• A study suggesting that patients with chronic conditions value the sense of control they gain from using complementary and alternative medicines

• Five suggestions for how primary health care researchers can boost global health.

***

How patients use complementary and alternative medicines for a sense of control

Christina Hagger writes:

Self-management is touted as an ideal in chronic disease control and yet some patients find the reality offers a very constrained experience in which success is measured by adherence to the bio-medical model.

Many see the use of complementary and alternative medicines (CAM) as a way of establishing autonomy and control of their disease management – and their lives.

A recent study by researchers from Monash University examines how Australians with Type 2 diabetes and/or cardiovascular disease supplement medical care with CAM use.

It illustrates how people not only utilise medical providers and pharmaceuticals but concurrently consult with CAM practitioners and use non-biomedical therapies to enhance their well-being. Their use of CAM is framed in the context of reclaiming personal control.

The authors maintain that a sense of loss of personal control, even powerlessness, often accompanies illness, particularly chronic and degenerative conditions.

This sense of powerlessness can be heightened when people feel they are placed in a position of reliance on practitioners for advice, recommendations and medications.

Their choice of CAM is seen as ‘taking control’ by ‘doing something extra’ towards self-care and better health.  These choices included strategies ranging from prayer, yoga and meditation through to over-the-counter products.

A significant observation from participants in the study is that they felt  ‘having time’ and ‘being heard’ were central to their relationships  with their CAM practitioners.

It is of some concern that a number of participants chose to further establish their sense of autonomy and control of their disease by controlling the flow of information on their CAM usage to their doctor.

They argued such lack of information exchange was to avert negative feedback from doctors who may be dismissive or disapproving of such  choices, and reported enjoying  a ‘quiet triumph’ when certain CAMs ‘worked’.

However, lack of disclosure about CAMs use may be problematic. Not only are the effects of common CAMs products and services unknown (and untested), but also combining CAMs with other medications may be contraindicated.

• Dr Christina Hagger, PHC RIS Research Fellow (Knowledge Exchange)

CAM – an indication of non-compliance or self-management? Warren N, Canaway R, Unantenne N, Manderson L. (2012). Taking control: Complementary and alternative medicine in diabetes and cardiovascular disease management. Health, published on-line 26 Sept 2012 doi: 10.1177/1363459312460699

***

Boosting the international capacity of primary health care research

Melissa Raven writes:

Leaders in primary health care research should prioritise global research capacity development, and should support more international research collaborations, with researchers from low-income countries included both as collaborators and in capacity building.

That is according to a recent article by researchers from England, Australia, Norway, the Netherlands, and the UK.

The authors, all members of the Oxford International Primary Care Research Leadership Programme, argue that primary health care research is an international responsibility.

They give five examples of how primary health care researchers can contribute to improving health globally:

1. Providing all patients with the opportunity to participate in research and to influence the research agenda. This will increase generalisability.

2. Responding more rapidly to changes in the global healthcare environment, e.g. the emergence of infectious diseases with the potential to become epidemics or pandemics.

3. Developing better understanding of how risk factors at the environment, population, and individual level influence health. This should include often-ignored factors such as domestic violence and access to health education.

4. Harnessing new technologies such as mobile phones, which should increasingly influence research, from initiation to dissemination.

5. Developing strategies to facilitate implementation of evidence-based treatments and other interventions into primary health care practice. The decentralisation and diversity of primary health care means that this will require tailoring and targeting of strategies for different systems and settings.

The authors acknowledge some criticisms of primary health care research, but argue that it performs well when it is well funded.

They are themselves critical of the World Health Organization for not including research and academic capacity building among the five key elements of primary health care involved in achieving the goal of better health for all.

More generally, they also argue that primary health care researchers should engage more in social and political debate.

They illustrate this by provocatively arguing that the gross inequity in health globally affects everyone and, rather than being merely a local problem in low-income countries, is a threat to global stability, one which PHC can help to address.

• Melissa Raven, PHC RIS Research Fellow

Primary health care research: an international responsibility. Hay AD, Rortveit G, Purdy S, Adams J, Sanci LA, Schermer TR, Schers HJ, van der Windt DA. (2012). Primary care research – an international responsibility. Family Practice, 29(5), 499-500

***

These articles featured in October 2012 editions of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php. The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php.

***

Previous PHC RIS columns at Croakey

• Wrapping three articles on: improving organisation of services, caution on smartphone use, nurse practitioners in primary care

• How best to improve management of childhood obesity and related health problems

• Sustaining small rural primary health care services

• What is the evidence on knowledge translation strategies?

• Should your doctor be asking after your pet too?

• Nurses add value to chronic disease management

• For patients to play a more active role in managing chronic health conditions, some changes are needed

• Some useful tips for finding health policy information on the web

• Pros and cons of telehealth for people in rural areas

• What helps GPs provide better mental healthcare (and what doesn’t)

• Improving collaboration in diabetes care

• Improving dementia management in general practice

• Pets and what they do for our health

• Improving the diagnosis of ovarian cancer

• Chronic health problems and depression

• Helping older patients with chronic diseases to navigate the health system

• Tackling overuse of antibiotics

• When doctors prescribe exercise, does it make any difference?

• Caring for country is also good for Aboriginal people

• The perils of surrogate markers

• Are Australians willing to pay more for better oral health?

• What helps encourage self-care for those with chronic illness?

• More effort needed to strengthen shared care for people with serious mental illness

What is promised/likely in the federal budget

• Expansion of the national bowel cancer screening program
(Some reaction to this will follow in the next post.)

• Funding for public dental waiting lists, oral health promotion.

• Department of Health and Ageing secretary Jane Halton has hinted the tobacco tax may rise, and there have been some suggestions the Government may have been receptive to calls for the abolition of duty free cigarette sales.

• Cuts to the Medicare Safety Net are foreshadowed – see here and here.

• Cuts to private health insurance subsidies for natural therapies are expected.

• Funding for Indigenous suicide prevention (although there are concerns about how this has been organised).

• Funding for personal helpers and mentors intiative for those with severe mental illness.

• Aged care reforms.

• National Disability Insurance Scheme.

***

What some health and related groups have been asking for

• Reform of alcohol taxation.

• ACOSS has called for cuts to wasteful spending (including in health) to fund social reforms. ACOSS is also concerned by reports of cuts to single parents entitlements.

***

Rural health

The National Rural Health Alliance has created a hub for all budget news related to rural and remote health matters.

***

What’s likely to go missing? 

A far cry from last year’s focus on mental health

Sebastian Rosenberg, Senior Lecturer, Brain and Mind Research Institute, Sydney Medical School, University of Sydney
Associate, ConNetica Consulting Pty Ltd, writes:

Like the eye of Sauron, the Gillard Government’s attention remains firmly fixed on a surplus. Twelve months ago, its gaze was fixed briefly on mental health. Treasurer Swan went as far as to call the $2.2bn 5 year package the ‘centrepiece’ of last year’s budget.

The recent leak of a further $51m for Personal Helpers and Mentors called last year’s mental health package ‘unprecedented’ (I am not sure how this claim can be justified given that $1.6bn was spent on the top three Better Access Program items alone between November 2006 and November 2011, under the $5bn National Action Plan on Mental Health initiated by the Howard and Iemma governments).

Leaving aside the spin and maths, the politics suggest that between the surplus, the National Disability Insurance Scheme, ageing and some other matters, it is just not mental health’s turn.

We had our turn last year and despite the fact that the investment made struggles to maintain mental health’s share of the overall health budget, we must simply wait till the wheel turns again.

The new mental health commissions, both state and federal will have to think creatively about which services are really needed. National funding arrangements, including Activity Based Funding and the new lines of demarcation between the feds and the states in health have left responsibility for community mental health care most unclear and future funding for this area imperiled.

