Microsoft word - atms submission to chief medical officer final

Au s t r a l i a n T r a d i t i o n a l -
M e d i c i n e S o c i e t y A B N
Australian Traditional-Medicine Society Ltd (ATMS)
Submission
Chief Medical Officer:
Natural Therapies – Review of
Private Health Insurance Rebate
October 2012
Table of Contents
Executive Summary. 3
About the Australian Traditional-Medicine Society. 4
Introduction . 8
Health Consumer Usage of Natural Therapies. 8
Background – Current Regulatory System. 8
Private Health Insurance Providers and Natural Therapies. 9
Rebates are Important to Natural Therapy Practitioners and Health Consumers . 11
Impact of Proposed Changes on ATMS Members and Health Consumers . 11
Literature Review – Evidence Supporting Natural Therapies . 12
Conclusion . 22
Executive Summary
In response to the federal Chief Medical Officer’s review of natural therapies, thissubmission provides a detailed analysis of the issues surrounding private healthinsurance and the natural therapy profession.
It argues strongly against restricting health funds from providing benefits to customerswho choose to frequent natural therapy practitioners.
The Australian Traditional-Medical Society is Australia’s leading representative of thenatural therapy profession, with 11,800 members.
Natural therapy is an important and growing health sector that contributes to improvingthe overall health outcomes for Australians.
It also outlines the current regulatory system and how private health insurance providerssupport the natural therapy sector.
This submissions outlines why the proposed changes will have significant, negative andlasting impacts on the businesses of ATMS members, the future viability of naturaltherapy in Australia and the health and the well-being of thousands of Australia’s whouse the services of natural therapy professionals.
The submission also summarises a literature review of into the efficacy of a naturaltherapy modalities.
Finally, the Conclusion re-states our preference for keeping the current arrangements inplace.
Contact Details
Allan HudsonActing Company SecretaryAustralian Traditional-Medicine SocietyPO Box 1027Meadowbank NSW 2114 Telephone (02) 8878 1500Fax (02) 9807 8130 Email: [email protected]: www.atms.com.au . Australian Traditional-Medicine Society. 2012.
This document is copyright. No part may be reproduced by any process except in accordancewith the provisions of the Copyright Act 1968 (Cth).
Staindl P, Grace S, Khoury R. (2012). Australian Traditional-Medicine Society Submission to theChief Medical Officer: Natural Therapies – Review of Private Health Insurance Rebate. October2012. Meadowbank, Sydney: Australian Traditional-Medicine Society.
About the Australian Traditional-Medicine Society
The Australian Traditional-Medicine Society (ATMS) is Australia’s largest professional association of natural therapy practitioners, representing approximately 65% of the total natural therapy profession. At October 2012,, the membership of ATMS was 11,800 practitioners.
ATMS was founded in 1984 and is a not-for-profit company incorporated with the Australian Securities and Investments Commission (ABN 046 002 844 233).
1. Executive and Administration
ATMS is governed by the Executive Board of Directors. The Society’s administration consists of 9 full-time and part-time staff. Six Departments have been established within ATMS to address the specific needs of massage therapy, traditional Chinese medicine, naturopathic nutrition, naturopathy, homeopathy and western herbal medicine practitioners.
2. Representation on Commonwealth Statutory Bodies
ATMS is the only natural therapy professional association represented on two Commonwealth statutory bodies ie the Therapeutic Goods Advertising Code Council and the Complaints Resolution Panel which have their legal authority underpinned in the Therapeutic Goods 4. Publications
 Journal of the Australian Traditional-Medicine Society (ISSN 1326-3390), a quarterly peer reviewed publication. The Journal is indexed in the following international bibliographic indexes: Alt Healthwatch (USA), Cumulative Index of Nursing and Allied Health (CINAHL) 5. Continuing Professional Education Program
ATMS is committed to a high quality Continuing Professional Education (CPE) program. The ATMS CPE program draws upon accomplished practitioners to discuss clinical experiences, as well as theoretical and philosophical perspectives. The CPE program is committed to quality education. It is mandatory that ATMS practising members participate in the CPE program.
6. ATMS Code of Conduct
The ATMS Code of Conduct sets the standard for adequate professional conduct for ATMS members. The Code deals with duty of care, professional conduct, confidentiality, patients records, advertising and stationery. It is ATMS policy that members must adhere to the Code. A wide range of sanctions are imposed on members who breach the Code, with a serious breach of the Code resulting in removal from the Society.
7. Criteria for a College to Gain ATMS Recognised Status
The ATMS Criteria for Recognised College requires that a teaching institution must meet the ATMS requirements for advertising, refunds policy, student information, student grievances, recruitment procedures, general standards as well as a college inspection. If the requirement is met, a teaching institution is granted provisional status for a three year period before being granted full Recognised College status.
8. Professional Indemnity Insurance
Practising members must have professional indemnity insurance of at least $1 million, and the Society has a master policy scheme with an insurer.
9. First Aid Certificate
Practising members must hold a current Level II First Aid Certificate.
