Patients have no safeguard with unregulated therapies

Nine years ago Thomas Schatten of Malahide in Co Dublin went into anaphylactic shock and died after being treated for his peanut allergy by a Dr Brett Stevens. The subsequent inquest recorded a death by misadventure. Dr Stevens wasn't a medical doctor, but a kinesiologist and chiropractor.

Medical practitioners who transgress can find themselves asked to account for their actions by the Medical Council and can face a variety of penalties, including being struck off the register of doctors and prevented from practising again.

But as journalist Fergal Bowers reported a decade ago when Dr Paschal Carmody of Killaloe was struck off for professional misconduct, the doctor "may work in the area of alternative medicine, which remains unregulated".

In 2005 the report of the National Working Group on the Regulation of Complementary Therapists recommended statutory regulation for herbalists, acupuncturists and traditional Chinese medicine practitioners.

These areas, it suggested, fitted into “a high-risk category”, while for other therapies there was a need “to develop robust systems of voluntary self-regulation”. To date, while there is ongoing work in this area, there is still no statutory regulation.

Professional standards
"Robust systems of statutory regulation cannot be put in place by a decision of the State alone," the Department of Health says.

“Rather, the State requires professional bodies to have the necessary reference professional standards – the 2005 report highlighted the need for agreement among individual therapies on common standards of education/training and codes of practice before statutory registration could be introduced.”

Now several doctors are also offering alternative or complementary medicine while using the title “Dr”.

Vega testing, “neural organisation technique” and homeopathy can be found on the websites of some doctors. So where does that leave consumers seeking treatment for an ailment? What protection is there for them, either as a patient or as a consumer?

The Medical Council regulates only medical practitioners on its register, even though the “practice of medicine” is not defined under the Medical Practitioners Act 2007. And someone cannot represent themselves as being a registered medical practitioner and practise medicine if not on the register here, even if they qualified in another country.

There are, of course, many other doctors free to use the title who are not doctors of medicine. One of our former ministers for health after all earned his phD in science.

So a doctor who has voluntarily left the register but uses alternative medicine is beyond the remit of the Medical Council and is still free to use the title “Dr”.

Arising from one such case it appears that so long as it’s made clear that the doctor is not using conventional medicine, then they are free to practise using alternative medicine.

For the consumer and patient, however, this is hardly satisfactory. A doctor may be using his or her title while offering diagnoses and treatments for which there may be little or no scientific evidence.

The Department of Health points out, however, that while complementary therapists are not subject to professional statutory regulation, they are subject to a range of other legislation and regulation, including consumer legislation, competition, contract and criminal law.

For example, under the Consumer Protection Act, a trader is prohibited from misleading consumers in relation to products and services – this would include the benefits and results that might be expected or claims that a product is able to cure an ailment when it cannot. Only last month a case before Dublin Circuit Court was settled over a skin reaction to Chinese medicine.

Different situation
A doctor who is using alternative treatments yet is still on the register of medical practitioners is in a different situation. The Medical Council provides guidance to doctors through its guide to professional conduct and ethics for registered medical practitioners. Under general principles, doctors are advised to "search for the best evidence to guide your professional practice". This seems to be as close as it gets to insisting on "evidence-based practice".

However, when it comes to advertising one’s services, the guide is quite clear that the information provided, for example, on a doctor’s website, should be “factually accurate, evidence-based and not misleading”.

It adds that in relation to the services provided “either directly or indirectly, you must make sure that the information published in the advertisement is true, verifiable, does not make false claims or have the potential to raise unrealistic expectations”.

A doctor who operated a “salt cave”, which he claimed could help patients with asthma and cystic fibrosis, was found guilty of poor professional performance two years ago. He’s still on the Medical Council’s register.

Incidentally, registered medical practitioners are required to publish their Medical Council registration number in any information they publish about their practice to ensure the public can identify doctors registered in this country.

Patients may also move between conventional and alternative medicine without realising the risks. Even some high-dose vitamins may interfere with chemotherapy for cancer patients and with the blood-thinning medicine Warfarin in those with cardiovascular disease. Patients can be reluctant to admit to doctors that they are also taking alternative treatments.

Regulation
The Irish College of General Practitioners (ICGP) says it would like to see all therapies their patients consider regulated "to ensure appropriate oversight, consistency of treatment and to ensure they are in the best interest of patient care. ICGP believes all such therapies should be evidence- based".

It calls for progress with the regulating of the alternative or complementary medicine sector “which would be in the best interest of patient care and safety”.

"There should be some robust mechanism for the policing of people who make claims – whether that's through the internet or the broadcast media – where there is no evidence base," says Simon Mills, barrister and former doctor now specialising in medical law.

The Department of Health has an information leaflet to assist consumers in making an informed health choice – a copy is available at iti.ms/1n8oFzw.