Ethics in the Biosciences (Photo credit: AJC1)
By Sue Shekut, Owner, Working Well Massage, Licensed Massage Therapist, Wellness Coach, ACSM Personal Trainer
What do you think? Is it ethical for your medical doctor, your massage therapist, your psychotherapist or any of your health care providers to use treatments on you that have not been backed up by legitimate research? What if the non-evidence based treatment simply makes you feel cared for and that alone makes you feel better?
I came across two articles today regarding the ethics of health care providers using non-evidence based treatments on patients. Allan Besselink, PT, Dip.MDT, writes in his blog post, Is Non-Evidence-Based Clinical Practice An Ethical Dilemma? that health care providers have an ethical duty to use evidence-based treatments. Bessenlink defines evidence-based clinical practice as “the use of assessment strategies and treatment interventions that have scientific evidence to support their use.” His main point is that using treatments that have not been scientifically proven to provide benefit to patients may cause harm and have not been shown to repeatedly produce the beneficial healing results they are claimed to produce.
Another article, in London’s Daily Mail, Don’t claim acupuncture works, NHS hospital told: Institution criticied over leaflets that made bogus claims about the treatment, describes the current situation in Britain’s National Health Service (NHS). Hospitals in the NHS are now being told they cannot advertise unproven benefits of non-evidence based treatments to the public.
Evidence-based (EB) medicine has become the preferred lens through which health care is being evaluated, practiced and compensated by insurers and third-party payors over the course of the last 20 years. While evidence-based practice has political implications and, at times, has led to misconceptions as to its application, EB medicine is the current standard for medical care in the U.S and, in other developed countries.
What does this mean for consumers and practitioners of “alternative medicine?” First off, as a consumer, you may want to think twice before forking over cash to a treatment they does not have evidence to support its effectiveness. If your health care provider or massage therapist tells you that he or she has a technique that had no evidence behind it but will make you feel better, what is the harm? Maybe it will work. Maybe you have tried medical treatments and they didn’t seem to work. Or maybe you have a condition that will heal on its own over time. Or maybe you simply are tired, have a lot of stress in your life and just need to lay down for an hour while a caring person pays attention to you and attempts to soothe you in some way. If that is the case and you know that the treatment being proposed will likely not sure cancer or fix a medical condition, but the treatment feels good, what is the harm? At the same time, if you do have a legitimate medical condition and you opt to try a non-evidence-based treatment, this may mean that you are putting off a treatment that could work for you. You could be harming yourself by waiting so long that by the time you attempt a EB treatment, it could be too late. For consumers, when you pay out-of-pocket, you can pretty much do what you want healthcare wise though. People do and take the consequences as they come.
For health care providers like massage therapists that do not have a wealth of evidence-based practices at their fingertips (bad pun intended), there is a fine line between doing no harm and doing good. I am a firm believer that massage therapy “works,” but what does this mean and in what context? For me, this means massage therapy is an effective method to help people relax, feel comforted, be able to move more easily and to overall feel better physically and mentally. Massage therapy has evidence to support these results and I have received these results myself when I have had massage and with my own clients. However, it would be unethical for me to claim that massage cures cancer or that I can cure medical conditions using massage therapy. Until more clinical research is conducted and until results are verified scientifically, I believe it is unethical to provide my clients with treatments that are not scientifically based. It is unethical to make claims about my work that are not based on empirical evidence.
I am reminded of a story my second grade teacher told me years ago when we were studying Frontier days. She told the story of a woman who came into the general store and told the shopkeeper that she wanted to swap her milk pail for a fresh pail from his store. She revealed that a mouse had fallen into her pail of milk and she wanted to swap her pail with one that had not had a mouse fall into it. She said, “What people don’t know, won’t hurt them.” The shop keeper smiled and took her milk pail. He went into the back room and set her pail down so she could hear it set down. Then he picked her pail up again, brought it back to her and said, “You are right, what people don’t know won’t hurt them.” But is that true? Can we be hurt by what we don’t know or what we believe is true without evidence to support our belief? (We now know that having a mouse fall into one’s milk could lead to bacterial contamination and disease, but I doubt either the woman or the shop keeper in this story knew about germs carried by rodents back then.)
Over the next few years, the conflict over EB medicine and “alternative” health care will continue. Do you want to know if the treatment being applied by your massage therapist, doctor, or other health care provider is evidence-based? Do you think it is ethical for your health care provider to use treatments on you that are not evidence-based? Share your thoughts in the comments section!
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