10. Website
The ATMS website address is www.atms.com.au Recognition by the Australian Taxation Office for GST-free Status
ATMS gained a Private Ruling from the ATO on 27 November 2002 that allows its acupuncture, herbal medicine and naturopathy practitioners to have GST-free status.
ATO Private Ruling 21937 consists of two decisions. The first decision is that: ATMS is a professional association that has uniform national registration requirements for practitioners of natural and traditional medicine. Consequently practitioners (acupuncturists, herbalists and naturopaths) who are members of ATMS will be considered to be recognised professionals for the purposes of paragraph 38- Acupuncture, herbal medicine and naturopathy services will continue to be GST-free  a practitioner that satisfies the ‘recognised professional’ criteria; and the services provided are considered by the profession as necessary for the appropriate treatment of the recipient.
ATMS acupuncturists, herbalists and naturopaths must be financial members of ATMS in order to Section 38-10(1) of the GST Act uses the term ‘appropriate treatment’. For the purpose of GST legislation, appropriate treatment in this context refers to the process when the practitioner ‘.assesses the patient’s state of health and determines a process to pursue, in an attempt to preserve, restore or improve the physical or psychological wellbeing of that patient insofar as that recognised professional’s particular area of training allows’.
Introduction
Natural therapy is an important and rapidly growing component of Australia’s overall healthsystem. More than 70% of Australians use a form of natural therapy as a regular part of theiroverall health care, with close to 2,000,000 professional consultations conducted annually.
ATMS is deeply concerned that the removal of natural therapy practices from private healthinsurance will have significant, negative and lasting impacts on the businesses of ATMSmembers. Further, it threatens the future viability of Australian natural therapy practices and thehealth and the well-being of thousands of Australians who use the services.
ATMS is also concerned that the changes to the rebate system will see private health insuranceless attractive, as individuals will opt not to buy coverage with fewer additional and innovativeextras such as natural therapies.
Natural therapies are efficacious, cost-effective, safe and of a high standard, and thereforeshould be allowed to continue to be covered by private health insurance providers. As such,ATMS strongly supports leaving in place the current arrangements, which sees private healthproviders and individual consumers make their own decisions about incorporating naturaltherapies into their broader health care.
Health Consumer Usage of Natural Therapies
In 1984, the Parliament of Victoria Social Development Committee Inquiry into Alternative Medicine and the Health Food Industry found that 22% of Victorians had used the services of a natural therapy practitioner in the preceding 5-year period (Parliament of Victoria Social Development Committee, 1986). In 1989, the Australian Bureau of Statistics found that 2.6% of the population used the services of a natural therapy practitioner (Australian Bureau of Statistics, 1991). In June 1995 The Australian newspaper reported that a private survey found 50% of the sample group of 400 respondents had consulted the services of a natural therapy practitioner In 1996, Adelaide researchers found that 20.3% of 3,004 respondents in South Australia had used the services of a natural therapy practitioner (MacLennan, 1996). It was estimated that South Australians had spent AUD$25 million annually in 1993. When age and sex are standardised to the national population this amounts to AUD$621 million. This compares to the AUD$360 million patient contributions for all classes of pharmaceutical drugs in 1992–1993 (MacLennan, 1996). In 2000, it was estimated that 52% of the population had used at least one complementary medicine, and that 23% had visited a natural therapy practitioner (MacLennan, In 2006, an article in the West Australian estimated that Australians spent AUD$6 billion a year on natural therapy services and medicines (Pryer, 2006). Herbal medicine practitioners alone conduct 1.9 million consultations annually (Casey, Adams & Sibbritt, 2007). In 2007, Xue et al reported that Australians had made 69.2 million visits to natural therapy practitioners, compared to 69.3 million visits to biomedical practitioners (Xue et al, 2007). This study also estimated that national health consumer expenditure was AUD$4.13 billion. Accordingly, this highlights strong health consumer community involvement and significant monetary expenditure on natural Background – Current Regulatory System
Currently, the Australian Government provides the private health insurance rebate to individualsand families to encourage the up-take and maintenance of private health insurance. Most peopleare eligible for a 30% rebate on their insurance costs. This has typically included the cost ofadditional coverage and optional extras, including natural therapies.
However, the release of the 2012-13 Budget included the announcement that the FederalGovernment will review this stance, with Government set to mandate private health insuranceproviders only pay benefits for natural therapy practices that have been found to be ‘clinicallyeffective’.
Private Health Insurance Providers and Natural Therapies
Private health insurance providers are increasingly aware of the health benefits of naturaltherapies. In recent years, many of these therapies have been added to the list of ancillary orextras cover services.
The health fund insurers establish the eligibility criteria for a natural therapy practitioner to beregistered. The criteria includes:  membership of a professional association recognised by the private health funds current professional indemnity insurance current senior first aid certificate ATMS Continuing Professional Education requirements Registered Training Organisation qualification in the relevant field or a Government National Training Package qualification.
This arrangement, which ATMS wholeheartedly supports, ensures that clients accessingrebates are visiting highly qualified natural therapy practitioners. The process provides an extralayer of protection for clients who use natural therapies, ensuring quality health care.
Fundamentally, it also ensures the private health insurance rebates and the FederalGovernment’s contribution to private health providers are only going to accredited healthprofessionals. This protects against wasteful spending.
