Criticism of Sydney Uni chair of integrative medicine reveals contradiction

The recent announcement, by Blackmores Institute and the University of Sydney, of the new Chair in integrative medicine at the Sydney Medical School has attracted a lot of criticism enabled by the provision of a sturdy soapbox from the mainstream press. The voices behind that negative response are crying foul with warnings of a conflict of interest and trotting out the same old refrain “there is no evidence for complementary medicine”. But therein lies the rub. Their main argument has always been that complementary medicines (CM) are untested and have no evidence to back up claims for their efficacy. They say that CMs are, at best unnecessary and at worst unsafe. They bandy about the term “pseudoscience”. But when Blackmores Institute bestows a major university with an unencumbered gift of funds to enable such research (which may in fact produce negative findings in some cases), they frown on it. These detractors can’t have it both ways. At the heart of this issue is patient care. With more than three quarters of all Australians being regular or sometimes users of CM, it is not only prudent to investigate how such therapies are being used, what they do, if they interact with pharmaceutical medicines, it is also the responsible thing to do. Considering government hasn’t seriously taken up the mantle to fund CM research, we feel it’s imperative for industry to help facilitate the process, or else who will? CM use is growing not dwindling. Ultimately those found to be safe and effective can be added to the armamentarium already integrated into standard practice. Despite the detractors saying their uppermost consideration in criticising CM is advocating for health interests of Australians this last week has convinced me that most of these groups and individuals would prefer to “notch one up against the enemy” than to have an informed discussion about an initiative that supports more research in Australia and protects patients and consumers. Another aspect to the criticism that I find intriguing is that the detractors will first say “there’s no evidence”, but when presented with good evidence, will say: “well now that’s just medicine – it’s not complementary any more”. In the first place, it’s ridiculous to proclaim there is no evidence behind complementary medicines and anyone who does so has not done their homework, and in the second place, if this initiative is about creating more Australian research, isn’t that a good thing? At Blackmores Institute we see this as contributing to discovering more medicines to help a broader range of people. Whilst pharmaceutical medicines can have positive, life-changing effects, there are still many areas where effective and safe treatments are lacking (such as depression or cancer), or current treatments are problematic (e.g. non-steroidal anti-inflammatory drugs and their safety issues). It is important to bear in mind our industry is not protected by patents, so any research that finds a certain herb or therapy actually works means it is then free for everybody to use. Clearly most Australians want CM to be available to them and that factor does not even begin to address the long-term cultural usage of many of these therapies.  It is grossly narrow-minded to espouse the homogenous viewpoint that Western medicine is the only way. The irony is that the CM industry is the one of the foundation blocks of the current mainstream pharmaceutical industry. Pharmacies were once bastions of naturopathic investigations. That is why it is, in many cases, baseless to create a distinction between mainstream medicines and CM. The endeavour to find cures and treatments for humankind’s multiple and varied ills is as old as humankind itself. The Egyptians used honey as an antibiotic and garlics to fight colds. In Persia they were using saffron for improving mood. In the Pacific kava is still in use for easing tension and anxiety. I believe the use of patents has created a divide. Research requires money, lots of it and the pharmaceutical industry has no incentive to fund expensive trials in CM due to this lack of patent protection. They also have no incentive to fund any essential research that will give them little return on investment. Antibiotic resistance is a case in point. According to an article published on 1 June 2015 in the International Business Time, major pharmaceutical companies abandoned or cut back antibiotic research and development a long time ago. Because antibiotics work so fast and so well, they reap weak returns on investments for industry. The article cites a recent report from the US the Review on Antimicrobial Resistance,  as saying as many as 10 million people a year could die from antibiotic-resistant bacteria worldwide by 2050 if new treatments are not discovered. One reason for the rise in antibiotic resistance is due to prescribing them unnecessarily for viral colds and flu. It therefore behooves everybody to give prescribers effective alternative treatments to combat cold and flu such as Pelargonium sidoides (a medicinal plant native to South Africa. Also known as Umckaloabo and South African Geranium that has shown efficacy in treating bronchitis and shortening cold symptoms and dose not induce resistance), so that antibiotics can be used only when absolutely necessary. It is also a registered medicine with the TGA. During this week one critic argued that Blackmores Institute should have given the money to the NHMRC to do research in this area. However, I would argue that the NHMRC has an extremely poor track record in funding complementary medicine research or placing significant CM academics on review panels who have the experience to critique the proposals they are reviewing. According to the NHMRC Research Funding Datasets 2003 - 2012, allocations for research funding into complementary medicine have been just 0.2% of total funding over the past ten years, despite burgeoning use of complementary medicine by the Australian public. In 2015 nothing has changed. Industry funding to support staff and research is a common activity at universities around the world, such as Stanford, Cambridge and Harvard. Universities have strict guidelines about this and in fact, many rely on external funding to enable critical work to be done. According to the Dean of Sydney Medical School, Professor Bruce Robinson, the university will collaborate with international partners in Canada, China and Asia, and proposed schools in the USA and UK. “The role will also work closely with leading centres within the university, such as the Charles Perkins Centre, the NHMRC Clinical Trials Centre, the Woolcock Institute, the Kolling Institute and our eight clinical schools.” That is a commitment to openness and transparency. No one is saying that this should not be subject to ongoing scrutiny, but it should be said that all Sydney University’s requests to ensure strict governance have been happily met by us. Another criticism was that the Chair should not have been named for the founder of Blackmores, Maurice Blackmore – because Maurice Blackmore was “clearly not a champion of evidence-based medicine.” It is prudent to point out that Maurice Blackmore died in 1977 and evidence-based medicine or EBM was not even a concept until the early 1990s. He was a pioneer in applying clinical nutrition to improve patient outcomes. We have to start somewhere. But that aside, in criticising this initiative by the University of Sydney to fund research and education in complementary medicine (CM) and integrative medicine the detractors are highlighting the manifest contradiction in their opposition to it. Clearly there is a need for more scientific investigation to uncover new and novel mechanisms of action and clinical effectiveness of CM. That is the very aim of this Chair. The University of Sydney is set to add to that evidence-base by undertaking more research. As Professor Robinson puts it “I really can’t countenance standing by on the sidelines being critical without rolling up my sleeves and getting in and gathering the evidence that is so sorely needed." References http://www.ibtimes.com/antibiotic-resistance-why-arent-drug-companies-developing-new-medicines-stop-1833248 https://www.nhmrc.gov.au/grants-funding/research-funding-statistics-and-data/burden-disease-and-health-issues "Evaluation of pharmacodynamic activities of EPs(®) 7630, a special extract from roots of Pelargonium sidoides, in animals models of cough, secretolytic activity and acute bronchitis" Bao Y1, Gao Y, et al Phytomedicine 2015 Apr 15;22(4):504-9. doi: 10.1016/j.phymed.2015.03.004. Epub 2015 Mar 20.