ABSTRACT

Evidence is presented leading to the suspicion that the British Columbia Medical Association (BCMA) and College of Physicians and Surgeons of British Columbia (COPSBC) are executing a carefully-crafted 16-year long plan to eliminate funding for complementary and alternative medicine (CAM) services within medicare in this province by the year 2000.

Known as "Project 2000" at its conception in 1984, and manifesting today as the BCMA's Alternative Therapies and Allied Health Committee, this initiative influences physicians, government, media, the public with a single mindset: CAM is "unnecessary", "wastes medicare money", is scientifically "unproven", and " should not be funded by medicare". The BCMA argues only conventional medicine is "proven"; presumably, only medicine should be funded by medicare.

The facts do not support the assertion that conventional medicine is generally "evidence-based". On the contrary, mainstream medical journals report, decade after decade, that medicine is only about 15% proven safe and effective by double-blind trial. Recent popular and medical reportage indicates millions of medically-caused drug overdoses and deaths every year. While double-blind evidence-based research is also generally lacking in CAM, there is worldwide research using other experimental models, as well as thousands of years of tradition, and everyday clinical experience in the various CAM disciplines, which suggest that CAM does not present the level of hazard which drugs and surgery have repeatedly proven themselves to pose. CAM manual therapies do not lend themselves, by their very nature, to double-blind, placebo-controlled trials. It is unfair for the BCMA to expect CAM to use experimental designs which cannot be applied, or to engage in research which only conventional medicine, with its phramaceutical endowments, can afford. The low level of risk evident in CAM therapies does not justify the use of the same stringent criteria which should be applied to dangerous drugs and surgery.

The BCMA's insistence that CAM pass the same criteria used for drugs and surgical interventions leads to the suspicion that what the BCMA wants is to eliminate its competition within medicare. It seems clear the BCMA and COPSBC have a double standard: they demand of CAM what medicine, itself, has failed to attain in terms of scientifically proving its own safety and efficacy.

Public support for CAM has never been higher: 84% of the population of BC visits CAM, driven by growing dissatisfaction with conventional medical care. The BCMA and COPSBC try to discredit CAM, saying that it is not "proven" safe and effective on scientific grounds. While some physicians may be influenced to change their referral habits, the public chooses its therapy on the basis of what, in their personal experience, "works", not on whether the BCMA or a scientific study shows that their chosen therapy is valid. There is a conflict between organized medicine's "scientific" approach and the public's "pragmatic" one. The government, having to listen to both voices, would be committing political suicide if it cut CAM from medicare.

Health-care is increasingly consumer-driven rather than medically-managed. The medical monopoly within medicare is losing ground. Ten courses of action are suggested which consumers may take towards creating a health-care system more responsive to their needs.

1. INTRODUCTION: Intent to document the existence and activities of Project 2000 from 1984 to 2000: the elimination of CAM from medicare (MSP) in the year 2000.

2. BACKGROUND: What are MSP, supplementary benefits? Changing the public’s perception of these services from being “medical” and “medically necessary” to “non-medical” and “non-medically necessary”; how this could point to removal of such services from Medical Services Plan.

3. COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM): Defining CAM; the intentional manipulation of public perception of CAM by "de-medicalizing" the term; if CAM is "not medical", should it be on Medical Services Plan?

4. CONVENTIONAL MEDICINE: BCMA and COPSBC re-define CAM as "unproven therapies" and conventional medicine as "proven medicines": what is not proven should not be funded on MSP.

5. PROJECT 2000: Evidence of BCMA's intent to "decrease the influence and power of those individuals and groups, less qualified than physicians, who are making health-care decisions"; strategy to influence government, media, physicians, public with the message that CAM is "unnecessary ", while "restoring the strength of the profession (of medicine)".

6. ALTERNATIVE THERAPIES AND ALLIED HEALTH COMMITTEE: "Spirit " of Project 2000 in present day: "therapies found to be non-efficacious, dangerous, exploitive or otherwise clinically or ethically unacceptable to the profession (of medicine), will be recommended to be exposed as such, and dealt with as judged appropriate by the board of the BCMA"; BCMA influencing physician opinion with "quack-buster" seminars; BCMA discouraging ICBC funding; BCMA calling for removal of CAM from MSP in media; fallacious economic argument; BCMA expanding scope stops Chiropractic and other CAM schools within BC universities and BCIT; BCMA resolution to control health products; BCMA resolution to control federal and provincial funding to health professions.

7. COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA: Warns physicians not to refer to CAM; "patient's preference cannot be sufficient grounds to select a given treatment"; and physicians reminded they may terminate patient-physician relationship if patient persists in asking for CAM referral when physician cannot ethically comply.

8. FREEDOM OF CHOICE IN HEALTH CARE: Disenchantment with conventional medicine drives public to CAM , say surveys; BCMA and COPSBC want patients to believe "doctor still knows best"; should the public be free to choose any form of treatment, or should it make an "informed decision" based on input from physicians?; surveys conflict as to whether more than half the public wants medical opinion to determine whether CAM should be covered on medicare.

9. EVIDENCE-BASED MEDICINE?: Conventional medicine claims to be "evidence-based", "proven" safe and effective, yet decades of mainstream medical research belies this claim, showing that only about 15% of medical interventions really are proven to do more good than harm; BCMA demands a double standard, wherein CAM must prove itself by the same experimental methods supposedly used to test drugs and surgery, while conventional medicine has itself failed to live up to this standard more than about 15% of the time. This double standard suggests BCMA's intent is to eliminate the competition, not protect the public.

10. IS CONVENTIONAL MEDICINE SAFE AND EFFECTIVE?: Doctors' deadly mistakes catch up with them in the literature.

11. LEVELING THE PLAYING FIELD: Using experimental designs that can actually be applied to CAM therapies would be fair; eliminating intentional anti-CAM bias (prejudice) at medical seminars, so that doctors can adequately evaluate CAM and truthfully educate their patients, would be fair and would protect the public; inviting CAM professionals to talk at CAM-slam seminars might counter anti-CAM bias and be a fairer appraisal of the field; inviting the public to these seminars, because they have a stake in what is being promulgated, would be fair; most significant, it would be fair for BCMA and COPSBC to admit, in the media and on their websites, the truth about “doctors' deadly mistakes”--so that the public can make an "informed decision" about whether to choose conventional or CAM treatment.

12. CAM POPULARITY: 84% of BC population attends some form of CAM; the public represents a powerful force influencing the course of health care, in opposition to the direction in which the medical monopoly wants it to go; a revolution, consumer-driven, is taking place, in which the old health-care system and medical establishment must evolve or face possible extinction..

13. WHAT YOU CAN DO: Ten strategies for consumer-based action; taking responsibility for our future by learning from our past. (An update on new legislation introduced in British Columbia during summer 2000 which, if approved, would limit the power of the College of Physicians and Surgeons of BC.)

14. WEBSITE ADDRESSES

15. ABOUT THE AUTHOR and HOW TO REACH HIM

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