But the gardener’s delight may be a patient’s peril – recent tests suggest some ginkgo products in Australia have been adulterated and that consumers are being conned.

Dr Ken Harvey, Adjunct Senior Research Fellow in the School of Public Health at La Trobe University, has been investigating the issue over the past year, and has some questions for the Therapeutic Goods Administration.

He writes:

“Ginkgo biloba (the Maidenhair tree) is a deciduous tree native to China, Korea and Japan. Ginkgo leaves and seeds have a long history of use in traditional Chinese medicine for a range of conditions. Ginkgo is one of the most widely used herbal medicines in Europe and the United States of America.

There are currently more than 400 products that contain Ginkgo on the Australian Register of Therapeutic Goods (ARTG). These are listed medicines and are commonly indicated for stimulating blood circulation.

On 2 October, 2009 the TGA noted (on their web site) that they had recently conducted tests on twenty-two (22) batches of herbal medicines containing Ginkgo biloba, covering twenty (20) products.

The TGA said:

“In some of the samples tested, elevated levels of quercetin and rutin were noted. These are naturally occurring components found in Ginkgo and many other plants. Variation in the content of these components may occur due to natural variation in the plants or the processing and storage of the herbal material. The TGA is currently working with its expert advisory committees and the complementary medicine industry associations to refine the quality standards for Ginkgo extracts used in medicines available in Australia.”

What the TGA neglected to point out was that one third of the samples tested had, in fact, failed the United States Pharmacopoeia (USP) identity test for Ginkgo biloba (Test B) because they had ratios of flavonoid components that were consistent with adulteration, not natural variation (for more info, see here and here).

It is common knowledge that some Chinese suppliers of cheap Ginkgo use only a little genuine leaf extract and spike it with less expensive sources of flavonoids, such as rutin (from buckwheat). This tricks standard tests that looks only at the total amount of flavonoids, not the spectrum specific to ginkgo. The concept is not dissimilar to
the scandal about melamine being added to milk in China although, fortunately, the compounds used to adulterate ginkgo do not appear to be harmful.

Nevertheless, consumers unknowingly purchasing adulterated ginkgo products are being hoodwinked, sponsors of products who have sourced genuine (but more expensive) extracts of Ginkgo biloba are being disadvantaged and those responsible for supplying adulterated products are clearly engaged in deceptive and misleading conduct as defined in the Trade Practices Act, 1974.

Eleven months ago, on 21/10/2008, I submitted a Freedom of Information (FOI) request to the TGA. I said, “I wish to know if the TGA has ever tested Australian complementary medicines containing Ginkgo biloba for adulteration with added flavonol glycosides or aglycones such as rutin from buckwheat”.

On 04/12/2008 I received a telephone call from Dr David Briggs (then Head of the Office of Complementary Medicines, TGA). He said, “the TGA was looking into this matter”. Subsequently, I heard no more.

On 11/05/2009 I became aware that the TGA had found that a random sample of 20 Australian herbal products containing Ginkgo biloba had failed United States Pharmacopoeia (USP) Identification Test B.

On 13/05/2009 I telephoned the TGA to inquire why I had not been informed about these results. I was told to submit a new FOI request.

On 14/05/2009, I submitted another FOI, “From testing documents held by the TGA, I request the brand and sponsors names of the 20 products tested and the identification of those products that passed and those that failed USP Identification Test B”.

On 01/10/2009, I received a letter from the TGA refusing my FOI request on the grounds that the documents contained information that:

* could adversely effect business (of third parties) if disclosed;

* if disclosed could prejudice the future supply of information from industry.

I have written to relevant government Ministers (Butler and Ludwig) expressing my concern that the TGA had failed to properly balance the public interest for disclosure against commercial interests that support suppression.

This matter is now open for public debate.”

***

Croakey will send Dr Harvey’s article to the TGA’s media people and ask for a response. We will keep you posted.

Update…and here it is:

From a spokeswoman for the TGA:

“It is important to note first that the TGA has been provided with no evidence of significant safety matters related to Ginkgo products by Dr Harvey.

While presented as a consumer interest matter, this issue appears to have been raised to allow certain companies to attempt to gain a commercial advantage by claiming other products are not meeting standards that are not
actually part of Australian regulatory requirements.

