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.