ACC and Alternative Medicine

The Accident Compensation Corporation (ACC) is part of the healthcare system in New Zealand. To quote themselves on their purpose, they provide “comprehensive, no-fault personal injury cover for all New Zealand residents and visitors to New Zealand”. To put it simply, if you hurt yourself in an accident in New Zealand, ACC will likely pay for all treatment you require to recover from that injury.

They are not strictly part of the government, but they are a Crown organisation set up via the Accident Compensation Act 2001, and they are controlled directly by the government through an ACC minister. At the time of writing, the current ACC minister is Judith Collins. The ACC is funded publicly through various avenues, including levies on people’s earnings.

Recently, the current chair of the New Zealand Skeptics, Gold, submitted an Official Information Act (OIA) request (using the great service FYI, which makes these requests public) to the ACC asking:

Please can you tell me, for each of the last 10 years, how much the
ACC has paid out for each of the following services:

Acupuncture
Chiropactic
Osteopathy
Naturopathy

On the 20th of May 2014, the ACC responded to Gold’s OIA request with this information:

The following table shows the total amount (in dollars, excl GST) ACC has paid under Regulations for Osteopathic, Acupuncture and Chiropractic services for the last 10 years.

Financial Year $ cost
Osteopathy Acupuncture Chiropractic Total
2003/04 6,210,642 4,424,458 8,056,875 18,691,975
2004/05 6,767,849 5,452,119 8,007,011 20,226,979
2005/06 7,237,766 5,954,239 7,947,342 21,139,347
2006/07 8,038,676 7,616,042 8,734,453 24,389,171
2007/08 10,082,351 12,392,494 12,007,580 34,482,415
2008/09 10,945,880 15,761,415 13,173,902 39,881,197
2009/10 10,470,269 15,605,042 11,804,095 37,879,406
2010/11 9,802,401 16,225,902 10,832,912 36,861,215
2011/12 10,029,446 16,958,808 11,654,292 38,642,546
2012/13 10,964,806 19,961,329 12,312,832 43,238,967

Naturopath is not an ACC funded service; therefore your request for this information is declined under section 18(e) of the Act, as the document alleged to contain the information requested does not exist or cannot be found.

Here’s that information on a chart, excluding the totals. As you can see, spending on acupuncture in particular has increased dramatically over the last decade:

ACC spending on alternative therapies per financial year from 2003/04 to 2012/13
ACC spending on alternative therapies per financial year from 2003/04 to 2012/13

This OIA request was a follow-up to an earlier request from Mark Honeychurch regarding essentially the same information. The response to Gold’s request included a new column for 2012/13, as well as the “Total” column although that isn’t strictly new information. Also, the information from Gold’s request seems to have been a catalyst for an article published on the 24th of May 2014 on stuff.co.nz: Big Bill for Alternative Health.

This article did a little more digging, asking questions of doctors, acupuncturists, and the ACC. I highly recommend you read it. The most interesting part to me was this:

In 2009, then-ACC Minister Nick Smith questioned the ballooning ACC bill for complementary treatments and said their effectiveness would be reviewed.

Since then, the cost has risen another $5m but ACC said no review ever took place.

ACC Minister Judith Collins did not answer questions about the review.

It is not mentioned in this article, but I have known for some time that the ACC has a document published on their website entitled Acupuncture Treatment Profiles. The document describes itself as:

a valuable guide in the application of protocols that are included within a Traditional Chinese Medical (TCM) diagnosis, providing important information that assists an acupuncturist’s treatment strategy.

This appears to be an official ACC document, to be used by ACC-registered acupuncturists to determine appropriate methods of diagnosis and treatment that are approved for ACC funding. However, having a look through it one can’t help but notice egregiously wrong and pseudoscientific statements such as the following:

  • Acupuncture… Relieves pain by treating stagnation of Qi and Blood in the affected areas and channels
  • Qi is the vital force of life which… Is the material substrate of the Universe
  • Brain… Is considered to be the same in substance as marrow
  • the Kidney produces marrow

I shudder at the thought that the ACC levies I pay are partly used to fund this. It seems to me that it’s high time the ACC carried out a review of the evidence behind these therapies that it funds, so problems like this can be rooted out and dealt with. Publicly funded healthcare should be based on science, after all.