Private health insurance providers are increasingly aware that natural therapies has a loyalcustomer base. Of course, the range of natural therapy disciplines covered by health insuranceproviders varies greatly between the private health funds and the level of coverage purchased.
ATMS believes that the inclusion of natural therapies as extras offers private health funds with apowerful additional selling point encouraging customers to take out higher levels insurancecoverage, as well as maintaining existing coverage, and differentiates between different healthinsurance providers.
Generally, naturopathy, herbal medicine, homoeopathy, nutrition as well as tactile therapiessuch as massage, reflexology and aromatherapy are all covered through private healthinsurance rebates.
The rebates are, generally speaking, more attractive for tactile therapies, because theseconsultations usually have a fixed price per visit as complementary medicines are notprescribed. The cost for ingestive modalities, such as naturopathy and herbal medicine, oftenvaries from client to client, due to the additional costs of complementary medicines.
In addition, a range of other factors should be considered in this review of natural therapies: 1. Private health insurance providers cap the annual limit that can be claimed for natural therapy consultation. These caps depend on the level of cover – the higher the premiumthe higher the benefits, but these are typically between $200 and $300 per year. As apercentage of total private insurance benefit outlays, this is marginal, certainly whencompared to overall benefits these services provide to health care outcomes in Australia.
2. Some health insurance providers offer coverage for some natural therapies, but may specifically exclude others. For example Australian Unity’s “Super Extras” cover,provides benefits for naturopathy, but excludes kinesiology and shiatsu. This could bebased on financial considerations or views about the efficacy of different naturaltherapy practices.
3. Generally, optional extras are only part covered ie the majority of costs fall on individuals, with the health fund reimbursing for a percentage of the total consultation cost or a fixedvalue. For example, Australian Unity’s “Super Extra”, their premium extras cover,provides a fixed $25 benefit for remedial massage, capped at $150 per person per year.
However, this cover, reimburses 80% of the consultation cost for naturopathy, capped at$400 per person annually. This is not a high figure, compared to the natural therapiessector’s contribution to mainstream health care.
The overall conclusion is that the private health insurance providers only provide a marginal levelof funding to natural therapy clients. Many health insurance funds have already put in placemechanisms to ensure that funding only goes to natural therapies that are efficacious andcomplementary to mainstream health care.
Rebates are Important to Natural Therapy Practitioners and Health
Consumers
The current system, which allows private health insurance providers to pay rebates to clientswho use natural therapy, is extremely important to the natural therapies profession.
Rebates ease the financial cost of visiting natural therapy practitioners, particularly in lower-socio economic groups.
As there are no other schemes, either government or private, that provide assistance to naturaltherapy clients to improve health outcomes, private health insurance rebates are of vitalimportance. Medicare, for example, does not offer financial support for Australians that usenatural therapy.
There are a number of flow-on benefits from private health fund rebates assisting the healthconsumer using natural therapies ie  it helps build hardworking local natural therapy businesses and supports the natural  encourages people to engage more with their health offers more healthcare choices for Australians improves the health and wellbeing of many thousands of Australians.
Impact of Proposed Changes on ATMS Members and Health
Consumers
ATMS and its member practitioners are deeply concerned about the impact the proposedchanges will have on the traditional therapies sector, particularly those modalities in whichadverse findings are made about the clinical efficacy of the particular therapy.
ATMS believes that the changes to the rebate system could see practitioners forced to close,costing jobs and undermining other local businesses. It could also see dedicated natural therapyclients forced to cease natural therapy treatment.
Changes to the system could dramatically undermine the vital work done in recent years by thenatural therapies sector in building public awareness and demonstrating its contribution toachieving positive health outcomes and improving the wellbeing of natural therapy healthconsumers. Cutting the rebates would send a dangerous message to the general public thatnatural therapies are unsafe or mere “quackery”, in spite of substantial evidence that naturaltherapy practices improve health. ATMS believes this is counterproductive and an unfair attackon an industry that is dedicated to improving the health and wellbeing of all its healthconsumers.
Three main hypotheses have been proposed to explain the health consumer’s demand for natural therapies (Astin, 1998; Astin et al, 1998; Baer, 2001; MacLennan, Wilson & Taylor, 2002; Siahpush, 1998). The first was dissatisfaction with the outcomes of medical treatment, including adverse drug effects. The second was discontent with the medical patient-doctor relationship encounter, that is, duration of the consultation and lack of personal attention. The third was that natural therapy placed emphasis upon nature and natural, as well as on health rather than disease. An increasing number of heath consumers want to participate in the healing Clients who use natural therapy practitioners for their health care are taking a more active role intheir long-term health and are deeply interested in holistic healthcare. Removing this assistance,could see these people become less healthy. ATMS is also concerned that the loss of rebates willnegatively impact the wider health of many of thousands of people who rely on their health careprovided by natural therapy professionals.
Finally, ATMS is deeply concerned about the impact cuts to the rebates will have on the privateinsurance industry. Private insurance optional extras, such as benefits for natural therapies are akey selling point for private insurance customers. We believe that the proposed changes couldrender private health insurance less attractive as people feel they are getting less value-for-money. Certainly, such a move could discourage people from taking out more comprehensivecover.
