Friday, January 29, 2016

MacDonald & Gavura in Bioethics 2016: CAM is a Violation of the Ethics of Commerce

here, some excerpts from and my comments regarding a recent excellent article that explains why CAMs like naturopathy can't even meet the lower bar of 'commercial ethics', never mind the higher bar of 'professional medical ethics':

001. MacDonald, C. ( ) and Gavura, S. ( ) write in "Alternative Medicine and the Ethics of Commerce" [ISSN 0269-9702 (print); 1467-8519 (online) doi:10.111 I/bioe. 12226
Volume 30 Number 22016 pp 77-84]:

"complementary and alternative medicines [...] are also products and services - things offered for sale in the marketplace [...] is it ethical to market complementary and alternative medicines? [...]";

the central question.

"[let's] consider CAM from the perspective of commercial ethics [...] the ethics of selling CAM [...] to examine whether it is ethical, generally, to produce and sell CAM [...this will be done] through the lenses of three specific ethical questions [...] does selling CAM violate the standards of merchantability [...aka] does selling CAM involve selling something that fails to function as it should? [...] does selling CAM involve deception? [...] does selling CAM do harm to third parties? [...]";

and that is often a very LOW bar!  Can CAM pass over it?  If not, we'll have to invoke that so-easy low-hanging fruit label, sCAM!  I'll extend the three questions answers in 002. specifically onto naturopathy.

 "[and the authors write] as part of this exploration, we touch upon the evidence for the (non-) effectiveness of representative complementary and alternative therapies. In doing so, we examine not just the evidence as we see it, but also the extent to which expert consensus renders it unjustifiable - epistemically and ethically - for anyone to take a substantially different view on the evidence [...]";


I'm loving it.  Oh how naked the CAM Emperors are. Getting into the study of knowledge-kind, epistemology!  By the way, that 'e' word may seem very esoteric even to scientists, but I do have to remind: the American Next Generation Science Standards state "from an epistemological perspective, the NGSS reinterpret a traditional view of epistemology and history of science. For example, Science for All Americans stated: 'the recommendations in this chapter focus on the development of science, mathematics, and technology in Western culture, but not on how that development drew from earlier Egyptian, Chinese, Greek, and Arabic cultures. The sciences accounted for in this book are largely part of a tradition of thought that happened to develop in Europe during the last 500 years – a tradition to which most people from all cultures contribute today [...] 'at that time, although the goal of “Science for all Americans” was visionary, the definition of science in terms of Western science while ignoring historical contributions from other cultures presented a limited or distorted view of science. The NGSS, by emphasizing engineering, recognize contributions of other cultures historically. This (re)defines the epistemology of science or what counts as science, which, in turn, defines or determines school science curriculum."  So the 'e' word is a basic science-literacy requirement, as US science standards are evolving aka there's more to science literacy than memorizing the facts that science spits out of its process.

"[the authors speak of] difficulty in classifying specific treatment modalities as being inside or outside of the category CAM presents challenges to anyone attempting to evaluate CAM, as a category, from an ethical point of view [...]";

and I'll further add, there is quite fuzzy-wuzzy thinking habits on the part of CAM purveyors.  Naturopathy, for instance, state it fundamentally "blends".


"[in favor of CAM are arguments] grounded in autonomy and [...] competition [...]";


you see this often in CAM proponents' language such as 'health freedom' and AMA monopoly.  Check out ND Glidden's YouTube performances, for instance.


"[regarding] the ethics of commerce generally [...] our approach therefore will be to appeal to a simple set of norms implied by the very act of participating in the market economy, and arguably assumed and tacitly endorsed by everyone who participates in it. In this section, we will explain that framework [...]";

excellent.  This article my well be useful for my teaching of Medical Law and Ethics.

 "[there's a] general ethical presumption in favor of market transactions [...] the ethical legitimacy of market transactions is conditional in nature, because it assumes - inter alia - that the participants are well-informed and that truly beneficial outcomes (as measured by the participants themselves) have some chance of occurring. Market exchanges, in other words, are generally good but not always good [...]";

as in buyer beware and specific protection / regulation for certain contexts, like cars.

"among the principles deduced by Hasnas are [...#1] refrain from physical coercion
[...#2]  refrain from fraud and improper deceptive practices [...#3] honor all the terms of one's contracts [...#4 treat all parties with equal respect for their autonomy [...#5] personal ethical responsibility is inalienable[...]";

an interesting shopping list [excuse the pun].

