By Dr Richard Trembath*
I was once told never start an article with an anecdote, but, as this is an opinion piece, I shall ignore that advice. In the mid-1990s, when working at RMIT, I was asked to liaise with a leading Melbourne naturopath to establish a TAFE level course in naturopathy at the university. The course did not materialise but I remember my doubts at the time about what such a program would say about a fledgling university’s academic credentials. Such worries, if justified, came too late.
The first complementary medicine (CM) bachelor level course in Australia had been established at Preston Institute of Technology in 1980. Macquarie and Murdoch universities were quick to follow Preston’s lead and CM had established its tertiary foothold. By 2012 sixteen Australian universities and TAFEs were offering courses in complementary and alternative health fields, evidence that the demand for such training was high. Today, RMIT is probably the leading provider in the alternative arena in Australia offering a range of programs up to a PhD in Complementary Medicine. Private training institutions still exist, catering for those therapies that haven’t been snaffled by the public bodies. For example, just down the block from RMIT’s city campus is Endeavour College of Natural Health which has bachelor’s degrees in Naturopathy, Nutritional and Dietetic Medicine, Acupuncture and Myotherapy.
The demand for CM courses exists because over the last fifty years usage of CM services and products has grown steadily. The statistics are slippery to say the least. One large-scale study, now over a decade old, suggested, that in a particular fortnight, 32% of Australians attended a doctor or related professional, whereas approximately four percent of the country attended one or more of seven selected CM practitioners. Later studies indicate that the true number of those attending complementary practitioners is higher than this. Of course, many of us are eclectic, and while we might sneer at reiki (non-invasive massage) or homeopathy (diluting a substance to make it more potent), we are off to the chiropractor when our back twinges. And even if we don’t see the chiropractor or the naturopath, we buy a lot of so called natural products. In 2014, Complementary Medicines in Australia, an umbrella industrial organisation, claimed that 2/3rds of Australians used complementary medicines, a figure derived from the National Health and Medical Research Council (NHMRC). Krill oil was the most popular product, generating over 200 million dollars in sales.
Not that long ago, around 1965, orthodox medicine was trampling all over its rivals. Antibiotics and vaccinations repelled infectious diseases, surgery was routine and safe, drug treatment was effective. Alternative offerings retreated to the fringes. The history of Prince Henry’s Hospital in Melbourne is telling in this regard. Founded in 1869, it was originally a homeopathic dispensary. It soon became the Melbourne Homoeopathic Hospital, staffed by qualified doctors who were also interested in that esoteric discipline. In that period, not as esoteric as it would become. Orthodox medicine, the one of hospital training, societies, licensing and university degrees, was still competing at some levels with rival systems. In 1934, in commemoration of a Royal Duke’s visit, the Homoeopathic Hospital became Prince Henry’s: this was a sign, as the hospital’s historian says, ‘of homoeopathy’s fading appeal’. It became a respectable teaching hospital, closely connected to universities. In 1987 Prince Henry’s merged with other hospitals and by the time the St Kilda Road site closed in 1991, homeopathy was back, perhaps not mainstream, but some way from the fringes.
Demand for CM services increased in Australia in the 1970s. This occurred in the same period as development of heart transplants, the popularity of cataract operations, the eradication of smallpox and the reduction in smoking rates. I think many people were not aware that there were dissenting voices, alternative practices, until well after these had re-established themselves. So, why did alternative systems become more popular? I can only mention a few possible explanations here.
Some authorities talk, often rather generally, of the 1960s, the rise of the counter culture and a greater willingness in Western societies to experiment with alternative practices. For one commentator, ‘alternative medicines found support as an outgrowth of counterculture and human potential movements and from the influence of Eastern medical, philosophical and religious practices’. It is a neat theory and anecdotal evidence supports the influence of this factor, but it is hard to quantify.
Then there is the critique of the medical establishment’s hegemony. For example, Ivan Illich attacked the power of orthodox medicine which not only defined disease but operated as a state sanctioned closed shop. This resonated with those who were sympathetic to the anti-psychiatry theories of Thomas Szasz and R.D. Laing. It’s wry, to say the least, that in 2018 anti-psychiatry seems to have dropped out of favour with the educated elite who once so enthusiastically espoused it. Perhaps, the educated elite don’t like being lumped in with Tom Cruise and the Scientologists.
But the medical establishment was hegemonic, and in many ways still is. The medical world was a world with its own codes and zealous guardians. Its entrance was controlled by doctors via State accreditation, its educational requirements set by doctors, its disciplinary procedures conducted by doctors, its status high in the absence of a local aristocracy. Doctors ruled nurses, and everybody else working in a hospital was ‘ancillary’ or ‘para-medical’, terms that set medicine at the centre and everything else at the periphery. The Australian Medical Association (AMA) resembled the RSL in its stout defence of the status quo and their members’ privileges. ‘The world’s two best trade unions’, my mother used to say.
In some ways orthodox medicine is the victim of its own success. As Karen Hitchcock has argued in the Monthly, often what ails us now, is, lifestyle and social problems. Wrong food, lack of exercise, work stress, poor infrastructure, reliance on cars, failed education, especially about our bodies. Many people have genuine problems, but they are often ones CM cannot possibly address. Medicine cannot always address them either; only society can. Therefore, a pluralist society encourages pluralist health options. Nobody rational would suggest orthodox medicine is not the centrepiece of our health system, but the CMs, at least the more respectable ones like chiropractic and Traditional Chinese Medicine (TCM), have achieved that most elusive of goals for any occupation – they’re respectable.
