Australian Volume 26 | Number 1 | Autumn 2020

Journal of the Traditional Natural Medicine

Medicine and Sustainable

Society Healthcare

ISSN 1326-3390

How to Manage
Hypersensitivity
with Integrated
Education Standards Manual Therapies
and the Future
of Complementary
Medicine Professions
Part 2. Dry Needling:
A literature Review
Part 1.

ATMS Award

Sage Advice Dinner 2019

for Cognitive
Improvement
Health Fund News | New Research | Book Review
The Australian Traditional-Medicine Society Limited (ATMS) was
incorporated in 1984 as a company limited by guarantee ABN 46 002
844 233.

ATMS HAS FOUR CATEGORIES OF MEMBERSHIP

Accredited member
Associate member
LIFE MEMBERS
Student member (free)
Catherine McEwan - bestowed 09/12/1994
Fellow
Phillip Turner - bestowed 16/06/1995
Life member
Nancy Evelyn - bestowed 20/09/1997
MEMBERSHIP AND GENERAL ENQUIRIES Leonie Cains - bestowed 20/09/1997
ATMS, PO Box 1027 Meadowbank NSW 2114 Sandi Rogers - bestowed 09/04/1999
Tel: 1800 456 855 Fax: (02) 9809 7570 Maggie Sands - bestowed 09/04/1999
info@atms.com.au Freida Bielik - bestowed 09/04/1999
www.atms.com.au Marie Fawcett - bestowed 09/04/1999
Roma Turner - bestowed 18/09/1999
PRESIDENT
Bill Pearson - bestowed 07/08/2009
Peter Berryman | peter.berryman@atms.com.au
Sandra Grace - bestowed 18/11/2018
VICE-PRESIDENTS
HALL OF FAME
Brad McEwen | brad.mcewen@atms.com.au
Dorothy Hall - inducted 17/09/2011
Trisha Mok | trisha.mok@atms.com.au
Marcus Blackmore - inducted 17/09/2011
DIRECTORS Peter Derig - inducted 17/09/2011
Donna Ciccia | donna.ciccia@atms.com.au Denis Stewart - inducted 23/09/2012
Sandra Grace | sandra.grace@atms.com.au Garnet Skinner - inducted 22/09/2013
Brendan Meek | brendan.meek@atms.com.au Simon Schot - inducted 10/12/2015
Christine Pope | christine.pope @atms.com.au
Maggie Sands | maggie.sands@atms.com.au

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PEER REVIEWERS GRAPHIC DESIGN & PRODUCTION

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Thomas Harris Betty Tannous
Copyright 2020. All rights reserved. The opinions expressed in this
Brad McEwen Ann Vlass journal are those of each author. Advertisements are solely for
Robert Medhurst Daniel Zhang general information and not necessarily endorsed by ATMS.
 Journal of the
Australian Traditional Medicine Society

Volume 26 | Number 1

Contents
AUTUMN 2020

4
PRESIDENT’S MESSAGE
P. BERRYMAN

5
CEO’S REPORT
C. WURF

32
ARTICLES ATMS AWARDS DINNER 2019
15 MYERS S.
HOW TO MANAGE
HYPERSENSITIVITY WITH INTEGRATED
MANUAL THERAPIES 37
BAXTER P. PRACTITIONER PROFILE
CATHERINE CLARK

REPORTS

6 36
SAGE ADVICE FOR COGNITIVE BOOK REVIEW
IMPROVEMENT
MCEWEN B. 38
LAW REPORT

9 20 42
EDUCATION STANDARDS AND THE UPDATE ON RECENT RESEARCH ATMS UPDATE
FUTURE OF COMPLEMENTARY IN HOMEOPATHY
MEDICINE PROFESSIONS. MEDHURST R. 44
PART 2. RECENT RESEARCH
STONE M.

NEWS

48
HEALTH FUND UPDATE

49
HEALTH FUND NEWS
22
STUDENT RESEARCH 57
12 DRY NEEDLING: A LITERATURE REVIEW. CONTINUING PROFESSIONAL
NATURAL MEDICINE AND PART 1. EDUCATION
SUSTAINABLE HEALTHCARE FIRTH C, MEON J, PRICE M,
GRACE S. TAYLOR J, GRACE S. 58
PRODUCTS & SERVICES GUIDE

JATMS | Autumn 2020 | 3

 President’s
Report
Peter Berryman | ATMS President
This summer and the new year
have been very challenging times
for all. Condolences from the ATMS
Board to members and their families
who have been challenged by our
environmental crises, in bush fires,
floods, and the pandemic of nCV2019.
ATMS has been extensively involved
in responding to these issues in many
collaborative ways. Social media and
email have continued to play a major
role in communicating with both
members and our clients in providing
updates to promote fire awareness and
coordinated responses.
We have also continued to exert our
influence in Parliament to campaign
for climate change mitigation, small
businesses’ assistance, and the return
of rebates for 16 natural medicine
modalities. Tangible evidence of our
efforts is the upcoming launch of
the new Parliamentary Friends of
Complementary and Natural Therapies
Group, initiated by ATMS. This gives
us another opportunity to change the
culture within Parliament, at both non-
ministerial and ministerial levels. We
have continued having appointments
with Senators, Ombudsmen,
Government Departments and MPs
and their support staff keeping
the message of the relevance and
requirements of natural medicine
practitioners and their clients in front
of mind. We have also continued
to pursue the coordinated ATMS
submission of high-quality evidence to
NTREAP, supporting the Tranche One
modalities. Another submission will
follow, supporting the Tranche Two
modalities.
4 | vol26 | no1 | JATMS
Our aspiration to significantly influence
public awareness and patronage of
natural medicine practitioners has its
annual focus in our Natural Medicine
Week, from 25-31 May 2020. You are
invited to participate and make a local
difference as part of your community
network.
We have had awesome uptake of our
2020 Continuing Professional Education
(CPE) events, recently launched and
selling out fast. We do offer special
events for our student members too,
such as our Transition to Practice
workshops, with Christine Pope and
Betty Tannous as presenters this year.
Our annual special event for 2020 is a
Menopause Symposium, to be held in
Sydney in September, with five specialist
presenters booked, covering a wide
range of modalities.
ATMS wishes to congratulate
Southern Cross University, Lismore
on the launch of the new National
Centre for Naturopathic Medicine,
where post- graduate programs in
Advanced Naturopathic Medicine are
now underway, greatly aided by the
generosity of Marcus and Caroline
Blackmore. Their philanthropic grant
has been the largest single donation ever
received by Southern Cross University.
For the thirteenth season, the Woodford
Folk Festival has again had the gift of a
free natural medicine clinic. This last
season, ATMS has been the generous
sponsor for both acupuncture and
homeopathic practitioners and students
to consult with 328 clients over six days
and nights. This was such a success for
all involved that ATMS has decided to
again sponsor next season’s festival, in
the hope that it will become entirely
self-funding through the generosity of
our family of clients. Many thanks to our
practitioners, students and their families
who gave their time to a magnificent
effort for the benefit of the extensive
Woodford Folk Festival community.
ATMS would also like to celebrate
members of ten or more years standing
by giving you the opportunity to take
up our new membership category of
“Fellow”, approved at our November
2019 Annual General Meeting in Sydney.
Details will follow with your annual
renewal.
I would also like to congratulate our
cutting-edge contribution to natural
medicine research in Australia: the
ATMS-sponsored N-of-1 study, led by
Sandra Grace and her large team. Upon
publication, this research is expected
to make a significant contribution to
how nutrition and an improvement in
the human gut microbiome can assist
mental health. I hope all our members,
and particularly those who have been
challenged by extreme weather this
summer will hear and be cheered by this
good news story.
Always in your service …
Peter Berryman
President
CEO’s
Report
Charles Wurf | ATMS CEO
On behalf of members, ATMS continues
to be actively engaged in the Natural
Therapies Review 2019-20. This review
was announced by Greg Hunt, Minister
for Health, and is an update to the 2014-
15 review. The new review has been
established to assess additional evidence
of the clinical effectiveness of the 16
natural therapies excluded from private
health insurance from 1 April 2019.
As ATMS members know all too well,
since 1 April 2019 the following natural
therapies have been excluded from
complying health insurance products:
Alexander technique, aromatherapy,
Bowen therapy, Buteyko, Feldenkrais,
Western herbalism, homeopathy,
iridology, kinesiology, naturopathy,
Pilates, reflexology, Rolfing, shiatsu, tai
chi, and yoga.
ATMS has consistently opposed the
process, deliberations and outcomes
of the 2015 Review of the Australian
Government Rebate on Private Health
Insurance for Natural Therapies. We
have argued that in the 2015 Review the
methodology was flawed and the final
Report does not provide a sound basis for
Australian public policy.
The Natural Therapies Review 2019-20
will examine additional evidence which
has emerged since the previous review
and provide advice to Government on
whether any of the natural therapies
should be covered by private health
insurance and therefore eligible for
subsidy through the Private Health
Insurance Rebate.
In January 2020, The Department of
Health invited stakeholders to submit
citations for published scientific research
studies for consideration in the Natural
Therapies Review 2019-20. That call for
evidence is for natural medicine therapies
identified as tranche one. Of these
therapies ATMS currently accredits:
• naturopathy;
• western herbal medicine; and
• shiatsu
For the tranche one natural therapies,
published scientific research studies
will be considered for inclusion in the
systematic reviews if they satisfy the
following:
• the population/participants in the
study are people of any age, with or at
risk of developing any injury, disease,
medical condition or pre-clinical
condition;
• the study evaluates the clinical
effectiveness of the therapy in
humans only. This includes whole-
system, multi-component practice
and may include components of the
therapy (i.e. tools of the trade); and
• the study reports human health
outcomes in relation to prevention or
treatment of a specific injury, disease,
medical condition or pre-clinical
condition.
No restrictions apply to publication
date, language, geographical location,
publication status or number of
participants in the study.
Evidence that is out-of-scope for this call
for evidence and will be excluded from
the systematic reviews. For the tranche
one natural therapies, published research
evidence will not be considered for
inclusion in the systemic reviews if the
following apply:
• it is a case report or not a scientific
study, i.e. it is an expert opinion
article, editorial, letter/email, detailed
personal history/narrative, personal
medical information/record, blog or
newspaper article;
• the study is not formally published
(for example, in a book or non-peer
reviewed journal article); or
• the study was included in the 2014-
15 Natural Therapies Review unless
approved for reconsideration by the
NTREAP.
ATMS enlisted a range of support and
commissioned academic researchers to
compile a substantial submission to the
review for the tranche one therapies.
This submission was made in February
2020 and ATMS members can access the
submission via the ATMS website.
The proposed next call for evidence is
for natural medicine therapies identified
as tranche two. Of these therapies ATMS
currently accredits:
• aromatherapy;
• Bowen therapy;
• homeopathy;
• kinesiology; and
• reflexology.
At the time of writing our expectation is
that there will be a call for evidence for
the tranche two therapies in the April
– June 2020 period. ATMS will prepare
for this call for evidence and will make
a similar submission for the tranche
two therapies once the public call for
submissions is announced.
Charles Wurf
CEO
 ARTICLE
Sage advice for
cognitive improvement
Bradley McEwen | PhD, MHSc (Hum Nutr), BHSc, ND (Adv), DBM, DNutr, DSM, M.ATMS, Naturopath, Nutritionist, and
Mentor. Adjunct Senior Lecturer, School of Health and Human Sciences, Southern Cross University.
Introduction
Chronic diseases are the leading cause
of morbidity and mortality worldwide.1,
2
With populations around the world
rapidly ageing, there has been a
significant increase in life expectancy.
With this increase in age there is a
parallel increase in cognition-related
diseases.3-7 Some of these cognitive
diseases include mild cognitive
impairment, cognitive decline, dementia,
and Alzheimer's disease.3-5 Cognitive
impairment and decline are growing
global burdens of disease.6 Cognitive
impairment is a multifactorial condition
with a complex interplay of many
factors, such as age,3-7 demographics,
genetics, socio-economic position,
environmental factors, and nutrition.7
Herbal and nutritional medicines are
being investigated to slow, or even
reverse, this process and to improve
overall cognitive function in all age
groups. Herbal medicines8, 9 and
optimum nutrition10, 11 are fundamental
for the management and prevention of
various health conditions, particularly
chronic disease. Salvia officinalis (Sage)
belongs to the plant family of Labiatae
(Lamiaceae).12, 13 It is native to the Middle
East and Mediterranean areas and can be
found naturalised throughout the world.12
6 | vol26 | no1 | JATMS
Sage has numerous health benefits, such
as improving cognition,14-16 improving
mood,15, 17 reducing inflammation,12, 18
and antioxidant effects.12, 19 The focus
of this article is on the utility of Sage for
cognitive improvement.
Salvia Officinalis (Sage)
Salvia originates from a Latin word
meaning “to heal”.14 The use of Sage
(Salvia officinalis) spans several
millennia17 and has a long history of
use in cooking, for medicinal purposes,
and in traditional medicine.12, 14 Salvia
officinalis has a long-standing use
as a traditional herbal remedy that
can enhance memory and improve
cognitive functions.20 The use of sage
as a cognition enhancer and for the
treatment of cognitive decline dates
back to the ancient Greeks.21 Indications
from the earliest texts onwards include
the use of sage for the amelioration
of age-associated memory loss.17 Sage
was often quoted as a remedy for
memory disorders in 16th and 17th
century English herbals.22 Nicholas
Culpeper said of sage that it “helps the
memory, quickening the senses, and
helps lethargy and lowness of spirits”
(Culpeper’s Complete Herbal, published
in 1653).23
Constituents of Sage
Salvia officinalis contains numerous
constituents, including monoterpenes
(e.g., thujone,1,8‐cineole,24 and
camphor),20 diterpenes (e.g., carnosic
acid), triterpenes (e.g., oleanoic acid,
ursolic acid),12, 20 alkaloids, fatty acids,
glycosidic derivatives (e.g., cardiac
glycosides, flavonoid glycosides,
saponins), ellagic acid, epicatechin,
epigallocatechin gallate, quercetin,12
caffeic acid,24 luteolin,25 and
phenolic compounds such as rosmarinic
acid.12, 20, 24, 25
Actions and Uses of Sage
Sage has various uses (Table 1) relating
to cognitive function, including
improving attention,14 learning,14
memory,14, 26 secondary memory,16
cognition,14 and cognitive decline.12, 17
Other uses include mood,15, 17
inflammation,12 oxidative stress,12, 19, 25
hypercholesterolaemia,27, 28 gout,
dyspepsia, heartburn, bloating,
ulcers, diarrhoea, tremors,12 and
hyperglycaemia.12, 27 Sage has
enormous potential for the
treatment and management of
cognitive disorders,14-16 learning
disorders,14 and mood.15, 17
 ARTICLE

Table 1. Actions of Salvia officinalis (Sage)

hours (P=0.022) and 4 hours post-dose
Cognitive effects14-16 (P=0.031). Additionally, in-vitro analysis
Improves memory performance on a computerised cognitive assessment battery17 confirmed cholinesterase inhibiting
Improves secondary memory (long-term, unlimited storage of processed information)16 properties for the extract.
Enhances learning14
Improves attention task performance in older cohorts17 A randomised, double‐blind, placebo‐
Increases alertness17 controlled study assessed the efficacy
Improves delayed word recall16 and safety of Salvia officinalis extract in
Cholinergic activities15, 26 patients aged 65-80 years with mild to
Inhibition of acetylcholinesterase16, 17, 22 moderate dementia.15 The participants
In vitro cholinesterase inhibiting properties17, 22 were allocated to two groups: 60
Enhances mnemonic performance in healthy young participants17 drops daily of sage liquid extract (1:1)
Improves mood15, 17 or placebo for 16 weeks. Compared
Improves mood in healthy young participants17 with the placebo group, those who
Reduces anxiety17 received Salvia officinalis experienced
significant benefits in cognitive function
Carminative20
(as measured by attention, language,
Antispasmodic20, 24
memory, orientation, praxis, judgement,
Antiseptic20
problem-solving and reasoning) by the
Astringent20, 24
end of the treatment (P=0.03). It was
Antihydrotic properties20
noted that agitation appeared to be
Anti-inflammatory12, 18, 22, 24
more frequent in the placebo group
Antioxidant12, 19, 22, 24, 25
(P=0.09). It would be interesting to see
Reduces blood levels of total cholesterol, triglyceride, LDL and VLDL27, 28 if sage reduces agitation in the general
Lowers glycated haemoglobin (HbA1c)27 population.
Increases HDL level27, 28
Reduces fasting glucose27 A double-blind, placebo-controlled study
Reduction of 2-hour postprandial glucose and cholesterol13 was performed to assess immediate
and delayed word recall to assess
Sage has been found to inhibit administered immediately following memory.30 Subjects were assigned
acetylcholinesterase.12, 16, 17, 22 a baseline assessment, with further to either a combination of 5ml sage-
Acetylcholinesterase is an enzyme assessment at 1 hour, 2.5 hours, 4 rosemary-lemon balm ethanol extract
that metabolises and breaks down hours, and 6 hours post-treatment. or 5ml placebo. The combination
acetylcholine. Acetylcholine plays The 333 mg dose was associated with contained Salvia officinalis (1,670 mg),
an essential role in the formation of significant enhancement of secondary Rosmarinus officinalis (1,670 mg), and
memories and cognition.29 Inhibitors memory performance at all testing Melissa officinalis (1,670 mg). Significant
of acetylcholinesterase are the leading times. Significant improvements to the improvements to delayed word recall
therapeutics used in Alzheimer’s accuracy of attention following the were found. Each of these herbs in the
disease and through its actions sage has 333 mg (equiv. 2,155 mg) dose were study contain rosmarinic acid. The
great potential for the treatment and observed. The lowest dose (167 mg, mechanisms behind the delayed word
management of cognitive decline and equivalent 1,200 mg) had significant recall effects were thought to be likely
Alzheimer’s disease. improvements for the delayed word due to anticholinesterase actions of
recall task at 1 hour (P=0.036) and these herbs.
Trials on the Cognitive Effects at 2.5 hours post-dose (P=0.002),
of Sage and trends were noted at the 4-hour A double-blind, placebo-controlled,
A randomised, placebo-controlled, (P=0.130) and 6-hour sessions (P=0.17). crossover study investigated the
double-blind, five-period crossover Significant improvements in delayed effect of sage on mood and anxiety.17
study investigated the acute effects of word recall were observed for the 333 Thirty healthy participants (17 males
standardised extract of Salvia officinalis mg dose of sage at 1 hour (P=0.0004), and 13 females (mean age 24.4 years,
on cognitive performance in older at 2.5 hours (P=0.0005) and 6 hours SD 4.4)) attended the laboratory on
adults.16 Four doses of sage extract post-dose (P=0.019). The 666 mg dose three separate days, 7 days apart.
concentrate (167 mg, 333 mg, 666 mg, demonstrated improvements at 1 hour They received a different treatment in
and 1,332 mg) and a placebo were used, (P=0.004) and at 2.5 hours (P=0.0002). counterbalanced order on each occasion
with a 7-day wash-out period between The highest dose (1,332 mg) revealed (placebo, 300 mg (equiv. 2,155 mg), 600
visits. On study days, treatments were improvements at 1 hour (P=0.043), 2.5 mg (equiv. 4,311 mg) of dried sage leaf.

JATMS | Autumn 2020 | 7

 ARTICLE
On each day mood was assessed pre-dose
and at 1-hour and 4-hour post-dose. Both
doses of sage showed improvement in
the ratings of mood in the absence of
the stressor. The lower dose of 300 mg
reduced anxiety and the higher dose of
600 mg increased “alertness”, “calmness”
and “contentedness”.
Conclusion
Herbal medicines and optimum nutrition
play a fundamental role in the prevention
and management of chronic disease. Sage
has multiple actions and uses such as
improving cognition, attention, learning,
and memory and has significant potential
for use in cognitive disorders, such as
cognitive decline.
REFERENCES
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 ARTICLE

Education
standards
and the future of
complementary
medicine professions
Part 2.
Martin Stone | BHSc, ND; Managing Director, Switch on Health

Abstract
Part 1 of this article discussed the dramatic recent reduction of opportunities to study within our profession. While this has
occurred partly as a result of a push for a Bachelor to become the new minimum standard, Part 1 argued that Bachelor
programs are not always suitable, or even necessary, to produce safe and competent practitioners. Part 2 of this article
argues that industry regulation of our qualifications and colleges is more appropriate, and has been more successful, than
governmental regulation. This regulation would negate the need for our qualifications to be recognised by the Australian
Qualifications Framework (AQF). Current commercial reality shows that the future of our profession is placed at significant risk
should only AQF qualifications be recognised.

Is Government Regulation
Necessary to Protect the
Public?
In Part 1 of this article, it was argued
that the content of a qualification is
a more appropriate determinant of
its accreditation than its name. It
also stated that the content should
be determined by our professional
associations. Is it sufficient for
industry associations alone to regulate
the standards of our qualifications
and our colleges, or is some form of
external governance required? Such
governance was in existence from 2002
to 2018, when our Advanced Diploma
qualifications were part of the Health
Training Package, and as such were
regulated by the Australian Skills Quality
Authority (ASQA).
Before the introduction of the Health
Training Package qualifications in
2002, regulation of CM qualifications
occurred via industry accreditation.
Prospective students seeking a place
of study would wish to know that,
upon completion of their studies, they
would be recognised by bodies such
as ATMS, ANTA and NHAA. Colleges
were therefore required to meet
association standards if they were to
continue to attract students. Standards
among such associations were fairly
similar and this arrangement meant that
the qualifications offered by different
colleges were also fairly consistent in
their content.
The introduction of the Health Training
Package challenged this situation
as the qualifications were no longer
based on a scaffolded framework of
knowledge acquisition followed by
practice. Instead, they consisted of
Units of Competency to be awarded
when a student could demonstrate
satisfactory performance of a task. It
is remarkable that the Health Training
Package qualifications, designed to
standardise training nationally, appeared
to bear little resemblance to existing
industry standards, nor to the existing
programs that were successfully
producing capable practitioners.
Colleges were forced to somehow try
to create an awkward marriage of Units
of Competency with the requirements
of their accrediting associations.
The letter of the law dictated that
compliance to Health Training Package

