Statement No. 149 - Unproven Therapies
Preamble
All physicians
must meet the same standards of practice and any medical act must
meet the following criteria:
-
the context within which it is performed has the informed
consent of the patient or appropriate legal authority;
-
the medical act is carried out in a manner reasonably consistent
with the standards recognized by the profession.
Evidence based
medicine is the foundation of medical practice. Today
some physicians are asking for better direction regarding the
criteria which must be met in those areas of medical practice which
are not evidence based. Questions arise such as -
What activities may be considered unacceptable? Are
there any specific requirements with respect to patient
consent? This paper is intended to answer such
questions and provide some guidance to physicians who wish to
introduce unproven activities into their practice.
Definitions
The word
"unproven" is used in preference to "alternative" or
"complementary" because it implies that the processes lack
scientific basis and are adjuncts, rather than replacements, for
orthodox processes.
Unproven
therapy refers to those processes and interventions used for
diagnosis, prevention, therapy, or rehabilitation for which there
is no scientific evidence of efficacy, reproducibility, and
reliability. Some of these activities have become
accepted by the medical community over the years, despite no
evidence to support them.
Orthodox
medicine consists of evidence based knowledge and also those
unproven concepts which have become commonly accepted by the
medical community. New activities or concepts which are
shown to be "evidence-based" become part of orthodox
medicine. Activities which are discredited by
scientific evidence cease to be acceptable and are unorthodox.
Diagnosis
Only diagnostic
tests acceptable to orthodox medicine will be used to determine a
patient's biochemical, physiological, anatomical, or psychological
status.
Requirements Relative to Unproven Therapies
-
Unproven therapies are to be practised as adjuncts to
evidence-based medicine, and not as alternatives. The
physician may also use unproven therapies where no evidence-based
alternative is available.
-
The patient has a right to seek health care from any provider
even if the health service provided is unproven. If the
therapy is known to be harmful, then the physician must inform the
patient.
-
A physician must review the scientific literature in order to
assess a theory before using it in patient care.
-
The nature of the unproven therapy being provided by a physician
must be explained to the patient with regard to the quality of
research relative to efficacy, reliability, reproducibility, and
risk.
-
If the unproven therapy may cause harm, the potential for this
harm must be fully explained.
-
The physician must not provide a service when harm significantly
exceeds that of orthodox medicine, or where there is no reasonable
expectation of offsetting benefit.
-
Physicians must be aware of the economic well being of their
patients, and advise regarding cost/benefit of any unproven therapy
they may propose.
-
Where physicians may personally profit from the sale of any
device, service, or product associated with the unproven therapy
service, they must comply with conflict of interest guidelines.
The overriding
principle of all medical practice is, "Remember first the well
being of the patient." All of medical practice must
adhere to the same standards.
First Print EXEC/09-94
Revision EXEC/02-99
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A statement is a formal position of the College with
which members shall comply.
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