The governments have not agreed to any new National Action Plan but have signed a partnership agreement under CoAG worth $200m over 5 years.

There have been only two surveys specifically about mental health in the Australian community conducted by the Australian Bureau of Statistics.  In 1997 it showed that of people with a mental illness in the last 12 months, only 38% received any care for their illness.  In 2007 that figure was a disappointing 35%.

While the success or otherwise of the Better Access Program has been the subject of considerable debate, what is not in question is the Program’s capacity to highlight the massive latent community demand for mental health care.  Well over 15m services have been provided to Australians since the Program began.

The level of damage caused by mental illness, together with the level of unmet need in the community, mean that as far the budget goes, every year should be mental health’s year, at least until the community feels confident it has a service system on which it can rely.

Note from Croakey: Readers may be interested in this account of a new national mental health strategy for Canada. It proposes six strategic directions:

Promoting mental health and prevention of mental illness; Fostering recovery and upholding rights; Providing access to the right services, treatments and supports; Reducing disparity and addressing diversity and those suffering mental-health problems; Working with first nations, Inuit and Métis, communities where addictions and suicide are major problems; Mobilizing leadership and fostering collaboration.

As part of the ABIM Foundation’s Choosing Wisely campaign, this website lists tests and procedures identified by medical societies as commonly used but not always necessary. The nominations come from societies representing immunologists, family physicians, cardiologists, gastroenterologists, clinical oncologists, nephrologists, radiologists and others.

According to the ABIM statement, the lists cover matters such as whether brain imaging scans like a CT or MRI scan are necessary after fainting (probably not), and whether patients need stress imaging tests for annual checkups (not if you are an otherwise healthy adult without cardiac symptoms).

You can read more about the campaign in this JAMA article from Christine Cassel, president and CEO of the ABIM Foundation.

The campaign has been welcomed by some doctors, including the surgeon and writer Atul Gawande.

But others are not convinced the campaign will change physician or patient behaviour and see it as more of a political measure.

Meanwhile, this NYT report on the campaign mentions that a major conference will be held in Boston this month, “Avoiding Avoidable Care,” which is being billed as “the first major medical conference to focus on the perils of unnecessary and unhelpful medical care”.

All of which suggests that Croakey columnist Dr Justin Coleman has excellent timing in presenting his second instalment of the Naked Doctor column (which made its debut here earlier this year), which he introduces below by describing some of the feedback he’s had so far.

The column seeks to encourage discussion and awareness of the opportunities to do more for health by doing less. It is a compilation of articles, books and other works that highlight overdiagnosis and overtreatment.

*** 

Introducing the second instalment of Naked Doctor

Justin Coleman writes:

When the Naked Doctor bared all in January, the world stood up to watch.

Health gurus and fellow sceptics from all over the planet sent wolf-whistles of encouragement, while others posted a raspberry—or Bronx cheer, depending on country of origin. Stripping back some of the excesses of medicine is clearly a debate whose time has come.

Naked Doctor found friends in the expected places—HealthNewsReview.org, and the BMJ’s Richard Lehman —but also discovered some small, dedicated organisations with overlapping aims.

The Australian Institute for Patient and Family Centred Care plugs away at patient-centred medical care. The Slow Medicine movement is a bit like the Slow Food one, except even healthier. The folk at Healthy Skepticism beat Naked Doctor to a title which pretty neatly sums up the aim of the whole shebang. And the American College of Physicians—admittedly, not a recent Naked Doctor discovery—is climbing on board, big time, with a push to save $200 billion a year on excessive testing.

Interestingly, some commentators suggested that Naked Doctor is exposing himself to his clothed colleagues while ignoring the excesses of the alternative medicine industry. As to the former charge, there is nothing indecent about subverting a medical practice when new evidence suggests it is unhelpful to our patients. That’s what good doctors get paid to do, by a health system which can ill afford the alternative.

As for ignoring complementary and alternative medicine (CAM), the charge sticks. The lack of evidence for diagnosis and treatment is a pandemic of overwhelming proportions in CAM. Naked Doctor chose to limit entry into the strip show, where the audience at least knows the rules. He doesn’t envy those on the stage next door, attempting to peel back the layers to reveal the ghost within. He watches with interest the ongoing debate about whether those charged with that very task—CAM academics—warrant their university tenure.

Naked Doctor thanks his many emailers and tweeters for suggestions for this updated list (which is archived here and also reproduced below).

Enjoy the show.

• You can follow Justin Coleman on Twitter. 

***

Naked Doctor: the list

Over-intervention unveiled

Start at home with our very own Melissa Sweet who introduced the over-intervention theme to Crikey readers. A systematic approach is needed to balance the all-powerful “give us more” lobby.

Speaking of which, Melissa does give us more; in her non-Croakey spare time, she sums up our ‘less is more’ theme at Inside Story.

Recent Croakey stories include Simon Chapman refuting the claim of the UK quit smoking campaign that ‘not many’ smokers quit by going cold turkey, and Olga Anikeeva tries to stem the tide of antibiotic resistance.

Adelaide psychiatrist Jon Jureidini offers a fine explanation of ‘unexplanations’ in psychiatry. Jon moonlights as spokesman for Healthy Skepticism, a small group with a big mandate to counter misleading drug promotion.

Brisbane GP Andrew Gunn’s unravelling of the numbers needed to treat and to harm (NNT, NNH) is worth reading for the opening quote alone: “It is an art of no little importance to administer medicines properly: but, it is an art of much greater and more difficult acquisition to know when to suspend or altogether to omit them.” Philippe Pinel 1745-1826. Oops, a spoiler! Read it instead for the Galen quote, which is even better.

Sharon Beglee at The Daily Beast pens a neat appraisal of situations where saying ‘No’ to a test or procedure can potentially save your life. Some thoughtful doctors are voting ‘No’ when it comes to their own health—and Sharon names names.

In 2010, Archives of Internal Medicine started a column ‘Less is More: How Less Health Care Can Result in Better Health’. Section editor Deborah Grady maintains the impressive article list. Naked Doctorrecommends a pleasurable browse through the less-is-more garden, plucking full-texts at whim. A commentary on the overuse of stents in stable coronary artery disease describes what went wrong in previous meta-analyses, which included acute-MI patients. Nothing wrong with the number crunching; the results just didn’t apply to most of the stent population. Overuse of health services is understudied; why has it taken decades to reduce antibiotics for viral infections, despite the education campaigns themselves almost going viral?

Josh Freeman, physician educator, Kansas US, writes a lovely blog mixing medicine with social justice. A number of articles discuss the inequities of spending money on treatments that don’t work. He worries about sounding nihilistic when identifying useless screening tests (know the feeling!) or when criticising doctors who don’t keep up with significant shifts in evidence. But that’s part of what we clinicians get paid for.

Shannon Brownlee discusses a study by cardiologists Grace Lin and Rita Redberg, who designed three theoretical cases where evidence suggests non-intervention was the correct treatment. They found that their cardiologist colleagues would almost always recommend surgical intervention. Surprise! Maybe author Upton Sinclair had it right when he said: It is difficult to get a man to understand something when his salary depends upon his not understanding it. Talking of which, it is a concern when the BMJ notes that, of the chairs and panel members producing North America’s screening and treating guidelines for hyperlipidaemia and diabetes, half have financial conflicts of interest.

Always worth a mouse click is Dr Richard Lehman’s journal review which consistently espouses the same themes as Naked Doctor but does it on a weekly basis and is wittier. Only click on him if you promise to return. The American health system is saturated with the influence of the pharmaceutical and medical devices industry: huge payments are made directly to individuals or institutions to influence purchasing decisions. In the UK, we call this corruption, but only for the time being.

