Homeopathy! Why do the National Institute of Complementary Medicine continue to defend it?

With age comes wisdom, but for some, age comes alone. Let me explain.

I recently noticed an UK newspaper article which referred to the much discussed Australian NHMRC review on homeopathy (published in 2014). Main finding: Homeopathy was found to be ineffective for 68 medical conditions and “people who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.”  Add to this that there has been a class action lawsuit against a homeopathic company in the US, then the conclusion can easily be drawn that homeopathy is nothing more than a placebo. This was also confirmed by the mass protests where people overdosed themselves with homeopathic medicine – obviously without it having any effect.  Surely then, any scientist will concede that homeopathy simply does not work for any medical condition!

But there is also a much more serious side to this. The clear warning of the NHMRC is that people put their health at risk, not due to the homeopathic medicine itself, but mainly by delaying effective treatments. That this warning is not an overstatement has been tragically demonstrated over and over. Add to this that you can also buy homeopathic medicine for serious conditions such as malaria and HIV, then I would argue that any scientist supporting homeopathy is out of their mind, and is acting not only unethically but in some countries criminally.

Now back to the year 2000. In my previous blog post I discussed the National Institute of Complementary Medicine’s (NICM), hosted by Western Sydney University (WSU), rather misleading statements regarding the efficacy of TCM and CM in general. During those particular radio interviews the statement by the NICM concerning homeopathy was;

“In homeopathy there’s a very difficult field because whilst there are some clinical trials that show benefits, and well-controlled clinical trials that show benefit, the theory that accompanies homeopathy, if anything gets up a medical scientist’s nose”.

Another participant however stated that;

“….so we have seen much better studies about homeopathy. And actually it turned out that most, I would say almost every one of those newer studies, was negative for homeopathy”. 

So even back in 2000 the NICM was trying to convince the public that there are indeed scientific evidence for homeopathy, even though they knew that high quality studies gave negative results.

If we now look at the systematic reviews that the NHMRC included in their 2014 study we find that 51 of the 58 (or 68 of the 176 individual trails) studies were published since 2000. Therefore, in the 14 years since the radio interview almost 90% of the reviews on Homeopathy were published and one might argue that with time comes wisdom and with all this new scientific information the NICM will surely change their stance on homeopathy. Unfortunately, they did not! Their response to the NHMRC report remains the same as what they claimed in 2000. According to the NICM there are a number of high quality clinical trials that support homeopathy and they simply make the NHMRC report look suspect. So, why do they continue to knowingly mislead the public?

The NHMRC stated shortly after the release of their findings the following:

Indeed the International Council for Homeopathy is currently leading a fund-raising effort: not to fund better research, but to attack the NHMRC document.”

And what does the NICM do as an “independent” scientific institute? The highlighted text on page 2 of this document should clarify their stance. They join forces with their (homeopath) sponsors in order to attack the NHMRC report. They don’t do much of the dirty work themselves but they leave that to their partners, specifically the ‘Complementary Medicine Australia’ (CMA) organisation. The CMA promptly publish a report called the; “The Five Fundamental Flaws of the NHMRC Homeopathy Review”. This report is now being used all over the world to ignore the NHMRC’s findings and recommendations.

In previous blog posts I made it clear that the NICM is nothing more than a front company for the complementary medicine industry. For them no amount of science, common sense or even compassion for people who are currently suffering at their hands will be enough to change their views or the views of the university that hosts them. If you are funded by industry or fervent supporters of CM, including homeopathy, then you will never be able to take an unbiased independent scientific stance on homeopathy.

The public needs to get unbiased information from institutes at universities who does not have this level of vested interests, in order to make informed choices regarding healthcare issues. After all, universities are mainly funded by the taxpayer. As it stands now, this is impossible and, in my view, makes the NICM a serious public health threat. This, however, is not an Australian issue but a global issue. With time comes wisdom but only if you seek the truth – and this is not something that the NICM is looking for.

What can you do about all of this?

Unfortunately, if you fall for their trickery and you get hurt, then you will be all alone. The bureaucracy involved is extremely complex so the best thing to do is prevention.  Stop buying their products or using their treatments, and inform yourself and your family and friends about how these people play their game and what the dangers are regarding these ‘treatments’. ‘Friends of Science in Medicine’ provides valuable healthcare information as well as the website of Prof Edzard Ernst, where he discusses everything complementary medicine (what works and what doesn’t). If you are interested in receiving automatic updates regarding the NICM and what they are up to, you can always follow my Blog,  Twitter or connect on LinkedIn.

Intentionally misleading the public. Part 4: Efficacy of TCM and CM in general

In previous blog posts I’ve written about how the National Institute of Complementary Medicine (NICM), hosted at Western Sydney University, are creating public trust via radio interviews in Traditional Chinese Medicine (TCM). They did this by comparing the theory and practice of TCM with quantum physics and comparing the efficacy of complementary medicine (CM) to that of surgery. Their arguments have been debunked, on this blog, as attempts by the NICM to intentionally mislead the public by creating ‘trust’ in TCM and CM in general. We have to remember that it is usually people suffering from some kind of medical condition that listens to these radio shows. It is also these people who are, unfortunately, the main target of the NICM. In this post the story continues. Below an excerpt of the radio interview:

 “Norman Swan: And so herbal medicine, the traditional Chinese herbal medicine? What about that? Well we know about irritable bowel syndrome, there’s been good evidence for that. Alan Bensoussan: Eczema as well has demonstrated some good evidence in some UK studies, we’ve had some preliminary work done on chronic hepatitis.Norman Swan: The thing about Traditional Chinese Medicine, TCM, though is that it does have a history and long track record which gives it credibility. But does a TCM practitioner and academic like Alan Bensoussan have time for non-TCM therapies? Alan Bensoussan: I think the fact that Chinese medicine is so well established in the public health system in one of the biggest countries, in the biggest country in the world, counts for an enormous amount because there’s an enormous amount of research.

