By Mark Crislip
One person’s ethics is another’s belly laugh, but in medicine ethics are formalized. The basic principles in the US are
- Respect for autonomy – the patient has the right to refuse or choose their treatment (Voluntas aegroti suprema lex)
- Beneficence – a practitioner should act in the best interest of the patient (salus aegroti suprema lex)
- Non-maleficence – “first, do no harm” (primum non nocere)
- Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
These are guidelines, not mandated, but if you get an ethics consult in my institutions the above concepts are the framework within which the consult will be completed.
Patients can only be autonomous if they are given accurate, truthful information with which to make a decision about their treatments. You can’t lie to patients, but we all know how you phrase an idea can subtly alter the response. Do you say an 80% success rate or a 20% failure rate? I tend to say both. And not everyone can handle the unvarnished, blunt truth. Part of the art of medicine is trying to tell each patient the truth, the whole truth and nothing but the truth in a manner palatable for the individual patient. It is not easy and I am certain I do not always do a good job.
What troubles me is how much what is written about SCAM’s is to my way of thinking, not truthful, or shaded in a way as to be, at best, disingenuous. I am not referring to the Natural News or Dr. Oz. I long-ago realized those are not sources for a reality-based understanding medicine. I am referring to major medical centers that offer what I would consider misinformation. As an example, take the Mayo Clinic. Please.
I did my residency in Minneapolis at the county hospital. Occasionally a patient would go to the Mayo Clinic in Rochester for a second opinion, get all their tests repeated and more, and come back with the same diagnosis and treatment plan. We would say if you want a Rochester Sandwich, hold the Mayo.
That started my skepticism about big name clinics and famous hospitals. There are good and bad doctors everywhere. Judging from the metastasis of pseudo-medicine into many of the prominent medical institutions in the US, I suspect that these institutions are more interested in income than science-based medicine.
Which brings us to “Complementary and alternative medicine” from the Mayo Clinic, with the subtitle:
You’ve heard the hype about complementary and alternative medicine. Now get the facts.
Given that they have an Integrative Medicine Department, I was wondering how they would spin ‘the facts.’ As always in a CAM article, they start with the disingenuous.
Nearly 40 percent of adults report using complementary and alternative medicine
It’s actually 38.3 %.When I was in grade school I would have been told to round to 38. I am surprised they did not round it up to “nearly 50%”. And you only get to that number by including interventions that are not alternative, like diet and exercise.
The use the National Center for Complementary and Alternative Medicine (NCCAM) classification:
- Whole medical systems
- Mind-body medicine
- Biologically-based practices
- Manipulative and body-based practices
- Energy medicine
What all of these have in common, with the exception of “biologically based” which includes herbs, is a complete disconnect from reality as it is understood by the sciences. You would not know that from the Mayo.
Homeopathy is described as using
minute doses of a substance that causes symptoms to stimulate the body’s self-healing response.
Most homeopathic nostrums have zero active substance in them and the ideas behind homeopathy are totally nonsensical.
Energy medicine is an
Invisible energy force flows through your body, and when this energy flow is blocked or unbalanced you can become sick. Different traditions call this energy by different names, such as chi, prana and life force. The goal of these therapies is to unblock or re-balance your energy force.