I am used to SMA's weak stance against alternative medicine, but this letter in the ST Forum today is a new low for the "professional" association.
Unwise to criticise alternative medicine, says SMA
DR ANDY Ho wrote that he was disappointed with the local medical profession for not warning the public about the dangers of chiropractic neck manipulation ("Perils of chiropractic neck manipulation"; Jan 21) and criticised homeopathy ("Indefensible ideas behind homeopathy"; Jan 22).
His scathing commentary on acupuncture criticises the Singapore Medical Association (SMA) for suggesting that the ethical code of the Singapore Medical Council (SMC) be amended to allow medical practitioners to refer to traditional Chinese medicine (TCM) practitioners and acupuncturists ("Pinning down acupuncture: It's a placebo"; Saturday).
While Western-trained doctors do warn their patients about the risk and safety profile of what they prescribe and voice their opinions on various kinds of alternative medicine to their patients, it is another thing to advocate that the local medical profession collectively criticise alternative medicine groups.
This is especially so when doctors and alternative medicine practitioners are seen to be competitors and criticising alternative medicine can be construed as self-serving.
Dr Ho's column on Saturday failed to take SMA's proposal to amend the SMC ethical code in context. When the current code was introduced, TCM practitioners and acupuncturists were not state-registered. They are now.
We do not think doctors will refer widely to TCM practitioners even if the code is amended. However, patients do request from their doctors medical reports and summaries when they seek care from TCM practitioners. The present code disallows such formal communication. Amending the code will facilitate better communication between a patient's various caregivers so that the patient's interest is best served.
The SMA does not encourage its members to refer to alternative medicine practitioners. But we have to be realistic. They exist and are here to stay. Most public hospitals already offer acupuncture services. Several have TCM clinics on their premises.
Continuing this "iron curtain" of no formal communication between doctors and alternative medicine practitioners is impractical and anachronistic.
Finally, many alternative medicine forms are steeped in cultural and religious beliefs, such as TCM and ayurvedic medicine.
From the perspective of safeguarding social cohesion in Singapore, getting the local medical profession to collectively criticise various alternative medicine modalities is unwise.
In Singapore's social context, journalists should not try to pit one group of caregivers against another. It is best for an impartial and respected body such as the Government to step forward
to decide what is safe and unsafe for patients.
Dr Abdul Razakjr Omar
Honorary Secretary
Singapore Medical Association (SMA)
Notice how Dr Razak had not addressed Dr Ho's main focus, which were on the lack of evidence behind alternative medicine.
Instead of accusing Dr Ho of failing to "take SMA's proposal to amend the SMC ethical code in context", Dr Razak should perhaps ask himself why SMC's ethical code specifically makes that distinction between medicine and "complementary medicine" - as I have argued in my previous posts, just because practitioners of a certain mode of alternative medicine are registered does not mean that there is any evidence backing their claims; reality does not alter itself because of cultural beliefs, political decrees, economic conveniences, or public opinion. Hopefully, as a professional society representing (about) half of all doctors in Singapore, SMA understands that.
There are many forms of alternative medicine out there which are being sold to unsuspecting patients. Just because they are a part of our "cultural beliefs" or that they are renting shop spaces in our hospitals does not mean that doctors as a profession must accept them or not speak up against them. If you know that certain forms of alternative medicine are ineffective or indeed potentially harmful, but choose not to advocate against it because you do not want to be seen as "self-serving", what does that say about your strength of character? Will we rather our patients be harmed by such therapy than we be falsely accused of being self-serving?
If we claim to be a profession that is built upon science, if we claim to be advocates for our patients, then we must speak up even when we know it will not be well-received, even when we know it will offend.
Thus, that line about "safeguarding social cohesion" is really a betrayal of what this profession and SMA should be about. If you go through the SMA's constitution, you will find nothing that states that it is its aim to safeguard social cohesion. In fact, this cowardly defence of alternative medicine can be said to go against a few of the stated aims.
SMA needs to ask itself whether it will choose what is expedient over what is right, and whether it is more important to be popular or to be intellectually honest.
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19 comments:
Well said, Angry Doc!
Upholding what is right in the patient's interest must take precedence over political correctness or else how can patients trust the doctors?
This Dr Razak seems to be more keen on Political Correctness than patients' interests. Perhaps we will see him in the upcoming elections?
Dr Razak is a good doctor, just in case you are wondering.
OK, Dr Razak is a good physician.
1. Hospitals are also profit centers. If hope and revenue meet, why not? Besides, it's impossible to argue that doctors have a monopoly on knowledge.
2. The reality is, some if widely-held convictions can only be whispered in private, not shouted in public. At least it gives the fragrance of "cohesion" until the stink of the next accident (witness cosmetic specialists).
