The College of Physicians and Surgeons of Ontario are poised to vote on the new revision to the Complementary/Alternative Medicine policy that has been under review for the past several years. The new revision sports a name change and other clarifications that are generally good, however, the restrictions put on doctors to offer their opinion on a specific CAM therapy remain in the document. The previous efforts of the Centre for Inquiry Canada and the Committee for the Advancement of Scientific Skepticism (CASS) were detailed on Skeptic North on August 31st 2011.
The new revision (pages 247-276) includes the following important changes:
- “Allopathic”/”non-Allopathic” replaced by “Conventional”/”Complementary/
Alternative” throughout. Conventional medicine also referred to as “science-based medicine”.
- Requirement that diagnoses and therapeutic recommendations be “informed by science and evidence” added in several places.
- Tightening of some loopholes that weakened standards of evidence in certain cases. Scientific evidence is now required at all stages.
- Consent for CAM treatments requires notification about “true facts” about conventional options, and physicians may not “malign proven benefits” of treatments.
- Removal of (bizarre) requirement that physicians propose all appropriate CAM and conventional treatments.
The results from the survey were telling and it was obvious to the CPSO that there were two groups fighting over this document, the “scientific/sceptic lobby” and the “pro non-allopathic/anti-CPSO” lobby, as detailed in their analysis. The name change alone could be lauded as a win for skepticism and critical thinking, as the term “allopathy” is a pejorative term, however what is even a bigger win is the use of “science-based medicine” as a descriptor of conventional medicine. The folks at SBM should be happy with us for sure!
Unfortunately, all is still not well with the policy, and several problem still remain:
- No change to requirement that physicians “refrain from expressing personal non-clinical judgements” about their patients choices to use CAM therapies. Physicians are still not allowed to comment on unfamiliar modalities.
- No acknowledgement that CAM therapies are mostly worthless.
- Prohibition on use of ineffective therapies still only applies to those “proven ineffective through scientific study” (changed from “proven ineffective”). Since proof is hard to come by, this is a very weak prohibition.
It is important to emphasis point one in this list. Doctors have many years of scientific education. While they are not trained as researchers, they rely on the scientific method and its outcomes to investigate, diagnose and treat their patients. This should allow physicians to come to an informed opinion when faced with a CAM therapy despite the fact that they are not trained in it. When approached by a patient who wants to eschew standard medical treatment or spend precious healthcare dollars on a treatment for cancer that includes “rebalancing their energy field” a doctor should be able to have a frank conversation with their patient about the absurdity of this therapy. It is vitally important that physicians do not alienate their patient in this exchange and it is a delicate conversation to have in order to properly inform the patient of the lack of evidence for this decision while persuading them to accept the proven treatment, however this policy goes a long distance to put a chill on physicians who wish to have this conversation in the first place. This policy must be changed to allow open and free communication between the physician and patient, lest the doctor miss an important opportunity to help the patient protect themselves from harm.
What is most heartening is that the Toronto Star published an editorial this week stating their concern with the above policy. It appears we are building allies against those promoting dubious medicine, and we are using the same language.
That said, in the revised policy there is an emphasis put on the fact that clinical investigation should be science-based and that any diagnosis and treatment should flow from this requirement. This puts potential limits on alternative diagnosis methods that are decidedly unscientific, like the pulse or tongue diagnoses used by Traditional Chinese Medicine practitioners, including naturopaths.
The document linked to above from the CPSO also contains their submissions to the transitional councils of the colleges of Homeopaths and Naturopaths in Ontario and is worth the read (pages 447-465). Despite the growing interest in these dubious therapies, the medical profession in Canada remains focused on science and proper evidence.
The Centre for Inquiry Canada is committed to promoting an objectivity through critical thinking and scientific investigation and we have been energised by this win with skeptical activism. If you have a concern about health policy and CAM in your area. please let us know. firstname.lastname@example.org