CASS Submits Critique to Ont. Homeopathy Regulatory Body
October 19, 2011
Today, the Centre for Inquiry Canada’s Committee for the Advancement of Scientific Skepticism (CASS) submitted feedback to the Transitional Council of the College of Homeopathy of Ontario, the body responsible for setting up the new regulatory body in Ontario for homeopaths. The feedback was for the public consultation phase of the develpment of the College’s Professional Misconduct, Registration and Quality Assurance policies, the deadline of submission for which has been extended until October 26 2011. Please have a look at the original documents here and read our submission below. We encourage concerned members of the public to make their own submissions to the Transitional Council and let them know that we expect them to, first and foremost, protect the public.Transitional Council of the College of Homeopaths of Ontario
Submission from Committee for the Advancement of Scientific Skepticism
at Centre for Inquiry Canada
As an organisation that promotes an evidence-based perspective on the world, CASS has several concerns regarding the regulation of homeopaths in Ontario and the commitment that the College of Homeopaths of Ontario has to protect the public from harm. These concerns are focused on: (i) the concept of Standards of Practice, (ii) the titles used by homeopaths in Ontario, (iii) the treatment of chronic and acute illness, (iv) the role that homeopaths intend to play in the prevention of communicable diseases and the use of vaccines in their practices, and (v) the sale of prescribed products including all compounded formulae and devices by the prescribing homeopath or his or her business.
Standards of Practice
The criteria for the Standard of Practice as set out in Professional Misconduct Part I, Section 1 is a cause of concern for us. It is important when discussing Standards of Practice, to define the term “standards” as an average and agreed upon level or degree. This becomes a problem when faced with two different conflicting standards of practice, namely “classical” and “contemporary” or “combination” homeopathy. We are concerned that since the standard of care is so broad, being both “written and unwritten” as suggested in the explanation for this provision, that any care rendered by the homeopath and supported by another homeopath, regardless of the state of evidence of efficacy or safety of such practice, can be determined to be the standard of practice for the profession.
The efficacy of the modalities used by the homeopath should meet an “Objective Standard” as detailed in the explanation of Part I, Section 8. This objective standard is one that exists, by definition, outside of the homeopathic doctrine. CASS has examined many investigations into the efficacy of homeopathy and the consensus is that the modalities presented do not have sufficient evidence to support their use as treatment for any medical condition (for an example summary, see the report of the Science and Technology Committee of the U.K. House of Commons1). We feel that the policy sets an, as of yet, unmet standard in the practice of homeopathy, and the council should consider this when setting out the scope of practice and the conditions for which the homeopath can prescribe treatment.
Use of Title “Doctor” and “Homeopathic Doctor” (HD)
In the Professional Misconduct policy, we support the inclusion of a passage specifically outlining the use of titles by homeopaths. It must be made clear to registrants (and enforced where necessary) that “Doctor” is a restricted title in Ontario and homeopaths must use the title “homeopath”. We are concerned that despite this clear restriction there are many homeopaths in Ontario still using the restricted title “Doctor” or “Homeopathic Doctor”. We have attached a recently confirmed list of those using either of these terms and expect this to be a tightly regulated policy when the College of Homeopaths of Ontario begins to accept registrants.
Claims to Treat Serious Chronic and Acute Illness
Many homeopaths make claims that overreach their abilities without any plausible evidence to support such claims. These claims include - but are not limited to - being able to cure cancer, provide effective prophylaxis for malaria, and immunize against common childhood infections. These claims carry significant health risks when they lead patients to eschew effective conventional treatments. It is unethical for any medical practitioner to make misleading claims about the efficacy of any treatment, or to make any health claims that cannot be supported by rigorous scientific evidence. Genuine informed consent is not possible unless medical practitioners are entirely open and honest about the available evidence, or lack of it, for the treatments they propose.
The draft regulations do include some provisions that seem intended to address this issue. However, it is our view that these provisions do not go nearly far enough, and in any case, are, overall, far weaker than corresponding language in similar regulatory documents (e.g. those issued by the College of Physicians and Surgeons of British Columbia2). Part 1, Section 25, of the proposed Professional Misconduct Regulations prohibits “Making a claim about a remedy, treatment, device or procedure other than a claim that can be supported as reasonable professional opinion.” This language is identical to the language governing physicians in Ontario (the Ontario Medicine Act, 19913). However, in application to homeopaths, the language is questionable. Our concern is that “reasonable professional opinion” is ambiguous. If the standard were the same as that applied to physicians, the reasonable professional opinion would be based upon a standard of evidence that comes from empirical observation and that has been subject to rigorous scientific inquiry. A homeopath can have a reasonable professional opinion that is based upon an irrational medical paradigm, like vitalism, and provide support for a claim that is not otherwise supportable with objective scientific evidence.
