Saturday, November 22, 2008

"Dr." Robert Wohlfahrt: "A Blight On Us All"

"Who Is A Physician?

The identity of “physician”, generally understood as referring to someone who has completed medical school, other requisite training, and is practicing medicine. 

...What about people who present themselves as doctors, but do not practice the science-based medicine that we teach and practice?  They may have an M.D. or D.O. degree, they may even be board-certified, but if they are practicing outside of the standard of care, are they still bound by the same system of ethics as their more traditional colleagues?

Absolutely.  Anyone who presents themselves as a doctor must behave in a way concordant with medical ethics.  A patient seeking help should expect the same ethical treatment from all practitioners.  No doctor is exempt from our ethical principles.

What about a doctor who believes in the implausible medical claims that they practice?  Since they believe that they are helping the patient, aren’t they behaving ethically?

If intention were the only principle of medical ethics, well, sure.  But good intentions do not excuse incompetence, and one of our responsibilities as physicians is to strive for excellence in our knowledge and practice.  This means maintaining our science-based education.

What about non-physicians who offer quasi-medical services? Professionals such as nurse practitioners have their own codes of ethics, but often enough non-professionals such as homeopaths, acupuncturists, and others present themselves as healers.  Patients have a responsibility to educate themselves and protect themselves from harm, but people who are suffering are vulnerable, and non-professional healers take advantage of this vulnerability.  While they are not bound by the same medical ethics that I am, they are bound by the same ethical principles that all of us are as members of a larger society.  As a society, we generally frown upon folks pretending to be experts and futzing around with people’s health and hopes.  We only tolerate 'alternative healers' because their deceptions extend beyond their victims—we sometimes believe they are doing good, even if they are not.

Alternative Medicine Is Prima Facie unethical

To the extent that alternative practitioners are bound by medical ethics, alternative medicine is unethical. It violates most of the commonly agreed-upon precepts of our profession.  Medicine is based on the humane application of science-based practices.  Standards of care are based on either what has been shown to work, or when insufficient data is available, what we as a profession agree is likely to work.  There are written resources that any doctor can look up in minutes.  Altmed practitioners don’t 'slip' away from real medicine, they intentionally turn away from it, sometimes with good intentions, sometimes not. So-called alternative medicine practices are ethical failures on many levels.  As to the principle of beneficence, the most benefit they may offer is emotional comfort, something real medicine could just as easily offer.  When it comes to non-maleficence, it fails miserably, in that it often deprives patients of real treatments, or subjects them to ineffective ones.

When it comes to patient autonomy and truthfulness, however, it really hits a wall.  For a patient to exercise autonomy, they must be as informed as possible.  If an altmed practitioner were to truthfully inform patients that the wares they are peddling have never been shown to be useful, are shunned by real doctors, and may in fact harm, patients would knock each other down to get out the door.  But they don’t.  When they do give lip service to the unproven nature of their practices, it is always with a wink and a spiteful nod to those silly non-believers at the hospital.

Even the most heartfelt modern shaman is an unethical sham.  Alternative medicine, that is medicine that is outside the embrace of science-based practice, is inherently unethical, and it’s time to call it what it is—a blight on our profession, and so far as we tolerate it, a blight on us all."

-- Peter Lipson, on the thinking and behavior all doctors agree on - except the "homeopathic doctor", Robert Wohlfahrt, and those like him - who don't practice Science-Based Medicine.

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