Respectful Insolence

ORAC NOTE: Work kept me out late last night going out to dinner with a visiting professor. Fortunately, it was actually pretty fun. Unfortunately, it kept me from cooking up a heapin’ helpin’ of the Insolence, either Respectful or not-so-Respectful, that my readers crave. So instead, here’s a repost from elsewhere. I didn’t think I could use it because the deadline for the survey I discuss was originally September 1. Fortunately, the College of Physicians and Surgeons of Ontario (CPSO) extended the deadline to September 16, making this post relevant for exactly one more week. Enjoy! And go and comment!

Detroit is my hometown. One thing that people unfamiliar with the city are rarely aware of (besides how Detroit is the only point in the U.S. that lies north of Canada) is how intimately southeast Michigan interacts with Canada. This closeness is not surprising, given that Detroit and Windsor are separated by only about a half mile of Detroit River. Indeed, a there are a lot of Canadians who cross the border on a daily basis to work in the Detroit area and vice-versa. The reason I point this out is not to wax nostalgic for trips to Windsor or for the occasional trip to Stratford to see plays but to point out that hat happens there is of concern to me because I know quite a few people who live there and because it can on occasion influence what goes on over here on the U.S. side of the border.

I recently learned that the College of Physicians and Surgeons of Ontario (CPSO) has been working on updating its policy on the use of nonconventional medical therapies. The wag in me can’t help but wonder why such a policy would need to say anything other than that, if it isn’t science- and evidence-based, the CPSO doesn’t support using it, but in a less sarcastic moment I realized that such a policy is probably not that bad an idea, as long as it doesn’t legitimize pseudoscience, which is, of course, the biggest pitfall to be avoided when writing such a policy. Not too long ago, the CPSO released its draft policy and has asked for public comments, with the deadline being September 1. I was happy to learn that I had not missed the deadline, because there is much to comment about regarding this policy, but it’s definitely true that time’s short. Unfortunately, I wasn’t so happy when I read the title of the draft policy, namely Non-Allopathic (Non-Conventional) Therapies in Medical Practice, with a subtitle of “Formerly named Complementary Medicine.” The full policy in PDF form can be found at this link.

“Allopathy” versus everything else?

Regular readers will probably notice one thing right away, even before clicking on either of the links and reading the draft policy. The problem is right there in the title and, in fact, I was floored when I first read the title. My jaw dropped, and dropped hard. Basically, I couldn’t believe that the CPSO had decided to use the term “allopathic” to describe science- and evidence-based medicine. True, that wasn’t the only problem, but it gave me a sinking feeling to see such a term right there in the title that this policy statement was not going to end well. So what’s the problem?

“Allopathic medicine” was a derogatory term originally coined by Samuel Hahnemann, the inventor of homeopathy to contrast homeopathy with the medicine of the time, namely that of 200 years ago. Hahnemann, as you may recall, believed in what he called the Law of Similars, which states that “like cures like,” or, to be more clear, that medicines that cause the same symptoms as a disease should be used to treat the disease. Doing this would stimulate the “vital force” and lead to resolution of the symptoms. Of course, this is nothing more than the principles of sympathetic magic transmuted (if you’ll excuse the term) into a different element, namely that of medicine; there has never been any convincing evidence–or even much in the way of evidence at all–that “like cures like” (or, using the Latin that Hahnemann favored, similia similibus curentur) is a general principle in biology or medicine. According to Hahnemann, “allopathy,” as opposed to homeopathy, is medicine that violated the law of similia similibus curentur and treats disease using remedies whose effects differ from those produced by that disease, the term meaning “other than the disease.” From its very origin, in fact, “allopathy” has been a derogatory term for medicine that is not homeopathy. Indeed, you can even find quotes to that effect documented in–of all places–the Wikipedia entry on allopathy. For instance, James Whorton points out in his book Nature Cures: The History of Alternative Medicine in America:

One form of verbal warfare used in retaliation by irregulars was the word “allopathy.” Coined two hundred years ago by Samuel Hahnemann, founder of homeopathy, it was taken from Greek roots meaning “other than the disease” and was intended, among other things, to indicate that regular doctors used methods that were unrelated to the disharmony produced by disease and thus were harmful to their patients. “Allopathy” and “allopathic” were liberally employed as pejoratives by all irregular physicians of the nineteenth century, and the terms were considered highly offensive by those at whom they were directed. The generally uncomplaining acceptance of [the term] “allopathic medicine” by today’s physicians is an indication of both a lack of awareness of the term’s historical use and the recent thawing of relations between irregulars and allopaths.