Literature Review – Evidence Supporting Natural Therapies
In the wake of the Chief Medical Officer’s “Natural Therapies - Review of Private HealthInsurance Rebate”, ATMS has provided a literature review of Australian and internationalstudies into natural therapies. This review shows the overwhelmingly positive impact mostnatural therapy practices have on Australia’s long-term health outcomes. It shows, for the mostpart, natural therapies are underpinned by a robust evidence base.
We strongly believe that this review gives it a high degree of credibility, and thus its findingsshould be taken into consideration when reviewing what disciplines should continue to beallowed to attract the Health Insurance Rebate.
1. What Constitutes Evidence?
Evidence-based practice is a formal problem-solving framework that helps practitioners make informed clinical decisions about the care of individual patients (Wilson, Mills, McGowan, & Guyatt, 2002). Grant (2005) states that ‘evidence-based practice is a methodology for decision- making in clinical practice which describes the finding of the best quality information about treatment with reference to the hierarchy of evidence applicable to practice’(p. 5).
The National Health and Medical Research Council of Australia has developed a guide to ranking evidence or research findings according to the level, quality, relevance and strength of the intervention study. The hierarchy of evidence provides a useful guide for dealing with the volume and complexity of information available to practitioners and encourages critical appraisal of clinical evidence (Grant, 2005). It informs practitioners about the strength of research evidence supporting their assessments, treatments and recommendations for In natural therapies, informed clinical decisions are based not only on current best evidence from research findings and scientific trials, but also on clinical experience and traditional usage and knowledge. The Complementary Medicine Evaluation Committee within the Therapeutic Goods Administration includes traditional evidence as part of its evaluation process. Traditional evidence is the accumulation of experience of practitioners over hundreds and sometimes thousands of years (Mills et al., 2002). It is the systematic accounts in the spoken and written records of systems of medicines passed on through generations. An example is the materia medica used by herbal medicine practitioners which details traditional knowledge from many cultures and historical perspectives that formed the basis of health, healing and medicine Grace (2008) and Khoury (2009) argue that evidence paradigm for what is accepted as truth is socially constructed, as once a paradigm meets with unavoidable and substantial anomalies, it is abandoned for another paradigm. Therefore, the value of experiential knowledge based on the critical appraisal of past experiences of clinical effectiveness by both clients and practitioners is an important form of evidence. There is equal value in different ways of knowing and as society gains greater knowledge and choice in health care then the definition of what constitutes The two main weaknesses of evidence-based practice are the hypothesis testing and statistical p-values. Firstly, the hypothesis testing in randomised controlled trials rests in inductive logic, since the hypotheses one begins with are not axioms, but are based on previous experience and expectation. The problem with inductive logic is that it develops sophisticated argument from sensory experience, which is in discord to EBM tenets (Nordin, 2006). Secondly, the statistical p- values calculated at the end of randomised controlled trials actually represent the probability of the data given the null hypothesis, whereas the real interest lies in knowing the probability of the The Cochrane Complementary Medicine Field was established to meet the need for scientific evidence-based research in natural therapies. Even if it is accepted that randomised controlled trials are the gold standard to test for efficacy, it is clear that single studies are not fully convincing. Systematic reviews and meta-analyses which combine multiple randomised controlled trials and statistically pool the data may provide more compelling biomedical science The randomized controlled trial model is problematic in natural therapies research, because it assumes a relative equivalence of all cases with a particular condition, and therefore averages the uncertainty factor. In doing so, it provides no mechanism by which interactions between the intervention itself and the practitioner, clinical setting and context variables can be studied (Thorne et al, 2002). Also, blinding the patient and the practitioner to the therapeutic option is often difficult, if not impossible, given the contextual nature of diagnostic processes, negotiations around options and the degree of active involvement each party plays in the therapeutic relationship. Furthermore, the notion of placebo raises considerable suspicion in the herbal medicine context (Hilsden &Verhoef, 1999). Consequently, as a placebo effect exists, it is axiomatic that the helpful interaction of a placebo is in itself beneficial (Thorne et al, 2002).
Moreover, factors such as trust, relationship and transmission of healing energy are an inherent component of the natural therapies therapeutic relationship.
The number of systematic reviews of natural therapies research is increasing and this goes part-way towards answering calls for high quality research in natural therapy practices.
However, the scope of natural therapy, with its diversity of practices, language, and cultural norms, presents specific challenges for conducting reviews, such as the choice of appropriate topic for combining trials (Grace, 2008). Moreover, relying solely on the hierarchy of evidence to inform best practice and intervention does not suit all aspects of health care, especially considering the larger public health and social aspects of disease (Grant, 2005). One of the strengths of natural therapy practice is its focus on patient education for disease prevention which is an important public health initiative.
