Skeptic News: Oh sCAMada!

A proposed new policy on alternative medicine from the College of Physicians and Surgeons of Ontario (CPSO) has put forward the motion that would advise physicians to:

to propose both allopathic and non-allopathic therapeutic options that are clinically indicated or appropriate

The policy notes that there has been an increase in the number of patients seeking complementary and alternative treatments from physicians and makes the suggestion under the auspices of promoting patient choice and respecting individual autonomy. Though the policy does note that the college has a duty to protect patients from unsafe or ineffective “non-allopathic” treatments and makes provisions to attempt to ensure that doctors using CAM modalities meet the standards expected of a proper medical consultation. The report also deems that:

Any non-allopathic therapeutic options that physicians propose to patients must:

  • Have a demonstrable and reasonable connection, supported by sound clinical judgement, to the diagnosis reached;
  • Possess a favourable risk/benefit ratio, based on the merits of the option, the potential interactions with other treatments the patient is receiving, and other considerations the physician deems relevant;
  • Take into account the patient’s socio-economic status when the cost will be borne by the patient directly; and
  • Have a reasonable expectation of remedying or alleviating the patient’s health condition or symptoms.
However it is likely the following section which has prompted much of the backlash against the reports recommendations:

Reasonable expectations of efficacy must be supported by sound evidence. 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.

Which sets the bar at it’s highest for conventional or real medical treatments. However in the following paragraph this is found:

If the effectiveness of a therapeutic option or associated risks is unknown, the College expects physicians to proceed in a cautious and ethical manner.

Which many have seen as a lowering of standards by which to assess CAM therapies many of which have unknown effectiveness and unclear risks.

Our view? It’s difficult to maintain ethical practice as a physician if one accepts lower standards of evidence for one therapy over another.

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