Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Rolfing, Kinesiology, Crystals and other Preternatural Practices! - Why am I'm paying for them?

Loretta Marron OAM BSc

articles by this author...

From a Skeptics Perspective: Loretta Marron, a science graduate with a business background, was Australian Skeptic of the Year for 2007 and in 2011. She is the Chief Executive Officer of the Friends of Science in Medicine and that organisation won Australian Skeptic of the Year for 2012. On Australia Day 2014 she was awarded the Medal of the Order of Australia (OAM ) for "service to community health"  Loretta edits the websites www.healthinformation.com.au & www.scienceinmedicine.org.au

When the budget came out last month, private health insurance (PHI) was suddenly in the spotlight when funding was allocated for the investigation into so-called 'natural' services they include in their'extras'. Having left Medibank two years ago, when they announced they were including a rebate forhomeopathy, this is music to my ears.

PHI are health insurance funds and not medical funds.  While they state that they have a responsibility to "provide members with access, choice and flexibility in the treatment of health related illness or injury, through sustainable products", many of the services provided by Alternative Medicine (AltMed) and other so-called 'natural'  health practitioners that PHIs now pay rebates for, are based on alternative belief systems. 

There are 36 PHI funds and all but one, the Doctor's Health Fund, includes AltMed services, so I am now a member of the only fund where I know that I am not directly paying for quackery through my membership fees.  However, despite my best efforts, I am supporting many pseudo-scientific practices thanks to the Private Health Insurance Rebate (also known as the Federal Government 30% rebate) which contributes at least 30 cents for every dollar to pay for private health insurance; including  some of my (and your) taxes.  For some of the PHI's, with no opt-out , try to exclude these unproven services, and you may find your premiums are increased!

Currently, the AltMed Industry is a $3 billion dollar industry, with services subsided by Government funding through PHI's and Medicare, but those days may soon be over.  The 2012 Budget announced that there will be a "crack down on taxpayers' funds being used to subsidise 'natural therapy' services which do not present clear evidence they are clinically effective."   These are reported to include naturopathy, aromatherapy, ear candling, crystal therapy, flower essences, homeopathy, iridology, kinesiology, reiki and a very odd chiropractic technique called rolfing. 

In an effort to save $30 million a year, the budget has provided the Chief Medical Officer (CMO) with a million dollars and one year to complete his review of AltMed therapies, after which time "the Private Health Insurance Rebate will be paid for insurance products that cover natural therapy services only where the Chief Medical Officer finds there is clear evidence they are clinically effective."  

However, the investigation does not include chiropractic or acupuncture. 

While most of us think of chiropractic as a treatment for back pain, for which there is some evidence, hundreds of chiropractors take the dubious elements of chiropractic into absurd realms, and are openly targeting the lucrative market of babies and children.  The Chiropractors' Association of Australia (CAA), the peak body for chiropractors, has a strategic plan with a vision statement that "chiropractic is recognized as the most effective and cost efficient health regime of first choice that is readily accessible to all people"  as part of a long term goal to challenge the GP's for their small patients. 

The CAA also assess courses for practicing chiropractors such as "Double your Practice... with Children and Families!!" which attracts 4.5   Formal Learning Activities (FLA) hours and includes a wide range of objectives such as "How to build a family/Paediatric Wellness Practice", "How to dramatically increase the number of children and families you see in practice" and "How to have the majority of your patients as children".  

Another questionable course offered by the CAA, and there are many of them, is Auriculotherapy, which attracts 7.5 FLA hours and relates to diagnosing and treating patients through their ears

Chiropractors also widely use a range of unproven devices, such as the Activator  (which is justifiably described as a "stick that goes click")  and the "Insight Subluxation Station"  for diagnostics and treatments. These have also been accepted onto the Australian Register of Therapeutic Goods!

Chiropractors have been registered since 1985, but as they are self-regulated unless significant harm to a patient can be proven, there is no consumer protection.  Hundreds of chiropractic websites suggest that they can assist a wide range of childhood health conditions including ADHD, asthma, allergies, bedwetting, colic and ear infection, by using spinal manipulation.   Board members of the CAA are known to run anti-vaccination seminars to new parents, and the majority of the membership of the anti-vaccination group, the AVN is made up of chiropractors.

