MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Medical ethics are central to any type of healthcare – and this includes, of course, alternative medicine. The American Medical Association (AMA) have just published their newly revised code of ethics, AMA Principles of Medical Ethics.

It has long been my impression that, in alternative medicine, ethics receive no or far too little attention. Some alternative practitioners thrive to be able to call themselves ‘physicians’. Therefore, it seems interesting to ask whether they would also be able to comply with the ethical duties of a physician as outlined by the AMA.

The following 9 points are taken without change from the new AMA code; in brackets I have put my own, very brief comments pertaining to alternative practitioners. There is much more to be said about each of these points, of course, and I encourage my readers to do so in the comments section.

  1. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. [Most alternative practitioners use unproven treatments; I doubt whether this can be called ‘competent medical care’.]
  2. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. [Treating patients with unproven therapies in the absence of fully informed consent is arguably unprofessional, dishonest and deceptive. Crucially, alternative practitioners never object to even the worst excesses of quackery that occur in their realm.]
  3. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. [Treatment with unproven therapies can hardly be in the best interest of the patient.]
  4. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. [The right of patients includes full informed consent which is, according to my impression, rare in alternative medicine.]
  5. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. [Alternative medicine is frequently out of line with or even opposed to medical knowledge.]
  6. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
  7. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. [Some activities of some alternative practitioners are directly opposed to public health, for instance when they advise against immunising children.]
  8. A physician shall, while caring for a patient, regard responsibility to the patient as paramount. [Arguably this is not possible when using unproven therapies.]
  9. A physician shall support access to medical care for all people. [Some alternative practitioners advise their patients against accessing conventional healthcare.]

As I stated above, medical ethics are neglected in alternative medicine. The 9 points of the AMA together with my comments go some way towards explaining why this is so. If ethical principles were applied to alternative medicine, much of it would have to stop instantly.

15 Responses to The (lack of) ethics in alternative medicine

  • The AMA’s standards are boadly similar to the UK GMC’s ‘Good Medical Practice’.

    Camists (who practice camistry, the domain of CAMs) do have ethics – but they are not commensurate with those of regularly registered medical practitioners.
    That’s why they are indeed ‘alternative’.

    Patents, caveat emptor!

  • Add slick marketing and alternative medicine practitioners make a lot of money. When you try and explain to people that they are fancy snake oil salesmen. One is labeled as close minded and doubting the power of belief. The old and chronically ill are the easiest victims. I wish the medical profession would do more. The few like you who are willing to speak out are strongly criticized and even threatened for denying hope.

    Thanks for your posts.

  • “A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. [Most alternative practitioners use unproven treatments; I doubt whether this can be called ‘competent medical care’.]”

    You claim you have not sold your soul to the big pharma: How can you make such statement?

    1. Dr. David Eddy has repeatedly shown that 85% of the procedures followed by orthodox doctors have no evidence upon which the base their treatment. How do you define proven treatment?
    2. In USA medical errors are responsible for over 300,000 deaths every year. And this is increasing every year. Add to this reasons for many diseases that are based upon faulty medicines. This is your definition of “competent care”?

    Once you state your reply, I will take up the other points raised by you.

    • 1) Eddy’s article is about 40 years old now, I think
      2) sadly, errors do happen in all walks of life; medics treat many millions of patients and, on balance, they do more good than harm.

      • “Eddy’s article is about 40 years old now, I think”. You think wrong

        Look at the 10 year old report.
        http://www.bloomberg.com/news/articles/2006-05-28/medical-guesswork

        Nothing has changed. Actually if you listen to Dr. Eddy: “The problem is that we don’t know what we are doing,” he says. Even today, with a high-tech health-care system that costs the nation $2 trillion a year, there is little or no evidence that many widely used treatments and procedures actually work better than various cheaper alternatives.” (2006).
        “Think about the implications for helping patients make decisions, Eddy adds. “Go to one doctor, and get one answer. Go to another, and get a different one.” Or think about expert testimony. “You don’t have to hire an expert to lie. You can just find one who truly believes the number you want.” (2006)

        Then he goes on to add: “The goal of this movement is to pierce the fog that envelops the practice of medicine — a state of ignorance for which doctors cannot really be blamed. “The limitation is the human mind,” Eddy says. Without extensive information on the outcomes of treatments, it’s fiendishly difficult to know the best approach for care. The human brain, Eddy explains, needs help to make sense of patients who have combinations of diseases, and of the complex probabilities involved in each.”

        What is new about the human brain in the past ten years that changed medical practise to become evidence based?

        2. “sadly, errors do happen in all walks of life” – you made this statement on comparative basis: how many deaths can you calculate from alternative medicine? If you agree with Dr. Eddy, there is no way the deaths are reducing in a hurry. But is not the first rule of medicine: do no harm to the patient!

        • Some points :

          – It is not because there is conventional medicine error that we do not have to look at ‘alternative medicine’ error and outright lies.