JATMS | Autumn 2020 | 9

 ARTICLE
rules was paramount and that all the
industry association experience and
guidance was now no longer relevant.
The introduction of the Health
Training Package and regulation of our
qualifications by a government body, as
opposed to the decades-long regulation
by our accrediting associations, appears
to have had a negative effect on the
quality of our education. If this is the
case, it is therefore less effective in
safeguarding the public than regulation
by our associations.
Does Governmental
Regulation Protect Students?
With the closure of some 40 colleges
within our industry, prospective
students have every right to wonder
if their provider can be trusted not to
close overnight, leaving the student
out of pocket and with nowhere to
go. Unfortunately this is exactly the
scenario in which many students
enrolled in government-endorsed
Training Package qualifications found
themselves.
Governmental regulation of colleges
and their qualifications failed to protect
students from rogue operators, not just
in CM qualifications but in many other
professions. It has been estimated
that government student loans in the
form of VET Fee-help have cost the
taxpayer billions of dollars in funding
to colleges that had no intention of
serving their students.10, 11 Thousands
of students have incurred debts for
courses that they clearly should not
have been enrolled in. This rorting
of the system eventually led to a
clampdown on all private colleges in an
attempt to rid the vocational education
sector of such unscrupulous providers.
Administrative compliance became
increasingly difficult, unreasonable,
financially untenable, and legally risky.
Qualifications that made little sense in
the first place were audited by people
with no knowledge of our profession.
The result was inevitable. Even
without the removal of complementary
medicine qualifications from the
Health Training Package, operating
10 | vol26 | no1 | JATMS
a Registered Training Organisation
became increasingly unpalatable and
many colleges closed down. It appears
that the introduction of Health Training
Package qualifications and the ensuing
governmental regulation not only failed
to standardise qualifications and ensure
quality outcomes for graduates, but also
failed to protect students. The VET
Fee-help debacle of recent years has
shown that government regulation of
our qualifications does not protect the
public – students or consumers – any
more effectively than the professional
associations that had largely achieved
this for many years.
Government regulation clearly failed
for Advanced Diplomas. Colleges
offering a Bachelor degree are
regulated by a different government
body, the Tertiary Education Quality
and Standards Agency (TEQSA). Does
being an education provider that
offers a Bachelor degree confer any
more protection for students and
for our profession? In my opinioin,
unfortunately, the answer is no, as there
is already a precedent for unanticipated
closure of a Bachelor provider in our
industry. Paramount College of Natural
Medicine in Perth, one of only three
providers of accredited complementary
medicine Bachelor degrees, closed
without warning in 2018, leaving its
students seeking other options to
complete their qualifications.
High Barriers and Lack of
Choice
Having a Bachelor degree as the
minimum standard for our profession
creates barriers for both colleges
and students. Costs for students are
significant, with the two Bachelor
degree providers now charging $60,000
for their programs. These high fees
may be at least partly attributed to the
increased cost of delivering a Bachelor
program. The cost of becoming a
Higher Education provider, regulated
by TEQSA, is also significant, and partly
explains the low number of private
higher education colleges offering
degrees.
Choice and opportunity are further
eroded by simple geography.
Restricting education pathways to
degree courses reduces the option of
studying for anyone who does not live
in a major city. There are campuses in
just six locations. Although theoretical
components of courses can be taken
online, should a student reside in the
ACT, NT, or even Tasmania, they may
be required to relocate interstate to
complete their clinical training.
Furthermore, the pool of available
teaching staff for Bachelor programs
reduces dramatically compared
to Advanced Diplomas. A TEQSA
requirement is that those teaching at a
Bachelor level must hold a qualification
at least one level higher (i.e. post-
graduate, Masters, or above). This
reduces the number of available
teaching staff. It also means that
talented and experienced practitioners
may have little opportunity to pass on
their knowledge to students enrolled in
degree programs unless they have taken
time out of their practice to invest
in and pursue post-graduate studies.
Conversely, those who have pursued
a career in academia may be assigned
the responsibility of training our new
practitioners, regardless of their ability
or experience in clinical practice.
Our Future Hangs in a Delicate
Balance
If a Bachelor degree is to be required as
the new minimum standard for entry
to the profession, then our education,
and the future of our profession, will be
entrusted to a small number of private
providers. This author has previously
worked for two providers, and, along
with their students, will attest to the
efforts of their dedicated and passionate
staff and the quality of their programs.
A brief history of these colleges
though will illustrate how dangerously
close we find the continuance of our
qualifications to the mercy of market
forces.
ACNT and SSNT, two of Australia’s
oldest surviving complementary

medicine colleges, were acquired by
Think Colleges, who are partnered
with Torrens University, who are a
part of the Laureate network, who are
publicly listed in the US. Ownership
of these colleges is far removed from
their roots. ACNT, founded by an
osteopath, was originally built on
massage qualifications that were taught
for over 30 years, but these were
removed from the curriculum last
year. Thankfully, their three Bachelor
programs continue to be on offer.
Australia’s other complementary
medicine Bachelor provider is
Endeavour College of Natural Health.
Ownership of Endeavour has changed
several times, having recently been
sold for the third time in less than five
years. In 2014, they were acquired
by Vocation Ltd.12 When Vocation Ltd
went into voluntary administration,
150 staff lost their jobs, and up to
12,000 students were left in limbo.13
This rapid descent was primarily
caused by its management failing
to disclose the loss of government
funding to its shareholders, resulting
in the loss of some $700 million market
capital and the threat of class actions.14
Clearly, size offers no guarantee of
protection from closure.
Endeavour was then acquired by Study
Group Australia in 2015, who had also
acquired one of Brisbane’s largest and
most established natural therapies
colleges, the Australian Institute of
Applied Sciences (AIAS).15 In 2017,
Study Group Australia was informed
by ASQA that their license to deliver
vocational qualifications would be
removed due to non-compliance.16
AIAS is now closed, and Endeavour
changed hands once again. It is now
owned by private equity firm Allegro
Funds, who specialise in “turnaround”
of businesses, typically acquiring them
and then reselling within 3 – 5 years.17
Based on their business model, we can
expect Endeavour to be under new
ownership once again in a few years’
time.
Those who insist that a Bachelor degree
should be the minimum standard for
our profession are placing our future in
the hands of a small number of private
businesses, who unfortunately have
already reduced the programs they offer.
No matter how wonderful these colleges
are, a reliance on such a small number
places the future of our profession in a
very precarious position.
Conclusion
Governmental regulation of our
qualifications appears to have failed
to ensure both the quality of the
qualification and protection of students
in the event of college closure. This
has been the case for both vocational
(Advanced Diploma) providers and
Higher Education (Bachelor) providers.
The closure of so many colleges,
together with the cessation of some
qualifications in the few colleges that
remain, has brought the education
of our profession dangerously close
to extinction. It has already been
demonstrated that we cannot rely
either on public universities or private
providers to continue delivery of our
qualifications. Homoeopathy has already
disappeared from their curriculum and
Western Herbal Medicine may only
be one step behind. To stipulate that
a Bachelor degree should be the new
minimum standard required for entry
to our profession places our future in
jeopardy.
With the removal of the HLT
qualifications, there is now a need
for alternative industry accredited
qualifications to ensure our profession
continues to grow and thrive.
Educational standards, and the future
of our profession, can only be reliably
assured by our industry associations.
Their criteria for accreditation must be
based on the content of a qualification,
and not its title.
Declaration of interest
Martin Stone is part-owner and Managing
ARTICLE
Director of Switch on Health, the first
and only college since the removal of
the Training Package qualifications to
be accredited by ATMS to offer Advanced
Diploma qualifications in Naturopathy,
Nutrition, Western Herbal Medicine, and
Homoeopathy.
REFERENCES
10. Tomazin F. How Australia’s education
debacle is still creating victims. The Sydney
Morning Herald. 2018 Apr 22; Investigation,
Politics, Federal, Education. Available from:
https://www.smh.com.au/politics/federal/
how-australia-s-education-debacle-is-still-
creating-victims-20180419-p4zal3.html
11. van Onselen L. $7.5 billion later, Australia’s
VET scandal is still costing taxpayers.
Macrobusiness. 2018 Aug 21; Australian
Budget, Unconventional Economist. Available
from: https://www.macrobusiness.com.
au/2018/08/7-5-billion-later-australias-vet-
scandal-still-costing-taxpayers/
12. Vocation Limited. 2014. Vocation to acquire
Endeavour. Available from: http://member.
afraccess.com/media?id=CMN:/2A800784&f
ilename=20140610/VET_01523903.pdf
13. Rose S. Vocation collapses, 150 people lose
jobs, 10,000 students in limbo. The Sydney
Morning Herald. 2015 Nov 30; Business.
Available from: https://www.smh.com.au/
business/vocation-collapses-150-job-losses-
20151130-glbszd.html
14. Evans S. Vocation: How the threat of class
actions helped kill a company. Australian
Financial Review. 2015 Dec 4; Business.
Available from: https://www.afr.com/
business/how-the-threat-of-class-actions-
helped-kill-a-company-20151203-glec6g
15. Evans S. Second time lucky for Study Group
as Vocation sells Endeavour for $75m.
The Sydney Morning Herald. 2015 Mar 19;
Business, Education. Available from: https://
www.smh.com.au/business/second-time-
lucky-for-study-group-as-vocation-sells-
endeavour-for-75m-20150319-1m2r7r.html
16. Australian Skills Quality Authority.
UPDATED: ASQA cancels registration
of Study Group Australia Pty Ltd. 2018.
Available from: https://www.asqa.gov.au/
news-publications/news/updated-asqa-
cancels-registration-study-group-australia-
pty-ltd
17. Allegro Funds. Available from: http://www.
allegrofunds.com.au/
JATMS | Autumn 2020 | 11
 ARTICLE

Natural medicine and

sustainable healthcare
Sandra Grace | PhD, School of Health and Human Sciences, Southern Cross University

Abstract
Human health is inextricably linked to environmental health. The air we breathe, the water we drink and the quality of
the soils in which we grow our food have a fundamental effect on the healthy functioning of the human body. Natural
medicine has its foundations in practices that promote environmental sustainability through its low impact diagnostic and
treatment approaches and its promotion of healthy lifestyles. It is time to acknowledge the green credentials of natural
medicine practitioners who have long been custodians of sustainable healthcare and for natural medicine practitioners to be
acknowledged as leaders in the field.

What’s natural about natural
medicine?
What does it mean to be a natural
medicine practitioner? For many it
will mean encouraging your clients
to consume plenty of nutritious,
organically-grown unprocessed food,
incorporating a goodly quantity of raw
food and using cooking processes that
minimally damage their nutritional
content. It will mean taking plenty of
healthy exercise. It will mean advocating
mind-body health and focusing on
harmonising body and mind, spending
time in the natural world and finding
natural environments that complement
their clients’ temperaments and suit
them spiritually and aesthetically. It will
mean cultivating the spiritual dimension
of their lives, including exercising
kindness, having positive thoughts,
cultivating friendships and a healthy
work-life balance with plenty of sleep.
It will mean encouraging activities
that promote happiness, perhaps by
recommending the ‘grand essentials
of happiness’: having something to do,
someone to love and something to hope
for.(1) Educating our clients in this way
is fundamental to natural medicine
practice. In fact, it is one of the key
principles of natural medicine: docere -
to teach and share our knowledge.(2)
All natural medicines from Europe
and North America are underpinned
by a number of these principles that
demonstrate the inherently green
credentials of its practices. Perhaps most
explicit is the principle of vis medicatrix
naturae (the healing power of nature).
Naturopathy, with its roots in traditional
practices in Germany and Europe in the
16th and 17th centuries, drew on herbal
medicine produced locally from home
gardens, and the healing power of water
through hydrotherapy.(3) Osteopathy and
chiropractic, originally from the USA,
treated people with manual medicine,
good nutrition, physical exercise and
hydrotherapy.(4)
Today, many natural medicine
practitioners in Australia are highly
trained professionals who make a
significant contribution to Australian
health care. Simple, non-invasive and
inexpensive approaches, like those
drawn from nature described above,
are prioritised as a first line approach
when appropriate. (A key responsibility
of natural medicine practitioners is
to identify red flags of any serious
underlying condition and refer their
clients appropriately.) Diagnosis is
based primarily on case history and
good observation skills. Assessment
of vital signs can be conducted with
minimally invasive equipment. Manual

12 | vol26 | no1 | JATMS


therapists use their palpation skills
as a key source of information about
their clients’ conditions.(5) For those
clients deemed suitable candidates for
natural medicine, treatment modalities
are likewise environmentally frugal
and include counselling, naturally
occurring ingestives, touch and
manipulation, normalising energy flow
and guided exercise. Many natural
medicine practitioners already avoid
substances derived through animal
experimentation, and the potential
is there for all to do so. Unlike many
aspects of conventional medicine,
practising natural medicine can have
minimal detrimental effect on the
human and natural environment.
The relationship between
human health and
environmental health
Human health is inextricably linked to
environmental health. We are deeply
dependent on the quality of the soil in
which we grow crops and where we
graze animals, of the water we drink and
of the air we breathe.
Natural medicine and soil quality
The connection of human and animal
health to healthy soil has been
recognised over millennia.(6) While
there appears to be little experimental
NATURAL MEDICINE PRACTITIONERS ARE LIKELY TO BE STRONG
ADVOCATES FOR ORGANIC FARMING, WHICH SEEKS TO LIMIT
THESE HAZARDS TO SOIL SAFETY THROUGH NON-TOXIC
FERTILISERS AND BIOLOGICAL PEST CONTROL,
concurrence as to the nutritional
differences between organically and
conventionally-farmed food crops,
there is growing acknowledgement of
the benefits of organic practices to soil
quality. In recent history this perception
has found expression in the burgeoning
organic farming movement, to which
so many natural medicine practitioners
subscribe. A meta-analysis to quantify
differences in soil health between the
effects of organic and conventional
agricultural practices concluded that
organic systems resulted in increases
of up to 84% in key indicators, such as
microbial carbon and nitrogen biomass,
on a global scale.(7)
Soil quality is a significant problem
considering unprecedented
environmental challenges facing
future food production.(8) According
to Miller, (9) the soils in which we
grow our food are not all healthy.
Many have been contaminated with
toxins like heavy metals and sewage
sludge. Loss of biodiversity in the
soil leads to diminished nutrient
value in plants growing in that soil.
Consequently, soil quality may be
diminished in agricultural areas and
urban environments. The term ‘edible
landscaping’ refers to the inclusion of
edible plants in landscaping works to
ARTICLE
increase the potential for food security.
(10) However, early research suggests
that consuming plants grown in urban
centres may pose health risks in cases
where heavy metal accumulation in
plants has reached high levels.
Natural medicine practitioners are
likely to be strong advocates for organic
farming, which seeks to limit these
hazards to soil safety through non-toxic
fertilisers and biological pest control,
and enhances soil by traditional methods
like crop rotation and isolation, green
manure, composting and companion
planting.
Natural medicine and water quality
The same orientation by natural
medicine practitioners to organic
farming practices that promote soil
quality operates to promote water
safety. Water quality, whether used
for drinking, domestic purposes, food
production or recreational purposes also
has a profound effect on health. Water
of poor quality can cause epidemics of
disease and contribute to background
rates of disease that manifest over a
range of time scales.(11) Many programs
for improving water quality and safety
not only support public health, but also
promote socioeconomic development
and well-being.(12)
The greatest contributor to water
pollution is runoff from agriculture
of inorganic pesticides and fertilisers.
Even antibiotics passed through humans
into wastewater have been shown
to contribute significantly to water
pollution.(13)
Natural medicine and air quality
Atmospheric pollution has long been
known to affect those with chronic
respiratory conditions like COPD
and asthma and has been linked to
higher risk of neurodevelopmental
disorders, poor mental health and
cognitive defects.(14) Recent bush
fires in Australia clearly demonstrated
the impact of air pollution on our
health. Regular updates were posted
by the NSW government using the Air
JATMS | Autumn 2020 | 13
 ARTICLE
Quality Index and people, particularly
at-risk groups, were advised to reduce
exposure for the sake of their health.(15)
Natural medicine offers a range of
adjunctive therapies for sufferers
of asthma and COPD that, unlike
conventional inhalers, are entirely
carbon-neutral, including breathing
exercises such as Integrative Breathing
Therapy and Buteyko, diet, herbs and
yoga. No non-disposable or polluting
materials are required for practising
these therapies. Contemporary asthma
inhalers use hydrofluoroalkane (HFA)
as a propellant, which is a potent
greenhouse gas.(16) Doctors in the UK
are discussing moving to less deleterious
dry powder inhalers. We need to ensure
that no medical devices, including any
used by natural medicine practitioners,
make their way to landfill, adding a
secondary and considerable contribution
to greenhouse gas production and the
habitat loss caused by accumulating non-
biodegradable materials.
Sustainable healthcare
There are crucial implications in
the emerging conclusions about air,
water and soil quality for natural
medicine practitioners, who practise
modalities that inherently avoid, or at
least minimise, the use of many of the
factors shown to cause environmental
damage. In view of current accelerating
environmental degradation, there is
an urgent need for universally-adopted
environmentally sustainable practices,
globally, nationally and locally. The
Australian Traditional Medicine
Society launched its green strategy
in December 2019 outlining ways to
promote sustainable business practices
for natural medicine practitioners (see
JATMS 25(4):218-220). Recently, the
Australian Medical Association also
released their position statement on
environmental health.(17) According
to this statement, ‘Enhancing
environmental sustainability, through
reducing carbon emissions, curtailing
waste, and managing resources
efficiently, will deliver better outcomes
for patients, and provide broader
14 | vol26 | no1 | JATMS
social and economic benefits’. While it
is true that streamlining office and clinic
practices along sustainable lines is an
environmentally responsible principle,
it is not the sole preserve of natural
medicine practitioners. However, natural
medicine practitioners can legitimately
stake a claim to environmental
observance available to them alone:
the inherently green quality of their
therapeutic practices.
Conclusion
The quality of our planet’s air, water
and soil are crucial to health. Many
conventional modern methods of
producing food, managing health and
disposing of waste are harmful to
humans and their environment. Natural
medicine employs healing practices that
circumvent many of these harms and
promote individual and environmental
health. Because this is so, natural
medicine practitioners can lay claim to
green credentials that are specifically
theirs. They can justifiably promote the
planetary benefits that their professions
bestow.
REFERENCES
1. Burnap GW. The Sphere and Duties of
Woman: A Course of Lectures (1848),
Lecture IV.: George Quigley; 1848.
Available from: https://archive.org/
stream/spheredutiesofwo00burn/
spheredutiesofwo00burn_djvu.txt.
2. Pizzorno JE, Murray MT. Textbook of
Naturopathic Medicine. London: Churchill
Livingstone; 2005.
3. World Naturopathic Federation. WNF
Naturopathic Roots Report. Canada: World
Naturopathic Federation; 2016.
4. Chila A. Foundations of osteopathic
medicine. 3rd ed. Philadelphia, PA: Lippincott
Williams & Wilkins; 2010.
5. Grace S, Deal M. Textbook of remedial
massage. Sydney: Elsevier; 2012.
6. Reeve JR, Hoagland LA, Villalba JJ, Carr PM,
Atucha A, Cambardella C, et al. Organic
farming, soil health and food quality:
considering possible links. In: Sparkes DL,
editor. Advances in Agronomy. 137. Chennai:
Academic Press; 2016. p. 319-68.
7. Lori M. Organic farming enhances soil
microbial abundance and activityy: a
meta-analysis and meta-regression, PLoS
One. 2017; 12.7: e0180442. PLoS One.
2017;12(7):e0180442.
8. Nuttman S, Patrick R, Townsend M.
Addressing food insecurity in Australia
through education for sustainability. Health
Promot Int. 2020.
9. Mangan A. How soil health affects human
health: An interview with Dr Daphne Miller:
Bioneers; [Available from: https://bioneers.
org/how-soil-health-affects-human-health-
an-interview-with-dr-daphne-miller-
zmbz1911/.
10. Sevik H, Cetin M, Ozel HB, Ozel S, Zeren Cetin
I. Changes in heavy metal accumulation in
some edible landscape plants depending
on traffic density. Environ Monit Assess.
2020;192(2):78.
11. World Health Organisation. Water-related
diseases 2020 [Available from: https://www.
who.int/water_sanitation_health/diseases-
risks/diseases/diarrhoea/en/.
12. World Health Organisation. Water quality
and health strategy 2013-2020 2020
[Available from: https://www.who.int/
water_sanitation_health/publications/
water_quality_strategy/en/.
13. Water Action Decade 2018- 2028. Water
pollution from and to agriculture 2017
[Available from: https://wateractiondecade.
org/2017/12/09/water-pollution-from-and-
to-agriculture/.
14. Boda E, Rigamonti AE, Bollati V.
Understanding the effects of air pollution on
neurogenesis and gliogenesis in the growing
and adult brain. Curr Opin Pharmacol.
2019;50:61-6.
15. NSW Department of Health. Protect yourself
from bushfire smoke 2020 [Available
from: https://www.health.nsw.gov.au/
environment/air/documents/protect-
yourself-from-bushfire-smoke.pdf.
16. Wilkinson AJK, Braggins R, Steinbach
I, Smith J. The costs of switching to low
global-warming potential inhalers. An
economic and carbon footprint analysis of
NHS prescription data in England BMJ Open.
2019;9(10).
17. Australian Medical Association.
Environmental sustainability in health
care: Australian Medical Association,;
2019 [Available from: https://ama.com.
au/position-statement/environmental-
sustainability-health-care-2019.

How to manage
Hypersensitivity with
Integrated
Manual
Therapies
Phil Baxter | AdvDip(Health Science)Acu
A
hypersensitive patient may respond
negatively to a ‘normal’ dosage of
treatment, either bodywork, herbal
medicine or pharmaceuticals. Patients
do not often present with the symptom
of hypersensitivity but in cases of stealth
pathogen infections, hypersensitivity
needs to be treated first. Failure to address
hypersensitivity can mean failure of
therapy.
If a patient feels worse or experiences
an adverse reaction to manual therapy
treatment, it is important to respond.
Integrative Manual Therapies, the
integration of different forms of
bodywork with other forms of
medicine, may be helpful in managing
hypersensitive patients.
Bodywork for Hypersensitive
Patients
In massage, there are two basic
dosage levels: Swedish and Remedial.
Swedish Massage works superficially
over multiple muscle groups, whereas
Remedial Massage tends to focus on
individual muscle groups. Both are
looking for a softening of muscle tension
as a positive feedback sign. It is possible
that neither gauges the body’s systemic
tolerance to therapy, or ‘root treatment’,
but focusses more symptomatically
at the level of ‘branch treatment’
for symptoms. Systemic tolerance
is measured in many ways: medical
history, trauma history, and genetic
and constitutional factors provide a
theoretical basis. Observing initial signs
of ‘overdose response’ (including sweaty
palms and nausea) are clinical events
that can happen in real time. Such events
tend to be reliable as they show the
‘edge’ of the patients tolerance. Certain
modalities, incorporated in Integrated
Manual Therapies, are well suited to the
treatment of systemic hypersensitivity.
These include, in order of dosage from
higher dosage to lower:
• Visceral Manipulation: dosage level 5
• Japanese Acupuncture: dosage level 4
• Craniosacral Therapy: dosage level 3
• Direct Moxibustion: dosage level 2
• Lymphatic Drainage Technique:
dosage level 1
The differences between this suite of
subtle therapies are marked. The more
sensitive the patient is, the lower the
dose required (i.e. dosage level 3, 2,
or 1 are for the patients with a poor
prognosis). As the patient gets better,
and therefore becomes less sensitive,
you can take them up to the next level
of dosage, say from 3, Craniosacral
Therapy to 4, Japanese Acupuncture. (I
have observed that some patients are
constitutionally predisposed to respond
well to subtle therapies and always
ARTICLE
respond better to gentle work, whether
they are sick or well. However, these
people are not the focus of this article.)
The prognosis improves as the body
moves to the next modality, safely,
without side effects. This process builds
resilience and draws the patient out of
hypersensitivity.
After the patient’s hypersensitivity has
been de-escalated, the target condition
can be treated directly, often with a
normal dosage level of therapy. If the
patient’s condition starts to worsen,
lower the dosage level until they move
forward again. Let's look at these
modalities in more detail.
Visceral Manipulation Dosage
Level 5
Visceral manipulation, developed by
Jean-Pierre Barral, is a post-graduate
osteopathic technique from France (1).
Today it constitutes up to 25% of some
undergraduate degrees in osteopathy
in Europe. Visceral manipulation uses
gentle, slow-motion manual techniques
to sink down through the abdominal
wall to influence the abdominal viscera.
It uses a rocking motion to remove
adhesions. This is done in such a way so
as not to cause the patient any pain.
The greater omentum, part of the bag
that contains our organs, is an adhesion
factory.
JATMS | Autumn 2020 | 15
 ARTICLE
Its job is to wall off areas of infection so
they can heal. Unfortunately the body
may not remove the adhesions after the
area returns to health. Adhesions can
follow several conditions, including:
• intestinal infections such as
gastroenteritis or irritable bowel
syndrome and
• gynaecological infections such as
endometriosis, PCOS, fibroids, and
pelvic inflammatory disease
Each abdominal surgery (e.g. intestinal
resection of C-section) causes the drying
of serous fluid, the fluid that lubricates
our abdominal cavity, and this drying
can cause the formation of adhesions.
Visceral Manipulation can be extremely
useful in difficult cases with visceral-based
symptoms. For example, as in this case:
Female, age 52
Main Complaint: Chronic constipation
Previous treatment: included medical,
naturopathic and treatment for SIBO.
Integrated manual therapy: 3
treatments, over 6 weeks, working with
visceral adhesions around the lower
colon. Patient started moving her
bowel for the first time in 12 months
without laxatives.
Why are adhesions so pervasive?
The article, Tensile Strength of Water,
published in Discovery: Science
Technology and the Future” 3/1/2003
(2), describes how fluid rises in trees.
The water in the xylem in the redwoods
theoretically should not have the
strength to rise 100 metres to the upper
branches but it does so by collapsing on
itself to create extra strength. (So now
we have four states of water - ice, steam,
water and collapsed water.)
Healthy organs in the human body slide
and glide on each other, lubricated
by serous fluid. Adhesion forms when
the serous fluid collapses on itself,
generating higher tensile strength and
becoming like chewing gum.
16 | vol26 | no1 | JATMS
Separating this ‘chewing gum’ means
you need to find the two points of
attachment and traction them away from
each other. To find these two points of
attachment you need to use ‘listening
diagnosis’. Using this diagnostic method,
the connective tissues are engaged
using 5 grams of hand pressure, then
the pressure is released by 50% and a
direction of restriction is ascertained.
Therapy sessions are usually spread out
over 2-3 weeks.
Japanese Acupuncture Dosage
Level 4
There are many schools of acupuncture,
internationally as well as in China. In this
section, I am focussing on a small set of
needle techniques from a group of schools
in Japan coming under the umbrella of
Meridian Therapy, or Chiraku Chiyo.
For sensitive patients, these schools have
refined the use of a needle technique
called ‘touch needle’. In this technique,
the electromagnetic field of the body
is thought to be engaged using 0.5
grams of finger pressure and needle
pressure that does not break the skin.
For hypersensitive cases, a pure metal
probe, called a ‘Tashi’, is used instead of
a needle.
In Meridian Therapy, the weakest organ
system is found via pulse diagnosis,
and the ‘weakest’ acupuncture point is
treated first with ‘touch needle’ therapy,
followed by a specific sequence of
points, in a way that is designed to build
up energy, equilibrium and homeostasis.
This process is considered ‘root
treatment’. It uses points only on the
arms and legs. By starting at the weakest
point, and working up, this process is
like booting up the meridian system.
After each point is touch-needled the
practitioner returns to the pulse to
check for biofeedback, which delivers
the information about how to apply
the next needle technique. Positive
pulse feedback suggests that the touch
needling has made the muscular artery
wall feel softer, more consolidated and
more elastic. This reflects the neural
tone in the artery wall and a subsequent
change in the CNS. This biofeedback
is thought to give the practitioner a
specific and precise way of equalising
differential electrical charges in the
organs. Equalising these charges is
said to aid the body in becoming less
hypersensitive. Due to their gentle
energetic nature, touch-needle sessions
can be done every week, or every day in
a retreat setting, as needed.
An example of a suitable condition
for touch-needle therapy for
hypersensitivity would be Level
4 endometriosis. Because of the
amount of pain Level 4 endometriosis
patients suffer, it is very hard to touch
them without causing more pain or
discomfort, especially on the abdomen.
Touch-needle therapy, because of both
the gentle pressure and care taken in
applying it, and its focus on the lower
arms and legs, is a perfect way to ‘touch’
the untouchable patient.
Craniosacral Therapy Dosage
level 3
Craniosacral Therapy (CST) dates
from the 1930s, famously discovered
by Sutherland and developed by
Upledger (3). This therapy inspired a
new awareness in the West of working
with the human body in a more subtle
way. CST uses microscopic movements
to help to irrigate the central nervous
system with cerebrospinal fluid. CST has
an interesting therapeutic moment in
that it is not associated with movement,
but with stillness. The ‘still point’ is
reached when the craniosacral rhythm
stops. The theoretical result is thought
to be an extended moment of central
nervous system reorganisation. Because
CST is much more subtle than our
previous two therapies, less patient
verbal engagement is required during
treatment, allowing the sessions to flow
into a relaxed state.
Cases for prioritising craniosacral
therapy would be extreme insomnia,
panic attack or acute bereavement,
where the patient wants – or needs – to
lie down and completely relax.
 ARTICLE