Not everybody is entranced by these developments. In March 2017, the chairman of Universities Australia lamented the rejection of the value of expertise by a public supposedly hooked on Hansonite rhetoric. Barney Glover argued that universities stood up ‘for evidence, facts and truth’. Yet, many academics teach in disciplines which have about as much claim to science as current politics has to Socratic debate. In 2011 Friends of Science in Medicine was founded. One of its major objectives emphasised ‘the importance of having health care . . . based upon evidence, scientifically sound research and established scientific knowledge.’ And a chief target was ‘the increasing number of health courses and interventions on offer to Australians that fall far short of this standard’. In other words, universities.
This critique has forced a response from some institutions. For example, in 2012, RMIT responded to an article in the Medical Journal of Australiawhich argued that ‘[p]seudoscientific courses sully the genuinely scientific courses and research conducted at the same institutions’. The Acting Head of School of Health Sciences at RMIT stated that ‘Chinese medicine, chiropractic and osteopathy were all government regulated’ and RMIT’s education program did encourage clinical research into these treatments’.
Charles Sturt University (CSU) runs a Bachelor of Science (Complementary Medicine) by distance education, something I find a little odd given the interpersonal nature of this sort of work. Let’s leave that to one side. In 2016 Charles Sturt tried to ‘highlight the difference’ between its course and other universities’ offerings in CM. Its website stated that CSU did ‘not teach homeopathy, iridology, reflexology or any other subjects that are not based on experimental evidence.’ Apparently, its generic course is so based.
In 2015 two Australian government reports were blunt. The NHMRC investigated homeopathy, it of diluted doses and the power of the infinitesimal. It concluded ‘that there are no health conditions for which there is reliable evidence that homeopathy is effective’ and that therapy ‘should not be used to treat health conditions that are chronic, serious, or could become serious’. Then, the Federal Department of Health examined seventeen CM disciplines ranging from Alexander Technique to yoga. This was to establish whether private health insurance health rebates should be paid for these natural therapy services. Once again, the findings were clear and unequivocal. There was no evidence that the seventeen therapies were ‘underpinned by a credible evidence base that demonstrates their clinical efficacy, cost-effectiveness and safety and quality’.
In February 2017, Four Corners investigated aspects of the booming vitamin and supplement industry. Towards the end of the broadcast it dealt with homeopathy which had been savagely treated by the NHMRC review. The responses from Carl Gibson, CEO of Complementary Medicines Australia, were simply rubbish, including masterpieces like homeopathy being round for ‘thousands and thousands of years’, which it hasn’t. And there is his attack on the NHMRC review that it ‘was fundamentally flawed and skewed from day number one’. Which is not so, as the Australian review has attracted wide interest and respect internationally. No amount of waving your arms around until you go red in the face is a substitute for facts.
And no amount of Gerson or ginseng, even if pushed by an attractive huckster, such as Belle Gibson, is going to cure cancer.
*Richard is the author of several books, mostly in conjunction with colleagues. These include All Care and Responsibility: A History of Nursing in Victoria with Donna Hellier; A Different Sort of War: Australians in Korea 1950-53; Divine Discontent – The Brotherhood of St Laurence: A History (with Colin Holden);Witnesses to War: The History of Australian Conflict Reporting (with Fay Anderson). His most recent book is Defending Country: Aboriginal and Torres Strait Islander Military Service Since 1945 (with Noah Riseman) which was published in April 2016. Richard’s current research interests are the history of military veterans’ organisations and the social history of contemporary medicine.
Justin Norrie, ’Pseudosciences are destroying the destroying the reputation of Australia’s universities’, The Conversation, 5 March 2012, theconversationcom/pseudo-sciences-are-destroying- the-reputation-of-Australian-universities-5685.
Cited in Hans A. Baer, Complementary Medicine in Australia and New Zealand: its popularisation, legitimation and dilemmas, Verdant House, Maleny, 63.
Complementary Medicines in Australia, website, accessed 9 February 2017.
See Jacqueline Templeton, Prince Henry’s: the evolution of a Melbourne Hospital, 1869-1969, Robertson & Mullens, Melbourne, 1969.
Michael Wearing, ‘Medical dominance and the division of labour in the health professions’, in Carol Grbich (ed.), Health In Australia: Sociological Concepts and Issues, Prentice Hall, Sydney, 1996, 215 ff.
Karen Hitchcock, ‘Too Many Pills: On lifestyle diseases and quick fixes’, The Monthly Essays, September 2015.
Barney Glover, speech to the National Press Club, the guardian.com/Australia-news/2017/mar/01/universities-australia-chairman-warns-of-public-hostility-to-evidence-and-expertise,accessed 6 March 2017.
Friends of Science in Medicine website, accessed 10 March 2017.
Norrie, The Conversation.
Erica Cervini, ‘Research lacking in some alternative medicine programs’, Sydney Morning Herald, smh.com.au/action/printArticle?id=4035346, accessed 11 March 2016.
National Health and Medical Research Council Information Paper, Evidence for the effectiveness of homeopathy for treating health conditions, March 2015, 6.
Federal Department of Health, Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance, 2015, 3.
ABC, ‘Swallowing It’, Four Corners, 13 February 2017.