On November 29th, 2011, the Council of the College of Physicians and Surgeons voted to accept their new revision of the policy on Complementary/Alternative Medicine, a policy that has undergone revision with community consultation over the past two years.
Skeptics at the Centre For Inquiry’s Committee for the Advancement of Scientific Skepticism, after celebrating a win described here, with the revisions to the policy prior to the vote, were even more surprised when the last two controversial paragraphs describing the type of opinions physicians can express to their patients were struck from the document.
The following two paragraphs do not appear in the final document:
“Where physicians are unfamiliar with the CAM modality or intervention in question, they must indicate as much to the patient, and explain that they are consequently unable to comment on the matter.”
“Clinical concerns must always be highlighted, however physicians must refrain from expressing personal non-clinical judgements or comments about the therapeutic options, or the patient’s health care goals or preferences unless that input is specifically requested by the patient.”
The muzzle on a doctors that these two paragraphs represented was not the original intent of the policy, but concerns were expressed not only by CASS by by the Canadian Medical Association, the Toronto Star editorial staff, the National Post and our colleagues at ScienceBasedMedicine.org. When asked by CASS to confirm the dropping of the two paragraphs, a representative of the CPSO responded with this reply:
Thank you for your email, and your interest in the Complementary/Alternative Medicine policy. You are correct that the final version of the Complementary/Alternative Medicine policy differs slightly from the version that was included in the November Council materials. The changes incorporated into the final version of the policy were made at the Council meeting.
The changes relate to policy content on personal, non-clinical comments. The Working Group included this content originally out of an interest in promoting open, respectful communication between physicians and patients. Stakeholder feedback, however, suggested that the Working Group’s intention did not come through clearly, and respondents were concerned that the policy content would stifle or restrict physician-patient communication.
The Working Group felt this was an important issue to address. It proposed to Council that the content on personal, non-clinical comments be deleted in the final version of the policy. The Working Group felt this change would address stakeholder concerns, and that existing policy content was sufficient to promote professionalism in physician-patient communications.
Thank you again for your interest, and your participation in the consultation process.
The efforts of Canadian and American skeptics alike have resulted in a re-entrenchment of science and evidence in the practice of medicine but that has not stopped a certain fraction of the so called “integrative” medical community from characterizing the CPSO in less than flattering terms. The same weekend that the CPSO was voting on this final policy, the Whole Life Expo held a talk (near the bottom of the page), witnessed by CASS members, that discussed the new CPSO policy and resulted in describing those at the CPSO as “Nazis”, invoking Godwin’s law. They also announced the foundation of a new organisation that is meant to fight what they feel is an attack on non-conventional medical therapies: People for the Right to Integrative Medicine.
PRIM has decided to characterize what is, in essence, a commitment by the CPSO to follow the evidence when providing medical care as an attack on patient’s rights to alternative medicine. This is of course hyperbole, and no such limitation exists with the implementation of this policy, as the colleges that govern naturopaths and homeopaths will soon be taking registrants and patients can now choose to visit those practitioners, who do not appear to have any ethical restrictions regarding unproven treatments. It is important, however, for physicians to know if it is ethical to provide or prescribe a therapy that does not have any evidence to back it up. It is clear that, outside of experimental trials, unproven treatments should not be offered by physicians in Ontario.
As is often the case, those in the CAM or Integrative medicine communities will no doubt spread the myth that a large chunk of mainstream medical interventions do not have enough evidence to justify their clinical use. Dr. Steve Novella does a good job of tearing these myths down. When we turn the spotlight back on CAM, however, we see that many of the modalities practiced by naturopaths, the mainstream of CAM practitioners in Canada, are not supported by any evidence whatsoever. We have to make sure we are diligent to counter these unreasonable and irrational ideas and continue to promote the quality health care offered by science-based medicine.
This campaign by CASS at the CFI has been very successful and shows that with a little bit of public shaming and a lot of good, rational argument, supported by evidence, can turn the tide against bad regulation.