End of excerpt.

This statement is designed to convince people that somewhere in the world you will find all the scientific evidence for TCM. The NICM doesn’t have that evidence; someone else has it – in this case China (the biggest country in the world? what happened to Russia etc.). Using a long tradition of use as a measure of safety is a very dangerous thing to do. But let us look at the word traditional. There are a number of scientists that have questioned this ‘long tradition of use’ and if this can actually be used as a measure of safety or basically anything else. They state that TCM, as we know it today, has been invented in 1950 – 1960 communist China and it is in effect nothing more than a profitable export product.

But let us ignore this for a moment. In the NICMs statement it is said that in China “there is an enormous amount of research” – presumably that means research indicating that TCM is effective and safe to use. Indeed there are, but it is also interesting to note that close to a 100% of clinical trials performed in China on TCM gives positive results. To put this into perspective; there are many TCM clinical trials that have been conducted outside of China which gave negative results – so clearly we have an issue here! TCM, which is a belief based medicine will, by default, always give positive results. That is what belief based medicines are – they always work. So what are the NICM trying to achieve here? They want to convince the public that TCM will work for any condition in any setting under any circumstances. From a scientific perspective: why didn’t the NICM go and reproduce the very best Chinese clinical trials in Australia over the last 15-20 years and by doing so put everyone’s mind at ease? Where are those results? It should be a very simple and easy thing to do and there is nothing better than good scientific results if you want to convince people that a specific medication works. So is TCM indeed only a lucrative export product and the NICM only wants a slice of this pie? Here is what the NICM say “…the potential for Australia to tap into the $170 billion global traditional Chinese medicine market…” I belief the answer is very clear! Below the interview continues:

“Norman Swan: But that explains your commitment to TCM, what about non-TCM therapies? Alan Bensoussan: I think there’s an enormous amount of value in non-TCM therapies as well. There are basically three categories as I see it in complementary medicine. There’s those therapies that are very orthodox in their own countries, things like Chinese medicine, ayurvedic medicine in India for example. And there are others that are very new, relatively trendy modalities, rebirthing, magnet therapy, a number of them. And the evidence base behind those, it has to be said, is absolutely minimal. And so I think sometimes the term complementary medicine is a little bit unjust, because it also buckets all these therapies in together. But there’s some reasonable evidence in a number of other therapies. In osteopathy, in chiropractic, there are already systematic reviews that have been performed. In homeopathy there’s a very difficult field because whilst there are some clinical trials that show benefits, and well-controlled clinical trials that show benefit, the theory that accompanies homeopathy, if anything gets up a medical scientist’s nose”

End of excerpt.

Here again we have the notion that there is a body of scientific evidence supporting CM. In general any treatment or medicine that does not have any scientific evidence are categorised as a complementary and/or alternative medicine (CAM). There is just no convincing scientific evidence that these things work. One can now argue that these radio interviews took place more than 15 years ago (in 1999-2000) and as we all know with age comes wisdom (although, sometimes age comes alone) – so is there any recent examples where the NICM continued with their unbridled support for CAM in the face of new scientific evidence? In 2014 the Australian NHMRC released a report concluding that homeopathy was found to be ineffective for 68 conditions tested and thus advised consumers about the dangers of using homeopathic remedies. And how does the NICM respond – they just stick to their story (somewhere out there there is high quality positive results for homeopathy) and they do their best behind the scenes to contribute in making the NHMRC report suspect. Absolutely no progress, which is a tell tale sign of quackery, and the same goes for their support of TCM. At the end of the day it seems to be all about money, but how long will they be able to keep this up?

Intentionally misleading the public. Part 3: Effectiveness of complementary medicine

In part 1 and 2 I gave some comments on two radio interviews regarding complementary medicine (CM) and how the National Institute of Complementary Medicine (NICM) misleads the public. To be fair to the NICM, the full transcripts should be read in order to understand the context of these interviews. I cannot claim that everything that is being said is wrong or misleading – there are indeed some truths or half-truths. In this article I will focus on the most interesting part from another radio interview, regarding the effectiveness of CMs according to the NICM, and just give a short comment on the statements that they make.  This article deals with creating public trust that CMs really works.

 “Norman Swan: We’ll cover safety next week, and whether the alternative medicine industry should be regulated. But let’s get back to whether the treatments are effective, because many of those who use them tell you they are. The common response from orthodox practitioners though is that it’s just the placebo effect, the result of taking a sham treatment which you believe is going to do you good.

That riles people like Alan Bensoussan, who runs the Traditional Chinese Medicine unit at the University of Western Sydney.

Alan Bensoussan: Look I’ve been involved in complementary medicine for some years, and I remember 20 years ago the first reaction to acupuncture coming to the West was, ‘Oh look, it’s just a placebo procedure.’ About ten years later gradually people started turning around and saying, ‘Actually we know now something about it, we know that endorphins are involved, we know that other neurotransmitters like serotonin are involved in the process as well.’ And so gradually medicos are taking on acupuncture, practising it themselves, and there’s an increased acceptance of it. Whereby now, we wouldn’t say it’s a placebo procedure totally.

The point is that all therapeutic practices, all therapeutic interactions have a placebo component. Some practitioners of course and some therapies, may be able to potentiate that placebo more so. There’s no evidence that I’ve seen to say that complementary medicine is any more of a placebo than something as dramatic as surgery. Surgery could well carry a very strong placebo effect. Our knowledge of what works is increasing very rapidly. The Cochrane Collaboration have been active in accumulating data and good clinical trials in complementary medicine.”

Acupuncture is not only called a placebo anymore but a “theatrical” placebo. Looking at the scientific basis of acupuncture, energy flowing through non-existing meridians, it cannot be anything other than a placebo. And this has been shown over and over.

