Jewish World Review April 26, 2002 / 14 Iyar, 5762
Drs. Michael A. Glueck & Robert J. Cihak
http://www.NewsAndOpinion.com | What constitutes "non-conventional" medical treatment these days? That depends on whom you ask.
An internist may say acupuncture, though an orthopedist routinely "needles" his patients. Allergists regularly employ nutritional therapies, treatments that are far off the neurosurgeon's radar screen. Just a few years ago chiropractic medicine raised eyebrows.
The Federation of State Medical Boards (FSMB) is wrestling with the issue this week at their meeting in San Diego. They are poised to adopt Model Guidelines for "Complementary/Alternative Medicine" that would regulate the use of CAM treatments, assuming, that is, that they can define them first.
Patients don't give a hoot how a treatment is defined by a bunch of policy wonks -- they just want to get better. And they want their doctor to be able to use any combination of treatments to get the job done without some state agency's meddling.
But the FSMB wants to impose draconian guidelines on alternative medicine. They would hold those who use CAM to an impossibly high standard of care -- higher than the standard for conventional medicine. Our diagnosis is: a serious case of double standard.
The guidelines would harm patients, put physicians at extreme risk if they used "unconventional" methods, and open the door for the trial attorneys to sink their teeth into some fresh new meat.
Insiders tell us they're afraid to testify at this week's meeting. Some docs have tried to make changes at state licensing boards but have then found themselves the target of harassment and repeated disciplinary actions. Remember, we're talking about licensed doctors -- physicians with medical degrees, not voodoo doctors who have thrown up a shingle on their own hook.
At the very time consumers are demanding CAM treatments and more physicians are using them, the state medical boards are moving in the opposite direction, making it tougher for patients to get those services.
According to the New England Journal of Medicine, one in three patients seeks unconventional therapy. Estimates put the number of non-conventional patient visits at 425 million a year and spending at almost $14 billion.
Hospitals are incorporating CAM, particularly for post-surgical patients. Medical schools, such as prestigious Duke and Georgetown, are tripping over themselves to add integrated medicine to their curriculum. A White House Commission issued a CAM progress report, and, most telling, insurance companies are adding coverage of CAM therapies.
So why are a few dinosaurs dragging their feet?
Harassment and censure of physicians for the use of CAM therapies, even in the face of successful treatment and patient satisfaction, reveal a lack of understanding, education, and tolerance on the part of medical boards.
Under the proposed guidelines, doctors would be prohibited from providing any treatment that could be "harmful." That would knock out many conventional treatments. Ask anyone who has received chemotherapy; ask a mother whose child died after taking aspirin. With any treatment, you and your doctor should weigh the benefits and the risks.
The board warns against use of treatments that "may lack scientific research and clinical validation." This is a tar pit that should be avoided, because only the lawyers will be wearing the Teflon boots.
Moreover, what the warning doesn't mention is that the majority of medical treatments lack scientific validation. Murray Susser, M.D., president of the American Association for Health Freedom, points out that the board's approach flies in the face of medical history:
"An uncountable list of present valuable procedures would not be in use if we are held to this rigorous and arbitrary standard." He cites examples such as penicillin, cortisone, antibiotic treatment for H. Pylori when it is the cause of peptic ulcer, and the off-label use of practically every drug on the market.
Our caring bureaucrats aren't just worried about physical harm but about harm to your psyche as well. Under the guidelines, your physician could be sued or lose his license should he dare raise your expectations too high.
Also, physicians would be obliged to play "I spy" on other practitioners when they referred patients to them and would be expected to monitor their performance. Lawyers must be drooling over this one: it invites them to sue the referring doctor because of treatment the patient received from someone else. Don't think it's so far- fetched. A physician recently lost a case brought by a patient he had never seen.
While doctors would have to jump through a zillion hoops to employ non-conventional options, they wouldn't have to inform patients about them. Susser says that means that patients wouldn't get the whole story on treatment options, and that this could be the basis for major "informed consent" lawsuits.
Susser notes that while doctors don't have to use non-conventional options, or promote them, they should alert their patients to the fact that options other than the conventional ones do exist. Failure to do so means that patients can't make educated decisions.
If the guidelines are adopted this week in San Diego, they'll be coming soon to your state. The federation should NOT approve them.
We think the guidelines make for bad medicine
and even worse law. State medical boards
should use their time and resources more
wisely -- for instance, listening to
04/12/02: Insure the 'crazies'?