There are fundamental differences between the underlying philosophies of biomedicine and natural therapy. These differences have created misconceptions about the validity of natural therapies in the health care system. These differences include the traditional reductionist, mechanistic approach of biomedicine as opposed to the biocultural and holistic approach of natural therapy; biomedicine’s focus on eliminating the disease-producing agent as opposed to natural therapy’s focus on encouraging the innate ability of the human body to restore itself to health; and biomedicine’s focus on illness as opposed to natural therapy’s focus on wellness Randomised controlled trials do not take into account the holistic view and the complex treatment protocols offered by many natural therapy practices. The emphasis on an evidence- based approach to establishing the efficacy of single herbs and nutrients, for example, overlooks the way that natural therapy practitioners actually use these substances in practice (Grant, 2005). Moreover, blinding is impossible in physical therapies such as massage and when treatment requires the active cooperation of the patient such as in dietary or Despite the complexities of finding or developing suitable methodologies for natural medicine research, it is possible to design research studies for natural medicine that generate evidence capable of informing clinical practice. Several alternative approaches have been proposed as capable of providing a genuine assessment of the efficacy of natural medicine (Grace 2008).
 Systematic clinical auditing, with its large samples of clients, can be used to determine future research questions for randomised clinical trials.
 Pragmatic research that consider complete natural therapy treatment programs without identifying the underlying mechanism of action for each intervention may be useful, provided that there is a clear, clinically relevant outcome. A particular advantage of this approach is that it recognises that natural therapy treatment programs are frequently multifocal, collaborative (with the client) and integrated into the client’s lifestyle unlike the specific, isolated (distinguishable) treatments that are commonly delivered by medical  Outcome measures (questionnaires used as standardised proxy measures of effectiveness of treatment) are proving to be particularly useful in pragmatic research designs and have been keenly taken up by natural therapy researchers. They are simple to administer and their standardised scoring systems allow comparisons of clients’ responses over time. It is the reported validity of these outcome measures in different client populations that is having a considerable impact on the biomedical science 2. Scientific Evidence Base for Natural Therapies
Ernst’s critical appraisal of available scientific evidence-base for natural therapies provides a resource for natural medicine practitioners on the available scientific research and evidence to inform practice (Ernst, 2006). Since this publication, well respected experts in their speciality field of natural therapy practice in Australia, such as Braun and Cohen, Galvin and Bishop, Leach and Gillham, Sarris and Wardell, Grace and Deal have published books with extensive analysis of the most current available and valid scientific research findings. These combined works further the ongoing agenda to position and justify natural therapy practices in terms of their evidence-base practice (Braun & Cohen, 2010; Galvin & Bishop, 2010; Leach & Gillham, 2008; Sarris & Wardell, 2010; Grace & Deal, 2012).
Table 1 Scientific-evidence for Natural Therapies
Data used to construct Table 1 were derived from 313 systematic reviews dealing with the effectiveness of natural therapies. Cochrane Reviews, Medline and AMED databases were used to locate the systematic reviews in this summary. The five categories are based on the 1.Evidence of benefit (+): supporting evidence for natural therapy effectiveness. For example, phrases such as “evidence suggests/shows/supports” without need for further research to confirm the results have been assigned to this evidence level 2.Inconclusive but worth further research (I+): inconclusive but promising or positive results from limited quality trials. In these cases the authors suggested further research was required to confirm the results.
3.Inconclusive (I): insufficient data to confirm or refute the claims.
4.Inconclusive but probably not worth further research (I-): there was no evidence of benefit from good quality trials and/or evidence of no benefit from poor quality trials.
5.Evidence of no benefit (-): reviews with evidence of no benefit from good quality trials.
Table 1 contains more reviews on nutritional supplements (33.2%) than any other natural therapy. Herbal medicine had the highest percentage of reviews reporting evidence of benefit (40.6%). Only 5.4% of all reviews in the summary reported evidence of no benefit. Some reviews also belong to mainstream medicine, such as those comparing physiotherapy with other physical therapies and those reporting on nutritional supplements which are not exclusive Some areas of natural therapy, namely nutritional and herbal medicine supplementation, have been subject to thousands of scientific studies. Nutritional medicine, in particular, is an area of natural therapy practice that overlaps with other health care practices such as medicine, pharmacy and dietetics. High quality evidence exists for many nutritional medicines. This may be because of the popularity of nutrition as a research area, strong funding support by interest groups and stakeholders, and its suitability for gold standard randomised double blind controlled Table 1: What the scientific literature (based on systematic reviews) says about natural therapies
Natural Therapies
Author(s)’ conclusions (%)
Acupuncture
Chinese herbal medicine
Chiropractic and osteopathy
Herbal medicine
Massage, aromatherapy, touch
therapies
Nutritional supplement
Combined therapies
Inconclusive but probably notworth further research Hechtman’s (2011) recent text, Clinical Naturopathic Medicine, includes a comprehensive chapter on nutritional medicine. In this chapter essential major macro- and micro-nutrients are evaluated and assessed in terms of recent available scientific research into biochemical function, basic physiological requirements, pharmacological and therapeutic dose ranges and accompanying clinical application. Further evidence is provided on interactions (medications, nutrients and dietary), toxicity, dietary intake and the need for supplementation. Over two hundred in-text citations are made in this chapter to scientific research published in peer Acupuncture
For acupuncture there is a large number of studies of treatments of various disorders. The current evidence supports the claim that acupuncture is more effective than placebo for some conditions such as dental pain and nausea, especially post-operative (Ernst, 2001). Most of the seven Cochrane Reviews on acupuncture show inconclusive results based on too few and too poorly designed studies. There are some good quality studies on pain but no claims can be made about duration of benefit because of trials had relatively short follow-up periods. Overall, acupuncture seems to be beneficial for headache (Ezzo, 2003). Studies of nausea have found real acupuncture to be more effective than sham procedures. In general, needling acupuncture points is more effective than needling false points.
