Complementary medicine (CM) is increasingly popular in Australia with most people using some form of CM each year. Some therapies, such as Traditional Chinese Medicine (TCM) and herbal medicine, are steeped in ancient traditions, but there remains a limited amount of high-quality research available to explain treatment efficacies and safety concerns associated with many treatments. To improve the knowledge base surrounding CM therapies, more research is needed to investigate popular natural medicines, nutritional supplements and other therapies. This article concerns the issue of public funding for CM research. With a finite health and research budget, many academics and policymakers have inconsistent views on the subject. Some experts argue that governments should not waste valuable resources researching CM therapies, yet others advocate for a significant increase in public funding. This article considers both sides of the issue to help guide future directions for CM research funding in Australia.
The Current Situation
Complementary medicine is a broad term, commonly used to describe medicines and therapies which are not currently considered to be part of western or orthodox medicine. Therapies such as naturopathy, massage, herbal medicine, chiropractic and TCM are popular in Australia, with up to two-thirds of the population using some form of CM each year. For comparison, in the United States, CM therapies are used by about half of the population. In 2003 there were 1.9 million naturopathy, or herbal medicine consultations in Australia and CM use is increasing with Australians spending $3.5 billion on CM each year, significantly higher than the total out-of-pocket expense devoted to conventional medicines purchased through the Pharmaceutical Benefits Scheme.
As with all areas in healthcare, high-quality research is required to investigate the safety and efficacy of all complementary therapies. The Australian government spends around $170 billion on its annual health budget, with 3% of this spending directed toward scientific research. Despite the popularity of CM therapies, research into the area is minimal, with a mere 0.085% of National Health and Medical Research Council research funding allocated to CM. Some experts consider this level of funding disproportionately low, considering the widespread use of CM.
Australia’s research funding pales in comparison to countries like the United States and the United Kingdom, who both direct a significantly higher proportion of research funding towards CM related studies.
It is important to note that of all the publicly funded CM research that does take place in Australia, CM professionals are for the most part not involved in these studies. Instead, orthodox medical practitioners tend to lead CM studies, and research grants are overwhelmingly directed toward universities that operate medical schools, rather than institutions with a strong focus on CM such as RMIT in Victoria. In a 2013 study, Associate Professor Jon Wardle from UTS found that a concerted effort is needed to overcome the barriers that prevent CM practitioner involvement in high quality research.
Although public funding of CM research is already low in Australia, some health experts warn against increasing the current spend, suggesting that governments should explicitly avoid directing research funds to CM. Prominent researcher Ezard Ernst has argued that, although health research is essential, the study design and data produced in many CM studies are often of poor quality and flawed when compared to more orthodox areas biomedical research. There is a perceived lack of professional oversight in CM research projects, and scrutiny is less than commonly expected in conventional biomedical research.
It is conceivable that poor quality research can lead to the spread of misleading information which in-turn risks deterring patients from seeking more effective forms of treatment.
For example, research papers that report homeopathy as an effective cancer treatment has led to some cancer patients in the United States and Europe refuse more conventional treatments like chemotherapy. Ernst claims that any public funding of this kind of research is unethical as it is not beneficent to the health of cancer sufferers and may do more harm than good. Furthermore, an overemphasis on patient autonomy can lead to adverse health outcomes.
There are also criticisms that CM research papers focus overwhelmingly on the benefits of therapies and neglect the critical area of risk and patient safety. This is concerning because CM therapies are often considered by patients to be “safer” alternatives to orthodox medicine. In reality, there are significant safety concerns with many CM therapies.
By funding CM research, there is a concern that patients will increasingly focus on the benefits of complementary therapies and underappreciate any potential treatment risks. US paediatrician and author Dr Paul Offit has noted that negative study results don’t tend to change consumer behaviour, with patients often ignoring contrary evidence but acknowledging research results that reinforce their preconceived views.
Another argument against CM research highlights the fact that governments have limited research budgets, and any funds directed at CM research may be better spent in other areas of biomedical research. Moreover, increased funding and prevalence of CM research can give credibility to therapies that may be less beneficial to patients than treatments from orthodox medicine.