Direct Moxibustion Dosage
Level 2
Moxa is the leaf portion of the plant
Artemisia, or Mugwort. China has a
long history of using this plant-like
tobacco, in a cigar-like form, as heat
therapy to hold over the body to warm
specific tissues. Here, I am focussed on
a specific form of this therapy, where
minute specks of the refined and cured
leaf are placed directly onto the skin
and combusted until the heat is felt
by the skin, but the skin is not burnt.
This is called ‘direct, rice grain-sized
moxibustion’ or ‘Okyu’. Sawada Ken,
the prime advocate of Okyu Therapy,
was born in Osaka, Japan. He lived from
1877 to 1938. He was asked to treat the
Emperor of Japan but, not being allowed
to pierce his skin, chose to use moxa.
The Emperor recovered and Sawada
became the most famous moxibustion
practitioner in Japan.
Direct moxibustion with Artemisia leaf is
thought to have five therapeutic actions:
• The formation of heat shock proteins
in the blood that stimulate immunity
• Heat modulating pain receptors in
the skin via the sympathetic nervous
system, and counter-stimulation of
the parasympathetic nervous system;
• The teperin oils released by burning
the plant transmitting a transdermal
dose of the immune stimulant
interferon, a major constituent of the
plant;
• The removal of the heat threat
causing a relaxation response; and
• Adding small packets of heat to the
body, which aids in increasing low
basal body temperature to regulate
immune system function.
Historically, direct moxa was used in
Japan effectively for the treatment of
pandemic infections like tuberculosis
(TB) before the advent of vaccines and
antibiotics. Today, TB is not present in
most Western countries but is active
in Africa. Merlin Young, a colleague
of the author, started a charity called
Moxa Africa which teaches moxibustion
to doctors and TB patients, as a cost-
effective way of treating drug-resistant TB
and HIV in impoverished areas. Evidence
of this was published in 2018 (4).
The second form of moxa, cone moxa
or Chinetsukyu, is a specific treatment
used to treat a hypersensitive patient.
Cone moxa is performed at the base
of the neck, at the acupuncture point
Governor Vessel 14. We place a cone
at that point, let it burn down 50%,
and remove it. This process is repeated
3 to 5 times. The patient’s palms are
repeatedly checked. If they were

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JATMS | Autumn 2020 | 17

 ARTICLE
sweaty they should dry out with this
treatment. If the patient was feeling
faint, they should return to normal. A
sleepy patient should become more alert
and an agitated patient should settle
down. Cone moxa should be continually
applied until the patient feels better.
Lymphatic Drainage Technique
Manual Lymphatic Drainage Technique
(LDT) is thought to influence the
lymphatic system superficially, and the
viscera and the cranial dura. The dural
lymph is especially interesting as the
cranial lymphatic vessels were only
discovered in 2015 (5). Theoretically,
LTD also stimulates a microscopic part
of the lymphatic system called the primo
vascular circulation, responsible for the
movement of stem cells (6).
Dr Chikly of the Chikly Health Institute,
Scottsdale, Arizona developed his
own method for working with the
cranial lymphatic vessels called cranial
lymphatic drainage. Symptoms of brain
fog, lack of mental clarity, depression
and headache may be suitable for cranial
lymphatic drainage.
Hands-On Diagnostics
How do we know where to apply
therapy? Listening diagnosis finds the
greatest restriction; oriental pulse
diagnosis finds the weakest organ
system. The treatment is created
between these two data points with
information that comes directly from the
body. Touch-needling therapy is thought
to introduce new electricity into an area
of weakness. Visceral massage is thought
to clear the biggest adhesion or tightest
suspensory ligament.
In a study published in Neuropsychologia,
July 2018 (7), a blind person found their
way through a maze without touching
the walls. Blind people not only have
advanced touch, but they have other
advanced senses. Practitioners of LTD
need to develop their palpation skills.
Training in the modalities of listening
diagnosis, visceral manipulation, Toyohari
Blind Style Japanese Acupuncture, as
well as some martial arts like Tai Chi or
18 | vol26 | no1 | JATMS
Aikido, and some regular meditation,
is the pathway to develop this level of
touch. Using these techniques, most of
the diagnostic information comes directly
from the patient’s body without their
having to say a word.
Combining the five modalities
into the Integrative Manual
Therapies model
So now that we have gone through the
modalities and diagnostics, let’s look at
them as a single integrated whole.
Treatment Flow: The key to successful
treatment is: Antidote – Treatment -
Antidote
Step 1
Pre-antidote, which is to ‘antidote’ the
patient before the treatment starts, is
used to add energy to the body before
diagnosis. Even assessment can be
exhausting for some patients. This is
usually done with moxibustion.
Step 2
Structural Treatment is the second
part, after stabilising the patient with
the pre-antidote. Opening up the most
restricted part of the body, even a little
bit, helps the body to begin changing
itself. Remember we don’t have to do
the work. We need to assist the body
to work at its own pace. Structural
Treatment can include visceral
manipulation, osteopathy, muscle
energy technique and So Tai, a form of
movement therapy.
Step 3
Root treatment is the third part, and
it is about rebooting the ‘software
circuits’ of the body, via acupuncture
to the meridians. Root treatment and
branch treatment work like the wheel
and axle on a car: they work together.
Step 4
Branch treatment, the fourth part, is
to address the symptoms. If you ignore
the patient's symptom for the sake
of treating the root cause, they may
not be satisfied with the treatment. If
you ignore the root cause, the patient
won't get better. If you address both,
you get a good result. But don’t spend
too much effort on the symptoms, and
you have already worked on the system
itself in steps 2 and 3.
Step 5
Always finish with Antidote, again
after treatment.
If you finish with LDT as an antidote
the treatment is ‘integrated’ before the
patient gets up from the table. Cone
moxa can be used after LDT to further
magnify the treatment effect. Cone
moxa at the beginning and the end of
a bodywork treatment is a very safe
way to minimize the risk of an adverse
response in a hypersensitive patient.
Pulsing (Alternating) three
Session Cycles of Bodywork in
Hypersensitive Patients
In naturopathy, pulsing stages of
treatment are often used. For example,
first alkalise the detoxification
pathways, and second ask the body
to excrete toxins via this pathway.
In bodywork you can alternate
between two treatment models: ‘push’
treatments and ‘supportive’ treatments.
A push treatment refers to when we
want to find the biggest restriction
in the body, and change it in a small
positive way (i.e. do one thing). This
may seem very minimal, but when
treating hypersensitive patients, slow
progress seems to get results, without
pushing the patient away with adverse
reactions. Finish a push treatment with
visceral manipulation of the liver.
A supportive treatment is used when
we want to put energy into the
body, usually with stillness therapies
like touch needle, moxibustion and
craniosacral holds. Stillness is the
opposite of push – it is a kind of
enhanced rest. To finish supportive
treatment we also want to focus again
on liver lymphatics for clearance.
Leaving the patient to lie completely
still for a while at the end of the session
to rest, usually with a heat lamp and
some shallow acupuncture on the back,
is a very restorative approach.
One push treatment followed by two
supportive treatments appears to be
the safest model, but you can alter this
approach as appropriate. Note that some
people approach hypersensitive patients
by just doing supportive treatments.
What is our role as
bodyworkers?
• Improve the structure first, because
improved structure means improved
function. Strengthen the energy
pathways of the body.
• Work in a supportive role with
naturopaths, functional medicine
practitioners, psychologists,
psychiatrists, psychotherapists and
other health practitioners because the
mind is the captain of the ship.
Profound Bodywork CPE!
Biodynamic Craniosacral Therapy
Precise clinical skills for musculoskeletal, visceral,
Call for more info: +61 418 498 874
Conclusion
Bodywork alone is not an appropriate
intervention for hypersensitive patients.
Integrated Manual Therapies, with its
five dosage levels, appears to be a useful
approach for managing hypersensitive
patients. Using the rule of ‘antidote
– treatment - antidote’ and one ‘push
treatment’ followed by two ‘supportive
treatments’ is recommended.
REFERENCES
1. Barral JP. Visceral Manipulation. Seattle, WA:
Eastland Press; 2005.
2. Tensile Strength of Water. Discovery: Science
Technology and the Future. The Discovery
Magazine. 3 Jan, 2003. Available from:
https://www.discovermagazine.com/
magazine
3. Upledger J. Craniosacral therapy. Seattle, WA:
Eastland Press; 1983.
4. Ibanda HA, Mubiru F, Musiba R, Itaya S, Craig
J, Young M, Waako P. Adjunctive Moxibustion
treatment for tuberculosis: A randomized
Professional Training
World renowned Instructors
Refined palpation and listening skills.
and nervous system balancing.
www.WellnessInstitute.net
clinical trial investigating potential efficacy
and comparative safety. European Journal of
Integrative Medicine, 2018, 20: 90-97.
5. Absinta M, Ha SK, Nair G, Luciano NJ, Palsoc
M, Louvearu A et al. Human and nonhuman
primate meninges harbor lymphatic vessels
that can be visualized noninvasively by MRI.
Elife. 2017, Oct 3, 6. pii: e29738. doi: 10.7554/
eLife.29738
6. Yoo JS, Ayati MM, Kim HB, Zhang WB, Soh
KS. Characterization of the primo-vascular
system in the abdominal cavity of the lung
cancer mouse model and its differences
from the lymphatic system. PLoS One, 5
(2010), p. e9940. Available from: https://doi.
org/10.1371/journal.pone.0009940
7. Celeghin A, Bagnis A, Diano M, Méndez
CA, Costa T, Tamietto M. Functional
neuroanatomy of blindsight revealed by
activation likelihood estimation meta-
analysis. Neuropsychologia. 2018 Jul 17.
pii: S0028-3932(18)30277-X. doi: 10.1016/j.
neuropsychologia.2018.06.007.
WellnessInstituteNet
 ARTICLE
Update on Recent Research
in Homeopathy
Robert Medhurst | BNat ND DHom
F
or many government policy-
makers, educational institutions
and healthcare practitioners, it’s
no longer acceptable to use a healthcare
intervention simply because it has a
history of use. The call for “evidence-
based medicine” becomes louder and
more strident with each passing year
and it affects all types of healthcare
interventions: devices, procedures
and medicines. Fortunately, we have
a growing body of research data that
supports the practice of homeopathy.
Following are brief discussions on some
of the more interesting work that’s been
done in this area.
Human Research
1. Nayak C, et al. Management
of distress during climacteric
years by homeopathic therapy.
J Altern Complement Med, 2011,
17, 11, 1037-42. Researchers from
India’s Central Council for Research
in Homoeopathy (CCRH) carried out
this study to investigate the effects of
indivdualised homeopathic therapy on
the FSH levels, blood lipid profile, signs
and symptoms experienced by women
suffering from menopause. Patients
were enrolled from six CCRH outpatient
clinics and received one dose of an
individualised homeopathic medicine
from homeopathic medical specialists in
accordance with their experience of 15
predetermined menopause symptoms.
20 | vol26 | no1 | JATMS
These as well as their FSH and blood
lipid profiles were assessed at baseline
and again at 12 months from this point.
An assessment of the results was made
through statistical analysis using the
Wilcoxon signed rank test on Statistical
Package for Social Sciences (SPSS),
the result of which was a significant
association between the therapeutic
invention and relief from the menopausal
symptoms that were assessed. A
significant association was also found
between the homeopathic therapy and
improvements in the blood cholesterol,
triglycerides and VLDL profiles of the
study subjects. The medicines found to
be most frequently indicated and useful
were Sepia, Lachesis, Calcarea carb,
Lycopodium, and Sulphur.
2. Alecu A, Gafitanu D, Alecu M.
Homeopathic dilutions of TNF-alfa in
psoriasis and rheumatoid arthritis.
Int J High Dilution Res, 2012, 11, 40,
204-205. Proceedings of the XXVI
GIRI Symposium; 2012, Sep, 20-22;
Florence (Italy). A Romanian team
tested the hypothesis that Tumor Necrosis
Factor (TNF) alpha, a pro-inflammatory
cytokine, would, when homeopathically
potentised, exert an anti-inflammatory
effect. To do this, 10 people diagnosed
with either active psoriasis or rheumatoid
arthritis were given daily doses of TNF
alpha 9C for 3 months and assessed at
the beginning and end of the treatment
period. After analyzing the results it was
shown that all patients experienced an
amelioration of symptoms, with two of
the six people suffering from psoriasis
experiencing complete remission of their
symptoms.
3. Harrison CC, Solomon EM, Pellow J.
The effect of a homeopathic complex
on psychophysiological onset
insomnia in males: a randomized
pilot study. Altern Ther Health Med,
2013, 19, 5, 38-43. In a randomised,
double-blind, placebo-controlled, 4
week pilot study, using matched pairs,
researchers from the Homeopathy Health
Clinic at the University of Johannesburg
in South Africa enrolled 28 males aged
between 18 and 40 years diagnosed
with chronic psychophysiological onset
insomnia (POI). A total of 14 were given
a homeopathic combination and 14
were given a placebo. The results were
assessed using the Pre-sleep Arousal Scale
(PSAS) and the Sleep Diary (SD), which
assessed sleep-onset latency. On analysis
of the results it was found that the group
receiving the homeopathic combination
showed a statistically significant
improvement in pre-sleep arousal as well
as sleep onset latency over the 4 weeks
of the study. Intergroup analysis showed
through both the PSAS and the SD that
the homeopathic combination group had
outperformed the placebo group by day
28 of the study.

4. Ganguly S, et al. Homeopathic
treatment of vitiligo: an open
observational pilot study. Int J High
Dilution Res, 2013, 12, 45, 168-177.
This Indian research was carried out
to evaluate the effects of homeopathic
treatment for people suffering from
vitiligo. A total of 27 participants were
recruited for a prospective open-
label pilot study and treated with
individualised homeopathic medicines
for 6 months. Efficacy was assessed after
3 months and 6 months using Vitiligo
Area Scoring Index (VASI) score, Vitiligo
European Task Force (VETF) score, and
Dermatological Life Quality Index (DLQI)
score, which are validated outcome
measures evaluating the area, intensity
and spread of depigmentation of vitiligo
lesions, and quality of life (QoL). After
6 months of treatment, the median
VASI total score improved significantly.
Similarly, the VETF median score
improved and the total DLQI median
score exhibited significant improvement.
5. von Ammon K, et al. Long-term
effects of homeopathic treatment in
children suffering from attention
deficit disorder with and without
hyperactivity. Int J High Dilution Res,
2013, 12, 44, 119-120. Proceedings of
the XXVII GIRI Symposium; 2013,
Sep, 03-04; Bern (Switzerland), 119.
A total of 56 children diagnosed with
ADHD in accordance with the criteria
set out in the DSM-IV were treated
with individualised homeopathy using
a randomised, double blind, placebo-
controlled trial (RCT), embedded in a
prospective observational study design.
After diagnostic screening and a primary
run-in phase of homeopathic treatment,
crossover RCT was followed by open-
label long term follow-up and cost-
effectiveness evaluation. At diagnosis, the
beginning of, and after each crossover
period, and at yearly intervals over 10
years, parents reported Conners’ Global
Index (CGI, 10 items, rated 0-3 points
each; primary variable) by questionnaire
or telephone interview. By the end of the
study, 62% of the children were without
any homeopathic (HOM) or medical
treatment. In the remaining children,
successful results were achieved in six
with HOM, nine with methylphenidate
(MPH) and three with both HOM and
MPH. During cross-over RCT, CGI values
detected clinically and statistically
significant differences between verum
and placebo phase, respectively. Cost-
effectiveness evaluation demonstrated
non-inferiority of homeopathic treatment
compared to MPH treatment.
6. Coppola L, Montanaro F. Effect of
a homeopathic-complex medicine
on state and trait anxiety and
sleep disorders: a retrospective
observational study. Homeopathy,
2013, 102, 4, 254-61. This open-label
observational study was designed to
examine the effects of a homeopathic
combination product on anxiety and
the quantitative changes in the sleep
pattern of the subjects included in the
study. A total of 71 people suffering
from mild to moderate anxiety were
assessed for anxiety and sleep habits
at baseline and again after 30 days of
use of the combination. At both visits,
subjects were administered the State-Trait
Anxiety Inventory (STAI)-Y questionnaire
(consisting of trait and state subscales) to
assess their level of anxiety. Sleep quality
was assessed based on the subjects'
self-reported number of hours slept and
number of night-time awakenings, before
and after treatment. When compared to
baseline, the average (STAI)-state score
at visit one decreased by more than
six points, while the STAI-trait score
decreased by more than three points.
The average number of hours slept per
night increased significantly at visit
two compared to baseline, and a 42%
decrease in the average number of night-
time awakenings was also observed.
7. Maas HPJA. Ulcerative Colitis treated
with Homoeopathy British Homoeopathic
Journal, 1983, July 82, 179-185. In this
retrospective case analysis, 24 people
suffering from ulcerative colitis were
treated in an Argentinean clinic using
constitutional homoeopathy over periods
of up to 19 years. Of these 24, 16 patients
were assessed as having good outcomes.
ARTICLE
Animal Research
1. Zacharias F, et al. Effect of
homeopathic medicines on
helminth parasitism and resistance
of Haemonchus contortus infected
sheep. Homeopathy, 2008, 97, 3,
145-51. This Brazilian study reports
the findings of a group investigating
the effects of three homeopathically
potentised substances on sheep
infected with the Barber’s Pole worm
(Haemonchus contortus), a pathogenic
nematode common to sheep. A total of
20 sheep were randomly assigned to
receive Doramectin, a commonly used
antihelminthic; homeopathically prepared
Ferrum phos, Arsenicum album and Calc
carb; or no treatment. Faecal and blood
samples were taken 18, 38 and 68 days
from baseline and these checked for
evidence of the parasite. On assessment
of these results an association was found
between the use of the homeopathic
preparations and a reduction in the
presence of the parasites, leading to an
improvement in vital function and weight
gain. In addition, the homeopathic option
was also found to be more economical
than the standard antihelminthic method
of management.
2. Camerlink I, et al. Homeopathy
as replacement to antibiotics in the
case of Escherichia coli diarrhoea in
neonatal piglets. Homeopathy, 2010,
99, 1, 57-62. This work, performed by
a team primarily from the Wageningen
University in The Netherlands, concerns
the design and outcomes of the
homeopathic treatment of piglets suffering
from diarrhoea associated with E. coli.
A total of 52 sows in their last month of
gestation were given either placebo or a
homeopathically potentised preparation
of E. coli twice weekly for that month.
These sows subsequently gave birth to 525
piglets; 265 from the placebo sow group
and 260 from the homeopathic E. coli
group and all were monitored for E. coli
diarrhoea. On analysis of the results from
the observations made of both groups,
it was found that the piglets from the
placebo group had a diarrhoeal incidence
that was 6 times higher than the piglets
from the homeopathic group.
JATMS | Autumn 2020 | 21
 STUDENT RESEARCH
Dry Needling:
A literature Review
Part 1.
Courtney Firth | Joanne Meon | Matthew Price | Jasmine Taylor | Sandra Grace
The results of this literature review are presented in two parts. Part 1 discusses international guidelines for
dry needling (DN) and professional association guidelines for DN. Part 2 discusses DN course providers and
presents an overview of DN courses.
Introduction
Dry Needling (DN) is the insertion
of solid filiform needles or hollow
core hypodermic needles to pierce or
stimulate the muscle where the presence
of a myofascial trigger point (MTrP) is
detected.(1) MTrPs are most commonly
defined as hyperirritable structures
located in the tense band of a muscle.(2)
These MTrPs are of unknown aetiology
and are reportedly characterised by a
combination of motor alteration (taut
muscle band) and a sensation alteration
(numbness and referred pain).(3) After
stimulation by a variety of techniques
including DN, the MTrPs responsible
for referred pain (outside the local area
of the MTrP) and non-specific pain
are thought to be ‘toned down’. DN is
designed to act directly on the nerve
fibres that relay painful sensation.
Reduction of painful sensation and
the relaxation of taut muscle bands is
thought to occur via local activation of A
delta fibres and inhibition of C fibres.(4)
DN has become increasingly popular
since it was first introduced by Lewit in
the late 1970s.(5) It is now practised by
a number of complementary medicine
22 | vol26 | no1 | JATMS
practitioners, but is particularly
popular with manual therapists,
including chiropractors, osteopaths
and massage therapists.(1,6) This
broad uptake of DN as a treatment
technique for musculoskeletal pain
and associated functional impairment
has caused controversy among health
professions. For example, in May
2017, the Acupuncture Association of
Colorado filed a lawsuit against the
Colorado Physical Therapy Board in an
unsuccessful attempt to stop physical
therapists from practising DN.(7) Their
argument was that physical therapists
did not have a sufficient knowledge base
for practising DN and were therefore
putting their patients at risk. In the US,
physical therapists undertake 46 hours of
training in DN, whereas acupuncturists
perform nearly 2000 hours. Only some
states inside the US recognise DN as a
component of physical therapy practice.
Each state appears to have its own
independent legislation and therapists are
bound by each state’s law.(8)
Background
DN has its roots in traditional Chinese
acupuncture from where it has
been adapted to align with Western
medicine’s evidence-based agenda,
rejecting explanations of meridians and
focusing on the science of anatomy,
physiology and pathology.(9) Although
there are many similarities between
traditional Chinese acupuncture and
the DN framework, a 2016 article drew
a comparison showing that they are
separate modalities, with different
underlying theories and approaches
to clinical practice.(10) Traditionally
acupuncture was based on Eastern
energetic philosophy which included
the flow of Qi and Meridians, with the
aim of addressing underlying causes of
pain and disease.(11) However, once
brought to the West, it was subjected
to scientific scrutiny and codified into
physiologic and anatomic contexts to
support its effectiveness. DN does not
rely on traditional Chinese medicine
assessment methods or paradigms.
Instead, DN has developed largely as
a technique used to treat symptoms
of the musculoskeletal system.(1) DN
points are stimulated to create local,
spinal segmental or supra-spinal pain
modulating effects.(12)
Indications and
contraindications
The use of DN is predominantly
indicated for the treatment of MTrPs
and myofascial pain syndromes.
(13) Typical findings consistent
with the dysfunction of MTrP
include pain or tenderness on local
compression, recreation of referral
pain on compression or local pain with
associated autonomic responses, such
as pilomotor activity, vasoconstriction,
vasodilation or sweating.(13-15)
Contraindications outlined by
Dommerholt and Fernandez-de-las-
Penas (16) are divided into relative
and absolute categories. The absolute
contraindications specified include
patients with phobias of needles,
absence of patient willingness, inability
of a patient to give informed consent
due to cognitive, communicative or
age-related limitations, presence of
acute medical conditions, lymphedema, (13) Research suggests that DN is
infection, cellulitis or any other logical useful for the management of chronic
reason that the treatment would be musculoskeletal pain,(18) myogenic
deemed inappropriate. temporomandibular dysfunction,(4)
MTrP pain,(14,19) myogenic chronic
Relative contraindications include lower back pain,(20) neck, shoulder
thrombocytopenia, abnormal bleeding and upper thorax myofascial pain
conditions, use of blood thinning syndromes,(21) supraspinatus lesions,(22)
medications, immunosuppressive whiplash-associated disorders,(23) and
medication and immunocompromised other conditions involving myogenic
patients. Additionally, patients with pain. DN has also been shown to be a
vascular disease, hepatitis, endocarditis, beneficial treatment in the management
cancer, diabetes, pregnancy, epilepsy, symptoms such as pain related to
child patients, fragile patients or those primary dysmenorrhoea,(24) total knee
with vulnerable psychological states, arthroplasty,(25) disc herniation,(26)
should also be scrutinised for suitability fibromyalgia (27) and tendinopathy,(28)
in order commence treatment (16, 17). muscle spasticity related to stroke (29,
30) and the frequency and intensity of
Effectiveness of DN headaches in patients with tension-type
The effectiveness of DN as a treatment in headache.(31) Several studies found
research is typically verified by improved that DN was also useful as an adjunctive
pain scores, decreased disability and treatment to physiotherapy, multimodal
increased range of movement for patients physical therapy and therapeutic exercise
with specific neuromuscular conditions. programs.(32-34).

