Professionalism and Ethics in Complementary and Alternative Medicine

Ethan B Russo, Fernando Ania, John Crellin

• Publisher: Routledge
• Year: 2012
• Print ISBN: 9780789012258
• eBook ISBN: 9781136392238
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Gain a better understanding of the complex issues that will decide the future of health care!This is the first book of its kind in the rapidly growing field of complementary and alternative medicine. It addresses quality-of-care concerns and also focuses on the goals of many practitioners: to secure a firm place for their practice in health care systems and to establish levels of integration. Professionalism and Ethics in Complementary and Alternative Medicine is a unique textbook, but is also an essential resource for practitioners of complementary, alternative, and conventional medicine as well as the general public.This volume is divided into three parts. The first looks at a range of current concerns over complementary and alternative medicine, many of which raise ethical issues relating to quality of care. The next section, focusing on professionalism, indicates how practitioners must respond to the public's concerns, especially in light of the public's rising expectations of standards of care among all practitioners. The third part is comprised of case histories plus commentaries suitable for private study or classroom discussion.In this valuable book you will find:

• an examination of current issues in complementary/alternative medicine and bioethics
• explorations of other approaches to ethical dilemmas including "bottom-up" ethics such as consequentialism and social utilitarianism plus feminist ethics, virtue ethics, and more
• informed discussion of public expectations of professional roles and responsibilities
• case histories that illustrate ethical issues
• explanations of the Hippocratic Oath and complementary and alternative medicine codes
• an examination of the power structure within health care systems
• and much, much more!Growing from a course on ethics and law at the Homeopathic College of Canada in Toronto, Professionalism and Ethics in Complementary and Alternative Medicine will benefit everyone who is concerned with quality care and integrated medicine.

PART I:
THE CURRENT SCENE—PUBLIC AND PROFESSIONAL ISSUES

Chapter 1

Introduction: A Complicated Setting

How did nineteenth-century alternative practitioners deal with being labeled unorthodox or quacks? Did they see themselves as health reformers? Did they wish for more social standing? Are the same issues current today? The dichotomy between mainstream medicine and other forms of medical care has deep roots that anchor attitudes today.

Historians, like sociologists, generally see physicians’ concerns with maintaining monopoly as key reasons for this dichotomy.¹ It was particularly significant that, as mainstream medicine came to rely more on observing pathology and on science during the nineteenth century, it had new reasons for attacking “nonscientific” practices, which it commonly labeled as quackery. Fears of quackery continue to be fostered today, either specifically or as part of the general opposition to complementary/alternative medicine. One respected U.S. commentator wrote (1997), “as scientific medicine advanced and regulatory law gained greater power, pseudoscience also grew so that in our own day larger sums are expended on quackery than ever before in our nation's experience.”² The “dangers” are constantly highlighted by, for instance, media reports and the well-known, U.S.-based Quackwatch Internet site.³ Thus a long-standing specter continues to overshadow complementary/alternative care and prompts warnings to “beware” of it. This feeds worries about, for instance, the safety of various products, erratic licensing/nonlicensing of complementary/alternative practitioners in many jurisdictions, as well as countless ethical issues. If the latter are rarely as emotive as abortion and euthanasia, they are common, everyday issues affecting quality of care. Moreover, as ethicists often say, it is important to prevent small matters (e.g., misunderstandings in communication)—often due to the colossal amount of conflicting advice that exists—becoming major “fire-alarm” situations.

Historical perspective helps us, too, not only to understand reasons for the present rather chaotic state of complementary/alternative medicine in many Western countries, but also why current interest is probably not a “flash in the pan “ Many observers see a strong parallel between the enthusiasm for alternative therapies in the nineteenth century with the current widespread usage. They see a temporary fading of interest during the first half or so of the twentieth century as due primarily to public and government enthusiasm for new scientific developments in medicine, which aided the medical profession to develop virtual control in health care. It is no surprise that the rapid growth of complementary/alternative care in recent years—partly due to concerns with mainstream medicines—is being scrutinized by the medical profession. In fact, much of the scrutiny (also by governments, allied health professions, the general public, and practitioners of complementary/alternative medicine) is, as we now consider, constructive. It is certainly important for all practitioners in health care to appreciate the many concerns and questions, trends and counter trends, social and political issues, reflected in today's evaluations. Such matters are at the heart of how a profession “negotiates” the politics of health care.

