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Masic I Miokovic M Muhamedagic B Evidence based medicine new approaches and challengesActa Inform Med 2008164219RITISH COLUMBIA HUMANIST ASSOCIATION422 Richards St Suite 170Vancouver BC V6B 2Z4 604 26 Download

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�� - 1 - &#x/MCI; 0 ;&#x/MCI; 0 ; &#x/MCI; 1 ;&#x/MCI; 1 ;FEEDBACK REGULATING HEALTH PROFESSIONALSBy Ian Bushfield, Executive DirectorJanuary , 2020Enshrine evidencebased medicine in regulated healthcare professionsThe BC Humanist Association upports Masic I, Miokovic M, Muhamedagic B. Evidence based medicine new approaches and challenges.Acta Inform Med. 2008;16(4):219 RITISH COLUMBIA HUMANIST ASSOCIATION422 Richards St, Suite 170Vancouver, BC V6B 2Z4 (604) 265bchumanist.cainfo@bchumanist.ca �� - 2 - &#x/MCI; 0 ;&#x/MCI; 0 ;with systematic reviews and metaanalyses as stronger tools than individual case studies or even standalone clinical trials.By operating based on pseudoscientific principles and routinely failing to demonstrate the efficacy of their practices, chiropractic, naturopathy, Traditional Chinese Medicine and acupuncture operate in opposition to the approaches taken by otherrecognizedealth profession. While the scrutiny applied by more evidencebased professions in a consolidated regulatory college system will undoubtedly tamper some of the more egregious claims made by some individual practitioners, it fails to address the pseudoscientific bases of these practices.To accomplish the committee’s three key objectives of improving patient safety and public protection, improving efficiency and effectiveness of the regulatory framework and increasing public confidence through transparency and accountability, evidencebased medicine, and not a continued protection for pseudoscientific practices, must be placed at the centre of any regulatory reforms.In advocating this approach, we echo the December 2018 recommendation from Harry Cayton’s preceding inquiry into the Health Professions that “An evidence based occupational risk assessment process should be developed and implemented to identify the potential risks of harm from occupations within the health sector and to consider the appropriate mitigations.”Notably, Cayton suggested in followup comments to the media that the current system amounts to “whatever profession has lobbied hard enoughhas managed to win itself a college” and some professions could be deregulated.It should be selfevident that regulating health professions on the basis of each practice’s political acumen risks undermining patient safety.Finally, while our attention in this response has targeted those regulated fields of complementary and alternative medicine, we also recognize that there is f

2 ar more work to be done to ensure the pr
ar more work to be done to ensure the principles of evidencebased medicine in every health profession. Our previous work on addictions recovery options highlights one area in urgent need of greater evidencebased approaches.While the onsultation paperdoes not consider the deregulation of certain professionswe are optimistic thatas a first step, amalgamating regulatory colleges presents the opportunity for oversight bodies to apply greater skepticism to the claims made by many of these practitionersTo ensure this oversight meets itskey objectivesevidencebased medicine ust bea core mandate of each of the new colleges. Cayton H. An Inquity into the performance of the College of Dental Surgeons of British Columbia and the Health Professions Act. Dec 2018.Lindsay B. Rip up current system and start over, recommends review of B.C.’s professional health colleges. CBC News. Apr 11, 2019. https://www.cbc.ca/news/canada/britishcolumbia/bc healthprofessionalregulationreport1.5094180 Accessed: Jan 7, 2020. Ensuring choice in addictions recovery. BC Humanist Association. Aug 20, 2018. https://www.bchumanist.ca/ensuring_choice_in_addictions_recovery �� - 3 - &#x/MCI; 0 ;&#x/MCI; 0 ;Literature reviewA thorough scientific review of the claims behind chiropractic concludes that it has largely not been shown to be an effective treatmenthe possible exceptionin that review is or back painfor whichtwo Cochrane systematic reviews found chiropractic to be “no more effective” than other therapiesFurthermore, manipulation as been found to have frequent negative side effects and serious complications.Another metareview found that “ollectively these data fail todemonstrate convincingly that spinal manipulation is an effective intervention for any condition.”Studies frequently demonstrate that excessive xray and imaging tests are requested by the hiropractorswithout demonstrating significant medical value significantdemonstrated need.In addition to the practice having no basis in science and showing no therapeutic value, reports have shown that multiple BC chiropractors actively undermine other public health measures by perpetuating falsehoods about vaccinations or promote other pseudoscientific treatments like homeopathy.Naturopathy is based on theories that have little to no basis in cience. As it is not predicated on falsifiable claims, it attempts to avoid the scientific scrutiny we expect to be applied to other treatments.Similar to chiropractors and other alternative medicine pr