Complaints sent to AHPRA in 2010, relating to a wide range of claims made on practitioner website, were forwarded to the Chiropractic Board of Australia and two years on, they remain unchallenged.  This is not surprising in that some of their board members still support 'fundamentalist' 19th century-based chiropractic beliefs concerning  the existence of the "Vertebral Subluxation Complex" in the spine; alleged to block mythical "innate energy" which, when released, cures most health conditions and boosts immune systems so that vaccination is not required. 

While there is also some evidence that medical acupuncture  may help with some pain and nausea, it does not alter the course of any disease. While it warrants further research, claims made by other acupuncturists and Chinese Traditional Medicine practitioners are often grossly exaggerated, with some even claiming everything from helping patients quit smoking to  curing cancer, for which, again,  there is no evidence. 

Chinese Traditional Medicine (CTM) will be included under the Australian Health Practitioners Regulatory Agency (AHPRA) umbrella on 1 July 2012.  Based on the hundreds of chiropractic websites still targeting children, I have little confidence that registration will offer any additional consumer protection from recalcitrant CTM practitioners.

While the budget announcement has already acknowledged the lack of evidence for many AltMed therapies, "the elephants in the room";  chiropractic and acupuncture, with a brief that excludes them, will escape scrutiny by the CMO.  This will mean that vaccination rates will continue to plummet, parents of sick children, as well as patients with cancer and other major illnesses,  will be sold false promises at sometimes a huge cost; both financially and through the delay in administering evidence-based treatments. 

While some of the  services investigated by the CMO will be exposed as placebos, for treatments offered by 'fundamentalist' chiropractic and many acupuncturists we taxpayers will continue to pay the 30% subsidy, even though they are clearly not clinically effective.  In other words, for these practitioners, it will remain business as usual.

Return to home

Submitted by Peter Kennedy on Mon, 20/08/2012 - 14:46.

Dear Jenny and Mark
You are aiming your attack in exactly the opposite direction to that which is required.
Loretta and I are not seeking to limit anyone's choices, we are seeking to REMOVE the limits on choices which Medibank and all the other health funds impose (we are not just picking on Medibank, as Loretta points out they ALL do it). We would like to choose NOT to pay for worthless treatments which we never intend to use, but we are not allowed to!
Jenny, rip-off quacks are getting away with murder right now! And WE are being FORCED to pay their "professional fees"!
And Mark, I have never "claimed to be a medical doctor" and unlike you have no vested interest here (except the vested interest I have declared: stopping quacks from taking money out of my pocket against my will for treatments which I never asked for and do not want).

Submitted by Mark Coleman on Fri, 24/08/2012 - 16:10.

Dear Peter,
Taken from the Clinical Excellence Commission website:
Deputy Chief Executive Officer
Dr Peter Kennedy MBBS, FRACP

Would you confirm this is not you?
Regards, Mark.

Submitted by Jenny on Tue, 26/06/2012 - 12:03.

Why did my father fight for the freedom of this country from 1936 to 1945 (I was four when he returned). Sadly, the values we treasured so dearly then have now been taken from us. That being freedom to make choices. This controlling attitude being dogmatically shoved in our face about health choices by a woman whom calls herself a scientist but admits to no formal training in health sciences is biased and often poorly resarched. Loretta Marron was born in Germany and migrated to Australia, yet thinks she has the right to dictate how our health system works. So a homeopath advised you against chemotherapy for breast cancer in 2004 ? As a scientist, did you check on the credentials of the therapist before visiting her ? Surely you would have checked on her accreditation and qualifications. All registered natural therapists are affilliated with a professional body such as ANTA,with a strict code of conduct to do no harm and to only treat patients within the framework of their training and capacity as a complementary therapist, NOT a primary health care worker. Surely you reported the therapist to the CRP as you have done to over 800 CAM websites for what you believe to be misleading advertising. Ban CAM and it will become a booming undercover industry with the results being all sorts of rip-off quacks getting away with murder.

Submitted by steve jenkin on Thu, 07/06/2012 - 09:47.

This is Peter Arnold's entry from the published list of members of "Friends of Science in Medicine"

Dr Peter C. Arnold BSc MBBCh BA, Formerly Chairman, Federal AMA and Deputy President NSW Medical Board.

I find it disingenuous for members of FoSiM to not declare their membership when actively engaging in one of their campaigns. In the same way that Marron is a director and paid employee of FoSiM and doesn't declare that either.

This is not modelling best conduct.