The reasons the TGA is not releasing the information requested under FOI to Dr Harvey include the facts that:
1) no products breached applicable Australian standards at the time of testing,
2) exemptions apply under the FOI Act that exclude the documents from release  as there is the potential for damage to occur to the legitimate interests of third parties, and
3) to release the information to Dr Harvey may be detrimental to the public interest by discouraging future cooperation with TGA testing programs aimed at raising standards of therapeutic products available to the Australian people.

The TGA has released information on its website about Ginkgo and TGA’s ongoing work on this issue.

In order to ensure that the Australian public continues to have access to the highest quality Ginkgo products the TGA is working with its expert scientific advisory committees to clarify appropriate Australian requirements for the composition of Ginkgo products so that there is no ongoing confusion about this matter.”

Healthy Skepticism is hosting the panel discussion, at the Women and Children’s Hospital, to examine questions such as:

• Do partnerships with industry (as set out in Australia’s National Medicines Policy) bring about better health  outcomes?

• What are the strengths and deficiencies of our current system of regulation?

• Do the Therapeutic Goods Administration and state regulatory authorities have the political support and resources necessary to maintain objectivity?

• Is public access to regulatory processes and decisions sufficient to properly evaluate the operation of the policy?

The panellists will be:

• Hon Mark Butler MP, Parliamentary Secretary for Health
• Emeritus Prof Lloyd Sansom, AO, Chair, Pharmaceutical Benefits Advisory Committee
• Assoc/Prof Chris Doecke, Director of Pharmacy Services, Royal Adelaide Hospital
• Emeritus Prof Peter McDonald, AM, retired Infectious Diseases physician
• Dr Agnes Vitry, Senior Research Fellow, School of Pharmacy and Medical Sciences, Uni SA
• Dr Ken Harvey, Senior Research Fellow, School of Public Health, La Trobe University
• Dr Jon Jureidini, Head, Department of Psychological Medicine, Women’s & Children’s Hospital, and Chair, Healthy Skepticism
• Dr Peter Mansfield, OAM, GP and Director, Healthy Skepticism

The session will be facilitated by Prof Anne Tonkin Director, Medicine Learning & Teaching Unit, Adelaide University.

And here is the statement announcing the forum:

Healthy Skepticism, the international campaign against misleading health marketing, today called for a major review of government controls of medicines in Australia.

“Vioxx killed more Australians than the Victorian bushfires. Just as we re-think bushfire preparedness, it’s time we re-examined how well the public is protected by pharmaceutical regulation,” said Dr Peter Mansfield, the organisation’s director.

Australian regulatory processes failed to prevent the Vioxx disaster a few years ago because of failure on several fronts: “Drug regulators did not warn prescribers appropriately about potential cardiovascular risks. The Pharmaceutical Benefits Scheme did not limit unjustified drug expenditures. … Drug companies ran intense and misleading promotional campaigns. … Independent drug information was insufficient to counter the effects of the millions of dollars spent on advertising.”1

Dr Agnes Vitry (School of Pharmacy and Medical Sciences, University of South Australia) says that although Australia has a strong National Medicines Policy compared to most other countries, there are concerns that Australian regulators’ dependence on fees paid by drug companies might create a situation where they are more focused on serving the industry rather than prioritising the interests of public health e.g. by fast-tracking assessments without appropriate data to assess safety issues. The medicines agency requires more power and resources to ensure that safety is actively monitored after drugs are approved.

There are also concerns about Australia’s reliance on industry “self-regulation” to control the advertising and promotion of medicines. As Dr Ken Harvey (School of Public Health, La Trobe University) says, “The focus on self-regulation has produced a plethora of industry codes and complaint systems which makes it difficult for complainants to know where to send a complaint. There are gross inconsistencies between various codes.”

Healthy Skepticism would like to see much more streamlined and effective system, capable of meaningful constraint of companies like Pfizer, whose inappropriate marketing recently prompted US courts to order payment of $2.3 billion.

