Nov 29 2011

Creating a CAM Double-Standard in Canada

The College of Physicians and Surgeons of Ontario (CPSO) has a proposed guideline for physicians that has caused some controversy. The proposed policy addresses the issue of so-called complementary and alternative medicine (CAM) and has drawn serious criticism from Canadian physicians (at least those who are paying attention and have the slightest clue about what is going on). The backlash is good to see, but it is not nearly vigorous enough.

The original proposed policy contained several recommendations that are right in line with CAM proponents – who keep trying to achieve through legislation and intimidation what they cannot achieve through science and evidence, namely acceptance and access. The proposed policy is a good example of this, as well as demonstrating how CAM proponents wish to carve out a double standard for themselves, so that they can be free to practice whatever nonsense they wish without being held to all that pesky science and evidence.

The first clue that CAM proponents had their hands all over this policy is the fact that it referred to science-based medicine as “allopathic” and CAM and “non-allopathic.” Modern scientific medicine is not “allopathic” – that is a derogatory term invented by Hahnemann to refer to the standard medicine of his time (which was both ineffective and toxic) and to distinguish it from homeopathy. CAM proponents are very adept at playing semantic games to frame CAM in as positive a light as possible. The truth is that there is science-based medicine and there is everything else. All therapies and modalities lie someone along the spectrum of safety and efficacy, and are backed by various amounts of evidence, and may even have evidence for lack of efficacy.

That is all that matters – but when one common sense and science-based standard is applied, almost all of CAM collapses and crumbles to dust. That’s why it’s CAM – if it worked it would just be medicine. So CAM proponents have desperately tried to make the debate about anything else: healthcare freedom, conspiracies, Big Pharma, protectionism or elitism, they cry that they are being treated unfairly, or that science doesn’t work – that they need a new kind of science. It’s all an elaborate game of, “ignore that man behind the curtain.” It has been distressingly effective, as the CPSO proposal indicates.

The parts of the proposed policy that have caused the most concern are those that encourage physicians to work with “alternative” practitioners, granting CAM practitioners a status they have not earned and do not deserve. The Canadian Medical Association has responded, criticizing this aspect of the proposed policy. They state:

“It is a matter of concern for us, that CPSO’s draft policy appears to require of physicians a high level of knowledge regarding [alternative medicine], and a high level of acceptance for its routine incorporation into practice,” the CMA said.

I don’t think it’s a bad thing for physicians to have greater knowledge of CAM, the better to inform their patients about it properly. But physicians should not be encouraged to incorporate unscientific practices, or refer to those who do. This is definitely a step toward requiring physicians to practice CAM or refer to those who do, as I wrote about recently.

Perhaps the most disturbing part of the original proposed policy is this statement:

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.

This is a thinly-veiled attempt to silence criticism – to silence any doctor who has the sense to understand that it is their duty to protect their patience from unsafe or ineffective treatments. CAM proponents are as clever as creationists in couching their true goals in language that seems inoffensive, but the goal is obvious to anyone who has been paying attention.

Then there is this:

In its original form, it said doctors should respect patients’ wishes to try non-conventional care and require “sound evidence,” but not necessarily clinical trials, to back up any alternative treatments they use.

Here we have the double-standard. They want different standards of evidence for CAM than for conventional medicine – a lower standard, one that allows treatments that are unscientific and not backed by sufficient evidence to be accepted by science-based practitioners.

Fortunately there has been some backlash and media attention paid to this issue.  There is now a revised draft policy with some positive changes:

The new iteration of the Ontario draft suggests everything a doctor does should be informed by “evidence and science.” It removes a suggestion the type of evidence required to justify a therapy depends on the nature of the treatment. It also removes a statement that seemed to allow doctors to employ therapies whose effectiveness and safety are unknown, so long as they act “in a cautious and ethical manner.”

Still, the policy is soft on CAM. The very fact that there is a policy on CAM, and that the CAM category is recognized, plays into the framing of proponents. There is only medicine, and there should be only one standard. We don’t need a separate category for treatments that are not based on science and evidence, except as a marketing strategy.

The original proposed policy makes the agenda of CAM proponents clear. They want to create a double standard, with a lower bar of evidence for their preferred practices. They want to silence critics. They want doctors who may be skeptical of CAM practices to just shut up and refer their patients to CAM practitioners. They want to pressure physicians with accusations that they are being unfair, when in fact it is the CAM proponents who are being unfair.

While the revised policy is an improvement, the greater victory may be in just exposing the CAM agenda for what it is, and for waking up at least the CMA to the threat to science-based medicine and patient health.

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