 within the National Cancer Institute (NCI) to coordinate
and enhance activities of the NCI in CAM research as it
relates to the prevention, diagnosis, and treatment of cancer, cancer related
symptoms and side effects of conventional cancer treatments. Since its creation
funding has almost tripled to $119m in FY 2003.[265] In 1998, the National
Center for Complementary and
Alternative Medicine was also established and is dedicated to exploring
complementary and alternative healing practices in the context of rigorous
science training complementary and alternative medicine researchers and
disseminating authoritative information to the public and professionals. In FY
2005 it received $123.1m from Congress.[266]
4.34
Dr Kohn
reported that in the UK
the National Cancer Research Institute has a complementary therapies clinical
studies development group which is looking at prioritising areas for study and
methodological issues.[267] Professor
Maher emphasised that dedicated money from
government is necessary for research in this area to develop, as was the case
in the USA.[268] Australia
has no such equivalent organisations directing and prioritising research into complementary
therapies.
4.35
The Committee heard from a number of witnesses suggesting
that research funding for complementary therapies in Australia
is inadequate.[269] Research grants are
made available by the National Health and Medical Research Council (NHMRC)
which is a statutory body within the health portfolio. Since 2001, of the $1b
allocated to research on pharmaceutical drugs, no more than $85,000 has been
made available for research into complementary therapies.[270]
4.36
As therapies cannot be patented, which limits the
amount of profits that can be made, the government cannot rely on industry
alone to undertake research and has a role to allocate adequate funding for complementary
therapy research.
4.37
Mr Lerner
stressed the need for an ongoing research agenda and described a snowball
effect when underway:
Once you create a budgetary stream without increasing your
research expenditure – simply saying, 'Let's put one per cent into this area' –
then you begin to get the academics competing for those research dollars. Those
academic competitions for those research dollars make it credible in cancer
institutes to study these issues. When they are studied, the oncologists
recognise that they are being studied and they are being studied by, obviously,
the most credible people, since they want it to be done carefully, and so there
is a cascade effect down through the system of beginning a research program.
There are certainly a lot of people around the world who could support the able
researchers in Australia
interested in those kind of things.[271]
4.38
As a first step in developing further research in this
area, the Committee suggests dedicating a percentage of research funding each
year to ensure a funding stream for research into this area which impacts on
the lives of so many Australians.
Recommendation 22
4.39 The Committee recommends the National Health and
Medical Research Council provide a dedicated funding stream for research into complementary
therapies and medicines, to be allocated on a competitive basis.
4.40
The Committee notes that the Expert Committee on Complementary Medicines in the Health System recommended
that dedicated funding be made available for complementary therapy research in Australia
for a minimum of five years. The government response notes that no decision can
be made prior to the consideration of research needs and priorities. The
Committee therefore would encourage the speedy implementation of recommendation
34 of the Expert Committee's report.
4.41
The field of complementary medicine is very diverse and
trials have been criticised for being methodologically weak. However, this argument
was rebuffed by Australian and overseas witnesses who said that while there can
be methodological challenges in designing research, randomised controlled
trials are possible for complementary therapies.[272] In fact the Committee was told that
there is a substantial body of overseas clinical research into complementary
medicine. As an example, in 2003, the Cochrane Controlled Trials Register
recorded 641 clinical trials of acupuncture, 666 of herbal medicine, and 124 of
homeopathy.[273] 'The Cochrane
Collaboration is an international non-profit and independent organisation,
dedicated to making up-to-date, accurate information about the effects of
healthcare readily available worldwide. It produces and disseminates systematic
reviews of healthcare interventions and promotes the search for evidence in the
form of clinical trials and other studies of interventions'.[274]
4.42
Mr Spijer,
Chief Executive Officer of ACNEM, suggested the overseas studies should be used
as the basis for studies to be conducted in Australia.[275] Professor Hill, supported this use
of research, saying that sometimes NHMRC grant applications fail to take
account of existing knowledge.[276]
4.43
The Committee agreed that with the amount of evidence
based research available overseas, there is an opportunity for Australia
to further tap into that research and make it more widely available for medical
practitioners and cancer patients.
