College of Physicians and Surgeons British Columbia: Complementary and Alternative Therapies

The following is the outline that Physicians must follow (from their college) when it comes to complimentary and alternative medicine. It is good for us to know so we can comply with their guidelines and find ways to work with and around them, so as to provide our patients with the best integrated and shared care possible. This is a must read. Please please please lets start discussion around this, it is so important. Leave your comments.

The last few years have seen an enormous surge in interest in complementary and alternative therapies, and considerable confusion exists among physicians as to how to respond to this interest. The reasons for this phenomenon are complex and include patient dissatisfaction with available treatment and patient mistrust of scientific medicine.

Patients question physicians about herbal preparations and other unconventional treatments and expect reasonable answers based on the physician's interest and knowledge. Physicians must be aware of their patients' use of such therapies, and should ask about alternative remedies in the same way that they ask about non-prescription drugs. Both types of treatment can produce direct toxicity, or interactions with prescription medications or other accepted treatments.

Problems arise because even after the most diligent search for available information about complementary and alternative treatments, a physician may remain relatively ignorant about unknown or untested preparations. It is this lack of knowledge about risk and benefit that makes unorthodox treatment so difficult for physicians and their patients. The popular notion that herbal remedies are always safe - because they are deemed to be natural - is not true.

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.

Principles
In formulating any treatment plan, the physician must consider the relative risks and benefits of any potential therapy, and choose that course most likely to restore the patient to good health. Although the patient is always an active participant in this process, it is the conscientious application of the experience and knowledge of the physician that is essential in determining the patient's best interest.

It follows that the patient's preference cannot be sufficient grounds to select a given treatment, and the physician must be careful in advising patients who are considering or using complementary or alternative therapies, and especially careful in promoting or recommending such therapies.

With these precepts in mind, the ethical physician

Must carry out appropriate and conventional examinations and investigations in order to establish a diagnosis and basis for treatment.

Must employ a rigorous medical approach before offering any unorthodox therapy. The use of an effective and proven therapy must not be delayed or supplanted by the choice of a complementary or alternative treatment.

Must not expose the patient to any degree of risk from a complementary or alternative therapy of no proven benefit.

Must not misrepresent the safety or efficacy of any therapy or procedure, whether conventional or unconventional.

Must counsel the patient, to the best of his or her ability and knowledge, about the risks and benefits of any procedure, so that the patient can give informed consent.

Must not exploit the emotions, vulnerability, or finances of a patient for personal gain or gratification.

Must not associate with, or refer patients to, alternative practitioners who recommend unproven over proven therapies. By doing so, the physician assumes a degree of responsibility for the outcome of the treatment.

Must respect the autonomy of the patient in choosing from available treatment options. If the patient's choice of a complementary or alternative therapy has made it impossible for the physician to discharge his or her ethical responsibilities, it is acceptable for the physician to terminate the physician-patient relationship.

Physicians are advised to consult with the College of Physicians and Surgeons about any questions that arise concerning complementary and alternative therapies because these considerations can be difficult and sometimes ambiguous. Careful review by one's colleagues can prevent problems for both patient and physician.