New proposed Ontario guidelines for how doctors should acknowledge and incorporate alternative therapies in their practices are getting a backlash from professional and regulatory bodies. The groups argue that the College of Physicians and Surgeons of Ontario’s (CPSO) draft guidelines on Non-Allopathic (Non-Conventional) Therapies in Medical Practice use a lower evidentiary bar for measuring the safety and efficacy of complementary (alternative) medicine therapies and are effectively asking physicians to counsel patients to undertake unscientific health practices - and physicians will be placed in the position of breaching their duty to provide patients with the best possible care.
The current draft guidelines that would compel physicians “to propose both allopathic and non-allopathic therapeutic options that are clinically indicated or appropriate” must:
“have a demonstrable and reasonable connection, supported by sound clinical judgment, to the diagnosis reached;
possess a favorable risk/benefit ratio, based on the merits of the option, the potential interactions with other treatments the patient is receiving, and other considerations the physician deems relevant;
take into account the patient’s socio-economic status when the cost will be borne by the patient directly; and
have a reasonable expectation of remedying or alleviating the patient’s health condition or symptoms.”
The guidelines also discourage physicians from referring to nonconventional therapies are a form of quackery - 30% of the articles on Science 2.0 regarding nonconventional therapy, and 100% of the articles on homeopathy, would have to be edited if 'quackery' was not allowed.
Why? For no reason other than alternative medicine has gotten popular in Canada, it seems. "Patients are entitled to make treatment decisions and to set health care goals that accord with their own wishes, values and beliefs."
The Canadian Medical Association argues that the guidelines suggest a false equivalence between conventional and alternative medical approaches. "The use of complementary and alternative medicine in Canada should be founded on sound scientific evidence as to its safety, efficacy and effectiveness: the same standard by which physicians and all other elements of the health care system should be assessed. When alternative treatment modalities do demonstrate effectiveness, they are usually incorporated into the mainstream of medicine. Therefore, one could argue that complementary and alternative therapies are by definition less demonstrably effective than conventional medical treatment".
How do skeptics feel? The guidelines may be "interpreted as impressing tight limits on physicians' ability to state their honest, scientifically sound objections to pseudo-scientific medical theories and ideas," the Committee for the Advancement of Scientific Skepticism contended. "Their non-conventional medical counterparts feel no such compunction in spreading misinformation about legitimate medical practices such as vaccination, as well as in misrepresenting the scientific standing of dubious non-conventional practices."
In other words, doctors can't speak outside clinical judgment but homeopathy practitioners can. Obviously opinion is based on knowledge. Yet the standards seem to want to impose artificial equivalence and make medical doctors more collegial and willing to refer patients to practitioners of nonconventional and alternative therapies.
The British Columbia Medical Association argued that the notion that physicians should collaborate with, or refer patients to, alternative practitioners "is not compatible with the doctor's duty to provide care that is consistent with the best available information.”
Several organizations suggest the CPSO revise its guidelines to adopt the much more modest approach taken in British Columbia, which directs physicians to:
Employ a rigorous medical approach before offering any unorthodox therapy. The use of an effective and proven therapy must not be delayed or supplanted by the choice of a complementary or alternative treatment;
Not expose a patient to any degree of risk from a complementary or alternative therapy of no proven benefit;
Not associate with, or refer patients to, alternative practitioners who recommend unproven over proven therapies; and
Terminate the physician–patient relationship if a patient's choice of a complementary or alternative therapy has made it impossible for the physician to discharge his or her ethical responsibilities (www.cpsbc.ca/files/u6/Complementary-and-Alternative-Therapies.pdf).
According to the Committee for the Advancement of Scientific Skepticism, an estimated 76% of Canadians have used at least one alternative therapy in their lives, while Canadians spent a projected $7.84 billion on such therapies between 2005 and 2006.
Citation: Lauren Vogel, 'Backlash grows against Ontario’s nonconventional therapy guidelines', CMAJ, September 2011 DOI:10.1503/cmaj.109-4004