Alternative Medicine and the Ethics Of Commerce

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Posted 16 March 2016

Scott Gavura, a pharmacist, publishes to his own website, Science-based Pharmacy. His articles, always thought provoking, are cross-posted to Science-based Medicine.

In this article, titled “The questionable ethics of selling complementary and alternative medicine”, he points out that like other critics, “I looked at CAM from a scientific evidence perspective, the one I was taught in pharmacy school, using the same approach I’d take when assessing a new drug. Did the evidence support the claims made about these products, or not? The answers, as you might expect, were often the same. There was little or no credible evidence to demonstrate CAM had any meaningful benefits”.

He and Professor Chris MacDonald of Ryerson University have now focused on the ethics of selling CAMS, now published in the journal Bioethics, a peer-reviewed paper on the same topic: “Alternative Medicine and the Ethics of Commerce.”  The paper is currently open access, i.e., anyone can download and read it.

In the paper, they pose (and answer) three primary questions:

  1. What is the case for selling CAM? We consider the value of a diversity of choice and the benefits of a free marketplace.
  2. What are the general ethics of commercial transactions? We outline an ethical framework that can guide an evaluation of CAM.
  3. What does this ethical framework say about the commercial sale of CAM?
  • Is CAM merchantable – does it fail to function?
  • Does the sale of CAM involve deception?
  • Does the sale of CAM harm third parties?

Based on these questions, leads one to the final question:

Is selling CAM ethical?

Their answer?

“Even setting aside medical ethics, we argue that the sale of CAM is unethical. CAM can violate all three ethical principles of commercial transactions. In order for commercial transactions to be ethical, they must involve products that work. They must be advertised and promoted fairly and honestly. Finally, these transactions must not harm innocent third parties. Much of CAM fails on one or more of these measures.”

I strongly suggest readers look over their article – it is a very powerful argument. They agree that CAMS have a right to be sold, but only if they fulfil a number of aspects, e.g., the CAM is merchantable – i.e., there is proof that it functions (works)

Read the Science-based Pharmacy article.

Read the published Bioethics journal article. The paper is part of a series on complementary and alternative medicine.

The paper is open access (for now).

Abstract:

Is it ethical to market complementary and alternative medicines? Complementary and alternative medicines (CAM) are medical products and services outside the mainstream of medical practice. But they are not just medicines (or supposed medicines) offered and provided for the prevention and treatment of illness. They are also products and services – things offered for sale in the marketplace. Most discussion of the ethics of CAM has focused on bioethical issues – issues having to do with therapeutic value, and the relationship between patients and those purveyors of CAM. This article aims instead to consider CAM from the perspective of commercial ethics. That is, we consider the ethics not of prescribing or administering CAM (activities most closely associated with health professionals) but the ethics of selling CAM.

Macdonald, C. and Gavura, S. (2016), Alternative Medicine and the Ethics Of Commerce. Bioethics, 30: 77–84. doi: 10.1111/bioe.12226

The full paper is here.

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