 "avoiding deception, on the grounds that it fails to respect autonomy [...and] equal respect for autonomy [...] bear most directly on the question of selling CAM [...] we will focus on Principle 2 [...which] enjoins participants in commerce to refrain from fraud and improper deceptive practices [...] writes Hasnas, '...fraudulent and deceptive practices are intentional acts designed to override the autonomy of a trading partner. Hence, like coercion, they undermine voluntary exchange, and are inconsistent with market activity' [...] in entering the marketplace, any person of good will must be committed to avoiding deception. One enters the market to trade what one has (whether money or a product or service) for what one does not have, but wants. When a trading partner agrees to trade, he or she does so based on the understanding that the product or service on offer will satisfy a need or desire. Absent such an understanding, the agreement to trade would be senseless. Thus respect for the autonomy of one's trading partners implies a need to avoid engaging in deception. Particular market exchanges that promote rather than violate autonomy must be grounded in true, rather than false, beliefs [...]"; 

hear, hear.

"[and] Heath's view implies is that, as willing participants in a collective practice known as the market economy, merchants have an obligation not to do things that undermine the moral underpinnings of the market itself [...] 'there are a number of sui generis constraints ... that are specific to the context of a competitive market economy. Indeed, their primary function is to specify the permissible means by which this competition can be pursued'";

and I enjoy the exposure of this fact: markets are human-creations much like a sport activity and its rules.  They are not capitalism red-in-tooth-and-claw, that free-hand of the market is a HUMAN hand, the rules and lack of rules are human creations / choices.
 
"[in sum] participants in commerce should endeavor to: (1) offer a product that works - a product that is, in the language of commercial law, 'merchantable'; (2) only sell products to people who understand their fundamental characteristics, and who are reasonably capable of understanding (either on their own or with suitable professional help) whether that product will meet their needs. This implies a general demand for honesty on the part of sellers, and a refusal to profit from the ignorance of consumers; (3) take reasonable steps to ensure that third parties (those who do not consent to participate in a particular market exchange) are not harmed [...]";

very interesting.

"[and my favorite quote] while the credulous seller of (for example) homeopathy may not be guilty of knowingly selling something that does not work, he or she is guilty of having culpably low epistemic standards. Such a person does not sell knowingly, but he or she does arguably sell recklessly [...]";

superb. 

002. naturopathy and commercial ethics:


002.a. now, the root or stem "naturop" is in the article 5 times:

it is one of the key words,

there's "a specialized purveyor of CAM, for example a homeopath or a naturopath",

and "a complex homeopathic regime offered by an 'expert' naturopath, perhaps",

and "if a naturopath sells, and advises a patient to take, a particular homeopathic remedy - perhaps nux vomica to treat nausea - no third party is likely to be harmed, regardless of whether the supposed remedy does anything at all to alleviate the patient's symptoms. The success or failure of this remedy is strictly a matter between buyer and seller",

and "[but] there can thus be a very significant hazard to third parties when, for example, a homeopath or naturopath recommends and sells a homeopathic 'vaccine' to a patient."

002.b. but I'm thinking mostly of the summary characteristics and naturopathy.  I'll repeat them from above:

"[in sum] participants in commerce should endeavor to: (1) offer a product that works - a product that is, in the language of commercial law, 'merchantable'; (2) only sell products to people who understand their fundamental characteristics, and who are reasonably capable of understanding (either on their own or with suitable professional help) whether that product will meet their needs. This implies a general demand for honesty on the part of sellers, and a refusal to profit from the ignorance of consumers; (3) take reasonable steps to ensure that third parties (those who do not consent to participate in a particular market exchange) are not harmed [...]";

now, let me associate.

 002.b1. regarding "offer a product that works":

I'm immediately reminded of the whole American naturopathy edifice and how it claims homeopathy is a "medicinal science" when it isn't.  And how it suckered me with the term: "the modern science-based primary care doctor."  Quite not working.

002.b2. "people who understand":

I'm immediately reminded of how the University of Bridgeport claims that naturopathy is a "health science" with such bogus things within that science and homeopathy and acupuncture.

002.b3. harm to "third parties":

I'm immediately reminded of a) licensing NDs who have no rigorous epistemic standards and the harm that does to society all over the place, to the FABRIC of professionalism and education and b) the harm to taxpayers who FUND the educational loan system that this falsehood is feeding off of.  Taxpayers and States and the Federal Government are accomplices to this naturopathy fraud.

and, by the way, the paper's conclusion is that generally CAM is sCAM.
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