The Physician has but a single task: to cure; and, if s/he succeeds, it matters not a whit by what means s/he has succeeded. Hippocrates (400 BC)
Questionable and Deceptive Health Care Practices
In the position paper entitled “Questionable and Deceptive Health Care Practices (1),” The Federation of State Medical Boards (FSMB) suggests that Complementary and Alternative Medicine (CAM) (2), or that CAM practitioners themselves, provide medical care which is “unproven, unsafe, worthless, incompetent, unprofessional, improper, unlawful, fraudulent and felonious.” The National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health (NIH) (3) with a budget in 2010 of $128,791,000, “conducts and supports basic and applied research and training and disseminates information on complementary and alternative medicine to practitioners and the public.” In essence, the FSMB (4), an organization which governs the standards of care and licensing of all US physicians considers a 130 million-dollar-tax-payer-financed division of the NIH to be “unproven, unsafe, worthless, incompetent, unprofessional, improper, unlawful, fraudulent and felonious.”
This rift between large organizations which set policies as to what constitutes “accepted standards of care” is prototypic of the raging conflict between conventional and non-conventional or complementary and alternative medicine.
The National Center for Complementary and Alternative Medicine (NCCAM), being the “new kid on the block,” apparently treads lightly and seeks to merely “complement” conventional medicine in order to avoid a confrontation with conventional medicine, which sees any challenge to its supremacy as “unproven, unsafe, worthless, incompetent, unprofessional, improper, unlawful, fraudulent and felonious.” Most of NCCAMs projects and grants are aimed at research into indigenous healing practices such as herbal medicine, and very little is focused on functional medicine (5), the author’s field of expertise.
Functional Medicine
Functional medicine is defined as “personalized medicine that deals with primary prevention and underlying causes, instead of symptoms, for serious chronic disease (6),” and functional medicine is popularly classified as a type of Alternative Medicine (7). Functional medicine relies heavily on investigating biochemical, nutritional, metabolic, toxicological, allergic, immune, hormonal, neurotransmitter and genetic variables using diagnostic laboratory testing of stool, urine, saliva, blood and hair samples. Thus functional medicine seeks to determine the underlying causes of chronic disease, rather than palliative treatment of symptoms with medications or herbal products (see Diagram below, Conventional Medicine vs Functional Medicine Method of Establishing a Diagnosis).
The accepted standard of care in functional medicine for establishing a diagnosis represents a radical shift away from conventional medicine’s accepted standard of care (see Diagram below). That shift may appear so radical in fact to those who are schooled only in conventional medicine that it may appear to be a Questionable and Deceptive Health Care Practices (8) ,” or even “unproven, unsafe, worthless, incompetent, unprofessional, improper, unlawful, fraudulent and felonious.” Based on applications of biochemical science which are alien to most conventional practitioners, the prospect of “curing” chronic disorders, which until recently could only be managed with palliative, symptom-suppressive, drug therapies, is understandably a threatening prospect.
Conventional Medicine vs Functional Medicine Method of Establishing a Diagnosis
Note: The complete article (with chart) is available as a PDF download at the end of the article below. You are invited to download and distribute it to the world.
The American Medical Association defines seven “Principles of Medical Ethics (9),” one of which states that “A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception.” Despite the passage of state laws to protect CAM- or functional medicine-practicing physicians, when physicians are suspected or reported to be using so-called “questionable” practices they are often investigated (10). After a period of investigation by their State Medical Board, CAM (Complementary and Alternative Medicine) physicians are then often charged with negligence, incompetence and fraud for having violated certain ill-defined, conventional medicine “accepted standards of care.”
Because of revolutionary scientific advances in laboratory science which can define the unique biochemical, nutritional, metabolic, toxicological, allergic, immune, hormonal, neurotransmitter and genetic causes of medical and psychiatric disorders, conventional medicine’s accepted standards of care, intended to enhance quality of care, are in fact increasingly obsolete and threaten to destroy quality of care.
Who is Guilty of Negligence, Incompetence and Fraud?
