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NIIM RESPONSE - ABC Four Corners Program 13 February 2017 - ‘Swallowing It’
ABC Four Corners Program 13 February 2017 - ‘Swallowing It’ - How Australians are spending billions on unproven vitamins and supplements.
The National Institute of Integrative Medicine (NIIM) would like to provide further information and a measure of balance to some of the viewpoints presented in the Four Corners program last night.
It is unfortunate that Four Corners chose to focus on one area of integrative medicine, supplements, and presented only a narrow range of opinions. It has missed an opportunity to investigate what are the broader issues in health, including how we as a society are defining health, as well as what the public want. It seems clear that since almost 70% of Australians use some form of complementary medicine1, Australians have a broader understanding of health than what is defined in orthodox medicine, and are choosing to incorporate more options beyond pharmaceuticals.
Integrative medicine combines the best of orthodox or conventional medicine with evidence-based complementary medicines for the prevention and treatment of illness and the promotion of optimal health. Integrative medicine doctors are trained in conventional medicine as well as other evidence-based forms of complementary medicines, such as nutritional medicine and lifestyle approaches.
The use of the term ‘complementary medicine’ when the program was purely about supplements, may have confused viewers. The National Centre for Complementary and Integrative Health, part of the National Institutes of Health in the United States (https://www.nih.gov/ ), sets out a broader definition of complementary medicine which includes a range of therapies and treatments, not just products (https://nccih.nih.gov/health/integrative-health ).
The Four Corners program failed to offer an in-depth analysis of the evidence about supplements by researchers who are actually involved in researching complementary medicines. Unfortunately, some of those interviewed reported inaccuracies in relation to research. For example, one person stated that a study on Beta Carotene found that it had increased cancer. This study was criticised for several methodological flaws, including its use of a synthetic Beta Carotene and Vitamin E rather than a natural forms of the vitamins.2 Research needs to be interpreted carefully.
Another example is the claim that many studies into complementary medicines have small numbers of participants and because of this, it is easier to get a positive result. This is not the case; small numbers in clinical trials will often work against finding a positive result, due to lack of statistical power.
Not all studies on supplements have been small, as stated on the program. For example two very large, long running studies (over 30 years’ duration) that have provided data on supplements include the Physicians' Health Study (http://phs.bwh.harvard.edu/ ) and the Nurses’ Health Study (www.nurseshealthstudy.org). Both projects have included investigation of the efficacy of vitamins in various health conditions.
The criticism that supplement companies are funding research in universities and the implication that this is unethical, fails to acknowledge the fact that Australian universities and research institutions are bound to conduct research in accordance with the NHMRC national guidelines for research, are governed by Human Research Ethics Committees, and have processes in place to ensure that contract research is independent, rigorous and objective. To suggest or imply that because universities in Australia have accepted funding for research into complementary medicines, they are not being objective and could be open to corruption, is simply not accurate. The expanding need for good evidence based medicine is contingent upon good research.
Complementary medicine research is extremely poorly funded by the Australian government’s National Health and Medical Research Council (NHMRC) - in 2012 only 0.14% of its budget went towards complementary medicine research. If funding were not received from private companies, very little research would occur. The majority of pharmaceutical research is funded by pharmaceutical companies (only their budgets are so much larger).
The Four Corners program focussed on promoting vitamins and supplements as unproven and a waste of money, however little hard evidence was given to substantiate these claims. Contrary to their assertion that there is ‘no evidence’, there is a substantial body of scientific studies in the field pointing to not only the efficacy, but safety of vitamins for prevention and treatment of a range of medical conditions. Any scientific literature search including the ‘Cochrane Library’ (www.cochranelibrary.com) - considered one of the most reliable sources of medical evidence, will bring up a substantial number of scientific clinical trials on complementary medicines. For example, a systematic review conducted by the Cochrane Collaboration found the herb St John's wort works better than a placebo, and works as well as, and has fewer side effects than standard antidepressants.3
The program failed to address the important area of practitioner-only supplements, which accounts for a significant proportion of the industry. These supplements are dispensed by a practitioner at the correct dosage for specific conditions. However, the program did highlight the important fact that many people are self-medicating with supplements. NIIM strongly recommends that people consult a qualified healthcare professional for advice on supplements that may be relevant to their personal health needs.
Unfortunately the emphasis on Professor Avni Sali AM was to consistently try to link him to Swisse Wellness and insinuate a conflict of interest, seeking only to bring into question his reputation. NIIM has not received any funding from Swisse for research.
Prof Sali’s work has spanned decades of surgery, medical practice, academia, teaching, research and writing. He is known as the ‘Founding Father’ of Integrative Medicine (IM) in Australia, and is one of the most highly respected academics and clinicians in this field. Testament to this is his Order of Australia award, where he was honoured for “significant service to integrative medicine as an educator, clinician and researcher, and to professional education.”
NIIM welcomes open, informed and honest debate about complementary medicines, including vitamin supplements. NIIM’s mission is to educate healthcare professionals and the general public in integrative medicine, to conduct research into integrative medical treatments and technologies, as well as provide world class clinical services.
- Xue CC, Zhang AL, Lin V et al. Complementary and alternative medicine use in Australia: a national population-based survey. J Altern CompMed 2007; 13(6): 643-650.
- Hart J. Data support antioxidant use during chemotherapy. An interview with Keith Block. Altern & Comp Ther 2012; 18(2): 91-97.
- Linde K, Berner MM, Kriston L. St. John's wort for treating depression. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3. Available at URL: http://www.cochrane.org/CD000448/DEPRESSN_st.-johns-wort-for-treating-depression. [Accessed 14 Feb 2017]