The other aspect of the term “allopathy” is that it was consciously used by practitioners of “unconventional” medicine to relegate “conventional” medicine to nothing more than another “competing” school of medicine. The term thus serves the simultaneous purpose of bringing “allopathic medicine” down to homeopathy’s level and elevating homeopathy to the level of conventional medicine. Far better, albeit still imperfect, characterizations could be:

  • Science-based medicine versus nonscientific medicine
  • Conventional medicine versus unconventional medicine
  • Medicine versus unproven medicine

Other possibilities come to mind. Of course, my preferred one (reality-based medicine versus magic) is probably a bit too–shall we say?–insolent ever to be used in such a document. Be that as it may, I would contend that accepting the language of practitioners of unscientific medicine and using it in an official policy statement is not a good idea. Language has power and meaning. No one knows that better than promoters of “complementary and alternative medicine” (CAM) or “integrative medicine” (IM) or whatever it is that quacks decide to call it next. While the use of language in the CPSO draft is disturbing enough in and of itself, there are more substantive problems with the draft that need to be discussed.

Beyond “allopathic medicine”

The opening of the CPSO statement does not begin any more auspiciously than the title, after which the statement quickly devolves into meaningless platitudes that accept many of the false equivalencies promoted by CAM practitioners when arguing for pseudoscience. For example, check out how the draft opens:

In increasing numbers, patients are looking beyond allopathic medicine to nonallopathic therapies for answers to complex medical problems, strategies for improved wellness, or relief from acute medical symptoms. Patients may seek advice or treatment from a range of health care providers, including Ontario physicians.

The College supports patient choice in setting treatment goals and in making health care decisions, and has no intention or interest in depriving patients of non-allopathic therapies that are safe and effective. As a medical regulator, the College does, however, have a duty to protect the public from harm. Thus, the object of this policy is to prevent unsafe or ineffective non-allopathic therapies from being provided by physicians, and to prohibit unprofessional or unethical physician conduct in relation to these therapies.

Right from the beginning, all the buzzwords and false equivalencies are right there. There’s the appeal to popularity in the form of the unreferenced, unsupported statement that more patients are embracing non-science-based medicine. That’s rapidly followed by the platitude assuring us that the CPSO supports patient “choice,” which implies by contrast that those who might not be as open to “non-allopathic” medicine are somehow against “patient choice.” particularly given the line of how the CPSO has “no intention or interest” in “depriving” (note the word choice) CAM users of their woo. It is a favorite tactic of CAM apologists to equate permitting or tolerating pseudoscience with “patient choice” and implying that those of us who support SBM are doing so more through ideology and intolerance than out of concern for providing the best medicine possible to our patients. Of course, one wonders what these “non-allopathic” treatments are that are both safe and effective might be. After all, if they were both safe and effective they wouldn’t be “alternative.” I’m tempted to repeat that old trope that alternative medicine that is proven to be safe and effective ceases to be “alternative” and becomes simply “medicine.” Never mind. I just did. So did the CPSO:

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’ve tried to think of an example of any such therapies that have made the leap from “non-allopathic” to “allopathic” medicine and am hard-pressed to do so. Perhaps readers can provide a legitimate example or two. Be that as it may, just because this is an old trope doesn’t mean it isn’t true. Substituting the term “non-allopathic” medicine for term “alternative” medicine or CAM in this draft statement not-so-subtly equates what was once called CAM or “alternative medicine” with “allopathic medicine.” Again, language matters, and the if the CPSO doesn’t know it, it should. Its choice of the the term “non-allopathic” was deliberate:

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.

Notice also how the CPSO chooses to characterize patients looking for CAM as “looking beyond” allopathic medicine. To me, this phrasing implies that CAM modalities are somehow ahead of or superior to “allopathy.” A more appropriate way to phrase this concept would be to say that patients are looking “outside of” science-based medicine or “elsewhere than” science-based medicine. But, no. Patients are “looking beyond” that tired, old, hidebound, dogmatic, unimaginative scientific medicine. It’s so boring, you know, insisting on all that evidence and science.

Imagine my relief that the College is committed to preventing unsafe or ineffective “non-allopathic” therapies from being provided by physicians. You know, ineffective like homeopathy.

Platitudes mixed with disturbing statements

If there’s one thing about this draft that impresses me about the CPSO draft policy is the sheer number of meaningless platitudes the CPSO packed into it. Mixed in with these platitudes are statements that range from disturbing to just plain puzzling. For instance, one puzzling aspect of the draft occurs where the CPSO points out that physicians should “refrain from exploitation” and abusing his power over patients and avoid conflicts of interest. No one, least of all I, would argue that physicians should exploit their patients or engage in activities that represent a blatant conflict of interest, but nowhere in the draft is this principle related to the use of “non-allopathic” medicine by patients or physicians. At least for the other principles the draft at least takes a stab at trying to relate them to patient autonomy, which, of course, the CPSO supports. The CPSO also expects physicians to:

  1. Act in patients’ best interests, in accordance with fiduciary duties;
  2. Respect patient autonomy with respect to health care goals, and treatment decisions;
  3. Communicate effectively and openly with patients and others involved in the provision of health care;
  4. Maintain patient trust through a commitment to altruism, compassion and service.

