Having a bone to pick with natural medicine

THE women sat perched on the edge of their seats, desperate to hear more. "Many were bald, one even had tubes coming out of her breast, all were cancer survivors," remembers Loretta Marron. "Some would be dead now."

Marron survived her cancer, but she will never forget the presentation from a naturopath who had been invited to the 2005 breast cancer support group meeting. "She was just attacking doctors from the beginning to the end, saying they were funded by drug companies and you can't rely on them," says Marron, now chief executive of Friends of Science in Medicine.

The experience spurred her to spend the next eight years exposing the worst practices in alternative medicine. Complementary and alternative medicine varies widely, but is often not supported by scientific theory and research. From multivitamins to acupuncture, it's a growth industry. By some estimates, two-thirds of us use some form of complementary or alternative medicine every year - spending up to $1.8 billion.

And national registration has led chiropractors, Chinese medicine practitioners and osteopaths - and, perhaps soon, naturopaths and others - to be registered by the same federal body that covers doctors and nurses. Universities are running courses, and government funding for treatments has skyrocketed. In 2005, Medicare paid out just over $22,000 annually on chiropractic and osteopathic treatments - last year it paid $15 million.

But Marron wonders if bringing alternative medicine inside the mainstream has brought much-needed oversight, or simply given operators undeserved respectability. "People are told that chiropractors and osteopaths, for example, are registered, but they're not told they are self-regulated," Marron says. And the self-regulation looks loose.

Even the federally mandated Chiropractic Board of Australia allows chiropractors to make up the entirety of their annual 12.5 hours of formal education - which they must undertake in order to practise - from known anti-vaccination proponents. "Once they are regulated, that legitimises them, but it comes with a responsibility to consumers; they can't have it both ways," says Marron, who has spent hours trawling through the courses and documenting those promoting unscientific claims.

She is particularly critical of universities for offering courses in alternative medicines, giving an example of a former lecturer at Macquarie University who on her personal website says she can use naturopathic treatments to "enhance the efficacy of chemotherapy", and "alter the 'terrain' of the patient to be non-supportive of tumour cells".

Other lecturers claim to be able to use chiropractic for children with repeat infections, or mothers with problems breastfeeding. Macquarie University says it only offers rigorous, high-quality courses. "Our students are taught to understand that science proceeds only on the basis of evidence. They are taught only those techniques that are known through science to be beneficial," a university spokesman says.

But Marron argues that such courses give a veil of respectability to unscientific beliefs. "It's only when you scrape back to look at what is in the courses that you think something is quite wrong," she says.

Former AMA head Professor Kerryn Phelps says in the end it's not a matter of deciding whether or not to let alternative treatments into the mainstream. "It just reflects real life," she says. "There is a consumer-led movement ... people are looking for different ways to manage their illnesses".

Her recent book, Ultimate Wellness, argues doctors should practise "integrative medicine", adopting complementary treatments or referring patients on to practitioners. But even Phelps says she would hesitate before referring a child to a chiropractor, considering the potential for harm. Yet she also calls Friends of Science in Medicine an "ultra-conservative" force with "an alarming and far-reaching agenda".

Simon French, from the Melbourne School of Health Sciences at the University of Melbourne, has researched the practices of Australian chiropractors, and says within modern chiropractic there is a continuum of practice.

Some very fringe practices exist at one end and evidence-based practice at the other, according to French. But he believes the chiropractors' board is trying to bring the profession into the mainstream, by doing things such as commissioning reports on evidence-based practice - a development he calls "promising".

Yet the practice of some harks back to the oldest traditions of the therapy. Chiropractic was founded in 1895 by an American, Daniel David Palmer, after what sounds like a miracle. "Chiropractic began when a deaf guy got his hearing back when he got his spine adjusted, and that doesn't happen very often, but it happened," says Tony Croke, a national director of the Chiropractors' Association of Australia.

The early chiropractors believed subluxations, or (often painless) misalignments in the spine, could lead to almost any health problem. As medical technology advanced and subluxations could not be found using X-rays or other imaging techniques, many chiropractors abandoned the theory.

In 2010, the British General Chiropractic Council announced: "[Subluxation] is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns."

But the Chiropractors' Association of Australia is still committed to subluxation. Croke says the concept includes things such as inflammation, stiffness or poor function, which is then thought to have an impact on the nervous system.

"Diagnostic imaging is not particularly helpful for diagnosing [this type of] dysfunction," Croke says.

But the question remains how a painless reduction in joint function, invisible on medical scans, could change the signals sent by our nerves. Research papers supporting the theory are filled with references backing the claim, but when Fairfax Media examined them, most studied people with chronic pain or arthritis. Others documented uncontroversial facts about the central nervous system, but did not support the broader claim that a spinal joint with no pain or obvious symptoms could change nerve functions, and lead to asthma, infections or other childhood conditions.

"This is the hallmark of pseudo-science," says Chris Del Mar, a professor of public health at Bond University. "The way to do it is to churn out lots of this stuff, which is impressive to someone who doesn't understand it, and to do it with the imprimatur of the universities."

Del Mar, like every sceptic of alternative medicine, is keen to point out that he has no trouble with chiropractors who seek to treat musculoskeletal conditions such as back pain. (Although research reviews have found it is only marginally effective, just no worse than anything else offered for the condition.)

"When they start professing they are paramount and start saying you should do this and not that, it makes me narrow my eyes," he says. "It is no longer complementary medicine, it's oppositional."