Definitions:
neg•li•gent adj. 1- habitually failing to do the required thing; neglectful 2- careless, inattentive, etc. – neg’li•gence n.
in•com•pe•tent adj. without adequate ability, knowledge, fitness, etc. –n. an incompetent person – in•com’pe•tence n.
fraudulent adj. 1- deceitful; using trickery 2- Law intentional deceptiveness
A critical phrase in the definitions listed above is “the required thing” used to define the term negligent. “The required thing” or “things” which functional medicine (11) physicians do which are guided their potentially curative standards of care are entirely at odds with “the required thing” or “things” which conventional physicians do which are guided by their palliative standards of care. “The required thing” guiding the practices of functional medicine physicians is “personalized medicine that deals with primary prevention and underlying causes, instead of symptoms (my underlining), for serious chronic disease.(12)”
In other words and conversely, a physician who represents themselves as practicing functional medicine would be guilty of negligence should they not attempt to address the “underlying causes, instead of symptoms.” Furthermore, should they fail to provide “primary prevention” by not addressing biochemical, nutritional, metabolic, toxicological, allergic, immune, hormonal, neurotransmitter and genetic processes in their asymptomatic patients, functional medicine doctors would be misrepresenting themselves and would therefore be guilty of fraud.
“The required thing” for a conventional physician, however compassionate and devoted to the care of their patients, is entirely different and in essence completely opposite. Instead of dealing with “primary prevention and underlying causes, instead of symptoms, for serious chronic disease,” conventional medicine practitioners are “required” to manage (not prevent) the symptoms (not causes) of both chronic and acute diseases, usually with symptom-suppressing drugs. A conventional doctor would by definition be guilty of negligence should they fail to meet these “accepted standards of care” as defined by their State Medical Board(s) and Federation of State Medical Boards.
“The required thing” that consumers increasingly want of their physicians is to prevent and/or address the root causes of their ailments, and only manage them with drugs, surgery and radiation as a last resort. Even conventional physicians want more information about CAM (13) to be more informed about interventions other than disease management and symptom suppression. The quote from Hippocrates above (14) suggests that functional medicine physicians are in far greater compliance than their conventional medicine counterparts with the expectations of the public as well as the objectives of a much older, traditional, Hippocratic version of an “accepted standard of care.”
From the functional medicine perspective, conventional medicine practice is negligent because its accepted standards fail to do “the required thing” and provide “personalized medicine that deals with primary prevention and underlying causes, instead of symptoms (my underlining), for serious chronic disease.(15)”
From the conventional medicine perspective, functional medicine practice is negligent because it fails to competently manage the symptoms of both chronic and acute diseases according the accepted standards of care which are dictated by one’s licensure.
Each group is violating the “accepted standards of care” of the other.
As functional medicine physicians become increasingly proficient in the prevention and cure of disorders and diseases, the management of symptoms with drugs and surgery becomes increasingly obsolete and irrelevant. As an increasing proportion of their medical practices are devoted to CAM therapies, less of their knowledge and skills are devoted to the latest nuances of conventional medicine and drug management protocols. Thus CAM physicians often appear to be out of touch with the latest drug therapies and thus appear to be incompetent to conventional physicians.
Likewise, most conventional physicians were never trained in CAM and as CAM physicians become ever more convinced that CAM works (because it does), conventional physicians appear to be increasingly out of touch and incompetent. As with the issue of negligence, each appears incompetent to the other.
Finally, each group appears to be fraudulent to the other.
Conventional physicians believe that prevention, cure and healing is impossible for most of their patients, a true statement if their patient’s treatments are indeed largely limited to only the management of symptoms with drugs, surgery and radiation. CAM physicians have a completely different view, stemming from years of observing one “incurable” patient after another becoming well. Conventional physicians often dismiss the CAM physician’s claims of efficacy as fraudulent because such interventions, often involving a dozen or more different therapies applied simultaneously and prescribed in different combinations for different patients with the same diagnosis, are not “proven” by controlled studies.
In fact, CAM therapies cannot be “proven,” unless one is willing to acknowledge the validity of each patient’s cure by itself to be proof that each unique treatment tailored to the precise and unique biochemical, nutritional, metabolic, toxicological, allergic, immune, hormonal, neurotransmitter and genetic needs of that patient actually worked.
CAM physicians counter that conventional physicians are fraudulent, because disease management with surgery, radiation and especially drugs is often misrepresented as the only acceptable treatment, and furthermore conventional medicine treatments are often misrepresented as preventative, curative and healing interventions. As an example, mammography is often mislabeled as preventative when in fact it does not prevent cancer – mammography is an early detection technology to find the disease that is already present.
Except under limited circumstances, such as antibiotic treatment for infectious disease, drugs, surgery and radiation generally do not prevent, heal or cure diseases or disorders. On the contrary, conventional medicine disease management strategies employing drugs, surgery and radiation often interfere with healing and in fact are at least the 3rd leading cause of death in the USA.(16)
Conventional physicians often believe that CAM physicians are guilty of negligence, incompetence and fraud. CAM physicians often believe that conventional physicians are guilty of negligence, incompetence and fraud. There can be no compromise as long as each side judges the other based on different versions of the term “accepted standards of care.”