Chinese Herbal Medicine
Zemaphyte, for example, may improve erythema, surface damage to the skin, sleep disturbance and itching. Some pioneering research has examined the co-prescription of Chinese herbal medicines with Western pharmaceuticals. Examples include the use of Huangqi decoctions in patients on chemotherapy. Compared with patients treated by chemotherapy alone, patients treated with chemotherapy and Huangqi decoctions were less likely to experience nausea and vomiting or low white cell counts. There was some evidence to suggest that the decoctions also stimulated cells of the immune system, but did not affect the levels of antibodies in the blood.
Other Chinese herbal medicines when combined with antipsychotics may be beneficial for people Herbal Medicine
Many herbs contain active ingredients that have been found to be effective and they are often incorporated into orthodox pharmacy where research examines single compounds. In research into whole plants it is not always clear which components of the plant are the most pharmacologically significant. For example, it was thought that the active ingredient in St John’s wort was water-soluble hypericin which acted as a monoamine oxidase inhibitor. Later studies found the fat-soluble hyperforin to be equally important. The herb is now thought to inhibit Peters et al. (2002) lists the following eight herbal medicines as having a strong research- derived evidence base, mostly emanating from randomised controlled trials: . Ginkgo biloba for delaying the clinical course of dementia, improving circulation, aiding short- Aesculus hippocastanum seeds for chronic venous insufficiency Serenoa repens for symptomatic treatment of benign prostatic hypertrophy Hydrastis for long-term, low-grade depression, mild to moderate major depression, and Echinacea as an immune enhancer. It improves white blood cell production and mobility.
Angelica sinensis for dysmenorrhoea.
Pygeum africanum for benign prostatic hypertrophy.
There are more than 20 completed Cochrane Reviews on herbal medicines (Ezzo, 2004). They have provided the following further information. Herbal medicines containing beta-sitosterols, extracts from Pygeum africanum, cernilton and Serenoa repens may all help relieve urinary systems caused by benign prostatic hyperplasia. Cranberries are useful for treating urinary tract infections, although they appear to have a role in their prevention. The reverse appears to be true for Echinacea - it does not appear to be useful in preventing common colds but taking Echinacea after onset of cold symptoms shortens duration or decreases severity of symptoms, There is some evidence of the efficacy of Ginkgo biloba for dementia and cognitive impairment and extracts of St. John's wort (Hypericum perforatum) seem more effective than placebo and similarly effective as standard antidepressants for treating mild to moderate depressive symptoms. Avocado soybean unsaponifiables show beneficial effects in people with osteoarthritis and studies of gamma-linolenic acid in the treatment of rheumatoid arthritis are promising. Compared with placebo, kava extract might be an effective symptomatic treatment for anxiety. There is good evidence for recommending Ginkgo biloba for patients with mild to moderate cerebral insufficiency and possible intermittent claudication.
Homoeopathy
The Swiss government’s inquiry into homeopathy and complementary and alternative medicine, with findings published in late 2011, points toward a strong body of evidence to support the homeopathic treatment of upper respiratory tract infections and respiratory allergies, with 24 out of 29 studies reporting positive outcomes in favour of homeopathy. Other benefits to homeopathic treatment compared to conventional treatment were the efficacy, reduced side effects, and cost effectiveness of homeopathic medicine alongside clear public demand for this treatment option (Bornhoft & Matthiessen, 2011). This research demonstrates the viability of homeopathy as a valid treatment option for particular prevalent disorders within the wider population which will reduce demands on the conventional medical systems.
In 1991 the British Medical Journal published a review of all clinical trials of homoeopathy. The authors concluded that there were some trials that found positive results. In the 22 most rigorous trials, 15 found homoeopathy superior to placebo. For example, taking homoeopathic Oscillococcinum after the onset of influenza might shorten the illness, but more research is needed. A meta-analysis conducted by Linde et al. (1997) yielded a positive overall result for Massage and Other Touch Therapies
Some clinical trials have shown effectiveness of massage therapy in the following areas:  reducing anxiety and improving the perceived quality of life for patients with cancer reducing anxiety and depression in women who had been sexually abused improving function and self-image and reducing anxiety and depression in adults with  improving lymphatic drainage and tissue oxygenation improving respiratory function in asthmatics reducing pain and stiffness in chronic inflammatory conditions such as rheumatoid arthritis Massage has been shown to reduce short-term anxiety (Brattberg, 1999; Field et al., 1996; Hernandez-Reif et al., 2000). Systematic reviews show that massage gives some relief from back pain that has continued for many weeks or months and that the benefit may last at least a year after massage treatments cease. Infant massage may be useful for mother-infant interaction, infant sleeping and crying, and reducing the production of stress hormones but further research is needed. Antenatal perineal massage helps reduce both perineal trauma Nutritional Therapies
Systematic reviews have found the following benefits of nutritional supplementation:  Calcium supplements help prevent pre-eclampsia and lower the risk of death or serious  Calcium may have a moderate protective effect on development of colorectal  The dietary supplement chitosan may have a small effect in aiding weight loss.