          – Conventional medicine treat way more deadly conditions than alternative, hence way more death and way more risks.

          – There is no reccord for death occuring with alt medicine, so you cannot compare ! Worse, some death due to alt treatement can (and will) be put upon conventional medicine because of cross or double treatement from both side. (You know, if someone get cancer and die, it will be because of chemo, not because some quack tell him do stop chemo and start whatever alt say).

          – Anyway, medic do not want to harm patients, as you implied, we talk about ‘medical error’. And more the condition is severe and more it is hard to not do mistakes.

          – Still, life expectancy increased dramatically last decades, due to progress of medicine, not progress of alt med that does the same thing over and over since years (acupuncture, homeo…) even if nothing positive is proven about those methods.

          • “It is not because there is conventional medicine error that we do not have to look at ‘alternative medicine’ error and outright lies.”
            Why would you term alternative medicine outright lie? Any basis for this or just your opinion?

            “Conventional medicine treat way more deadly conditions than alternative, hence way more death and way more risks.”
            Is this not an assumption? My assessment is, if you stop taking allopathic drugs, most of the times you will not be sick. Specially with deadly conditions like cancer. “….when the doctors in Israel went on strike in March 2000, death rate fell significantly in Jerusalem city, while it did not change in the coastal city if Netayna, where doctors worked as usual. Even when compared to the month of March in 1999 and 1998 the fall in death rate in 2000 was noteworthy. Similar trend was reported from Los Angeles County in the 1970s and, possibly, also in Canada a few years ago.”

            ” There is no reccord for death occuring with alt medicine, ..” These are just conjecture.

            “Anyway, medic do not want to harm patients, as you implied, we talk about ‘medical error’. ” I agree and this is the question: Is safety not the first concern of the scientific medical world? What is the worth if it is just written as “sadly, errors do happen in all walks of life..”

            ” ife expectancy increased dramatically last decades, due to progress of medicine,..” This is NOT CORRECT. Life expectancy has improved because of improved sanitation and better availability of food. Relocate a person from Germany/USA to Somalia with all the drugs that are required and a Somali US/Germany. Any guess who will live longer and without illness?

          • @Iqbal Krishna

            You wrote:

            My assessment is, if you stop taking allopathic drugs, most of the times you will not be sick. Specially with deadly conditions like cancer.

            You may be right. If you conscientiously avoid ‘allopathic’ medicine for many years you will probably not survive long enough to contract cancer.

            You wrote:

            “….when the doctors in Israel went on strike in March 2000, death rate fell significantly in Jerusalem city, while it did not change in the coastal city if Netayna, where doctors worked as usual. Even when compared to the month of March in 1999 and 1998 the fall in death rate in 2000 was noteworthy. Similar trend was reported from Los Angeles County in the 1970s and, possibly, also in Canada a few years ago.”

            Might not a contributory factor be that because the doctors were on strike there was nobody around enabled to sign death certificates?

            You wrote:

            ” ife expectancy increased dramatically last decades, due to progress of medicine,..” This is NOT CORRECT. Life expectancy has improved because of improved sanitation and better availability of food.

            That was true in the late 19th century. When sanitation and food availability improved in many parts of the world there was a dramatic increase in average life expectancy: but it doesn’t explain the continued increase ever since. Public health medicine has played an enormous role in the subsequent continued prolongation of average life expectancy through the 20th century. Vaccination has massively reduced the incidence of fatal childhood diseases, and medical advances on many other fronts now postpone deaths from illnesses that were previously considered hopeless.

            I cannot fathom what your question about Somalia and US/Germany is trying to say. You might consider taking advantage of the after-post editing facility available on this blog to ensure your comments make sense.

          • “You may be right. If you conscientiously avoid ‘allopathic’ medicine for many years you will probably not survive long enough to contract cancer.”

            You cannot be more incorrect. ” For 3 generations (my parents, my and our children) we have never required a single dose of allopathic drug. There would be over 40 people in the extended family, with over 1200 years between us for a period of over 90 years now. (Exclude mandatory vaccinations for the generation of our children with adverse reaction in case of my elder son).
            Our family started in Multan (Pakistan) and shifted to Lucknow in India. No clean air and water and our earlier generation spent a lot of their years on farms in close contact with dogs, fowls and dairy animals. I have been seeing illness in our generation and our children and cure from homeopathic medicines as a routine activity. In 3 generations, we lost no child and average age at death in much higher than the India average.”
            For cancer and allopathic drugs, you should google Martin Blaser and read: Missing microbes.

            “Might not a contributory factor be that because the doctors were on strike there was nobody around enabled to sign death certificates?” You are not serious. You are?

            ” Vaccination has massively reduced the incidence of fatal childhood diseases, and medical advances on many other fronts now postpone deaths from illnesses that were previously considered hopeless.”

