The Need for Complementary and Alternative Medicine Regulation

Lies and Dangerous Practices: The Need for Complementary and Alternative Medicine Regulation

 Complementary and alternative medicines (CAMs) generally market themselves as an equal alternative to biomedicines. The danger behind this is that they are not. Both CAM therapies and their practitioners do not undergo the same rigorous peer review, regulations, and education as biomedicines and their practitioners. For this reason, CAM practitioners and their therapies require more stringent regulations regarding their education, advertising, and claims of efficacy.

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 CAMs include homeopathy, naturopathy, osteopathy, traditional Chinese medicine, chiropractic, and spiritual therapies. Many of these are informed and influenced by their cultures of origin. As outlined by Bissoondath (1998) in his essay, “No Place like Home,” Canadian’s pride themselves in their acceptance of cultural practices. However, practices such as CAMs are dangerous. As multiculturalism continues to grow, so has usage of CAMs. 79% of Canadians used complementary or alternative therapy in 2016, up from 75% in 2006 (Esmail, 2017).

I first encountered CAMs during my 3rd week as a nursing student. I was assigned a 57-year-old Chinese woman who suffered a stroke which completely took away her speech and mobility. She also suffered from atrial fibrillation; a potentially dangerous condition characterized by irregular beating of the heart. If uncontrolled, it exponentially increases the risk of a stroke or heart attack. Upon assessment, her heart was beating irregularly despite being on digoxin, a medication meant to normalize the heart. We hypothesized that the patient was taking ginseng, a popular Chinese herbal remedy which, when taken with digoxin, causes rapid and irregular heart rates (Karch, 2017). The patient confirmed she regularly visited a TCM (Traditional Chinese Medicine) practitioner who ‘prescribed’ ginseng to improve energy levels thereby inducing uncontrolled fibrillations. While it is impossible to say whether the ginseng caused her stroke, it undoubtedly contributed to it.

If more stringent regulations existed, it is not unreasonable to argue that my patient would still be able to walk and talk. From prescription to dispensing, a biomedicine such as digoxin passes through multiple healthcare professionals and screening tools prior to being taken by a patient. First, a physician or nurse practitioner prescribes the medication and conducts a medication reconciliation which reviews the medications the patient is already on to determine possible interactions. According to pharmacists Elbeddini and Zhang (2018), when the patient visits the pharmacy, a licensed pharmacist conducts the same reviews. Finally, if admitted to a hospital, the nurse follows the same protocol. Three checks by three professionals, all of whom were instructed to a high standard as mandated by the government and their regulatory bodies. An individual such as a TCM practitioner need not conduct the same review.

Moreover, their education is not held to the same high standards for accreditation as the three aforementioned professionals. Despite this, they can market themselves as being able to control serious chronic health condition like diabetes or asthma using medicine that has not been tested or approved by any government agency. For example, according to a report from Global News, a Vancouver Island naturopath gave a child diluted saliva from a rabid dog to treat his autism. Despite being educated at a recognized institution for Naturopathic medicine and being licensed by the governing body of Naturopaths, she still gave a medication so widely known to be ineffective and potentially dangerous that she was stripped of her Naturopathic license. Incredibly, she is still able to practice as a homeopath and still supports her usage of the medication (Young, 2018).

Compared to a licensed medical doctor, a CAM practitioner such as a Naturopath undergoes much less rigorous and in-depth training. To gain a medical degree, an individual must first attend 3-4 years of an undergraduate program, 4 years of medical school and write a multitude of rigorous, multi-subject tests. Following graduation, a physician then spends a further 2-7 years, depending on specialization, in residency training under the supervision of fully certified, specialized physicians. In total, a medical doctor needs between 9-15 years of rigorous post-secondary education before they can practice independently.