But now the claim is made that CM is equally effective as surgery (or surgery is equally ineffective as CM).  This is a very interesting comparison and it places CM on equal footing with surgery. Most people will agree that positive outcomes due to surgery cannot possibly be due to only a placebo effect (eg. removing your appendix, heart bypass operations, mending shattered bones etc). But most people will also be surprised to know that there are some surgical procedures that have been shown to be equally ineffective as sham surgery – in other words, the positive outcome was caused by only the placebo effect. Because of this a review of health care procedures are currently taking place, which will hopefully lead to the removal of ineffective treatments.  And rightfully so. If something is shown not to work (or it only causes a placebo effect) it should be stopped. This most definitely does not mean that every medical procedure out there is nothing other than a placebo effect. Some might be, but the vast majority have a clear effect on top of any additional placebo effects.

The NICM now wants the public to believe that CM is equally effective as surgery. Their argument: yes there might be some CM’s (they never specify which ones) that only causes a placebo effect, but most CM’s are just as effective as surgery. In a previous article I wrote about how they compare the theory behind TCM with quantum physics, in order to make people believe that there is a massive body of scientific evidence supporting TCM. Now they compare, again in a very convincing way, something that is in general very effective (surgery) with something that has been shown to be ineffective (most CMs). This is done to create public trust in the effectiveness of CM.

The term CM is difficult to define and it includes every medical procedure or treatment out there that has no or very little scientific evidence. This does NOT mean that no or very little research has been done – it means that all results indicate that it is not effective. An important distinction to make is disproven vs unproven therapies. Homeopathy is a disproven therapy (huge amount of research shows that it does not work) vs some herbal medicines where no research has been done and hence its effectiveness is unproven. However, most CMs are placebos while some of them like Homeopathy and Chiropractic can also be quite dangerous. There is a very good way to distinguish between medicine and CM. As soon as there is good and reproducible scientific results supporting the effectiveness and safety of any medical intervention, that medicine or treatment enters the realm of evidence based medicine, even if it was originally regarded as being a CM. Whereas, due to a lack of scientific evidence it enters or it stays in the realm of CM even if it was once regarded as a “conventional” intervention.

Intentionally misleading the public. Part 2: Comparing the theory that governs TCM with quantum physics.

The public usually wants to know two things regarding any medical treatment. Is it effective and what are the dangers associated with it. There is however other aspects that scientists use to put the public’s mind even further at ease. If they also tell the public that the mechanism of action is known and that everything regarding this treatment is backed-up by a considerable body of scientific literature, then surely people will even feel more confident to use a specific treatment. The public will not go and read the scientific evidence, simply because they do not have access to the literature and even if they had, they will in all likelihood not be able to understand the contents. It is written in a scientific language and thus the public trust trained people at Universities to explain this contents to them in plain language. Consequently, if scientists explain how traditional Chinese medicine (TCM) works in plain language and add that there is a massive body of scientific literature backing this up – why should the public doubt what they say?

In part 1 of misleading the public, I wrote about how the National Institute of Complementary Medicine (NICM) go about presenting research findings and how they remain quiet when they should speak up. Their main research finding was that individually tailoring TCM herbs for irritable bowel syndrome is inferior to a standardised herb extract, which proves that the TCM theory and practice is based on a pre-scientific belief system. Not only do they ignore their own research findings and mislead the public into believing that TCM is effective but they also take it one step further. Now they explain how the theory behind TCM works in a very convincing way! In a second radio interview, dealing with complementary medicine in general, they continue to mislead the public with the main objective to create public trust in the TCM theory and practice. Here is the unedited excerpt from the transcript.

“Norman Swan: And Alan Bensoussan of the University of Western Sydney, has found that in Australia, Traditional Chinese Medicine is more than a $90-million industry, for non-trivial interventions like acupuncture and herbal mixtures. But the problem for the sceptical consumer is the apparent lack of discipline amongst alternative practitioners. They seem to pick and choose between philosophies and theories to suit themselves rather than relying on hard data. There doesn’t often appear to be one body of proven knowledge which you can be sure they have.

Alan Bensoussan.

Alan Bensoussan: Let me give you an example in the purest of sciences, in physics. We look at light, and we describe light as being wave motion, particularly when we describe diffraction-refraction effects and so forth, and explain how a rainbow appears. But we also simultaneously choose another theory for explaining light, the photon theory, the quantum theory of light, when we want to talk about the momentum and particles being knocked out of place. So we choose, even in the purest of sciences, different theoretical tools to explain our observations.

Now naturopathy may do that in a very eclectic fashion, and I think naturopaths are probably the most eclectic of the complementary therapists. But I need to acknowledge that even in Chinese Medicine, there are different theoretical schools and those schools are not whimsical. They’re schools that describe for example the sort of thinking and tools one should use in treating and managing infectious diseases. And then there’s another school that one should use, another body of theory that one uses in managing chronic internal illness. So there are theoretical tools that are constructed for the understanding of particular clinical portraits.

Norman Swan: Give me a practical example of where almost this dualism, in terms of thinking about somebody and their problem, can work.

Alan Bensoussan: OK. Take two patients that have both got low back pain and they come in to see their GP. They’re both chronic low back pain patients. The first patient has pain that appears first thing in the morning, has a lot of stiffness, but once they’re up and moving around for an hour or so, have a hot shower, they improve. The second patient, also with low back pain says their pain is fine first thing in the morning, they have no problem when they get up, but as the day goes on their pain registers more significantly and they have to actually sit down, lie down and rest, and they’re fine the next morning when they get up.

