Health alternatives under the gun

Is Ontario's College of Physicians and Surgeons persecuting alternative health practitioners?

By: Bruce Livesey

  Joanna Smith never heard the gunshot - but she did find her husband's body. It was Dec. 21, 1992, and a real estate agent had shown up at the Smiths' farm, west of Ottawa. So Joanna went looking for her 52-year-old husband, Dr. Michael Smith, and found him on the floor of his office, a .22-calibre rifle in his hand. He'd put the barrel in his mouth before pulling the trigger.
  Smith says her husband committed suicide because, two weeks previously, the College of Physicians and Surgeons of Ontario (CPSO) - the body that regulates Ontario's 26,000 doctors - had yanked his licence to practise medicine. Despondent over being unable to support his wife and children, Smith "figured he was worth more dead than alive," surmises Joanna.
 

The college has become a battleground in the tug-of-war between conventional and naturopathic medicines

  Today, Joanna places responsibility for her husband's death on the shoulders of the CPSO and the investigation it launched against him. She believes the college targeted Smith because he practised alternative medicine. Indeed, Smith had begun to use acupuncture and bioenergetics after becoming disillusioned with conventional medicine. "Michael did not come to the decision to use alternative medicine easily," she explains. "He was not a crackpot - he was quite a brilliant man."
  The tragic case of Dr. Smith is just one of many in which MDs who practise alternative medicine have been investigated by the CPSO, charged with professional misconduct and even had their licences pulled. And although the head of the college, Dr. John Bonn, denies that alternative therapies have been singled out for scrutiny, some practitioners maintain the college applies different standards of stringency to alternative medicine. "We are being persecuted," insists Dr. Edward Leyton, an MD with a holistic clinic in Kingston.
  It would be misleading to infer that the college harasses all the 300 to 400 MDs in Ontario who practise alternative medicine. In fact, it passed a resolution in 1997 giving doctors qualified approval to practise alternative medicine. But the college has become a battleground in the tug-of-war between conventional and naturopathic medicines. Doctors who practise the former - relying on pharmaceuticals and surgery - are pitted against a growing minority who use naturopathy, acupuncture, herbs, homeopathy, nutrition and bioenergetics. And critics say the CPSO is weighing in too heavily on the side of conventional medicine, punishing doctors who practise alternative therapy while turning a blind eye to mainstream MDs who inadvertently kill, maim or harm their patients.
  Indeed, many of the CPSO's investigations of alternative practitioners don't originate from patient complaints. Consequently, dissatisfaction with the college is high. A private members' bill introduced by Liberal MPP Monte Kwinter - which would ensure that physicians who practise alternative medicine won't be found guilty of professional misconduct simply because they use non-traditional therapies - could soon pass the Ontario Legislature. And last winter, the Ministry of Health asked the management consulting firm KPMG to investigate how the college disciplines its members.
  George Belza, a Toronto-based business consultant who examined the CPSO while working on his MBA thesis in the mid-'90s, says he discovered that the college was more interested in protecting the power of doctors than in regulating them. "Public protection is way down on its list of priorities," he adds. Belza says doctors who practise alternative medicine challenge mainstream medicine's image, so the CPSO will "pursue them almost to a ludicrous degree" - even without evidence of harm. "You can see a discrepancy [when they] prosecute doctors who don't harm anyone but challenge the power and prestige of the profession, and protect doctors who harm patients so long as the interests of the profession are served."
  Dr. Smith's use of acupuncture and bioenergetics first attracted the ire of the CPSO in 1988. After seizing 34 files from his office, they focused on six cases; five of those patients said the doctor had done nothing improper (the sixth could not be found), so he was exonerated. Then, in 1992, he was charged over allegations of sexual impropriety with two patients. But his wife says bioenergetics involves some minor physical contact between doctor and patient that could be misconstrued as sexual. Nevertheless, the CPSO pulled Smith's licence without a hearing. "They did not follow due process," insists Joanna.
  Michael Code, a Toronto criminal lawyer and former assistant deputy attorney-general, agrees. Hired by a group of alternative doctors, he examined the Smith case and found that the CPSO's own investigator concluded that the physician's therapies produced extraordinary results in difficult patients. "I have compared the statements of the complainants with the summaries by CPSO officials, and [the summaries] were consistently misleading," observes Code.
  The CPSO's mandate is to regulate the practice of medicine, investigate complaints and discipline physicians who are guilty of professional misconduct or incompetence. Cases go to complaints and discipline committees, which are presided over by MDs and laypeople.
  The college employs its own investigators, who can seize doctors' files, pretend to be patients and tape conversations with doctors. It launches investigations based on patient complaints or because it feels a doctor is doing something improper, and it can suspend a licence without a hearing.
  If the college is waging a campaign against alternative medicine, it's probably because it feels threatened by the growing number of people dissatisfied with mainstream medicine who are flocking to alternative MDs. Between 20 and 40 per cent of Canadians use alternative therapists, spending $1.4 billion a year.
  And there's reason for their dissatisfaction. According to a 1998 study conducted by University of Toronto neuroscientist Dr. Bruce Pomeranz and researcher Jason Lazarou, an estimated 106,000 Americans are killed, and another 2.2 million hospitalized, due to properly prescribed pharmaceuticals every year (see sidebar). "It's a horror that's covered up," observes Dr. Carolyn Dean, a Canadian MD and naturopath now living in the U.S. "Members of the college sit on the boards of pharmaceutical companies, so their bias is suspect."
  Alternative doctors claim the CPSO accepts the high cost of conventional medicine. Says Dr. Zoltan Rona, a Toronto MD and naturopath: "Their attitude is, 'Yes, there are side effects [to drugs], and some people die. Why bother investigating those doctors?'"
  Indeed, only 1 per cent of the 1,200 complaints received each year by the CPSO are referred to its discipline committee. From 1996 to '97, only two doctors had their licences revoked, and of 4,523 complaint investigations in 1997, only 19 were referred to discipline.