By contrast, as Harvey says, “Pfizer Australia has had 17 complaints against Medicines Australia (MA) Code of Conduct upheld during 2005-09. Although one of these complaints received the maximum fine of $200,000, over this time the fines only averaged $50,000. There is no evidence that such modest fines have reduced Code violations by Pfizer or other member companies. “

1. Vitry A, Lexchin J, Mansfield PR. Is Australia’s national medicines policy failing? The case of COX-2 inhibitors.  Int J Health Serv. 2007;37:735-44.

More details are available here.

He writes:

The New York Times report says: “Prosecutors said that they have become so alarmed by the growing criminality in the industry that they have begun increasing fines into the billions of dollars and will soon start charging doctors individually as well.”

Not in Australia unfortunately!

This topic was aired on ABC Radio “World Today” program today. The transcript hasn’t added my interview but I made the point that Pfizer Australia has had 17 complaints against Medicines Australia self-regulatory Code of Conduct upheld during 2005-09. Although one of these complaints received the maximum fine of $200,000, over this time the fines only averaged $50,000. There is no evidence that such fines have reduced Code violations by Pfizer or other member companies.

Somewhat different to the $2.8 billion fine imposed on Pfizer by U.S. regulators!

Which is why Choice (Australian Consumers Association) and others wanted Medicines Australia to increase the maximum fine for Code transgressions to $1 million in submissions to the recent Code review. Not surprisingly, this was rejected by MA who then went on to make a token increase in fines of $50,000 only taking the maximum fine to $250,000.

Currently, Australia has a variety of complex and convoluted co-regulatory systems to control unethical therapeutic claims and promotional practices depending upon the type of product (innovator and generic prescription, over-the-counter and complementary medicines, therapeutic devices, food and cosmetics) and the media in which claims are made. There are different standards and gross inconsistencies between various Codes of Conduct, their complaint processes, timeliness, transparency, sanctions, monitoring and effectiveness.

I have suggested to the Australian Competition and Consumers Commission (ACCC) that it is time this craziness was simplified and unified by creating one Code applicable to all therapeutic claims and promotional practice; one complaint (and appeal) process, one monitoring process and one set of effective sanctions, including corrective advertising orders and fines related to the sales income of the product and company involved.

The process should be overseen by government, funded by industry (using a moiety of product registration fees), and administered by an independent committee representative of all stakeholders. The system should have a legislative base in the Therapeutic Goods Act and/or regulations and be capable of being enforced. South African legislation provides a model of such a broader system (involving all types of medicines), see here.

This would be in line with the 2007 World Health Assembly Resolution WHA 60.16.5 on Rational Use of Medicines which urged member states to,
“Enact new, or enforce existing, legislation to ban inaccurate,
misleading or unethical promotion of medicines, to monitor
promotion of medicines, and to develop and implement programmes
that will provide independent, non-promotional information about
medicines”.

• There should be a common national approach to evaluating all health interventions, with consistent evaluation of medical care, pharmaceuticals, prevention and population health interventions, medical devices and prostheses, allied health and complementary medicine.

“To use an example this might allow comparison of the relative efficacy of a medical intervention (gastric bypass), a pharmaceutical intervention (an anti-obesity drug), an allied health intervention (a structured perogram of exercises and diet management) and a population health intervention (a community walking program) in reducing obesity. P 97

• The Commission stresses the need for the planned National Health Promotion and Prevention Agency to be independent and to have a broader brief than has been envisaged to date by the Federal Government.

It should work across portfolios and industries, and also have major responsibility for commissioning, collecting and disseminating evidence on the good buys in prevention. It should also lead the development of new Healthy Australia Goals.

“Our model is fundamentally about engaging the whole community in prevention – individuals, the health sector, business, public health, researchers, sports, arts, the media, the finance sector, as well as governments.” P 97

• The Australian Commission on Safety and Quality in Health Care should shift from being a temporary body to becoming a permanent, independent national organisation. P 139

• A national health care quality innovations awards program should be established to recognise excellence across all health care settings. p 141

• Health workforce opinion surveys should be conducted regularly “so that we can listen and learn about what needs to be improved to make our health system work better.” P 125

Last night he gave a public lecture in Sydney, which was attended by Croakey contributor and proud skeptic, Dr Peter Arnold, who has filed this report:

“With the exception of an unhappy homeopath, the audience at the Seymour Centre on Wednesday evening gave Simon Singh an enthusiastic reception at his Sydney University’s ‘Sydney Ideas’ talk.

