Alternative and emerging therapies and the role of CPSA

College of Physicians and Surgeons of Alberta CPSA, Messenger 6 Comments


Research conducted by the Fraser Institute shows that Canadians’ attitudes towards complementary and alternative medicine (CAM) have changed a lot over the past 20 years. According to their 2017 report, a 2016 survey found 79 per cent of Canadians reported using at least one of these therapies sometime in their lives. Most interestingly, the majority of people who used CAM in the 12 months before the 2016 survey chose to do so for “wellness”­—to prevent future illness. Similarly, there seems to be a greater openness in our profession to emerging therapies—treatments of which we don’t yet fully understand or appreciate all the potential impacts.

What’s CPSA’s stance on CAM and emerging therapies?

Any physician offering treatments with limited scientific evidence to support them should be certain of the patient’s diagnosis and must also offer conventional treatment options. They should also be clear with the patient about the uncertainties, risks and potential side-effects of a non-conventional therapy. In many ways, this is not dissimilar to what we would expect from any physician offering any treatment—good reasoning, clear communication, setting expectations with the patient and ensuring informed consent.

These are the current expectations of Alberta’s physicians and represent what we know to be good medicine. But do we need additional guidance as CAM and emerging therapies are being used and requested more and more frequently?

How many physicians have patients on their roster looking to supplement or replace their treatment plan with complementary, alternative or emerging therapies? How many physicians offer CAM or emerging therapies as part of their routine practice? Should we, as physicians, offer any treatments with limited scientific research that support their effectiveness? Which therapies are classified as CAM and which are simply emerging? Is there truly a distinction when it comes to how we approach them?

All valid questions. As more and more people rely on these treatments, it’s time for Alberta’s physicians to think about how we want to approach these therapies in a future with rapid medical, scientific and societal developments.

Starting in 2020, we’ll be asking you for help, insight and feedback on what CPSA should be doing with regard to CAM and emerging therapies. You’ll see us asking new questions about these practices in the Renewal Information Form (RIF) and we’ll look to you for leadership as we revisit the CPSA standard of practice on Complementary and Alternative Medicine.

We welcome your comments and feedback on the future of CAM, emerging therapies and CPSA’s role in regulating them.

Dr. John Bradley                              Dr. Scott McLeod
CPSA Council President                 CPSA Registrar

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Noel

I agree with several of the comments here, that labels like “CAM” and “emerging” treatments are problematic. One problem is that it assumes that all treatments typically recommended by “standard” medicine have good scientific evidence to support them. It’s a wake-up call to realize how little we do is backed by really high-quality evidence. The second problem is that it entrenches an adversarial position between those patients and/or doctors who choose non-standard vs. standard ways to treat health problems. Not to sound jaded, but “standard” medicine also seems to follow the money rather more than it follows the evidence (“…mabs”… Read more »

G.E. (John) Coppola

I am not sure why the terms such as “alternative”, “complementary”, “functional”, “emerging” etc have evolved. The cynic in me suspects it all makes for good marketing. When we realized smoking was bad for patients and we started to recommend quitting and not starting was that an “emerging” treatment? It was good sense and good evidence is all. Therapies, be they medical or conservative, should all be considered based on an unbiased view of the current science and should, as you point out, be applied within a shared informed decision based approach with patients including discussion of the pros, cons,… Read more »

William Dafoe

It is very difficult and I’d argue unrealistic for any clinician “ to be clear with the patient about the uncertainties, risks and potential side-effects of a non-conventional therapy”. There will be some non -conventional therapies that may be known if they are in the area of expertise for the treating physician. What might be realistic is for the College to develop a position statement (that could serve as a handout) describing general aspects of non-conventional therapies, and possible inherent risk. This handout should not be patronizing, but provide a reasoned approach why people seek such therapies; what is the science… Read more »

Scott McLeod

Hi William,

Thank you for your feedback. We will keep this in mind moving forward.

Scott

Rick Zabrodski

What I find particularly sad about our profession after 40 years is that we seem to view lifestyle changes to be “complementary“. We tried to prescribe medicines to prevent diseases using the acute care model – which means prescribe drugs, and failed, while little or no effort was made to engage the patient to make difficult but important long-term dietary/exercise changes that can have a profound effect on the metabolic syndromes that are now so common.The rationale seems to be that there is no point in encouraging evidence based lifestyle changes first or alone, as nobody will make them, and… Read more »

Scott McLeod

Hi Rick,

Thanks for reading the Messenger and taking time from your busy day to respond. I appreciate the feedback.

This discussion does however go well beyond lifestyle changes. When we talk about emerging therapies we’re talking about things such as PRP. We’re looking forward to this discussion being very informative. Take care.

Scott