Tuesday, October 05, 2004

Complementary and alternative medicine & state licensing boards.

Adam Liptak has an article in today's N.Y. Times in which a South Carolina physician prescribes intravenous injections of what his lawyer describes as "a very dilute form of hydrogen peroxide" for a Minnesota patient with MS. The result: over the next five days, she bleeds to death. Local authorities classify her death as a homicide and the physician is sued for her wrongful death. The state licensing board, meanwhile, says the physician continues to be in good standing.

The article highlights the delicate balance maintained by the most conscientious state medical boards:
"The balancing act," said Dr. Robert M. Wachter, a professor of medicine at the
University of California, San Francisco, and a co-author of a book about patient
safety, "is that when we have a dangerous doctor, we don't have a good mechanism
to throw him out of the system or at the very least inform patients about him
while not casting the net so wide that the innocent, compassionate, caring
physician who makes an error once in a while is tarred by the same brush."

It's an age-old regulatory conundrum: is the public interest protected by a system of close scrutiny (accompanied by lots of "false positives") or one that is less punitive toward physician errors (and gives us more "false negatives")? In theory, at least, the resulting question for state boards like South Carolina's is a difficult one, although the story doesn't mention a single medical authority that supports "bio-oxidative therapy" for MS, AIDS, cancer, or the other illnesses for which it is sometimes prescribed. (The claims are detailed on this web site, among many others. A debunker's response can be found here, and the American Cancer Society's warnings are here. Memorial Sloan-Kettering Cancer Center's generally negative review provides no support whatsoever for the South Carolina physician's faith in this treatment.)

Apart from the public-health angle of this story, there is another balance to be struck: between supporting innovative therapies that have not yet been proven and cutting off dangerous quackery. State boards have been criticized for occasionally being too close-minded about alternative therapies (including acupuncture) that have subsequently proved to be effective. IV hydrogen peroxide may not be an example, but the issue is potentially raised anytime an "alternative" approach that challenges conventional medical wisdom is cited as a reason to limit or revoke the license of a physician. This particular physician is claimed by some who are closer to the facts than I am to be a dangerous quack, but some alternative therapies aren't that easy to rule out.
posted by Tom Mayo, 11:16 PM

Health care law (including public health law, medical ethics, and life sciences), with digressions into constitutional law, poetry, and other things that matter