Our submission to the Medical Council on their revised statement on complementary and alternative medicines is below. The consultation documents, which provide context for our submission, can be found on the Medical Council’s website.


Thank you for inviting the Society for Science Based Healthcare to provide feedback on the draft of your revised statement on CAM. The Society for Science Based Healthcare is an advocacy organisation dedicated to protecting the right for people to make informed decisions about their healthcare. We are particularly concerned with situations where people are misled about their healthcare options.


1. Do you agree with the proposed new title Doctors and complementary and alternative medicine? (If you prefer the existing title Complementary and alternative medicine, please provide your reasons).

Yes, this change is appropriate.

2. Are there other titles could Council [sic] adopt for the revised statement on CAM? If so, what?

3. Do you agree with adopting the following definition of CAM in the revised statement?

Complementary and alternative medicine (CAM) refer [sic] to therapies and treatments that are not commonly used in conventional medical practice. Complementary therapies are health care and medical practices that work alongside conventional medical treatments but are not an integral part of conventional medicine, while alternative therapies are used instead of standard medical treatments.

Yes, the proposed new definition is clearer and easier to understand compared with the definitions in the current statement.

4. What other changes, if any, should Council incorporate in its proposed definition of CAM?

We propose that the wording “Complementary therapies are health care and medical practices that work alongside conventional medical treatments” should change to say “Complementary therapies are health care and medical practices that are used alongside conventional medical treatments”. This change avoids the possible implication that all complementary therapies are effective.

5. Do you agree with the proposed changes to “Background” as outlined in the draft revised statement?

Yes.

The existing statement states only that Council does not oppose the use of CAM complementary and alternative medicines under certain circumstances and that practitioners will not be found guilty of a disciplinary offence for having adopted and practised a form of medicine if they acted honestly and in good faith.

The impression this gives is one of amnesty, that action will not be taken against physicians who practise complementary and alternative medicine, even if it is ineffective and may directly or indirectly harm their patients, so long as the physician sincerely believes in what they practise.

This stance would fail to protect patients – an honest quack can be just as harmful as a knowing fraud – and so would be inappropriate. The statements Council is proposing to add to this section fill this gap, clarifying that in these circumstances doctors are still held to the same standards.

6. Are there any other changes that Council should consider incorporating in “Background”? If so, what?

We believe Council should also consider publishing statements opposing the use of types of CAM that have been shown not to be beneficial, either in general or specific to common types of CAM that clearly do not meet the “demonstrated benefits” criterion such as homeopathy. This would be in line with the statements from the RACGP and PSA, for example:

“Medical practitioners should not practice homeopathy, refer patients to homeopathic practitioners, or recommend homeopathic products to their patients.”

On the 27th of September this year, one of our members had a complaint settled by the Advertising Standards Authority regarding a New Zealand doctor who was making misleading claims about homeopathy in advertising. We do not believe this complaint will have been sufficient to stop them from continuing to mislead their patients in the future.

Unfortunately, when we have complained to Council in the past our impression has been that they were protected by the current clause 4 of the statement on CAM. It is not appropriate for such harmful behaviour to continue on the basis that the doctor in question holds sincere beliefs that are inconsistent with the body of evidence.

Patients must come first, and sincerity should not be an excuse for a lack of competence when it comes to evaluating the evidence for types of CAM such as homeopathy.

A statement opposing the use of homeopathy, and any other types of CAM that have been shown to have no benefit beyond a placebo, could help prevent this harm more effectively than waiting for complaints to be laid after the fact.

7. Do you agree with the proposed changes to “Doctors whose patients use CAM” as outlined in the draft revised statement?

Yes.

8. Are there any other changes that Council should consider incorporating in “Doctors whose patients use CAM”? If so, what?

9. Do you agree with the proposed changes to “Ensuring patients make informed choices” as outlined in the draft revised statement?

Yes.

10. Are there any other changes or information that Council should consider incorporating in “Ensuring patients make informed choices”? If so, what?

Subclause 10(c), regarding providing sufficient information to allow competent patients to make an informed choice, could be relevant in more circumstances than just when a patient is making an initial choice whether to engage in CAM.

For example, if a patient tells their doctor that they are currently taking a product such as harmonized water (a real product sold in New Zealand by Osmosis Skincare for a variety of ailments, including “hormone balance”), a doctor might be justified in suspecting that their patient has been misinformed about that product, and therefore did not make an informed decision to start using it. In such a case, it could be appropriate for a doctor to ensure, to the extent of their knowledge, skills, and judgement as noted in subclause 10(c), that the patient has sufficient information to allow them to make an informed choice about whether or not to continue using the CAM.