We previously invited Dr Gary Schwitzer (HealthNewsReview.org) to come out of the closet and declare himself a Naked Doctor. Gary prefers to leave his hat on, but sent us a large series of articles on disease-mongering and on overtreatment. He recently highlighted 10 imbalanced TV news stories around health screening from the respected US ABC.

Chris Del Mar’s BMJ editorial provides a cogent argument for avoiding antibiotic prescription for colds, sore throats and ear infections. Unfortunately, patients expect doctors to intervene, and even when they don’t, doctors expect that their patients expect intervention. Confused? Paul Little explains the concept here.

Pharmed Out is a Georgetown University project educating healthcare professionals about pharmaceutical marketing practices. Check out the video links on the home page.  A former drug rep ‘fesses up: Statistics are like prisoners—torture them enough and they’ll tell you what you want to hear! Grab a ‘No Drug Reps’ certificate for your waiting room or play Drug Ad Bingo in your spare time.

Departing boss of the US Medicare and Medicaid system, Dr Donald Berwick, lists ‘overtreatment’ as the first of five reasons for the very high 20-30 percent of US health spending he calls waste that yields no benefit to patients.

Has all this scepticism left you feeling naked? If so many treatments don’t seem to make much difference, what is left? It’s not our brief to list the many interventions that do work, but we do like Dr Mike Evan’s entertaining video which demonstrates how physical activity can be more effective than pharmaceuticals. The same observation prompted ‘exercise prescriptions’, championed by the folk at Exercise is Medicine, as an alternative clothing option for naked doctors.

***

Revealing what lies behind the screening

We live in testing times. The National Cancer Institute provides a wordy but interesting overview of the hazards of cancer screening.

H. Gilbert Welch, author of ‘Overdiagnosed’ (see books, below) is a natural wordsmith, crafting a fine article for the NYT: If you feel O.K., maybe you are O.K.  The truth is, the fastest way to get…disease…is to be screened for it.

Two former ‘track favourites’ for cancer screening—mammograms and PSA tests —seem to be running off the pace in 2012, although both still have plenty of backing. The controversy provides insight into the pros and cons of screening tests.

Med Page Today is a hardworking site which covers medical news for clinicians and is prepared to call bad behaviour when spotted. Its scope is broad, so use the search function to find topics such as the risks of mammography  or the increased likelihood of an ADHD diagnosis in kids who start school early. For those who can cope with long lists, read ’22 things amiss in medicine today’, by the formidable editor-at-large Dr George Lundberg, whose time at the helm of JAMA wore down his inclination to pull punches.

Patients referred for MRIs by physicians who owned their own MRI machine were almost twice as likely to have no pathology on review by an independent radiologist. Nothing beats the moolah as an incentive for ordering a test. Do private hospitals also see dollar signs when over treating patients with dementia?

***

Books that bare all

Bad Science
Ben Goldacre
British epidemiologist Goldacre bases the book on his weekly ‘Bad Science’ column in the Guardian, where he gives bad medicine a lot of column inches. In the chapter ‘Pill solves complex social problem’, he even makes the big call, ‘Before 1935 doctors were basically useless.’ Older Naked Doctor readers excepted, of course.

How We Do Harm: A Doctor Breaks Ranks About Being Sick in America
Otis Brawley and Paul Goldberg
Dr Brawley, Chief Medical Officer with The American Cancer Society, closes ranks with everyone else in this blog as we all break ranks with those forces promoting ‘the overtreatment of the rich, the under treatment of the poor [and] the financial conflicts of interest that determine the care that physicians provide.’

The Treatment Trap: how the overuse of medical care is wrecking your health and what you can do to prevent it
Rosemary Gibson and Janardan Prasad Singh
For a taste of what lies behind the logorrhoeic title, Gibson blogs here. Her 16 years’ messing about in the politics of health quality and safety gives her a keen insight into the US health system

Overtreated: Why too much medicine is making us sicker and poorer 
Shannon Brownlee, 2007, US
Find out about Roemer’s Law ‘A built hospital bed is a filled hospital bed.’ Discover the ‘Limits of Seeing’, where high tech scans make us as transparent as jellyfish, but just as often cloud the diagnosis. And read the last chapter ‘Less is More’, which would have made a great title for this Croakey page, if only Naked Doctor had thought of it first.

Testing Treatments: Better research for better healthcare 
Imogen Evans, Hazel Thornton, Iain Chalmers, Paul Glasziou
With the addition of Queensland’s Paul Glasziou, this second edition discusses how to ensure research into medical treatments best meets the needs of patients. The chapter Earlier is not necessarily better covers a Naked Doctor pet theme of the benefits and harms of screening tests.

Overdiagnosed: Making people sick in the pursuit of health
H. Gilbert Welch, Lisa Schwartz and Steve Woloshin
As a society consumed by technological advances and scientific breakthroughs, we have narrowed the definition of normal and increasingly are turning more and more people into patients. Well worth a read: but why take Naked Doctor’s word for it, when you can read the BMJ book review by Croakey regular and fellow sceptic Ray Moynihan.

Ten questions you must ask your doctor
Ray Moynihan and Melissa Sweet
Ray and Melissa would make their mothers proud and their GP nervous. Their approach to keeping the bastards honest is patient-driven quality control at its best. I just hope they book longer consultations. There is little doubt that a dose of healthy scepticism is just what the doctor ordered. Indeed, the Naked Doctor orders scepticism twice daily, taken with a glass of water and a grain of salt.

House of God
Samuel Shem
Shem’s classic 1978 novel has the narrator as an intern admitting his hospital’s most important benefactor and secretly ordering no investigations or treatment. The patient’s rapid improvement underlines the thirteenth and final law taught to the intern by his wise mentor, the Fat Man: The delivery of good medical care is to do as much nothing as possible. Another Naked Doctor favourite is his tenth law; If you don’t take a temperature, you can’t find a fever. Indeed!

Disclaimer: Reading House of God as an intern was Naked Doctor’s original inspiration for a career-long interest in avoiding overtreatment. He does still own a thermometer and uses it discretionally.

***

Naked Doctor welcomes suggestions for inclusion on this list, but is responsible for the final decision about which entries are included. Please leave your comments and suggestions below.

***

TGA is still a “black hole” for advertising complaints

Dr Ken Harvey, Adjunct Assoc Prof of Public Health at La Trobe University, writes:

Little seems to have changed inside the Therapeutic Goods Administration (TGA). And that’s despite two years of reviews into the shortcomings of its regulatory processes and the release, late last year, of the government’s blueprint for reform.

Complaints about breaches of the Therapeutic Goods Advertising Code continue to generate a weak response – the latest of which involves the TGA-listed weight-loss product Undoit®. Its suppliers claim you can eat “fat-laden, carb-dense snacks” and just pop a pill to “undo” their effects.

Proposed reforms

Stakeholders put a ton of effort into submissions that documented problems with the TGA and suggested improvements. But the government’s “reform” document contained only an ounce of movement.

Stakeholders had pointed out, for instance, that numerous reports over the past decade recommended timely and effective sanctions to deter manufacturers or importers of complementary medicines (known as sponsors) from repeated breaches of the Therapeutic Goods Advertising Code.

Yet the reform “blueprint” merely said, “The TGA will develop options for consideration by Government in consultation with stakeholders on … developing a more effective approach to sanctions and penalties for breaches of advertising requirements.”

Many stakeholders had expressed concern in the past that the TGA was a “black-hole” of communication. Consumers could submit a complaint about a product but received no communication from the TGA about the outcome of the investigation.

In response to these concerns, the reform “blueprint” said, “the TGA will adopt a strong focus on improving its communication and engagement with the community”.

