Regulation of conventional and complementary medicine — it is all in the evidence

To the Editor: Complementary medicines may lack evidence of safety and efficacy, but conventional medicine lacks evidence of efficacy in 30%–40% of cases,1 and the breast implant and hip replacement debates demonstrate safety concerns. The debates about conventional versus complementary medicine expose how out of touch the medical profession is with the views of government and the people about complementary medicine. The medical profession was once central to health care and an opinion leader. Now it forms a small proportion of all health professionals registered under the Australian Health Practitioner Regulation Agency (AHPRA), while complementary therapists provide half of health consultations2 and the public spends almost three times as much on complementary medicine ($3.5 billion)3 as it spends on prescribed medicines directly ($1.3 billion).4 Our profession’s influence on health policy has been compared with “an ineffective chorus muttering on the edge of the stage about keeping things the way they were”.5

In this changing health care climate, a different approach is required, focusing on evidence-based regulation for practitioners of conventional and complementary medicine. The current system of regulation is demonstrably inadequate, relying on different legislation with overlapping and inconsistent standards. Our current regulators include AHPRA, Medicare, the Professional Services Review (PSR), state health complaints entities, the Therapeutic Goods Administration (TGA), state fair trading organisations, and the Australian Competition and Consumer Commission. The process of AHPRA registration for medical practitioners is rigorous, while some complementary medicine practitioners require minimal credentials. Medicare restricts the activities of medical practitioners, while private health insurers pay for almost any therapy. Cases against medical practitioners use diverse interpretations of “inappropriate practice” and procedures that appear to deny natural justice, for example, some practices of the PSR.6 Pharmaceuticals are more closely regulated than listed products such as slimming aids.

To ensure safe, evidence-based health care, authorities should implement effective regulation of practitioners, medicines and devices. Public outrage over rofecoxib (Vioxx; Merck Sharp and Dohme, Sydney, NSW), slimming aids, hip replacements or breast implants are all opportunities for the profession to demand uniform evidence-based standards of regulation for conventional and complementary medicine. In so doing, the medical profession will re-establish its relevance and respectability. Only then can we progress to a more equitable health system and a healthier Australia.