As opposed to, I suppose, advocating not acting in patients’ best interests, not respecting patient autonomy, not communicating effectively and openly, and not being committed to altruism, compassion, and service. I know, I know, I’m being a bit curmudgeonly, and I realize that these sorts of principles have to be repeated and emphasized, but it’s about the specifics of how physicians will adhere to such principles “where the rubber hits the road,” so to speak that such a policy should provide guidance. I would argue that it is a physician’s responsibility always to be honest with his patients and to pull no punches when it comes to giving his professional opinion. That is the very essence of acting in the patient’s best interest and communicating effectively and openly. What, then, am I to make of some of the statements in this draft that sound suspiciously like advocating pulling punches? For instance:

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.

I can’t help but wonder whether calling, for example, homeopathy “quackery” would be viewed as a “non-clinical” judgment by the CPSO. After all, that is my “best professional opinion” about homeopathy, and I can back it up with evidence and science, too! The language used smacks of the CAM-enabling sort of language that demands that we physicians above all remain “nonjudgmental.” Personally, I would counter that it is our professional responsibility to be judgmental when it comes to evaluating the evidence for a treatment. In fact, to me it is our duty as physicians to judge what treatments are safe and effective and which are not and to communicate that assessment to our patients; that’s what they come to us for.

Here’s another problematic passage:

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.

The problem here is that providing “non-allopathic” care that is not evidence- and science-based (in other words, nearly all of it) is inherently unethical and represents anything but “clinical excellence.” This is a rather amusing conundrum to me. Consider this example. If a physician (and, make no mistake, there are a fair number of physicians who do this) offers homeopathy, which is nothing more than magical water supposedly imbued with mystical healing caused by the “memory of water” remembering whatever remedy that was in it before and forgetting, as Tim Minchin puts it, all the poo that’s been in it. How can any physician ethically offer homeopathy, for example, to a patient? Similar arguments construct themselves for other “non-allopathic” therapies, such as reiki (which is faith healing that substitutes Eastern mysticism for Christianity as its basis) or acupuncture, which postulates that sticking needles into “meridians” that have no detectable anatomic counterpart somehow “unblocks” the flow of vitalistic mystical life energy to healing effect. Yet, the CPSO goes on to state:

Physicians must always act within the limits of their knowledge, skill and judgement9 and never provide care that is beyond the scope of their clinical competence.

This expectation applies equally to treatments or therapies that the physician proposes and those that may be requested directly by patients. Where patients seek care that is beyond the physician’s clinical competence, physicians must clearly indicate that they are unable to provide the care. Physicians should consider whether a referral can be made to another physician or health care provider for care the physician is unable to provide directly.

While this is simply a restating of basic physician ethics when it comes to science-based medicine, I can’t help but wonder: Does this policy in the context of emphasizing patient autonomy and choice somehow obligate or imply an obligation for an Ontario physician to refer to a “non-allopathic” practitioner if that is what the patient wants? Shouldn’t there be a clear statement that a physician is not obligated to support the use of “non-allopathic” medicine if he believes it–and correctly so–to be quackery? The whole thing is a muddle, particularly given the statements elsewhere in the policy about how diagnosis and treatment should be based on the principles of “allopathic” medicine?

A brief policy statement

It’s obvious from the wishy-washy approach to the scientific basis of medicine, the waffle words when it comes to whether an “allopathic” physician should support “non-allopathic” therapies, and the apparently inadvertent use of language favored by quacks that there were far too many “alternative” practitioners involved in drafting this policy. Similarly, the comments are dominated by believers, although I must admit that one of them does point out the conflict inherent in this policy, as the CPSO tries to have it both ways:

“To act in accordance with the standards of allopathic medicine, physicians providing non-allopathic care must reach an allopathic diagnosis”

This doesn’t make sense! If I want non-allopathic care, then that includes a non-allopathic diagnosis. Allopathic labelling is only useful for determining which prescription to write and has no business in non-allopathic medicine!

This would be a bit of a problem in traditional Chinese medicine, where the diagnoses are based on “imbalances” in heat, moisture, etc., and some diagnoses come about by mapping organs to locations on the tongue. Similarly, in homeopathy, diagnoses are not necessarily based on physiology and treatments are based on homeopathic “provings.” Yes, this believer nailed the conundrum that the CPSO is trying to dance around.

To that end, let me propose a much briefer policy statement for the CPSO to consider in a few bullet points:

  • Medicine should be science- and evidence-based. “Alternative” and “evidence-based,” “allopathic” and “non-allopathic,” “conventional” and “unconventional” are all false dichotomies. If a treatment is not evidence- and science-based, it is not medicine. Such a treatment becomes “medicine” only when it is demonstrated to work by science.
  • Competent adults have every right to seek out non-science-based medicine if that is what they desire. However, informed consent mandates that physicians who encounter such patients provide an honest professional assessment of such treatments based on science. While the patient should never be disparaged or denigrated for making such choices, physicians are not obligated to hold back their opinion out of fear of offending the patient. In fact, when a treatment is ineffective and/or dangerous, it is the physician’s duty to point that out as clearly as possible.
  • Physicians should always inquire about the use of non-science-based medicine when evaluating their patients, so that they can take into account possible interactions with medical treatments. (This is about the only thing where I agree with the CPSO, but that’s a trivial agreement.)
  • Physicians are in no way obligated to refer patients to “alternative medical” practitioners. For many forms of “alternative medicine” doing so is unethical because such modalities are not science- or evidence-based.

