Complementary and Alternative Medicine Policy

Striking the right balance in policy

A policy regulating the use of complementary or alternative medicine states that the higher the potential risk to the patient for a particular treatment, the higher the level of evidence required.

The Complementary and Alternative Medicine (CAM) policy approved by Council requires complementary or alternative treatments be informed by evidence and scientific reasoning to mitigate the risks associated with providing these treatments.

“We believe that when physicians depart from conventional medicine, their practice must continue to be informed by sound clinical reasoning, one where patient risk does not outweigh potential benefit,” said Dr. Keith Hay, a family physician and a member of the Policy Working Group.

On the basis of the available evidence, some complementary or alternative treatments appear to pose little risk in themselves; however, some can present significant, even life-threatening, health risks. This may be, for example, because the treatment itself is inherently risky, or because it is interfering with or replacing the administration of a more effective conventional medical treatment, especially for serious illness.

Before providing any treatment, physicians must think carefully about the strength of evidence there is for its efficacy, and how providing a particular treatment could impact a patient and their health care decisions. For example, where the evidence for a treatment is modest, but the risk of harm to the patient is low and it may be offered alongside conventional treatment, it is likely appropriate for a physician to provide such treatment. However, where the evidence for the treatment is modest, the risks to the patient are potentially high and it would be provided instead of conventional treatment, the treatment may be inappropriate.

The Policy Working Group’s aim was to strike the right balance between protecting patients from harm and respecting patient autonomy to choose non-conventional medical treatments, said Dr. Hay.

“We were also conscious of not impeding innovation or professional judgment,” said Dr. Hay, “but as with all our policies and initiatives, ensuring patient safety is our first priority.”

 The Policy Working Group reviewed all feedback received with much of it reflected in the final policy. For example, the draft policy requirement for physicians to document the full risk-benefit analysis they undertook to determine whether it is appropriate to provide a CAM treatment to a patient was removed. The feedback suggested this would be an onerous obligation as there are many treatments that are low risk and provided routinely. The Policy Working Group agreed that specific, additional requirements on top of what is required of all physicians by the Medical Records Documentation policy was unnecessary and there should be room for physicians to use their professional judgment in determining whether additional documentation may be required.

New content was added to the accompanying Advice document to address the fact that some CAM therapies or treatments may be of importance to specific cultural groups (for example, traditional Indigenous healing or Chinese medicine). This new content also reminds physicians of the importance of providing culturally competent care.

Weighing the Factors

The policy requires physicians to only provide a complementary or alternative treatment to a patient where the potential benefits of providing the particular treatment outweigh the risks.

Physicians need to determine this by weighing a number of factors, including:

• The health status and needs of the patient;
• The strength (e.g., quantity and quality) of evidence and scientific reasoning regarding the effectiveness of the treatment provided for the patient’s symptoms;
• The potential for harm to the patient;
• Any potential interactions between the proposed treatment and any other treatments the patient is currently undertaking; and
• Whether the treatment is being provided alongside conventional treatment or as an alternative to it.