3. The medical profession itself has conceded its high hippocratic ethos when some members recommend unnecessary procedures or dispense "accessories" like health supplements. The blurring is not one-directional. Unfortunately.
Because China is on the rise, so sometimes we have to carry their balls a bit...
Give me a break! The researchers and scientists (PhDs, or even MBBS-PhDs etc) are the ones who may be said to hold a monopoly over higher knowledge. The MBBS-only Drs are taking all the credit only because they are the public face of this knowledge that heal and save lives.
Give scientists (and even MBBS-PhDs) more credit. We need more of Duke-Singapore medical school doctors who are "clinician-scientists".
Who said anything about doctors monopolizing knowledge?
I agree with Anonymous that scientists including clinician-scientists deserve more credit for the current knowledge that have us optimize patient outcomes in management of diseases that we know the genetic, biochemical or anatomical mechanisms of, the diagnostic methods and their limitations, as well as which management modalities are effective for which groups of patients under which circumstances.
Doctors do not and should not have a monopoly on knowledge, instead, arguably they should have a monopoly on patient care by virtue of that they are the only guys around who are committed to using knowledge in patient care. Anybody else who refuses to base their clinical decisions on proven knowledge cannot say they are doing their best for the patient in patient care, but are simply insisting on a territorial war over a territories that they have not proven themselves worthy of controlling.
If and when an alternative treatment modality has been proven effective, I am confident that will become mainstream. The thing is, on the contrary when an alternative treatment modality gets proven uneffective we can reject them but they will stick around because their practitioners depend on practicing that modality for a living. Then, the practice of that modality can no longer be justifiably be bona fide in any sense, and advertising for that or the formation of associations or implementation of regulations is pointless, and in my humble opinion, unethical.
absence of proof is not proof of absence.
do no harm.
It is simple to show your displeasure with the SMA if you want to.
1. Cancel your membership.
2. Cancel your SMA credit card.
3. Update your Facebook status with an explanation of what you did and why.
I dont see how MBBS-PhD has anything to do with this discussion.
But still, there is always room for placeboic treatments to flourish. I reckon as ons no patient comes to grievous harm or financial loss, then perhaps there will be no need to take too huge a paternalistic role over how patients manage their eventual outcome.
Afterall, you need a bad treatment to make a good treatment look better
"absence of proof is not proof of absence."
Absence of proof is absence of proof.
"do no harm."
The only way to do no harm is to do nothing. Any form of treatment comes with potential to harm - it is a trade-off between risk and benefits, and to know what the risks and benefits are, you need to collect data and evidence and analyse them.
"It is simple to show your displeasure with the SMA if you want to.
1. Cancel your membership.
2. Cancel your SMA credit card.
3. Update your Facebook status with an explanation of what you did and why."
Since I do not:
1. Hold an SMA membership
2. Hold an SMA credit card
3. Have a Facebook account
I guess I am not qualified to show my displeasure with the SMA?
"But still, there is always room for placeboic treatments to flourish."
Really? To flourish? Why did you bother to go to medical school to study medicine then?
"Afterall, you need a bad treatment to make a good treatment look better"
No, 'no treatment' is enough to make a good treatment look attractive enough to the patient.
So can doctors now sell MLM products steeped in alternative medicine?
High time man.
A rule must be applied fairly. Doctors have been rightly castigated for indulging in unproven aesthetic medicine procedures outside the context of a clinical trial. Shouldn't acupuncture and other practices in alternative medicine be subjected to the rigors of a clinical trial?
@ Pathdoc
Well said!
I do not have a problem with the existence of alternative medicine. Consumers (note that I did not use the word 'patients') can choose what they like.
But I have a big problem with alternative medicine trying to stand beside the medical profession and passing itself off as some entity similar to us.
I am sure there is also a "placebo" effect when a patient sees a doctor for many minor ailments. If Andy Ho's article is fair, then it should be comparing the result of patients seeing a "trained" doctor vs an "bogus" doctor. I am quite sure that if such an expriment was done, he would find that bogus treatments is better than no treatment.
"The only way to do no harm is to do nothing."
I have yet to hear of a doctor doing nothing and asking a patient to go home and sleep it off. It that was the case, we won't have the problem of overprescription of antibiotics.
"I am quite sure that if such an expriment was done, he would find that bogus treatments is better than no treatment."
No doubt. But the comparison here is between bogus treatment and real treatment, not bogus treatment vs no treatment.
Specifically, what we have learnt about acupuncture tells us that there is no difference between bogus acupuncture and real acupuncture.
Nobody is arguing with the fact that poking people with needles make them feel better - what we are saying here is it doesn't matter where you stick the needles.
That means all the stuff about meridiens and qi and acupoints are irrelevant and wrong.
That means the entire basis of acupuncture is wrong. By extension, the whole basis of TCM is wrong.
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