The Pan Pharmaceutical recall and its effect on the CAM profession in Australia

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Public Health and Human Biosciences, Faculty of Health Sciences, La Trobe University, Bundoora.

In 2003, a travel sickness medication manufactured by Pan Pharmaceuticals, Travacalm Original, triggered a recall of 1600 Complementary and Alternative Medicine (CAM) products. This research assessed the impact of the “Pan recall” on the CAM profession in Australia. Data from a questionnaire survey of 452 CAM practitioners (19 percent response rate, covering Naturopaths, Homoeopaths, Acupuncturists, Chinese Herbalists, Massage therapists, Western Herbalists and other modalities), in-depth interviews of 9 key industry leaders (including manufacturers of CAM products, members of the Expert Committee on CAM, government officials, and medical practitioners who use CAM products in their practice) and an exhaustive collection of public media and governmental documents were gathered to examine the “structure, process and outcome” impact of the recall on CAM practices. The survey respondents had varied views on the recall, with 57 percent believing there was not an effect and 43 percent believing there was an effect on the CAM profession. Although 41 percent Pan product users expressed concerns about bad/negative effect of the recall on their patients, 10 percent viewed the recall as positive or good for patients. The appropriateness of the response of Therapeutic Goods Agency (TGA) to this event was doubted by the study participants with many querying why a Class 1 recall on an Over the Counter product triggered the recall of so many CAM products. This led to mistrust of the TGA by some of the practitioners. Some 58 percent of survey respondents believed the recall was unjustified. Different impacts were experienced by the various interest groups and fighting among these groups is obvious, which has been undermined by the historical struggle of CAM practitioners for recognition into the mainstream health care system. More than 85 percent of survey respondents endorsed changes in strengthening GMP standards of CAM products. However, the CAM professions have remained highly diversified, with only a few modalities being subjected to governmental registration. Media played a major role in the coverage of the recall and often from a negative standpoint as far as the CAM profession was concerned. Despite this, consumers continued to use the different CAM modalities available in Australia. The CAM industry has shown its flexibility and continues to grow. Lessons need to be learnt from the Pan recall event. Government actions should protect the interest of consumers. Inter- and intra-professional relationships need to be addressed given the diverse demands of consumers. Increased research in relation to the different CAM modalities and regulation is needed to ensure public safety and confidence.