NOTES

1. The history of complementary/alternative medicine is substantial. A few relevant texts to issues raised in this volume: S. E. Cayleff, Wash and Be Healed: The Water-Cure Movement and Women's Health, Philadelphia: Temple University Press, 1987; R. Cooter, ed., Studies in the History of Alternative Medicine, New York: St. Martin's Press, 1988; H. L. Coulter, Divided Legacy: A History of the Schism in Medical Thought, Berkeley: North Atlantic, 1994, 4 volumes.; J. K. Crellin, R. R. Andersen, and J. T. H. Connor, eds., Alternative Health Care in Canada: Nineteenth- and Twentieth-Century Perspectives, Toronto: Canadian Scholars’ Press, 1997; R. C. Fuller, Alternative Medicine and American Religious Life, New York: Oxford University Press, 1989; M. Saks, Professions and the Public Interest: Medical Power, Altruism and Alternative Medicine, London: Routledge, 1994; W. I. Wardwell, Chiropractic: History and Evolution of a New Profession, St. Louis: Moseby, 1992.

2. J. H. Young, “Health Fraud: A Hardy Perennial,” Journal Policy History’, 1997; 9, 117–140.

3. Web site address of Quackwatch: <http://www.quackwatch.com> (accessed September 2001).

Chapter 2

Scrutinies

FROM THE GOVERNMENT

Just what should be a government's role in health care, of which complementary/alternative medicine is but one aspect, has long raised heated debate. Indeed, in modern times, due to such episodes as the dramatic congenital side effects associated with expectant mothers taking thalidomide in the early 1960s, arguments that governments have a responsibility to protect the health of the public have strengthened. Nowadays, in “protecting the public and promoting health,” governments face the dilemma that they must also respect the autonomy of individuals. Some commentators paint the scene as public interest versus patient autonomy. Trying to find the “right” balance vexes not only legislators, but also stakeholders in complementary/alternative care. The latter are commonly concerned over government biases, and many believe that the medical profession's special influence on government bureaucracies—once very evident—still exists. Some hold, too, a longstanding view of political economists that the state primarily serves the needs of business, rather than of the individual (including in health matters). When worries have erupted over the safety of particular herbs (e.g., chaparral, comfrey, or ephedra) differences of opinion between governments, scientists, and users often center on charges that bureaucracies pay too much attention to vested interests.

Given all the issues, and especially public lobbying for less control of dietary supplements (also commonly known as nutraceuticals), it is not surprising that governments have, in recent years, actively looked for new policies.¹ It is noteworthy that in the United States, prior to the Dietary Supplement Health and Education Act of 1994 (and in the wake of the 1991 establishment of the government-funded Office of Alternative Medicine) “congress received more mail on the [Act] than on any subject since the Vietnam War.”² In Canada, following the “hot” issue of herbal remedies during the 1997 election, a Canadian House of Commons Standing Committee on Health investigated, with much public consultation, the place of natural health products in Canadian society.³ The committee's recommendation to establish a new regulatory framework for such products was accepted by the Canadian government.⁴ In one sense, as noted in Chapter 5, under Dietary Supplements and Regulations, the U.S. and Canadian governments have been led to compromise legislation.

Government scrutiny, in the early 2000s, extends to licensure, or at least setting frameworks for licensing. This varies from jurisdiction to jurisdiction (see Chapter 5, Research). Here we merely note that the complementary/alternative practitioner must recognize that the inconsistent practices of various jurisdictions is problematic. This is particularly so in the United States and Canada, where licensing is a state or provincial, not federal, matter. Clearly, questions of professional responsibility arise for all practitioners as they contribute to debate on how governments can best balance public safety with the autonomy, the freedom of choice, of individuals.

FROM THE MEDICAL AND ALLIED HEALTH PROFESSIONS

Long-standing and ongoing vigorous opposition to complementary/alternative medicine from the medical profession has already been emphasized. Many see this as resulting less from critical scrutiny than from the ideology of rejecting “nonscientific” practice. As said, the strengthening of medical opposition to alternative medicine in the nineteenth century was linked to the profession's commitment to new medical science, and to an increasingly science-based education that fostered a reformist zeal. This, in forging a new “improved” medicine, contributed to new ethical precepts that prohibited physicians from consulting with alternative practitioners.⁵

