Four months ago David Gorski wrote about the  College of Physicians and Surgeons of Ontario’s (CPSO) draft policy on “non-allopathic” medicine. He pointed out:

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.

I agree.  The proposed policy addresses the issue of so-called complementary and alternative medicine (CAM) and has drawn serious criticism from Canadian physicians (at least those who are paying attention and have the slightest clue about what is going on). The backlash is good to see, but it is not nearly vigorous enough.

There is now an update to this story as the CPSO has published a revised policy proposal. There are some improvements, based on the criticism, but still there are problems with the policy.

The original proposed policy contained several recommendations that are right in line with CAM proponents – who keep trying to achieve through legislation and intimidation what they cannot achieve through science and evidence, namely acceptance and access. The proposed policy is a good example of this, as well as demonstrating how CAM proponents wish to carve out a double standard for themselves, so that they can be free to practice whatever nonsense they wish without being held to all that pesky science and evidence.

The very category of CAM is a contrived marketing strategy, not a genuine discipline. The truth is that there is science-based medicine and there is everything else. All therapies and modalities lie someone along the spectrum of safety and efficacy, and are backed by various amounts of evidence, and may even have evidence for lack of efficacy.

That is all that matters – but when one common sense and science-based standard is applied, almost all of CAM collapses and crumbles to dust. That’s why it’s CAM – if it worked it would just be medicine. So CAM proponents have desperately tried to make the debate about anything else: healthcare freedom, conspiracies, Big Pharma, protectionism or elitism, they cry that they are being treated unfairly, or that science doesn’t work – that they need a new kind of science. It’s all an elaborate game of, “ignore that man behind the curtain.” It has been distressingly effective, as the CPSO proposal indicates.

The parts of the proposed policy that have caused the most concern are those that encourage physicians to work with “alternative” practitioners, granting CAM practitioners a status they have not earned and do not deserve. The Canadian Medical Association has responded, criticizing this aspect of the proposed policy. They state:

“It is a matter of concern for us, that CPSO’s draft policy appears to require of physicians a high level of knowledge regarding [alternative medicine], and a high level of acceptance for its routine incorporation into practice,” the CMA said.

I don’t think it’s a bad thing for physicians to have greater knowledge of CAM, the better to inform their patients about it properly. But physicians should not be encouraged to incorporate unscientific practices, or refer to those who do. This is definitely a step toward requiring physicians to practice CAM or refer to those who do, as I wrote about recently.

Perhaps the most disturbing part of the original proposed policy is this statement:

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.

This is a thinly-veiled attempt to silence criticism – to silence any doctor who has the sense to understand that it is their duty to protect their patience from unsafe or ineffective treatments. CAM proponents are as clever as creationists in couching their true goals in language that seems inoffensive, but the goal is obvious to anyone who has been paying attention.

Then there is this:

In its original form, it said doctors should respect patients’ wishes to try non-conventional care and require “sound evidence,” but not necessarily clinical trials, to back up any alternative treatments they use.

Here we have the double-standard. They want different standards of evidence for CAM than for conventional medicine – a lower standard, one that allows treatments that are unscientific and not backed by sufficient evidence to be accepted by science-based practitioners.

The revised draft policy has some positive changes:

The new iteration of the Ontario draft suggests everything a doctor does should be informed by “evidence and science.” It removes a suggestion the type of evidence required to justify a therapy depends on the nature of the treatment. It also removes a statement that seemed to allow doctors to employ therapies whose effectiveness and safety are unknown, so long as they act “in a cautious and ethical manner.”

The original proposed policy makes the agenda of CAM proponents clear. They want to create a double standard, with a lower bar of evidence for their preferred practices. They want to silence critics. They want doctors who may be skeptical of CAM practices to just shut up and refer their patients to CAM practitioners. They want to pressure physicians with accusations that they are being unfair, when in fact it is the CAM proponents who are being unfair.

At the end of his original report on this issue David offered his recommended policy with regard to CAM. Here it is, with my tweaks:

  • Medicine should be science- and evidence-based. “Alternative” vs “evidence-based,” “allopathic” vs “non-allopathic,” “conventional” vs “unconventional, ” “Western” vs “Eastern” are all false dichotomies and should not be recognized as legitimate categories. All healthcare interventions should be evaluated, regulated, and practiced according to one science-based and ethics-based standard of care.
  • 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. Physicians should sufficiently familiarize themselves with unscientific yet popular healthcare products and practices so that they can properly inform their patients.
  • 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.
  • Physicians are in no way obligated to refer patients to “alternative medical” practitioners or to recommend non science-based options. For many forms of “alternative medicine” doing so is unethical because such modalities are not science- or evidence-based.
  • Physicians, individually and as a profession, should actively advocate for and promote the science-based standard in medicine – in academia, regulation, and practice.

Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the president and co-founder of the New England Skeptical Society, the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also contributes every Sunday to The Rogues Gallery, the official blog of the SGU.