Clearly the choice belongs to the patient, and as noted earlier in the statement it is important that patients using CAM are treated with respect irrespective of a doctor’s views about CAM. However, in our experience it is excessively common within the CAM industry for patients to be misled about treatments, and those patients’ doctors could have an important role to play in ensuring their health literacy is not harmed.

Clause 14 seems to be inconsistent with clause 3, in that it is possible for a doctor to misrepresent a form of treatment or health service in order to obtain consent but also be acting honestly and in good faith. In such cases, which principle is more important? We believe clause 14 should be considered more important, as it serves to protect patients.

11. Are the responsibilities of doctors who practice CAM or refer patients to CAM practitioners outlined clearly in the section on “Doctors who practise CAM or refer patients to CAM practitioners”?

Yes, mostly.

We are happy to see the inclusion of a requirement that advertising complies with Council’s standards on advertising. This is directly relevant to a real problem that it has been difficult to address in the past, as mentioned above regarding our settled Advertising Standards Authority complaint against a New Zealand doctor promoting homeopathy.

Should the wording in subclause 21(a) read “nationally accepted guidelines” rather than “national accepted guidelines”?

The removal of the requirement for CAM research to obtain approval from an approved ethics review board or committee is concerning, particularly given the lack of plausibility common in CAM that can make it more difficult to conduct research ethically. Clearly this must remain a requirement, as protection of patients is essential in research.

If the the phrase substituting it – “follow national accepted guidelines for undertaking health and disability research” – is expected to include the requirement for ethical approval, this is not clear. The requirement for ethical oversight should remain a clear and prominent requirement. Such wording could be:

“(a) follow nationally accepted guidelines for undertaking health and disability research, including obtaining approval for the research from an approved ethics review board or committee;”

12. Are there any other changes that Council should incorporate in “Doctors who practise CAM or refer patients to CAM practitioners”? If so, what?

Clause 17 says “information on the safety, efficacy, benefits and risks of the CAM treatment or product” should be discussed. We believe it would be more appropriate to say this information “must” be discussed with the patient, as it is integral to their making an informed decision.

13. Are the responsibilities of doctors who are associated with a CAM clinic, therapy or device outlined clearly in the section on “Association with a CAM clinic, therapy or device”?

Clause 23 deals with published materials, including advertising. A very common first port of call for advertising complaints in New Zealand is the Advertising Standards Authority. However, they form part of a voluntary system of self-regulation, rather than a legislative framework. It is not clear in this section whether or not doctors who are associated with a CAM clinic, therapy or device are required to comply with the ASA’s decisions.

14. What other changes should Council include in the section on “Association with a CAM clinic, therapy or devices”?

It would be useful to clarify where complaints about advertising from doctors should be directed in the first instance, for example to the Advertising Standards Authority, and if Council has an expectation that doctors will always comply with the outcomes of those complaints.

When a member of the medical profession is associated with a CAM clinic, therapy, or device, it is likely to lend it credibility in the eyes of patients. In some cases, when it is not supported by credible evidence of efficacy or is associated with other unethical behaviour, this may harm patients’ health literacy or lead them to avoid seeing doctors. It is important that doctors are held to high standards in terms of clinics, therapies, and devices that they may associate themselves with. Particularly if this involves a promotional role.

As the two clauses in this section largely refer to standards described in other documents, it is not immediately clear if this consideration is already included.


Given the statement’s nature as an online document, if possible it would be useful to turn references to other documents (such as the Council’s statement on Information, choice of treatment and informed consent, referenced in footnote 1) into hyperlinks. This would make it easier for readers to follow these references.

One issue that is always at the forefront of our minds regarding documents such as this is how it is enforced. In the past, we have contacted the Medical Council regarding what we have interpreted as breaches of this document, but it seemed the principle expressed in the existing clause 4 – that a doctor was acting honestly and in good faith – was enough to override any wrongdoing.

It would also be useful for Council to keep in mind that though doctors are clearly the primary audience for this document, it will be used as a reference by patients and patient advocates.


We would like to reiterate our thanks to the Medical Council for involving us in this process, and actively seeking our feedback. We hope this submission will be useful, and look forward to seeing the outcome of the consultation process.

Sincerely,

Mark Hanna
Chair, Society for Science Based Healthcare

Dr Rob Seddon-Smith MB ChB FRNZCGP
Medical Advisor, Society for Science Based Healthcare

Submission on the Medical Council’s revised statement on complementary and alternative medicines
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