Positive Health Online

Somewhere in the growing public acceptance of complementary medical methods, and the increasing cooperation between some complementary practitioners (CPs) and mainstream medical practitioners and organisations, there lies the potential for a major crisis of confidence.

Much discussion seems to revolve around the current buzz-phrase, the demand for an 'evidence base'

"Can you show evidence of benefit?", "Can you show evidence of safety?" and increasingly, "Can you show evidence of cost effectiveness?" These hurdles have not been fully crossed as yet, although attempts towards satisfying the sceptical powers-that-be are being gradually addressed, with research evidence starting to be gathered (an exercise fraught with its own pitfalls).

Other key concerns are education and training standards, which provide some of the 'safety' guarantees. For unless a practitioner, of any discipline, is able to recognise danger signs, to know what not to treat, as well of course as what and how to treat and advise, the 'evidence of safety' cannot be offered. This is an area in which a very wide spectrum, ranging from excellence to inadequacy exists, and I will return to this topic in a later column in this series.

Lying close, but not clearly linked, to safety, effectiveness and cost effectiveness, lies the area of often unspoken concern, which I believe needs a spotlight to be focused on it: ethics and professional behaviour.

Some people, in ANY organisation, will always behave badly. That is why codes of conduct are established in all ethical professional organisations, to provide assurance to the public, to Government and other agencies, and to other professional bodies, that self regulation will take care of wrong-doing.

The ethical standards of any group in the health care world have to be set extremely high. Codes of conduct need to be based on principles, values and moral criteria which protect vulnerable members of the public from exploitation and harm, as far as this is possible. There also have to be well-publicised means of discipline, following a fair hearing of complaints which is based on prevailing concepts of fair play and justice.

Ultimately, short of actual criminal prosecution (if crime is involved), the most potent sanction a professional organisation can exercise is to disbar the individual from the right to practise. This can only happen effectively if the profession is a statutory one, in which the title of the profession is protected by law. In complementary health care, this now exists (in the UK) for osteopathy and chiropractic and will soon apply to acupuncture as well, following legislation which provides statutory recognition of these professions, and which has created bodies to exercise control over the members of these professions.

So ultimately, complaints against such members will be dealt with by procedures which will ensure that if they are guilty of professional misconduct, they may be prevented from using the title of osteopath, chiropractor or acupuncturist. That offers some protection to the public who can then be certain that anyone who uses these titles (osteopath etc) is well qualified and subject to an ethical code of conduct.

Yet what of the unregulated complementary professions, of which osteopathy, chiropractic and acupuncture were until recently a part? What protection exists for the public against misbehaviour by a practitioner or therapist from one of the professions which has no statutory status, or which has not even established effective self-regulated procedures?

What happens to the patient who feels disgruntled over inadequate care, or downright incompetence? If this falls outside of actual criminal behaviour there remains only the intimidating option of civil proceedings, with all of the cost and uncertainty which such action presents. Even if there is criminal behaviour (sexual molestation for example), and a successful criminal prosecution follows, which leads to prison, there would be nothing to prevent anyone belonging to an unregulated profession from starting practice again as soon as they were free to do so.

So where does protection lie?

It is necessary to recall that osteopathy, chiropractic and acupuncture have achieved a status which addressed these concerns by following a tried-and-tested series of professional exercises. They have all formed national organisations – after years of rival professional bodies slugging it out for dominance. As far back as the mid-1930s, osteopaths attempted to obtain parliamentary legislation to get themselves out of the professional wilderness. This failed because (among other factors) there was no single body to speak for all osteopaths. It took a further half century for this to be dealt with to the satisfaction of Government. During those long, tortuous years, educational standards were firmly established (osteopathy is now a BSc(Hons) course) and self-regulated ethical standards firmly imposed. Competencies were established defining in great detail what an osteopath had to know, and be able to demonstrate, and how to behave, in order to practise as an osteopath. When all this was in place, and the profession unified under one umbrella organisation, Government was ready to listen and act. Thus, the public was protected.

It may take half a century for this to happen to those professions currently in the wilderness, but unless they start now (and many have), something else may well happen, as a result of the UK's flirtation with a greater Europe. They may find themselves declared illegal for 'practising medicine without a licence'. Imprisonment is the sanction for this in some parts of our newly integrated Europe, although somehow I don't believe this is the sort of professional integration that most of us want!

All complementary professions need to unify, focus on establishing their competency requirements, educate accordingly, and institute high ethical standards – or face the consequences.