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 STUDENT RESEARCH
Despite the findings in support of DN
effectiveness, criticism of available
research frequently points out poor
quality trials (including limited sample
sizes) and focus on short term effects;
there are calls for larger, placebo-
controlled trials that include long-term
outcome measures.(15,19,35) Reviews
of research also tend to highlight the
general ‘unclear’ or ‘high’ risk of bias
associated with some DN studies (36,
37) and the need to clarify the most
beneficial frequency, duration, and
intensity of DN application to optimise
treatment outcomes.(13)
Safety
Dry needling is classified as an invasive
form of treatment and therefore has
inherent risks, complications and
adverse reactions.(15, 18, 38, 39). Mild
adverse reactions include aggravation of
bleeding, bruising, haematoma, pain and
stiffness. (15, 17, 38) More severe adverse
reactions include pneumothorax,
seizure, cellulitis, prolonged
headaches, spinal canal penetration,
cervical, thoracic and lumbar spinal
epidural hemorrhage, meningitis,
pneumocephalus, acute hypertensive
crisis, vasovagal reaction, asthma attack
with hypertension and angina.(15, 20,
40) Infection from needling techniques
is another significant risk and can be
significantly diminished through the
employment of safe sharps practice.(19,
38). Despite the serious nature of the
severe complications, they occur rarely.
The literature suggests that most severe
reactions are the result of practitioner
negligence (15, 40, 41) that may be
overcome by improved practitioner
training.
Aim
The aim of this literature review was to
better understand the range and scope
of DN education for practitioners.
Method
We searched six databases (Cinahl,
PubMed, AMED, Scopus, Medline,
Cochrane) and conducted a Google
search for literature on DN education
providers, DN course details and
24 | vol26 | no1 | JATMS
professional associations’ policies and
guidelines on DN.
Data collection
Data collection took place over a period
of 5 months from November 2018 to
March 2019. For international guidelines
the following search terms were used:
dry needling guidelines, international
dry needling guidelines and guidelines
for dry needling practice. We also
searched for ISCP, ASD Suisse Dry
Needling,(43) Canadian Physiotherapy
Association Dry Needling,(44) and
Osteopathic Council New Zealand
Dry Needling.(46) We searched for
dry needling or western medical
acupuncture-position statement,
practice guidelines, scope of practice,
policy statement, summary report and
guidelines. We excluded traditional
acupuncture and Chinese acupuncture.
Professional association guidelines
for dry needling practice were also
sought using Google searches. The key
terms were osteopathy, physiotherapy,
chiropractic, podiatry, massage,
remedial massage, myotherapy, dry
needling, acupuncture, Chinese
medicine, allied health, Australia,
association, board, council, authority,
organisation. Using association website
and links, we searched for guidelines,
requirements, continuing professional
development, endorsed courses, adverse
effect management, infection control,
programs, federal, national, constitution,
code of practice, accreditation, policy,
criteria; ethics and conduct. Criteria
for inclusion were must mention or
relate to the use of DN in practice,
training standards or requirements for
membership.
Data were collected from Australian
course provider websites after
conducting Google searches using the
key terms search terms: dry needling,
trigger point dry needling, myofascial
dry needling, training, courses,
Australia, ACT, NSW, QLD, VIC, SA, TAS,
NT, WA. Course content was sourced
from each provider using the search
terms: history of dry needling, dry
needling theory, wet lab, supporting
research evidence, anatomy, regions,
common musculoskeletal conditions,
other conditions, safe practice,
hygiene, risk management, beginner,
intermediate, advanced, advanced
techniques, course accreditation,
industry specific, podiatry, occupational
therapy. The inclusion criteria for
Google searching included dry needling
training or courses conducted in
Australia. The exclusion criteria were
acupuncture courses, courses not
conducted in Australia and DN courses
only provided as part of a degree.
Data extraction
An overview of Australian and
international association websites
identified those associations that had
published guidelines on DN training
and safe practice. Guidelines were
collated into legislation, prerequisites,
initial training, continuing professional
development (CPD) and mandatory
requirements. An overview of
Australian education provider
documentation identified two key
areas for analysis and required dividing
documents into course provider
information and course content
information. We extracted data in an
excel spreadsheet with pre-determined
categories within these two distinct
areas. From the course provider data,
we extracted information about
whether the provider was a private
or public institution and whether it
offered courses beyond dry needling
courses. Course information was
categorised into prerequisites for
entry to the course, private or public
provider, duration, preparation, pre-
and post-course support, teacher/
presenter qualifications, other courses
available by the provider whether a
qualification was issued on completion
of the course, and whether the course
had accreditation or other endorsement.
Data about course content were also
extracted, including: history of DN,
theory of DN and trigger points,
availability of wet lab, supporting
research evidence, anatomy, application
 Table 1. DN International Guidelines*
of dry needling for common
musculoskeletal conditions and other Guideline ISCP ASD CPA APTA OCNZ
conditions, safe practice (hygiene, risk Prerequisites Undergraduate Undergraduate Doctorate Bachelor’s
management), beginner, intermediate physiotherapy physiotherapy physical degree or
degree degree therapy degree equivalent
and advanced levels, advanced + 2 years
techniques such as electrotherapy professional
practice
and, whether industryspecific training
Minimum duration (face- 21 46 20 days
for disciplines such as podiatry and to –face hours)
occupational therapy were available. Required content
Definition & history - - - ✓ ✓
Data analysis Anatomy & physiology, ✓ ✓ ✓ ✓ ✓
pathophysiology
Categorisation and tabulation of data
Pain management ✓ ✓ ✓ ✓ ✓
enabled comparison across categories
Scope of practice ✓ ✓ ✓ ✓ ✓
and against Australian association Contraindications & ✓ ✓ ✓ ✓ ✓
and international guidelines so that precautions, safety
summaries could be produced. procedures, infection
control
Informed Consent ✓ ✓ ✓ ✓ ✓
Results Clinical Record Keeping ✓ ✓ ✓ ✓ ✓
The results of this review are presented Required Practical ✓ - ✓ ✓ ✓
in four sections: (1) International Components
guidelines for DN; (2) Professional Supervised Clinical Hours - - - ✓ ✓

association guidelines/policies on DN; Assessment of - - - ✓ ✓

Techniques
(3) DN course providers; and (4) DN Assessment of Record - - - ✓ ✓
courses. Keeping
Ongoing DN CPD 6 hrs formal +6 ✓ ✓ ✓ -
hrs informal
(1) International Guidelines for DN every 3 years
A number of international associations (50% practical
had published guidelines for the component)
Insurance - ✓ - ✓ ✓
training and practice of DN available
Local, state and national ✓ - ✓ ✓ ✓
online. These associations were legislation compliance
the Irish Society of Chartered *This information is based on data available on publically accessible websites
Physiotherapists,(42) the Swiss
Association of Dry Needling,(43) Table 2. Summary of Professional Association Education Standards for DN
the Canadian Physiotherapy
Guideline AMT ANTA ASAP ATMS MMA MA
Association,(44) the American Physical
Prerequisites ✓ ✓ ✓ ✓ ✓ ✓
Therapy Association (45) and the
Contact hours 60 72 >12 >100 6 -
Osteopathic Council of New Zealand. (face-to-face)
(46) A summary of DN international Required content
guidelines is presented in Table 1. Definition & history - - - ✓ - -
Anatomy & physiology - ✓ ✓ ✓ ✓ ✓
The Irish Society of Chartered Pathophysiology - - - ✓ - -
Physiotherapists Guidelines for Dry Pain Management - - - ✓ - -
Needling Practice (42) are considered Scope of practice - - - ✓ - -
the international standard on DN, Contraindications & - - - ✓ ✓ -
precautions
according to industry consensus.
Safety procedures ✓ - ✓ ✓ ✓ ✓
The key points of these guidelines
Infection control ✓ - ✓ ✓ ✓ -
are: 1) a minimum education of
Informed consent - - - ✓ - -
three days (21 hours); 2) practice to
Clinical record keeping - - - ✓ - -
be limited to areas of competence
Supervised Clinical Hours 15 Recommended - 20 - Recommended
and experience; 3) practitioners to Assessment - -
✓ ✓ ✓ ✓
commit to DN continuing professional Ongoing DN CPD - - 8h/2 years - 20h/3 years Recommended
development (minimum of 6 hours Insurance - - ✓ - ✓ ✓
of formal and 6 hours of informal Local, state and national - - ✓ ✓ ✓ -
CPD in a three year cycle, including legislation compliance
a 50% practical component); and 4) International DN Guidelines - - ✓ - - -

JATMS | Autumn 2020 | 25

 STUDENT RESEARCH
minimising adverse events through
good technique, hygiene and applied
anatomical knowledge.(42) The
guidelines emphasise that practitioners
must remain aware of indications,
contraindications, anatomical
considerations, patient suitability,
patient education, informed consent,
hand hygiene, clean needling technique
and safe needle disposal. The Society
require an undergraduate degree in
physiotherapy as a prerequisite for
initial training in DN.(42)
The Swiss Association of Dry Needling
(43) and the Canadian Physiotherapy
Association (44) base their guidelines
on the Irish guidelines. Practitioners
are directed to adhere to regulatory
requirements in the jurisdiction in
which they practise. They also do not
contain specific CPD requirements.(43,
44)
In the USA, The American Physical
Therapy Association (45) produced
a resource paper to address scope of
practice issues on DN. Practice and
training guidelines are determined by
individual state boards and details for
requirements of training vary widely.
In 50% of the states where dry needling
is approved, practitioners must have
two years professional practice as a
physical therapist before undertaking
any initial DN training, and this must
be a minimum of 46 hours of face-to-
face training.(7) Conversely, guidelines
for training in other states were non-
specific or in development.
In New Zealand, the Osteopathic
Council of New Zealand has mandatory
training requirements for the
practice of DN and this requirement
falls under the Health Practitioners
Competence Assurance Act 2003.(46)
Practitioners require an osteopathy
qualification and completion of
either the Post-graduate Certificate in
Health Science-Acupuncture from the
Auckland University of Technology
(20 days face-to-face teaching), Post-
graduate Certificate in Western
Medical Acupuncture, University
26 | vol26 | no1 | JATMS
of Hertfordshire UK, or be able to
demonstrate that other overseas
qualifications in DN are equivalent.(46)
(2) Professional Association
Guidelines/Policies for DN
Fifteen Australian accrediting bodies
and associations were identified
in professions with members who
practise DN: ten were accrediting
member associations (see Table 2)
and five were practitioner registration
boards (Chiropractic Board of
Australia, Osteopathy Board of
Australia, Physiotherapy Board of
Australia, Podiatry Board of Australia,
Occupational Therapy Board of
Australia).(47) Of the associations
in this review, seven provide links
on their websites to post-graduate
dry needling courses: Australian
Natural Therapists’ Association
(ANTA),(48) Australian Physiotherapy
Association (APA),(49) Australian
Podiatry Association (APodA),(50)
Australian Society of Acupuncture
Physiotherapists (ASAP),(51) Massage
Association of Australia (MAA),(52),
Myotherapy Association Australia
(MA),(53) Osteopathy Australia
(OA).(54) Six associations endorse
specific dry needling providers:
ANTA, (48) ASAP, (51) Massage and
Myotherapy Australia (MMA),(55)
MAA,(52), MA (53) and OA.(54).
Two associations run their own dry
needling courses for members and
associates (APodA (50) and MAA (52))
and six provide documents which
specifically discuss dry needling and
provide clear information outlining
dry needling course requirements
or recommendations for members:
Association of Massage Therapists
(AMT),(56) ANTA,(48), ASAP (51), the
Australian Traditional Medicine Society
(ATMS),(6) MA (53) and MMA (55) (see
Table 2).
Of the six associations that provided
publicly available documents outlining
dry needling course requirements
and recommendations, four provided
detailed dry needling training
guidelines for members. These
four associations all required that
courses include content on infection
control and safe needle handling, and
outlined minimum requirements for
prerequisite knowledge/qualification,
contact hours, clinical practice hours,
learning outcomes and assessment.
Recommendations to complete dry
needling CPD activities in the years
following initial DN training were
made by MMA and ASAP but it is
unclear whether this is a monitored
requirement of practice for members.
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Metagenics New Zealand
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Atin-Arratibel MA, Fernandez-de-las-Penas
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a multimodal physical therapy program for
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38(3), 179-187. doi:10.1016/j.jmpt.2014.11.007
34. Nunez-Cortes R, Cruz-Montecinos C, Vasquez-
RoselA., Paredes-Molina O, Cuesta-Vargas A.
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in Patients With Chronic Postsurgical Pain
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209-216. doi:10.2519/jospt.2017.7089
35. Tough EA, White A., Cummings TM, Richards
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md.0000000000011225
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YT, Zhao JM. Evidence for Dry Needling in the
Management of Myofascial Trigger Points
Associated With Low Back Pain: A Systematic
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apmr.2017.06.008
38. Abbaszadeh-Amirdehi M, Ansari NN,
Naghdi S, Olyaei G, Nourbakhsh MR. The
neurophysiological effects of dry needling
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39. Zugasti AM, Rodríguez-Fernández ÁL, García-
Muro F, López-López A, Mayoral O, Mesa-
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40. Lee J, Lee H, Jo D. An Acute Cervical Epidural
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brs.0b013e3181fc1e38
41. Vulfsons S, Ratmansky M, Kalichman L. Trigger
Point Needling: Techniques and Outcome.
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Dublin, Ireland. 2012. Retrieved from https://
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Practice%20ISCP%202012.pdf
43. Swisse Association of Dry Needling. Swiss
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fileadmin/documents/Swiss_Guidelines_for_
safe_1.7_Dry_Needling_01.pdf
44. Canadian Physiotherapy Association. Position
Statement: Acupuncture and the Use of Dry
Needling Techniques in Physiotherapy. 2012.
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and-the-use-of-dry-needling-techniques-in-
physiotherapy_en-doc.pdf
45. American Physical Therapy Association.
Physical Therapists and the Performance of
Dry Needling: An Educational Resource Paper.
2012. Retrieved from http://www.apta.org/
StateIssues/DryNeedling/ResourcePaper/
46. Osteopathic Council of New Zealand.
Western Medical Acupuncture (WMA) and
Related Needling Techniques. 2019. Retrieved
fromhttps://www.osteopathiccouncil.org.nz/
scopes-of-practice
47. Australian Health Practitioner Regulation
Agency. 2019. Retrieved from: https://www.
ahpra.gov.au/
48. Australian Natural Therapists Association.
Course Assessment and Recognition.
2019. Retrieved from https://www.
australiannaturaltherapistsassociation.com.
au/Public/Courses/Course_Recognition/
Assessment_Guidelines/Public/Recognised_
Courses/Course_Assessment_and_
Recognition.aspx?hkey=52b72d55-6fe1-4076-
8d67-19f88d7c2bf2
49. Australian Physiotherapy Association.
Acupuncture and dry needling. 2019. Retrieved
from: https://australian.physio/membership/
national-groups/acupuncture-and-dry-
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50. Australian Podiatry Association. 2019.
Retrieved from: https://www.podiatry.org.au/
51. Australian Society of Acupuncture
Physiotherapists.(2018) Retrieved from http://
www.acupuncturephysio.org/training/
52. Massage Association of Australia. 2019.
Retrieved from: https://www.maa.org.au/
53. Myotherapy Association Australia. Study
Myotherapy. 2019. Retrieved from:https://
www.myotherapy.org.au/studying-
myotherapy/
54. Osteopathy Australia. 2019. Retrieved from:
https://www.osteopathy.org.au/
55. Massage and Myotherapy Australia.
Position Statement on Myofascial Dry
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U0000012/00000001/PDF/Polices and
Procedures/Myofascial Dry Needling - Position
Statement.pdf
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 ARTICLE
ATMS
Awards
Dinner
2019
Professor Stephen Myers
I
believe in natural medicine not just
because its ‘natural’, but also because
it makes fundamental common sense
to me. In fact, my flag is firmly planted
in the realm of common sense. The idea
of starting out to treat people using the
least force necessary is an approach that
resonates deep in my sense of common
wisdom.
I nearly did not make it tonight due to a
bushfire burning near my home in the
Northern Rivers region. I believe that
we as an Australian community need
to have the discussion about climate
change and its impact on our lives. On
the way here, I noted in the media that
the Venetian City Council voted against
a plan put forward to develop a climate
change policy for Venice. Two minutes
after the council voted this climate
policy down, the Venetian council
flooded. I'm not sure if that's instant
karma at play, but I think it indicates
that there's a wider conversation that we
need to have in our society about what is
happening to our planet.
One of the things that I realised this
week in preparing for the fires is that
in a lot of ways, we have given up what
I'll call for the moment, the ‘grey zones’
in society. We've become much more
black and white about the ways that we
do things. I also realised this week that I
was in a grey zone. I didn't sleep most of
Tuesday night because I was checking on
32 | vol26 | no1 | JATMS
the bushfire, but people around me that
I was working with (and as an academic,
you work with people around the world)
for them, it was business as usual. There
were expectations on me to perform, to
deliver, to engage, to communicate, but I
wasn't in the white space of business as
usual, however, I also wasn’t in the black
space of disaster. I was somewhere in
the middle in this grey zone of … it's not
business as usual and it's not a disaster.
I said to a colleague, "I've got low level
magnesium-depleting anxiety at the
moment” and as such could not perform
as “usual”.
Another grey zone that we have virtually
given up in our society is a thing called
convalescence. We now consider people
are either ill or they're well, that we don't
have this place in the middle where they
transition from one to another. When
I was six, I had a cardiac complication
from the measles, and I had a cardiac
arrest. My dad thought I'd died. He lifted
me up by my feet and beat me on the
back and laid me down on the couch
and told my mother that I was dead. My
mother being a very serious and astute
woman rang our local doctor. Our local
doctor ran out on a patient, grabbed his
bag, drove to our house, which was a
couple of minutes away and resuscitated
me. I then spent six months in a hospital
- three months in the Royal Children's
Hospital here in Camperdown, and
three months in Campbelltown in a
convalescence hospital for children. We
used to have these things in our society
called convalescence hospitals where we
acknowledge as a society that there was
a transitional space between being ill and
being well that you needed to go through.
Now we no longer have those transitional
spaces.
We expect somebody, if they're ill, to
be off work and then we expect them
to be back at work and 100% business
as usual. We have developed this sort
of black and white nature of society.
On a different day, I could take this
discussion down a pathway of talking
about the speed of communication, the
incessant nature of social media and the
stresses and pressure that we're actually
under as a community. One of the most
significant debilitations that occurs in
our society is the perception of stress
– in this case I don’t mean having a bad
boss who abuses you, but the perception
of stress that causes anxiety. The cost of
perceived stress is literally in the vicinity
of tens of billions of dollars a year in
presenteeism and absenteeism that
occurs in our community.
Tonight, I want to spend a moment just
reflecting on the fact that we live in a
society where we are out of balance.
We need to reset our priorities. One
of the areas that we need to reset our
priorities has to do with what brings
all of us into this room tonight - the
field of health. I'm not saying anything
that I don't think any of you in the
audience has not already reflected on;
or thought about; or have not heard; or
even discussed; or proselytised – which
is the fact that we have a health system
that we call a healthcare system, which
is fundamentally a disease-care system.
We may need to move out of a disease-
care system back into true health care
system, and we in this room are actually
engaged in moving society to make this
change.
About 20 to 25 years ago, I spoke at an
international herbal conference. At that
time, there was a lot of concern about
the fact that medical doctors would
steal the jobs of herbalists because they
were starting to prescribe herbs. One
of the points I made to everybody in
that room, and I would say to everybody
in this room, is to stand firmly in the
position that you've already taken in
life. We are among the people that
have made the noise. We've created the
movement that has led our community
down the track of adopting natural
therapies much more effectively. All the
medical fraternity have done is to join
the bandwagon that we've created. I
think it's important for us to be aware
of the fact that we're the people at the
front of that bandwagon. We are the
people making the noise and taking the
lead. We're the people that are doing
the therapies on a day to day basis out in
our communities. Every person that sees
a massage therapist, an acupuncturist,
a naturopath, a herbalist, conveys that
message and it in ripples out into our
community. The fact that we're now
starting to see positive changes occur
in our society is one of the things that
we need to be proud of collectively.
We, as a committed collective of natural
healthcare practitioners have achieved
this outcome.
One of the travesties that I'm sure
you're aware of, that's occurred in the
past couple of years in Australia, is
the fact that the federal government
has stopped health insurance rebates
for a wide range of natural therapies.
I've said on the public record that the
National Health and Medical Research
Council (NHMRC) should have been
ashamed of the quality of the report
that they generated that said stated
there is no evidence for naturopathic
medicine. It so incensed me that I went
to my research group and said, "let us
do what the NHMRC should have done
properly." In February this year, we had
published in the Journal of Alternative
and Complementary Medicine, the first
global scoping review of whole systems
multi-modality naturopathic medicine*.
We found 33 papers – that’s not a lot
- but it really stands up in comparison
to the amount of similar research in
medical general practice that's been
done as a whole system. While there is
lots of research on drugs, and there is
lots of research on surgery, there is very
little research in the medical literature
on general practice as a whole therapy.
So, the fact that there are only 33 papers
in the international literature that we
were able to locate on naturopathic
medicine, stands very solidly. And one of
the things that our review determined
was that naturopathic medicine has
been demonstrated to be effective for a
wide range of chronic conditions.
One member of the Friends of Science
in Medicine who is very vocal, said the
review was hogwash. They said that
we had demonstrated that people who
had high blood pressure could lower
their blood pressure by losing weight
and that we [the medical community]
have known that for ages. What this
eminent professor missed, was that the
complementary medicine profession
and my own colleagues as naturopaths
demonstrated that they could translate
this research into clinical practise. My
argument would be that any profession
that can show that it can translate
scientific evidence into clinical practise
should be applauded, not derided. And
instead, this particular individual said
that Southern Cross University should
be ashamed for letting me publish that
paper without having any credible
evidence to back up such a contentious
statement.
On reflection, I think I'm a threat to
people like that. I'm willing to be open
to whatever scientific evidence is out
there. I think these people have closed
their minds to what the evidence is.
They've decided that it's not something
that they want to give credit to and
so they attack what we're doing
remorselessly, but not scientifically.
The interesting thing about the Friends
of Science in Medicine is that are not
a group of open-minded scientists.
They're a group of people that practise
scientism. And scientism is a belief that
gives credit to science, but at the same
time has an underlying political agenda
that has nothing to do with science. In
other words, they use science as the
mouthpiece to be able to push forward
a political agenda that has nothing to do
with science.
The Medical Board of Australia this year
(2019) put out a consultation paper that
lumps together medical doctors who
practise complementary medicine;
doctors who practised unconventional
medicine and prescribed drugs for
conditions that were not indicated; and
doctors practising emerging therapies
such as stem-cell injections. The Medical
Board had no data that demonstrated
that complementary medicine caused
any danger. Yet, they developed a
definition that bizarrely conflated these
three areas together, which is ridiculous.
A definition is something that would
show the commonality of things. For
example, you could say a pigeon, an
eagle, and a penguin are all birds. And
if we had an ornithologist in the room,
who could confirm this, they would say:
"yes, a pigeon, an eagle and a penguin
are all birds." Here, we are talking about
doctors who practise integrative medicine
compared to doctors who give anybody
who comes into their surgery - anabolic
steroids or opioids or whatever is on offer
or emerging, yet to be proven therapies
such as stem cell therapy. The interesting
thing is if you read their definition, the
only thing that ties it together is a political
agenda. The three groups were considered
NOT to be conventional medicine.
JATMS | Autumn 2020 | 33
 ARTICLE
I worked with several organisations
to put submissions into the Medical
Board. To make their definition have
some legs, you would have to define
what conventional medicine is. Is
conventional medicine an autocracy?
Is it somebody standing on high and
saying what conventional medicine is?
Is it a group of people who are trying
to hold up the walls of what they
believe conventional medicine is? Is
it a democracy? Is it a science? Does
it change with emerging knowledge?
If 50% of doctors now believe that
there's value in some? complementary
therapies, that to me suggests that it is
already conventional medicine. So why
should we be in a situation where we're
conflated with other practices when the
only reason we've been conflated with
them is to suggest that we're dangerous?
Interestingly, flying in a plane or taking
a bath is considered by individuals who
work in the area of risk assessment to be
much more dangerous than going to see
a complementary therapist.
And while I'm bursting bubbles, one
of the things the Friends of Science in
Medicine continue to point out is the
danger of chiropractic therapy. They
say that chiropractic has been shown to
Lily Cubrilo, Marcus Blackmore and Stephen Myers
34 | vol26 | no1 | JATMS
increase vertebrobasilar strokes. There
was a delightful study in Canada that
actually demonstrated that at any specific
point in time, unfortunately, given the
nature of our society, the lifestyle that
people have, the diets that they eat,
their genetic backgrounds –considering
all of those things – there is going to
be a certain number of vertebrobasilar
strokes. What this research group
demonstrated, was that there was as
much chance of somebody having a
vertebrobasilar stroke by going to see
a general practitioner (GP) as there
was by going to see a chiropractor. So
actually, it was just random population
chance and that has been completely
ruled out as being a risk associated
with chiropractic. Therefore, it is
something that shouldn't be articulated
or promulgated, yet we're finding that
argument continues to go on.
We’re in this clash - this black and
white clash between evidence and
experience. And when the Friends of
Science first became a phenomenon,
my colleague Alan Bensoussan at
the University of Western Sydney,
called to ask if I would talk at a
conference on the academic merit of
complementary medicine. Two days
before the conference I went to see
my acupuncturist. On that morning
after I had woken up, I had an hour
or two at home and I needed to do
some housework, but I just didn't
have any energy. I also had a mild
headache, which I very rarely get,
and I remembered at the time that
I saw my acupuncturist, I thought
that I also might need to have my
neck adjusted by my osteopath or
chiropractor. Regardless, I went to see
my acupuncturist and they did their
thing. When I finished, I didn't have a
headache. I also didn't have any neck
problem (which amazed me); and I
went home, and I did several hours of
housework as I had lots of energy.
When I got to the conference on
Thursday, I actually communicated that
while I'm an academic and I work with
scientific evidence, as a patient, as a
client, and as somebody that has these
therapies practised on them, I actually
don't give a damn whether there's
any scientific evidence, because they
work for me. And that, I think is one
of the big differences that we need to
understand. There is evidence and then
there is experience. All our patients are
experiencing what we do. And I could
unpack that if we had another couple
of days and talk about how we might
look at that within various frameworks.
But the one thing that I would point
out is that we talk a different language.
Rex Perkins wrote a delightful song
We Speak a Different Language. I
sometimes reflect on that. One of the
things about medicine, and you know I
love my medical education, is that it is
based on the concept of reductionism.
The belief that the universe can be
broken down into little mechanistic
parts. And reductionists fundamentally
believe that you can take all of those
individual mechanistic parts and build
the whole.
There's another group of people who
believe in complexity science and I
believe that that's the language that
we talk in complementary medicine.
Complexity scientists say that you