 Vitamin B1 and magnesium may help reduce the pain of dysmenorrhoea.
 Folate may reduce depressive symptoms in people with depressive disorders.
 Folate supplementation reduces the side effects in patients receiving methotrexate for  Supplementing preterm babies who have respiratory distress with the nutrient inositol may  Melatonin is remarkably effective in preventing or reducing jet lag and occasional short-  There is evidence of benefit of vitamin A supplementation in children with HIV infection, but no evidence for micronutrient supplementation with adults.
 Probiotics appear to be a useful adjunct to rehydration therapy in treating acute, infectious  Omega-3 fatty acid supplementation for intermittent claudication reduces blood triglycerides without improving lower leg discomfort measured by walking distance.
 There is limited evidence that selenium supplementation might help reduce symptoms of chronic asthma, but more research is needed.
 Vitamin A supplementation for pregnant women in areas where deficiency is common can reduce night-blindness, but more research is needed on other possible health  Vitamin E has been evaluated for treating neuroleptic-induced tardive dyskinesia but so far the benefit of this medication seems small and restricted to avoidance of deterioration  Some evidence exists for the effectiveness of oral protein and energy feeds for hip fracture aftercare in older people, but overall the evidence for the effectiveness of nutritional Conclusion
Ultimately, if the CMO decides in favour of cutting the Rebate for natural therapies, especiallywhen it can be demonstrated that many natural therapy modalities are backed up by a strongevidence base that shows their efficacy, the federal government risks undermining theextraordinary contribution this sector continues to make towards achieving genuine health careoutcomes for Australians.
ATMS notes that in this year’s budget $15.4 billion was committed to state health services. Theexisting federal funding for natural medicines in comparison is a meagre $30 million per year, yetconsidering this sector contributes to the improved health care of Australian the federalgovernment does not give the industry the credit it deserves.
ATMS believes that it should be up to individuals as to whether they chose optional privatehealth insurance cover for natural therapies, based on their individual circumstances, healthneeds, and their traditional use of natural therapies. The clients of natural therapiespractitioners would almost universally say that all natural therapy modalities are effective, safeand affordable.
We also believe that each individual private health insurance provider should be free to decidewhether it offers natural therapy as an optional extra for its clients, based on the demands of theircustomers, financial and commercial considerations, the effectiveness of natural therapies inappealing to potential new customers and their own judgment on whether such extras add valueand promote good health outcomes for their customers. The fact that many, if not all, privatehealth insurance providers offer benefits for natural therapy consultations is a strong indicationthat the natural therapies sector meets many of these benchmarks.
To conclude, ATMS believes the federal government should see natural therapies as preventiveand lifestyle medicine. ATMS’s members help prevent and maintain health outcomes for manythousands of Australians every year, through the provision of primary and quality health care.
Natural therapies are highly cost effective and, as shown, are based on supporting evidenceand a long history of support from many thousands of clients in Australia. It is no surprise,considering this, that natural therapy is a booming professional sector.
ATMS thus proposes that the current system be left in place. If anything, on the evidencepresented in this submission, federal funding for many natural therapies disciplines, should begreatly increased, not decreased.
References
Astin, J.A. (1998). Why patients use alternative medicine. Journal of the American
Medical Association 279, 1548–1553.
Astin, J.A., Marie, A., Pelletier, K.R., Hansen, E., Haskell, W.L. (1998). A review ofthe incorporation of complementary and alternative medicine by mainstreamphysicians. Archives of Internal Medicine 158, 2303–2308.
Australian Bureau of Statistics. (1991). 1989–90 National health survey: Summary ofresults. Cat. No. 4364.0. Canberra: ABS.
Baer, H.A. (2001). The socio-political status of US naturopathy at the dawn of the 21stcentury. Medical Anthropology Quarterly 15(3), 329–346.
Bornhoft, G., & Matthiessen, P. (2011) Homeopathy in Healthcare: Effectiveness,Appropriateness, Safety, Costs. Goslar, Germany: Springer.
Brattberg, G. (1999). Connective tissue massage in the treatment of fibromyalgia. EuropeanJournal of Pain, 3, 235-245.
Braun, L., & Cohen, M. (2010). Herbs and Natural Supplements an evidence based guide (3rded.). Australia: Elsevier Casey, M.G., Adams, J., Sibbritt, D. (2007). An examination of the prescription anddispensing of medicines by Western herbal therapists: a national survey in Australia.
Complementary Therapies in Medicine 15, 13–20.
Ernst, E. (2006). The desktop Guide to Complementary and Alternative Medicine An evidence-based approach (second ed.). United Kingdom: Elsevier Ltd.
