Many an integrative health practitioner has been harassed by state medical boards with the power to revoke licenses with a charge such as: “The use of vitamin C is outside the standard of care.” What is the standard of care, and who sets this standard?
Webster’s New World Medical Dictionary defines “standard of care” as:
“1. A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance 2. In legal terms, the level at which the average, prudent provider in a given community would practice.”
In his eye-opening article “Bypass Nation,” published in the March 1999 issue of Talk magazine, Abraham Verghese, M.D., noted that coronary artery bypass grafting surgery was the standard of care in Houston simply because that is what market forces (i.e., Dr. Denton Cooley and Dr. William DeBakey) deemed it to be. But that “standard of care” is not always what’s best for the patient.
Recent headlines make the point:
- “Scans may be misleading for hockey players: MRIs shouldn’t take the place of a good clinical exam, study finds” (70 percent of healthy professional and college hockey players had abnormal hip and pelvis MRIs).
- “Mammograms fail to detect 66 per cent of breast cancers” , but of course do produce many false positives and do significantly increase the exposure to radiation, which itself can lead to cancer.
- “Growing doubts over standard prostate cancer test” (this from Dr. Richard Ablin, of the University of Arizona, who discovered the PSA test.
- “Panel: Women need chance to avoid repeat C-section” (a government panel urges doctors to rethink the principle of “once a C-section, always a C-section”).
- “Study suggests too many invasive heart tests given”.
- “Popular osteoporosis drugs linked to hip breaks”. They might have added: also linked to jaw death. But the number of deadly drug side effects is too great to begin to cover here.
The truth is that most of medicine is not truly science-based. In most cases, evidence for efficacy and safety is limited. Therefore the conventional “standard of care” is not adequately science-based, yet practitioners can lose their licenses for not following it.
Why is this? Why do we have monopoly medicine run by the American Medical Association (AMA), the drug companies, and medical equipment manufacturers? The short answer is that this monopoly is government supported. Government, which starts out by trying to help, all too easily falls into the hands of special interests.
Does this have to happen? No. Coal companies do not control the Environmental Protection Agency. And it is high time for the American public to insist that there be a top to bottom house cleaning of the government agencies charged with regulating medicine, all the more so after the passage of the recent healthcare legislation and the imposition of national government standards on health insurance.