Saturday, August 13, 2011

Non-Allopathic (Non-Conventional) Therapies in Medical Practice


The College of Physicians and Surgeons of Ontario has produced a draft policy on Non-Allopathic (Non-Conventional) Therapies in Medical Practice. The document is flawed from the beginning because it gives credence and respectability to "alternative medicine," otherwise known as non-evidence based medicine or quackery.

The policy is designed to provide guidelines for physicians who are: (1) tempted to employ non-evidence based medicine, (2) tempted to condone non-evidence based medicine in situations where it might harm patients. We all recognize that front-line physicians face these issues all the time and they often find themselves in a position where they disagree with the choices their patients are making.

However, most physicians don't hesitate to tell you that you should stop smoking. They seem to enjoy lecturing you on the benefits of diet and exercise even when it's clear that a patient prefers a different lifestyle. Why should it be any different when a patient reveals that they are taking homeopathic concoctions or when they refuse to vaccinate their children. Don't physicians have a professional responsibility to inform their patients that they are making unwise decisions?

The draft policy address these issues but it does so in a way that's far too lenient toward quack medicine. To begin with, it defines allopathic medicine as,
Different operative terms have been adopted that were deemed to be value-neutral: ‘Allopathic medicine’ refers to traditional or conventional medicine (as taught in medical schools) and ‘non-allopathic therapies’ refer to complementary or alternative medicine.
This is idiotic. "Allopathic" medicine is NOT a value-neutral term. It's the term used by homoepathic quacks to describe medicine that uses drugs to treat patients. By adopting this terminology, the College of Physicians and Surgeons is playing right into the hands of the quacks.
Allopathic Medicine: refers to the type of treatment, diagnostic analysis and conceptualization of disease or ailment that is the primary focus of medical school curricula and which is generally provided in hospitals and specialty or primary care practice.

Non-Allopathic Therapies (Non-Conventional Therapies): refers to a broad range of procedures or treatments that are not commonly used in allopathic medicine; this includes those referred to as complementary or alternative. Non-allopathic therapies tend to differ from allopathic medicine in terms of diagnostic techniques, theories of illness and disease, and treatment paradigms. The categorization of specific therapies as non-allopathic is fluid: as clinical evidence regarding efficacy is accumulated, certain non-allopathic therapies may gain broad acceptance and thus be accepted in allopathic medicine.
I work in a medical school. The operative phase is "evidence-based medicine" and I suspect that's a term used in most medical schools in Ontario. That's what is taught in medical schools and hospitals and that's how you describe proper medicine.

The opposite of evidence-based medicine is "non-evidence-based treatment." Those are not "value-neutral" terms. They are something different—it's called "truth," and truth is not neutral. The College of Physicians and Surgeons needs to acquire some gumption and stand up for what's being taught in the medical schools and stand up for science. This draft policy is ridiculous, it announces that the College is abandoning science and evidence in favor of condoning quackery.

Here's how the draft policy would read if we substitute the true definitions.
Respect Patient Autonomy

Patients are entitled to make treatment decisions and to set health care goals that accord with their own wishes, values and beliefs. This includes decisions to pursue or to refuse evidence-based or non-evidence based therapies.

The College expects physicians to respect patients’ treatment goals and decisions, even those which physicians deem to be unfounded or unwise. In doing so, physicians should state their best professional opinion about the goal or decision, but must refrain from expressing non-clinical judgements.
Nothing has been lost by using "evidence-based" instead of "allopathic." Now, let's look at the meaning of this policy statement.

It's classic gobbledygook because it confuses "respect" with "responsibility." Physicians are not obliged to "respect" parents who refuse to give their child a life-saving blood transfusion. They aren't obliged to "respect" parents who deny their children vaccinations. They certainly don't "respect" parents who abuse their children. And I've never encountered a physician who "respects" smokers and drug users, have you?

Lots of patients don't earn respect and don't deserve it.

Read the guideline carefully as I amended it. If they were adhered to, then no physician could possibly recommend non-evidence based therapies since that would conflict with their professional opinion (or, at least it should). But later on we read,

Providing Non-Allopathic Therapies

When providing non-allopathic therapies, physicians are expected to demonstrate the same commitment to clinical excellence and ethical practice, as they would when providing allopathic care.
What the heck is that all about? The policy should read ...
Any physician who provides non-evidence based therapies (especially for a fee) will be subject to charges of professional misconduct and may lose his/her license to practice medicine in Ontario.
That's the only sensible policy that's consistent with what's written elsewhere in the document. You simply can't provide non-evidence-based therapies while maintaining "a commitment to clinical excellence and ethical practice." That's oxymoronic.