4.44
The NHMRC reported that applications for project grants
to support complementary medicines research to date have been minimal, with the
number of applications ranging from eight to 15 in any one year. The success
rate of the applications has varied from 0 per cent in 2004 to 21.4 per cent in
2003, the latter figure being close to the normal success rate for all project
grant applications. The NHMRC highlighted that the low success rate reflects a
lower competitive standard of the applications as assessed by the NHMRC's peer
review process. To improve the success rate they suggested that institutions
identify researchers in that area and for the NHMRC to provide mentoring and
advice from experienced NHMRC recipients on strategies to improve the number
and quality of applications.[277]
4.45
Professor Hill advised that the Cancer Council also funds
research on a competitive basis on aspects of cancer research. He also noted
that it is difficult for researchers to get funding and suggested mentoring as
a way to improve applications.[278] Dr
Snyder from the Cancer Council Victoria, highlighted
the need for research infrastructure and suggested recognising that
non-commercial research should be part of any quality cancer program.[279]
4.46
Dr Kohn
emphasised that collaboration is needed across research and practice
communities to make sure trials are meaningful in their design. Witnesses,
including Professor Aranda
from the Peter MacCallum Cancer Centre, also suggested greater collaboration and
partnerships to build up complementary therapy research expertise and
credibility and agreed specific funding would be required to develop the
research infrastructure in this area. Professor Currow also emphasised
collaboration and stated 'you have got to get the right relationships; you have
got to get the right expertise; you have got to form the right collaborative
groups that actually bring the clinical – including complementary care – the
research and the ability to attract research dollars together. That is about
building collaboration'.[280]
4.47
The demand for complementary therapy from the general
population and for people with cancer make it essential that the government
exercise its social and ethical obligations to ensure complementary therapies
are appropriately researched. The Committee agreed that in order to protect the
public, the same rigorous evaluation needs to be applied for complementary
therapies as for mainstream treatments. Further, the demonstrated potential of complementary
therapies to manage chronic illness and in preventative care represent
important national research priorities. In research, Bensoussan also suggests
that Australia
could become an international leader in evidence-based complementary therapies
as medical research expertise is high and clinical trial costs are relatively
low.[281]
4.48
However, the fledgling state of Australia's
complementary therapy research needs dedicated government funding to develop the
infrastructure and expertise. The Committee suggests the body of complementary
therapy research conducted overseas is an opportunity for Australia
to use and adapt on so that medical practitioners and patients are assisted to
make informed decisions. The Committee also agreed that to develop the complementary
therapy research infrastructure in Australia,
collaborative work needs to be coordinated and prioritised by a central agency.
Recommendation 23
4.49 The Committee agrees with the recommendation of the
Expert Committee on complementary medicines in the health system, that the
NHMRC convene an expert working group to identify the research needs addressing
the use of complementary medicines, including issues around safety, efficacy
and capacity building. The Committee recommends that this working group should
include complementary therapists in order to develop a strategy to coordinate
and prioritise a dedicated research funding stream for complementary medicine
and therapy research, taking into account research conducted overseas. The
group should also encourage the development of collaborative partnerships
across disciplines.
Recommendation 24
4.50 The Committee recommends that the NHMRC develop
workshops for complementary therapy researchers intending to compete for
funding, where experienced researchers discuss their preparation of research
proposals.
Recommendation 25
4.51 The Committee recommends that the NHMRC appoint two
representatives, (including one consumer), with a background in complementary
therapy, to be involved in the assessment of research applications received by
the NHMRC for research into complementary and alternative treatments.
Safety and efficacy of
complementary therapies
4.52
The Government has a duty of care to ensure that
complementary therapies are safe for the public. The regulation of
complementary therapies provided by healthcare practitioners is not addressed
in any Federal legislation. As such, the Commonwealth has no direct power or
authority over the way in which health practitioners conduct their professional
practice.
4.53
Complementary medicines are, however regulated under
the Therapeutic Goods Act 1989 (the Act), which is administered by the Therapeutic
Goods Administration. The Act aims to provide
a national framework for the regulation of therapeutic goods in Australia
and to ensure their quality, safety and efficacy. Under the Act, ‘complementary
medicines’ that make therapeutic claims are regulated as therapeutic goods. All
complementary medicines in Australia
are scrutinised for safety and quality by the TGA. The overall objective of the
Act is to ensure the quality, safety, efficacy, and timely availability of
therapeutic goods, including medicines, supplied or exported from Australia.[282] In Australia,
the Office of Complementary Medicines was set up within the Therapeutic Goods
Administration to focus exclusively on the regulation of complementary
healthcare products.
4.54
Australia has a risk-based system where the level of
evaluation and regulatory control of a therapeutic good is based on the
relative safety of the product and the seriousness of the condition for which
it is intended to be used.
4.55
Generally, therapeutic goods must be either Listed or
Registered in the Australian Register of Therapeutic Goods before they can be
supplied in Australia.
Before a product can be included in the Australian Register of Therapeutic
Goods, a sponsor is required to submit an application to the Therapeutic Goods
Administration, together with relevant supporting data.
4.56
Whether a
product is Listed or Registered in the Australian Register of Therapeutic Goods
depends primarily on three matters:
- The ingredients;
- The dosage form of the product; and
- The promotional or therapeutic claims made for
the product.
