It may be time to expand the principles of the Hippocratic Oath

First do no harm. That’s the major principle of the doctor’s Hippocratic Oath. For the most part, the public are well-served by that principle and by our medical community. It’s a principle which any health professional should follow as a matter of course. But I think they could do with an addition to “First do no harm” — how about “Second, do some good&quot.

I’m not convinced, though, that that would have been enough to help the unfortunate patients of Dr Richard Gorringe, the Hamilton GP recently struck off the register after being found guilty of disgraceful conduct. His combination of unorthodox practices appeared to pass neither principle for a number of his patients, and he was found to have caused them “unnecessary suffering”.

Perhaps the most disturbing aspect of this case was the comment from the Medical Practitioners Disciplinary Tribunal that:

“Dr Gorringe’s belief in the accuracy of his diagnoses and in the efficacy of his unusual treatments is such that the tribunal can have no confidence that, were he to continue in practice, his patients would be properly advised of their nature and limitations so as to permit informed choice.”

Patient advocates have fought long and hard to get informed choice enshrined as an important principle in medical practice, so it’s worrying to hear that Mr Gorringe intends to continue to offer medical advice and treatment, albeit as a naturopath.

Given the tribunal’s caveat, one wonders how informed his next patients will be as to the principles guiding his treatments. And what protection or redress, if any, there will be for future patients who find themselves undergoing “unnecessary suffering”.

These are not questions solely for the Gorringe case, however, but ones we all need to consider. After all, we have a Ministerial Advisory Committee for Complementary and Alternative Health currently examining what modalities are to be integrated into the New Zealand health system, and what regulations, if any, this new and lucrative health market is to operate under. The committee has defined complementary and alternative medicine (CAM) to include “all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and wellbeing.”

I guess this extremely loose definition is understandable, given that five of the eight committee members are self-identified CAM practitioners, with business interests in iridology, naturopathy, natural medicines, traditional Chinese medicine, acupuncture, aromatherapy, massage therapy, counselling, sclerology, osteopathy, homeopathy, anthroposophy and culturally defined health sectors.

However, such an all-encompassing, self-serving definition doesn’t help the patient trying to decide if a recommended practice is safe and effective, and it’s a bad look for the CAM industry as a whole. Two CAM practitioners who were members of the White House Commission on CAM Policy, were honest enough to warn that:

“Generic recommendations neither serve the public interest nor protect the public health because they fail to distinguish between approaches, practices and products for which there is some scientific evidence and those that either stretch the realm of logic or are demonstrably unsafe.”

And while it’s said more Kiwis are turning to alternatives, they also want reassurance that not only are such practices safe, but that they will really work. According to the New Zealand Family Physician journal, 71 per cent of New Zealand patients surveyed wanted regulation of complementary medicine to be on a par with orthodox medicine.

The distinction, of course, is an artificial one. As Marcia Angell, editor of the New England Journal of Medicine, says, there is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work.

Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. Everyone would welcome cures for cancer, eczema, multiple sclerosis, arthritis, whatever their origin, so long as they do no harm and, as an equally important requirement, actually do some good.

But if the modality involved has no basic grounding in reality, then it doesn’t matter how many doctors take it up, how many products are sold, how well integrated it is in our hospitals, it won’t do any good and, as demonstrated, can do a great deal of harm — physical, emotional and economic.

Any health practitioner, whether registered doctor or naturopath, who refuses to acknowledge this, is guilty of disgraceful conduct. You don’t need a professional board to tell you that, just simple ethical principles.

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