As was reported by David Gorski (surgical oncologist), Scott Gavura (pharmacist), the CFI Committee for the Advancement of Scientific Skepticism, Larry Moran (biochemistry professor), and others a bit more colorfully, the College of Physicians and Surgeons of Ontario (CPSO) has drafted an appalling (and at times simply confusing) policy regarding alternative medicine as it relates to general medical practice. Originally, the policy had been open for public commentary until 1 September, but after an overwhelming response the CPSO has extended the deadline to 16 September.
The first issue is in the title: Non-Allopathic (Non-Conventional) Therapies in Medical Practice-Revised Draft Policy. The term “allopathic” was coined by homeopathy inventor Samuel Hahnemann and is used as a pejorative by members of the alternative medicine community to refer to doctors. The term is also used by people who do not fully appreciate the context of the word, using it simply to refer to “conventional medicine practitioners” as a way to accentuate the differences between modern doctors and alternative health practitioners. In any case, the words “doctor” and “medicine” already suffice and it is frankly bizarre that the CPSO chose the word “allopathic”.
Also, though the policy seems to be encouraging patient rights, inclusion, and other nifty and friendly-sounding things, there is no clear stance taken on the current proof of efficacy of alternative medicine remedies nor is there detail on the threshold of evidence that is required for them to consider a so-called “non-allopathic” remedy to be effective. Therefore, for all the suggestive wording of patient empowerment and protection, basic policies such as evidence thresholds and standards of quality are not explicitly discussed.
Other issues are apparent in the survey with misleading, loaded, doublespeak questions like:
- “If physicians recommend non-allopathic therapies, do you think their recommendation should be supported by scientific evidence?” These therapies are already called “medicine” and “health care”. If something works (i.e., has the scientific evidence to prove efficacy), it is adopted into mainstream medical care. Why wouldn’t it be?
- “Do you believe that physicians must only propose non-allopathic therapies that: Take into account patients’ financial status when patients are paying for treatment directly?” It is distressing to see the CPSO imply that more well-off individuals may receive different recommendations than those less well-off. Though discussion of affordability with several options is completely appropriate, depending on context, overall recommendations should remain the same with every effort made to go through appropriate parties to attempt to secure treatment funding.
The CPSO is trying to have their cake and eat it too: On the one hand, participate in the currently fashionable placation of alternative medicine adherents despite a crippling lack of robust supporting evidence, but on the other hand insist that recommendations be science-based. If the recommendations were truly science-based, then the entire policy seems superfluous except to say essentially what the succinct 2-page College of Physicians and Surgeons of BC’s policy says:
“Complementary and alternative therapies differ from conventional medicines because they are generally unproven. When an alternative treatment undergoes rigorous testing, for example in a controlled and randomized trial, then the results dictate whether the alternative treatment becomes conventional treatment, whether the unorthodox becomes accepted, and whether the unproven becomes proven. Assertions, speculations, and testimonials do not substitute for scientific evidence.
Physicians who consider using complementary and alternative methods should recall that, although some untested remedies may be harmless, the absence of good evidence about a given herbal or other agent makes recommendation of that treatment unethical. The optimal environment for the use of an unorthodox therapy is within a clinical trial designed to establish the therapy’s safety and efficacy.”
The CPSO policy (highlights here) needs extensive clarification on its stance regarding alternative medicine, medicine, physician responsibilities, and patient rights. BC managed to do that in 2 clear, unequivocal pages. The CPSO took 9 pages to say much less. I challenge the CPSO to do better: At the very least, remove the ridiculous word “allopathic” from the document entirely and revise and clarify evidence policies rather than vaguely saying “supported by scientific evidence” (what kind? how much?) and making appeals to popularity. The CPSO policy, as written, does not adequately address issues of efficacy, thresholds of evidence, or accountability for either recommending or referring to practitioners of alternative medicine remedies.
To comment, this link is for the rather leading CPSO survey which can be filled out between 5-20 minutes, depending on how much commentary is offered. Or the CPSO can be contacted by email at ComplementaryMedicine@cpso.on.ca for a more prose-style comment that is not limited by the format of the survey.
Science-Based Therapy 