4.57
Registered medicines are assessed as having a higher
level of risk, and are subjected to a high level of scrutiny. They are
individually assessed by the Therapeutic Goods Administration for quality,
safety and efficacy prior to market entry.
4.58
Listed medicines are lower risk than Registered
medicines and may only contain ingredients approved by the Therapeutic Goods
Administration as being of low risk.
4.59
Indications/claims related to neoplastic diseases
(cancers) may only be made after evaluation of the product (and the claims)
through Registration of the product. Therefore, claims related to cancer may
not be made for Listed medicines. There are currently no complementary
medicines Registered for indications/claims related to cancer.[283]
4.60
In May 2003, to reassure the public and maintain
confidence in Australia's
reputation as a supplier of high quality and safe medicines, the Australian
Government established the Expert
Committee on Complementary Medicines in the Health System. In the wake of
the Pan Pharmaceuticals
recall it was asked to focus on issues around the supply of safe high-quality
complementary medicines, quality use of and timely access to those medicines,
and the maintenance of a responsible and viable complementary medicines
industry. The Committee recognised three fundamental principles: 'firstly, the
need to protect the public health and safety; secondly, the primacy of the
right of consumers to be able to make informed choices on matters of
healthcare; and thirdly, the ethical responsibilities of all healthcare
providers – from manufacturers to healthcare practitioners'.[284]
4.61
The Expert Committee report recommended that the
government take a more active role in ensuring that consumers have access to
reliable information about complementary medicines, and the skills to interpret
this information to be able to make informed decisions. The report also
recommended creating a greater awareness among all health professionals and
consumers of the potential for complementary medicines to interact with other
medicines, and ensuring that consumers are better informed about the potential
risk of importing medicines for personal use. It also called on State and Territory
governments to introduce legislation to regulate practitioners of traditional
Chinese medicine and dispensers of Chinese herbs, based on existing Victorian
legislation as soon as possible. The report recommended that internet
advertising be considered part of mainstream advertising and be subject to
mainstream advertising requirements and protocols. The report also made a
number of recommendations about improving the level of research and funding
available for complementary medicines.[285]
4.62
In March 2005, the Government responded to the Expert Committee's
report, accepting most of the recommendations and stating that it will develop
and implement a range of initiatives to improve the regulation of complementary
medicines.
Towards Integrative Medicine - Integrating complementary therapies and conventional
medicine
A fully
integrated approach
People often asked me - and they still do - whether it
was the chemo or the other things that made me get well. As far as my
experience goes, that is not the right question. What helped me get my health
back was a fully integrated approach, which was more than any one discipline
could offer. I needed the chemo, the meditating, the diet and the psychological
help. From what the doctors said at the time, they certainly did not think that
just the drugs could do it. Whether I would have got well without the drugs at
all, I suppose I will never know, and I do not think it matters. What did
matter at the time was that the Gawler Foundation helped me to pull all the
different strands together. There is a lot of expertise in a lot of fields out
there but, as a cancer patient, you need them to work together. I just cannot
stress that point too strongly.
Committee Hansard 18.4.05,
p.56 (Ms Barb Glaser).
There is a tremendous interest amongst
younger physicians and also amongst older physicians in recovering the heart of
medicine – the psychological and spiritual reasons why they went into medical
practice – and moving away from the exclusively technological and biomedical
base on which medicine is taught. I offer that as an indicator that there is a
hunger in the medical community for responsible, integrative approaches, which
is by no means limited to cancer. I think that hunger really reflects that fact
that physicians are part of the culture as a whole and that the culture as a
whole has a hunger for these integrative therapies.[286]
4.63
In Europe, there has been a
rich, historical tradition of herbal medicine, naturopathy and other
complementary therapies, with conventional doctors working with their
counterparts in the complementary therapy sector. In the USA
and Europe, the benefits of complementary therapies have
been acknowledged and are being actively introduced into the conventional
health sector as part of what is called integrative medicine (IM).
4.64
Professor Avni Sali, a surgeon and Foundation Head of
the of the Graduate School of Integrative Medicine at Swinburne Univeristy of
Technology, described integrative medicine as combining the best of both
worlds, the scientific aspects of conventional medicine with the scientific aspects
of complementary medicine, in order for the patient to get the best result.[287] Michael
Lerner also described simply that
'integrative therapies' means 'the integration of the best of both conventional
and complementary areas'.[288] However,
in respect of the situation in Australia
Professor Sali
commented:
Almost every medical faculty in the US has an integrative
medicine component, and I think it is a disgrace that here in Australia more
than two-thirds of the Australian public are using some form of complementary
medicine and most doctors would not have a clue what their patients are doing.