Now a GP would examine these two patients and send them off for various tests and determine whether there’s any pathology involved at all, whether there’s any arthritis or rheumatism or malalignment of the vertebra, whatever. If there’s no particular pathology in these two patients, the question has to be asked what can the GP actually do? How can the GP actually using medical science, differentiate between these two patients if there’s no obvious pathology. And I don’t think this is too contrived a situation, there are many inexplicable low back patients.

If those two patients went to a Chinese Medicine practitioner, there’s one theoretical tool that that Chinese Medicine practitioner can use which will help actually distinguish those two patients. And this might sound a little bit simplistic because the theory does, but if we just go along with this for a minute: the concept of circulation of energy is paramount in Chinese Medicine. The Chinese physicians have always said there’s more than just blood circulating in the body, there’s also energy, human energy of some sort circulating in the body. We don’t know how to measure that yet.

If we accept that as a theoretical tool though, we accept this concept of circulation of energy, the patient who has pain upon rising first thing in the morning when they’ve been rested all night through the coldest part of the day, they get up, they’re stiff, they’re sore, they move around for a while and when their energy starts circulating they add warmth as well, their energy starts circulating, their blood starts moving, the pain dissipates. So that first patient had a problem that was related to obstruction, stagnation of energy, a blockage of energy, an accumulation.

The second patient you’ve probably already understood, is quite the opposite, because they’re fine when they get up in the morning, it’s as the day goes on when their energy becomes depleted, their area of greatest vulnerability is exposed, which is their low back. So in fact for that second patient, they’re suffering a weakness or a deficiency of energy in the low back.

Now the concept of energy there is only a little tool, but what it’s done for the Chinese Medicine practitioner is it’s actually allowed a separation of those two patients, a conceptual separation. The first patient has too much energy in the low back, an accumulation, a stagnation, and that needs dispersing. The second patient has a deficiency of energy in the lower back and that actually needs strengthening, you actually need to bring energy, in in a sense, to the low back. So the treatments are actually at opposite ends of a spectrum.

The first patient would receive acupunctural herbs that disperse the accumulation of energy, the second patient would receive acupunctural herbs that strengthen and tonify the low back. It’s a tool like this concept of circulation of energy, that actually allows the Chinese Medicine practitioner to distinguish these patients, and allows the Chinese Medicine practitioner to treat the patients in a way that the patient themselves may understand better, and ultimately hopefully, be more effective.The alternative with Western medicine would have been simply to prescribe both of those patients analgesics or anti-inflammatories of some sort.”

End of transcript

There is a lot that can be said about this radio interview, but the most important aspect is the explanation of the theory that governs TCM. If scientists know how TCM works (mechanism of action) surely that will put peoples’ mind at ease about using TCM. So comparing it to quantum physics, which most people know something about (e.g Large Hadron Collider and the Higgs boson), makes sense and is quite convincing. For most of us quantum physics is something we only know about, without us even going to try and understand it – it is just way above our heads. By placing the theory governing TCM on equal footing with research into quantum physics, surely the public will think that TCM is very well studied and thus safe and effective?  And this is the NICM’s intention.

The question is; can you put these two theories on equal footing? Let’s look at the example of light. We can observe light, we can use light (torch, laser etc), we can predict how light will behave under specific conditions, we can scientifically define light – all of this due to hundreds of years of scientific research. By using the scientific method and by running one experiment after the other, many of which failed at first, we gained valuable knowledge of light and quantum physics in general, that we can now use in our everyday lives. Thus it is based on thorough scientific research. Do we know everything there is to know about light? Probably not – but future research will reveal the deeper quantum secrets which will hopefully lead to even more practical uses of light.

The theory behind TCM and the reason that different practitioners will prescribe different herbs for the same patient is based on a complete lack of scientific research or evidence. We cannot observe the energy that flow through these so-called meridians, thus we cannot measure it. And if we cannot measure it we cannot influence it or use it or predict what it will do under specific conditions. The main theory behind TCM, that energy flow through meridians, has been discussed endlessly and it has been relegated to pseudoscience – but not at the NICM. They are simply comparing apples with pears with the main objective to create public trust in the theory governing TCM.

Although this radio interview might at first sound really convincing this is nothing more than intentionally misleading the public. These people at the NICM are trained scientists and they know exactly what is going on. They are also fully aware of the very long list of risks associated with the use of herbs and yet they continue to work very hard at creating and strengthening the publics’ trust in TCM. The reasons for this can be found here. My next blog post will deal with the so-called “body of scientific evidence” for TCM and the simple question; where are all those excellent results?


Intentionally misleading the public! The National Institute of Complementary Medicine. Part 1.

The steady growth in the use of Complementary Medicine (CM) is caused by one main role player – the public! Why? We have been swayed into buying the stuff, and we do this because of the massive and effective marketing campaign targeting the publics’ weaknesses and by creating distrust in conventional medicine. But there is another aspect to this complicated issue. Scientists are usually ranked near the top of the most trusted professions list, amongst nurses and teachers, and quite predictably lawyers are usually near the bottom of this list.  So we tend to trust that what a professor say will in all likelihood be the truth. I have no doubt that this trust is well placed in scientists operating in many of the diverse fields of science, but is our trust warranted when it comes to scientists in the field of CM? Let us look at one simple example.

Traditional Chinese Medicine (TCM) “holds that the body’s vital energy (chi or qi) circulates through channels, called meridians, that have branches connected to bodily organs and functions”.  By manipulating these meridians (e.g. acupuncture) or increasing/decreasing the flow of energy (e.g. herbal treatments) disease can be prevented or the sick can be healed. TCM theory and practice has been discredited by the scientific community as dating from the pre-scientific era. The flow of energy, or the meridians they supposedly flow through, has never been observed or simply put, it doesn’t really exist.