Advertisements

Fluoride in Onehunga

In last month’s issue of my local community newsletter, Onehunga Community News, an article was published about water fluoridation. For those of you who are non-locals, Onehunga is a suburb of Auckland, and in general drinking water in Auckland is fluoridated.

Click to view the full image and read the article
Click to view the full image and read the article.

The article mentioned some of the recent national news about fluoridation, which I won’t get into here, and used it to bring up the fact that much of Onehunga’s water is not fluoridated. It gave links to the Ministry of Health for pro-fluoridation information and Fluoride Action Network New Zealand (FANNZ) for anti-fluoridation information, and it called for readers to send in their thoughts.

I decided to send in a message in response to the article. The May edition of this newsletter has just been released, and as part of it several responses, including a small part of mine, have been published:

Click to view the full image and read the article.
Click to view the full image and read the article.

I was happy to see that most of the responses were sensible, although there was still one talking about such rubbish as “chemicals” being synonymous with “poisons”. As only a small section of my message was published, I’ve decided to publish the entire message here. Here is the full message I sent in to Onehunga Community News:

To whom it may concern,

I was rather disappointed to see the article “To fluoridate or not to fluoridate…” mention the anti-fluoride group “Fluoride Action Network New Zealand” as though it were a reputable source of information on fluoride. This group relies largely on scare-tactics and misinformation, driven by ideology rather than evidence. In comparison, the Ministry of Health is driven by the available to evidence to find the best conclusion, which it believes is that fluoridating the public water supply is an effective, safe, and cost-effective way of improving dental health.

The Ministry of Health website has a page listing a number of websites that provide accurate information on water fluoridation. The FANNZ site is not on this list. That is not simply because FANNZ disagrees with the Ministry of Health on this issue, it is because FANNZ is not a reliable or trustworthy science-based source of unbiased information on this issue.

When I first discovered that Onehunga is not fluoridated I admit I was very disappointed. I had thought that all public water supplies in Auckland were fluoridated, and was sad to hear that I lived in one of the few areas in which this is not the case. I would be ecstatic to see the public water supply in Onehunga go through a process of fluoridation.

It is worth noting that the process of fluoridation is not necessarily as simple as adding fluoride to the water – it is ensuring that the levels fall within a particular range. As some locations have high natural levels of fluoride, this process can involve the lowering of fluoride levels in order to ensure it is maintained at a concentration that is safe and effective.

According to data from the New Zealand Institute of Chemistry (the data are from 1995, but I’m not aware of any more recent data. I have no particular reason to expect a large change since that date though) the level of fluoride in Onehunga drinking water is around 0.15-0.16 mg/L. In comparison, the fluoride level in Ardmore drinking water was increased from 0.04 mg/L to 0.86 mg/L. Onehunga water did have substantially higher natural levels of fluoride than that of the other Auckland areas sampled, but the final level after treatment was also significantly lower than those areas in which the water was fluoridated.

Water fluoridation to prevent dental caries is akin to the fortification of bread with folic acid to prevent neural tube defects in children, or iodine in table salt to prevent iodine deficiency. These are all safe and effective science-based preventive methods that improve public health.

I understand the journalistic urge to provide balance on all issues, but it is important not to establish a false balance such as this. This is a topic on which it is important to listen to the experts.

Sincerely,
Mark Hanna

The editor responded to defend their approach to pursue balance by saying that they shouldn’t only provide government resources. I didn’t find it convincing, but I do understand somewhat the urge for journalists to provide both sides of every story. There is some merit in that but, as I said in my message quoted above, it is possible to take it too far.

It feels relevant to note that, since I sent this message, 3 separate ASA complaints have been upheld against FANNZ on the basis that they failed to adequately distinguish opinion from fact. I wouldn’t be surprised to see a couple more in the future either.

When it comes to the fluoride debate there is a lot of misinformation out there, so you have to be extra careful that you’re getting yours from a reliable source. FANNZ is not a reliable source of information. The Ministry of Health is, and if you want a non-governmental source then you might want to check out Making Sense of Fluoride.

For the sake of full disclosure, I’m Facebook friends with some of the people in charge of Making Sense of Fluoride, and gave some advice on the ASA complaints submitted against FANNZ when they were being written.