There really needs to be some stimulus in trying to change that culture.[289]
4.65
Courses in IM are now part of the undergraduate and
post graduate medical curriculae in many parts of the world but not in Australia.
An exception is that Professor Avni
Sali was mainly responsible for the
establishment eight years ago of the first postgraduate medical school of its
kind in IM at the Swinburne University of Technology. The school is primarily
focused on educating doctors about complete medicine or IM. Only a handful of
Australian universities are currently offering courses in IM, naturopathy and
nutritional and herbal therapies.
Psychosocial therapies and approaches like massage, deep
relaxation, exercise and healthy diet – what I call the vital quartet of
spiritual, psychological, nutritional and physical approaches to cancer that
intrinsically enhance health and quality of life – absolutely are very likely
to emerge as tomorrow's mainstream therapies...the evidence that they are
becoming mainstream is that more and more cancer centres offer them[290]
Providers of complementary
therapies
The number and type of healthcare practitioners who supply or
provide advice to consumers on complementary medicines is large and varied. The
group ranges from complementary healthcare practitioners such as naturopaths,
TCM (Traditional Chinese Medicine) practitioners, and herbalists, to medical
practitioners who may or may not provide complementary medicines to patients
but who nevertheless need to be aware of the complementary and the other
medicines that patients may be using.[291]
4.66
The Committee noted the variety of groups providing
complementary therapies and considered that given the issues raised by the Expert
Committee on complementary medicines in the Health Care system, there would be
value in forming an umbrella organisation to represent the sector. This
organisation would be able to progress recommendations made in the Expert
Committee's report such as self-regulation.
4.67
The Committee considered that complementary therapy
could be better promoted if there was a more positive interaction between the
different organisations in order to discuss common policies on issues such as
standards and accreditation. Establishing an umbrella organisation may also
lead to more positive interaction with associations representing conventional
treatment and integration with their services.
4.68
The Committee saw value in a forum being held on a
regular basis which professional complementary therapy bodies could attend to
discuss State and Territory government initiatives and issues such as
accreditation of members.
4.69
In context of the significant number of cancer patients,
as well as those being treated for other conditions, who are using complementary
therapies, the government has a duty of care to ensure that patients and their
carers can make well informed decisions about which complementary therapies
will be the best for their needs. At present complementary therapy practitioners
appear to be penalised by the health care system. There are no formal
interactions at a professional level between complementary therapy
organisations and those representing conventional medicine and yet the numbers
of patients using complementary therapies continues to grow. The Committee
believes that as a first step, the government should provide a threshold for
collaboration between conventional medicine and complementary therapists.
Dialogue is essential and the dividends from collaboration will be of benefit
to cancer patients.
Recommendation 26
4.70 The Committee recommends that complementary therapy organisations
form a collaborative group with the authority to negotiate with representatives
from the established medical organisations and to make recommendations to
government. This body should organise a regular forum for representatives of complementary
therapies to come together and discuss issues affecting their members such as regulation,
research funding issues, collaboration and health and cancer initiatives at the
Commonwealth, State and Territory levels.
4.71
Professor Sali
expressed surprise that in general oncology there is so much resistance to
looking at other possibilities, particularly in the area of complementary
medicine. Oncologists were particularly mentioned as a group of medical
professionals where most negative, dismissive and patronising attitudes towards
complementary therapies were frequently encountered. The Committee was told
that in Australia,
most oncologists are very apprehensive about any type of complementary therapy
being offered in an orthodox medical setting and some actively discourage
people from even investigating complementary therapies. In contrast, in the USA,
major cancer centres such as the Sloan-Kettering Cancer Centre in New
York and many others provide complementary therapies
as part of their multidisciplinary treatment.
4.72
The Committee heard evidence from Dr Barrie Cassileth
of the Memorial Sloan-Kettering Cancer Centre in New York
and Professor Jane
Maher from the Mount
Vernon Cancer Centre and the Chief Medical Officer at Macmillan Cancer Relief in
the UK, both of
whom support complementary therapies and provide them within their centres. They
both quoted figures that 90 per cent of cancer centres in the USA
and UK offer
some form of complementary therapy be it on a large scale such as Sloan-Kettering
or Mt Vernon Cancer Centre or on smaller scales as resources permit. They said
their centres arose from consumer demand, from patients wanting to control
side-effects and promote optimum health and overall well being.
4.73
Professor Maher told the Committee that touch
therapies, mind body, acupuncture, and energy therapy are well accepted in the
UK and that medicinal nutritional therapies are offered but at a lower rate.
She reported that over the last few years a change has been brought about by
patients, and doctors have moved from being dismissive of complementary
therapies to appreciating the benefits of improving quality of life and symptoms.