Submitted by Joseph Ierano, Doctor of Chiropractic on Wed, 06/06/2012 - 23:50.

I thank Ms Marron for her passionate discourse surrounding the flawed practices of the systems she (and many) refer to as "natural therapies".

As a self conferred sceptic (I have no national award for what is really a sound philosophical state of mind), and similarly having a science grounding but a business 'foreground', I have looked into the flawed practice of chiropractic, the flawed practice of TCM, the flawed practice of Rolfing - which some of my patients turn to for welcome relief of pain - which indeed is NOT chiropractic. I am sceptical of Ms Marron's information here.

In my health discipline travels I stumbled upon the flawed practice of medicine too, and the ever changing flaws of pharmacopeia that we acknowledge as 'knowledge' ever changing. However the whole profession does not need to suddenly fall in to disrepute does it?

Health care providers can be a desperate dissonant bunch, constantly touting that their cures reign supreme. Thats what we tend to do in a free market place that was borne of the literal marketplace where we showed our wares openly. But alas regulation MUST protect the innocent and that is why we are registered professions now. Chiropractic registered since 1978, not 1985, as Marron incorrectly states. I doubt her ability to research a somewhat minor point?

A major point is that Chiropractors do not regulate any differently from the medical doctors they studied alongside with at university. True they may have made stupid claims in the past, thinking they can cure anything outside of the manual care and neuro-musculoskeletal realm they are experts in. But what of the medical manipulation experts who treat children? Yes, they exist. Osteopaths have done so longer than we.

Chiropractors treat children with postural and musculoskeletal dysfunction and spinal pain syndromes daily. Why? Because they have joints and spines. Yes little ones at that. Because spinal care that starts young, conservatively, and as a 'first-choice' practice can avoid the use of drugs and surgery. This does not mean we cure asthma or colic. Or negate medicine. I have treated MDs (several of my DC mates are married to them) and referred to and from. The touting of cure is nonsense that CAA does not tolerate and battles against, like any medical union or body.

CAA, to my knowledge, has never, ever conducted an anti-vaccination seminar and we encourage research to make the latest adverse effects upon children that certain vaccines have had to be a thing of the past. We welcome development of a flawed procedure (that it once was) called vaccination that has been refined over centuries and continues to be. Just like chiropractic has been, just like the three quarters of the world that does still rely on traditional healing.

I challenge Ms Marron to enter into a dispassionate discussion about healing methods, just as chiropractors who stand to show non-evidence based procedures for what they are, and represent the CAA, such as myself. Also, it would be encouraging that she bring the facts to her next article as this one is somewhat flawed. The 'stick that clicks' argument is flawed inasmuch as 'a hacksaw does nothing in the hands of a blacksmith' would. An instrument is an extension of the hand that manoeuvres it, as the extensive research does show it does do 'something'.

However, her main points I respectfully appreciate and can see the benefit in what she is doing. Her probing, more carefully directed, and approached with a mirrored degree of scepticism from the reader could be very useful in refining health care into one integrated system, not just 'natural' and unnatural health care.

Disclosure: I am a volunteer board member and director of the CAA, NSW Branch.

Submitted by Dr Peter Arnold on Sat, 02/06/2012 - 20:26.

Dear Pharmacists,
You expect my profession to respect your knowledge and to collaborate in the prescribing and dispensing of evidence-based pharmaceuticals.
How can you expect to retain our respect when you sell, for purely mercenary reasons, unproven rubbish to the self-same customers whom you and I are trying to treat scientifically?
Collectively, you deserve the bent spoon award given to you some years ago by Australian Skeptics.
Why don't you tell your Guild and your Society to insist on scientific practice by their members?
There are certainly exceptions amongst you, but your collective behaviour makes us doctors see you as nothing but glorified, unscientific shopkeepers.
Shame on you, as a collective!
Dr Peter Arnold

Submitted by Mark Coleman on Mon, 04/06/2012 - 09:46.