I’m sure readers can come up with their own versions or suggest modifications and/or additions to the bullet points above.

In the meantime, there is still a week left before the September 16 deadline for supporters of science-based medicine to let the CPSO know the problems in its draft policy by e-mailing ComplementaryMedicine@cpso.on.ca or filling out CPSO’s online survey. It’s a horrible survey that buys into a lot of the false dichotomies beloved of CAM supporters. It’s also clear from the comments that are there now that more input from supporters of science-based medicine is needed.

Fortunately, since the CPSO extended the deadline to September 16, there’s plenty of time for you to provide just that.

Michael Kruse at Skeptic North has more.

Comments

  1. #1 Andy
    September 9, 2011

    Survey done – from Australia.

  2. #2 Science Mom
    September 9, 2011

    The College supports patient choice in setting treatment goals and in making health care decisions, and has no intention or interest in depriving patients of non-allopathic therapies that are safe and effective. As a medical regulator, the College does, however, have a duty to protect the public from harm. Thus, the object of this policy is to prevent unsafe or ineffective non-allopathic therapies from being provided by physicians, and to prohibit unprofessional or unethical physician conduct in relation to these therapies.

    Emphasis added. How can they not see this glaring contradiction?

  3. #3 Collin
    September 9, 2011

    You’re suffering from the same mental block as they are. Nobody seems to want to admit what “integrative” means. We have integrative restrooms, integrative movie theaters, etc. They all result from the same ethic, that discrimination based on color is flat-out wrong.

    Perhaps the medical staff you spoke to were too PC to mention it, but I’ve seen the advert on the TV Ontario website. This is not about abridging science; it’s about extending science-based medicine beyond the setting of the Western-style hospital. If they mention things like homeopathy and acupuncture, just tell them to grow up, stop hiding behind cliches, and face the real issue.

    Consider two doctors, one dressed as a Western physician and one dressed as a Native Canadian shaman, doing the exact same science-based operation. Who’s more likely to be successful? Neither; the way they’re dressed is absolutely irrelevent.

    The Canadian hospitals need to have a serious, respectful dialogue with the doctors of the Native Tribes about what they would consider an appropriate setting for science-based medicine.

  4. #4 Orac
    September 9, 2011

    You’re suffering from the same mental block as they are. Nobody seems to want to admit what “integrative” means. We have integrative restrooms, integrative movie theaters, etc. They all result from the same ethic, that discrimination based on color is flat-out wrong.

    This makes no sense as an analogy. Discrimination against pseudoscience and quackery is not the same thing as discrimination based on race. In fact, I’d argue that “discriminating” against pseudoscience and quackery is actually a positive attribute. Science-based medicine should “discriminate” against quackery.

  5. #5 Bronze Dog
    September 9, 2011

    I sense racism inherent in calling things “Western.” There’s nothing “Western” about science-based medicine aside from an accident of history. Science exists to counteract universally human shortcomings. It’s racist to suggest that some particular group isn’t subject to those cognitive failings.

  6. #6 lilady
    September 9, 2011

    I sent my comments in directly to the CPSO website that Orac provided. The thrust of my arguments is that I am a licensed registered nurse…not a licensed “allopath” nurse and I received a university conferred degree BSc-Nursing…not BSc-Allopath Nursing.

    I also “plugged” the SBM website and the practicalities of clinical practice in infectious diseases based solely in science/evidenced based medicine and the self-stigmatizing use of the pejorative “allopath medicine”.

  7. #7 Denice Walter
    September 9, 2011

    The other night, I had the distinct displeasure of hearing Rep Ron Paul ( a libertarian and MD, as is his son, Sen Rand** Paul) advocate de-regulation of just about everything from finance to medical care: he is the fave of the idiots I follow ( see NaturalNews for Adams’ take on Paul). Nothing warms a health freedom fighter’s exercise-strengthened heart more than cutting both taxes and regulations; in addition, it should stimulate the stagnant *qi* or exhausted *elan vital* that so plagues our unhealthy economy ( I like how the econ-woo fits in thematically with med woo: all matchy matchy!)

    Whenever Orac sublimely de-constructs quackademic medicine I can imagine our major league woo-meisters simultaneously singing, “WE are the Champions” strutting, as they reveal how they were “ahead of the curve”, that the “tide has turned”, the Old Guard is upon the ash heap of history: science has undergone a people’s revolution and a spiritual evolution- the paradigm has shifted.