Professor Maher
said that in her centre they are very comfortable using acupuncture,
homeopathy, aromatherapy, massage, reflexology, shiatsu and the Alexander
technique.[292] They also provide a
directory of available services and offer therapies to carers and staff. Dr
Cassileth mentioned that Sloan-Kettering
also offers a consultation service for leaders of hospitals and hospital
systems who have come to them from all over the world to lean how to put their
program in place.[293]
4.74
Dr Hassed
commented on the integration of complementary therapies from a systemic
perspective:
The issue of the potential health care savings of a more
holistic and integrated approach is vital, because I do not think the health
care system as it currently is, with an industry that supports more intervention
and more expensive intervention, is sustainable.[294]
Moving to integration - from ideas
into practice
My experience is that the only way that you make progress is
actually to have complementary therapists, alternative therapists and medical
scientists who have open minds, working together in reflective practice, and
then you find the points of contact.[295]
4.75
The Committee asked the expert witnesses from overseas
who have already travelled the path that the Australian health system is now moving
along regarding complementary therapies as to what they considered would be the
most effective methods to implement best practice services and overcome
resistance to the use of and integration of complementary therapies. They
advised the following:
1. Start small
4.76
Professor Maher
suggested a step by step approach, where therapies are introduced into centres
one at a time so that people get used to them and are able to see the benefits.[296]
2. Develop a shared language
4.77
Professor Maher
highlighted that it is important for complementary therapists and medical
practitioners to develop a shared language in order to work together,
emphasising that shared language promoted a better connection between the
therapist and medical practitioners.[297]
She remarked that while on the Population and Behavioural Sciences Committee on
Cancer Research UK,
she had been involved in many discussions and debates which started as
stand-offs but then gradually moved together as they found a connection. [298]
3. Use Local Champions
4.78
Dr Kohn
mentioned the importance of local clinical champions, people with a very solid,
orthodox background who are open minded, who are willing to get involved and be
actively supportive.[299]
4. Use and adapt information from overseas
4.79
Dr Kohn
referred to not just sharing information resources between countries but adapting
them for local needs. She particularly mentioned the national guidelines
published by the National Council for Hospice and Specialist Palliative Care
Service with the Prince of Wales Foundation which deals with issues such as
qualification of therapists and evidence base for therapies used.[300]
5. Location, location, location
4.80
Location of the complementary therapy services was also
mentioned as important to promote use for not just the people who are more
likely to access these services, namely, higher-educated women but also for men.
Dr Kohn
mentioned a very successful complementary therapy centre in the UK
which is physically integrated within an oncology centre and she reported that
they get as many men as women and also people from lower socio-economic
backgrounds. She added that patients view it as part of the service, the same
as any of the other oncological services.[301]
Co-location of complementary therapies with conventional cancer treatment also assists
with acceptance as the benefits for the patients can easily be seen by the
medical practitioners.
6. Education, training and information for
medical practitioners
There seems to be a long lag between research and evidence
finding its way into clinical practice and maybe this is the way doctors have
been educated; maybe it is the lack of a large amount of money to promote
non-patentable products for patients; maybe it has to do with a particular way
of thinking about cancer which finds it difficult sometimes to think outside
the square.[302]
4.81
Education and training has a very important role to
play in breaking down the barriers and resistance to complementary therapies
and in improving knowledge. Witnesses stressed that medical practitioners do
not have to be experts in offering complementary therapies but they need to be
experts in understanding its value or lack of value and able to engage in
useful dialogue with their patients. Dr Cassileth
commented that she had been asked to write chapters on complementary therapies for
every major oncology textbook over the last few years. She also emphasised the
wealth of information that is available in medical literature, on the internet
on sites such as the Cochrane Collaboration and at conferences. In addition, she
has just finalised a book, Integrated
Oncology: Complementary Therapies in Cancer
Care that details all the literature, research and what has been shown to
be useful and not useful.
There needs to be a standard. At a minimum, a modern, trained
doctor needs to know about complementary approaches, holistic approaches and
integrated approaches. There is a bare minimum, because the number of people
who are using these things and not telling their doctors is a significant
concern.[303]
4.82
The Committee encourages greater education of
conventional medical practitioners in the role that evidence based complementary
therapies can play to increase patient well being, quality of life and support
their conventional treatment. In 2002, the Australian Medical Association produced
a position statement on complementary and alternative medicines which
recommended education in complementary medicines so that it could be
incorporated into medical practices, called on educational institutions and
professional colleges to provide CM education, recognised that evidence-based
CM should be part of mainstream medicine and encouraged public education in CM.
In 2003, the Expert Committee on Complementary
Medicines in the Health System recommended education and training of
medical practitioners in CM. In 2004, the Royal Australian College of General Practitioners
and the Australasian Integrative Medicine Association established a joint
working party responsible for a number of issues to do with how aspects of CM
can be introduced into general practice as well as reviewing the Australian
Medical Association's Position Statement and its implications for GPs and other
issues.