Following the publication of the government’s reform “blueprint”, several TGA staff have resigned, although these changes are not reflected on the current TGA organisational chart.

Weight-loss fads

The sponsors of Undoit® claim their pills let you “have the cake without the calories” – it’s “the snack without the guilt” and “the taste without the tummy”. The sponsors claim a biscuit can be undone with one tablet, a tub of ice-cream may take two and a Big Mac and fries requires the maximum does of five pills.

Each tablet (Aust L 166770) contains Ascorbic acid 7.5 mg, Chitosan 337.5 mg and Phaseolus vulgaris 375 mg.

Another version listed on the Australian Register of Therapeutic Goods (Aust L 193428) adds the laxative Cassia senna 62.5 mg (although the marketing manager of Undoit, Michael Romm, says this version “has not been manufactured yet”).

Regardless, there is no scientific evidence that taking five pills containing Ascorbic acid, Chitosan and Phaseolus vulgaris will “undo” the impact of eating a Big Mac and fries.

More worryingly, the dose of Cassia senna contained in just one pill of the second version of the product is potentially dangerous and likely to cause diarrhoea, abdominal pain, cramping, loss of fluids and hypokalemia (low potassium). The usual recommended laxative dose of Cassia senna is 17.2 mg daily, with a maximum of 34.4 mg daily – almost half the dose of a single Undoit® pill.

The claims made for Undoit® exploit the large and vulnerable population of overweight and obese people. They undermine the crucial public health message that reducing the health impact of obesity requires fundamental lifestyle change. In my opinion, they breach numerous sections of the Therapeutic Goods Advertising Code.

Regrettably, Undoit® is just the latest in a long line of ineffective complementary medicine weight loss products listed by the TGA. These include Xantrax, Weight Loss Accelerate, Fat Blaster, Fat Magnet, SensaSlim and Hunger Buster.

A reformed TGA?

So, what happened when a complaint about Undoit® alleging at least eight breaches of the Therapeutic Goods Advertising Code was sent to the new, hopefully more transparent TGA?

The TGA sent the following response (my emphasis added):

“Thank you for your correspondence dated 17 February 2012 in relation to Undoit. The TGA has noted your complaint in relation to this matter.

“The TGA may use this information and conduct investigations in relation to the safety, quality and regulatory status of the goods as part of the TGA’s ongoing regulatory activities.

“Investigations are prioritised upon potential level of risk to public health and safety.

“Please note that you may not be informed of the outcome of any investigations as the information may be confidential to the owner of the medicine. Thank you again for referring this matter to us.”

Consumer or commercial protection?

The issue of what should constitute commercial-in-confidence information was a hot topic in the TGA reviews.

Unsurprisingly, the views of consumers and health professionals differed from those of industry. While consumers accepted that genuine trade secrets, such as manufacturing processes, should be commercial-in-confidence, they did not accept that information about product safety or advertising violations should be suppressed.

One problem concerning potentially commercial-in-confidence information, raised by the TGA in the past, is Section 47 of the Freedom of Information Amendment (Reform) Act 2010, which states that a document is an exempt if its disclosure under this Act would disclose:

(a) trade secrets; or

(b) any other information having a commercial value that would be, or could reasonably be expected to be, destroyed or diminished if the information were disclosed.

The latter provision (b) is of particular relevance if the TGA determines that a complaint about the efficacy of a product, such as Undoit®, is justified because sponsors can argue that the commercial value of their product would be diminished by such disclosure.

Consumers and health professionals need access to such information but the TGA currently appears to rate the commercial protection of sponsors more highly that the public interest. On this matter, the government’s blueprint for reform merely said, “The TGA will develop and publish a policy on the disclosure of commercial-in-confidence information”.

Consumer complaints

The TGA’s website explains its policy is “to publish the outcome of certain investigations into complaints about therapeutic goods advertising directed to consumers which have been referred to the TGA by the Complaints Resolution Panel for follow-up action”. The criteria the TGA use to disclose “certain” investigations have not been made public.

I’m aware of at least 20 complaints referred to the TGA by the Panel over the last 18 months because of sponsor non-compliance. The TGA has yet to report any outcome of their “investigations”. These include Nurofen, Homeopathy Plus, FatBlaster Reducta and Fat Magnet, Maqui Berry Capsules, Virility Pills, Energy Slim and Berocca Performance.

So it seems the TGA’s transparency review and other reports have yet to make any impact on the organisation. Unfortunately, the TGA remains a “black hole” for reporting advertising complaints.

• This article was first published at The Conversation.

Disclosure Statement

Dr Harvey has accepted travel expenses only to talk about problems of complementary medicine regulation to pharmaceutical companies and industry associations. He has also been paid travel expenses and sitting fees for his involvement with government inquiries and working groups concerning pharmaceutical promotion and the regulation of complementary medicines.

Ray Moynihan writes:

The campaign by the Friends of Science in Medicine to shut down alternative medicine courses on campus is raising some fascinating questions about the interplay of science, education and healthcare – and sparking much lively debate.

Leading Australian complementary medicine researcher, naturopath and medical doctor, Professor Stephen Myers told me he sees the campaign as a “witch-hunt.”

Professor David Colquhoun – who has helped run a successful campaign to close down complementary medicine courses at British Universities – told me he was glad researchers saw it as a witch-hunt. “Good, that’s the intention.” Colquhoun – who’s helping to advise the new Australian group – argues the field is all nonsense, it’s advocates are quacks, and ancient wisdom is “mostly wrong.”

Australian campaign co-founder Professor John Dwyer says it’s not a witch-hunt, but an attempt to remove “pseudo-science” from university courses.

Interestingly, the AMA president Steve Hambleton has withdrawn his initial support for the campaign, telling me he thought the campaign’s pitch had become “much fuzzier and less clear”, and that rather than using a “sledgehammer” by calling for mass closures across campuses, a case-by-case approach might be better.

You can see the full text of the BMJ piece here: http://bmj.com/cgi/content/full/bmj.e1075?ijkey=zwFDDTnYJvF0ooA&keytype=ref

It includes articles about universities teaching complementary medicine, the Medicare Safety Net, new research on caesarean sections, e-prescriptions and hospital errors, and urban development.

You can also read an article from The Conversation’s editor, Andrew Jaspan, on mining magnate Gina Reinhart’s ambitions for Fairfax.

***

Why universities should teach alternative medicine

By Evelin Tiralongo, Senior Lecturer at Griffith University

Most readers would know of the current debate about universities teaching complementary and alternative medicine (CAM). A core question not being addressed in this debate is what other institution is better placed to deliver evidence-based knowledge of CAM.

The latest controversy started when a group called Friends of Science in Medicine (FSM) wrote to vice chancellors across the country asking them to review their health science courses. FSM rightly says that rigorous academic standards and evidence for scientific conclusions and health-care practices are of the essence and should be the basis of all university teaching.

More: https://theconversation.edu.au/why-universities-should-teach-alternative-medicine-5159

***

Who reaps the benefits? Rethinking the Medicare Safety Net

 By Kees Van Gool, Health economist at University of Technology, Sydney

Medicare is one of the cornerstones of the Australian health care system, but there are serious questions about some aspects of the program. Over time, government reforms have created some perverse incentives that have led to greater inefficiency and inequity.

One feature of Australia’s Medicare program is that doctors can determine their own fees and patients can only claim a predefined Medicare benefit. For out-of-hospital services (such as GP and specialist attendances), patients have historically had to pay the gap between the doctor’s fee and the Medicare benefit. The bigger the gap, the bigger the out-of-pocket cost to the patient.

