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Criticism > Monday, 15 August 2011 17:14:05 EST

I Expect Better From The CPSO

Keywords: health, alternative medicine, Canada

The College of Physicians and Surgeons of Ontario (CPSO) has just released a draft policy statement meant to address the popularity of alternative medicine.  The document is entitled Non-Allopathic (Non-Conventional) Therapies In Medical Practice.

Straight away I have grave concerns about the content of this document.  This is the governing body for medical doctors in Ontario, and they're actually considering using the word "allopathic"?  This word is not a part of the science based medical lexicon.  Doctors do not call themselves "allopaths", that's a word used by the alternative medicine crowd.  It's one of those words that sounds science-y and technical, but isn't useful in any way except as a pejorative label.

The word has no business being part of the title of a document released by the CPSO.  There's no reason for any medical professionals to adopt this word, and the CPSO shouldn't be giving it legitimacy by using it so casually.  They put "Non-Conventional" in parentheses, I suppose partly as a recognition that medical professionals may not recognize the term "allopathic", but that's silly.  They could have just said "Non-Conventional" and left it at that.

If it was just the title that bothered me, though, I wouldn't have enough material for a blog post.  Unfortunately, the document makes several statements intended to open the door for alternative medical treatments and to stifle opposition.  CFI Canada has released a response to this draft policy that I sincerely hope will encourage the policy makers at the CPSO to rethink their position.

But I presume you're here to find out my perspective on this document, other than my nitpicking on the title.  Well, they actually defend their use of the term "allopathic" in their key features of the revised draft policy:

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.

What they mean by "value-neutral" is, of course, neutral towards alternative medicine practitioners.  Heavens forbid we should be judgmental by calling them alternative or non-conventional, pointing out that these modalities have nothing to do with the improvements in medical science that have significantly reduced pain, suffering, and death over the last century.

Personally, I'd be happy enough if they just released a policy paper on the prescription of placebos, and any inquiries about complimentary medicine can be directed there.  That's probably why I'm not a part of the policy decision making process.... that and the fact that I'm not a medical professional or anything.

You might say "Hey Dumbass, it's just a word, why are you making such a fuss over it? Why not accept it as a term for conventional medicine?".  The reason is because I think it engenders a dangerous misconception of what medicine is all about.  Conventional medicine doesn't need a technical sounding label, because it doesn't have any valid competition. 

There is no other kind of medicine than conventional medicine.  "Alternative medicine" is entirely a misnomer because it's no kind of medicine at all.  They are not equivalent modalities that both reach the same ends through different methods.  Conventional medicine consists of treatments that have been shown to work, alternative treatments haven't.  There's no room in the science of medicine for accepting practices that have not been shown to be effective.

But the policy decision makers here are apparently confused enough by their adoption of the word "allopathic" that they can't make the distinction:

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.

Any time you see the term "patient choice" you know that you're dealing with some hard core alternative spin.  Who isn't for patient choice, after all?  We all want the right to choose our health care options, how dare anybody deny patient's a choice about something as fundamental to them as health?

This kind of language is often favoured by homeopaths, as I've found out by listening to the Skeptics With A K podcast (just started listening to it, they're very entertaining and highly recommended.)  They've talked about this fallacy of patient choice before, but I'm going to take a crack at my own analogy here:

The thing is that yes, of course you have a choice in pretty much anything you do.  If you're looking to have a new suit made for you, you could go to a conventional tailor, and that tailor will give you a choice of fabrics and styles.  You also have the option of using an alternative tailor who only works with a special fabric that's only visible to people who are smart and virtuous enough to see it.

You're free to choose the alternative tailor if you like.  However, I would expect any body of professional tailors to reject any membership application from this alternative tailor.  One of the membership criteria should be that the tailor must be trained in the use of proven techniques on reality-based fabrics.

Can you see the confusion over the nature of medicine throughout this CPSO statement?  When they say that they ahve "no intention or interest in depriving patients of non-allopathic therapies that are safe and effective", they're missing the point that there is no "non-allopathic" therapy that is effective.  If one of these therapies were to prove to be effective, it would become part of conventional medicine. 

The distinction here means absolutely nothing.  Nobody wants to deprive any patient of safe and effective treatments.  It's just a fact that there are no alternative medical modalities that have been shown to be both safe and effective, and that's pretty much by definition since if they had they would no longer be alternative.

They go on to say:

Thus, the object of this draft 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.

Great!  That means that you prohibit the use of alternative therapies across the board right? ... well, apparently not.  While the above statement sounds good, the language in the rest of the document puts in a hell of a lot of wiggle room for deciding what counts as safe and effective.  For example:

If physicians also form a non-allopathic diagnosis, such diagnosis must be objectively justifiable, based on the clinical assessment conducted and other relevant information available to the physician.

This is just a really weird statement.  Why should we even leave the possibility open to diagnoses that aren't based in conventional medicine?  If a diagnosis is "objectively justifiable", then it's science.  Saying that a diagnosis can be justified based on "the clinical assessment conducted and other relevant information available" leaves the door wide open for any justification.

After all, there are plenty of books out there on alternative medicine that can be claimed as an authoritative source for these kinds of diagnoses, and there are plenty of alternative devices claiming to diagnose medical conditions.  If a doctor bases a clinical assessment of a patient on the results of a test from one of these devices, they can claim empirical support under this kind of wording.

Do we really want medical doctors telling patients that they have an allergy to the wind?  Yes, that's right, I said allergy to the wind.  I recorded this video and posted about it back in January of 2010, but I think it's worth bringing up again in this context:

This is exactly the kind of practice that the CPSO should be discouraging amongst its practitioners.  People have a right to seek out this kind of diagnosis if they like, but it should not be considered a valid practice for science based medical doctors.

To further erode away any semblance of proper perspective on what should count as evidence, the paper also states:

The type of evidence required will depend on the nature of the therapeutic option in question, including, the risks posed to patients, and the cost of the therapy. Those options that pose greater risks than a comparable allopathic treatment or that will impose a financial burden, based on the patient’s socio-economic status, must be supported by evidence obtained through a randomized clinical trial that has been peer-reviewed.

The only reasonable thing to say about this is "No, absolutely not!"

The type of evidence required does not depend on risks or costs.  And here it seems that they're only talking about evidence for effectiveness, since the statement assumes that we already know the risk of physical harm.

The effectiveness of a treatment does not depend on how risky of cost effective it is.  The standards for evidence of effectiveness should not be loosened just because the treatment is cheap and/or mild.  Peer reviewed, randomized clinical trials are the ONLY method of determining whether an intervention works.  Period.  There is no valid alternative, that's just the way it is!

And there's more.  Read the CASS response for all the details.  There's also language that would make it more difficult for doctors to explain to their patients why an alternative treatment probably doesn't work.  These kinds of modalities can't gain acceptance from the medical community legitimately, so they worm their way in surreptitiously with language like this so as to cloak themselves with the clothing, but none of the substance, of actual science.

It's heartbreaking that the medical regulatory body of my province is entertaining a document with language like this, and it should be a concern to anybody who believes in science based medicine.  Patient choice is important, but alternative therapies are just wearing no clothes.

I encourage all like minded people to leave feedback on the document at the CPSO's website.  Try to be courteous and polite, don't resort to name calling or insults.  I think we want to put our best foot forward in trying to represent our position on the CPSO's official website, so polite but firm is the way to go.  Hopefully we can make a difference.


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