4.83
The Committee believes that medical practitioners
treating cancer patients have an obligation to inform themselves and their
patients about a wider range of approaches to cancer and know how to direct
patients to find reliable information. An example of information recently
released is A Practitioners Guide to
Alternative Therapies produced by Oncology Mayne Pharma which contains 266
references, refers to information from Sloan-Kettering, the Medical Journal of Australia and
contains useful websites.
Information for cancer patients
4.84
Many cancer patients do not tell their medical practitioners
that they are using complementary therapies as they are worried about their
reaction. This has the potential for unsatisfactory risk as some complementary
therapies have the potential to affect orthodox treatments.
Doctors'
attitude to complementary treatment
Why would I tell my doctor? They don’t believe in
non-hospital treatments. I don’t know if it’s working but I know it makes me
feel better.
Submission 33, p.8 (Breast Cancer Network of Australia).
4.85
Cancer patients want credible information on
complementary therapies. Witnesses said they wanted assistance to be able to
find legitimate information and also to identify products and therapies for
which there may be no scientific evidence.
4.86
The Expert Committee on Complementary Medicines in the Health
Care System recognised the need for more information and recommended that the 'Government
needs to take a more active role in ensuring that consumers have access to
reliable information about complementary medicines, and the skills to interpret
information and make informed decisions'.[304]
4.87
Evidence presented to the Committee identified the vast
amount of information that is currently available from many sources including the
NCCAM at the US National Institute of Health, the British Columbia Cancer
Agency in Canada
and at Cancer Support UK,
which is part of the British National Health Service. This appears, to the
Committee, to present an opportunity to access this information for use in Australia.
4.88
However, cancer patients can be vulnerable to people
promoting cancer cures with no scientific evidence and at great personal cost and
therefore need information from an authoritative Australian source. One witness
described his experience to the Committee:
There is no end on the internet to people trying to sell you
things or promote their own therapies for whatever cancer...when you have nothing
else to grab onto these things are at the end of the line...There are multilevel
marketing people...he wanted me to buy $1,000 worth of supplements every month...I
would ask a lot of these people 'show me the proof', and they would tell me
every time that they could not afford to run clinical trials.[305]
4.89
The Committee believes that the government has a duty
of care to provide this information which will contribute to informed decision
making by cancer patients and those supporting them. The Committee considered
the Expert Committee on Complementary Medicines in the Health System's
recommendation 25 regarding a study to determine complementary medicines
information and skills needs of healthcare professionals. The recommendation
was accepted by the Government and the Committee considers that work can
contribute to the following recommendation to better promulgate information on
complementary therapies.
Recommendation 27
4.90 The Committee recommends that Cancer Australia
access the information available internationally on different complementary
therapies ad alternative products in order to provide up-to-date,
authoritative, evidence-based information which can be regularly updated. This
information should be made available in different forms and made available to
cancer patients and their families as well as health professionals and other
interested individuals.
Regulation of complementary therapy
practitioners
4.91
In the context of the concerns expressed by health
professionals about some practitioners in the complementary or less
conventional sector, Dr Hassed
suggested the introduction of some form of accreditation and standards.[306] A number of disciplines have already
introduced accreditation and the Committee would encourage the development of regulation
by professional bodies to further enhance their status and general acceptance
and to protect the public from unqualified or poorly educated practitioners.
4.92
In the UK,
Dr Kohn
advised that only osteopathy and chiropractic practitioners are statutorily
regulated but there is well advanced work underway for acupuncture and herbal
medicine to be regulated and for some other therapies ultimately being self
regulated.[307]
4.93
The regulation of complementary therapies provided by
healthcare practitioners is not addressed in any Federal legislation.[308] The Expert Committee of Complementary Medicines in the Health System
made recommendations to introduce nationally consistent regulations to licence
practitioners of complementary medicines and self regulatory structures. In its
response, the Government noted that the recommendations in these areas are State
and Territory responsibilities, and indicated that the matter will be brought to
the attention of the States and Territories through the Australian Health
Ministers' Conference. The Expert Committee's recommendations are supported by
the Committee which would caution that nationally consistent regulations do need
to apply to ensure that there is uniformity between the States and Territories.
Integrative medicine as practiced in
Australia
4.94
There is no integrative medicine in Australia
along the lines of the USA
and UK. Some
models in Australia
where complementary therapies are offered to patients undergoing conventional
treatments include the Peter MacCallum Cancer Centre in Melbourne
and the Brownes Cancer Support Centre at Sir
Charles Gairdner
Hospital in Perth.