More: https://theconversation.edu.au/who-reaps-the-benefits-rethinking-the-medicare-safety-net-5076

***

Forget ‘too posh to push’ – doctors are behind the rise in c-sections

By Hannah Dahlen, Associate Professor of Midwifery at the University of Western Sydney & Sue Kruske, Director of the Queensland Centre for Mothers & Babies at the University of Queensland

The proportion of Queensland women giving birth via caesarean section has increased by a staggering 74% in the past 20 years. This wouldn’t be of concern if more babies’ lives were saved as a result but the evidence suggests otherwise.

There’s a belief among some in the health industry and wider community that women who are “too posh to push” are driving the increase. But this myth has been consistently busted, most recently with a study from the University of Queensland’s Centre for Mothers & Babies (QCMB), which surveyed more than 22,000 Queensland mums about their maternity experience.

More: https://theconversation.edu.au/forget-too-posh-to-push-doctors-are-behind-the-rise-in-c-sections-4986

***

Bicycle registration is not the answer for bad behaviour

By Chris Rissel, Professor of Public Health at University of Sydney

There’s nothing like a “bikes vs drivers” story to whip commentators into a frenzy, and the stoush between Shane Warne and a Melbourne cyclist is no exception. Whenever this issue comes up, there are calls for cyclists to be registered – either to “pay their way” or so their behaviour can be monitored. But what difference would registration make?

Resorting to legislation is rarely the best solution to any social problem. It’s easy for Warne to call for “cyclists to be registered” or the Lord Mayor of Melbourne to want to “crack down on hoon cyclists” in pedestrian areas whenever someone on a bicycle breaks a rule. But a legislative response is out of proportion to the size of the problem and creates more problems than it tries to solve.

More: https://theconversation.edu.au/bicycle-registration-is-not-the-answer-for-bad-behaviour-4987

***

E-prescriptions could slash errors in hospitals

By Justin Norrie, News Editor, The Conversation

Electronic prescribing technology could reduce mistakes made by hospitals in medication prescriptions by up to 66%, a study has found.

The study of the technology in two hospitals found procedural errors such as incomplete, unclear medication orders fell by more than 90%. Serious errors, including the prescription of incorrect drugs or doses, fell by 44%.

The results of the study, by a team from the University of New South Wales, are published in the journal PLoS Medicine.

More: https://theconversation.edu.au/e-prescriptions-could-slash-errors-in-hospitals-5102

***

What is green space worth?

By Jason Byrne, Senior Lecturer at Griffith University

Recent patterns of residential development in Australian cities are threatening to overwhelm green space in our urban cores. Policies of urban consolidation have concentrated medium to high density residential development in inner ring suburbs where green space is comparatively scarce. And the zoning and development regulations of many local authorities actually allow a reduction of green space for higher density development – usually without any justification.

Everyone likes parks, but we may be greatly undervaluing their importance to our health and wellbeing, and to the wellbeing of other species.

More: https://theconversation.edu.au/what-is-green-space-worth-4703

***

The Conversation’s Editor’s Note: 2 February

By Andrew Jaspan, Editor, The Conversation
https://theconversation.edu.au/our_team#management

News of Gina Rinehart’s tilt at Fairfax Media is a circuit breaker in the never-ending story of the media company’s decline.

As a former editor of The Age, one of Fairfax’s prized mastheads, I have spent the day wondering where this might end. Whichever way, it looks bad for quality, independent journalism. This is a defining moment for the kind of Australia we want.

When I arrived in 2004, The Age was earning more than $100 million profit a year, while the Sydney Morning Herald was always just ahead of us. Seven years later, the papers barely make money.

Later in 2007, Fairfax and Rural Press merged into a  $12 billlion behemoth, the biggest in the southern hemisphere. This week it’s valued at a mere $1.7bn, and has become one of the most short-sold stocks on the ASX. No one loves it.  But the papers need to be loved.

And Fairfax’s papers have an awful lot of clout. The combined audience for The Age in print and online is about 1 million readers per day, and the SMH just above. For those who follow these things, that’s higher than for any Channel 7, 9, 10 or ABC news bulletins.  And more importantly, the audience for the Fairfax papers, including The Australian Financial Review, is the influential and affluent “AB” market. For these people, what the Fairfax papers report, matters. Unlike the tabloids read by the bulk of Australians.

The Age, SMH and The Fin, along with The Australian, set Australia’s news agenda and are slavishly followed by the radio talk-back and TV news shows.

So why is Gina Rinehart buying? She has no interest as a shareholder in making money. She wants to buy influence. In 2007 she placed full page ads in The Age and SMH against then-Prime Minister Kevin Rudd’s proposed mining tax. That campaign ended with the removal of Rudd and the collapse of the tax. Now instead of buying pages, she wants to buy the papers.

Such motivation is deep in the Rinehart family genes. In a 1979 polemic called Wake up Australia,  Gina’s father, Lang Hancock argued: “We can change the situation so as to limit the power of government,” before concluding: “it could be broken by obtaining control of the media and then educating the public”.

And on the miners’ right to mine anywhere, he wrote: “Nothing should be sacred from mining whether it’s your ground, my ground, the blackfellow’s ground or anybody else’s. So the question of Aboriginal land rights and things of this nature shouldn’t exist.”

The Murdoch press in Australia is already favourably disposed to the miners and the Minerals Council view of the world. Fairfax provides an alternative view. And one that Gina no doubt wants neutered, silenced or turned around. Perhaps by Gina’s favourite columnist, Andrew Bolt?

Whether Australia retains an independent and semi-pluralist media will become clear within the near future. In the meantime, The Conversation will keep a close eye on this matter of national importance.

Here is the latest compilation, covering from 6 October – December 23, 2011. The latest readership figures are now also available, showing that more than 137,000 people visited Croakey in 2011, with 305,987 unique pageviews.

The links below have been grouped into these categories:

General public health
Climate change and health
Food, tobacco, alcohol
Indigenous health
Mental health
Rural health
Health reform
TGA-related matters
Evidence-based issues
Personal health and healthcare
Pharma industry and conflict of interest issues
The Medicines Australia deal with The Australian
Other media-related issues
Wraps of health and medical reading at The Conversation

***

General public health

The GFC and global health: why Australia needs to step up to the plate
Mary Moran

The financial crisis and what it means for peoples’ health
Stephen Leeder

Why we need to transform Australia: leading public health expert
Bob Douglas

Uranium sales to India: a public health disaster?
Margaret Beavis

So we now have another international declaration on the social determinants of health. What difference will it make (or not)?
Sharon Friel

Has the WHO lost the plot, when it comes to tackling the social determinants of health?
Fran Baum

Public health experts take a stand against compulsory income management

Why we need healthy housing policy (and introducing Croakey’s first intern)
Caroline Chen

Is Victoria the pace-setter in health promotion?
Boyd Swinburn

Place-based approaches to supporting children and families: what are they, and why do they matter?
The Centre for Community Child Health

The Tax Forum: so much for “health in all policies”
Mike Daube, Ian Olver, Jan Barendregt, David Atkinson, Rob Roseby, Guy Maddern, AHHA, ACOSS

What is the single best thing you could do for your health? (Promoting physical activity on the eve of New Year’s resolutions…)

Some good news on childhood obesity (but who will act on it?)
Elizabeth Waters

New immunisation incentives are good policy, and merit sensible debate
Julie Leask

Why Meryl Dorey should stay on the Woodford Festival program
Jon Wardle

More people would cycle if helmets were not compulsory: new study
Chris Rissel

Cycle helmet debate continues
Tim Churches

The backlash against “pinkwashing” and breast cancer marketing
Becky Freeman

The backlash against universities offering complementary medicine courses
Loretta Marron

Some suggestions for the national and NSW reviews of health and medical research

Why do researchers donate their time and money to help private conference organisers make big bucks?
Simon Chapman

***

Climate change and health

A wrap of news on climate change and health: from Durban to Tuvalu and Martha’s Vineyard
Fiona Armstrong

Richard Smith: tweeting the news on climate change, health and security

Climate change is an “immediate, growing and grave threat” to health and security

***

Food, tobacco, alcohol

Who is supporting the push for pregnancy warnings on alcohol?