A logical consequence of this is that different TCM practitioners will differ widely in the diagnosis and subsequent treatment that they prescribe to the same patient. Hence it is said that you will be prescribed 10 different herbs from 10 different practitioners. The TCM practitioners call this the “individualised care” (also holistic or whole-body) which they claim is lacking from conventional health care and hence they tailor their prescription for each patient. Not only does this make quality control next to impossible but for a scientist this simply means that there is no real science behind diagnosis and treatment – this by itself is very dangerous but not surprising, given the pre-scientific ideas that TCM is based on.

This aspect of individualised treatment has been studied by the National Institute of Complementary Medicine at Western Sydney University and the results confirmed what most scientists already know. Individually tailoring a combination of herbs has no extra benefit, and is even inferior, compared to a standardised set of herbs.  Now what does this mean?

  1. There are herbs that may contain useful medicinal compounds and deserves further scientific investigation.
  2. The TCM theory and practise is, as expected, invalid and it is at best a shotgun approach. Give a patient 20 different herbs and hopefully one of them will have some sort of positive effect (and ignore all the documented dangers).

Now most scientists will agree with these two points whereas scientists in the CM field will only devotedly agree with point 1. They will however vehemently object point 2 since it proves that the TCM theory and practice is indeed pre-scientific and that it is not based on science at all.  It basically destroys their whole “scientific” field! Because CM research is more a religion than a science they will now have to get rid of this result in some way or the other. Falsifying data is difficult and risky – if you are caught you are out. So what do they do?

They publish their  scientific findings in such a way that it actually looks like individualising TCM treatments are indeed working, whilst the most important finding was the fact that it doesn’t seem to be working. The exact opposite! But it doesn’t stop here. Now they have to go and sell TCM to the public because the public is the main role player in the explosive use of CM including TCM. During a radio interview this important issue of individualising TCM treatments came up and the response from Prof Alan Bensoussan, lead researcher in this study and also a registered Chinese herbal medicine practitioner and acupuncturist, to this question is quite revealing (interestingly, no conflict of interest was declared in this publication). Below the unedited transcript (interesting part in bold).

“…But more and more sufferers of irritable bowel syndrome are now trying alternative treatments. Dr Anna Guo has over 30 years experience and extensive qualifications in both Western medicine and traditional Chinese medicine. She specialised in gastroenterology in China. She treats IBS in her Chinese herbal practice in Sydney, and says she has a very high success rate.

Anna Guo: In Chinese medicine they’re related to the liver, spleen and sometimes they’re related to the yin and yang and balance. So when we use some Chinese herbs to smooth the liver, strengthen the liver and improve the digestive system, and then the symptoms will go and they’re good for the general health too.

Lynne Malcolm: But it’s not right for everybody? Do some people just not respond to Chinese medicine?

Anna Guo: Yes, some people not so sensitive to the herbs, that’s true. Just effective rates about 80%.

Lynne Malcolm: OK, well in front of us we have some bowls of different herbs. Can we just describe what each one is? OK, so we’ve got a very bright orange-looking one here all cut up in slices. What’s this?

Anna Guo: This is huang lian. This can gather from the heat from the stomach and the bowel.

Lynne Malcolm: And this one, it looks like a bark, it’s in a ring shape and it’s sliced up as well. Is that a bark from a tree?

Anna Guo: Yes, and that name is hou po. This herb can accurate the energy circulation, so very good to relieve some of the bloating of the stomach.

Lynne Malcolm: And this one, this is a long, looks like bones to me, what’s that one?

Anna Guo: That’s the dang shen, and they can improve the energy. So use of these herbs can supply the energy, improve the digestive problem.

Lynne Malcolm: And that’s from a plant too, I gather?

Anna Guo: Yes, that’s fungus plant, yes.

Lynne Malcolm: And this one, hard white sheets?

Anna Guo: This one actually is a fungus, but they are very good for the immune system, and they can get rid of some extra fluid, because the patients always they feel have the fluid retention.

Lynne Malcolm: So you would make a concoction, a mixture of all these herbs in different proportions, would you, for different patients?

Anna Guo: Yes, that’s right. Because in Chinese medicine we always fix the patient individually. All the different persons, they have the different conditions, different problems, and then we choose the right herbs for different persons.

Lynne Malcolm: How do you know that these herbs work and do you know how they work and why they work?

Anna Guo: I think is just from experience. You know in China, we already have 5,000 years experience on the herbs. Of course we study in the formal university, and we can get some experience from our teachers. And after we start our practice and we can get some experience from our practice too.

Nick Talley: Now I was a great sceptic about Chinese herbal medicine. So we set up a trial in conjunction with Alan Bensoussan, who’s one of Australia’s experts in the field at University of Western Sydney. We set up a trial to actually look at Chinese herbal medicine compared with placebo, with dummy preparations.

Lynne Malcolm: Gastroenterologist, Professor Nick Talley. The results of this trial were published in JAMA, the Journal of the American Medical Association in November last year. Alan Bensoussan.

Alan Bensoussan: Well overall we showed that patients who were receiving active treatment responded significantly better than those receiving placebo. The degree of improvement was estimated to be about two or three times that of the placebo.

Lynne Malcolm: Alan Bensoussan heads the Research Unit for Complementary Medicine at the University of Western Sydney. They run rigorous clinical trials on the effectiveness and safety of so-called alternative medicines.I asked him why they chose to evaluate Chinese herbs as a treatment for IBS

Alan Bensoussan: Chinese doctors use a different theoretical understanding of how the body works. To differentiate between patients that may, on the surface, appear to be exactly the same in the Western medical eye. So what Chinese medicine does is it actually tailors the treatment to some extent, much more specifically to the patient. So each patient would normally receive a very different set of herbs or a very different set of accupuncture points. And irritable bowel syndrome, because of its variety of clinical presentations, it lends itself ideally to testing this premise of Chinese medicine. So what we did that was very novel about this particular trial, is we actually set up one treatment group who were receiving a standard formulation in Chinese medicine, another treatment group who were receiving a sham formulation, something that smelt and tasted and looked like Chinese herbs, a placebo; and the third treatment group actually received tailor-made Chinese herb formulations. We wanted to test whether this tailoring was actually of any value at all. We do have to demonstrate that the herbs actually do work for this condition, and that had to be tested properly. I mean our outcomes were positive; active treatment did prove to be significantly better than the placebo. But having said that, that came as no surprise of course to Chinese medicine practitioners that were involved or even on the periphery of this trial. These herbs that were used in the trial, are used routinely in some of the largest public hospitals in the world for this condition.