In these centres, complementary therapies, which have been proven to be
effective, have been offered alongside conventional treatment.
4.95
The Peter MacCallum Cancer Centre supports
complementary therapies aimed at relieving side-effects or improving general
well being where there is evidence from appropriately conducted clinical
trials.[309] The Brownes Cancer Support
Centre at Sir Charles
Gairdener Hospital
in Perth is based on a UK
model developed by Dr Jane
Maher, who was a witness
during the inquiry.
4.96
These centres were very well regarded by witnesses and
medical practitioners the Committee spoke with but they are an add-on rather
than an integral part of a comprehensive cancer service. These centres were
seen by the Committee as exceptions to prove the rule. That is, there exists a
basic rejection by conventional cancer centres in Australia
to integrate with complementary therapies for the benefit of their patients and
their carers.
Hospital
based support centres
Thirteen months ago I was the same as
everyone else out on the street, just trotting along. I found a small lump in
my neck. The next thing I knew, there was a diagnosis of cancer. That has turned
my whole life completely upside down - in a fairly positive way in the long run
but there have been some hurdles to go over along the path... When it came, I
suppose the first thing that hit me was the fear of telling my children and my
parents. When you think of cancer, you generally associate it with a death
sentence. That is how I perceived it until about 12 months ago. So there was a
big mental leap to make.... I have had quite a few visits to the [Brownes Cancer
Support] centre here. The centre made a huge difference to my perception of
going to the hospital. I would go not only to receive chemotherapy and other
nasty things but to lie down and have a massage for an hour. At a time close
after diagnosis, when I had a veneer of control but where everything underneath
was turbulence, it was such an oasis. It was a wonderful place to visit.
Committee Hansard 31.3.05,
p.55 (Ms Betsy Bush).
4.97
As the evidence base increases, the Committee agrees
that complementary therapies should increasingly be integrated into
conventional cancer care centres and the Committee encourages institutions and
medical practitioners to use the steps outlined above to facilitate greater
access to complementary therapies by their cancer patients.
Recommendation 28
4.98 The Committee recommends that where quality of life may
be improved by complementary approaches, methods to make such therapies more
accessible be discussed by State and Territory cancer services, including
consumer representatives.
Complementary therapy services in
the non-government sector
4.99
The majority of complementary therapy services are
still funded largely through charities and by individuals.[310] In Australia,
in the non-government sector, there are many organisations providing
complementary therapies. Some, such as the Gawler Foundation in Victoria,
have been providing a service for over 25 years. Their funding comes from fees
charged for their services, including retreats, and fund raising. The Gawler
Foundation has active participants from conventional medicine on the Board of
Management including Dr Craig Hassed from Monash
University and Professor
Avni Sali. Dr
Hassed and Professor
Sali both referred to significant amounts of
scientific evidence that complementary therapies improve quality of life and may
extend survival time. Dr Gawler,
the founder of the Gawler Foundation, noted that there is quite a body of
research and their submission contains about 160 references.[311]
4.100
Dr Gawler
referred to the adversarial situations they often found themselves in with some
of those representing conventional medicine and institutionalised organisations.
The Committee was surprised to hear that despite the Gawler Foundation's
historical presence in Victoria
and the large numbers of patients and carers that they cater for and
successfully assisted, they had not been invited by the Victorian Department of
Health to make any contribution to the planned reorganisation of the state's
cancer treatment services.
4.101
Bloomhill Cancer Care in Queensland
was another organisation providing complementary therapies which the Committee
spoke with. It works very closely with all oncology wards in the surrounding
area and has a formal partnership with BlueCare Palliative Care Service. Bloomhill
provides therapies such as massage, music and art therapies, reflexology, meditation
and others as well as counselling. They support not only the cancer patient but
the whole family and carers, from the time of diagnosis. The Founder of
Bloomhill, Margaret Gargan
emphasised that they encourage people to access orthodox medical treatments but
utilise complementary therapies as well. Ms
Gargan said that in the Bloomhill model,
once a person is assessed, they send letters to their doctors to tell them what
therapies they are being offered so they are working as a team.[312]
4.102
The popular demand for the complementary therapies
offered by these services is demonstrated by the large number of interstate
courses run by the Gawler Foundation and Bloomhill expanding into the Blue
Mountains in NSW.
4.103
Various Foundations and Associations representing
different sectors of complementary therapy, as well as individuals, presented
evidence to the Committee. The Committee was concerned to hear from
professional complementary therapy organisations that they were not involved
with the cancer initiatives being implemented at the State and Territory level.
The Committee considers that such disregard of complementary services operating
in the non-government sector by government bodies needs to be resolved to encourage
the further development of integrative medicine in Australia.