In comparison, the educational requirements of a CAM practitioners are far less stringent. According to Brit Hermes, a former naturopathic doctor, the education for naturopathic doctors “[are] riddled with pseudoscience, debunked medical theories, and experimental medical practices” (Hermes, 2015). Her training was comprised of textbook level comprehension of core medical sciences and lacked actual clinical application. Her classes were taught by unqualified individuals. For example, her embryology class was taught by a doctor of naprapathy, a specialization focusing on chiropractic and homeopathic manipulation of connective tissues. Furthermore, the highly competitive ‘residency’ she found herself in was a total of a single year in length of which only a small amount of time was dedicated to actually treating patients. She concludes that naturopaths are not qualified to practice primary care, which is the area for which they claim to be experts.

As such, CAM practitioners should be subjected to similar regulations as other healthcare professionals. For CAM practitioners, lawyers Trebilcock and Ghimire (2019) argue that provincial-sanctioned self-regulation should be implemented. This would entail a self-governing body comprised of CAM practitioners be given power by the provincial government to grant professional credentials. A few detractors, such as attorney Michael Weir (2005) argue that granting licensure would validate CAM practitioners as licensure does with biomedical practitioners. However, instead of licensing an individual, certification should be given. Formal certification “gives strong incentives for certification bodies and their members to promote their brand and reputational status.” It also does not give the same legal protections as licensure thereby not legitimizing them in the view of the law (McHale & Gale, 2015). The main advantage of certification is normalizing educational requirements thereby setting minimum standards for CAM practitioners

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 Equally important is controlling how these therapies are advertised. Medical procedures and their efficacy are established by the healthcare professionals themselves. However, the major difference between biomedical professions such as medicine or pharmacy and CAMs are that the prior’s practices are informed entirely on peer-reviewed scientific literature. Regulatory recommendations made by biomedical bodies are backed by extensive, peer reviewed scientific literature. On the other hand, CAMs lack this rigorous peer review and can make claims unsubstantiated by evidence. One such example occurred in BC. Epidemiologists Murdoch, Carr, and Caulfield (2016) found that the majority of CAM clinics claimed that they were able to either diagnoses or treat both allergy/sensitivity and asthma despite using diagnostic techniques that were not supported by the Canadian Society of Allergy and Clinical Immunologists due to the lack of evidence supporting them. Furthermore, these same clinics used potentially harmful treatments such as IV hydrogen peroxide and spinal manipulation. Accordingly, it is vital to regulate CAM advertising to prevent harm to the public.

 Lastly, CAMs should never be promoted as being a substitute for biomedicine. CAM advertising has been shown to redirect patients from pursuing biomedical treatments despite many of their claims being unproven or fabricated. This has major ramifications to the health of individuals and can prove lethal. A study conducted by the Yale School of Medicine showed that CAMs, when taken as a substitute for chemotherapy and radiation, accounted for a mortality rate 2.5 times greater in cancer patients (Johnson, Park, Gross, & Yu, 2018). When conditions such as these remain untreated, people die. Therefore, advocating for the replacement of proven medical practices with unproven CAMs poses a great danger to the individuals who are the targets of these advertisers. One may argue that CAM practitioners are simply exercising their right to advertise in a capitalist free market. However, there exists a fundamental unfairness to CAM medicines. They can make unsubstantiated claims with little to no ramifications. These claims, in and of themselves, should be regulated. It is illegal in Canada to advertise for pharmaceutical companies to advertise medications directly to consumers (Gibson, 2014). The Canadian government has dictated that individuals lack the expertise to choose a treatment for themselves especially when subjected to purposefully manipulative advertising. Yet CAM practitioners can freely advertise to the public. This asymmetrical advertising model skews members of the general populace to choosing CAM therapies as they are presented as alternatives rather than complements to traditional biomedicine (Johnson, Park, Gross, & Yu, 2018).