            This is correct. But you are not fully informed. In the latest research, it is becoming evident that vaccination allowed small pox epidemic to be replaced by HIV epidemic. So the new system allowed children to grow up and die of a more virulent disease. Who profited from this exchange: the drug companies.

            “I cannot fathom what your question about Somalia and US/Germany is trying to say.”

            If “modern medicine” was so effective, a malnourished Somali should have a shorter life span than an American in Somalia with his drug kit. It does not happen. Lack of sanitation kills the american in spite of the drugs (medicines) he takes.

          • “Is this not an assumption? My assessment is, if you stop taking allopathic drugs, most of the times you will not be sick”

            Well, take a diabetic, stop giving him insuline and see what happen.
            Get an anaphylatic shock, do not take anti-histaminic, see what happen
            Get a blood clot, do not take heparine (or the like), see what happen
            Well, i could continue, over and over, especially for infectious disease.

            “” There is no reccord for death occuring with alt medicine, ..” These are just conjecture. ”
            -> Conjecture, there is your problem. Your annectode about Israel is conjecture. This, is a fact that alt med have hard time to deal with.

            “Is safety not the first concern of the scientific medical world? What is the worth if it is just written as “sadly, errors do happen in all walks of life..””

            -> Surely alt med never do mistakes. Wait, there is no reccord available, how convenient =)))
            Of course safety is a major concern, but when you actually do a (REAL) medical intervention there is always risks. You have to look at the number of people SAVED by those interventions too, you are just looking the part that goes your way.

            ” Life expectancy has improved because of improved sanitation and better availability of food. Relocate a person from Germany/USA to Somalia with all the drugs that are required and a Somali US/Germany. Any guess who will live longer and without illness?”

            -> This make no sense at all… Indeed if you have nothing to eat, you will starve and die. Your exemple is stupid and meaningless. In ‘rich’ country (where people can eat), life expectency have increased, even with all the bad habbits of smoking, alcool and bad diet.

            “This is correct. But you are not fully informed. In the latest research, it is becoming evident that vaccination allowed small pox epidemic to be replaced by HIV epidemic. So the new system allowed children to grow up and die of a more virulent disease. Who profited from this exchange: the drug companies.”

            -> This is, by far, the most dumb thing i’ve read by a long shot. Yes there is new virus emerging. So what ? Let’s just people die to small pox ? If we now can treat HIV, let’s not do it ? Because maybe, there will another epidemic of something else ? Are you out of your mind ?

        • Yes, real medicine tracks it’s errors because that’s the ethical thing to do.

          Where are the CAM numbers? You are implying that CAM is error free so where the hell are their numbers?

          The numbers are not there because CAM only cares about dollar figures. Nearly everything CAM is an error done on purpose.

          CAM often rejects things like the germ theory of disease. It can not be trusted.

          Speaking of ethics. Sharing the numbers for one side while providing none for the other side is unethical. It’s a dirty trick to force the other side on defense to avoid talking about your sides lack of efficacy.

          If god forbid you end up in a car wreck resulting in multiple fractures in both legs and an arm. You full well better demand EMS take you to a naturopath. Good luck with the crystals and black salve.

          • in most areas of alt med, the error rate is 100%, because the therapies in question are themselves based on errors.

          • “Yes, real medicine tracks it’s errors because that’s the ethical thing to do”.
            Real medicine is business. There are no ethics beyond the rules to be bent at each possibility. Are you aware how many US$, the pharmaceutical industry have paid to settle charges for violating federal health care laws alone in USA in 2015? This is bigger than even the defence industry. The names inclued the largest companies.
            The reported adverse effect data and the research to find out adverse effects and deaths do not match even in the wildest imagination.

            “The numbers are not there because CAM only cares about dollar figures. Nearly everything CAM is an error done on purpose.”
            If you add up the total CAM business, it will not be equal to one big pharma company. And using US$ reference, generic drugs sell for 1/100 of the price. And companies doing generic drugs are “laughing their way to the bank.”

            “CAM often rejects things like the germ theory of disease. It can not be trusted.”
            You have no clue. Germ theory is the most stupid concept in medicine. You have a few billion germs interacting with you on daily basis at all times. Why are you alive?

            Every thing written by you sounds more emotions than knowledge.

  • 8. A physician shall, while caring for a patient, regard responsibility to the patient as paramount. [Arguably this is not possible when using unproven therapies.]

    How do you explain this when read in context of your comment: sadly, errors do happen in all walks of life; medics treat many millions of patients and, on balance, they do more good than harm.
    Where they do good, it is expected of them, they get paid for their service also.
    How do you justify the deaths the errors? The family that lost a member is to be happy to be informed of the many other patients that walked out alive?
    Hospitals insist on getting their payments before they release the dead body.

  • “in most areas of alt med, the error rate is 100%, because the therapies in question are themselves based on errors.”

    Is this not a wild statement? You did not rebut R Hahn destroying your analysis on homeopathy.

    What do you know about Ayurveda or Chinease traditional medicine?

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