    A commenter here @ RI remarked how the OMD ( of an earlier post) had both a sociology and a( 2 year) business degree- both apropo for bilking people. Null also has a business AA and Adams bills himself as a “software executive by age 30″! Indeed, real doctors like Ornish, Oz, Mercola, Chopra, and Weill have demonstrated startlingly good entrepreneurial acumen: selling books and being on TV can be quite lucrative. Would it be too much to stop regarding alt med as a form of science ( albeit pseudoscience) and start calling it purely *business*? Perhaps hospitals and universities involved in quackademic medicine have decided that the bottom line trumps all; they are giving the *customers* what they really want- like a mall does.

    Which would be horrifying and sickening ( in more ways than one). If this is true, the paradigm has indeed shifted their way. I now have a headache.

    ** “Rand” is short for “Randal” (sic), not Ayn Rand as I had previously thought.

  8. #8 Reuben
    September 9, 2011

    You’re suffering from the same mental block as they are. Nobody seems to want to admit what “integrative” means. We have integrative restrooms, integrative movie theaters, etc. They all result from the same ethic, that discrimination based on color is flat-out wrong.

    What? How can being pro-science and pro-evidence be discriminatory against any one race or ethnicity… Creed maybe, like the “discrimination” against Christian Scientists’ notion that seeing a doctor is a sign of lack of faith.(That “discrimination” is for the good of all, not for the detriment of a few, really.)

  9. #9 Banjo
    September 9, 2011

    Pretty sure Alaska lies north of Canada…

  10. #10 lilady
    September 9, 2011

    @ Reuben: Thanks for the interpretation of “integrative”…I couldn’t quite figure out what the “intergrative” rant was all about.

    Just a short note about the Christian Science “religion” which in my opinion has nothing to do with Christianity and nothing to do with Science and every thing to do with the quirkiness of Mary Baker Eddy.

  11. #11 Drachasor
    September 9, 2011

    I’ve been reading this blog for a while and it is a bit disturbing. Are there any studies on how widespread woo is in the medical field and how this has changed over time? It would be nice to know how big of a problem it is in a more objective sense.

    Still, in America at least I feel that we don’t really teach how awesome science is. What it has done for our understanding of the Universe and humanity in general is nothing short of breath-taking. It doesn’t seem to get the respect it deserves.

  12. #12 Scott Cunningham
    September 9, 2011

    I sent an email to CPSO on August 31, briefly outlining my own negative experience as a former CAM user, the bad statistical practice and spin common to CAM studies, the logical fallacies commonly used to promote it, it’s faithful followers use of whale.to and prison planet links as the “equals” of scientific studies, and a short takedown of “patient choice.” I hope it makes a difference, but their language is alarmingly wooful so I have my doubts.

  13. #13 Science for Sale
    September 9, 2011

    How wonderful science is?

    Everything in America is for sale, science is sold like woo like everything else. Here is a typical science based woo bio.

    “Dr. X was named NeuroInvestment’s CEO of the Year and was recognized by PharmaVoice Magazine as one of the 100 Most Inspirational People in the Biopharmaceutical Industry. He is a recipient of the Ernst & Young Entrepreneur of the Year Award for the New York Metropolitan Region and is an inductee of the National Spinal Cord Injury Association’s “Spinal Cord Injury Hall of Fame.” In 2010, Dr. X was recognized by the New York Biotechnology Association as the NYBA “The Cure Starts Here” Business Leader of the Year.

    Science legitimizes its own special form of quackery. Seems like Reality based medicine is all about dollars.

    What is a consumer to do?

  14. #14 John Doe
    September 9, 2011

    Hypocrites all. Science is for sale like everything else.

  15. #15 sailor
    September 9, 2011

    Physicians should always have a bottle of water in a bottle marked “Magic Water”.
    If a patient ever asks about alternative treatments, he should say. “Oh this magic water is just as effective as them and I can sprinkle a little on you. It is completely free, and wont cost you a dime”.

  16. #16 labdude
    September 10, 2011

    @Banjo: I think Orac meant that Detroit is the only border crossing that is north of Canada. Here in Windsor that fact is common knowledge (since our identity is completely dependant on the emphasis of NOT being Americans… We should really find a better identity.)

  17. #17 palindrom
    September 10, 2011

    labdude @15 — Well, there’s always this Canadian identity:

    http://www.youtube.com/watch?v=GsgVspgy184

    [100% Canadian humor -- Rick Moranis and Dave Thomas as Bob and Doug McKenzie.]

  18. #18 John Smith
    September 10, 2011

    Fatal Distraction. The vigilante Orac dines on roasted quack.

  19. #19 Orac
    September 10, 2011

    I think Orac meant that Detroit is the only border crossing that is north of Canada.

    Yes, and Alaska is west of Canada, not north.

    Oh, and I really hate pedantry such as that demonstrated by Banjo. Indeed, although I rarely moderate or delete comments, comments that are nothing but pedantry with nothing to do with the substance of the actual post sometimes irritate me enough that I will delete them with extreme prejudice. They contribute nothing except to massage the commenter’s ego. I almost did that with Banjo’s comment.

  20. #20 One Way
    September 10, 2011

    Out dining on roasted quack with woo sauce?

  21. #21 Lawrence
    September 10, 2011

    Once again, sockpuppets are a big no-no.

