Medicine is ever evolving.  This is generally a good thing for doctors, patients and the community but it creates challenges around what is “appropriate evolution”, including the evidence for it.

It can be difficult for legal and regulatory frameworks to keep up.   The oft repeated quote “The law marches with medicine but in the rear and limping a little”¹ remains apt.

The Medical Board of Australia recently completed public consultation on new draft guidelines for complementary, unconventional and emerging medicine. ²

These proposals arise from concerns about certain complementary and alternative medicine practices by doctors and a number of other issues, ranging from off-label prescribing, innovative and emerging treatments, through to unconventional and experimental medicine.³

The draft guidelines will apply both to doctors who practise in complementary, unconventional and emerging medicine, and those who do not but whose patients use such treatments.

The draft guidelines attracted some controversy.⁴

MIGA provided a detailed submission to the Board’s consultation.   We support clear guidance for doctors practising in complementary, unconventional and emerging medicine. We are however concerned about the potential for confusion and uncertainty the draft guidelines pose, and their sheer breadth covering a wide range of different, diverse practices, both conventional and unconventional.

For all doctors, the Board proposes a range of obligations around inquiring about the patient’s complementary, unconventional and emerging medicine use, considering this as part of ongoing care, and advising the patient of the limited evidence for some treatments and to be aware of possible financial implications.

For doctors practising in complementary, unconventional and emerging medicine, a range of additional obligations are proposed around expertise, conflicts of interest, advertising, informed consent, assessment, treatment and ongoing care.  A key theme is to ensure the patient understands the level of evidence for recommended treatments and how they compare with other, conventional treatment options.

MIGA believes the focus should be on developing guidelines for complementary and unconventional medicine first.  ‘Emerging’ medicine within a conventional medicine context, such as off-label prescribing and developing practices, should require separate, tailored guidelines.

We now await the Board’s response.

1 Mount Isa Mines v Pusey (1970) 125 CLR 383 per Windeyer J at 395
2 The draft guidelines are available at www.medicalboard.gov.au/News/Past-Consultations/Consultations-February-2019.aspx 
3 The Board raised particular concerns about alternative cancer treatments, stem cell therapies and anti-ageing treatments
4 For a summary of the controversies and various professional perspectives, see F Nelson “Are we being too hard on integrative doctors?” Medical Republic 10 July 2019, available at medicalrepublic.com.au/hard-integrative-doctors/21649 

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