Hands off mainstream doctors?
  Yet a number of doctors practising conventional medicine have emerged relatively unscathed after serious mishaps have occurred. For example, Dr. Christine Bloch was hired to do obstetrics at Oakville-Trafalgar Memorial Hospital in 1992. During the 14 months she worked there, she was involved in incidents which resulted in at least three lawsuits and four formal complaints to the CPSO. In October 1993, Jackie Houghton, an Oakville resident, went into labour with Bloch as the attending obstetrician. During the delivery, the baby's skull was fractured, causing brain hemorrhaging. "[Bloch] basically ripped him out of me," says Houghton. "My husband was screaming at her to stop."
  The baby died 25 minutes after delivery. The hospital decided not to employ Bloch anymore - although its advisory committee decided against reporting her to the CPSO, leaving that up to her patients. At least three sued her (the Houghton case was settled out of court).
  It took the college four years to charge her with professional misconduct. In the meantime, Bloch - the only applicant - was hired as an obstetrician at the Syndenham District Hospital in Wallaceburg, Ont. One evening in 1996, she went home instead of delivering the baby of her patient, Martha McGregor. That task was handed over to a GP who wasn't qualified to do the difficult delivery. The infant's shoulders got stuck, and his brain was cut off from oxygen for a critical period. He died 13 days later. McGregor complained to the college. "If the college had done its job in the beginning, Dr. Bloch would not have been hired [at our hospital]," she says.
  The college declined to give eye details on its investigations, but it did undertake an assessment of Bloch's skills. She continues to practise medicine today.