Nick Talley: Now I was very surprised by the results. We actually showed that people with this combination of 20 different herbs, got better, compared to the placebo group. And it was a study that was done as well as we could to avoid bias in the results. Of course the trouble is, we need to confirm these results. And there’s one other issue: there are many Chinese herbs that are being used, and some of them actually have significant side effects. In fact some of them are potentially quite toxic. And people don’t realise this, they think that natural treatments shouldn’t have any problems, but in fact some natural treatments have significant potential problems. Still in the study we did, it did seem to work and it did seem to be safe over a 16 week period. So I’m impressed with this, and I must say it’s something that’s going to be followed up. But I’m not routinely prescribing Chinese herbs at the present time for irritable bowel, as I’d like to be sure of the long term safety, and also the long term treatment effects of the compounds.

Lynne Malcolm: Is it understood what the actual process is, and how these Chinese herbs work?

Nick Talley: No-one has the faintest idea how these herbs work. In fact I suspect probably only one or maybe two of these things are actually active, the rest of them are probably worthless. The trouble is, which two out of 20 might actually work, and how are they working? I just don’t know.”

End transcript

We know that people suffering from certain medical conditions listen intently to these radio shows – specifically the elderly. We know of the long list of risks associated with the use of herbal remedies and most shockingly, the participants in this radio show also knows about these risks. The main scientific finding of their study is that individualising herbal treatments is inferior to a standardised herbal treatment and thus again proves that TCM theory and practice is not based on science but rather on a pre-scientific believe system. As a registered Chinese herbal medicine practitioner, this aspect has to be ignored because it destroys your practise and makes your research invalid. To mislead the public is not always what you say or write, but it is also the important information that you intentionally omit. If I make the statement that the public is intentionally being misled – would I be lying? The many reasons why they do this can be found here!

Much more to come

The National Institute of Complementary Medicine, Australia; a place where you learn how to BS people!

“368,379 people killed, 306,096 injured and over $2,815,931,000 in economic damages” A complementary medicine (CM) practitioner arrested and parents jailed whilst a professor supporting these CM’s receive accolades. These treatments that can get you arrested are not considered to be on the fringes of CM but rather mainstay treatments such as naturopathy, including homeopathy. Clearly something is wrong! Is it people’s inability to think critically! Or is it because of our trust that professors at universities will think critically for us, the layman, and provide us with clear unbiased information regarding complex issues, such as disease and healthcare in general. After all, not everyone has the ability to comprehend complex scientific issues, especially children, or had the opportunity to study science.

With university bureaucrats focussing more on short term profits and improving their image (rankings), surely some cracks will start to appear. The abovementioned numbers includes people who got hurt or died using CM’s including homeopathy. It is extra heartrending when young children, who cannot yet think critically, are the victims. Is this because universities continue to allow these unscientific disciplines to be taught as science, for short term profits, flooding the public with misleading and unscientific information that caused these children to die?  One would argue that a National Institute of Complementary Medicine (NICM), at a respected University, will warn the public in a clear way about the dangers of some CM treatments.  That is after all part of their public role. So what does the NICM do and where does most of the taxpayers’ money go to?

The NICM’s modus operandi

After joining the NICM in 2012 I soon realised that I have entered wonderland. A simple case of selfplagiarism was my first clue, but after witnessing how science was being practiced in general and after being probed as to where my allegiance lay, I realised that I am in for a rough ride. They do whatever they can to put a positive spin on CM e.g. an independent systematic review used the title “Chondroitin for Osteoarthritis”, that the NICM reports as “New research confirms efficacy and safety of chondroitin sulphate for osteoarthritis” excluding the rather neutral/negative results in the original publication (reading all of the NICM’s newsletters will by itself confirm the abovementioned statement). Another comparison can be found here and here. They have no problems with simply misleading the public commenting on publications that borders on scientific misconduct (compare the abstract, limitations of this study and radio interview transcript). They use innovative experimental designs that assure positive results and claim that CM is very cost effective (water is very cost effective but does it work?). The question of in vivo bioavailability, efficacy, toxicity etc. is rarely, if ever, addressed. As such the approach of  most CM researchers has been very well documented and discussed and at the NICM it is no different (click on the publications link), with “believers” reviewing (notably Claudia Witt who was invited to become NICM director in 2012/2013) the scientific publications or funding applications of fellow believers. That is how the “body of evidence” for CM is being built. They continue to give an accurate measure of their existing bias, caused by an undying believe that CM is efficacious, safe and cost effective – although fame and fortune also appears to play a crucial role.

The NICM plans every possible scenario in the finest of detail.  Funding was recently received from the Jacka Foundation in order to establish a Chair position at the NICM. This position has only recently been advertised whilst the NICM worked on pre-selecting possible candidates (including the Queen’s homeopath), and on defining all possible questions that the media might ask and the “correct” answer that should be given as far back as April 2015. Why not just be honest? Because the NICM cannot run the risk of employing a real unbiased scientist! An unbiased scientist will ask; does a specific medical treatment work? – yes or no! A NICM scientist asks the question; How can we show that this treatment works?

