Critical questions patients should ask camists.
Reference should be made to the web sites of associations and practitioners who practice in the field of the CAM in which you are interested.
Do not believe all you read – retain your critical faculties and ask:
What is the evidence the CAM has any effect on any specific disease process?
Have any controlled clinical trials been carried out?
If not, how can I know whether the CAM works or not?
Are all outcomes published, or just the ones supporting the CAM?
Is there any evidence the practitioners are prepared to change their stance in the light of further and better particulars?
How do I know whether a practitioner is an ethical and sincere camist, a quack, or a fraud?
Do practitioners suggest patients should avoid conventional orthodox mainstream treatments?
Does the practitioner obtain fully informed consent?
Are potentially harmful treatments or remedies promoted and sold without adequate warning of risks?
Is false hope encouraged?
Are critical faculties’ suppressed, magical thinking promoted, non-science encouraged?
However it has been obtained, there should be at least some evidence of effectiveness of any proposed treatment on specific diseases. Randomised double-blind controlled trials are gold standard, but are not essential. ‘Evidence’ means an objective plausible account which has been reproduced by other investigators – not simply anecdotes of the subjective experiences of wudoka and opinions of camists. It goes without saying that all results should be published, not just the ones which prove the claims the camist wishes to make. Publication bias is research misconduct, and you must be the judge. If what is wanted is consolation, hope and tender loving care, then seek appropriate counselling, support or physiotherapy, but avoid camist remedies and therapies which have no effect on specific conditions.
Styles and titles used in Conventional Orthodox Medicine.
Just as the practices and products used in CAM may be couched in pseudo-scientific and misleading terms, so camists themselves may uses imaginative titles to dupe the unwary. Before the profession of medicine was regulated, the public found it difficult to differentiate a genuine practitioner acting with integrity from a quack seeking to take advantage of the gullible. Many quack practitioners styled themselves as ‘Doctor’ or even ‘Professor’. Healing practices had evolved from the Middle Ages to become distinct professions by the 19th century. Apothecaries originally manufactured medicinal herbs for physicians but the Apothecaries Act of 1815 allowed them to prescribe and dispense as well. Physicians slowly improved their methods of diagnosis and the barber-surgeons improved their specialised skills. These practitioners were regulated and licensed by their own colleges, but it was not always easy to distinguish their practices from those of unqualified quacks and charlatans.
In the UK, the first Medical Reform Bill was placed before Parliament in 1840, but many disagreements delayed introduction of the General Council of Medical Education and Registration until 1858. In 1951 the name was shortened to General Medical Council. Although the title ‘registered medical practitioner’ is protected, anybody can use the title ‘Dr’ – whether registered or not. All practitioners must be careful they are not using such a title to deceive and defraud. Today, the GMC has the task of ensuring educational standards of entry to the register and of restricting the practice those who are unfit to practice – removing them from the register if necessary.
In the American colonies, the system of medical practice licensing was initially based on that of the British Royal Medical Colleges, diluted by the Atlantic, but the advent of the United States saw change. The 10th Amendment of the United States Constitution, part of the Bill of Rights (1791), authorises each State to establish laws and regulations protecting the health, safety and general welfare of their citizens. Medicine is a regulated profession because of the potential harm to the public if an incompetent, impaired or fraudulent physician is licensed to practice. State regulation of a learned profession has had its political problems. ‘The condition of the American medical profession at the close of the Civil War was, in almost every particular, significantly different from that which obtains today. The profession was unlicensed and anyone who had the inclination to set himself up as a physician could do so, the exigencies of the market alone determining who would prove successful in the field and who not. Medical schools abounded, the great bulk of which were privately owned and operated and prospective students could gain admission to even the best of them without great difficulty.’ 1
In 1847 the American Medical Association was founded to upgrade medical education, establish medical licensing laws and replace proprietary medical schools with non-profit institutions. The non-orthodox medical sects were not welcome. In each of the United States, conventional physicians now qualify as Doctors of Medicine – identified with the initials M.D. In the United Kingdom, those initials indicate a physician who has been awarded a doctorate – a higher post-graduate qualification based on original research and publication of a thesis together with an examination on its concepts and ideas.
The basic medical qualification as awarded by a university in the UK is identified by various initials dependent upon whether the university uses English, Latin or Greek terminology! All will be double degrees as Bachelor of Medicine and Bachelor of Surgery (e.g. M.B., B.S.) Different UK medical schools have different entry criteria and curricula but all are inspected and deemed equivalent. Additionally, but controversially, the GMC is required to recognise conventional medical graduates from all European Community states.