Drugs and surgery only
  Contrast the Bloch case with the way the college pursues doctors who practise alternative medicine. Dr. Jozef Krop, a Mississauga-based MD who specializes in environmental medicine, came to Canada from Poland 28 years ago, after having been trained in conventional medicine. Eventually he saw that drugs and surgery didn't always work. "You can't run medicine only on drugs," he says. Krop realized that pesticides, pollution and poor nutrition affect people's health, and he changed his practice in 1980.
  Eleven years ago, Krop received the first of many letters from the CPSO saying it was concerned about his "highly unusual" treatments after receiving complaints from doctors and at least one patient. According to internal documents, the CPSO may have targeted Krop to send a message to alternative doctors. A September 1989 memo written by the college's current deputy head, John Carlisle, said, "This will be a costly and lengthy process, but may be the only way of finally dealing with these clinical ecologists."
  In 1991, the college seized 29 charts from Krop's office. However, in a July 1993 memo, a lawyer hired by the college wrote, "The desire of the college to send a message to unsafe alternative practitioners requires that prosecution be commenced only in clear cases. This is not such a case."
  Ignoring that, the college referred Krop to a disciplinary hearing in 1994, accusing him of professional misconduct and incompetence. None of the patients whose charts had been seized had complained - in fact, the patients in five of the six cases they focused on supported Krop's treatment. The sixth said she hadn't benefited, but wasn't harmed either.
  The disciplinary hearings went on for three years. Attention focused on Krop's methods for diagnosis, chemical detoxification, hair analysis and dietary change. In December 1998, the college found Krop guilty of professional misconduct, saying his diagnosis, treatment and record-keeping were substandard. But last summer, when his sentencing came up, they decided against suspending his licence. Krop is appealing.
  Krop says the 11-year ordeal has cost him $1 million in legal fees and $500,000 in lost income, and points out that the college's discipline committee and experts are not trained in environmental medicine. "They're not impartial," he says. "You cannot be the investigator, prosecutor, judge and executioner. It was unjust, unfair and abusive."
  That sentiment is echoed by one of Krop's patients, 53-year-old Lorelei Kominar, who says CPSO investigators never even interviewed her. Kominar says Krop successfully treated her daughter and herself for allergies. "He's brilliant," she says. "Everything he has recommended has helped."
 

In the US, 225,000 people die every from problems caused by health care. Are Canadians dying at the same rate?

Fear of opiods?
  Neuropsychiatrist Dr. Frank Adams trained at McMaster's medical school and moved to Texas, where he worked at the largest cancer hospital in the world. There he discovered that traditional methods of dealing with chronic pain were inadequate, and he became a leading expert on chronic pain management, especially in the use of opiods.
  Derived from the poppy, opiods can control pain in cancer patients or people who've suffered severe trauma. While they are controversial, many pain-management specialists embrace opiods as a humane and effective treatment.
  Five years ago, Adams returned to Canada and began prescribing opiods to patients suffering pain. Adams says the CPSO knew he prescribed opiods and still "gave me a goddamn licence. It's almost like entrapment - they give you a licence and then they screw you."
  In 1998, the CPSO's investigators raided his office and took the charts of 25 patients, though none had complained. The college alleged that in six cases Adams excessively prescribed opiods. Two months ago, the CPSO pulled his licence after finding him guilty of professional misconduct and incompetence.
  Now at least 200 of his patients are returning to their previous states. "I didn't commit harm," says Adams. "These bastards commit harm and get paid for it. If you do this to 200 people as a doctor, is this not a crime against humanity?"
  One patient affected by Adams' suspension is Bonnie Roos of Napanee, Ont. Six years ago she was in a major car accident, and she has experienced excruciating pain ever since. For years, she couldn't work, sleep or remember anything. "It's like being a walking zombie," she says.
  In 1997, Roos became one of Adams' patients and was put on opiods. Immediately the pain became tolerable. "I got a life back," she says. "I could function." Today, Roos is slipping back. "I am really scared," she says. "I couldn't handle going back to the way I was."

A fishing expedition
  Dr. Carolyn Dean's first run-in with the CPSO occurred after she appeared on TV's Dini Petty Show in 1989 and spoke about the dangers of the overuse of sugar. The Sugar Institute complained to the college, which sent Dean a letter of reprimand.
  In 1991, a week before she left for what was supposed to be a one-year sabbatical in New York, the college seized 36 of Dean's files, based on complaints from three patients. "They went on a fishing expedition," says Dean.
  In the end, Dean was forced to remain in the States. In 1993 she was notified in New York that a hearing into her case was imminent and that the CPSO would be in touch. But in 1995, the college suspended her licence after holding a hearing without her. The CPSO says it tried to contact her; Dean says it did not. "They took away my licence without me knowing of it," says Dean. "They just proceeded when they felt like it."
  Yet during the hearing only one patient testified, complaining that Dean diagnosed candidiasis without a proper examination and charged her extra for a blood test (which was legal). The one expert who testified admitted that Dean's patients had not been harmed.
  After Dean found out about the suspension, a lawyer told her that it would cost $250,000 to fight the case. "I am not going to spend a quarter of a million dollars," states Dean. "I was an easy target - they knew I wasn't going to fight back." Today Dean works as a writer and researcher in New York.

