Skepticblog

I have stated before that I think one of the most important battle lines for skeptics and science promoters relates to issues of science in medicine. The science-based standard of care is being systemically attacked on every conceivable front – not just public opinion, but legislative, academic, and commercial. Promoters of dubious health treatments and products, what used to comfortably be called “health fraud” have successfully rebranded their products as “natural” and “alternative.”

But at its heart, the complementary and alternative medicine (CAM) movement is about eroding science as an obstacle to selling bogus treatments.

I created the Science-Based Medicine site in order to confront the public opinion and academic angles of this important issue. But educating the public and exposing the flawed arguments and weak evidence of CAM does not directly address what is perhaps the most important front -legislation. Ultimately, it is laws and regulations that establish or weaken the science-based standard of care.

That is why Larry Sarner and Linda Rosa have brought together an international group of 42 physicians (and growing) to form the Institute for Science in Medicine. From the ISM website:

The ISM is a non-profit educational organization dedicated to promoting high standards of science in all areas of medicine and public health.  We are a watchdog group of medical professionals who believe the best science available should be used to determine health policy and establish a standard of care that protects and promotes the public health.  We oppose legislation that seeks to erode the science-based standard of care and expose the public to potentially fraudulent, worthless, or harmful medical practices or products.

Already we are faced with many urgent legislative issues. Our first press release deals with the stealth promotion of dubious treatments in the proposed health reform bills in the US House and Senate. These provisions would mandate coverage of non-science-based practitioners, essentially giving them equal status to recognized health professionals. While the provisions are promoted as “fair,” they are fair in the exact same way that teaching Intelligent Design along side evolution would be “fair.” These provisions essentially remove science and evidence as a way of distinguishing between which health care modalities are safe and effective and therefore worthy of use and reimbursement. Essentially these provisions would mandate that state and federal governments pay for worthless or harmful treatments.

These provisions are anti-consumer and anti-health as they would further erode the standard of care.

At the same time, in Canada there is a legislative move to allow Naturopaths to prescribe drugs. This is a good example of the steady expansion of the scope of practice that tends to occur once you license dubious “professions.” Naturopaths promote a wide range of unscientific health philosophies and treatments, such as homeopathy, the “water cure”, and nutritional pseudoscience. But they have been successful in acquiring licensure in some states and countries, usually with the old argument that licensure will provide quality control (but it never does). As Edzard Ernst said, (I’m paraphrasing slightly)  “The most meticulous regulation of nonsense must still result in nonsense.” Often one group of naturopaths uses licensure to remove competition from other naturopaths – but licensure never results in establishing a science-based standard of care, because naturopaths are not science-based.

Then, once licensure is achieved there is the steady lobbying for expanded coverage and scope of practice – beyond their training and expertise.

Other legislative mischief includes so-called health-freedom laws, now passed in about 15 states, that effectively remove the standard of care for so-called “alternative” treatments. What this means is that the state board of health cannot act against a practitioner’s license simply because they are engaged in sub-standard care, if they label what they do as “alternative.” If you cannot discipline sub-standard care – then there is no standard of care.

Sometimes such provisions are issue specific. For example, several months ago in Connecticut a bill was passed that states that the the board of health cannot act against a practitioner for treating “chronic Lyme disease” – again, specifically eliminating any mechanism for maintaining the standard of care with respect to a specific controversial issue.

What such laws represent, in part, is legislative arrogance – putting the political process above the scientific process of determining what treatments are legitimate.

We are still a relatively small group of professionals, with a mountainous and endless task before us, but the ISM gives us a mechanism to take on directly the more important legislative issues that come up. We will need to grow and expand our resources, and we plan on doing so.

And as always we will  need the support of the scientific and skeptical communities if we are to succeed.