Alternative medicine

Docs cry foul over CPSO’s proposed policy changes for alternative medicine

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Has your doctor ever told you to consider acupuncture for pain relief? If so, your doctor has recommended what is called “alternative” therapy.

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It is difficult to explain how Complementary and Alternative Medicine (CAM) differs from conventional medicine because the boundaries change all the time. According to one definition, conventional medicine deals with disease, while alternative medicine aims to maintain overall health.

The College of Physicians and Surgeons of Ontario (CPSO) has announced potential changes to its CAM policy.

The CPSO is the governing body for physicians in this province. The CAM policy is for regularly trained doctors who also want to do alternative (sometimes called integrative) work. They are not naturopaths or osteopaths or other dignified practitioners, as they have their own governing organizations.

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Physicians who use alternative methods fear that their medical interventions will be reduced by the proposed changes in the CAM policy.

There is a history of college animosity towards alternative practitioners – call it anecdotal evidence – and the current wording of the proposed changes does nothing to change an apparent “us” versus “them” mindset.

(Full disclosure: 20 years ago, a former husband of mine immersed himself in the study and use of alternative medicine, which influenced my views.)

The CPSO says these changes are only proposals and that a comment period ending March 15 allows physicians and patients to voice their opinions by take a survey created by the college.

If you rely on another physician, you will find the wording of the proposed policy changes frustrating. The college appears to view alternative doctors as if their work automatically warrants additional police surveillance.

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Patient safety is given as a first priority, which is admirable, but it surely applies to traditional and alternative practices; does the existing regulation not cover this?

CPSO Policy Director Craig Roxborough said this rewrite of CAM policy is a matter of timing – the policy has not been changed since 2011 and has been revised. The framework hasn’t really changed, he says.

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“Our intention is to enable this space while effectively regulating it. This is the balance we are trying to find. »

In Australia, when this exact situation arose, the decision was made to use the existing code of conduct for all doctors and move to a risk-based approach to identify at-risk therapies across all areas of medicine – as opposed to practice-focused therapy.

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CPSO Registrar Dr Nancy Whitmore said the proposed changes are “to create space and empower patients to make their own choices independently.” Patients have the right to choose, and we just want to make sure they get enough information to make their decision anyway.

Citing a high-risk example, she said: “If the patient chooses not to have conventional chemotherapy which could save their life and uses an alternative where there is a significant risk of harm, we want to be very sure that ‘there is a very clear understanding, the patient understands what it looks like.

Doctors who use alternative remedies, however, fear that the new policy will limit their ability to use many of the interventions they currently use. And they fear being unfairly disciplined.

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A doctor said he believed the wording of the new policy would prevent natural approaches to treatment because they are not considered ‘evidence-based’.

(The new policy clarifies that doctors should only provide treatments backed by evidence collected in randomized controlled trials and the like, but anything that can’t be patented, like natural substances, rarely attracts the money for those. expensive trials – where there is no patent, there is no money to be made, and no incentive to fund the evidence required.)

In the review Dialogue, a publication for doctors in Ontario, Dr Keith Hay said: ‘The task force felt strongly that doctors should always start from a position of conventional medicine, and so we have updated the expectations to exclude the possibility that physicians will proceed with complementary or alternative treatments without considering the conventional options available.

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He continued: “We believe that when physicians deviate from conventional medicine, it should be done in a way that is based on sound clinical reasoning and where the risks posed to a patient do not outweigh benefits.” It’s an unfortunate wording that suggests that alternative therapies should be considered risky activities until proven otherwise.

Like the 200 answers published online with proposed changes clearly illustrate, many patients seek out alternative doctors when traditional medicine cannot help them; a review of conventional options would be in the rearview mirror.

“There are double standards,” said one alternative practitioner, who preferred to remain anonymous. “We can only offer our interventions when there is evidence that would satisfy them, and I’m not sure what they would find acceptable.”

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(None of the alternative physicians listed here agreed to have their name used for fear of retaliation from the college. It must be said that mainstream physicians express the same concern on other matters. CPSO Discipline Committees have a bad reputation. )

A doctor who treats Lyme disease said the new CPSO guidelines do not take into account a doctor’s experience, patients’ wishes or expert opinions.

Being treated like outcasts from the start is a problem, another doctor said.

“I see a lot of people who are not well despite conventional treatments, and we help a lot of them. Conventional medicine has no answers for many of these people. They are goes wrong, is not treated and feels like he is not being listened to.

“It’s not like we’re destroying what conventional medicine does and putting people at risk – we’re taking people who aren’t doing well with conventional medicine and using other techniques.

“Any prominent person practicing alternative medicine has been targeted,” he continued. “At the end of the day, we are their colleagues. They can’t help people who come to see us anyway and should be grateful for what we do.

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