Although it is wrong to assume that the medical profession has ever had a totally uniform voice, a very conspicuous level of diverse opinion presently exists over whether complementary/alternative medicine should be excluded from or incorporated (perhaps after reformulation) into conventional medicine. Although criticism from physicians about complementary/alternative medicine-—commonly on the basis that it is “unscientific” in approach, at best a placebo action or merely for the “worried well”—remains very noticeable, many physicians added one or more complementary/alternative modalities to their regular practice between the 1980s and early 2000s. These physicians on both sides of the Atlantic—usually general practitioners (but also some specialists)—are persuaded by empirical evidence that patients are helped; they often ignore the “unscientific” theory (acupuncture and homeopathy are commonly mentioned), and suggest that Western science will ultimately explain the practice.⁶ Further, their approach, albeit often reshaping practices (e.g., so-called “modern acupuncture” is a Westernized approach based on conventional anatomy and physiology), may well fit the holistic philosophy associated with much complementary/alternative medicine (compare Box 2.1).

BOX 2.1. “But Many of My Professional Colleagues Swore at Me”

Already a legend was growing up about me. It was suggested that ! used unconventional methods and there is nothing a professional group mistrusts so nervously as it does anything that appears unconventional, and that has not been thoroughly written up in the journals, ft may be quackery, Worse still, it may be effective. And if it is both quackery and effective it is utterly hateful.

The reasons why many physicians have added complementary/alternative practices to mainstream medicine are diverse. Famed novelist Robertson Davies captures many issues sn his highly recommended novel, The Cunning Man (1994). In this “autobiography” of a physician, Robertson Davies offers many insightful thoughts about the interface—often a challenging one—between conventional and complementary medicine. Although a regularly licensed physician, the novel's central character, Dr. Jonathan Hullah, became known for a distinctive practice in which he attached much importance to the psychosocial aspects of care. As Hullah said:

Many of my patients, in their phrase, swore by me. But many of my professional colleagues swore at me, for I appeared to them to be a heretic about health.,,. My dictionary says that a quack is somebody who professes a knowledge of which he is ignorant; but I profess nothing of the sort—I simply profess a knowledge of which a great many of my professional colleagues are ignorant. I suppose I might call it humanism.^*

* The dilemmas of shifting into unconventional practice appear in many places in R, Davies, The Cunning Man, Toronto: McClelland and Stewart, 1994, but especially pp, 245–249, Used with the permission of Pendragon Ink.

Other physicians, although not practicing complementary/alternative care themselves, at least believe that it should be available for their patients. A British study (1998) on access to complementary/alternative medicine in general practice stated that recent studies of general practitioners, hospital doctors and medical students have “shown a softening of attitudes and a general integration of complementary therapy within traditional practice.”⁷ This supported earlier studies (e.g., 1994) that claimed three-quarters of U.K. doctors thought that some form of complementary medicine should be provided by the National Health Service.⁸ This is only slightly higher than a U.S. study (also 1994) indicating that more than 60 percent of community physicians referred patients to complementary/alternative practitioners.⁹ Studies in 1998 of U.S. physicians found that many psychobehavioral and lifestyle therapies appear to have become accepted as part of mainstream medicine, that chiropractic and acupuncture were apparently gaining acceptance, despite low levels of training, and that substantial personal use occurred.¹⁰ A further 1998 “review of the incorporation of complementary and alternative medicine by mainstream physicians” in various countries found that acupuncture had the highest rate of physician referral (43 percent) followed by chiropractic (40 percent) and massage (21 percent).¹¹

An important aspect of physician involvement is the influential local, national, and international physician-promoters of complementary/alternative medicine; examples from the 1990s range from Dr. Andrew Weil, a U.S. media star, commonly introduced by his “Harvard-trained” pedigree, to Dr. Jozef Krop of Toronto, a practitioner of environmental medicine, whose protracted disciplinary hearings with the Ontario College of Physicians and Surgeons became a public cause célèbre.¹²

It is also clear that many physicians, often in positions of influence, believe that alternative/complementary medicine should no longer be ignored, even by skeptics. Surveys of usage of complementary/alternative therapies have now appeared in many specialty...

Table of contents

• Front Cover
• Half Title
• THE HAWORTH INTEGRATIVE HEALING PRESS
• Title Page
• Copyright
• CONTENTS
• ABOUT THE AUTHORS
• Foreword
• Preface
• Introduction: What to Consider
• PART I: THE CURRENT SCENE—PUBLIC AND PROFESSIONAL ISSUES
• PART II: PROFESSIONALISM
• PART III: PROFESSIONAL/ETHICAL ISSUES IN EVERYDAY PRACTICE—CASE HISTORIES/ READINGS
• Index