The supermarket grog wars are a health hazard
Michael Livingston

It’s time for a campaign to tackle media framing of alcohol and other drug issues
Laurence Alvis

Quit smoking, save money, feel better, and write a special book
Maxie Ashton

It’s a Knockout! ACMA report delivers blow to self-regulation
Jane Martin

The new draft dietary guidelines: look beyond the headlines
Warwick Anderson and Rachel Nowak

The latest news from the world of food policy and regulation
Michael Moore

The “fat tax”: some wide-ranging analysis
Rosemary Stanton, Jane Martin, Gary Sacks

***

Indigenous health

Why this Indigenous health project is an award-winner
Neil Thomson

How can health reform help Aboriginal and Islander health: a practical vision
Selwyn Button

Profiling some of the barriers to progress in Indigenous health
Judith Dwyer

***

Mental health

(Most of these articles were posted as part of an ongoing series associated with my articles on mental health reform that were jointly published by Crikey and Inside Story.)

Suggesting some long-term goals for mental health reform
Alan Rosen

Important for mental health: a fair society and a good start to life
Helen Keleher

Early childhood trauma and long-term health
Josey Anderson

Don’t rush the roadmap for national mental health reform: Alan Rosen

What matters for people living with psychotic illness
Sandy Jeffs

More effort needed to strengthen shared care arrangements for people with serious mental illness
Olga Anikeeva

Some lessons from rural innovation in mental healthcare
Charles Alpren

How we are dodging some important mental health issues
Matt Fisher

Falling through the gaps – the unmet mental health needs of people with intellectual disability
Sophie Howlett

A note of clarification about Croakey and coverage of mental health policy

***

Rural health

Physician assistants win support of rural/remote doctors – and a report from the coalface
Deborah O’Kane

Physician assistants: an update on the policy, politics and state-of-play
Sharon Barnwell and Allan Forde

Climate change and rural health: a GP’s call for action, plus an update on recent studies
Andrew Bracey

***

Could spending less on healthcare be better for our health?
Patrick Bolton

How can we ensure a sustainable health system? Plus recent articles on surgery waiting lists, e-health and gambling reform
Ann-marie Boxall

Health reform: the musical
With contributions from Philip Davies, Carol Bennett, Prue Power, Gawaine Powell Davies, Paul Grogan, Alan Rosen, Andrew Gunn, Andrew Pesce, Peter Sainsbury, Ruth Armstrong, Simon Burrow.

The Ministerial reshuffle and health: plus analysis of Roxon’s tenure and advice to Plibersek
Tony Hobbs, Andrew Pesce, Stephen Leeder, Robert Wells, Mike Daube, Peter Sainsbury, Gavin Mooney, Alan Rosen, Paul Grogan, Ian McAuley, Gawaine Powell Davies, Mary Chiarella, Justine Caines, David Penington, Michael Vagg, Ron Batagol, Anonymous

Some more advice for the new Health Minister, Tanya Plibersek
Prue Power, Carol Bennett, Jon Wardle, Hal Kendig

An update on the state of health reform: the pros, the cons and the questions
Jane Hall and Jonathan Karnon

Is this the future for Medicare Locals? (With musical references)
Philip Davies

Next round of Medicare Locals announced

Health reform: in whose interests? And what happened to the vision for primary healthcare reform?
Lyn Morgain

The quality of health service managers is an important health issue
Daryl Sadgrove

Are Australians willing to pay more for better oral health?
Rachel Katterl

Pressure for abortion law reform in Queensland
Caroline de Costa

The argument for a federal takeover of health in Tasmania
Martyn Goddard

The devil in the detail: how Tasmanians lost out in Royal Hobart Hospital deal
Martyn Goddard

Your thoughts on the good and bad of eHealth in primary health care?
Olga Anikeeva

Some things you mightn’t have known about Mick Reid (on the occasion of the Sidney Sax medal)

A nurse was murdered. Questions are being asked about health service management
Jenny Haines

Why Mary, Kylie and I may prefer to be known as Doctor….
“Enrico Brik”

A response to critics of organ and tissue donation reforms
Anne Cahill Lambert
***

TGA and related matters

Statement from Australian Skeptics on the Ken Harvey and SensaSlim cases

Some VERY interesting reading: on the TGA, Ken Harvey, and pertinent questions for public health advocates
Rebecca Johnson

Consumers need much better information about complementary medicines
Ken Harvey, Carol Bennett

***

Evidence-based issues

New international project to support evidence in practice and policy
Andy Oxman

A new health book that is worth reading (and free online)
Hazel Thornton

Why the US Preventive Services Task Force is recommending against PSA screening for prostate cancer

***

Personal health and healthcare

We need more action on hospital infections: expert
Lyn Gilbert

For those with chronic illness, what helps encourage self-care?
Petra Bywood

GPs are getting older and working more intensively. And what about their patients?
Helena Britt

How to improve understanding of palliative care?
Erin Koop

Concerns continue about unsafe home birth practices: Dr Andrew Pesce

Home births: it’s time to broaden the focus of the debate
Hannah Dahlen

Crying babies: what parents need to know Vs what they are often told
Pamela Douglas

Some wide-ranging conversations on death and dying

A push to improve pain management
Lesley Brydon

A personal story of living with pain
Geri Badham

***

Pharma and COI-related issues

US wants to give pharma more power over our medicines policy
Deborah Gleeson

Our medicines supply is not as secure as you might assume
Simon Quilty

Should pharma industry fines be used in good works that create positive industry PR?
Andrew Roberts

Clock is ticking on the NHMRC and conflicts of interest policy

Conflicts of interest: the issue goes on, and on….

Conflicts of interest in health and medicine: calls for a culture change

Update on the links between public health and corporate interests
Some reaction to the news on the Pharmacy Guild and Blackmores
Andrew Podger, Ken Harvey, NPS, Richard Di Natale

Pharmacy Guild deal with Blackmores ends in tears

***

The Medicines Australia deal with The Australian

Concerns raised about pharma-sponsored health journalism at The Australian
Medicines Australia, Gary Schwitzer, Charles Ornstein, Amanda Wilson, Wendy Lipworth, Carol Bennett, Christopher Jordens, Peter Mansfield, Philip Davies

Adam Cresswell responds to concerns about Medicines Australia’s deal with The Australian

The pharma industry is also distributing The Australian’s health series…

 The potential pitfalls of special deals between media and pharma
Tim Woodruff

Doing the dance: journalism and pharma

Medicines Australia: concerns about conflict of interest are overblown (and besides, we’ve got a great story to tell)
Brendan Shaw

No need to be so precious about conflicts of interest…the discussion continues
Ron Batagol

***

Other media-related coverage

Health story of the year (if not in the mainstream media): social media and health

New guidelines encourage nurses to embrace the potential of social media
Debra Cerasa

Social media and healthcare: recent news and developments
Carolyn Der Vartanian

Media Doctor Australia puts out a call for help
Amanda Wilson

An overview of changes at the health media watchdog, HealthNewsReview
Gary Schwitzer

What the news about health often leaves out
Amanda Wilson

What is the future of scientific publishing?
Ben Harris-Roxas

Does media coverage of health reflect the grant cycle of medical researchers?
Amanda Wilson

Medical writers: what do they talk about?
Justin Coleman

***

Wraps of health and medical reading from The Conversation

Reema Rattan, Froncesca Jackson Webb

December summary

November summary

October summary

***

Previous summaries of Croakey coverage

October, 2011

July, 2011

***

Thanks to Croakey’s supporters

And, finally, I would also like to take this opportunity to acknowledge and thank the organisations that have supported Croakey over the past year; particularly the Public Health Association of Australia, which organises the Croakey funding consortium, which also includes the Epidemiology Unit of the Victorian Infectious Diseases Reference Laboratory; the UNSW Research Centre for Primary Health Care and Equity; the Australian Health Care Reform Alliance; VicHealth; the Australian Health Promotion Association; and RaggAhmed. (More details here).

