Welcome to the first entry of my blog. Before I get started, I should begin by saying that I am starting this blog because my friends no longer listen to me complain about complementary and alternative medicine, either due to lack of interest or the fact that I tend to rant on and on. I’m constantly amazed by the ridiculous claims made by CAM therapists and their hostile attitude to conventional medicine. I’ll do my best not to lapse into mindless ranting here but I apologise in advance if frustration gets the better of me.
As CAM therapies claim to be interested in maintaining health and treating disease, I’ve always assumed that there was some degree of regulation to their practise as there is for conventional medicine. I suppose I shouldn’t have been surprised, given the speed at which the government in this country seems to move, when I discovered that the practise of complementary and alternative medicine in Ireland is completely unregulated. This is despite calls from the European Commission as far back as 1999 to “protect citizens against unjustifiable claims and quackery while at the same time recognising their freedom to choose from a variety of healthcare options.” This lack of regulation is a result of Ireland’s common law tradition which allows CAM therapists to practise without any form of state regulation until laws are passed specifically legislating for these therapies.
Perhaps in an effort to heed the advice of the Commission, the Department of Health published the “Report on the Regulation of Practitioner’s of Complementary Medicine in Ireland” in 2002. This report was based on opinions obtained from a forum composed almost completely of complementary and alternative medicine practitioners held in 2001. Unsurprisingly, the forum recommended self-regulation where practitioners of each therapy would come together to “develop their own statistics, educational programmes, codes of ethics, research programmes and competency standards.” This surely was a resounding success for practitioners of CAM therapies. Their regulatory bodies would be established by a method approved by the government, providing them with the perception of government approval in the eyes of the public, while the Department of Health would actually have no direct role in recognising these therapies. The Department would also play no role in examining the effectiveness and safety of these therapies as all research and statistics would be produced by the CAM organisations themselves.
On the recommendation of the report, a Working Group was established to devise a plan for implementing the self-regulation of CAM therapies in Ireland. At the request of the working group, the Higher Education and Training Awards Council (HETAC) is currently reviewing the regulation and academic recognition of unproven practices such as osteopathy, chiropractic and acupuncture. It is interesting, however, that a planned review of the therapeutic effectiveness, safety and contemporary public policy of these practices was scrapped. CAM organisations have effectively sidestepped any requirement to provide a base of evidence for their treatments even though a cursory search of freely available studies would reveal this evidence base to be almost non-existent. They are still, however, improving their image and credibility by engaging in a government-approved regulation process and the development of HETAC-approved training courses.
While specific legislation governing the practice of CAM is more or less non-existent and the proposed regulation of the industry promises to be completely biased and ineffective, existing law should provide some protection to consumers. The Department states that while customers are not protected by professional statutory regulation of CAM practitioners, they are afforded security by consumer, competition and criminal law. The “Sale of Goods and Supply of Services Act, 1980” states that the service supplier must possess “the necessary skills to render the service”. Many CAM therapies should be banned on this basis alone as it impossible for any individual to attain the level of skill required to turn ineffective and sometimes dangerous therapies into effective remedies for pain or illness. The act also states that any materials provided will be “sound and reasonably fit for the purpose for which they are required”. Surely the majority of remedies provided by CAM therapists are unsound and unfit for purpose when they are generally no more effective than sugar pills. Evidently, existing consumer legislation should protect customers from either well-meaning idiots who unknowingly practise ineffective therapies or calculating conmen aiming only to separate people from their money. CAM therapists, however, continue to practise unregulated and are attaining increasing approval from both government and academic institutions.
The Working Group charged with organising the regulation of complementary therapists has stated that the “public needs to be well-informed and to take personal responsibility and due care in this area as in any other areas of their lives.” While people should always be free to make their own decisions, Thaler and Sunstein demonstrate in their book “Nudge” that many people make poor decisions when left to decipher complex information on their own. Determining which CAM therapies are effective may appear almost impossible for many individuals for a number of reasons. First of all, the enormous and ever-increasing variety of CAM therapies makes it almost impossible to determine which are effective. Secondly, many CAM therapists portray intentionally imitate conventional medical practitioners through practises such as wearing white coats, calling themselves doctors and practising in settings designed to imitate conventional medical clinics. These practices often make it difficult to distinguish unproven CAM therapies from conventional medical practises. Finally, the claims made by CAM therapists may be difficult to interpret for the majority of people who do not have any medical or scientific training. A quick search on the internet will reveal and almost endless lost of journal articles supporting CAM therapies. To the untrained eye, these journals appear as trustworthy as major medical journals such as The Lancet and The New England Journal of Medicine. To anyone with even a working knowledge of critical appraisal, however, these articles are quickly revealed to be riddled with flaws and biased and unreliable results.
As suggested by Thaler and Sunstein, in order for people to truly practise free will, they must first be provided with easily digestible and accurate information. This could be accomplished by requiring organisations regulating CAM therapies to provide a satisfactory base of evidence for each treatment before these practices can be offered to the public. This simple measure would still allow CAM organisations to direct their own research and training while protecting consumers both from financial exploitation and the practise of unproven and potentially dangerous therapies. It should also be cost-effective as even perfunctory investigation of most CAM therapies by a scientifically-educated individual would reveal their claims of effectiveness to be completely baseless and often deliberately misleading. A list of approved therapies could then be made available to the public in both printed and online formats to provide them with the easily digestible information required to make safe and well-informed decisions about their health.
The regulation of complementary and alternative medicine in Ireland today is completely unacceptable. Individuals are free to practise almost any form of “treatment” without any training and without the risk of any repercussions for practising exploitative and potentially dangerous therapies. This could easily be avoided with a couple of easily implemented and cost-effective measures. It would however, require greater will from the Department of Health to protect the health and financial security of the public instead of the current practise of appeasing CAM organisations to avoid making decisions that would be incorrectly portrayed by CAM therapists as unfair and dictatorial.