cannot take the parts and build the
whole. Complexity science considers
the whole as an emergent phenomenon.
It is something greater than the sum of
the parts. When it comes to life, we (the
human race) can play in some of the vital
components of living systems in science
and medicine, but we do not have the
capacity to create life (with the obvious
natural biological exception). Creating
life in a test tube is one of those myths
that runs through our society; I think
best captured by Mary Shelley when she
wrote about this concept of creating life
in Frankenstein. But life is an emergent
phenomenon that I don't believe that
in our lifetime or in the lifetime of our
grandchildren we will come anywhere
near to grasping.
While I find medical science fascinating,
there are always levels of new
information on the incredible complexity
that is actually the living being. That
raises a conversation about vitalism and
in turn the vis medicatrix naturae (the
healing power of nature) which is again,
something that I know that all of us have
a very deep commitment to.
You probably realise I don't often get
the opportunity to wax philosophical
with audiences. So, I'm grasping the
nettle. But I think the thing that I want
to say about that language is that there
is a distinction about the way that
we operate within it. You know, as a
medical practitioner, I could prescribe
a non-steroidal anti-inflammatory and
we know that it will have an effect on
a particular or a number of different
enzymes systems that cause a reduction
in the amount of inflammatory
molecules that are produced. Therefore,
it dampens inflammation in the
majority of cases. That's what we call
ARTICLE
specificity. That's one of the wonders
of mechanistic science - that we can
develop this amazing specificity for our
understanding. As a naturopath I can
prescribe a fast - not giving anybody
anything to eat for a period - and it can
have the same effect on dampening
inflammation. But the effect is non-
specific. It's not blocking a specific
enzyme; it's having a systems-wide
effect.
We need to be aware in making our
argument to the medical community
that we're talking to people who speak a
different language. We're trying to speak
to them in a language that's different
from theirs and we're not effectively
communicating. Some of us, and there
are a number in the room with doctoral
degrees, who've learned very eloquently
to be able to speak to the scientific
community. But it still doesn't help them
JATMS | Autumn 2020 | 35
 ARTICLE
understand experience. It still doesn't help them understand
tradition. It still doesn't let them into the world that we operate
in. It just gives them a scientific edge of what we're doing. We
have a long way to go to be able to translate the full extent of
our practices in a way that makes sense to the people on the
other side of that language divide.
And that's where organisations such as ATMS come in. Part
of its role is to advance natural medicine in the broader
community. Southern Cross University is going to launch a
new National Centre for Naturopathic Medicine next year
through a delightful untethered personal bequest from Marcus
Blackmore. I have to take my hat off to you, thank you Marcus.
One of the things that I have to acknowledge with Southern
Cross University is that they have committed to not allow the
intellectual property to ever be lost. The intellectual property
associated with any of the Centre’s educational programmes
will not be owned by the university, which is quite amazing.
When we lost the Bachelor of Naturopathy at Southern Cross
- long story regarding that - we lost the intellectual property
with it. And certainly, I made a commitment that if we ever
developed new programmes that we should never ever be in a
situation where that intellectual property is lost again.
The first programme that Southern Cross is launching is a
Master of Naturopathic Medicine for Bachelor graduates of
naturopathy. It's going to be the first degree, the first true
higher degree in naturopathic medicine anywhere in the world.
We're hoping to follow that with a Professional Doctorate in
Naturopathic Medicine alongside classical PhDs with a research
designation in Naturopathic Medicine. So, I guess it's currently
“watch this space”.
We are all part of this process of moving us into the future.
Everyone makes their own contribution in their own way, but
have no doubt that what you are doing is moving us and our
society much closer to realising that concept of true health and
wellbeing. I'm always reminded about the quote from Thomas
Jefferson, one of the great inventors and one of the people
who put their signature to the US Constitution. He said that the
doctor of the future was somebody who would not actually
prescribe any medicine, but give people an understanding of
diet and lifestyle and the cause and prevention of disease. And
that really is where we need to go as a society. Thank you for
your involvement in that.
*Myers SP, Vigar V. The state of the evidence for whole-system,
multi-modality naturopathic medicine: a systematic scoping review.
The Journal of Alternative and Complementary Medicine. 2019 Feb
1;25(2):141-68. Free Open Access: https://www.liebertpub.com/doi/
pdfplus/10.1089/acm.2018.0340
36 | vol26 | no1 | JATMS
BOOK REVIEW
Textbook of Remedial Massage
(Second Edition)
Grace, S and Graves, J. Elsevier Australia. Chatswood
NSW. 2020. ISBN 978-0-7295-4334-7. Available at
https://www.elsevierhealth.com.au/australian-
new-zealand-titles/textbook-of-remedial-
massage-9780729543347.html. AUD$116.52
Reviewed by Stephen Clarke.
This is the second edition of a book that has become a worldwide standard
text. It maintains the focus on safe and evidence-based health care that
originally motivated its authors: remedial massage therapists are often first-
contact practitioners, and it is essential that they have a sound knowledge of
red and yellow flags and a willingness to collaborate with other health care
practitioners. Familiarity with the evidence for their practices will enhance their
understanding of their role in such collaborations, and help to cement the
legitimacy of remedial massage in the healthcare system.
The Textbook of Remedial Massage distils a vast range of research, including
new research that has emerged since the first edition, providing sound
foundations for the exhaustive range of techniques that are described and
illustrated with exceptional clarity. There are clear and succinct tables of
evidence for managing the enormous range of conditions that remedial
massage practitioners will encounter. Videos of assessment and treatment
routines are included.
The book is presented in three sections. The first discusses the scope of
practice of remedial massage, its place in the Australian healthcare system
and its potential role in the important emerging field of integrative health
care. It presents a comprehensive evidence base for assessment and
treatment. Client safety, the application of current research and client
education are prioritised.
The second lays out some of the most important and widely used remedial
massage techniques, all accompanied by a rationale based on current
evidence, and clear expositions of contraindications and precautions.
Techniques are illustrated by photographs and drawings.
The final section is divided into regions of the body. Each chapter presents
a description of common conditions of the region, relevant assessment
procedures and a range of remedial massage techniques that can be safely
applied in treatment, with the clinical reasoning underpinning treatment
choices clearly described.
This book is a definitive guide for anyone involved in remedial massage:
students, teachers, and both beginning and experienced practitioners.
Its focus on evidence and clinical reasoning, and on the role of remedial
massage in integrative health care. It reinforces the importance, already
established by the first edition, of its profound contribution to the remedial
massage profession.
 PRACTITIONER PROFILE

increasing experience, meeting the needs of my clients, and a

strong sense of curiosity and compassion has kept me in natural
medicine and continues to motivate me into the future.

What do you like about being a natural medicine

ATMS Member Interview
practitioner?
Catherine Clark Natural medicine practitioners take the time to understand and
support their clients from a holistic perspective. I see this as our
greatest asset. I love being a lifelong student of natural medicine
Which modalities do you practice? and the human experience, and I get a real thrill from being able to
I am a Naturopath and Meditation Teacher. I primarily utilise herbal
support the body and mind through natural holistic processes.
medicine, nutrition, vitamin and mineral therapy, functional
pathology and mindful meditation exercises in my practice.
What advice would you give a new practitioner starting
out?
How long have you been in practice? My advice would be to try and position yourself in an environment
I completed my degree in 2002 and have been in active practice for
where you are surrounded by other practitioners who can mentor
10 years as I took some time off to raise my family.
and support you through the first few years. Learn as much as you
can from them!
What have been the major influences on your career?
I was first introduced to natural medicine many years ago by the
What are your future ambitions?
brilliant Dr Christine Houghton. She was a great inspiration to me
I am currently completing a Bachelor of Psychology (Honours).
and influenced my decision to begin study in the field. During
My intention is to complete a research PhD and contribute to the
my studies I was inspired by several of my lecturers who were
scientific evidence for integrative medicine, particularly as it relates
pioneering an integrative approach to medicine. Over the years,
to optimization of mental health and general well-being.

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JATMS | Autumn 2020 | 37

 LAW REPORT
Small Business and
Cyber Security
Ingrid Pagura | BA, LLB
Most of us live in a world where much
of our lives are conducted online. For
many of us this extends to running
our small businesses. Stop and think
about it for a moment. How many of
you order stock online, bank online and
take client appointments online? What
about storing clients’ credit card details
and clients’ contact details? Many of
you will also complete your tax and BAS
electronically. Many of you might think,
“I’m just a small practice in Australia,
how big a problem could this be for
me?”
Research found that 6% of small business
respondents reporting having been the
targets of a cyber-attack. They don’t
happen often but when they do, the
ramifications can be devastating and
expensive. Some of the damage could
include loss of access to accounts and
customer data, high costs to fix the
problem and, in some cases, even the
temporary closure of businesses.
The Australian Cyber Security Centre
(ACSC) quotes the following statistics:
• 6.09 million Australian adults were
hit by cybercrime or cyber-enabled
crime last year. This is one in four
Australians.
• 43% of cyber-attacks are aimed at
small businesses, incurring an average
cost of $10,000.
• 59% of people use the same password
across all their devices and accounts.
• 80% of Android users and 23% of
38 | vol26 | no1 | JATMS
iOS users haven’t installed the latest
software update on their devices,
leaving them exposed to cyber
threats.
• 87% of people have taken risks on
public Wi-Fi.
• 58 % of small businesses are in
the category of most vulnerable to
malware attacks.
• 60% of hacked small business go out
of business within six months.
• Only 30 % of businesses regularly
check for vulnerabilities, and 40%
rarely do.
So why are small businesses so
vulnerable? This is mostly because either
the business owner doesn’t understand
enough about cyber-security or doesn’t
have the resources or time to devote to
security compared to larger businesses.
Hackers generally search for any
vulnerability and then try to do as much
damage as possible.
Let’s look at some types of risks and how
you can prevent becoming one of these
statistics.
In December 2019, the ACSC released
a document called the Small Business
Cyber Security Guide. The Guide can
be found in full at www.cyber.gov.au
and I have summarised parts of it below:
Malicious Software (Malware)
This includes viruses, spyware and
worms. Hackers use this generally to
access information such as bank account
details and passwords and can take
control of your computer.
Scam emails (Phishing)
This includes emails from people you
think you know and that appear real.
They urge you to click on a link or an
attachment and then ask for personal
details. Of course, the link or attachment
is not to the website you think. Many
banks and the ATO have fallen target
to this. Sadly, it is no longer just emails
but also SMS, social media and Instant
Messenger that are used for this purpose.
Ransomware
This is malware that locks your
computer or files until a ransom is paid,
usually in cryptocurrency.
So what can you do to protect yourself?
First, perform a Risk Assessment.
Evaluate potential risks that might
compromise the security of your
business’ networks, systems and
information. Look at where and how
your data is stored and who has access
to it. Look at potential threats, and
how they could affect your ability to
provide for your clients, should they
occur. Look at strategies for coping with
this eventuality. This should form part
of your regular Risk Management and
Disaster Recovery plans.
Second, organise your software. Register
for Automatic updates. An update is
a new and improved version of your
software package, usually protecting
you from the new threats that have been
uncovered.
 PASSWORD/ TIME TO CRACK
PASSPHRASE
Brute Force Attack (BFA);
cost to attack
password123 Instantly
Less than AU$0.01
Spaghetti95! 48 hours
AU$587.50
5paghetti!95 24 hours
AU$293.70
A&d8J+1! 2.5 hours AU$30.60
I don’t like More than 1 year
pineapple on More than AU$107,222.40
my pizza!
Tips from ASCS Guide:
• Turn on or confirm auto-updates,
especially for operating systems
• Regularly check for and install
updates ASAP if auto-updates are
unavailable, especially for software
• Install updates as soon as possible (if
auto-updates are unavailable)
• Set a convenient time for auto-updates
to avoid disruptions to business as
usual
• If you use anti-virus software, ensure
automatic updates are turned on
Third, do automatic backups of all
your data. This is a digital copy of your
business’ most important information.
This can be done on a USB or in the
Cloud. Backups can also be set to
occur automatically, so that no human
intervention is required.
Fourth, consider multi-factor
authentication. This means combining
something like a pin number with a
secret question. It can also include a
fingerprint or sending a code via SMS for
EASY TO
REMEMBER
Dictionary Attack;
cost to attack
Instantly Very Easy (too easy)
Less than AU$0.01
Less than half an hour Easy
AU$6.10
Less than 1 hour Somewhat Easy
AU$12.20
2.5 hours AU$30.60 Very Difficult
More than 40 days Easy
More than AU$11,750.40
your correspondents to enter as well.
This makes it much harder for hackers to
attack your business.
The fifth strategy involves people.
Consider implementing access control:
who needs to look at what, and limit this
access to whatever you deem necessary.
The ASCS Guide recommends giving
people the bare minimum permissions
they need to perform their work. This
reduces accidentally downloading
malware for example.
The sixth also involves people and
passwords or passphrases. The ASCS
Guide suggests that businesses consider
using a passphrase rather than a
password. They are more effective as
they are longer, more unique and often
easier for the person to remember. This
means that they are harder to crack.
People often forget their passwords
especially when they are required to
add characters and numbers but may be
more likely to remember the phrase ‘my
favourite coffee is a macchiato’.
Here is an interesting example from the
Guide. See the Table for a comparison of
password vs passphrase security.
COMMENTS
One of the most commonly used
passwords on the planet.
Some complexity in the most common
areas, and very short length. Easy to
remember, but easy to crack.
Not much more complexity than above
with character substitution, and still short
length. Easy to remember, but easy to
crack.
Mildly complex, but shorter than the
above passwords. Hard to remember, easy
to crack (against BFA).
Excellent character length (35 characters).
Complexity is naturally high given the
apostrophe, exclamation mark and use of
spaces. Very easy to remember, and very
difficult to crack.
Some other password tips
• Don’t use the same one for every
application
• Don’t give people your password
• Don’t use ‘password’ as your password!
Employee training
The final strategy involves employee
training. This includes training
employees in the information about
passwords contained in this article, and
being careful with mobile devices such
as phones, laptops and tablets. Losing
this equipment and not having adequate
security on them makes a hacker’s job
much easier.
Talk to your employees about not
opening suspicious-looking emails or
texts and reporting anything they think
looks suspicious.
Public WiFi
Lastly, take care when using public
WiFi as others can see this too. Don’t
do anything that is sensitive over public
WiFi and ensure that your employees
don’t either.
JATMS
JATMS||Summer 2020 | 39
Autumn 2019
 ATMS UPDATE

COSBOA – Lobbying and Advocacy

including assistance for fire affected businesses
Christine Pope

ATMS became a member of COSBOA months requests have been received by seeks to provide support for young females
over 2 years ago as it provided assistance COSBOA for advice on Small Business who are demonstrating entrepreneurial
in our lobbying and advocacy efforts and Agribusiness Finance, Innovation flair. The project is being delivered in
in regards to the changes to the Private and Patents and Workplace Integrated partnership with 89 Degrees East Pty
Health Insurance rebates. As a result of Learning by the Department of Education. Ltd and provides support materials via
the membership we realised that the Charles Wurf and Christine Pope were a digital platform together with face-
organisation also consulted widely with also invited to attend an NBN event to-face workshops in an effort to build
Government on a range of issues relevant “Connecting Australia” where the guest entrepreneurial skills amongst the young
to small business and ATMS members. speaker was the Communications Minister, female cohort. The program was launched
ATMS is represented in its own right on a Paul Fletcher. Christine Pope attended an in Canberra in December 2019 and in 2020
number of Government bodies relevant to Australian Banking Association event on a series of workshops will be run around
natural therapies, such as the TGA, however National Small Business Lending. This was the country for young women in the target
through our membership of COSBOA a panel discussion with representatives demographic of 10-18 years old. If you have
we now are effectively represented on a from Westpac, Judo Bank and the CEO of a daughter who is interested in running
further 22 government advisory groups. COSBOA focussing on the issues with small her own business one day please register
business accessing finance. her details at enterprisinggirls.com.au
Critically the COSBOA Board was involved so that she can be advised of upcoming
in extensive discussions through January COSBOA is managing two projects to workshops as well as getting access to the
with the government regarding the recent improve innovation in the economy and digital resources.
bushfire crisis and was instrumental in to provide young women with the skills
lobbying for significant assistance to to start their own businesses. The first of The second of these projects is the National
small business. This included one-off these, the Academy for Enterprising Girls, Innovation Games. This programme teams
grants of up to $50,000 for fire-affected
businesses as well as concessional loans of
up to $500,000. In addition to the financial
assistance COSBOA focussed on the mental
health of people in the fire-affected areas,
who are entitled to receive up to ten free
counselling sessions. Financial counsellors
will work with businesses to ensure they
are aware of assistance available and able
to access it. Updates on services in NSW
are being provided on the Small Business
website https://www.smallbusiness.
nsw.gov.au/get-help/small-
business-bushfire-support-
january-2020. Victorian services are
through Bushfire Recovery Victoria https://
www.vic.gov.au/bushfire-recovery-
victoria and the South Australia site is
through SA Government https://dhs.sa.gov.
au/services/disaster-recovery.

COSBOA members are also invited to

provide advice to government on topics Peter Strong, Cosboa CEO, with the PM, Treasurer and Minister for Small Business Michaelia Cash and the CEO of the
of specific interest. In the past few Business Council of Australia announcing the support package for small businesses in bushfire affected regions.