Singh’s latest book, ‘Trick or Treatment’, co-written with Professor Edzard Ernst, Chair of Complementary Medicine at Exeter University, is unfortunately not available here in any quantity.  His previous book ‘Big Bang’ has been available since release in 2004.

Singh took the audience on a trip from the exposure of Chinese heart surgery, allegedly done ‘under acupuncture anaesthesia’, through a discussion of the rationale of controlled trials of purported remedies, whether ‘natural’ or discovered by pharmaceutical companies.

Reviewing the history of homeopathy, he demonstrated the need for properly conducted trials, even of the seemingly craziest theories. He illustrated one of these by referring to Fritz Zwicky, thought to be a real ‘nutter’ when he suggested the existence of dark matter, but since proven to have been correct.

Singh argued strongly against giving patients with serious illnesses false hope about possible cures, when the remedies were totally unproven.
Simon argued forcefully for the same rigorous testing to be applied to any proposed remedy, regardless of its source.

He then explained the background to his being sued by the British Chiropractic Association.

Unfortunately for all of us, even here in Australia, it seems that a libel action could be mounted in the UK for what we say or write downunder – the British courts have a global jurisdiction in these matters.

And the onus of proof is on the defendant!

Simon alluded to the campaign being mounted in the UK to have the law changed.

He concluded the evening answering questions about the practice of alternative therapies by some registered medical practitioners, justifying themselves on the grounds that it can’t hurt the patient and might just work.

The irony that people in the UK must be trained as vets to treat animals, but need not be trained as doctors to treat humans was not lost on the audience.

Our lonely homeopath, initially cheered on for her courage in coming forward, clearly had no understanding of the meaning of the concept of ‘meta-analysis’.

Quite failing to comprehend what this entails, she finally earned the derision of the audience as her ignorance unfolded through her interminable ‘question’ to Simon.

Chairman Professor David Day, Dean of Science, thankfully stepped up to the mike and put a stop to the rowdy exchange which had ensued.

The meeting concluded with (almost) unanimous acclamation for Simon.”

You can read more about Singh’s stoush with the chiropractors here, in the latest British Medical Journal.

Meanwhile, Michael Vagg, a member of Australian Skeptics, has written the following account for Croakey:

“The well regarded UK science writer Simon Singh published an article in The Guardian newspaper last year to coincide with Chiropractic Awareness Week.

In the article he wrote that the British Chiropractic Association (BCA) ‘happily promotes bogus treatments’ in that it recommends chiropractic treatment for conditions such as infantile colic and asthma.

Singh went on to detail the lack of scientific evidence to support these claims in his article.

He based much of the article on a book he had co-authored with Professor Edzard Ernst, a Professor of Complementary Medicine in the UK entitled Trick or Treatment: The Undeniable Facts About Alternative Medicine. The BCA, rather than backing up its claims of efficacy with scientific evidence, sued Singh for libel.

Events escalated after the preliminary hearing for the case took place in May of this year. The presiding magistrate Sir David Eady, was required to rule on the meaning of the objectionable words, and decided to interpret the phrase ‘happily promotes bogus treatments’ as meaning that Singh was alleging he could prove that the BCA knowingly and dishonestly promoted treatments which it knew to be ineffective. Neither Singh nor the BCA had understood the phrase to mean what the judge decided it meant.

The BCA appears to be angling for a court win similar to the decision of the USA Supreme Court against in the American Medical Association in 1990 where the AMA was forced to stop discouraging the public from using chiropractors.

This was on the basis of restraint of trade, rather than on the basis of convincing scientific evidence of the effectiveness of chiropractic.

A major libel payout against Singh would have an enormous negative effect on journalists reporting the steady stream of negative studies which have been published in high-quality journals for years now, many of them ironically funded by the National Centre for Complementary and Alternative Medicine (NCCAM) in the US.

Newsweek magazine recently reported that NCCAM has spent over $US2.5 billion over the last decade researched alternative medical treatments and has failed to have even one modality proven to be effective for a single condition or symptom at a level which would encourage mainstream adoption of the treatment.