UK surgeons who secure a postgraduate degree of the status of M.D. are usually designated M.S. or M.Ch. (Master of Surgery/Chirurgery). American doctors cannot be expected to understand these conventions, and many UK doctors attending American conferences put M.D. after their names so they may be recognised as orthodox physicians or surgeons, although strictly speaking not all will have earned that distinction as applied in the UK.
In the UK, the only title for a medical doctor with any form of legal protection is that of ‘registered medical practitioner’. Conventionally, such practitioners will style themselves as ‘doctor’. Except that just to add a spot of confusion, doctors who go on to specialise as surgeons, generally revert to styling themselves ‘Mr’, ‘Mrs’, ‘Miss’ or ‘Ms.’ This custom and practice is based on historical precedents – reflecting the time when surgeons were indeed not of the same status as physicians (the doctors) and the title Mister was adequate to describe them. It cannot be denied that this tradition is now perpetuated by an undercurrent of inverted snobbery (of the most benign and professional variety).
In many countries, dentists are also designated as ‘Dr’. In the UK it is conventional for dentists to style themselves as ‘Mr’, ‘Mrs’, or ‘Miss’. After all, they are dental surgeons. There has been a recent trend for some dentists to use the title ‘Dr’ but as that can cause confusion with medically qualified practitioners, the General Dental Council states: ‘Dentists should not use the courtesy title ‘doctor’ (or the abbreviation ‘Dr’) unless they have a Ph.D. or are medically qualified and registered doctors. Its use as a courtesy title is potentially misleading to patients and it is important that patients do not assume that you have training or competencies which you do not possess.’ Indeed, why not use the title ‘Dentist’?
Similarly, the medical profession and the Department of Health is concerned that practitioners who carry out surgical procedures but are not medically or dentally qualified should not use the title ‘surgeon’, as that too has a propensity to mislead patients. Indeed, why would practitioners use such titles unless it was their intention to deceive?
All patients need to be aware of these issues so that they can give properly informed consent to any treatment.
Section 49(1) of the Medical Act 1983 provides that: ‘Any person who wilfully and falsely pretends to be or takes or uses the name or title of physician, doctor of medicine, licentiate in medicine and surgery, bachelor of medicine, surgeon, general practitioner or apothecary, or any name, title, addition or description implying that he is registered under any provision of this Act, or that he is recognised by law as a physician or surgeon or licentiate in medicine and surgery or a practitioner in medicine or an apothecary, shall be liable on summary conviction to a fine not exceeding level 5 on the standard scale’.
Although the title ‘Dr’ is conventionally used by those who possess the relevant academic qualification and by those who practice as medical doctors registered by the General Medical Council, use of such a title by anybody else is regarded as pretentious and smacking of quackery. It is hard to have constructive professional relationships with parties who abuse these conventions. President Yahya Jammeh of Gambia who left school at sixteen insists on the title: ‘His Excellency Sheikh Professor Doctor President’.2
Conversely, many people who do have doctorates decline to use the title. Former Prime Minister Dr Gordon Brown Ph.D. being one, and Queen guitarist Dr Brian May Ph.D. another. Dolly Parton has an honorary doctorate from the University of Tennessee but she has never been known to use it.
Perhaps inevitably, some practitioners who do not wish, have failed, or cannot qualify as members of one of the regulated health professions, nevertheless wish to improve their status, repute and financial opportunities – and seek to have their status ‘regulated’ and ‘licensed’. They claim this ‘helps patients’ but US attorney Jann Bellamy has given good reasons why CAM practitioners should not be licensed:
‘Practice Acts grant CAM practitioners a broad scope of practice, including legalization of scientifically implausible and unproven (or disproven) diagnostic methods, diagnoses and treatments; CAM practitioner education is inadequate preparation for the scope of practice permitted; licensing is a stepping-stone to mandatory public and private insurance coverage; licensing confers undeserved legitimacy causing public confusion; and licensing decreases important health care consumer protections.’
Bellamy believes that health care systems should be rooted in a single, science-based standard of care for all practitioners and that practitioners whose diagnoses, diagnostic methods and therapies have no plausible scientific basis should not be licensed or permitted to practice under any other regulatory scheme.3
1. Robert Hamowy. The Early Development of Medical Licensing Laws in the United States, 1875-1900. Department of History, University of Alberta. http://mises.org/journals/jls/3_1/3_1_5.pdf.
2. Damian Thompson, Daily Telegraph 12th November 2011.
3. Bellamy J. Six reasons why CAM practitioners should not be licensed. Science-Based Medicine Blog, June 27, 2013.