  22. #22 DaveH
    September 10, 2011

    My response to the questions

    “Based on the College’s role, does the revised draft policy address all of the important issues related to physician conduct?”

    NO.

    “If not, what issues do you think we missed?”

    The College’s role is to promote and mandate the best possible standard of care, with flexibility for individual circumstances and physician’s judgement and discretion. However, failure to clearly and explicitly condemn and forbid the use of implausible and often demonstratedly ineffective treatments violates this goal and duty. The vague language used in the draft policy is not sufficient. By comparison, something such as “The College supports the individual patient’s choice as to their preferred treatment, but cannot and will not support the use of ineffective or unsafe treatments. Alternatively, the College cannot and will not support the use of an ineffective but safe treatment, as it might be seen as a legitimate alternative to effective treatments.” would be more appropriate.

    -A concerned resident of Ontario

  23. #23 Homeophobic
    September 10, 2011

    “I’m tempted to repeat that old trope that alternative medicine that is proven to be safe and effective ceases to be “alternative” and becomes simply “medicine.” ”

    Just so I have this straight. Alternative practitioners come up with some successful treatment of a disease, treat their patients successfully for many years, and then after its well known that this treatment works, medicine comes along, patents it and then sells it after disparaging the alternative practitioners for having used it in the past? Sounds like alternative medicine is doing all the work and is way ahead of the curve, and medicine is simply waiting around for alternative practitioners to come up with successful treatments for them. If this is true, why disparage it so? Sounds to me like medicine is benefiting handsomely from this arrangement.

  24. #24 tresmal
    September 10, 2011

    Just so I have this straight.

    I’ll save this for last.

    Alternative practitioners come up with some successful treatment of a disease,…

    When was the last time they’ve done that?

    …treat their patients successfully for many years,…

    Did you mean profitably?

    …and then after its well known that this treatment works,…

    On the rare occasions when such a treatment’s effectiveness is validated by properly designed and performed studies.

    …medicine comes along,…

    It’s accepted by medicine.

    …patents it…

    No.

    …and then sells it after disparaging the alternative practitioners for having used it in the past?

    After acknowledging, grudgingly perhaps, that even a blind squirrel can find some nuts.

    Sounds like alternative medicine is doing all the work…

    What work? Taking a handful of anecdotes, some facts pulled from their fundaments and some quantum and spiritual gibberish and selling the resulting mess as useful treatment? No. The real work is done by those performing difficult, thankless and frustrating labor of finding out what really works.

    …and is way ahead of the curve,…

    If a total lack of regard for reality is what you mean by “way ahead of the curve”.

    and medicine is simply waiting around for alternative practitioners to come up with successful treatments for them.

    The vast majority of successful treatments are the result of medical researchers actively seeking them.

    If this is true,…

    It isn’t.

    …why disparage it so?

    Because very nearly all of it is useless.

    Sounds to me like medicine is benefiting handsomely from this arrangement.

    Medicine gets pretty much nothing from alt med.

    So you didn’t get it straight. You didn’t come close.

  25. #25 titmouse
    September 11, 2011

    homeophobic,

    “Medicine” is not a special interest group, just as “science” is not a special interest group.

    Prove that a treatment works, and it’s medicine.

  26. #26 Locklin
    September 11, 2011

    @Homeophobic: just so you know, all the “work” is not coming up with an idea and selling it as the alt-med practitioners do, it is testing that idea. Ideas are cheap, plentiful, and most of them are dead wrong. Science, especially the empirical validation of a medical treatment, is damn hard work.

    I’ll include an example to illustrate the point. Witch-doctors have used willow bark tea as one of many concoctions for various ailments for generations. However, it was decades of hard work isolating and testing the effectiveness of the active ingredient for specific medicinal effects, using techniques that avoid human cognitive failings, that has produced the medicine we know today as Asprin. Even so, most medicines don’t have this type of origin.

  27. #27 Reuben
    September 11, 2011

    So a certain Catholic hospital that shall go unnamed is not allowing an OB friend of mine to offer birth control or perform abortions of any kind. That’s right, of any kind. So another friend of mine applied for a job as a lab tech there just to get an interview. Once they called him in for the interview, and going through the paces, they offered him the job. For the follow-up interview to sign the contract, my friend asked if the lab had a full microbiology lab. “Of course,” said the director of human resources. “And do you do testing for antimicrobial resistance?” Again, the HR guys said, “Of course.” That’s when my friend pointed out to the man that viruses and bacteria gained their resistance through evolution, which is against the thinking of the Catholic Church. He then went on to indicte the hospital for being hypocritical in their obedience to the church. Abortions were not allowed, but supporting evolution through the work of the lab was.

    Needless to say, my friend didn’t take the job… He wishes he could blog about this big, elaborate plot he hatched to make a member of that hospital’s leadership very angry. Maybe some day.