 This is not to argue that CAMs have no place in healthcare. Canada, and many democratic countries support the right for an individual to choose the treatment they want. Furthermore, CAMs are not without proven benefit. According to a study conducted by the Epidemiologist Staud (2011), several CAMs have scientifically proven efficacy and many of them are being studied for their potential implementation into biomedicine. Despite this, the possible danger they pose cannot be mistaken. Some detractors from regulation, such as bioethicist Sarah Budd (2002), bring forth concerns that regulating CAMs in the same manor as biomedicines may legitimize them to the public. However, failure to regulate them poses even greater problems such as dangerous therapies, poorly educated CAM practitioners, and potentially dangerous advertising. As well, approaching regulation with a laissez faire view may itself cause the public to believe that CAMs are at worst harmless and at best useful. Some, such as medical attorney Michael Cohen (1996) argue that regulation infringes upon the personal freedom of individuals who wish to practice their culture’s health practices. While this remains a legitimate concern, lawyers Trebilicock and Ghimire (2019) argue that CAM regulation should be regulated according to a risk calibration. This entails that CAMs claiming to address life threatening health conditions should be scientifically validated and regulated accordingly. This would allow individuals to practice and market their own cultural practices while still protecting the public from dangerous therapies.

 Regulating CAMs is necessary in order to protect the health and wellbeing of the general populace.  The regulatory steps outlined in this essay provide a few basic controls on the uncontrolled CAM market. As the general populace is unable to properly diagnose a disease and consequently pick the appropriate treatment, choosing which healthcare professional is often difficult. Granting professional certification and establishing advertising rules helps protect the general public from dangerous practices, whether they come from biomedical or CAM practitioners. Finally, holding these CAM professionals and therapies to these higher standards protects the population and encourages improvement.

References

• Aronson, J. (2017). Medication reconciliation. BMJ, 356, i5336-i5336. doi:10.1136/bmj.i5336
• Bissoondath, N. (1998). No place like home. Reprinted in LIBS 7001 course reader 2018 (pp. 212-216). Burnaby, BC: BCIT
• Brody, Jane. (2018, October 1). The risk of alternative cancer treatments. New York Times, retrieved from https://www.nytimes.com/2018/10/01/well/live/the-risk-of-alternative-cancer-treatments.html
• Elbeddini, A., & Zhang, C. X. Y. (2019). The pharmacist’s role in successful deprescribing through hospital medication reconciliation. Canadian Pharmacists Journal, 152(3), 177-179. doi:10.1177/1715163519836136
• Esmail, R., Nadeem, L. (2017). Complementary and alternative medicine: use and public attitudes. Vancouver: Fraser Institute, 1(1), 11
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• Gibson, S. (2014). Regulating direct-to-consumer advertising of prescription drugs in the digital age. Laws, 3(3), 419. doi:10.3390/laws3030410
• Hermes, B. (2015, May 17). Naturopathic clinical training inside and out. [Blog post]. Retrieved from https://www.naturopathicdiaries.com/nd-confession-part-1-clinical-training-inside-and-out/
• Johnson S., Park H., Gross C., & Yu J. (2018) Use of Alternative Medicine for Cancer and Its Impact on Survival, JNCI: Journal of the National Cancer Institute, Volume 110, Issue 1, January 2018, Pages 121–124, https://doi.org/10.1093/jnci/djx145
• Karch, A. M. (2017). Focus on nursing pharmacology (7th ed.). Philadelphia, PA: Wolters Kluwer.
• Murdoch, B., Carr, S., & Caulfield, T. (2016). Selling falsehoods? A cross-sectional study of canadian naturopathy, homeopathy, chiropractic and acupuncture clinic website claims relating to allergy and asthma. BMJ Open, 6(12), doi:10.1136/bmjopen-2016-014028
• Staud, R. (2011). Effectiveness of CAM therapy: Understanding the evidence. Rheumatic Diseases Clinics of North America, 37(1), 9-17. doi:10.1016/j.rdc.2010.11.009
• Trebilcock, M. J., & Ghimire, K. M. (2019). Regulating alternative medicines: Disorder in the borderlands. C.D. Howe Institute Commentary, (541), COV.
• Weir, M. (2006). Regulation of complementary alternative medicine practitioners. Law in Context, 23(2), 171-198.
• Young, Leslie. (2018, November 8). B.C. naturopath who prescribed rabid dog saliva remedy to child surrenders her license. Global News, Retrieved from https://globalnews.ca/news/4644439/bc-naturopath-license-dog-saliva/
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