Dear Peter,
Given that you have held senior positions with the AMA and the Doctor's Health Fund it is understandable that you would make strong statements against pharmacists - it has always been the case, with a political rather than a scientific basis.
The lack of collaboration with other health professionals by the AMA, is well known and understood, but not accepted.
And when you talk about dispensing evidence-based pharmaceuticals, please examine the literature and news reports that demonstrates that a large amount of this "science fiction" is fraudulent and is used as a basis to extort large sums of money from medical consumers.
Even the retractions of exposed medical fraud continue on in some form, as that evidence has been utilised to derive other conclusions (also posing as evidence).
So pharmacists do not trust or respect the "evidence" you promote and rely on their own professional experience and judgement to sort their way through the minefield of "science fiction".
This has not, however, prevented some inter-professional and fruitful relationships developing on an individual and personal basis.
Those are formed around the integrity of those individuals, free of politics.
The "bent spoon award" is a political fiction developed to prop up the notion that medical evidence is the only evidence base, and that it is somehow the only standard.
Pharmacists prefer to judge themselves via an independent community evaluation through the Morgan-Gallup poll.
In 2012 they find their approval rating for ethics and honesty up by 1%, to a total of 88%.
For the same period, the doctors approval rating fell by 4%, to a total rating of 83%.
Thus five percentage ratings points separate pharmacists and doctors in the ethics and honesty department.
What does this tell you?
I know that this continually frustrates the skeptics and the medical profession that there is a strong quality component in the service provided by pharmacists.
However, pharmacists can see a need to improve their primary care services, but not by the dictates of the medical profession or the skeptics. Any constructive criticisms are taken on board with the remainder being dealt with for what it is.
Improved quality pharmacy services will be delivered as chargeable services, and are currently being designed.
If they attract the same consumer approval rating as for all other pharmacy services, no doubt the medical collective will oppose any government reimbursement to these quality services as well?
i2P continually takes the pharmacy leadership organisations to task for any perceived failings. This is an ongoing process if you read some of the articles from the archives.
And shame on your collective for its attempts to maintain a market share by trying to manipulate the public purse and eradicate other health modalities that provide greater consumer satisfaction than the medical model.
When you use the word "unscientific" do so in the knowledge that the medical evidence base is horribly flawed and that people promoting flawed knowledge are not respected.
Perhaps you might better utilise your time in retirement to encourage your own "collective" to tidy up its own backyard?

Submitted by Peter Kennedy on Fri, 01/06/2012 - 13:47.

But unfortunately only doctors and their immediate families can join the Doctors' Health Fund, so that's not a solution for most people.

I too complained to Medibank about this and the excuse was "most of our members want us to cover these services". (Do they really? Nobody ever asked me if I wanted to pay for them.) If most of their members wanted Medibank to insure them against losing money at the TAB, would they cover that too?

And then on the other hand, Medibank refuses to cover laser corneal surgery to correct myopia, a procedure with solid scientific proof that it works and that side effects are relatively rare, trivial or easily controlled. Even though paying for one laser eye op in a lifetime would save Medibank decades of payouts for glasses and contact lenses, totalling a much greater expense. The excuse they gave me was "because it doesn't have a Medicare Item Number".

Get that? Medibank won't cover anything that a real doctor does, no matter how beneficial to patient health and scientifically sound it is, unless Medicare also covers (part of) the same procedure/treatment. In fact they apparently legally CAN'T cover it, because the only medical expenses that private health funds are allowed to cover are "gap" amounts of procedures/treatments for which Medicare pays part of the doctor's fee.

But they CAN and DO cover and pay for ANYTHING that any anti-scientific witchdoctor does for the purpose of supposedly improving your health. And we are FORCED to pay for it!

The system is totally upside-down!

Submitted by Mark Coleman on Mon, 04/06/2012 - 09:04.

Dear Peter,
Some of your comments are a bit misleading and confusing.
You have previously claimed to be a medical doctor and if that is correct, you can choose to belong to the Doctor's Health Fund.
That solves your problem of not having to subsidise other health modalities.
The author of the above article is not a medical doctor, yet claims to be a member of the Doctor's Health Fund.
Something is not quite right here!
The fact that other health funds cover a range of modalities you take issue with arises from their member's requests and the fact that those people get better care and service from those modalities than they do from their medical doctor.
Freedom of choice is a concept that most people can live with and you certainly have it...but you seem to choose Medibank as your health fund.
That is your choice.
Yet you seek to limit the choices for all other consumers in association with your "friends".
Your reference to "witch doctors" and "anti-science" have no credibility when compared to the "science fiction" that is published as "evidence" for mainstream drugs.
Given your public position in upholding "clinical excellence" I would suggest that cleaning up your own backyard would attract more support and be a better starting point than attacking other health modalities.
Medical fraud is something that I do not wish to personally subsidise.

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