After it appeared Singh might have to settle as his case had become unwinnable, the online community weighed in.

In early June a group of bloggers and scientists began inundating the Advertising Standards Authority with complaints about individual websites and the claims made thereon. The result was stunning. Within a week, bloggers had laid complaints against over 500 websites, and hundreds of them had been either taken down or modified.

The legal blogger Jack of Kent described it as the ‘Quacklash’. The regulatory scrutiny of treatment claims of chiropractic was dramatically increased, and the processing of the complaints lodged with the Advertising Standards Authority will probably lead to increased examination of the claims of chiropractic treatment to treat such conditions as infantile colic, asthma, frequent crying and ear infections.

The Sense About Science charity has launched a campaign entitled Keep Libel Laws Out of Science, and began with an online petition demanding changes to the British libel laws to protect scientific debate. At present the petition has over 12000 signatories, including celebrities such as Stephen Fry and Ricky Gervais, as well as a galaxy of scientists from the most eminent Nobel laureates to undergraduate students.

Encouraged by the support, Singh has announced that he intends to appeal the controversial preliminary decision, and will continue to fight the action.

For its part, the BCA has sent a circular to its members ‘strongly encouraging’ them to review their advertising materials and remove claims such as those subject to legal action. This has also been done by some other smaller professional bodies such as the United Chiroparctic Association and the McTimoney Chiropractic Association in the UK. The BCA has also published its scientific evidence in support of its claims. A typical response from medical professionals is found in Prof David Colquhuon’s Improbable Science blog here. Suffice to say that Simon Singh’s defence of Fair Comment is looking fairer by the week.

The overriding principle at stake in this imbroglio is that journalists should not be threatened with legal action (note that Singh himself was sued, not the Guardian) for making justifiable comments, particularly in an arena like scientific debate where the self-correcting process of aggressive peer review allows for a far more robust consensus of the truth to be arrived at compared to politics or economics.”

This week the Steering Committee for the Australian Register of Naturopaths and Herbalists has formally called for submissions as part of its process to set up an independent register for Australia’s largest complementary medicine professional group.

Chinese Medicine practitioners have recently been announced as one of the three new professions to be part of the National Registration and Accreditation Scheme for Health Professionals, joining Chiropractors and Osteopaths as registered complementary medicine professions.

However naturopaths are by far the largest complementary medicine profession in Australia and at this stage don’t look to be considered for this process until 2012 when currently unregistered practitioners are considered.

A report commissioned by the Victorian government in 2003 and published in 2005 strongly urged that these practitioners be statutorily regulated and moves were even made towards this goal before being delayed indefinitely due to the current National Registration and Accreditation Scheme.

Whilst the aim of this register is to eventually be subsumed by this process, it is being initiated now to ensure minimum standards and afford public safety in the interim.

Many may ask why this is even a health issue? It‚s easy to dismiss the registration of complementary medicine practitioners as a trivial pursuit and this attitude could possibly be a reason that the issue has failed to gain any traction for so long. But, like it or not, complementary medicine practitioners  now form a very real part of the Australian healthcare landscape and look set to remain so for the foreseeable future.

Australians now spend more out of pocket on complementary medicine practitioner consultations than they do on conventional practitioners, and nearly half – more than half in some areas – of all health consultations are with complementary therapists.

Less than half of those who do consult with complementary therapists discuss this use with their conventional medicine practitioners, and an astounding 1 in 6 Australians now rely on complementary therapists as their primary care practitioner.

Setting benchmarks and standards in these professions has moved from an issue of minor consequence even a decade or two ago to one of major public health importance. However, whilst most of the attention on improving standards in complementary medicine has focused on product issues, practitioner issues have very much fallen off the radar.

Naturopaths are now chosen by patients with a broad range of health conditions and need appropriate levels of health knowledge not just to treat but also to be aware of the limitations of their treatments.

A case report in the Australian Family Physician highlighted this perfectly – a man with a head wound was unsuccessfully treated by his naturopath for so long that by the time he eventually consulted with a medical professional the infection had reached the meninges of his brain.

The matter here was not an issue of inefficacy of the naturopath’s treatments, but rather the opportunity costs borne by the naturopath not referring for more appropriate treatment sooner, and it could have been easily averted through adequate training.