Ezzo, J. (2003). From the five blind men to Cochrane Complementary Medicine SystematicReviews. The Journal of Alternative and Complementary Medicine, 9(6), 969-972.
Ezzo, J. (2004). A brief history of time: the power of botanical systematic reviews. The Journal ofAlternative and Complementary Medicine, 10(4), 692-697.
Ferrari, J. (1995, June 3). “Alternative remedies woo 1 in 2”. The Australian.
Field, T., Grizzle, N., Scafidi, F., & Schanberg, S. (1996). Massage relaxation therapies' effectson depressed adolescent mothers. Adolescence, 31, 903-911.
Galvin, K., & Bishop, M. (2010). Case studies for complementary therapists : a collaborativeapproach Chatswood, N.S.W.: Elsevier.
Grace, S. (2008) Integrative Medicine in Australian Health Care. Postgraduate Theses retrieved17 May 2011 from The Sydney eScholarship Repository/Postgraduate Theses/Sydney DigitalTheses http://ses.library.usyd.edu.au/handle/2123/4048 Grace, S., & Deal, M. (2012). Textbook of remedial massage (first ed.). Chatswood, Australia:Elsevier.
Grant, A. (2005). Education in natural medicine: what's love got to do with it? IntegrativeMedicine: A Clinician's Journal, 4(1), 30-34.
Hechtman L. (2011). Clinical naturopathic medicine (pp. 48 - 102). Australia: Elsevier. Chapter5: Nutritional medicine Hernandez-Reif, M., Martinez, A., & Field, T. (2000). Premenstrual symptoms are relieved bymassage therapy. Journal of Psychosomatic Obstetrics and Gynaecology, 18, 238-245.
Hilsden, R.J., Verhoef, M.J. (1999). Complementary therapies: evaluating theireffectiveness in cancer. Patient Education and Counseling 38, 101–108.
Khoury, R. (2009). The Professionalisation of Herbal Medicine 1980-2007: Usurpation, Schismand the Culture of Professionalism. Unpublished PhD Thesis, University of Sydney.
Kulkarni, A.V. (2005). The challenges of evidence-based medicine: a philosophicalperspective. Medicine, Health Care and Philosophy 8, 255–260.
Leach, M. (2010). Clinical decision making in complementary medicine. Australia: Elsevier.
Leach, M., & Gillham, D. (2008). Evaluation of the Evidence-Based practice Attitude andutilization Survey for complementary and alternative medicine practitioners. Journal OfEvaluation In Clinical Practice, 14(5), 792-798.
Linde, K., Clausius, N., Ramirez, G., Melchart, D., Eitel, F., Hedges, I. V., et al. (1997). Are theclinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials.
Lancet, 350, 834-843.
MacLennan, A.H., Wilson, D.H., Taylor A.W. (1996). Prevalence and cost ofalternative medicine in Australia. Lancet 347, 569–573.
MacLennan, A.H., Wilson, D.H., Taylor, A.W. (2002). The escalating cost andprevalence of alternative medicine. Preventive Medicine 35, 166–173.
Mills, E. J., Hollyer, T., Guyatt, G., Ross, C. P., Saranchuk, R., & Wilson, K. (2002). Teachingevidence-based complementary and alternative medicine: 1. A learning structure for clinicaldecision changes. Journal of Alternative & Complementary Medicine, 8(2), 207-214.
National Health and Medical Research Council. (YEAR) Evidence-based clinical practiceguidelines. Available from www.nhmrc.gov.au/publications/synopses/cp65syn.htm .
Nordin, I. (2006). Complex causation and the virtue of pluralism. Medicine, HealthCare and Philosophy 9, 321–323.
Parliament of Victoria Social Development Committee. (1986). Inquiry intoalternative medicine and the health food industry. Vols I and II. Melbourne.
Peters, D., Chaitow, L., Harris, G., & Morrison, S. (2002). Integrating complementary therapiesin primary care. Edinburgh: Churchill Livingstone.
Pryer, W. (2006, 4 July). The cost of being healthy. West Australian.
Sarris, J., & Wardell, J. (2010). Clinical Naturopathy an evidence based guide to practiceAustralia: Elsevier.
Siahpush, M. (1998). Postmodern values, dissatisfaction with conventional medicineand popularity of alternative therapies. Journal of Sociology 34(1), 59–70.
Thorne, S., Best, A., Balon, J., Kelner, M., Rickhi, B. (2002). Ethical dimensions inthe borderland between conventional and complementary/alternative medicine.
Journal of Alternative and Complementary Medicine 8, 907–915.
Wilson, K., Mills, E. J., McGowan, J., & Guyatt, G. (2002). Teaching evidence-basedcomplementary and alternative medicine: 5. Interpreting the results of a study on therapy andapplying them to a patient. Journal of Alternative & Complementary Medicine, 8(6), 867-873.
Xue, C.C.L., Zhang, A.L., Lin, V., Da Costa, C., Story, D.F. (2007). Complementaryand alternative medicine use in Australia: A national population-based survey.
Journal of Alternative and Complementary Medicine 13, 643–650.

Source: http://atms.com.au/wp-content/uploads/2013/02/ATMS-submission-to-Chief-Medical-Officer-Final.pdf