40 | vol26 | no1 | JATMS


a selection of small businesses with young
and emerging talent to explore real-world
solutions to current challenges facing
small business owners. In all, the two-year
programme will result in the delivery of
between 24 and 30 Innovation Game
Days and is being delivered in partnership
with Paddl Co. The National Innovation
Games will be run in rural and regional
areas and in all states. In November, 2019
events were run in Hobart on 12 November
and in Lismore on the 26 November.
ATMS contacted members in Tasmania to
support recruitment in the event as the
project was focussed on “microbusinesses”
who were looking to improve the use of
technology in their business.
The Challenge Day event theme was
“How can your business better manage
waste and reduce Australia’s landfill?”. The
corporate partner was Virgin Australia.
There were ten teams focussed on a
problem or challenge faced by businesses.
Students from nine education institutions
as well as seven subject matter experts
participated.
Successful outcomes were delivered by
each of the ten teams, with the solution
presented for Currumbin Wildlife Sanctuary
judged the best. The solutions presented
included:
Currumbin Wildlife Sanctuary – an App
(Wombat Warrior) to assist site visitors to
separate recycled waste, which links into an
existing site tour App, including a rewards
program for correct recycling;
All Saints Anglican School – an awareness
program to assist students to recycle,
including recycling bins and a challenge
program between school year groups; and
Climate Wave Enterprises – an event
App (GreenFest) focussed on zero waste,
targeted at both concessionaires and
patrons.
A website will be set up shortly to allow
small businesses to register their interest in
participating. For the attendees it is a good
opportunity to have a team of experts
focussed on their business for a full day.
Teys Abattoir – a behaviour change
program for staff, including bins to
segregate waste and a container deposit
program for charity;
SATTWA – an App to return and recycle
product packaging, including a rewards
program for returns;
Stuart Surf Designs – use of alternative
materials (cork, UV resin) to manufacture
surfboards targeted at beginner and
intermediate level;
IGA/Metcash – a container swap scheme to
replace take-away containers, involving a
container deposit and machine washing of
glass containers (for food safety);
Do Good Labs/Virgin – a staged strategy
to stream in flight waste, including
recycling soft plastics, and a passenger
education program;
RACV Royal Pines – a bulk waste
separation facility, including waste
separation at conference/meeting rooms;
Blackboard Coffee – a recycling program
for coffee grounds to be used as soil
compost, including sale of compost at
coffee shops;
JATMS | Autumn 2020 | 41
 ATMS UPDATE
ATMS announce Winners of the
2019 Natural Medicine Awards
On Saturday night (16 November), ATMS
hosted the Natural Medicine Awards
Gala Dinner in Sydney, where the finalists
for Practitioner of the Year, Clinic of the
Year and Student of the Year, industry
professionals, family and friends gathered
for a special evening to celebrate their
great achievements.
The event included keynote speaker
Professor Stephen Myers, a highly
respected academic and passionate
advocate for complementary and
integrative medicine and honoured special
guest Marcus Blackmore who presented
the award for Clinic of the Year, dedicated
to his father Maurice Blackmore, for
Professionalism and Contribution to the
Natural Medicine Industry.
We are thrilled to announce the 2019 ATMS
Natural Medicine Awards winners.
ATMS 2019 Practitioner
of the Year
Angie Savva
Angie is an
integrative
acupuncturist
who infuses
genuine care and
compassion into
everything she
does. She has
been studying and practising natural
health for over fifteen years, with additional
42 | vol26 | no1 | JATMS
qualifications in health coaching,
aromatherapy, nutrition, massage, and
infant massage instruction, and has been
practising acupuncture and Chinese
medicine since 2009. She is passionate
about healing, deeply dedicated to her
patients, and is always looking for ways to
better serve, delight and exceed their
expectations. Angie is passionate about
working with women and children, and is
committed to ensuring the best health
outcomes, both for them, and for future
generations. She has also been committed
to providing affordable access to high
quality treatments by running several
community-based clinics over the years,
and currently works with a local charity to
bring subsidised treatments to people
living with cancer. She owns and manages
a beautiful, eco-friendly, multi-disciplinary
natural health clinic which is becoming a
well-known oasis of healing and peace in
the Blue Mountains.
ATMS 2019 Clinic of the Year
Studio You
Studio You was founded on the
collaborative desire to help women and
children with naturopathy, homeopathy,
and evidence-based medicine provided by
Emma Sutherland, a highly experienced
naturopath, nutritionist, author and
speaker, as well as the wider Studio You
team. Emma is multi-faceted naturopathic
practitioner with a vast array of both
clinical and business skills. A little energiser
bunny, she lives by the motto “be what you
love, do what you love”.
Emma believes that every woman has the
right to live a life filled with Mojo, to have
that bounce in their step which comes from
feeling strong, well and healthy. She has
honed her craft and continues to update
her knowledge constantly, looking for new
ways to present that knowledge, be it at
Studio You, an online program, through the
media, a speaking event, or health retreats.
A huge passion is found in Emma’s love
of mentoring and supporting other
practitioners. Her team aims to provide
clients with true collaborative care, and
both educate and inspire women to
exceptional health
ATMS 2019 Student of the Year
Jenna Carroll
Jenna is a final
year student in
the Bachelor of
Health Science
(Naturopathy)
degree at
Endeavour
College of
Natural Health. She is an advocate for the
holistic principles of naturopathy, and
passionately believes in preventative and
individualised medicine. Her academic
output and patient outcomes in student
clinic have been exemplary. Once she
graduates, Jenna desires to continue
educating the community on nutrition and
natural medicine through her social media
platforms and business, whilst nurturing
and supporting their health in clinical
practice. With a talent for research and
writing, Jenna has co-authored an article
for the Journal of the Australian Traditional-
Medicine Society this year.
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JATMS | Autumn 2020 | 43

 RECENT RESEARCH
Acupuncture and TCM
Zhang LM, Zhen R-R, Gu C, Zhang T-L, Li Y, Jin
M, Hu B, An H-M.
Chinese medicine Di-Huang-Yi-Zhi protects
PC12 cells from H2O2-induced apoptosis
by regulating ROS-ASK1-JNK/p38 MAPK
signaling. BMC Complementary Medicine and
Therapies. 2020, 20:54
Background: Oxidative stress mediates
the nerve injury during the pathogenesis
of Alzheimer’s disease (AD). Protecting
against oxidative stress damage is an
important strategy to prevent and
treat AD. Di-Huang-Yi-Zhi (DHYZ) is a
Chinese medicine used for the treatment
of AD, but its mechanism remains
unknown. This study is aimed to
investigate the effect of DHYZ on H2O2
induced oxidative damage in PC12 cells.
Methods: PC12 cells were treated with
H2O2 and DHYZ. Cell proliferation
was detected by Cell counting kit-
8 (CCK-8) assay. Cytotoxicity of
H2O2 was measured by lactate
dehydrogenase (LDH) release assay.
Apoptosis were identified by Annexin
V-FITC/PI staining. Caspase 3 activity
was detected by commercial kit.
Mitochondrial membrane potential
(MMP) was detected by JC-1 staining.
Reactive oxygen species (ROS) was 2′,
7′-Dichlorodihydrofluorescein diacetate
(DCFH-DA) staining. Protein expression
and phosphorylation was identified by
western blot.
Results: The results showed that DHYZ
antagonized H2O2-mediated cytotoxicity
and proliferation inhibition. DHYZ
reduced ROS production, stabilize
mitochondrial membrane potential,
inhibit Caspase-3 activity and apoptosis
induced by H2O2. In addition, DHYZ
inhibited the phosphorylation of ASK1,
JNK1/2/3 and p38 MAPK which were
up-regulated by H2O2.
Conclusions: The present study
suggested that DHYZ protected PC12
cells from H2O2-induced oxidative stress
damage and was related to inhibition
44 | vol26 | no1 | JATMS
of ROS production and ASK1-JNK/p38
MAPK signaling. The present study
provides experimental evidence for the
application of DHYZ for the management
of oxidative stress damage and AD.
Huang KY, Huang CJ, Hsu CH.
Efficacy of Acupuncture in the Treatment of
Elderly Patients with Hypertension in Home
Health Care: A Randomized Controlled Trial.
Journal of Alternative and Complementary
Medicine. 2020. doi: 10.1089/acm.2019.0172.
[Epub ahead of print
Objective: To evaluate the efficacy of
acupuncture in helping antihypertensive
drugs lower the hypertension of elderly
patients in home health care.
Design: Randomized controlled trial.
Setting: Subjects were recruited from
Branch of Linsen, Chinese Medicine, and
Kunming, Taipei City Hospital, Taipei,
Taiwan.
Subjects: A total of 70 participants with
hypertension in home health care were
assigned randomly to the acupuncture
group (35 participants) or the control
group (35 participants).
Interventions: The acupuncture
group received antihypertensive
drugs plus acupuncture twice a week
for 12 weeks, and the control group
received antihypertensive drugs only.
Acupuncture points SP10, SP6, LR3,
ST36, and LI4 were used bilaterally. Each
acupuncture treatment session lasted
30 min. All the subjects were instructed
not to alter their diet, physical activity,
or use of drugs.
Outcome measurements: Blood
pressure (BP), heart rate variability, and
the Constitution in Chinese Medicine
Questionnaire (CCMQ) were assessed at
baseline and at 6 and 12 weeks from the
baseline between 9 am and 10 am in all
subjects.
Results: A total of 31 participants in
each group completed the study. Within-
group differences were observed in
systolic BP (SBP) (p < 0.001), diastolic
BP (p < 0.001), standard deviation of
normal sinus beat intervals (SDNN)
(p = 0.01), low frequency (p = 0.05),
high frequency (p = 0.01), total power
(TP) (p = 0.01), percentage of successive
intervals that differ by more than
50 msec (PNN50) (p = 0.01), qi deficiency
(p = 0.003), blood stasis (p = 0.02), and
qi depression (p = 0.03) constitution.
Significant between-group differences
were observed in SBP (p = 0.001), SDNN
(p = 0.008), and TP (p = 0.04).
Conclusions: This study suggested that
in the home health care hypertension
population, antihypertensive drugs plus
acupuncture may be more beneficial in
lowering BP and in regulating autonomic
nervous system activity than drugs
alone. A longer follow-up and larger
sample size should be considered in
future studies to reveal the precise effect
of acupuncture followed by evidence-
based practice.
Herbal medicine
Heba J. Sabbagh, Khalil S. AlGhamdi, Hattan T.
Mujalled and Sara M. Bagher.
The effect of brushing with Salvadora persica
(miswak) sticks on salivary Streptococcus
mutans and plaque levels in children: a
clinical trial. BMC Complement Med Ther. 2020;
20, 53. https://doi.org/10.1186/s12906-020-
2847-3
Background: The aim of the
randomized double-blinded clinical
trial was to evaluate the effect of
tooth brushing with Salvadora persica
(miswak) sticks on Streptococcus
mutans count and the mean plaque score
relative to brushing with fluoridated
tooth paste (FTP).
Methods: Our sample included 94
healthy, high caries-risk, 8 to 9-year-old
students recruited from a government
school, in Jeddah, Saudi Arabia between
February and April 2016. Subjects were

randomly grouped into test (provided
with miswak sticks) and control groups
(provided with FTP and soft brushes).
Both groups were introduced to a
preparatory period (PPP) of 3 weeks.
Plaque score and saliva sampling were
conducted prior to the PPP and in
follow-up visits by a single, calibrated
and blinded dentist.
Results: Both groups showed a
statistically significant decrease in the
mean plaque score across the study (P
= 0.007 and P = 0.001, respectively). In
addition, subjects in the test group with
abundant S. sanguinis increased from
zero to six after 3 months.
Conclusions: Salvadora Persica
(miswak) and brushing with FTP
significantly reduced plaque scores
among school children. In addition,
Salvadora persica was found to change
the proportions of salivary bacteria in
favor of species with less risk of inducing
caries.
Janakiram C, Venkitachalam R, Fontelo P. et al.
Effectiveness of herbal oral care products
in reducing dental plaque & gingivitis – a
systematic review and meta-analysis. BMC
Complement Med Ther. 2020; 20, 43. https://doi.
org/10.1186/s12906-020-2812-1
Background: Despite the large number
of trials conducted using herbal oral
care products for the reduction of
dental plaque or gingivitis, results are
conflicting and inconclusive.
Objective: To assess the effectiveness
of herbal oral care products compared
to conventional products in reducing
dental plaque and gingivitis adults.
Methods: We searched the following
databases for Randomised controlled
trials (RCTs): MEDLINE Ovid, EMBASE
Ovid etc. which yielded 493 trails.
Of which 24 RCTs comparing herbal
toothpaste or mouth rinse with over the
counter toothpaste or mouth rinse in
adults aged 18 to 65 years were included.
RECENT RESEARCH
Two authors extracted information and
assessed the methodological quality
of the included studies using Risk of
Bias. Meta-analyses using the random-
effects model were conducted for four
outcomes for tooth paste and mouth
rinse respectively. Mean difference (MD)
or standardized mean difference (SMD)
were used to estimate the effect, with
95% confidence intervals.
Results: A total of 1597 adults
participated in 24 RCT studies. These
were classified as herbal toothpaste
(HTP) (15 trials, 899 participants) and
herbal mouth rinse (HMR) (9 trials,
698 participants) compared with non-
herbal toothpaste (NHTP) or non-herbal
mouth rinse (NHMR). We found that
HTP was superior over NHTP (SMD
1.95, 95% CI (0.97–2.93)) in plaque
reduction. The long-term use of NHMR
was superior in reduction of dental
plaque over HMR (SMD -2.61, 95% (CI
4.42–0.80)). From subgroup analysis it
showed that HTP was not superior over
fluoride toothpaste (SMD 0.99, 95% CI
(0.14–2.13)) in reducing dental plaque.
However, HTP was favoured over non-
fluoride toothpaste (SMD 4.64, 95% CI
(2.23–7.05)).
Conclusion: For short-term reduction in
dental plaque, current evidence suggests
that HTP is as effective as compared to
NHTP; however, evidence is from low
quality studies.
de Sousa Lima, C.M., Fujishima, M.A.T., de Paula
Lima, B. et al.
Microbial contamination in herbal medicines:
a serious health hazard to elderly consumers.
BMC Complement Med Ther. 2020; 20, 17.
https://doi.org/10.1186/s12906-019-2723-1
Introduction: The use of herbal
medicine is on the rise worldwide,
and safety issues associated with
herbal medicines may have an
exacerbated impact in elderly because
this population has an increased
susceptibility and sensitivity to health
complications due to the aging process.
Methods: This cross-sectional study
was carried out at a primary health
care unit in the city of Macapa, Brazil.
The herbal medicines used and the
sociodemographic characteristics of
123 voluntarily consenting participants
were collected using a structured
questionnaire. A total of 132 herbal
medicines with oral or topical
administration were donated by the
elderly for microbial analysis before
consumption, and 18 water samples used
in the preparation of homemade herbal
medicines were collected. Bacterial
and fungal counts and identification
of bacterial pathogens (Escherichia
coli, Salmonella spp., Pseudomonas
aeruginosa and Staphylococcus
aureus) were performed according
to the regulations of the Brazilian
Pharmacopoeia and World Health
Organization. Water analysis for the
detection of coliforms and E. coli was
carried out using Colilert® according
to the manufacturer’s instructions and
the techniques established by Standard
Methods.
Results: Of the study participants, 78.8%
were women. Bacterial growth was
observed in samples from 51.5% of study
and 35.6% had fungal growth. A total of
31.8% of the herbal medicine samples
exceeded the safety limits (CFU/g ≤ 105),
including 16.7% of the homemade herbal
medicines and 15.1% of the commercial
herbal medicines. It was also found
that 31.0% of the samples exceeded
the safety limit for fungal growth. The
microorganisms most commonly isolated
from the herbal medicines were S.
aureus (49.2%), followed by Salmonella
spp. (34.8%), E. coli (25.8%), and P.
aeruginosa (14.4%). Of water samples
analyzed, 77.8% were positive for total
coliforms (1 ml) and in 66.7% water
samples E. coli was detected (1 ml),
making them unfit for consumption.
Conclusions: The use of homemade
and commercial herbal medicines is
a major risk to the health of elderly
who use these therapies due to the
lack of microbial quality standards. We
observed levels of viable bacteria and
JATMS | Autumn 2020 | 45
 RECENT RESEARCH
fungi that were above safety limits;
in addition, we were able to isolate
pathogenic bacteria from these herbal
medicines.
Massage, myotherapy and
other bodywork
Vahirniak V, Kusniak N, Kashperuk-Karpiuk I,
Andrushchak L, Protsak T, Pentelejchuk N.
Studying Changes of the Effective Radius
in Blood Vessels after Exposure of Lower
Extremities to Periodical Mechanical
Vibrations. Journal of Biomedical Physics &
Engineering. 2019; 9(6):673-678. doi: 10.31661/
jbpe.v0i0.1168.
Background: Previous studies
demonstrated a health improving effect
in patients underwent an automatic
vibratory massage taking 10 minutes.
One of reasons that may explain a
healing effect of the automatic massage
is a stimulated increase in both blood
circulation through vascular system and
effective size of blood vessels.
Objective: This paper aims to quantify
a contribution of the automatic
mechanical massage of lower extremities
into the observed reduction in arterial
blood pressure and explain this effect.
Material and Methods: In our
experimental study, the lower
extremities of male and female patients
were exposed to low frequency (12 Hz)
mechanical vibrations for 10 minutes
and the change in systolic and diastolic
arterial blood pressures before and after
this procedure was measured.
Results: The experiments showed there
is a reduction in systolic and diastolic
arterial blood pressures after vibrational
massage. There were corresponding
3.5±1.8 mmHg and 3.1±1.6 mm Hg
arterial blood pressure reductions
among men and 5.5±3.2 mm Hg and
2.2±1.2 mm Hg reductions among
women.
Conclusion: We explained this effect
46 | vol26 | no1 | JATMS
by increasing effective radius of blood
vessels. Based on the Hagen-Poiseuille
equation, we made estimates for the
relative change in the effective radius of
blood vessels. They gave the 0.7% and
1.3% increases in the effective radius
of blood vessels in lower extremities
in men during systole and diastole,
respectively, and the corresponding 1.1%
and 0.6% increases in the effective radius
of blood vessels of lower extremities in
women during the same periods.
Yoshimura A, Schleip R, Hirose N.
Effects of Self-Massage Using a Foam
Roller on Ankle Range of Motion and
Gastrocnemius Fascicle Length and Muscle
Hardness: A Pilot Study. Journal of Sport
Rehabilitation. 2020; 11:1-8. doi: 10.1123/
jsr.2019-0281
Context: Several studies have reported
that self-massage using a foam roller
(FR) increased joint range of motion
(ROM) immediately. However, the
mechanism of increasing ROM by the FR
intervention has not been elucidated.
Objective: To clarify the mechanism
by investigating properties and
morphological changes of muscles
targeted by the FR intervention.
Design: An interventional study.
Setting: An athletic training laboratory.
Participants: Ten male college volunteers
with no injuries in their lower limbs
(mean [SD]: age 23.8 [3.2] y, height 173.2
[4.9] cm, weight 69.5 [8.6] kg).
Intervention: The FR intervention on
the right plantar flexors for 3 minutes.
Main Outcome Measures: Maximum
ankle ROM, muscle hardness, and
fascicle length of the gastrocnemius
muscle at the neutral (0°), maximum
dorsiflexion, and maximum plantar
flexion positions. All measurements
were conducted before (PRE) and after
(POST) the FR intervention.
Results: Dorsiflexion ROM increased
significantly at POST (PRE: 13.6° [8.0°],
POST: 16.6° [8.4°]; P < .001), although
plantar flexion ROM did not change
significantly between PRE and POST
(PRE: 40.0° [6.1°], POST: 41.1° [4.9°]).
There was no significant difference in
muscle hardness and fascicle length
between PRE and POST in any of the
angles.
Conclusions: Dorsiflexion ROM increased
significantly by the FR intervention in the
present study; however, muscle hardness
and fascicle length did not change. FR may
affect not only the muscle but also the
fascia, tendon, and muscle-tendon unit.
The FR protocol of the present study can
be applied in clinical situations, because it
was found to be effective to increase ROM.
Nutrition
Szajewska H, Hojsak I.
Health benefits of Lactobacillus
rhamnosus GG and Bifidobacterium
animalis subspecies lactis BB-12 in
children. Postgraduate Medicine. 2020. doi:
10.1080/00325481.2020.1731214
Abstract: While the literature indicates
that probiotics are effective for the
treatment or prevention of several
conditions, data in children specifically
focusing on individual probiotic
strains are still limited. Therefore,
we conducted a narrative review
that summarizes data on the efficacy
and safety of two common probiotic
strains-Lactobacillus rhamnosus GG
(LGG) and Bifidobacterium animalis
subspecies lactis BB-12 (BB-12)-when
administered to children. Our search
of the PubMed database identified 13
meta-analyses, three systematic reviews,
and 15 randomized, controlled trials that
assessed BB-12 and LGG, either alone
or in combination, when administered
to infants to improve growth or to
children of any age to prevent or treat
acute gastroenteritis (AGE), antibiotic-
or healthcare-associated diarrhea (AAD
and HAD, respectively), respiratory

infections, otitis media, and functional
gastrointestinal (GI) disorders including
irritable bowel syndrome (IBS). Our
review found evidence that LGG can
prevent AAD and improve the symptoms
of AGE, particularly among children
in Europe. However, we found only
moderate evidence regarding the
benefits of LGG for treating respiratory
infections and IBS in children and
minimal evidence to support the use of
BB-12. While no serious safety concerns
were identified, LGG was associated
with two non-serious safety concerns of
wheezing and viral skin infections. In
conclusion, we propose that LGG can
be safely administered to toddlers and
older children to manage the symptoms
of AGE and prevent AAD. These findings
should be considered for incorporation
into clinical practice guidelines and
should help to focus the efforts of the
probiotic industry.
Dinu M, Pagliai G, Angelino D, Rosi A, Dall/
Asta M et al.
Effects of Popular Diets on Anthropometric
and Cardiometabolic Parameters: An
Umbrella Review of Meta-Analyses of
Randomized Controlled Trials. Advances in
Nutrition. 2020;pii: nmaa006. doi: 10.1093/
advances/nmaa006.
Abstract: The prevalence of overweight,
obesity, and their related complications
is increasing worldwide. The purpose of
this umbrella review was to summarize
and critically evaluate the effects of
different diets on anthropometric
parameters and cardiometabolic risk
factors. Medline, Embase, Scopus,
Cochrane Database of Systematic
Reviews, and Web of Science, from
inception to April 2019, were used as
data sources to select meta-analyses
of randomized controlled trials that
examined the effects of different diets
on anthropometric parameters and
cardiometabolic risk factors. Strength
and validity of the evidence were
assessed through a set of predefined
criteria. Eighty articles reporting 495
unique meta-analyses were examined,
RECENT RESEARCH
covering a wide range of popular diets:
low-carbohydrate (n = 21 articles),
high-protein (n = 8), low-fat (n = 9),
paleolithic (n = 2), low-glycemic-index/
load (n = 12), intermittent energy
restriction (n = 6), Mediterranean
(n = 11), Nordic (n = 2), vegetarian
(n = 9), Dietary Approaches to Stop
Hypertension (DASH) (n = 6), and
portfolio dietary pattern (n = 1). Great
variability in terms of definition of
the intervention and control diets was
observed. The methodological quality
of most articles (n = 65; 81%), evaluated
using the "A MeaSurement Tool to Assess
systematic Reviews-2" questionnaire,
was low or critically low. The strength of
evidence was generally weak. The most
consistent evidence was reported for
the Mediterranean diet, with suggestive
evidence of an improvement in weight,
BMI, total cholesterol, glucose, and
blood pressure. Suggestive evidence of
an improvement in weight and blood
pressure was also reported for the DASH
diet. Low-carbohydrate, high-protein,
low-fat, and low-glycemic-index/load
diets showed suggestive and/or weak
evidence of a reduction in weight
and BMI, but contrasting evidence for
lipid, glycemic, and blood pressure
parameters, suggesting potential
risks of unfavorable effects. Evidence
for paleolithic, intermittent energy
restriction, Nordic, vegetarian, and
portfolio dietary patterns was graded
as weak. Among all the diets evaluated,
the Mediterranean diet had the strongest
and most consistent evidence of a
beneficial effect on both anthropometric
parameters and cardiometabolic risk
factors. This review protocol was
registered at www.crd.york.ac.uk/
PROSPERO/ as CRD42019126103.
Compementary and
alternative medicine
Seet V, Abdin E, Vaingankar JA, Shahwan S,
Chang S, Lee B, Chong SA, Subramaniam M.
The use of complementary and alternative
medicine in a multi-ethnic Asian population:
results from the 2016 Singapore Mental
Health Study. BMC Complementary Medicine
and Therapies. 2020; 20, 52 (2020). https://doi.
org/10.1186/s12906-020-2843-7
Background: This study seeks to
investigate factors associated with using
complementary and alternative medicine
(CAM) for a mental illness among the
three major ethnic groups (Chinese,
Indians and Malays) in the general
population of Singapore.
Methods: Data from the 2016
Singapore Mental Health Study was
used; responses from the “Services”
section of the Composite International
Diagnostic Interview version 3.0 (CIDI
3.0) administered during face-to-face
household interviews with participants
were analyzed to establish prevalence
of CAM use among Singaporeans.
Additionally, sociodemographic variables
of interest were selected for sub-group
regression analyses to yield correlates of
CAM use among the three ethnic groups.
Results: 6.4% of Singaporeans used
at least one form of CAM in the past
12 months for their mental illness.
Malays reported using CAM the most,
followed by Indians and Chinese.
Sociodemographic variables such
as education and employment were
differently associated with CAM use
among the ethnicities. Across all three
ethnic groups, CAM users were more
likely to report poorer mental health-
related quality of life.
Conclusion: Despite the significant
differences in CAM use among Chinese,
Malays and Indians, those who had
a mental illness were significantly
more likely to use CAM regardless of
ethnicity. This highlights the need
for communication between CAM
practitioners and conventional mental
healthcare providers for early referral
when appropriate which would lead to
improved healthcare delivery and better
clinical outcomes.
JATMS | Autumn 2020 | 47
 HEALTH
FUND

48 | vol26 | no1 | JATMS

UPDATE

(No longer ATMS Accredited)

Traditional Chinese
Traditional Chinese
Remedial Massage

(Certificate IV)
(HLT Diploma or higher level
(Certificate IV)
qualification)
(HLT Diploma or higher level

Chinese Herbal
Remedial Massage
Remedial Massage
Remedial Therapies
Remedial Massage

Acupuncture
Counselling
Hypnotherapy
qualification)

Medicine
Nutrition
Health Fund
Australian Health Management √ √ √ √
Australian Regional Health Group
ACA Health Benefits Fund √ √ √ √  • •
Cessnock District Health √ √ √ √  • •
CUA Health (Credicare) √ √ √ √ √ 
Defence Health √ √  •
GMHBA (Geelong Medical) √ √ √  •
Frank Health Fund & Budget Direct √ √ √  •
Health Care Insurance Limited √ √ √ √  • •
HBF √ √ √ √ √ 
Health.com.au √ √    √ √  • •
HEALTH FUND UPDATE

Health Partners √ √ √
HIF (Health Insurance Fund of WA) √ √ √ √  • •
Latrobe Health Services √ √ √  • •
MDHF (Mildura District Hospital Fund) √ √ √ √ •
MyOwn Health √ √ 
Navy Health Fund √ √ √ √  • •
Nurses & Midwives Health √ √ √ √ • •
Onemedifund √ √ √ √  • •
Peoplecare Health Insurance √ √ √ √  • •
Phoenix Health Fund √ √ √  • •
Police Health Fund (including Emergency Services) √ √ √ √  • •
Queensland Country Health √ √ √ √ √ •
Railway and Transport √ √ √ √  • •
Reserve Bank Health Society √ √ √ √  • •
St Lukes √ √ √ √  • •
Teachers Health √ √ √ √  • •
Teachers Union Health √ √ √  • •
Transport Health √ √ √ √  • •
Westfund √ √ √ √ √  • •
Australian Unity √ √ √ √ √
BUPA √ √ √ √
CBHS Health Fund √ √ √ √ √ √
Doctors Health Fund √
HCF √ √ √
Medibank Private √ √ √ √ √ √ √
NIB √ √ √ √

√ Therapy covered by Fund Please note that this table is only a guide to show what funds cover ATMS accredited modalities. If the modality that you are accredited for is not listed, this means that no health fund covers the modality. The only
exceptions are Chiropractic and Osteopathy. ATMS accreditation in a modality does not guarantee provider status as all funds have their individual set of strict eligibility requirements. Please see our website
www.atms.com.au or contact our office for current requirements. Rebates do not usually cover medicines, only face to face consultations. For further rebate terms and conditions, patients should contact their health
fund. Policies may change without prior notice.

