Alt-medicine and the veneer of scientific legitimacy

Tristan Bronca, associate editorWhatever the difficulties with care providers such as nurse practitioners, pharmacists or physician assistants, most doctors consider them allies. The same can’t always be said of their relationship with alternative medicine providers. Any MD could rhyme off a list of unscientific, and sometimes dangerous, claims they’ve seen from these providers—from fear-mongering about vaccines, to ineffectual treatments (homeopathy, etc.), to far more outlandish proposals.11You may remember the naturopath in B.C. who was in the news after she tried to treat a boy with behavioural issues with a remedy derived from rabid dog saliva; or the Quebec naturopath who was recently convicted of manslaughter for injecting her patient—who was having breathing problems—with magnesium.This is more troubling because of the number of Canadians using these services—a figure the CMPA estimates is more than 25%.Granted, some doctors do consider certain alternative medical practitioners allies, provided they remain within their scope of practice. For example, recent studies have shown that chiropractic care, when paired with solid primary care, is a low-cost, safe and effective way to alleviate chronic back pain. Some physicians have friendly working relationships with acupuncturists, or themselves dabble in traditional Chinese medicine. Even homeopathy, which is totally useless by any modest scientific standard, has its share of physician supporters. When the Medical Post surveyed hundreds of Canadian physicians in 2016, 41% said they believed that it was useful as a placebo as long as it didn’t replace medical care.But that’s about where the tolerance ends. The problem is not so much that anyone claims alternative medicine can or should replace medical care—because the professionals in any alt-medicine field will readily admit it cannot. The problem is that, intentionally or not, these professionals position themselves as if it could; and they’re making that pitch to patients who aren’t always able to discern their limitations. Put another way, some patients can be convinced that a chiropractor or a naturopath is literally an alternative to sound, scientific medicine.Dr. Timothy Caulfield (PhD), the Canada Research Chair in Health Policy, is probably one of the best-known critics of junk science and he has widely studied this phenomenon (his 2015 book, Is Gwyneth Paltrow Wrong about Everything? is a general audience book that complements a far larger body of academic work on the topic). He said that professionals such as naturopaths and chiropractors have fundamentally different philosophies of health and wellbeing than doctors, but they co-opt certain aspects of traditional medicine for credibility. They adopt scientific language to justify what may be non-scientific tests or treatments (stem cells, genetics or, in some cases, quantum physics). They often call themselves “doctors” without going to great lengths to make clear to patients that they are different than medical doctors. They’ll refer to their training in terms equivalent to medical training. They wear white coats and stethoscopes.When confronted about more egregious behaviour, the stock response from their professional bodies is that this is “one bad naturopath” or “one bad chiropractor”—but this kind of misrepresentation is endemic.2 “I’ve even challenged people on social media to find a naturopath’s website that doesn’t have someone in a white coat,” Dr. Caulfield told the Medical Post. “They want to be legitimized by science but they also don’t want to be bound by it.”2It’s worth mentioning that the Canadian Association of Naturopathic Doctors, the national representative body for the profession, does the same things on its own website. Their banner image is of 10 naturopaths in white coats and stethoscopes. Their tagline is “Medically trained. Naturally focused.”This is problematic because there is a lot of overlap between the conditions that alt-medicine providers purport to diagnose and treat, and those that should be handled by a primary care provider, such as asthma, ADHD or allergies. These are conditions whose symptomologies may be amorphous, but for which alt-medicine tests are not (or cannot be) scientifically validated. “Has a person ever gone to a naturopath asking questions about a sensitivity for an allergy and not come away with a diagnosis?” Dr. Caulfield asked. “I think probably the answer is no.”According to Dr. Caulfield, this also punctures the claim that alternative medicine providers often levy against traditional medicine: That doctors are only interested in treating symptoms with pills, while they (the naturopaths) are far more interested in prevention. “Which is nonsense,” Dr. Caulfield said. “All good MDs work on prevention and (alt-medicine) practitioners sell all kinds of things to ‘treat’ ailments.”Dr. Caulfield was clear that he didn’t think the medical profession was under any obligation to play nice with these other professions, a sentiment echoed by Dr. Jeff Blackmer, VP of medical professionalism at the CMA.The CMA has several policies explicitly supporting scientific-based practices, meaning doctors have an obligation to warn patients about the pitfalls of non-science-based practices. “We don’t want to see them relying on other kinds of interventions at the expense of scientific ones,” Dr. Blackmer said.Read related:Playing doctor; with other professions expanding their scope, do MDs have any reason to worry?

Alt-medicine and the veneer of scientific legitimacy

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