Most people at the NICM focus on protecting and enhancing the image of the NICM and the CM industry. They do this by providing misleading “scientific” information with which they lobby health insurance companies, various politicians, members of the Royal family (eg.  Prince Charles) etc. They involve themselves with the regulatory agencies (TGA) and even act as chairperson for many years on the “advisory committee on CM”. The effect thereof; a long tradition of use is basically all you need to put a CM on the market- and that is handsomely rewarded by the CM industry. The NICM is being funded by industry so is this the perfect example of “industry regulating industry”? Industry funds research projects at the NICM with the understanding that a positive result will be found, thus leading to a scientific stamp of approval for their “products”.

The NICM is however very careful to stay within the rules and their focus is rather on changing the rules in favour of the CM industry. They perform commercial work for the CM industry that sells products that are mainly based on air such as chlorophyll for detoxification and enhanced energy (and many other misleading medications). Any scientific criticism on these products is not refuted with scientific facts, they rather take you to court. This begs the question if the NICM has ever lodged a complaint with the TGA about the unscientific basis of many of their clients’ products and the subsequent effects thereof on the well-being of Australian citizens?

Traditional Chinese Medicine, the NICM’s main focus

They set up collaborations with questionable Chinese companies and universities and manage to include the signing of a Memorandum of Understanding during the Australian-China free trade agreement ceremony.  Why? They want to use Australian citizens as guinea pigs for testing ancient Traditional Chinese Medicine (TCM) – much of it unproven, ineffective and some outright dangerous – just to make a dollar. They mislead the public by using western medicine as examples of TCM in order to create public trust in the effectiveness of TCM. And since the TCM market is apparently worth $170 billion, they win the backing of politicians as well. For China this is excellent, they can use Australia as a new export market for TCM’s and upon acceptance within Australia, due to the endless lobbying of the NICM, open up the more lucrative US and EU markets.  And because China is the “biggest country in the world”, TCM has to be effective and safe to use in Sydney clinics. So the NICM plans to introduce TCM’s via acupuncture clinics in Sydney, and they will use cancer as the disease of choice because the media would be reluctant to report negatively on cancer issues – but what about safety, efficacy etc?

The lack of quality control (QC) is a main critique against the use of TCM (specifically Chinese herbal medicine). To address the QC issue the NICM focus on developing analytical methods to quantify preselected compounds. They do this because it constitutes “scientific research”, it creates trust in TCM and it “solves” the QC issue. The NICM is involved with the TGA and was instrumental in establishing a long tradition of use as an indication of safetywhich is a somewhat risky thing to assume. Now they are lobbying the regulators that developing methods to quantify “chemical markers” solves the QC issue. The NICM knows that the real problem is that usually the putative active compounds, other compounds that might play a role (positive or negative) and toxic compounds are all unknown. The long term effects, compound–drug interactions, bioavailability, etc. of all of these unknown compounds are also unknown, and the levels of all of these unknown compounds will differ dramatically between batches, suppliers, year of harvest, storage conditions etc. On top of that, adulteration and a decrease in adherence to prescribed medicine is also a big concern.

The NICM knows that QC in TCM is next to impossible to do with current technology and this apply to one herb whilst TCM practitioners individually tailor up to 20 different herbs for any given treatment! The theory behind TCM makes QC impossible to do which implies that testing for efficacy and safety is next to impossible to determine as well. I call the practice of giving multiple herbs to a patient – the “shotgun approach”. Mix as many herbs as possible and hope that one of them will at least do something, but by doing this the risks are increased as well. The NIMC recently published a ranking scale in order to select markers to be quantified in herbs based on a number of criteria. While I, being an analytical chemist, had absolutely no input in this it again reminds me of continuing to accurately measure our existing bias. We are simply not in “control of the quality” – yes, we can generate a chemical “snapshot” and we can quantify a number of compounds, but we know nothing, or very little, about the total chemistry and therefore the biological effect. And importantly we cannot do anything about it – we cannot change the chemistry, it is what it is.

Nevertheless, the NICM will push ahead (it is a $170 billion market after all) and use the shotgun approach on the Australian public, and hopefully one herb will one day be shown to be actually effective. If anyone gets hurt or dies along the way then the NICM will simply claim that they only did QC on a few compounds, identified from literature, so someone else is responsible. The NICM get their publications, they mislead the public into thinking that they are using high quality TCM’s, and if anything goes wrong then the NICM cannot be held responsible. I have to admit that this is, although heartless, quite clever.

And toxicity?

Does the NICM have an interest in the potential toxicity of these products? Not really. As soon as a product show some toxicity that would mean that a full study has to be undertaken and the product cannot be marketed (or it has to be taken off the market) – and the NICM do not have much time for that. After asking numerous times that toxicity should be included for one such product, they again decided to only quantify preselected known compounds. Testing for toxicity has not even been discussed in any of the project meetings. There were good reasons to test for toxicity, but then again these products will reach the market, simply because the NICM is doing the QC and there is a long tradition of use and that gives the appearance of being effective and safe.

The taxpayer

The above paragraphs describe what most employees at the NICM do. The NICM received $2.15 million from the taxpayer in 2015, most of which went to salaries, in order to maintain this massive complicated network. It is a remarkable balancing act to keep the money flowing in, to continue to mislead the public and the university management and to give the appearance that the NICM is practicing unbiased independent science for the general good of the Australian public. And this is what the taxpayers’ dollars are being used for. It is just so sad that people are actually dying along the way and that this issue, when raised with the NICM and WSU, was simply ignored.