I would also like to thank Crikey, which provides logistical and other support and encouragement, and members of the Crikey Health and Medical Panel, who generously volunteer their time (often late at night) to contribute articles.

Thanks also to other contributors and, of course, to readers. I am looking forward to more healthy debate and discussions in 2012.

Like to be a ‘doctor’? Interested in ‘new age’ medicine? Maybe you want to go to Uni but your entrance score is not up to scratch.  Don’t give up!  Why not check out your local college and see what’s on offer as there just may be a course tailor-made for you.

Nearly one third of medical and health science faculties are now including complementary or alternative medicine courses that may offer little more than ‘voodoo’ or pseudo-science such as ‘energy medicine’ and ‘fundamentalist’ chiropractic.  Masquerading as real medicine, they sit side-by-side with real science-based subjects such as cell-biology and pharmacy.

So what’s wrong with a bit of ‘woo’ in the health system – surely it can do no harm?

That’s not the opinion of over 30 of our most prominent doctors and scientists hailing from universities across Australia, who this week joined ranks to voice their concerns as yet another university has announced plans to introduce anti-science into their curriculum.

Fundamentalist philosophy is based on a belief that chiropractic adjustments can cure 95% of what ails man.  Worried that a new chiropractic degree may encourage inappropriate treatments on sick babies and children, they broke their silence to expose not just this course, but the goings on in their own establishments and to warn the public.

At the fore-front of this campaign are questions about the Central Queensland University (CQU)’s Bachelor of Science (Chiropractic) which opens in 2012 and which is being run by the same people who helped the RMIT win the 2011  ‘Bent Spoon’, an annual trophy from the Australian Skeptics “presented to the perpetrator of the most preposterous piece of paranormal or pseudoscientific piffle”.

According to Flinders University-based neuroscientist Prof Marcello Costa, “It is disturbing to see a centre of learning, of supposed excellence, teaching and perpetuating health practices based on beliefs in principles that are totally unscientific”.

His comments were joined by prominent science writer and broadcaster, Professorial Fellow Rob Morrison, South Australian-based Prof Alastair MacLennan from the School of Paediatrics & Reproductive Health, The Women’s and Children’s Hospital and by Emeritus Prof John Dwyer AO, the Founder of the Australian Health Care Reform Alliance and the clinical consultant to the NSW Government’s Inter-Agency committee on Health Care fraud.

Prof Morrison commented that, “Alternative therapies may have a placebo effect, but wrapping them up as science and discussing them in the same way as treatments that pass rigorous efficacy and safety tests is harmful for everyone”.

Prof Alastair MacLennan added that “the issue is much bigger than CQU’s chiropractic course and we condemn the “teaching” of unproven beliefs such as homeopathy, naturopathy and iridology in public institutions”.

Prof Dwyer was concerned that it made it “increasingly difficult to encourage patients to accept only evidence-based treatments for their problems when some universities and indeed private health insurers, provide unacceptable, often dangerous practices with undeserved credibility.”

All agreed that they were not trying to stop the public using alternative therapies and supported research into their efficacy.  They also agreed that these courses should not be Government funded because their introduction “encourages the spread of quackery within the Australian Health System, misuses the public’s health dollars, encourages unnecessary ‘treatments’ and may delay effective treatment when true disease is present.”

So should  the Federal Government fund these courses?  Should they even regulate claims made for health services the same way they do for therapeutic goods? And should health funds reimburse patients who want to use them?

Perhaps inadequate Government funding for our Universities, the lack of interest in real science amongst our youths and the increase in consumer demands for all things ‘natural’ are sending us back to the dark ages.

Once deemed to be pillars of ‘excellence and enlightenment’, let’s hope this campaign will help restore the fading reputation of these formerly prestigious institutions and slow down the explosion of quackery that continues to  target our most vulnerable patients, with the potential for tragic results.

• Loretta Marron is a former Australian Skeptic of the Year. See here for some of her previous articles.

Over at The Conversation, public health advocate Dr Ken Harvey analyses the Government’s response – and says it is so disappointing that he has resigned from the Labor Party. He writes:

Like the Curate’s egg, the government’s reform blueprint appears to be good in parts. But it also displays a timidity to grapple with key issues, such as therapeutic goods advertising reform, and that seems to be a common failing of this Labor government.

I’ve been a card carrying member of the Labor Party for some time. I worked hard to get rid of the Howard government and get Labor elected and I’ve sat on a number of the working parties and consultations that have made the recommendations outlined above.

But I can no longer be a member of the party when a Labor government fails to implement unanimous recommendations from its own working parties, and continues to procrastinate after a decade of calls for effective sanctions on advertising violations. I have today submitted my resignation.

Meanwhile, public health advocate, Rebecca Johnson, examines in the article below what lessons the public health community can learn from Ken Harvey’s battles with SensaSlim. She makes many useful points that merit consideration, from individuals as well as organisations and public health leaders.

***

The SensaSlim saga: what have we learnt?

Rebecca Johnson writes:

Many readers have followed Dr Ken Harvey’s recent legal ordeal with the company peddling the discredited weight loss spray SensaSlim.

For those that haven’t: earlier this year, Ken was hit with a SLAPP suit by SensaSlim after he complained about the company’s outlandish advertising claims to the Therapeutic Goods Advertising Complaints Resolution Panel.

The action, which was thrown out of the NSW court, cost Ken time, energy and $42,000 in legal fees – which were thankfully covered by donations from members of the public health, skeptics and consumer communities.  SensaSlim has since lodged a similar action in QLD, for which Ken is being defended pro bono.

It is a sticky, complex ordeal that sprung from a valid complaint made through an appropriate channel.  So – what can we, the public health community, learn from Ken’s experiences with SensaSlim? 

One question immediately stands out: even where we are unshakably confident in our own actions as public health practitioners, do we have the confidence that our colleagues and peers will back us up?

The question applies to the everyday actions of many health-based organizations, not just those that challenge products or practices that are on the fringe.  If your statement, action or position is challenged, do you have a ‘SWAT team’ of colleagues/organizations that you can call upon for support?  Do you have a way of reaching them quickly and effectively?

In Ken’s case, his links with the Skeptics networks, consumer organizations such as Choice and social media tools such as Croakey were invaluable in helping him raise awareness of the legal action, invoke ire about the issues, and – although not at his request – raise dollars to assist with his costs.

Ken’s experience invites us to examine our own professional and organizational networks, and to set about improving their strength and reliability.  It may also invite us to create new networks, and to engage with tools like social media and the blogosphere, that can make the connections happen.

Thinking about confidence leads us to consider the extent to which we’d stand by our professional actions if they are challenged.  Ken’s perfectly legitimate complaint was met with a legal challenge to the tune of $800,000.  It’s possible that if he’d quietly withdrawn the complaint the legal suit might have gone away – but he didn’t.

Any practitioner or organization offering health information that potentially undermines a commercial interest – and there are likely to be many – could find themselves subject to a similar suit.  Should we therefore watch our backs and cover our arses, or should we stick up for our work?