Recommendation 29
4.104 The Committee recommends that State and Territory governments
include the views of peak complementary therapy bodies in each State and
Territory regarding the planning and delivery of cancer services.
Conclusion
4.105
The Committee supports the recommendations made by the
Expert Committee on Complementary Medicines in the Health System in their
Report to the Parliamentary Secretary to the Minister for Health and Ageing in September
2003.
4.106
As noted by Dr Ian
Gawler, cancer services are in the early
stages of a paradigm shift fuelled by the public demanding better outcomes and
better access to information on complementary therapies and medicines. The use
of complementary therapies is increasing in Australia
and overseas. Some patients are disillusioned with the outcomes provided by
conventional medicine and turn to complementary therapies and alternative
therapies to alleviate and better manage acute conditions such as cancer. This
dissatisfaction can be due to the limited success with conventional outcomes;
the lack of time of many medical practitioners to discuss health concerns and
provide comprehensive explanations; and the shift to a more holistic view of
health which looks at the whole person, including their lifestyle and emotional
health and not just their symptoms.
4.107
The Committee recognises that complementary therapies are
a priority for cancer patients. People want to be more active participants in
their own health and due to increasing information, especially on the internet,
they are better informed. Evidence has shown that there are ethical, evidence
based integrative approaches to cancer care that enhance quality of life and
may contribute to life extension. Patients should be able to access the level
of information they require and weigh up information on proven complementary
therapies so they can make informed choices about their use. The Committee
believes that government has a social and ethical obligation to respond to
community needs. Enhancing quality of life is a major social benefit which
could be achieved at relatively low cost. As well as the government, the
Committee would urge health professionals, institutions and organisations to
recognise their social and ethical obligations in this area.
4.108
Evidence based research leads to informed choice and
some complementary therapies are now supported by research. They are driven by
progressive universities providing more graduate and postgraduate training and
their use is being adopted within progressive hospitals. To date most complementary
therapy research has been undertaken overseas, even though Australia
has a world renowned capacity for undertaking quality research. The development
of complementary therapy research in Australia
requires dedicated funding along with a strategy to identify priority areas and
to assist researchers competing for funding.
4.109
It is apparent from the inquiry that Australia
is lagging some distance behind the USA
and the UK in
the development of the complementary therapy sector and the integration between
mainstream and complementary therapies. After speaking to witnesses, the
Committee was left with the indelible impression that, in the best interests of
cancer patients in Australia,
there needed to be an integrative approach based on the models in the UK,
the USA and
other international centres.
Lisa's
story – An integrated approach
When I began my journey in February 2000, I
was keen to embrace an Orthodox and Natural approach to Breast Cancer. Although
a multidisciplinary tactic to my wellness was suggested in the reading
material, when I inquired whom my Naturopath, Homeopath and Chinese Herbalist
would be, the silence was deafening. I was soon to realise there was no
methodology in place to support the delivery of my request for other
modalities. There was also an observable culture of resistance, to the pursuit
of legitimate objectives, by a broad range of those in positions of power in
the Medical arena.
In 2004 the Cancer returned. My experience
this time round was very different, but then so was the disease. The final
Diagnoses: Liver, lung kidney, left breast now two lumps, an external tumor on
my left side, lymph nodes, neck, right sixth rib, a moth eaten left hip lower
spine and pelvic area...
This time I searched for practitioners that
were willing to work together. Over the past 12 months my journey has been
amazing. I was able to collaborate with 4 different practitioners. My medical
heroes are:
Dr. Qi Chen, a Chinese Oncologist who has been practicing Traditional Chinese
Medicine (TCM) for over twenty-three years.
Professor Martin Tattersall of RPA with 30 years experience and Australia’s first Professor of Oncology.
Michael Trembath who works on aligning both the physical structure and vibrational
balance of the body.
Alistair Gray, a Practitioner in Homeopathic Medicine. A discipline committed to the
seamless dynamic health of the mind, the emotions, and the physical body.
In the beginning we agreed that they were
free to discuss any part of my treatment with each other. I would have regular
visits with them – some weekly, some monthly, to have treatments. I was
empowered with understanding, knowledge and support to make informed decisions...
Rarely does a day go past without a conversation
about health. The more people I speak to the more I hear of such stories and
desire for something in addition to their current treatment...We have a
responsibility to share these experiences and give other patients the options,
remembering we must also respect their choices. We are more than capable of
combining many facets of medicine to establish a truly integrated approach and
whilst we are at it, a Healthcare system that supports these modalities. This
will only happen and be sustainable through continuing education.
Through the course of the past 5 years, I
have come to the conclusion that there is an urgent need for a place or center
where information of this nature is readily available, with an integrated
approach to wellness. There must also be a program of attitudinal change.
Submission 55 (Ms
Lisa Whittaker).
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