  28. #28 Travis
    September 11, 2011

    Reuben,
    I am not fan of the Catholic Church or religion at all. But have to defend them a little bit here. I have issues with their viewpoint on evolution but the church has indicated that evolution is compatible with Catholic teachings, thought with some caveats. There have been some elements pushing ID and creationism but it is not really the mainline position.

  29. #29 David
    September 12, 2011

    Thanks for the information, Orac!

    As a Naturopathic Doctor who specializes in homeopathy I may be personally disposed to use the term “allopathic medicine” when specifically criticizing a point of conventional medicine; but I agree that it is entirely inappropriate to label conventional medicine as “allopathic” generally speaking (outside of the above specific context).

    I’ve therefore taken the time to email the organization to let them know my thoughts — there are saints in Sodom yet! — suggesting that the use of terms such as “orthodox” –[following the] right rules [of science] — versus “unorthodox” medicine would be more appropriate, as the word carries no historical baggage and properly refrains from prejudging the therapies’ validity.

    “Conventional” versus “complementary” or “alternative” prejudges the role, if any, that unorthodox therapies should have in the health-care system. “Western” versus “non-western” is historically incorrect because homeopathy and naturopathy both originated in Europe. Finally “scientific” versus “non-scientific” prejudges unorthodox therapies as unscientific which I naturally disagree with. The classic points of this debate are already known and I won’t be pursuing them here, but I will at least clarify the claim itself: while I agree that there are accepted rules of science that are not followed by unorthodox therapies, this does not imply that they are non scientific, as they could potentially lie on the margins of science (using Kuhn’s terminology: their being allegedly “revolutionary [unorthodox] science,” versus the “normal [orthodox] science” underpinning conventional medicine).

  30. #30 Beamup
    September 12, 2011

    Finally “scientific” versus “non-scientific” prejudges unorthodox therapies as unscientific which I naturally disagree with.

    Says the person who “specializes” in magic water that has been emphatically proven by an overwhelming mountain of incontrovertible evidence to do absolutely nothing whatsoever beyond placebo effects.

    There are three classes of therapy. The first is those which have been scientifically demonstrated to work. The second is those which have been scientifically demonstrated to NOT work (such as homeopathy). The third is those which have no good evidence one way or another.

    Using the first is scientific medicine.
    Using the second is fraud.
    Using the third is grossly irresponsible since it’s not known whether it is beneficial.

    “Alternative” medicine or any of the other terms falls, by definition, into the second and third classes and thus its use or practice by anyone cannot be justified.

  31. #31 Vicki
    September 12, 2011

    Beamup–

    I think you’re being too harsh on category 3, for two reasons. One is that clinical trials generally constitute using therapies that are in category 3: there’s no way to show that something works without using it, in particular ways with appropriate measurements and controls. The other is that there are as-yet-unproven treatments that there is evidence for the safety of, and for which there may be no alternative treatment. I don’t think it’s grossly irresponsible to say “we’re still testing this, but it may help you, and it’s been shown to be safe,” if the alternative is “sorry, we have no treatment for this.”

    I’m not saying “just do anything,” I’m saying that there’s space between “scientifically proven to work” and “no good evidence one way or the other,” and that anecdotes and case studies may be a reasonable basis for starting trials and for treating people off-label in the meantime.

  32. #32 Beamup
    September 12, 2011

    Those cases fall under category 1. “Work” was perhaps a bit too broad, for which lack of clarity I apologize. “Supported by appropriate evidence” would probably be better. A clinical trial is supported by the appropriate preclinical evidence; safety and plausibility evidence are the support in the latter case.

  33. #33 Bronze Dog
    September 12, 2011

    “Alternative” medicine or any of the other terms falls, by definition, into the second and third classes and thus its use or practice by anyone cannot be justified.

    My own quibble: I see this as a bit backwards. When people like us point out that their treatments fall into the fraud or untested categories, they try to label it as “alternative” in hopes of making a special pleading case, as well as enforce a false dichotomy for propaganda purposes.

  34. #34 kd
    September 12, 2011

    Finally “scientific” versus “non-scientific” prejudges unorthodox therapies as unscientific which I naturally disagree with.

    No such prejudice exists. The alleged mechanism behind many “unorthodox” therapies is plainly stated by adherents of the intervention, and in no case that I can recall has a well-designed and repeatable scientific study verified these claims.

    For example, acupuncture is based upon flow of qi/chi through “meridians” in the body. Neither the existence of qi nor the meridians has been proven. Ever. At best, attempts have been made to equivocate the merdians with nerve fibers or blood vessels (thus co-opting the real science of physiology), but the traditional meridian pathways just don’t match up with their claimed physical counterparts. In randomized clinical trials, acupuncture is only as effective as placebo, and no penetration of the skin is even required to simulate the effect.

    For another example, reiki postulates the existence of a “universal energy” that is both intelligent and compassionate. A practitioner need only introduce this energy into the patient, and it will seek out and repair what ails him/her. No scientific basis for this universal energy exists. No repeatable study of the effects of this universal energy has demonstrated its efficacy better than placebo.