"The outcome is irrelevant"
  Dr. Sukhdev Singh Kooner studied medicine in India and Canada before moving to Windsor, where he set up practice as an allergist. Kooner uses a diagnostic and treatment method called intradermal provocative neutralization food and SET testing, which he says was developed more than 50 years ago and is used by half the allergists in the U.S.
  Unlike traditional puncture allergy tests - which give patients a set amount of substance - Kooner relies on diluted doses, reducing the chance of dangerous reactions. "It's very safe," he says.
  But in 1997, the college began investigating him. A hearing was held, during which Kooner heard one of the college's lawyers say, "The outcome of [Kooner's] treatment is irrelevant. You have to decide whether he acted in accordance with Ontario standards."
  Kooner is now waiting for the college's decision, although he's pessimistic. "It's already decided - this is a formality." Meanwhile, his patients have initiated a letter-writing campaign. One supporter is Dan Watts, a college professor who went to Kooner in 1988 when his seven-year-old daughter was sick. "We were desperate - she was hacking and coughing and not getting any sleep," he says. Kooner successfully treated her and the rest of the family.
  "The college doesn't really care whether or not Dr. Kooner has successfully treated patients - they care whether he fits the cookie-cutter approach to allergy treatment," says Watts. "What the college is saying is, 'We don't care if patients are well and staying well. We only care how you do it.'"
  The CPSO denies it's unfairly targeting alternative physicians (the college rebuffed our request for an interview with a senior member of the staff). Last year, in a medical journal, college head Dr. John Bonn said a 1997 committee set up to examine the issue found that "only eight of the previous 462 consecutive referrals to the Discipline Committee over many years involved physicians who practised complementary medicine." And their use of alternative therapy was not why they were targeted. "In short, there is no evidence that this group has been singled out," said Bonn.
  Still, few doctors practising alternative medicine in Ontario are likely to believe him.

Can the system make you sick?
  According to an article published in July by the prestigious Journal of the American Medical Association, the U.S. health-care system can sometimes actually contribute to people's poor health. Dr. Barbara Starfield, of the Johns Hopkins School of Hygiene and Public Health, estimates that every year in the US there are:
  12,000 deaths from unnecessary surgery; 7,000 deaths from medication errors in hospitals; 20,000 deaths from other hospital error; 80,000 deaths from infections in hospitals; and 106,000 deaths from properly prescribed pharmaceuticals.
  The total? An estimated 225,000 deaths caused by the health-care system annually - and this could be a low estimate. The real number could be as high as 284,000 deaths. Given the similarities between the types of treatments available in Canada and the States, some researchers claim this figure can be translated into at least 22,000 Canadian deaths caused by our vaunted health-care system.
  In fact, when U of T neuroscientist Bruce Pomeranz and researcher Jason Lazarou published their study on the impact of properly prescribed drugs (which found that they caused the deaths of 106,000 Americans annually), they pointed out that drugs actually kill more people than diabetes and pneumonia.
  Overall, modern medicine kills people at horrendous rates. Consider these statistics:
  Between 1976 and 1985, 52 per cent of all drugs introduced during that period had to be relabelled because of serious adverse reactions found after the drugs were marketed. The reactions included heart, liver and kidney failure, birth defects, respiratory arrest, seizures and blindness. Studies suggest that when doctors go on strike, death rates actually drop. Physician strikes in Israel in 1973, Colombia in 1976 and the U.K. in 1978 led to declines in death rates while doctors were picketing. Indeed, some studies have shown that health-care systems have minimal impact on people's longevity compared to sound nutrition and public sanitation.

This article was first published by eye Weekly in Toronto, December 14, 2000. eye.net/

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