Update: Natural Therapies Review 2019/20

On 7 April 2019, the Minister for Health announced new 2019/20 reviews of 16 natural therapies to assess the clinical effectiveness of those therapies to advise if private health insurance should again cover them.

From 1 April 2019, a number of natural therapies were excluded from private health insurance coverage on the basis of previous reviews conducted in 2014/15. These reviews received strong expert and public backlash, due to poor methodology, extensive exclusion of relevant research and perceptions of bias.

The 2019/20 Review was announced after the Government was flooded with complaints via the Your Health Your Choice campaign in early 2019.

Project delay due to Covid-19:

Work began on the 2019-20 Natural Therapies Review in late 2019, with was anticipated to be completed by the end of 2020. However, the Covid-19 pandemic resulted in delays in the project during 2020.

Work has recently re-commenced on the Review, which is now expected to be completed by the end of 2021.

How is the Review being conducted?

The Review is being led by the Australian Government Chief Medical Officer (CMO) supported by the Natural Therapies Review Expert Advisory Panel (NTREAP) and utilising the expertise of the National Health and Medical Research Council (NHMRC). The NHMRC has appointed a Natural Therapies Working Committee (NTWC) to oversee the work.

The 2019-20 Natural Therapy Review is being completed in two Tranches:

– Tranche 1 includes Western herbal medicine, naturopathy, Pilates, Rolfing, shiatsu, tai chi, and yoga

– Tranche 2 includes Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, homeopathy, iridology, kinesiology and reflexology.

Invitation to submit evidence:

As part of the Review, the Department of Health has invited stakeholders to submit citations for published scientific research studies for consideration in the Review.

The Tranche 1 call for evidence closed on 21 February 2020. The call for evidence for Tranche 2 closed on 23 October 2020.

Asking stakeholders to submit evidence before developing the research protocols introduces the risk of scientific bias. This is because the reviewers are ‘getting the answer before they ask the question’. For this reason, in scientific reviews literature searches are usually not done until after research protocols have been developed, to avert conscious or unconscious manipulation of the methods/results.

In the 2014/15 reviews, additional research studies the public and stakeholders were requested to submit were ‘downgraded’ due to ‘risk of bias’ (because they were externally submitted), providing the NHMRC with a reason to dismiss the results of these studies from consideration.

This issue has been identified and flagged with the Department of Health Natural Therapies Review Secretariat for transparency and as a safeguard against this happening again in the new reviews.

What happens next?

Once finalised, the research protocols for each natural therapy will be made publicly available on PROSPERO – an international database of prospectively registered systematic reviews in health and social care.

The research protocols for a number of Tranche 1 therapies (yoga, pilates, tai chi, rolfing) have already been finalised and published on PROSPERO (to access them, type ‘natural therapies review’ in the PROSPERO search field). Contractors have also been appointed to conduct the reviews. .

With regard to Tranche 2 therapies, the NHMRC is in the process of seeking contractors. Once contractors have been appointed, they will begin developing the research protocols for each therapy in collaboration with the NTWC (as with Tranche 1).

The Department of Health Secretariat has advised that they expect the research protocols for Tranche 2 therapies to be finalised in mid-2021.

At this stage, the Review (both Tranches) is anticipated to be completed by the end of 2021 – however, a later completion date won’t surprise anyone.