Earlier this month, two doctors working in private practice and treating their patients with complementary medicine were found guilty of serious professional misconduct by the General Medical Council. The ruling is a landmark in several respects and deserves to be analysed in detail.
The two physicians had treated and advised a patient with breast cancer. Instead of recommending conventional surgery, possibly supplemented with chemotherapy, they advocated alternatives including Laetrile, a compound derived from apricot kernels, diet and pancreatic enzymes. These treatments have not been demonstrated to be effective and Laetrile has even been shown to be ineffective. The GMC panel found that the information pack routinely handed out to patients by these doctors was misleading, without peer-reviewed scientific evidence and biased against conventional treatments. Furthermore, the information failed to alert patients to the risks of the recommended alternative cancer cures, which were significant.
Essentially, the judgment suggests that UK doctors must make sure the information they provide to patients is evidence-based and up to date with current scientific knowledge. GMC rules have always stated that "information must be factual and verifiable". But this has rarely been checked and even less frequently enforced. Therefore this ruling could indicate a new attitude within the GMC of enforcing evidence-based medicine, which would have far-reaching consequences for all of British medicine.
The GMC panel did not accept the assurance of one of the accused that he advised patients to pursue conventional treatments. It was felt that he misled his patient into not choosing conventional medicine. Providing information about a treatment for which there was no scientific evidence was irresponsible and not in the best interests of patients, the panel felt.
Again, this could indicate a tightening of the rules that doctors have to follow. In a general sense, it suggests that doctors must always advise patients on the best treatment for their condition. This seems logical to you and me, but it implies doctors should know not just about the treatments they happen to regularly employ but about all demonstrably effective ways of treating disease. If, for instance, a herbal treatment is of proven efficacy, doctors need to know this and advise patients accordingly. The fact that they may be unaware of the evidence is irrelevant. As double standards are not acceptable in healthcare, the same should apply to all regulated health professionals. Do chiropractors and osteopaths therefore have a duty to advise their patients to use conventional treatments if the evidence demonstrates them to be superior?
The GMC ruling has a further unusual feature. No patient ever complained about the two doctors in the dock. The complainant was a surgeon worried about his patient's refusal to have surgery. Being in full agreement with patients and having good intentions is thus not enough - "outsiders" can complain.
Again, I feel compelled to point out that double standards must be avoided. It would be most unfortunate if complementary medicine was being singled out as an easy target. Similar complaints should be possible in all areas of healthcare.
The sentences given to the two doctors were by no means lenient. For one doctor, the serious misconduct charge meant that conditions were imposed on his licence for 18 months. During this time he will only be allowed to work in an NHS hospital under the supervision of a mentor. The other physician was suspended for 12 months. This means he cannot work as a doctor treating patients. During this period, he has to undertake a programme of re-education, which includes patient assessment and follow-up, medical ethics and his understanding of combining complementary, alternative and conventional treatment approaches.
The latter point is, I think, of huge importance for complementary medicine in the UK. Integration ("the best of both worlds") is the current buzzword in this area. In my view, this is often done in a worryingly uncritical manner. The GMC seems to be reminding us that the integration of complementary medicine has to be based on scientific evidence; otherwise it is in danger of amounting to professional misconduct.
· Edzard Ernst is professor of complementary medicine at the Peninsula medicine school at the universities of Exeter and Plymouth.