 ARHG are only recognising Remedial Therapists who are accredited for this modality and were approved for ARHG Provider status under their old criteria.
• ARHG are recognising Chinese Massage, however the eligibility requirements and provider number is exactly the same as Remedial Massage. See ARHG Health Fund Information for further information.

Please note as from 1 April 2019,
the Australian Government’s
reforms for private health
insurance means certain natural
therapies will no longer be covered
under private health insurance.
The 16 natural therapies will no
longer be eligible for health fund
rebates.
Claims for services dated prior to 1
April 2019 will continue to be paid
as arranged, however claims for
services dated 1 April 2019 forward
will be rejected by the funds as
required by the legislation.
Health Funds
ATMS is a ‘professional organisation’
within the meaning of section 10 of the
Private Health Insurance Accreditation
Rules 2011. This potentially allows ATMS
accredited members to be recognised
as approved providers by the various
private health funds. Approved health
fund provider status is, however, subject
to each individual health fund’s eligibility
requirements.
Consequently, membership of ATMS does
not automatically guarantee provider
status with all health funds. Please also
note that several health funds do not
recognise courses done substantially
by distance education, or qualifications
obtained overseas.
Additional requirements for recognition as
a provider by health funds include:
• Clinic Address (Full Street Address
must be provided – Please note that
some health funds may list your clinic
address on their public websites)
• Current First Aid Cert (HLTAID003)
• Current Senior First Aid
• Current Professional Indemnity
Insurance (some health funds require
specific minimum cover amounts.
Please refer to the individual health
fund terms and conditions for further
information)
• Compliance with the ATMS Continuing
Education Policy along with any additional
continuing education requirements
HEALTH FUND NEWS
stipulated by the health fund
• Current National Registration (where
applicable)
• Compliance with the Terms and
Conditions of Provider Status with the
individual health funds.
ATMS must have current evidence of
your first aid and insurance on file at
all times.
When you join or rejoin ATMS, or when
you upgrade your qualifications, you
will need to fill out the ATMS Health
Fund Application and Declaration Form
available on the ATMS website. Once this
is received, along with any other required
information for health fund eligibility
assessment, details of eligible members
are sent to the applicable health funds
on their next available listing. The ATMS
office will also forward your change of
details, including clinic address details
to your approved health funds on their
next available list. Please note that the
health funds can take up to one month
to process new providers and change of
details as we are only one of many health
professions that they deal with.
Lapsed membership, insurance or
first aid will result in a member being
removed from the health funds list.
As health funds change their provider
eligibility requirements at any given
time, upgrading qualifications may be
necessary to be re-instated with some
health funds.
TERMS AND CONDITIONS OF
PROVIDER STATUS
Many of the Terms and Conditions of
Provider Status for the individual health
funds are located on the ATMS website.
For the Terms and Conditions for the
other health funds, it will be necessary to
contact the health fund directly.
BEING A PROVIDER IMPLIES
ACCEPTANCE OF THE TERMS AND
CONDITIONS FOR THE HEALTH
FUNDS.
Please note that whilst there is no law
or regulation requiring patient clinical
notes to be taken in English, many
of the major health funds do require
patient clinical notes to be taken in
English. Failure to do this will be a
breach of the Health Funds Terms
and Conditions and may result in
the practitioner being removed as a
provider for that health fund.
For health funds to rebate on the
services of Accredited members, it is
important that a proper invoice be
issued to patients. The information
which must be included on an
invoice is also listed on the ATMS
website. It is ATMS policy that only
Accredited members issue their own
invoice. An Accredited member must
never allow another practitioner,
student or staff member to use their
provider details, as this constitutes
health fund fraud. Misrepresenting
the service(s) provided on the
invoice also constitutes health
fund fraud. Health fund fraud is a
criminal offence which may involve
a police investigation and expulsion
from the ATMS Register of Members.
It is of note that the health funds
require practitioners to be in private
practice. Some health funds will not
recognise claims where accommodation,
facilities or services are provided or
subsidised by another party such as
a public hospital or publicly funded
facility. Rebates are only claimable
for the face to face consultation (not
the medicines or remedies); however
this does not extend to mobile work
including markets, corporate or hotels.
Home visits are eligible for rebates for
some health funds.
MOBILE SERVICES ARE NOT
RECOGNISED FOR HEALTH FUND
REBATES. Health Funds that do not
allow mobile services for rebates are:
AHM, ARHG, BUPA, HCF and Medibank.
ONLINE OR PHONE CONSULTATIONS
ARE NOT RECOGNISED FOR HEALTH
FUND REBATES.
JATMS | Autumn 2020 | 49
 HEALTH FUND NEWS
Please be aware that whilst a health fund
may indicate that they provide a rebate
for specific modalities, this rebate may
only be claimable if the client has the
appropriate level of health cover with
that fund and has not exceeded any limits
on how much they are eligible to claim
back over a certain period of time.
Please note : All health funds require
minimum $5 million Professional
Indemnity Insurance & $10 million
for Public Liabilities Insurance for
all Acupuncture & Chinese Herbal
Medicine practitioners.
Australian Health
Management (AHM)
Names of eligible ATMS members will
be sent to AHM each month. AHM’s
eligibility requirements are listed on the
ATMS website www.atms.com.au.
ATMS members can check their eligibility
by checking the ATMS website or by
contacting the ATMS Office on 1800 456
855. Please contact AHM on 13 42 46 for
your provider number.
Australian Regional Health
Group (ARHG)
This group consists of the following
health funds:
• ACA Health Benefits Fund Ltd
• Cessnock District Health Benefits Fund
• CUA Health Limited
• Defence Health▼▼
• HBF (Including GMF Health) ▼▼
• GMHBA ▼▼ (Including Frank Health Fund &
Budget Direct)
• Health.com.au
• Health Care Insurance Limited
• Health Partners
• HIF WA
• Latrobe Health Services (Federation
Health)
• Mildura District Hospital Fund
• MyOwn Health ▼▼ ▼
• Navy Health Fund
• Nurses & Midwives Health
• Onemedifund
• Peoplecare Health Insurance
• Phoenix Health Fund
• Police Health Fund (Including Emergency
Services)
• Queensland Country Health Fund Ltd
50 | vol26 | no1 | JATMS
• Railway and Transport Fund Ltd
• Reserve Bank Health Society
• St Luke’s Health
• Teachers Health
• Teachers Union Health
• Transport Health
• Westfund
▼▼ Special condition applies for Remedial
Massage
Details of eligible members, including
member updates are sent to ARHG by
ATMS monthly. The details sent to ARHG
are your name, address, telephone and
accredited discipline(s). These details
will appear on the ARHG websites. If you
do not wish your details to be sent to
ARHG, please advise the ATMS office on
1800 456 855.
The ARHG provider number is based
on your ATMS number with additional
lettering. To work out your ARHG
provider number please follow these
steps:
1 Add the letters AT to the front of your
ATMS member number
2 If your ATMS number has five digits
go to step 3. If it has two, three or
four digits, you need to add enough
zeros to the front to make it a five digit
number (e.g. 123 becomes 00123).
3 Add the letter that corresponds to your
accredited modality at the end of the
provider number;
A ACUPUNCTURE
C CHINESE HERBAL MEDICINE
U NUTRITION
If ATMS member 123 is accredited in
Acupuncture, the ARHG provider number
will be AT00123A.
4 If you are accredited in several
modalities, you will need a different
provider number for each modality
(e.g. if ATMS member 123 is accredited
for Chinese Herbal Medicine and
Nutrition, the ARHG provider numbers
are AT00123C and AT00123U.
ARHG - Remedial Massage
and Chinese Massage
Remedial Massage and Chinese Massage
therapists who graduated after March
2002 must hold a Certificate IV or higher
from a registered training organisation.
Members who are accredited for
Remedial Massage or Chinese Massage,
will need to use the following letters.
M MASSAGE THERAPY
R REMEDIAL THERAPY
The letter at the end of your provider
number will depend on your
qualification, not the modality in
which you hold accreditation*. All
members who meet the ARHG eligibility
requirements, who hold a Diploma
of Remedial HLT50302, HLT50307 or
HLT52015 or a Diploma of Chinese
Remedial Massage HLT50102, HLT50107
or HLT50112 will be able to use both the
‘M’ and ‘R’ letters. It is recommended
to use the ‘R’ as often as possible, but
as not all health funds under ARHG
cover ‘Remedial Therapy’, it will be
necessary to use the ‘M’ at the end of
the provider number for those funds
only. All other eligible Remedial Massage
Therapists who do not hold the Diploma
of Remedial HLT50302, HLT50307 or
HLT52015 or a Diploma of Chinese
Remedial Massage HLT50102, HLT50107
or HLT50112 are required to use the ‘M’
at the end of their provider number.
*Members accredited for Remedial
Therapies and approved for ARHG for
this modality under their previous
criteria will continue to be recognised
under Remedial Therapy and will be
fine to use the ‘R’ in their provider
number. Should members in this
situation lapse membership, first aid or
insurance etc they will then be required
to meet the current ARHG criteria.
Please note : as of 1 July 2020, ARHG
requires all providers to have a
minimum of $2 million Professional
Indemnity Insurance & $10 million
for Public Liabilities for Nutrition and
remedial massage.

HBF Health – – Hypnotherapy
Names and details of eligible ATMS
members will be sent to HBF for this
modality only each month.
Australian Unity
Names and details of eligible ATMS
members will be sent to Australian Unity
each month. ATMS members will need
to contact Australian Unity on 1800 035
360 to register as a provider, after filling
out the Australian Unity Application Form
located on the ATMS website to activate
their provider status. This only needs
to happen the first time. The provider
eligibility requirements for Australian
Unity are located on the ATMS website
www.atms.com.au. Your ATMS number
can be used as your Provider Number,
or you can contact Australian Unity for
your Australian Unity generated Provider
Number. Please note that Australian Unity
requires Professional Indemnity Insurance
(to at least $2 million) and Public Liability
Insurance (to at least $10 million).
BUPA
Names and details of eligible ATMS
members will be sent to BUPA on a
monthly basis. The provider eligibility
requirements for BUPA are located on the
ATMS website www.atms.com.au. The
Provider eligibility requirements include
an IELTS test result of an overall Band 7 or
higher for TCM qualifications completed
in a language other than English. BUPA
will generate a Provider Number after
receiving the list of eligible practitioners.
BUPA advises ATMS of your Provider
Number and ATMS will then advise those
members directly.
Please note that BUPA requires all
providers to have a minimum of
$2 million Professional Indemnity
Insurance. Also they now have a
restriction of maximum four (4) clinic
addresses for all modalities.
CBHS Health Fund Limited
Names and details of eligible ATMS
members will be sent to CBHS each
month. The details sent to CBHS are your
name, address, telephone and accredited
HEALTH FUND NEWS
discipline(s). These details will appear on
the CBHS website. If you do not want your
details to be sent to CBHS, please advise
the ATMS office on 1800 456 855. The
provider eligibility requirements for CBHS
are located on the ATMS website www.
atms.com.au. Your ATMS number will
be your Provider Number.
Please note: CBHS now no longer
accredits Nutrition as of 1 April 2019.
Doctors Health Fund
Names and details of eligible ATMS
members will be sent to Doctors
Health Fund each month. Please note
that Doctors Health Fund only covers
Remedial Massage. The provider eligibility
requirements for Doctors Health Fund
are located on the ATMS website www.
atms.com.au. Your ATMS number will
be your Provider Number.
HCF
Names and details of eligible ATMS
members will be sent to HCF on a
fortnightly basis. The provider eligibility
requirements for HCF are located on the
ATMS website www.atms.com.au.
HCF do not issue provider numbers nor
use your ATMS number as your provider
number. They do however require your
ATMS membership details, including
your ATMS number, to be clearly
indicated on all invoices and receipts
issued.
Please note: HCF requires all providers
to have a minimum of $2 million
Professional Indemnity Insurance.
Also, they now no longer accredit
Nutrition as of 1 April 2019.
Medibank Private
Names and details of eligible ATMS
members will be sent to Medibank Private
on a fortnightly basis. The provider
eligibility requirements for Medibank
Private are located on the ATMS website
www.atms.com.au. Medibank Private
requires Clinical Records to be taken
in English. Medibank Private generates
Provider Numbers after receiving the
list of eligible practitioners from ATMS.
Medibank Private sends these provider
numbers directly to ATMS. ATMS will
then forward this information to the
provider. Please note that Medibank has
placed a restriction of up to a maximum
3 clinic addresses that will be recognised
for Remedial Massage. There are no
restrictions on the number of recognised
clinics for other modalities. Please refer
to our website for updated recognition
criteria and standards for Medibank.
NIB including APIA, AAMI
Health Insurance, Qantas
Health Insurance & GU Health
Names and details of eligible ATMS
members will be sent to NIB on a
weekly basis. The provider eligibility
requirements for NIB are located on the
ATMS website www.atms.com.au. NIB
does accept overseas Acupuncture and
Chinese Herbal Medicine qualifications
which have been assessed as equivalent
to the required Australian qualification
by Vetassess. Your ATMS Membership
Number will be your provider number.
HICAPS
ATMS members who wish to activate
these facilities need to register directly
with HICAPS. HICAPS do not cover all
health funds and modalities. Please go
to www.hicaps.com.au or call 1800
805 780 for further information.
JATMS | Autumn 2020 | 51
 ADVERTORIAL
Tea & Sympathy
byAnthia Koullouros | Naturopath & Herbalist
Create a supportive, caring and
calming clinical experience by
offering herbal teas on arrival, in
your waiting room and during your
patient’s consultation.
Here at Ovvio, we don't just love tea, we
revere it, treasure it, revel in it, ritualise
it, exalt it and applaud it. And we know
we're not alone. After water, it's the
most consumed beverage worldwide.
The power of a well-timed cup of tea
is undisputed; a moment of serenity, a
warming meditation, an opportunity
to create wellness with an open and
relaxed mind and body, and an open
heart and spirit.
Here are my 5 tips to creating a calming
and comforting tea experience in your
clinic.
1. Begin with mindful tea.
Choose certified organic tea, free
from artificial or ‘natural’ flavours or
fragrances. Mindful tea is good for you,
your patient and the environment. Why
offer anything less. Your patients’ health
is top priority.
2. Loose leaf or teabag.
It’s a personal choice. Biodegradable,
transparent, delicate plant based mesh
bags are the most ideal teabag. They
offer loose leaf convenience without
compromise. Be wary of bleached paper
teabags, nylon teabags claiming to be
made of silk and poor quality ingredients
turned into dust also known as fannings.
3. Tea, tisane or herbal tea.
Tea comes from the Camellia sinensis
plant also known as the Tea plant. These
include black, green, white, oolong,
yellow and pu-erh. Anything else,
while sometimes called “tea”, is more
Disclaimer: The views and opinions expressed in these advertorials are those of the authors and do not necessarily reflect the opinions of ATMS or its Directors.
52 | vol26 | no1 | JATMS
accurately referred to as an herbal tea,
infusion or tisane and they’re caffeine
free. Whereas greens and blacks and
everything in between, naturally contain
caffeine. Sometimes you just can’t beat
a simple cup of high quality, organic
English Breakfast Tea. This offering is
usually served with milk and sweetener.
Entice your patients with a unique
offering depending on how they want to
feel. Naturopathically formulated herbal
teas can offer instant relief and make
your patient feel better.
4. How do you want to feel?
What is the experience you
want to create?
When a patient visits my clinic, I warmly
greet them with the following questions
“how do you feel?” and “how do you
want to feel?”.
~ Feeling stressed…. I want to feel
calm. Choose herbal tea blends that
contain: chamomile flower, lemon
balm, withania root, holy basil leaf
and lavender flower.
~ Feeling tired….. I want to feel
energized. Choose herbal tea blends
that contain: peppermint leaf, licorice
root, Siberian ginseng root and
astragalus root.
~ Feeling foggy….. I want to feel
clear. Choose herbal tea blends that
contain: bacopa, rosemary leaf, sage
leaf and peppermint leaf.
~ Feeling sluggish…. I want to feel
light. Choose herbal tea blends that
contain: dandelion root and leaf,
ginger root, cinnamon bark and globe
artichoke leaf.
Equally important – tea should be good
for you and taste delicious too!
5. Create a vignette for your
tea offering.
A vignette, in decorating terms, is a
collection of beautiful items displayed
or clustered together. Choose your
favourite mindful items such as a candle,
crystals, figurines, shells, pretty vessels
and flowers. Display all items on a
beautiful tray with a teapot and teacup.
With tender, gentle infusions and
unhurried ceremony, we can create a
memorable experience - a tea worth
drinking and a life well steeped.
Anthia Koullouros is a Naturopath and
Herbalist and the author of I am Food, She
is the founder of Premium Organic Tea by
Ovvio. For further information visit the
website www.ovvioorganics.com.au
 ADVERTORIAL

Herbal Farming and

Manufacturing Update
by Warren Morey | Herbalist and Manager of the Pharmaceutical Plant Company (PPC Herbs)

All TGA licensed manufacturers are

audited to a schedule set by the TGA.
January 2020 was time for PPC Herbs to
receive its scheduled audit.

The TGA auditor carefully examines

all elements of the companies Good
Manufacturing Practices (GMP),
including Quality Assurance and Quality
Control, Equipment, Processes, and
batch documentation.

They look at raw material purchase,

receipt, testing and approval. They look
at Process validation, Stability programs,
Staff Training and many more things.
The audit takes 2-3 days. At the end of
the process they write a report and rate
your companies compliance.

A1 - Few deficiencies of relatively minor

nature. Top 15% of Manufactures audited
worldwide by TGA
A2 - Few major deficiencies (<6) and/or
a large number of minor deficiencies and
no critical. (about 70% of manufacturers)
A3 - A large number of major (5<x>11
and/or a large number of minor
deficiencies and no critical.
Not Rated (Unacceptable) - One or more
critical and/or a large number of major
deficiencies.
The Pharmaceutical Plant Company (PPC
Herbs) is very proud to be rated A1 by
TGA and be in the top 15% of companies
audited worldwide.
Reference: Good Manufacturing Practices for
Complementary Medicines Presentation.
Farming
The start of 2020 has continued to
present enormous challenges for
farmers throughout Australia. After
fires started in November the fire
season went from bad to shocking
throughout the country. Luckily for
farms associated with PPC they escaped
the fire fronts, but like most of us they
had many sleepless nights and anxious
moments.
Marleen Herbs in Tasmania, the primary Regardless PPC and Marleen herbs look
source of the Fresh Plant Tinctures is forward to delivering our Herbalists and
in relatively safe open farmland but has Naturopaths, the highest quality extracts
suffered its most difficult year to date. and Freshest ACO certified Tinctures
This season has been very dry and with grown in Australia
more than 120 different crops under
cultivation, some manage the drier
weather well, other not so well. If you have further questions, please email
me at warren.morey@ppcherbs.com.au

Disclaimer: The views and opinions expressed in these advertorials are those of the authors and do not necessarily reflect the opinions of ATMS or its Directors.