Since the AMA mandates that “A physician shall ….. strive to expose those physicians deficient in character or competence, or who engage in fraud or deception,”(17) should CAM physicians be ethically compelled to expose all conventional physicians as fraudulent and vice versa? Both sides need to expand their definitions of such standards to include the others.
Federation of State Medical Boards Accepted Standards of Care
If State Medical Boards only apply conventional medicine’s, increasingly obsolete, accepted standards of care (management of disease symptoms – their version of “the required thing”) to judge and prosecute CAM physicians and fail to realize that CAM physicians are practicing by a completely different, curative, preventative, Hippocratic-based standard of care, State Medical Boards will continue blindly to wage their illegitimate war against CAM physicians.
The chilling effects over the decades of such prosecutions on conventional physicians, who might otherwise have expanded their repertoires by now to learn and apply safer, science-based, cost-effective and often more efficacious CAM and functional medicine therapies, may be the single greatest impediment to authentic medical innovation and to a genuine solution to the current health care crisis. The narrow definitions of “accepted standards of care,” negligence, incompetence and fraud used by the Federation of State Medical Boards must be redefined so that curative and preventative CAM therapies can be introduced into mainstream medicine.
The complete article is available for download at the link below:
Medical-Negligence-Incompetence-and-Fraud
Article Footnotes:
1) See http://www.fsmb.org/pdf/1997_grpol_Deceptive_Health_Care_Practices.pdf or search www.FSMB.org and click on “Policy Documents” on the main page (2nd down on the buttons on the left). The 14th paper down is entitled “Report on Questionable and Deceptive Health Care Practices.” This listing may change as other position papers are added or deleted by the FSMB.
2) See http://nccam.nih.gov, The National Center for Complementary and Alternative Medicine. NCCAM, a division of the National Institutes of Health, conducts and supports basic and applied research and training and disseminates information on complementary and alternative medicine to practitioners and the public.
3) NIH is the National Institutes of Health, which has a tax-payer-funded budget of 10.4 billion dollars (2009).
4) The FSMB sets the licensing standards for physicians and defines the national policies their state’s boards.
5) See: The Institute for Functional Medicine (http://www.functionalmedicine.org) and The Academy of Functional Medicine, Dentistry and Psychology (http://www.academyoffunctionalmedicine.com).
6) Jones DS, ed. Textbook of Functional Medicine. Gig Harbor, WA: The Institute for Functional Medicine; 2005.
7) See http://en.wikipedia.org/wiki/Functional_medicine. “Functional Medicine is an alternative medicine that focuses on improving physiological function as a primary method of improving the health of patients with chronic disease.
8 ) See http://www.fsmb.org/pdf/1997_grpol_Deceptive_Health_Care_Practices.pdf or search www.FSMB.org and click on “Policy Documents” on the main page (2nd down on the buttons on the left). The 14th paper down is entitled “Report on Questionable and Deceptive Health Care Practices.” This listing may change as other position papers are added or deleted by the FSMB.
9) See “Code of Medical Ethics” published by the American Medical Association (1998), p. xiv, item no. II.
10) Barrette, J A, (2003) The Alternative Medical Practice Act: Does It Adequately Protect the Right of Physicians to Use Complementary and Alternative Medicine, St. John’s Law Review, volume 77, Winter 2003, number 1, pp. 75-122.
11) See: The Institute for Functional Medicine (http://www.functionalmedicine.org) and The Academy of Functional Medicine, Dentistry and Psychology (http://www.academyoffunctionalmedicine.com).
12) Jones DS, ed. Textbook of Functional Medicine. Gig Harbor, WA: The Institute for Functional Medicine; 2005.
13) Corbin Winslow L, Shapiro H. Physicians want education about complementary and alternative medicine to enhance communication with their patients. Arch Intern Med 2002 May 27;162(10):1176-81, Center for Integrative Medicine, University of Colorado Hospital, PO Box 6510, Mail Stop F730, Aurora, CO 80045, USA. lisa.winslow@uchsc.edu
14) The Physician has but a single task: to cure; and, if s/he succeeds, it matters not a whit by what means s/he has succeeded. Hippocrates (400 BC)
15) Jones DS, ed. Textbook of Functional Medicine. Gig Harbor, WA: The Institute for Functional Medicine; 2005.
16) JAMA (Journal of the American Medical Association), July 26, 2000-Vol 284, No. 4, pp. 483-485. This article also ranked the US Healthcare System almost in last place, based on morbidity and mortality statistics, compared to many leading Western nations.
17) See “Code of Medical Ethics” published by the American Medical Association (1998), p. xiv, item no. II.