Wednesday, November 14, 2007

Panda Bear continues his series of posts on CAM

In today’s post Panda Bear likens the patient to a person seeking automotive repairs:

And yet I am not so confident in my intelligence that I don’t think I can be fooled. Because, for example, I having nothing but a polite interest in automotive technology I am pretty much at the mercy of my mechanic when he describes the repairs needed by our aging pair of automobiles. I trust the guy because nothing he has ever suggested sounds too outrageous and on a couple of occasions he replaced a three-dollar fuse when he could have taken me for an alternator. I am however at his mercy unless I want to study car repair or haul the thing to more than one mechanic.

That is, the consumer’s only real option is to accept the findings and recommendations of the professional since he/she lacks the expertise needed to independently verify the professional’s findings. The analogy between auto repairs and medical treatment, as Panda Bear points out, isn’t perfect because medicine is far more complex. It comes down to a level of trust, to which the patient has no viable alternative. In other words there’s no caveat emptor in medicine. This puts doctors in the position of fiduciary duty. I used this same analogy to raise the principle of fiduciary duty last year.

The ethical questions posed by this analysis may differ between proponents of non-evidence based CAM within and outside of mainstream medicine. Many CAM practitioners outside of conventional medicine honestly believe in their methods. By contrast, mainstream practitioners purport to adhere to scientific principles and evidence based medicine and know, or should know, that water does not possess memory and that acupuncture meridians have not been documented to exist. Their credentials attest to scientific integrity and are the basis for public expectations. Thus, for mainstream medical institutions or their representatives to promote non-evidence based and biologically implausible claims is a violation of fiduciary duty. It’s the most egregious form of woo.

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