JATMS | Autumn 2020 | 53

 ADVERTORIAL
Proton pump inhibitors:
re-emerging safety concerns
Wendy McLean | BHSc(Nat), BAdvSc (Hons), PhD
Proton pump inhibitors (PPI) are used
for the management of a variety of
gastrointestinal disorders, including
gastro-oesophageal reflux disease
and functional dyspepsia. Since their
introduction in the early 1990s,
the use of proton pump inhibitors
has increased by more than 1000%
in Australia, with over 19 million
prescriptions written in 2013–14.1 Over
the last decade, at least two PPIs have
featured in the top 10 most prescribed
PBS-subsidised medicines every year.2
Currently, long-term PPI use is
approved for the prevention and
symptom control of gastroesophageal
reflux disease (GORD), for Barrett’s
oesophagus, and as prophylaxis
for nonsteroidal anti-inflammatory
drug (NSAID)– associated bleeding.3
However, several studies suggest that
a substantial proportion of PPI users
do not have a clear indication for
therapy.3,4 Not surprisingly, there is
concern over the unnecessary personal
and healthcare costs associated with
their increasing use.
Adverse effects of long-term
PPI use
Recent observational studies suggest
that taking PPIs is associated with
several serious adverse events
including myocardial infarction and
ischemic stroke,5 osteoporosis and
bone fractures,6,7 acute kidney injury,8
chronic kidney disease,9 dementia,10,11,12
Clostridium difficile infections13 and
acquired pneumonia.14 The results of a
recent longitudinal cohort study suggest
an increased risk of all-cause mortality
with PPI use, including death due to
cardiovascular disease, chronic kidney
Disclaimer: The views and opinions expressed in these advertorials are those of the authors and do not necessarily reflect the opinions of ATMS or its Directors.
54 | vol26 | no1 | JATMS
disease, and upper gastrointestinal
cancer.15
While observational studies may not
provide sufficient evidence to prove
direct causation, the accumulating
evidence does require consideration
and highlights the need to promote
awareness of potential adverse events
related to long-term use, for better
pharmacovigilance and the need
to limit the prescription of PPIs to
patients where the benefits outweigh
potential risks. Furthermore, there is
enough evidence to indicate a high
probability of causality between PPIs
and increased risk of gastrointestinal
infection, nutrient deficiencies (vitamin
B12 and magnesium) and small intestinal
bacterial overgrowth.3,16
PPIs, the gut microbiome
and disease
A significantly lower abundance in
gut commensals and lower microbial
diversity has been found in PPI users,
with an associated significant increase
in the abundance of oral and upper
GI tract commensals. In particular,
Streptococcaceae is significantly
increased in PPI-users.17 These
alterations to the gut microbiota increase
the risk of enteric infections such as
Clostridium difficile, Salmonella spp,
and Shigella spp.18,19 Gut microbiota
can resist or promote colonisation of
C. difficile and other enteric infections
through mechanisms that either directly
inhibit bacterial growth or enhance the
immune system. Furthermore, changes
in gastric acidity and gastric motility
can result in increased microbial density
in the small intestine (known as small
intestinal bacterial overgrowth (SIBO)).20
Several recent population studies have
associated PPI use, through secondary
changes in microbiota composition, with
a risk of major depression,21 childhood
obesity,22 irritable bowel syndrome23 and
allergic disease.24
Herbal, nutritional and lifestyle
support for upper digestive
complaints
The evidence from all available
studies suggests that long term PPI
use is associated with serious adverse
events, including an increased risk
of all-cause mortality. In addition,
evidence indicates that more than half
the people taking PPIs do so without
a medical need, exposing themselves
to unnecessary health risks. Given
these risks, alternative therapies for the
treatment of gastrointestinal disorders
such as GORD and functional dyspepsia
should be considered. The naturopathic
treatment approach aims to address
the individual causative and modifiable
risk factors for functional dyspepsia,
GORD and related conditions while
providing relief of symptoms. Diet and
lifestyle interventions are combined
with evidence based and traditional
nutritional and botanical medicines such
as licorice,25 meadowsweet26 and zinc
l-carnosine27,28,29 to provide symptom
relief, support normal gastrointestinal
function and repair and protect
oesophageal and gastrointestinal mucosa.
For further clinical support, view
BioMedica’s upper digestive complaints
resources at biomedica.com.au or
contact the BioMedica technical
support team on technicalsupport@
biomedica.com.au.
REFERENCES
1. Hollingworth S, Duncan EL, Martin JH.(2010)
Marked increase in proton pump inhibitors
use in Australia. Pharmacoepidemiol Drug
Saf;19:1019\u201324.
2. Weekes, L. M. (2015). Proton pump inhibitors:
too much of a good thing? The Medical
Journal of Australia, 202(9), 464. doi:10.5694/
mja15.00477
3. Nehra, A. K., Alexander, J. A., Loftus, C. G.,
& Nehra, V. (2018, February). Proton pump
inhibitors: review of emerging concerns. In
Mayo Clinic Proceedings (Vol. 93, No. 2, pp.
240-246). Elsevier.
4. Ksiądzyna, D., Szeląg, A., & Paradowski, L.
(2015). Overuse of proton pump inhibitors. Pol
Arch Med Wewn, 125(4), 289-98.
5. Sehested, T. S. G., Gerds, T. A., Fosbøl, E. L.,
Hansen, P. W., Charlot, M. G., Carlson, N.,
... & Gislason, G. H. (2018). Long-term use
of proton pump inhibitors, dose–response
relationship and associated risk of ischemic
stroke and myocardial infarction. Journal of
internal medicine, 283(3), 268-281.
6. Cai D, Feng W, Jiang Q. Acid-suppressive
medications and risk of fracture: an
updated meta-analysis. Int J Clin Exp Med.
2015;8:8893–8904.
7. Hussain, S., Siddiqui, A. N., Habib, A., Hussain,
M. S., & Najmi, A. K. (2018). Proton pump
inhibitors’ use and risk of hip fracture: a
systematic review and meta-analysis.
Rheumatology international, 38(11), 1999-
2014.
8. Antoniou, T., Macdonald, E. M., Hollands, S.,
Gomes, T., Mamdani, M. M., Garg, A. X., ... &
Juurlink, D. N. (2015). Proton pump inhibitors
and the risk of acute kidney injury in older
patients: a population-based cohort study.
CMAJ open, 3(2), E166.
9. Arora, P., Gupta, A., Golzy, M., Patel, N.,
Carter, R. L., Jalal, K., & Lohr, J. W. (2016).
Proton pump inhibitors are associated with
increased risk of development of chronic
kidney disease. BMC nephrology, 17(1), 112.
10. Haenisch B, von Holt K, Wiese B, et al. Risk of
dementia in elderly patients with the use of
proton pump inhibitors. Eur Arch Psychiatry
Clin Neurosci. 2015;265(5):419–428.
11. Gomm W, von Holt K, Thomé F, et al.
Association between proton pump
inhibitors with risk of dementia. A
pharmacoepidemiological claims data
analysis. JAMA Neurol. 2016;73(4):410–416.
12. Tai SY, Chien CY, Wu DC, et al. Risk of
dementia from proton pump inhibitor use in
Asian population: a nationwide cohort study
in Taiwan. PLoS One. 2017;12(2):e0171006.
13. McDonald EG, Milligan J, Frenette C, Lee
TC. Continuous proton pump inhibitor
therapy and the associated risk of recurrent
Clostridium difficile infection. JAMA Intern
Med 2015;175:784– 91
14. Lambert, A. A., Lam, J. O., Paik, J. J., Ugarte-
Gil, C., Drummond, M. B., & Crowell, T.
A. (2015). Risk of Community-Acquired
Pneumonia with Outpatient Proton-Pump
Inhibitor Therapy: A Systematic Review and
Meta-Analysis. PLOS ONE, 10(6), e0128004.
doi:10.1371/journal.pone.0128004
15. Xie, Y., Bowe, B., Li, T., Xian, H., Yan, Y., &
Al-Aly, Z. (2017). Risk of death among users
of Proton Pump Inhibitors: A longitudinal
observational cohort study of United States
veterans. BMJ Open, 7(6), 1–12. https://doi.
org/10.1136/bmjopen-2016-015735
16. Haastrup, P. F., Thompson, W., Søndergaard,
J., & Jarbøl, D. E. (2018). Side Effects of
Long-Term Proton Pump Inhibitor Use: A
Review. Basic and Clinical Pharmacology
and Toxicology, 123(2), 114–121. https://doi.
org/10.1111/bcpt.13023
17. Jackson, M. A., Goodrich, J. K., Maxan, M. E.,
Freedberg, D. E., Abrams, J. A., Poole, A. C., …
Steves, C. J. (2016). Proton pump inhibitors
alter the composition of the gut microbiota.
Gut, 65(5), 749–756. https://doi.org/10.1136/
gutjnl-2015-310861
18. Cao, F., Chen, C. X., Wang, M., Liao, H. R.,
Wang, M. X., Hua, S. Z., … Xu, Y. L. (2018).
Updated meta-analysis of controlled
observational studies: proton-pump
inhibitors and risk of Clostridium difficile
infection. Journal of Hospital Infection,
98(1), 4–13. https://doi.org/10.1016/j.
jhin.2017.08.017
19. Imhann, F., Bonder, M. J., Vila, A. V., Fu, J.,
Mujagic, Z., Vork, L., … Zhernakova, A.
(2016). Proton pump inhibitors affect the gut
microbiome. Gut, 65(5), 740–748. https://doi.
org/10.1136/gutjnl-2015-310376
20. Su, T., Lai, S., Lee, A., He, X., & Chen, S. (2018).
Meta-analysis: proton pump inhibitors
moderately increase the risk of small
intestinal bacterial overgrowth. Journal of
Gastroenterology, 53(1), 27–36. https://doi.
org/10.1007/s00535-017-1371-9
21. Huang, W. S., Bai, Y. M., Hsu, J. W., Huang, K.
L., Tsai, C. F., Su, T. P., … Chen, M. H. (2018).
Use of Proton Pump Inhibitors and Risk of
Major Depressive Disorder: A Nationwide
Population-Based Study. Psychotherapy and
Psychosomatics, 87(1), 62–64. https://doi.
org/10.1159/000485190
22. Stark, C. M., Susi, A., Emerick, J., & Nylund, C.
M. (2019). Antibiotic and acid-suppression
medications during early childhood are
associated with obesity. Gut, 68(1), 62–69.
https://doi.org/10.1136/gutjnl-2017-314971
23. Schmulson, M. J., & Frati-Munari, A. C.
(2019). Bowel symptoms in patients that
receive proton pump inhibitors. Results
of a multicenter survey in Mexico. Revista
de Gastroenterología de México (English
Edition), 84(1), 44-51.
24. Jordakieva, G., Kundi, M., Untersmayr, E.,
Pali-Schöll, I., Reichardt, B., & Jensen-Jarolim,
E. (2019). Country-wide medical records
infer increased allergy risk of gastric acid
inhibition. Nature Communications, 10(1),
1–8. https://doi.org/10.1038/s41467-019-
10914-6
25. Raveendra, K., Jayachandra, Srinivasa,
V., Sushma, K., Allan, J., & Goudar, K. et al.
(2012). An Extract of Glycyrrhiza glabra
(GutGard) Alleviates Symptoms of Functional
Dyspepsia: A Randomized, Double-Blind,
Placebo-Controlled Study. Evidence-Based
Complementary And Alternative Medicine,
2012, 1-9. doi: 10.1155/2012/216970
26. Samardžić, S., Arsenijević, J., Božić, D.,
Milenković, M., Tešević, V., & Maksimović,
Z. (2018). Antioxidant, anti-inflammatory
and gastroprotective activity of Filipendula
ulmaria (L.) Maxim. and Filipendula vulgaris
Moench. Journal Of Ethnopharmacology,
213, 132-137. doi: 10.1016/j.jep.2017.11.013
27. Mahmood, A., FitzGerald, A., Marchbank,
T., Ntatsaki, E., Murray, D., Ghosh, S., &
Playford, R. (2007). Zinc carnosine, a health
food supplement that stabilises small
bowel integrity and stimulates gut repair
processes. Gut, 56(2), 168-175. doi: 10.1136/
gut.2006.099929
28. Miyoshi, A., Namiki, M., Iwasaki, A.,
Kobayashi, J., Hayakawa, A., Matsuo, H., &
Asaki, S., et al. (1997). Clinical Evaluation
of Z-103 in the Treatment of Gastritis. Jpn
Pharmacol Ther, 25(5), 1403-1442.
29. Miyoshi, A., Namiki, M., Asagi, S., Harasawa,
S., Ooshiba, S., & Hayakawa, K., et al., (1992).
Clinical Evaluation of Z-103 on Gastric Ulcer: A
Multicenter Double-Blind Comparative Study
with Cetraxate Hydrochloride. Japanese
Pharmacology & Therapeutics, 20(1), 199-223.
JATMS | Autumn 2020 | 55
 ADVERTORIAL
Scar Tissue, the most
overlooked issue in
Healthcare
by Marjorie Brook
What do all of the following have
in common? Caesarean “C” section,
Breast reduction, Breast augmentation,
Appendectomy, Laparoscopy,
Arthroscopy.
Well, that is easy right? They are all
surgeries. But would it surprise you to
know that 6 out of 10 women who walk
into my office do not consider C-sections
or breast work surgeries?
There is an alarm going off in my head.
When a new client comes to see me,
I have them fill out a medical history
intake form. It is very common for
people to “forget” about past injuries,
illness and, yes, even a minor surgery. It
has always amazed me nonetheless, how
does one forget they broke an arm or an
ankle? During a session I will observe
a scar and inquire as to its origin. The
client inevitably says, “What scar?
Where? Oh right? ...That’s from when I
wiped out on my motorcycle...”
I have been a licensed massage therapist
for over 20 years and, in all that time,
a recurring theme seems to have
prevailed. The presence of scar tissue
can have a lifelong physiological effect
on the body. This realisation, combined
with my clinical experience, education,
teaching and research, has led to my
developing the STRAIT (Scar Tissue
Release And Integrated Therapies)
Method to release restricted tissues
and restore balance and freedom of
movement.
Disclaimer: The views and opinions expressed in these advertorials are those of the authors and do not necessarily reflect the opinions of ATMS or its Directors.
56 | vol26 | no1 | JATMS
I’ve treated many patients whose
problems could be traced back to a scar
they had forgotten they even had. While
not every scar presents a problem, often
they can. This is due to the fact the body
is one large, three-dimensional piece of
fascia that envelops us like an intricate
spider web. Any kink, pull or restriction
in one area affects the whole matrix.
Scar tissue and adhesions are the result of
our body’s natural healing process and it
occurs both internally and externally. The
process, if working correctly, is supposed
to eliminate the scars and adhesions once
the wound is healed. In some cases, a
person’s body does not break down the
scar tissue. In others, adhesions have
built to help support the body due to
poor posture, repetitive use or injury.
The adhered tissue continues to spread
which can trigger a cascading effect of
compensations throughout the body.
The STRAIT Method is a series of fascial
techniques that release and realign the
restrictive tissue from the starting point
(visible scar) to the end point (where
the line of frozen fascia stops). This
release system, which I have developed
and now use with my clients, differs
from traditional methods because it
approaches the multi-faceted matrix of
fascia three dimensionally.
You see, I believe that our bodies are
intrinsically linked to our thoughts,
feelings, and actions. When we are
stressed, anxious or upset, our bodies
communicate back to us that something
isn’t right — for example, we may feel
increased tension in our shoulders. In
extreme circumstances, such as after the
loss of a loved one, high blood pressure
or a stomach ulcer may result. This is
why I think it’s crucial for therapists to
know their patients inside out in order
to understand what’s needed for long-
lasting healing.
The techniques behind the STRAIT
Method™ have been adopted by a
multitude of healthcare professionals —
from doctors and physical therapists, to
chiropractors and massage therapists. I
believe this kind of evolution towards
new treatment techniques means our
patients will always receive the very best
therapy we have to offer.
The STRAIT Method™ combines fascial-
scar work — working with a patient’s
damaged, restricted connective tissues
— with mind-body interactions, body
mechanics, therapeutic stretching and
strengthening, and proprioceptive
support. Each of these, when combined,
create a balanced treatment session that
can be modified to the needs of each
individual.
Marjorie Brook is an International Instructor/
Therapist. She is the creator of the STRAIT
Method, a specialized therapy for fascial
scars & adhesions. She will teach S.T.R.A.I.T
Method in Australia in May 2020, more
information at terrarosa.com.au

Continuing Professional Education
Continuing Professional Education
(CPE) is a structured program of
further education for practitioners in
their professional occupations.
The ATMS CPE policy is designed
to ensure its practitioners regularly
update their clinical skills and
professional knowledge. One of the
main aims of CPE is to keep members
abreast of current research and
new developments which inform
contemporary clinical practice.
The ATMS CPE policy is based on the
following principles:
• Easily accessible to all members,
regardless of geographic location
• Members should not be given
broad latitude in the selection and
design of their individual learning
programs
• Applicable to not only the
disciplines in which a member has
ATMS accreditation, but also to
other practices that are relevant to
clinical practice which ATMS does
not accredit (e.g. Ayurveda, yoga)
• Applicable to not only clinical
practice, but also to all activities
associated with managing
a small business (e.g. book-
keeping, advertising)
• Seminars, workshops and
conferences that qualify for CPE
points must be of a high standard
and encompass both broad based
topics as well as discipline-specific
topics
• Financially viable, so that costs
will not inhibit participation by
members, especially those in remote
areas
• Relevant to the learning needs of
EDUCATION & TRAINING
practitioners, taking into account
different learning styles and needs
• Collaborative processes between
professional complementary
medicine associations, teaching
institutions, suppliers of
therapeutic goods and devices
and government agencies to offer
members the widest possible
choice in CPE activities
• Emphasis on consultation
and co-operation with ATMS
members in the development and
implementation of the CPE program
ATMS members can gain CPE
points through a wide range of
professional activities in accordance
with the ATMS CPE policy. CPE
activities are described in the CPE
policy document as well as the
CPE Record. These documents can
be obtained from the ATMS office
(telephone 1800 456 855, fax (02) 9809
7570, or email info@atms.com.au) or
downloaded from the ATMS website at
www.atms.com.au.
It is a mandatory requirement of ATMS
membership that members accumulate
20 CPE points per financial year. CPE
points can be gained by selecting any
of the following articles, reading them
carefully and critically reflecting on
how the information in the article
may influence your own practice and/
or understanding of complementary
medicine practice. You can gain one (1)
CPE point per article to a maximum of
three (3) CPE points per journal from
this activity:
• McEwen, B. Sage advice for
cognitive impairment
• Stone M. Education standards
and the future of complementary
medicine professions part 2
• Grace S. Natural medicine and
sustainable healthcare
• Baxter, P. How to manage
hypersensitivity with integrated
manual therapies
• Medhurst R. Update on recent
research in homeopathy
• Pagura I. Small business and
cyber security
• Taylor et al. Dry needling: a
literature review
As part of your critical reflection and
analysis, answer in approximately
100 words the following questions
for each of the three articles:
1 What new information did I learn
from this article?
2 In what ways will this information
affect my clinical prescribing/
techniques and/or my understanding
of complementary medicine practice?
3 In what ways has my attitude to this
topic changed?
Record your answers clearly on paper
for each article. Date and sign the sheets
and attach to your ATMS CPE Record.
As a condition of membership, the CPE
Record must be kept in a safe place, and
be produced on request from ATMS.
JATMS | Autumn 2020 | 57
 PRODUCTS & SERVICES
10 knots Uniforms
sales@10knots.com.au | www.10knots.com.au | 0487 101 001
Imagine if your uniforms were designed by a fellow Practitioner, someone who
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knots uniforms, designed by Practitioners for Practitioners.
• Style and Comfort – freedom to move, adjustable fit and superb cut.
• Durable and breathable quality fabrics. Natural Linen or Functional
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• Ethically designed and manufactured in Australia, stock held on site,
no minimum order.
Feel the difference, from AM to PM appointments you will look and feel fresh. … I
designed your uniforms with a genuine desire to make a difference, aesthetically and
practically.
Australian College of
Weight Management
support@collegeofweightmanagment.com.au |
www.collegeofweightmanagement.com.au | 1300 969 367
The The Certificate IV in Weight Management (10576NAT) provides a holistic
approach to weight management including psychology, nutritional science and
exercise as well as how to structure and manage one-on-one consultations and
group clinics to maximise client results and business revenue streams.Get qualified
to write individualised meal plans for your clients and better understand how to
identify behaviours that sabotage your clients results and modify behaviours to
ensure long term client success. Study online anywhere, anytime with the flexibility
of online study. Download your free course prospectus today at www.tinyurl.com/
ATMSAD
Certificate IV in Weight Management (10576NAT) delivered by the Australian College of Weight
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Australian School of Remedial Therapies
admin@asrt.edu.au |www.asrt.edu.au | 02 9763 2388 |
0416 286 899
Established in Sydney in 1990 and founded and directed by Master Zhang Hao (B.
ED, Dip. TCM, RM.) the Australian School of Remedial Therapies offers nationally
accredited vocational education training qualifications in Diploma of Remedial
Massage and Diploma of (TCM) Remedial Massage.
The school also regularly delivers the short CPE skill update workshops throughout
the year which are specifically designed for professional massage therapists and
health care workers.
If you like a caring, practical, fun and personalised training tradition and environment
then try us!
To book an ATMS Products & Services Guide listing please
contact Yuri Mamistvalov on 0419 339 865.
58 | vol26 | no1 | JATMS
BioMedica Nutraceuticals
info@biomedica.com.au | www.biomedica.com.au
| 1300 884 702
BioMedica is an Australian owned company dedicated to the research, development
and production of high quality, low excipient and efficacious practitioner
formulations. Our products are developed by practitioners for practitioners. As a
‘Strictly Practitioner Only’ company, BioMedica is strongly dedicated to preserving
and enhancing the role of the holistic practitioner.
Our products are only sold to practitioners in a clinical setting, this has been our long
standing policy since our inception in 1998, and remains firmly in place to this day.
We also aim to provide highly relevant technical education materials and seminars,
with practical research and insights that can be immediately integrated into clinical
practice.
Bio-Practica
info@bioptactica.com.au | www.bio-practica.com.au | 1300 551 077
Bio-Practica believes that natural healthcare practitioners should play a fundamental
role in preventative healthcare. Key products in Bio-Practica range:
• BASICA – Alkalizing therapy rich in alkalising mineral citrates to support acid-base
balance in the body.
• MAGNESIUM DIASPORAL – Clinically trailled therapeutic Magnesium with proven
bioavailability.
• FROXIMUN TOXAPREVENT – Unique patented natural system for detoxification on
the intestinal tract and relief of liver.
• D-LACTATE FREE ProBiome PLUS – probiotics contain highly therapeutic,
scientifically documented probiotic strains.
Cathay Herbal
orders@cathayherbal.com | www.cathayherbal.com |
1800 622 042
Established in 1986, Cathay Herbal is a company that is run by practitioners who
constantly work to ensure they understand and meet the needs of you, the
practitioner. All products sold by Cathay Herbal undergo rigorous development
and investigation before being offered as part of their range. With one of the largest
ranges of Chinese Classical formulas outside of China, they don’t just stock the
popular ones. Cathay’s range is large and comprehensive. As well as the classical
Black Pill range they also have many formulas available in tablet and capsules and a
range of herbal granules, liquids and plasters.
Core Body Therapy
info@corebodytherapy.com.au |
www.corebodytherapy.com.au | 0405 386 256
Core Body Therapy was developed in 2003 by Chris O’Brien, one of the most
respected Myofascial Release Therapists and Teachers in the industry. A complete
system of bodywork not offered in any other institution, our hands-on CPE courses
will take your therapeutic bodywork deeper than traditional injury therapy moving
beyond your initial training.
Core Body Therapy recognises the need for small groups to give the highest quality
training possible. We make sure you get plenty of one on one time for optimum
learning. Our courses are geared towards dedicated, results oriented therapists
seeking to further their practice.
 Health World Limited
PRODUCTS & SERVICES

www.healthworld.com.au | 07 3117 3300

Health World Limited is recognised as a Leading Natural Health Science Company

and the innovators in Natural Health products and Healthcare professional
education. Health World Limited and Metagenics have invested in cutting edge
manufacturing technology and equipment in order to expand production of the
highest quality Natural Medicines. This level of commitment ensures that Health
InterClinical Professional
World Limited produces products that you and your patient can trust for quality and

lab@interclinical.com.au | www.interclinical.com.au | 02 9693 2888
effectiveness.

InterClinical Professional is an Australian Owned practitioner only range of nutritional

and herbal supplements. Our close collaboration with local researchers, experts and
Helio Supply Co
practitioners, together with Dr David L. Watts in the USA have created a low excipient,

flexible dosing range of vegan friendly nutritional supplements. Specifically designed
tcm@heliosupply.com.au | www.heliosupply.com.au | 02 9698 5555
to address biochemical individuality, our evidence based range uses bio-activated,
fully reacted chelated minerals and synergistic nutrients for optimal absorption. All our
Helio Supply Co is a wholesaler of Acupuncture and TCM supplies. We distribute
products are manufactured in Australia in accordance with GMP compliances and TGA
both nationally and internationally and we pride ourselves on our service to
regulatory guidelines; and we source the highest quality raw material inputs with the
customers. Established in 2000, we are committed to providing educational
least amount of potentially allergenic ingredients. Our products are gentle, economical
opportunities, a practitioner support line and sourcing the best domestic and
and encourage patient compliance.
international equipment and materials.

Herbs of Gold Pty Ltd

McLoughlin Scar Tissue Release®
info@herbsofgold.com.au | www.herbsofgold.com.au | 02 9545 2633
gailtumesMSTR@gmail.com | www.mcloughlin-scar-release.com/gail-
tumes | 0417 005 510
Herbs of Gold has been dedicated to health since 1989, providing premium and
practitioner strength herbal and nutritional supplements. Formulated by qualified, clinical
CPE RECOGNITION with your preferred Instructor – Gail Tumes. MSTR® is a highly-
and industry experienced naturopaths, herbalists and nutritionists, our formulations are
advanced, innovative and successful method of scar tissue treatment. Untreated
based on current scientific research and traditional evidence. We take great care in all
scar tissue can impede or prevent successful therapeutic intervention. Many
aspects of our business; right from the selection of raw materials through to the finished
bodyworkers have little or no knowledge of scar tissue, how it affects the body and
product, reviewing our environmental impact and sustainability of ingredients. All Herbs
more importantly what can be done to treat it and minimise its effect. This 1-day
of Gold products meet stringent regulations for safety, quality and efficacy.
Workshop can change all that. To secure your place with Gail Tumes, go to www.
mcloughlin-scar-release.com/gail-tumes

HESTA
Terra Rosa
hesta@hesta.com.au | hesta.com.au | 1800 813 327
Terra Rosa
www.terrarosa.com.au
Your Source for Massage Information
For more than 25 years, HESTA has focused on helping those in the health and terrarosa@gmail.com | www.terrarosa.
community services sector reach their retirement goals. We now have more than 785,000 com.au | 0402 059 570
members, 155,000 employers and more than $28 billion in assets. HESTA’s size means
we can offer many benefits to members and employers. These include: low fees, a Terra Rosa specialised in educational massage DVDs and books. It has the largest
fully portable account, easy administration, access to low-cost income protection and collection of massage DVDs in Australia and the world, covering all modalities from
death insurance, limited financial advice (at no extra cost), super education sessions and Anatomy, Swedish Massage, Reflexology, Sports Massage to Myofascial Release
transition to retirement options. We also provide access to great value health insurance, and Structural Integration. We also provide the best in continuing education with
banking and financial planning. For more info visit hesta.com.au or call 1800 813 327. workshops by international presenters including Orthopaedic Massage, Taping,
Issued by H.E.S.T. Australia Limited ABN 66 006 818 695 AFSL No. 235249,Trustee of Health Employees Superannuation Trust
Australia (HESTA) ABN 64 971 749 321. For more information about HESTA, call 1800 813 327 or visit hesta.com.au for a copy of a Fascial Fitness and Myofascial Therapy.
Product Disclosure Statement which should be considered when making a decision about HESTA products.

InterClinical Laboratories The Pharmaceutical

Plant Company
lab@interclinical.com.au |www.interclinical.com.au | 02 9693 2888

sales@ppcherbs.com.au | www.ppcherbs.com.au | 03 9762 3777

InterClinical Laboratories have been providing a 37 element Hair Tissue Mineral

Where nature, science and health come together. PPC offers healthcare professionals
Analysis (HTMA) for over 20 years. We are pleased to be able to provide the gold
a choice of either traditionally made herbal extracts from dried plant materials; or
standard in reliable testing, using the most up to date technology. We provide real
fresh plant tinctures that are all grown in Tasmania and processed within hours of
measurements in parts per million. Measuring individual mineral levels is effective,
harvest. PPC uses Organically certified herb where possible, with the entire Fresh
however knowing patient nutrient and toxic mineral ratios is crucial for a proper
Plant Tincture range being Australian Certified Organic. The Pharmaceutical Plant
understanding of your patient’s health. Our reports are easy to understand and
Company has 25 years experience in manufacturing and distributing traditional
comprehensive, including dietary and supplement recommendations. Join our team
herbal extracts, fresh plant tinctures and listed medicines in Australia.
of thousands of practitioners who use authentic HTMA to help establish an accurate
picture of a patient’s tissue mineral status. We provide a free, friendly, one on one
training and technical service; taking you through each report in detail.

JATMS | Autumn 2020 | 59

AUSTRALIAN OWNED
& MANUFACTURED