Bans on insurance rebates for seven techniques should be lifted, a comprehensive review has found.
Six years ago almost to the day, the federal government made 16 “natural therapies” ineligible for private health insurance rebates, drawing cheers from the science-based medicine mob and boos from the alt-medicine mob.
You can tell which crowd yelled louder from the fact that within a week the government had promised a review of the evidence, to be undertaken by then commonwealth chief medical officer Professor Brendan Murphy, supported by the NHMRC.
Six years later – yes, it’s quite a project and there was a bit of a pandemic in there – Professor Murphy’s successor Professor Michael Kidd has released the report, which after a rigorous-looking systematic review of the literature on each of the 16 techniques, recommends lifting the ban for naturopathy, Pilates, shiatsu, tai chi, Western herbal medicine, yoga and the Alexander technique.
Aromatherapy, homeopathy, reflexology, rolfing, kinesiology, iridology, Bowen therapy, Buteyko and Feldenkrais failed to convince and remain out in the cold.
The review was asked only to look for effectiveness, not comparative effectiveness; the modalities only had to pass a “better than nothing” test, if you like, which is lucky because that’s the form that most evidence in this area takes.
There needed to be only moderate-certainty evidence that a technique was effective in achieving one health outcome in one condition for the review to recommend its rebate ban be lifted.
Here are the “key messages” for each of the therapies reviewed, in alphabetical order, based on what evidence they could find, with their verdict – note that “probably” translates to “moderate-certainty evidence” and “may” and “appears to” mean “low-certainty evidence”:
Alexander Technique – lift ban
- For people with chronic musculoskeletal pain (low back or neck), the Alexander Technique probably reduces disability and may reduce pain, but may make little difference to quality of life or emotional well-being.
- For people with mobility limitations or at risk of falls, the Alexander Technique may improve mobility, but effects on other critical outcomes, such as falls, disability and quality of life, are very uncertain.
Aromatherapy – ban stays
- It is not possible to draw conclusions about the effects of aromatherapy with confidence for any condition or outcome.
Bowen Therapy – ban stays
This is where “therapists use their thumbs and fingers to apply gentle rolling movements over muscle, ligament, tendon and other connective tissues … to promote healing by stimulating the body’s nervous, endocrine and connective tissue (fascial) systems”.
- A single trial found Bowen therapy may improve health-related quality of life and mental health among people with neck pain.
Buteyko Method – ban stays
This involves “breathing techniques, posture, health and lifestyle guidelines, with the aim of returning breathing to an optimal pattern”.
- For people with asthma, evidence from six small trials shows that Buteyko may reduce asthma symptoms, but effects on other critical outcomes such as health-related quality of life and physical function (activity limitations) are very uncertain.
- For other conditions, effects on critical and important outcomes such as health-related quality of life, symptoms and physical function are either very uncertain or unknown (because the outcome has not been measured in any study).
Feldenkrais – ban stays
Practitioners use “touch, movement, guided imagery, and mindful body awareness with the aim of stimulating the brain to make useful and lasting improvements to movement and posture”.
- The evidence is very uncertain about whether Feldenkrais improves critical or important outcomes for people with chronic musculoskeletal conditions and people with conditions that affect mobility or at risk of falls. There are no studies among people with other conditions.
Homeopathy – ban stays
- [It] appears to provide little to no benefit when compared with placebo … for most of the priority outcomes for which there is evidence available.
Iridology – ban stays
- For the populations (or conditions) assessed with manual examination of the iris or images of the iris, the evidence shows, with low certainty, that iridology is not an effective diagnostic tool.
Kinesiology – ban stays
This “uses manual muscle testing to assess imbalances expressed in the body”.
- The evidence is very uncertain about whether specialised kinesiology improves critical or important outcomes for people with chronic low back pain.
Naturopathy – lift ban
This was split into two reviews: A for “whole system, multi-modal or single modal interventions”, B for “selected nutritional supplements”.
- Naturopathy] appears to provide people with some benefit for some of the conditions and outcomes assessed in this evaluation, when compared with people who do not use naturopathy.
- [Some] nutritional supplements can probably, or may, improve some key health outcomes.
- Probiotics probably improves the number of people with global symptom improvement for people with irritable bowel syndrome (IBS) although probiotics may have little to no effect on global IBS symptoms or response on average,
- Antioxidants (specifically CoQ10 and alpha-lipoic acid (ALA)) probably reduce global fatigue severity/burden for people with fatigue (including myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS)),
- Zinc probably reduces recurrent infections when measured by the number of episodes of infection per child per year in children with otitis media
- Antioxidants (specifically CoQ10 and ALA) probably improve fasting blood glucose and glycaemic control in people with obesity at risk of type 2 diabetes.
Pilates – lift ban
- Pilates appears to provide people who practise it with some benefit for some of the included conditions and outcomes … The evidence provides moderate certainty that Pilates is effective in:
- improving incontinence-related quality of life in men (after radical prostatectomy) (from two studies, 126 participants),
- reducing disability (12 studies, 937 participants) and improving overall quality of life (one study, 295 participants) in people with chronic low pain back.
Reflexology – ban stays
- It is not possible to draw conclusions about the effects of reflexology with confidence for any condition or outcome.
Rolfing – ban stays
This “incorporates manipulation of the fascia, guided movement and movement education to improve overall body alignment, and biomechanical functioning”.
- [The] evidence provides very low certainty about the effect of Rolfing on the outcomes assessed.
Shiatsu – lift ban
This is massage with pressure applied to acupuncture points on the body.
- Shiatsu probably improves bowel recovery in people recovering after minimally invasive surgery.
Tai Chi – lift ban
- Tai Chi probably:
- reduces pain and stiffness in people with osteoarthritis,
- reduces fear of falling in adults at high risk of falling, improves psychosocial wellbeing in adults with neurocognitive conditions
Western herbal medicine – lift ban
- There is moderate-certainty evidence for a range of outcomes including
- reducing menstrual pain (ginger, cinnamon, valerian root or fenugreek)
- increasing remission in inflammatory bowel diseases (green tea extract, curcumin, Boswellia, aloe vera gel, Wormwood, St Mary’s thistle or Andrographis)
- reducing depression (curcumin, saffron or St John’s wort)
- reducing anxiety (valerian root, kava, Passiflora, saffron, chamomile, ginkgo biloba or lavender)
Yoga – lift ban
- The evidence provides moderate certainty that yoga probably:
- reduces blood pressure
- improves emotional wellbeing in people with anxiety
- reduces symptoms of depression
- improves health-related quality of life in people with low back pain
Welcome back to partial respectability, you seven – you cleared a very low bar.
The rest of you, think about what you’ve done (used up government time confirming yet again that super-diluted toxins have no therapeutic value, the iris is not a blueprint for the body and essential oils smell nice and that’s about it).
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