The Committee for the Advancement of Scientific Skepticism (CASS) is very interested in this issue. Read what Michael Kruse has to say on his blog Skeptic North: Ontario Doctors Given Green Light to Promote Quackery.
I would not be writing this if I thought we could do nothing to oppose and change the viewpoint of the CPSO. That is why CASS is calling on members of both the public and the medical field to read the policy and comment on it. There is strong representation in the current comments of supporters of alternative medicine and we do not want all of the feedback to be pro-pseudoscience. Please visit the CPSO policy site above and fill out the comment form available at the bottom of the page. The deadline for this consultation is September 1st 2011, so we must move quickly and let the CPSO know the safety of Ontarians depends upon sound medical opinion based on modern scientific evidence.
Please voice your opinion at Feedback: Non-Allopathic Therapies draft policy. Your response has to sent by email to ThirdPartyProcesses@cpso.on.ca. I have no idea how much censorship is applied to the responses they post—I suspect it's considerable so don't expect criticisms to appear on the website.


9 comments :

  1. Assopathic medicine -- Harnessing the energy fields of 300C guano in the treatment of all muscular, skeletal, respiratory, coronary-vascular, neurological diseases/conditions and the maintenance of balance of the four humours, seven chakras, and twenty meridians.

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  2. Hey Larry,

    This is Ron Brown - formerly of UTSA and The Frame Problem blog.

    I just did a spoof post on homeopathy at my blog.

    http://deathbytrolley.wordpress.com/2011/08/14/tomorrows-dinner-homeopathic-chicken-stirfry/

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  3. a) my doctor has never told me to lose weight, even though I'm on the normal/overweight border. Doctors also never told my grandparents to quit smoking. It's easier to prescribe a drug than a behavior change.

    b) many of our conventional medicines started out as "homeopathic" remedies--e.g. chewing on willow bark. Once the reasonable evidence based treatments have been exhausted, I see no reason to not try homeopathic remedies.

    c) If allopathic doctors actually practiced evidenced based medicine, I'd have more faith in the system--just look at the evidence regarding inductions and C-sections and it's obvious that convenience trumps evidence, at least in OB land.

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  4. Its really interesting that they are using allopathy to describe 'medicine' and non-allo-pathy to describe the alternative.

    Allopathy was apparently coined by a Homeopath, to contrast 'medecine' with homeopathy.

    So, if they're going to use allopathy in their statement, they should also use 'homeopathy', forget about evidence vs. non-evidence. They should be talking about Allopathy vs. Homeopathy, non-allopathic is an idiotic term.


    Anyway, this is all very interesting. Consider that Osteopathy used to be a competitor to 'medicine', and osteopathic colleges were part of that 'alternative medicine' world. BUT, in order to do things like treat and cure patients, they started dropping osteopathic treatment, and made their college curricula in-line with that of Medical Schools. The result is that, today, you can get medical treatment from an MD or a DO, but not a naturapath or a homeopath.

    Osteopathy gained respectability and success by making their curricula and degree path identical to that of a Medical School, and here these guys are, rather than defining 'allopathy' as 'evidence based medicine', are calling it 'medicine as taught in medical school'.
    I think that's /really/ interesting that they'd describe it that way. They've gone out of their way to avoid making a 'value based statement' (like calling it 'evidence based medicine' and thus endorsing it), BUT at the same time, they need to effectively say that doctors should be practicing just that, so they use a fallback term like 'medicine as in medical school', which is exactly the same standard that Osteopathy now uses (and thus undid itself as 'bone alignment as the source of disease and sickness').

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  5. You know what they call alternative medicine that works ? - Medicine.

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  6. Whatever happened to respecting patients desire to be treated medically or naturally? Who died and made medicine god? Medicine is great when its absolutely needed to save someones life in a time of need, but at times it is unnecessary and natural remedies and lifestyle choices should be respected as an alternative. We live in a country of freedom of choice and its absolutely unprofessional to put other professions down, not only is it unprofessional but it is doing a disservice to your patients.

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    Replies
    1. You're very confused. Sure, patients have the right to use ineffective or dangerous quack therapies if they want. But there is nothing "unprofessional" about pointing out when a therapeutic claim is inconsistent with scientific evidence.

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    2. Lutesuite:'patients have the right to use ineffective or dangerous quack therapies'. I believe you have it backwards.
      In the USA alone, over 200,000 people die every year for doing exactly what the doctor says (your doctors, the allopathic practitioners that you do seem to like so much); when you take a medication as prescribed, in a 5 year period 1000,000 will die because of the side effects. Look it up, I am sure you are smart enough to see how absurd is your prior post.

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    3. Yes. Medical errors occur, and no medication is completely without risk or side effects. So what is your point? You're still much less likely to die if you are treated by a competent professional, as opposed to a quack who uses unproven or disproven "alternative treatments".

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