The education situation has undoubtedly improved since the days when Australian Skeptics  members’ dogs could get a government accredited complementary training organisation registered but complementary medicine qualifications are still extremely variable.

Anyone can currently call themselves a naturopath, and practise as one, without any qualifications, and whilst four-year Bachelor degrees do exist in naturopathy there also exists a cacophony of other courses of varying quality, and numerous professional associations that are more than willing to accredit their graduates.

The board of at least one professional association that accredits practitioners is composed of representatives of various private training colleges and therefore exhibits clear conflict of interest in setting educational benchmarks. This situation has left little incentive for improving standards and earlier this year Australia’s largest complementary medicine provider cut assessment of its students by between a third and one half to better compete financially with other providers.

Accreditation of naturopaths and herbalists is currently  carried out through professional associations. However the standard to which this is done is variable due to the large number of associations in Australia. Qualifications for entry, continuing professional education requirements and practice standards all vary considerably, as do complaints handling processes. Sometimes this can have drastic consequences.

One naturopath was allowed to remain a member of his professional association due to fear of legal action even after it had become apparent that he had falsified qualifications and had a history of fraud and violent crime. And even when removed from professional associations unethical practitioners may continue to practice as naturopaths.

Another naturopath was allowed to continue practising whilst under investigation for sexual crimes – eventually being found guilty of 34 counts – as there was no mechanism to bar him from practise.

Notwithstanding these examples it is patently obvious an organisation can’t promote the public’s interest and the interests of the profession it represents without clear conflict of interest. Whilst this arrangement hasn’t been legally tested in Australian it has in other jurisdictions, and is part of the reason that naturopaths are now statutorily registered in South Africa.

It should be acknowledged that the vast majority of practitioners are well qualified, behave ethically and support the initiatives to clean up the industry more generally.

However, given the emerging role that the public is choosing for naturopaths to play in healthcare it is essential that minimum benchmarks and standards are put in place by a body independent of the profession. The health and safety of a large swathe of the population is dependent on it.

• The Steering Committee for the establishment of the Australian Register of  Naturopaths and Herbalists is calling for submissions on the registration of these professions. Submissions are due in by close of business Monday, 31 August 2009. More details are here.

The Food and Drug Administration says the supplements have been associated with serious side effects, including liver toxicity.  In Canada, a class action law suit has been filed.

Harvey, Adjunct Senior Research Fellow School of Public Health, La Trobe University, says the key issue is why do the company &/or the TGA believe that Australian products are safe when some of those withdrawn in the US appear to be the same as those available in Australia; see here.

He says: “To-date, the TGA has only warned consumers not to purchase US productsvia the Internet! The assumption is that the Australian products have a different formulation and that makes them safe. No evidence has yet been provided to support this assumption.”

Here is Harvey’s letter with some questions for the Federal Government:

6 May 2009

Senator Jan McLucas
Parliamentary Secretary to the
Minister for Health and Ageing
Parliament House
Canberra ACT 2600

Dear Senator McLucas,

Re: TGA warning issued on complementary medicines weight loss products  (Hydroxycut)

Adam Cresswell reported today that “AUSTRALIA’S drug watchdog has warned consumers to stop using a range of weight-loss products bought on the internet from the US, after 23 reports of serious liver problems, including one death” .

“A TGA spokeswoman said last night it had been informed by the Australian sponsor, Export Corporation (Australia) Pty Ltd, that the four Hydroxycut products approved for sale in Australia had a different formulation to the products sold in the US, as some of the US ingredients were not permitted here”.

I am unclear why the TGA warning is restricted to US products bought on the Internet and why the TGA has accepted the sponsor’s advice that the Australian listed products differ from those removed in the US and Canada.

I have appended the names of Hydroxycut products (and their ingredients) listed on the ARTG as sponsored by Export Corporation (Australia) Pty Ltd.

I have attached printouts of three current Australian advertisements for Hydroxycut products from:
http://www.mrsupplement.com.au/

One advertisement promotes Hydroxycut (ARTG No: 154243) as “America’s #1 selling weight-loss supplement. The ingredients in this product appear to be the same as those in product removed from sale in the US and Canada. In particular, they include Garcinia quaesita (cambogia) . The latter ingredient has been associated with hepatoxity .