3 actitioners, it’s well documented t
actitioners, it’s well documented that some naturopaths antagonize public health interventions including vaccinations.Where naturopathy has demonstrable benefits, those practices can and are incorporated by evidencebased healthcare professions. Ernst E. Chiropractic: A Critical Evauation. Journal of Pain and Symptom Management2008;35(5):544562. doi:10.1016/j.jpainsymman.2007.07.004RubinsteinSM, TerweeCB, AssendelftWJJ, de BoerMR, van TulderMW. Spinal manipulative therapy for acute lowback pain. Cochrane Database of Systematic Reviews2012;9. Art. No.: CD008880. doi:10.1002/14651858.CD008880.pub2.RubinsteinM, van MiddelkoopM, AssendelftWJJ, de BoerMR, van TulderMW. Spinal manipulative therapy for chronic lowback pain. Cochrane Database of Systematic Reviews20112. Art. No.: CD008112. doi:10.1002/14651858.CD008112.pub2.Posadzki P, Ernst E. Spinal manipulation: an update of a systematic review of systematic reviews. N Z Med J.2011;124(1340):5571.Jenkins HJ, Downie AS, Moore CS, French SD. Current evidence for spinal Xray use in the chiropractic profession: a narrative review.Chiropr Man Therap. 2018;26:48. Published 2018 Nov 21. doi:10.1186/s129980217Ammendolia C, Taylor JAM, Pennick V, Côté P, HoggJohnson S, Bombardier C. Adherence to radiology guidelines for low back pain: A survey of chiropractic schools worldwide. Journal oManipulative and Physiological Therapeutics.2008;31(6):412418. Doi10.1016/j.jmpt.2008.06.010Lindsay B. 50 B.C. chiropractors refuse to remove misleading claims from websites, face possible discipline. CBC News.Nov 16, 2018. https://www.cbc.ca/news/canada/britishcolumbia/50 bcchiropractorsfacepossibledisciplinemisleadingclaims1.4909071 Accessed: Jan 7, 2020 Barrett S. A Close Look at Naturopathy. Quackwatch. Nov 26, 2013. https://www.quackwatch.org/01QuackeryRelatedTopics/Naturopathy/naturopathy.html Accessed: Jan 7, 2020. Lindsay B. Complaints levelled at B.C. naturopaths offering ‘complete elimination’ of autism. CBC News. May 24, 2018. https://www.cbc.ca/news/canada/britishcolumbia/complaintslevelled naturopathsofferingcompleteeliminationautism1.4675461 Accessed: Jan 7, 2020. �� - 4 - &#x/MCI; 0 ;&#x/MCI; 0 ;Traditional Chinese Medicines (TCM), similar to naturopathy, is based on hypotheses which largely have no basis in science. Systematic reviews of TCM have found few studies in support of its effectiveness or value.Possibly the most popular form of TCM is acupuncture, which has been studied extensively and shownlargely inconsistent results.

4 In particular,the underlying theory behi
In particular,the underlying theory behind acupuncture is based on concepts such as qi (life energy), meridians (qi pathways through the body) and special acupuncture points, none of which are supported by a contemporary scientific understanding of anatomy. Further, “sham acupuncture” studies debunk the importance of elements that ought to be fundamental for acupuncture to work according to its underlying theory, with a 2013 review finding thathen comparing acupuncture to sham controls, there was little evidence thatthe effects of acupuncture on pain were modified by any of the characteristics evaluated, including style of acupuncture, the number or placement of needles, the number, frequency or duration of sessions, patientpractitioner interactions and the experience of the acupuncturist.”About the BC Humanist AssociationThe British Columbia Humanist Association has been providing a community and voice for Humanists, atheists, agnostics, and the nonreligious of Metro Vancouver and British Columbiaince 1984Our values include thatHumanism advocates for the application of the methods of science and free inquiry to the problems of human welfare.n our position statementon the subject, we describecalled complementary and alternative medicis and treatments as unethical.As it is beyond our organizational expertise, we refrainingfrom nswering the specific questions posed in the consultationpaper Shang, Huwiler, Nartey, Jüni, EggerPlacebocontrolled trials of Chinese herbal medicine and conventional medicinecomparative studyInternational Journal of Epidemiology2007;10861092doi:10.1093/ije/dym119Zhang, Kong, ZhangEvaluation of impact on healthrelated quality of life and cost effectiveness of Traditional Chinese Medicine: A systematic review of randomized clinical trials. The Journal of Alternative and Complementary Medicine2012;18(12) doi:10.1089/acm.2011.0315Colquhoun D, Novella SP. Acupuncture is theatrical placebo. Anethesia & Analgesia.2013;116(6):13601363. doi:10.1213/ANE.0b013e31828f2d5eMacPherson H, Maschino AC, Lewith G, et al. Characteristics of acupuncture treatment associated with outcome: an individual patient metaanalysis of 17,922 patients with chronic pain in randomised controlled trials.PLoS One. 2013;8(10):e77438. doi:10.1371/journal.pone.0077438BC Humanist Association. Amsterdam Declaration 2002. https://www.bchumanist.ca/issues_summary#3.4 BC Humanist Association. Complementary and Alternative Medicine. Issues Summary. August 13, 2018. https://www.bchumanist.ca/issues_summary#3.

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