Section 26, regarding advertising, compounds the problem of Section 25. While it is of course entirely correct to bar false or misleading advertising, this does not go far enough. Many doubtful claims cannot be demonstrated to be false, yet it would be entirely inappropriate for a medical practitioner to advertise services by making such claims. Medicine does not advance through the falsification of a claim but by the presentation of robust evidence supporting a claim. Therefore the standard should be that advertised claims must always be backed up by solid scientific evidence. Far more appropriate language is that proposed by the College of Chiropractors of Ontario, requiring advertising to be “accurate, factual, and contain information that is verifiable.“4
Vaccine Preventable Illness and Other Health Professionals
Section 50 of the proposed Professional Misconduct Regulations commendably requires homeopaths to attempt to collaborate with other relevant health care providers. However, this language fails to capture a serious failure of collaboration, which occurs when homeopaths actively disparage the treatment options provided by other medical practitioners. Of particular concern to us is the frequent promulgation of false and misleading information concerning vaccinations. Vaccinations are one of the most important and effective public health initiatives of modern times, responsible for saving millions of lives every year. Unfortunately, many alternative health practitioners, including a significant number of homeopaths, frequently spread scare stories about supposed risks of vaccination, and offer ineffective alternative treatments in their place5. Such misinformation, and the decline in vaccination rates it causes6, is one reason why, after years of decline, developed countries are now seeing renewed epidemics of infectious diseases - such as mumps and measles - that are entirely vaccine-controllable.
Regulated health professionals occupy a position of significant trust in our society, and patients rely on them for accurate, factual information regarding health matters. This trust often goes far beyond the professed areas of competence of the practitioner. For this reason, it is vital that homeopaths are tightly regulated regarding the claims that they may make concerning non-homeopathic treatment options, including vaccinations. Any such statements should be required to meet the same standards of accuracy and verifiability as should be required of the positive health claims made by homeopaths. Moreover, such claims should be prohibited where there is a reasonable likelihood that they will lead to unfounded fears or concerns regarding medical treatments. (Such may include true statements regarding known side effects of conventional treatments, without indicating the likelihood of such side effects, or the counterbalancing benefits expected.)
In addition to a requirement of accuracy, verifiability, and fairness in describing conventional medical treatments, we believe that the regulations must make abundantly clear the duty of homeopaths to refer patients to an appropriate physician or other medical practitioner whenever there is any risk to the life or health of the patient. This includes collaboration regarding routine and non-routine vaccination programs.
Sale of Homeopathic Prescriptions and Devices by Homeopath
It is unclear in Part II of the Professional Misconduct policy what the duties of the homeopath are regarding the sale of therapeutic substances and devices while protecting the patient’s economic status. Part II, Section, 3 Paragraph ix covers the sale of any products and the necessity of the homeopath to inform the patient of the availability of such items by other sellers, but it fails to go as far as the College of Physicians and Surgeons of Ontario Policy 1-10 on Dispensing Drugs7 when speaking about the conflict of interest that will exist when making a profit on such drugs. We ask that a provision such as that found in the Ontario Medicine Act 1991, Section 16(d) be added to ensure that it is a “conflict of interest for a physician (homeopath) to profit on the sale of a drug to a patient except in very limited circumstances,” (CPSO Policy 1-10). Those circumstances are set out in the Medicine Act above and concern only emergent and life-threatening situations.
In the light of this legislation and policies, it is obvious that a conflict of interest occurs when a homeopath profits from the dispensation of homeopathic preparations and this should be considered professional misconduct.
Conclusion
It is clear to us that the Transitional Council, in producing the codes of conduct for its registrants, must take a very close look at the evidence supporting the practice of homeopathy, and when dealing with serious or potentially serious illnesses, restrict any practice that would endanger the public through non-evidence-based interventions or advice to eschew standard mainstream medical care in favour of homeopathic care. We believe that due to the rising interest in homeopathy in Ontario a regulatory college is required to ensure a defined standard of practice and we hope the Transitional Council will focus its efforts on protecting the public rather than protecting the profession.
References
1 UK House of Commons Science and Technology Committee (2010) Evidence Check 2: Homeopathy, HC45. http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/45.pdf
2 College of Physicians and Surgeons of British Columbia (2009). Resource Manual: Complementary and Alternative Therapies.
https://www.cpsbc.ca/files/u6/Complementary-and-Alternative-Therapies.pdf
3 Ontario Medicine Act (1991), Part 4, Section 15.
http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_940114_e.htm#BK1
4 College of Chiropractors of Ontario (2009) Proposed Regulation: Advertising. http://www.cco.on.ca/site_documents/Proposed%20Advertising.pdf
5 Ernst, E. (1997) The attitude against immunisation within some branches of complementary medicine. European Journal of Paediatrics, 156: 513-515.
http://www.springerlink.com/content/daq9mb133a837qxt/
6 François, G., Duclos, P., Margolis, H., Lavanchy, D., Siegrist, C.-A., Meheus, A., Lambert, P.-H., Emiroğlu, N., Badur, S., Van Damme, P. (2005) Vaccine safety controversies and the future of vaccination programs. Pediatric Infectious Disease Journal, 24 (11): 953-961.
http://journals.lww.com/pidj/Abstract/2005/11000/Vaccine_Safety_Controversies_and_the_Future_of.3.aspx
7 College of Physicians and Surgeons (2010) Dispensing Drugs (Policy 1-10). http://www.cpso.on.ca/uploadedFiles/policies/policies/policyitems/dispensing_drugs.pdf.
Homeopath Using Restricted Term (Last Checked Aug. 2011 – evidence upon request)
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