Impact on society

Are the parents who were jailed after their child died due to the use of homeopathic remedies really to blame? The following example epitomises the whole problem: The National Health and Medical Research Council (NHMRC) of Australia published a report on Homeopathy in 2014 and they found that there is no evidence of efficacy and that people may put their health at risk – which is clearly the case. This report dominated the media and one would expect that the NICM will discourage the public from using homeopathic treatments. The NICM knows about the recent deaths caused by CM and homeopathy, that it lacks any scientific basis and that the public should be warned against these dangers. Unfortunately this does not fit into the NICM’s larger than life future plans and in a position statement the NICM states, “Randomized controlled trials of homeopathy were not systematically and independently reviewed. …..No homeopathic expert was appointed……” and “This conclusion is consistent with many, but not all, international reviews of homeopathy”. They make the NHMRC report suspect, they do not give the citations reporting the positive reviews for homeopathy, and therefore this statement can only cause public confusion. Parents will look at this statement, from a respected Institute/University, and will continue to give their children homeopathic treatments because the trustworthy professor said that homeopathy is an effective treatment of disease. A wonderful example is the difference between the information that the US based “National Centre for Complementary and Integrative Health” gives to consumers regarding homeopathy and other CM’s as compared to the rather misleading information that the NICM gives on their website. Yes, the consumer needs to inform themselves about CM’s before they use it-  but where should they find this information? I would argue that they should definitely not go to the website of the NICM! The public do not have the scientific knowledge to understand what a CM is, and due to the flood of misleading information (mainly from the CM industry and the NICM) this can only lead to a lot of misery for a lot of people.  The NICM is knowingly misleading the public and when they are in the media it is almost always in defence of CM, using misleading numbers that should be questioned and sometimes unscientific scientific jargon to convince the public that there are indeed some science involved and thus CM’s can be trusted. It is odd that no media statement from the NICM can be found regarding the much publicised NHMRC report. But then again, not really!

It is all about money!

The NICM received about $4 million from the Jacka Foundation of Natural Therapies, which actively supports and promotes the following (and much more) as effective and proven treatments: “Energy and Subtle Healing, Homeopathy, Hypnotherapy, Planetary and Human Ecology, Reflexology, Acupuncture, Chiropractic……… “. Why does the NICM defend these CM’s? There is just too much money involved and the NICM’s misleading statement on homeopathy is a direct result of this. It is a blatant conflict of interest and scientific misconduct! We have to remember that people are currently dying due to the reluctance of the NICM to warn the public in an unbiased clear way of the dangers of some CM’s. Will the NICM change to become an independent scientific department, and advise the public of the clear dangers of some CMs? No, as long as funding is received from the CM industry and the Jacka foundation they will continue to mislead the public, policymakers, politicians etc. Neither will the university for as long as the NICM can provide them with the external income and publish as much as they can.  I have only touched on some aspects regarding the NICM and the way they operate. During general conversations and in meetings sometimes rather shocking scientific statements were expressed, while all my diplomatic attempts to try and get some of these statements on paper failed, due to the NICM’s growing suspicion that I am an unbiased scientist. However, there are a lot more that needs to be discussed and hence a series of reports will be published, discussing each aspect in much more detail.

Risk-benefit of the NICM’s operations

While working at the NICM I’ve asked myself one simple question. Does any CM or any treatment that the NICM, with its 50 odd researchers, work(ed) on give a clear well-defined medical benefit? To date my answer is, no! Once I really got excited when there was a buzz in the NICM’s hallways regarding a remarkable breakthrough in a clinical trial for a TCM – a buzz comparable to the moon landing. Looking at the results I was at first confused, then angry and then completely dismayed. Combined with the expensive cost effectiveness report of the top five CM modalities, I had a very clear answer to my question. Is this it – is this the best there is in CM? Apparently there is also a massive body of research (evidence) for TCM in the Chinese literature, and as a scientist you would logically pick the TCM’s which showed the best results, translate it and study it in Australia. The NICM has been involved with their Chinese partners for decades, so where are all those excellent results? Thus the overall benefit of all the CM modalities remain at best marginal and the NICM have been “researching” CM’s for decades, costing the taxpayer millions of dollars.

The risk of the NICM operations became clear when they published their misleading position statement on the NHMRC homeopathy report; when I was contacted by a medical doctor for advice regarding suspected herbal poisoning of a young girl after taking several herbal mixtures (from a well-known Australian manufacturer) for a common cold; and their insistence on developing analytical methods to quantify preselected compounds in herbs while they know what the real risks are. Taking into account the NICM’s general attitude to mislead the public while they know that people are dying because of it, makes the overall risk-benefit unacceptably high.

The way forward – is there a solution?

There might be a solution. The public has to be made aware of what CM is and what the associated risk-benefit is of CMs, so that an informed choice can be made. They need to know what their hard earned dollars are currently being used for at the NICM. The public should be convinced, if it is not too late already, that general well-being should focus around a balanced diet and physical exercise, and people should be persuaded, with facts, to get away from all these expensive CM “quick fixes”.

Scientists, especially at WSU, should speak up and defend science – granted a difficult thing to do because WSU is aggressively defending the NICM. Politicians, regulators, health  authorities, funding agencies etc. all the stakeholders that the NICM lobbies should be made aware of how the NICM operates, what their objectives are and the clear dangers associated with it.

As with everything else in life, money speaks louder than words, and I would therefore propose that the government raise a tax on CM and limit the CM industry from advertising their products. Currently the CM industry is allowed to advertise water as a scientifically proven health care option (and this is defended by the NICM) whilst people are dying because of this. This tax should be maintained on a CM product until that product has been shown beyond any doubt to have a clear benefit and minimal risk. Randomized controlled trials, funded by this new tax, should be conducted by a truly independent authority and only on CM’s which have a clear scientific basis (this excludes another expensive trial on homeopathic remedies). This will also prevent the CM industry from putting just about anything into a capsule and claim that it works. A full investigation into the NICM’s operations is also urgently needed. We cannot allow that short term unemployment figures and economic considerations, let alone the impact on the credibility of science, are deemed more important than peoples’ lives. Taxing CM will benefit the public as well as generate much needed income that can be used to fund research into real healthcare options, stimulate the economy and create jobs.