    Now consider homeopathy, your claimed speciality. One of its fundamental principles is the Law of Similars, proposed by Samuel Hahnemann in 1796. This principle is accepted by homeopathy based upon Hahnemann’s assertion alone; it is not reached by deduction from any scientific principle, nor is it experimentally validated. His other principal theory, that repeated dilution through “succusion” — or vigorous shaking with water — increases rather than decreases potency of a substance, is in direct contradiction to a massive body of research in physics, chemistry, and medicine. Hahnemann’s support for this second principle? Again, nothing more than his own rather bizzare assumption.

    Now consider any “orthodox” medical intervention. Its acceptance and use is preceded by exhaustive scientific study and experimentation. The results of these studies are further verified by additional studies after its acceptance. Its safety and effectiveness is proven and can be revalidated again and again.

    Louis Pasteur conceived of the existence of microorganisms and their role in fermentation (and later disease), and then he conducted controlled experiments to prove his hypothesis. In one of his earliest experiments, he demonstrated that a boiled broth solution would not ferment and sour until after exposure to outside air, and that therefore fermentation was not simply an inherent property of a substance: an external factor must be involved. This is the scientific method – conceiving a hypothesis based upon what is known (or believed to be known) and then experimentally validating it.

    Saying, “this is so because I believe it to be so” is not at all scientific.

    Science is a methodology, not a belief system. Any “unorthodox” therapy based upon an individual’s assumption and with no support derived from scientific study is by definition unscientific.

  35. #35 Jenora Feuer
    September 12, 2011

    And the CBC recently posted an article entitled ‘Doctors slam alternative medicine proposal’:

    http://www.cbc.ca/news/health/story/2011/09/09/alternative-medicine-guidelines.html

    The article has a bit of the ‘tell both sides’ fallacy, but mostly comes down on the side of medical science. Granted, folks heavily on the woo side of the fence don’t seem all that happy with the proposed policy either, but that’s damning the policy with faint praise…

  36. #36 Collin
    September 14, 2011

    Orac, you’re missing my point. I’m saying science is being misrepresented as a racial issue by the insistence on using Western-style clothing, architecture, etc. in science-based hospitals. I’m saying that Native Canadians might be very put-off by these cultural details. And most importantly, I’m saying that Native Canadians are just as likely to be opposed to pseudoscience as we are, if only we’d discuss it with them as equals.

  37. #37 Orac
    September 14, 2011

    Pseudoscience is not the equal of science and never will be, and I refuse to dignify it by pretending that it is. That’s exactly what “integrating” quackery into medicine is. “Integrative” practitioners and real doctors can discuss issues as human equals, but as scientific and medical equals? Nope, because they’re not scientific or medical equals. In fact, that’s the very purpose of the term “integrative medicine,” to give the false appearance that quackery is the equal of scientific medicine.

  38. #38 Andrew F
    September 14, 2011

    Collin,
    I think your point is unrelated to the topic. “Integrative medicine” is not about racial or cultural integration, it’s about integrating alternative medicine (e.g. homeopathy, reiki) into conventional medicine.

    The policy makes no mention of real medicine in non-conventional settings (like your example of a doctor dressed as a shaman), but discusses how the physicians and surgeons of Ontario (who are presumably conventional doctors) might give alternative medicine.

  39. #39 Chris
    September 14, 2011

    Collin:

    I’m saying that Native Canadians might be very put-off by these cultural details.

    I think you just insulted a whole bunch of people. The First Nations folk I have known would go into convulsions of laughter is some medical personnel came in dressed as a shaman. Trust me, they are fully integrated into the 21st century. Some of them are actual doctors. But, then again, I have mostly been to British Columbia (spouse is from Vancouver Island).

  40. #40 Chris
    September 14, 2011

    Comment in moderation. I just want to say that I am disturbed by Collin’s characterization of the Native people of Canada, and the rest of the Americas. Perhaps it is because where I live these are people who are parents of kids in the my kids’ schools, lawyers, doctors, teachers, police officers, politicians, activists, etc. I think they would prefer the infection control of scrubs to a shaman’s costume.

    I think it might be Collin who has an issue dealing with these people as equals.

  41. #41 Jenny with the Axe
    September 15, 2011

    I’ve been thinking of the terms homeopathy and allopathy.

    To simplify, homeopathy is treating like with like, while allopathy is treating like with unlike. So, if I scald my finger, the homeopathic treatment should be to apply some mild heat, while the allopathic one would be to apply some cold water.

    I know which one I prefer.

  42. #42 Soma
    September 15, 2011

    “to give the false appearance that quackery is the equal of pedantry.”

    Fixed that for ya.

  43. #43 Krebiozen
    September 15, 2011

    Soma,
    Insisting that medicine we use to treat illness has been tested and proven to work is pedantic?

  44. #44 Adrianne
    September 15, 2011

    I am not in favor of this proposition of legitimizing quackeries. If that’s the case, then even those who don’t have enough knowledge on healing people could pose as someone who can heal. Worst, more physicians will get frustrated and would just opt for non-clinical jobs.

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.