I have also attached the detailed US Health Hazard Evaluation Board Report concerning Hydroxycut, “Liver toxicity following consumption of dietary supplement”.

I have the following questions:
1.     In what way does the formulation of Hydroxycut product (ARTG No: 154243) differ from those removed from sale in the US and Canada?
2.    Why has the TGA not withdrawn this product from the Australian market as has occurred in the USA and Canada?
3.    Does the TGA agree that the claims made for these products in the attached advertisements breach the Therapeutic Goods Advertising Code? If so, what action will be taken?

Yours sincerely,

Dr. Ken Harvey
Adjunct Senior Research Fellow
School of Public Health, La Trobe University
http://www.medreach.com.au

“I remember when the NT Intervention was announced, many families rang asking why the government was sending the army to take their children. This wasn’t through rumour mongering, but what people had deduced from news reports on radios and TV. Crucially, this shows how threatened and vulnerable Aboriginal peoples feel. These fears continue to the present day.

My co-lecturer who had lived in Darwin and worked at the university said she and her relatives no longer walk the streets and go shopping during the day. She was, and still is embarrassed by the outrageous child abuse claims in the media. This is one reason why she retired and left Darwin.

Another mother said; I do every time I can to bring up my children with dignity pride and self-esteem.  I send them to school, I feed them properly, I take great care of them, but through the intervention I have stopped watching TV and listening to the radio, I will not go to Darwin because I know I will be viewed upon by whites as a child abuser. These claims are unfair and racially based.  I personally believe the level of child abuse in north-east Arnhem is way below the national average.

I was reminded again a couple of night ago of how embedded these feelings of oppression and second class citizens are in people’s psyche and lives. Two families have been staying with us in Darwin for the past few weeks. For an outing we went to the eatery at the Wharf. All the adults have been to Darwin and one had travelled extensively overseas. All shop comfortably by presenting the goods to the cashier and holding out the money, there’s no need to engage. When confronted with ordering the fish and chips at the Wharf, everyone in felt intimidated and unable to order, though it was easy to buy drinks from the self serve fridge. It wasn’t a matter of English, all of the family members speak and understand sufficient English; it was a matter of intimidation by the dominant culture.

What affects me most are these unfounded and untrue reports in the media. I remember Fran Kelly one morning on Breakfast talked about ‘the rivers of alcohol flowing into Arnhemland’ …. I wrote to her immediately requesting she correct her statement by acknowledging that East Arnhemland is dry (except for the mining town of Nhulunbuy). There was no correction, apology nor reply from her.

Issues that deserve greater public debate and attention include:

• Self esteem and confidence first

I don’t think anything is more important for a child to develop than self-esteem, confidence and a vision for the future. Skills will always follow. I say this as a teacher of 30 years.  The Yolngu men and women who most comfortably and ably managed to live in both worlds are highly educated and in your culture. Often these people have little western schooling, but because they are confident on the ground of their culture identity, they actively and productively engage with western culture.

We should not not equate schooling with education.

May I tell you a short story? Yingiya grew up around the Arafura Swamp, he didn’t attend school until he was about 12 years old. When he started school he had no Western numeracy, nor knowledge of English. One night I asked him to give a guest lecture, during his talk he told how he had become a pilot, then a bi-cultural consultant. One of the students asked, “What would you have become if you had gone to school when you were 4 years old?” Implying that he may have become a doctor, a lawyer or the Prime Minister. Yingiya replied that he would not have achieved anything, he would not have had a future…   he replied; ‘My parents had given him the best education possible. I learnt about myself and his place within my families, I learnt respect for all people and how to behave, I learnt to hypothesise and read the land and environment.”

In short he was confident in himself as a modern Yolngu man living in a modern society. While today Yingiya lectures at Charles Darwin University, he describes himself as a ‘little below the average’.

• Close the Gap in what whites know about black Australia.

I am not convinced that Sandra Bailey is right (in the Inside Story article) when she intimates that with better representation, we would get better health outcomes. All too often I see advisory groups set up by governments with little or no effect on policy.