In light of calls to limit CM research, a growing number of experts suggest the opposite should occur.
Professor Alan Bensoussan, director of the NICM at Western Sydney University, has stated that governments have an ethical obligation in responding to community needs. If citizens of a democratic society autonomously choose to utilise CM therapies in such large numbers, the government has a responsibility to direct levels of research funding, reflective of the community’s overwhelming appetite for these therapies. From a moral standing, this idea may be regarded as overly virtuous, but, ultimately, the crucial bioethical concept of justice is realised by not denying the desires of the citizens.
In addition to public funding, industry and private sector contribute funding and resources to a significant proportion of CM research. For example, in 2014, supplement company Swisse donated $15 million to Latrobe University to fund CM research. There are concerns that any research funded by corporate giants like Swisse may result in flawed research designs or biased reporting of research outcomes. So contentious is corporate research funding that the large Swisse donation led to one of Latrobe’s leading public health experts to resign from his position as an Associate Professor. After standing down, Dr Ken Harvey claims that the Swisse donation provided a fundamental conflict of interest for Latrobe University and any staff involved in associated research.
Setting conflicts of interest to one side, private sector funding has additional limitations. For example, CM companies may be reluctant to fund research into specific therapies if their market competitors are likely to benefit from positive research results. This contrasts large pharmaceutical companies who are more proactive in protecting their intellectual property through patents, preventing competition from capitalising on positive research findings. RMIT’s Associate Professor Zhen Zheng suggests that a strong push should be made to not rely on corporate funding, but, increase public financing in CM research.
Paul Offit acknowledged that many pharmaceuticals currently used in orthodox medicine were initially derived from plants used in traditional medicine. For this reason, many of those experts advocating for increased CM research believe that investigating traditional medicines may be vital to help discover breakthroughs which will lead to improved pharmaceutical medicines.
Increased public funding may also improve critical research aimed at debunking some of the more dangerous alternative therapies that make outlandish claims and puts consumer health at risk.
Where to Next?
Some level of public research funding is clearly necessary for CM as there are problems associated with corporate funding models. Public funding of CM research is remarkably low in Australia but there are multiple economic reports that highlight the exceptional return on investment health research provides for the nation. Publicly funded research should therefore be viewed as an investment rather than merely a cost to the budget.
Professor Bensoussan has previously proposed that 5% of GST raised from the CM industry should be directed towards high-quality research, effectively allowing the CM profession and consumers to pay for their own research.
Although CM therapies are often regarded as being safer than conventional medicines, there is no doubt that some treatments do provide potential health risks. If improved models of funding lead to better research, consumers can adequately consider the risks and benefits of their treatment options. Research that investigates efficacies of CM may be beneficial for the health of Australians and reduce the risk of ill-informed patients undertaking dangerous treatments. Patient autonomy is an important ethical principle to uphold in both CM and conventional medicine. However, for patients to have genuine autonomy, they must have access to accurate information regarding a treatment’s therapeutic efficacy and risks.
Increasing public funding to rates proportionally similar those in the United States of the United Kingdom is likely to lead to higher-quality research with less influence from the conflicts of interest associated with corporate-funded research.
It is still important to acknowledge the fact that government health budgets are finite. Drawing a line in the sand to ensure that implausible therapies are not researched with public funding is a worthy consideration and has been recommended by Ezard Ernst. But, one must be careful when deciding where the plausibility line is drawn. For example, Ernst argues that acupuncture and much of TCM are implausible because they are not grounded in contemporary scientific theory. This contentious view may be partly true but overlooks the fact that much has been learnt from TCM and incorporated into biomedically aligned areas of CM such as myofascial dry-needling and western herbal medicine. Contrary to what some anti-CAM hardliners espouse, Evidence-Based Practice does exist in many CM fields.
The issues surrounding research funding are complex, and both sides of the argument need to be considered. Increasing public funding for CM research might not benefit the profitability of companies like Swisse, but it will help Australian’s make informed, sensible healthcare decisions which will undoubtedly lead to better health and economic outcomes.