Home > Medical/Health Commentary > Is it worth legislating science to have science-based regulation?

Is it worth legislating science to have science-based regulation?

October 23, 2011 Leave a comment Go to comments

I’m no fan of quackery, whether it’s of the homeopathic, naturopathic, chiropractic, craniosacral, ayurvedic, or other woo-tastic flavour. I’m even less of a fan when it’s practiced by people with the letters MD or DO after their name. I think it’s deceptive and unethical to promote these unproven and often disproven practices to patients who come to you for professional advice.

Earlier this year, a Florida-based lawyer wrote a piece at SBM arguing that many quacktitioners are likely committing misrepresentation, in the legal sense, and possibly fraud in some cases. This was followed up with a series examining the background and historical legal status of naturopathy, acupuncture, and chiropractic, and now a proposal to enshrine science-based medicine in law.

Read the whole blog post to get a better sense for what’s proposed. The short version is that the proposed law would limit the scope of practice of licensed healthcare professionals by imposing a two-part test to be interpreted “according to its generally accepted meaning in the scientific community”:

  1. Is it (a diagnosis, treatment, procedure, medication, etc.) plausible, based on “well-established laws, principles, or empirical findings in chemistry, biology, anatomy or physiology?”
  2. If not, is it “supported, to a reasonable degree of scientific certainty” by either “good quality randomized, placebo-controlled trials” or “by a Cochrane Collaboration Systematic Review or a systematic review or meta-analysis of like quality.” If not… it’s verboten.[a trial that would pass the legal test would have a placebo control group, random assignment, no more than 25% attrition, at least 50 participants in each study arm, and publication in a “high-impact, peer-reviewed journal.”]

    If so, has its ineffectiveness been “demonstrate[d], within a reasonable degree of scientific certainty” by the aforementioned controlled trials or Cochrane Reviews? If so, plausibility won’t save it from being forbidden.

With a scheme like this, the devil is usually in the details. In this case, I don’t think one needs to dive in too deep to realize why this is a bad idea.

Politics is a sausage factory, and the science-based medical community should be hesitant to get it unnecessarily involved. Just because something is wrong/a bad idea (like quackery) does not necessarily mean that it should be forbidden in an ideal world. Just because something wouldn’t exist in an ideal world (like quackery), it doesn’t mean that it’s a good idea to use the force of law to ban it.

As narrowly-tailored as it aims to be, this proposed law will have the effect of legislating scientific truth. What constitutes scientific consensus? Plausibility? A high-impact journal? Do we really want these and other scientific questions that are now debated in the literature and the public sphere to be decided definitively by judge and jury? Do we want to give the power to certify science to our legislatures? The same legislatures that have already licensed all sorts of quacks at the behest of their lobbyists?

Science is politicized too easily. Where a scientific conclusion is translated by law into an inevitable legal and policy consequence, the science will make a better political target than the legislation. See this piece on the Endangered Species Act for an example of what I mean.

The best of policies can be undone by politics. I’ve given a fair bit of thought to how one might design an anti-quack law that doesn’t have the potential to go drastically awry. I can’t, though this is likely a result of insufficient creativity on my part.

In general, there are two types of people in government. “Our people” and “their people.” Who they are may vary based on the party or based on the issue, but both types will always be there. And both types win and lose elections.

Here’s the question: do you trust “their people” to exercise good stewardship of scientific truth? If not, let’s not be too hasty in handing over the reins to the politicians.

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  1. November 10, 2011 at 09:22

    Health Wonk Review: Olio Edition now online, and your post’s in it:

    http://insureblog.blogspot.com/2011/11/health-wonk-review-olio-edition.html

    Please let your readers know.

    And a friendly reminder to newbies and regulars alike – while we haven’t made it mandatory to give a link back, it’s the way that carnivals work best. If your submitted post has been included in an HWR issue, please remember to post about it on your blog because it helps us all.

    Thanks!

  2. October 28, 2011 at 07:51

    This post and the comment seem to reflect the general consensus that the proposed legislation would be unworkable. I learned a great deal from the discussion and am still thinking about a legislative solution. It is, after all, the state legislatures who give the “CAM” providers the authority to practice. Although I suggested in the post that actually repealing the “CAM” provider practice acts would be a long, slow, expensive process, I am rethinking that. Perhaps that, or at least severely curtailing their scope of practice, is the proper way to go. What I am not comfortable with is the status quo, whereby acupuncturists, naturopaths and chiropractors are given primary care provider scope of practice and allowed to use their implausible and unproven diagnostic methods and treatments on the unsuspecting public, all perfectly legal. As for M.D.s and D.O.s who employ quackery, it doesn’t seem their professions are doing nearly enough to prevent this — and they could if they wanted.
    Jann Bellamy

  3. October 24, 2011 at 00:32

    As someone who hails from a nation that politicizes anything and everything (India), I would just like to chime in agreement with your assessment. While I had thought on similar lines on reading the SBM manifesto, I guess I was far too lazy to take the trouble of typing up this storm!

    The concept of legally bulldozing the quackademics is alluring, to say the least, but it brings with itself an inherent folly – that of “defining” proper science. And as you said, a high IF journal, a placebo controlled trial (which is not applicable in MANY cases nowadays), etc. may be markers of good science but cannot be touted as ABSOLUTE!

    As students of Medicine, we learn to appreciate the risks of absolutism in our clinical and scientific thinking. Maybe this is another extension of the same?

    And anyways, being a bit of an anti-establishmentarian myself, I would hate the concept of some ivory-pillar-riding intellectual dictating the terms of doing proper science…

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