Ken’s experience encourages us to consider what we would risk in contexts where our legitimate professional actions face opposition, legal or otherwise.  It makes us consider the cultures in the organizations we work in, and whether they’d face a challenge or shy away from one.  It also makes us think about how strongly we feel about our own work, how invested we are, and the lengths we’d go to defend it.

On a less introspective note, the SensaSlim case reveals the need for the public health community to step up its scrutiny of both the therapeutic goods regulator and the complementary and alternative medicine (CAM) industry.

About half of the Australian population uses CAM, much of which is advertised using spurious health claims.  Therapeutic goods, particularly those that are as widely used as CAM products, are obviously a population health issue.  So are the problems with the regulator, which have been well and truly revealed in a series of recent inquiries and reviews. 

The Therapeutic Goods Administration does not ensure the claims associated with complementary products can be substantiated before it allows them to be legally sold in Australia.  Nor does it act swiftly upon issues when they are raised; indeed, it failed to de-list SensaSlim from the Australian Register of Therapeutic Goods for nearly a year after Ken’s initial complaint, allowing it to continue to be purchased by thousands of unsuspecting consumers.

As public health professionals, we possess health literacy that is considerably more advanced than Joe Public’s.  It is our responsibility to step further into this space and demand transparency, honesty, and substantiation of health claims on therapeutic products.

Currently, a few individuals and organizations do the vast majority of the advocacy, and take the hits for it.  Is that right?

In today’s world, where words like ‘collaborative’ and ‘cross-sectoral’ roll off our tongues, we should ask ourselves – what can we do to pull together better on issues like this?

Turning outwards, Ken’s experience should invite rigorous debate in the public health community about SLAPP litigation and legal protections.  Making a legitimate complaint about shonky advertising claims should not expose a complainant to legal action that is designed to silence and intimidate.  The case has exposed some important systemic flaws that are overdue for action.

We should call for comprehensive protections to be built into our legal systems to ensure that SLAPP actions do not chill public participation, or the SensaSlim case will be repeated.  This is very real issue for the public health community; SLAPP actions threaten our ability – indeed our responsibility – to keep things honest where commercial interests tangle with population health.

There are several valuable lessons to be learned from Ken Harvey’s SensaSlim experience, about confidence in our positions on issues and in our networks, about the importance of better scrutiny of the regulation of therapeutic goods and CAM, and about how legal intimidation can erode our ability to ensure health information does not mislead or deceive.

Ken’s experience also raises a lot of important questions.  Reflecting on those questions and applying the lessons could help make us, the public health community, better networked, supported and informed, and better able to stand up for our work.

• Rebecca Johnson is Policy Advisor, Cancer Council WA (This post does not necessarily reflect the views of Cancer Council WA)

• Here are more Croakey articles on the SensaSlim case

Thanks to Reema Rattan for providing this summary, which covers articles about the safety of vitamin supplements, health financing, humane approaches to preventing crime, disability services, ghostwriting of research articles, patenting of stem cell inventions, and the latest legal developments in the Vioxx case.

***

Vitamin supplements: more harm than help?

By Ian Chapman, Associate Professor and Senior Specialist Endocrinologist at The University of Adelaide

A study published in the Archives of Internal Medicine has investigated the link between taking dietary supplements and an increase risk of death in older women.

I don’t know if this is a great paper because there are so many variables that the authors have corrected for: there were clear differences between the women who took the supplements and those who didn’t at baseline.

The women who took the supplements were more likely to be non-smokers; they were twice as likely to be taking hormone replacement therapy (HRT); they had higher education levels and lower body-mass index; and they were more physically active.

What’s more, they were different on every single measure of dietary intake that was reported in the paper.

***

Should doctors be paid to keep patients healthy?

By Peter Sivey, Research Fellow in Health Economic at the University of Melbourne

Going to the doctor is, in many ways, like visiting a car sales yard. The customer has a limited knowledge of the product and the supplier may have a financial incentive to over-service or overcharge.

Of course, the main difference is trust. Most people trust their doctor to do the right thing and provide appropriate medical care. But, if you throw incentives into the mix, where does this leave patients?

***

Jailing fathers increases problems in Indigenous communities

By Richard Fletcher, Senior lecturer in the faculty of Health at the University of Newcastle

There are hopeful signs from a number of sources that the “get tough on crime” approach is working, with politicians promising the era of more prisons and longer sentences has had its day.

Movements such as Justice Reinvestment – redirecting money earmarked for prisons to address disadvantage in communities prisoners come from – is one manifestation of a more rational and humane approach to crime.

For Aboriginal communities, where imprisonment has reached epidemic proportions, this shift is long overdue.

***

Giving and taking away: NDIS and disability pension reform

By Karen Soldatic, lecturer in Disability Rights at Curtin University

A report released by the Australian Institute of Health and Welfare (AIHW) finds the number of Australians using disability support services is increasing. But it’s uncertain how the government will provide ongoing services for these people.

People with disabilities, their families and carers have long waited for a social support system that effectively responds to their real needs.

But while the Government-endorsed National Disability Insurance Scheme (NDIS) promises to provide effective help, other changes in disability policy seem to be removing supports for people with disabilities.

***

Giving up the ghost: exorcising biomedical research articles

By Wendy Lipworth, post-doctoral research fellow in bioethics at the University of NSW and Ian Kerridge, associate professor in bioethics and director, Centre for Values, Ethics and the Law in medicine at the University of Sydney

In 2009, medical editors from around the world gathered at a Peer Review Congress in Vancouver, Canada, to discuss, among other things, “ghost authorship” of medical research articles.

Ghost authorship of such articles involves deliberate suppression of the fact that it’s been written by someone other than the named author or authors.

In most cases of academic ghost authorship, (not to be confused with ghost authorship of sporting “autobiographies”), an article is written by a professional medical writer who is commissioned or employed by a pharmaceutical company.

The name of this ghost author is suppressed and the only names that appear on the article are those of researchers.

***

European court bans stem cell patents – what about Australia?

By Fady Aoun, law lecturer and doctoral student at the University of Sydney

The European Court of Justice has today banned patenting of stem cell inventions derived from human embryos which are capable of developing into a human being.

The court held that this exclusion from patentability is not limited to the use of human embryos for industrial or commercial purposes, but also includes the use of human embryos for the purposes of scientific research.

Although the ruling follows an earlier legal opinion, it appears to have caused general dismay among scientists who now fear their research discoveries may not be commercialized into patentable inventions.

***

Vioxx withdrawal: making send of the fight for compensation in Australia

By Bill Madden, Adjunct fellow and part-time lecturer at the University of Western Sydney

The enormous medical impact of modern pharmaceuticals has on occasion been matched by some large-scale litigation regarding adverse events. The Vioxx litigation in Australia and elsewhere is one such recent example.

The Federal Court last week overturned a ruling that could have seen up to 1500 former Vioxx users who suffered heart attacks or other forms of cardiovascular disease claim compensation from Vioxx’s manufacturer Merck.

In Australia, Merck Sharp & Dohme (Australia) Pty Limited recalled Vioxx in October 2004; it was reported as the biggest drug recall in history.

***

It’s not you, it’s the patients: why doctors should tell drug firms it’s over

By Ray Moynihan, Conjoint lecturer at the University of Newcastle

The extent of the financial entanglement between doctors and drug companies seems to know no bounds and I think it’s vitally important that there’s more scrutiny of these relationships.

The reason people are interested in doctor-drug company relations is not because of the desire to expose doctors wining and dining habits, the reason to expose this is because it distorts prescribing patterns and it means doctors are more likely to prescribe the latest and most expensive medicines. Sometimes a good thing but other times, wasteful and dangerous.