But I do think a system is needed to educate public servants and policymakers. Although these people are kind and thoughtful in their own worlds, they are also remarkably ignorant and deeply disrespectful of Australia’s First nations peoples.

Often policy makers in Canberra have no ‘on the ground’ knowledge of the situation in North East Arnhemland. They do not know how to consult with Yolŋu and seem uninterested in learning.

How is it possible for these bureaucrats to develop sound policy for peoples they know nothing about? They should all undertake programs of study, not a two day cross-cultural workshop, but a program where their ethnocentric views of the world are challenged. By way of example; I would estimate that less than 2% of Northern Territory and Commonwealth public servants would know the name of the most widely spoken language in the Northern Territory after English .

• Upskilling

In the Inside Story article, Alastair Harris is quoted as being convinced that the best way forward is to up skill the Aboriginal health sector. While I don’t believe up skilling is the most important step that could be taken to improve Aboriginal health, it is important.

I am wary of black and white health professionals who are blinkered and not trained to be respectful and knowledgeable of the many and varied First Nation cultures in Australia.  All too often I see white and black nurses patronising, arrogant and acting disrespectfully towards families from East Arnhem.

• Some specific issues

Governments must change their direction, away from developing policy based on ideology, to developing policy based on evidence and equality.

Possibly the most important and step in the government can take to improve its interactions with Australia’s First Nations peoples is to acknowledge that Australia is like the European Union: composed of multiple nation states; each with its own unique history, language, land and culture.

When governments are able to recognize this diversity and engage meaningfully and respectfully, then it will begin to understand how to work productively with First Nations peoples through their own governance structures.

• Homelands

The evidence is readily available and has been for years, that people living on homelands are happier, healthier, longer living and more productive than their counterparts who have been centralised into ‘communities’ for the bureaucratic convenience of governments. Where peoples moved from their own country into towns owned by ‘others’ where they do not have the ‘citizenship rights’ through the land.

• Distance learning

Remote white children across Australia are offered remote learning opportunities through computers, satellite connections and distance learning. Where one child on a cattle station is able to access these services, black children in numbers of 40 and 50 are not.

• Interpreters

The national Translating and Interpreting Service (TIS) offers services to migrants and people from other countries. It is also offers Auslan, (Australian Sign Language) for Australians who need assistance. Notably this national service does not provide for assistance for First Nation Australian languages.

While the government trains and tests interpreters in multiple languages, it does not offer any assistance for First Nation languages. This is the reason why there are no professional level Interpreters for any of Australia’s First Nation languages. If my relatives from Arnhem want an Interpreter to assist speaking with Telstra, the ATO or FACHSIA they have to pay.

It’s not because of the number of speakers, there are more speakers of Yolngu language in Arnhemland than Auslan speakers in Australia, let alone Haitian or some other obscure language.

“The Australian has reported my complaints to authorities over the promotion of complementary medicines on “liverdoctor.com” by Dr Sandra Cabot; real name Dr Sandra McRae, a NSW registered medical practitioner.

Dr McRae responded that the complaint had been rejected by Australian authorities as being outside their jurisdiction because the website on which they appeared was subject to US rather than Australian regulations.

The domain history of “liverdoctor.com” shows that Dr McRae was listed as the administrative and technical contact for this web site until she changed this to US personnel after receiving my first complaint. She remains a medical practitioner registered in NSW, she continues to promote herself and her products using her Australian credentials and her web server and name servers remain in Australia.

The same complaint was sent to two different bodies: the industry Complaint Resolution Committee (CRC) of the Complementary HealthCare Council of Australia and the independent Complaint Resolution Panel (CRP) who administer the Therapeutic Goods Advertising Code. Both bodies were involved because the complaint involved both the web site and information on product labels.

The CRC dismissed the complaint because they believed the matter was now the responsibility of US authorities. The CRP referred the matter to the Regulatory Compliance Unit of the Therapeutic Goods Administration (TGA). I have yet to hear if they have accepted jurisdiction over this
complaint.

Regardless, the different response received from two complaint bodies dealing with the same issue highlights the current uncertainty over who has jurisdiction over information on web sites that are alleged to breach national laws.
Is it the country where the web site is based, the country where the domain is registered, or the country of the person actively promoting themselves and their products?

Can anyone cast more light on these matters?”