When A Second Opinion Is Unreliable
The Sunday Age
Sunday September 29, 2002
A majority of Australians use alternative medicine. A reappraisal of its status is overdue, and that includes proper scrutiny.
ALEXANDER Fleming's discovery of penicillin in 1928 has come to be seen as one of the defining moments in the development of modern medicine. When first tried on patients, its effect was seen as magical. Fleming had foreseen the potential of the mould that killed bacteria in a Petri dish, and published his findings the next year, but they attracted little notice until 1938 and it wasn't until 1941, when the wartime need was urgent, that the drug was first used. Fleming is said to have lamented: ``Penicillin sat on the shelf for 10 years while I was called a quack." Advocates of alternative medicine cite that story, but there is a crucial difference in their circumstances today. Alternative medicine is already widely used and is a multi-billion-dollar industry. An Adelaide University study has found Australians spent $2.3 billion on alternative products (such as vitamins, mineral and herbal remedies) and therapies (aromatherapy, naturopathy, acupuncture, Chinese medicine and so on) in 2000 - about four times as much as public spending on pharmaceuticals. It found 60 per cent of women and 44 per cent of men used alternative medicine. Most saw it as completely safe - though the ``natural" products may contain similar active ingredients to pharmaceutical products and have serious side-effects. Some ``cures" simply don't work. Others do but, even then, commonly used products such as St John's wort interact dangerously with medication, while others such as gingko can cause bleeding complications during surgery. Despite the dangers, ``more than half of those who used alternative medicines did not tell their doctor and many assumed the medicines were harmless", according to Adelaide professor Alistair Maclennan.
This is not to say conventional medicine never causes harm or death, but such cases are subject to formal scrutiny and review. The medical profession is justified in calling for legislation to ensure all forms of medical treatment are subject to proper regulatory and scientific scrutiny. ``There should only be two types of drugs in Australia: proven and unproven," Professor Maclennan argues. At the same time, the profession has begun to acknowledge some of its own shortcomings, partly in response to the soaring popularity of alternative treatments. Australian Medical Association president Kerryn Phelps has been open to the possible benefits of complementary medicine and voiced concern that patients withhold vital information for fear of their doctors' disapproval. ``This is a really emerging area of health care," she said, ``and public opinion has in some respects been leading the medical profession." But, as illustrated by the case studies reported last week, the profession is also justified in its immediate concern about the dangers of loosely regulated and little studied alternative medicine - particularly when it encourages the rejection of proven treatments. It is open to serious question whether the Commonwealth's preference for systems of self-regulation and voluntary registration takes account of the true impact of alternative medicine on public health. It is unacceptable, for instance, that not all remedies are required to carry labels that fully disclose their ingredients, nor that extravagant and unproven claims are made for therapies that would not be tolerated of a medical physician. There is an urgent need for governments to cooperate on establishing a proper system of regulation.
In the past, the greatest opposition to formal recognition of alternative medicine came from the medical profession, but that attitude is changing. This change offers the best hope of a wider sharing of the benefits of complementary medicine, by sorting out the quacks from the potential modern-day Alexander Flemings. For there is another aspect of the story of penicillin that some advocates of alternative medicine overlook. The safe use of penicillin depended on the application of established science to its refinement and study. Fleming was unable to make progress on his own because of difficulties in culturing the mould, isolating its active antibiotic elements and analysing their properties. That required chemistry skills and research funding, the search for which occupied much of the time of Australian Howard Florey after he was appointed professor of pathology at Oxford University. Once he had found the money and biochemist Ernst Chain was able to go to work on Fleming's findings, penicillin became a safe, mainstream drug (subject to the knowledge that it can trigger allergic reactions). Accordingly, all three men shared the 1945 Nobel prize for medicine. Today, alternative medicine is hampered by charlatans, ignorance and lack of research funding, which prevent it becoming the truly complementary form of medicine that its advocates wish. While they note the benefits of a holistic tradition that dates back to Hippocrates, the father of medicine, he acquired the title for a particular reason. The ancient Greek's great contribution, which remains relevant today, is that he was the first to recognise the importance to medicine of distinguishing effective, rational therapy from mumbo jumbo.
PS
Mel Gibson has started shooting a ``filmic storytelling" of the last 12 hours of Christ, scripted in Latin and Aramaic with no subtitles. Gibson, a staunch Catholic with seven children, has yet to find a distributor.
Memo to P. Pilate III, Head of Production, from J. Iscariot, script-development.
LOOK, mea culpa and all that, PP, Mel's strong box office, a great guy, but this treatment ... well, what's he talking about? This script! Half of it is squiggles and the other ... well ... it's in some lingo that's all Greek to me. Look, quid quo pro, Mel's ne plus ultra as far as I'm concerned, but this magnum opus goes on ad nauseam: it's enough to bore the pants off the Pope - that's if he could understand this stuff. And Mel wants to film the Greatest Story Ever Told Before. He's started already! He's in Rome, my de facto's just told me, and the schedule's bigger than Ben-Hur, only it's crosses, not chariots, this time. I suggest the tabula rasa approach: wipe that shooting-slate clean and put the thing into English, French, German, et cetera ... anything that might attract an audience. Otherwise, prima facie evidence suggests we'll be persona non grata and the post mortem will tell you why. You know what they say at MGM, ``Ars longa, vita brevis". Yours, JI.
WE recall a marvellous mixed metaphor once published in that normally grammatically scrupulous magazine, The New Yorker: ``In the United States, chilli sales are mushrooming".We are reminded of this for no other reason that hot chillies are helping scientists to develop a more effective treatment for arthritis. The receptor in the mouth that reacts to the capsaicin in chillies is also activited in the skin by inflamed tissue, such as that caused by arthritis. We are not sure what proportion of the Indian or Thai populations suffer from arthritis, but we're sure that when some like it hot, the joint-creaking cools down. So start that chilli binge today! Pop a couple of lethal jalapenos before breakfast, followed by a mid-morning clutch of birdseyes. Before you know it - possibly, before you can speak normally - that arthritis will vanish. But keep those fingers away from your eyes. We can't help you there.
© 2002 The Sunday Age
