Alternative treatments are insufficiently supported by science and evidence: court
The Ontario Superior Court of Justice has ruled against a physician who prescribed alternative treatment and medicine which were insufficiently supported by science and evidence.
Dr. Akbar Khan is a conventionally trained family physician who worked in palliative care until 2007. He eventually expanded his practice by combining complementary and alternative medicine and therapies (CAM) with conventional medical care. He started prescribing dichloroacetate (DCA), a drug typically used to treat child metabolic disorders, to his adult patients as a treatment for cancer and to a pediatric patient for treating brain cancer or medulloblastoma.
As he further extended his practice, Dr. Khan began offering his cancer patients low-dose naltrexone (LDN) that physicians commonly use in addiction care. He also adopted a cancer treatment called "SAFE chemotherapy" to treat his patients after he met Kenneth Matsumura, who developed the treatment.
The Complementary/Alternative Medicine (CAM) policy of Ontario's College of Physicians and Surgeons governs the use of treatments not part of generally accepted "conventional" therapies. The policy emphasizes that physicians must comply with all their legal, professional, and ethical obligations.
The Ontario Physicians and Surgeons Discipline Tribunal found that Dr. Khan had engaged in conduct that could be regarded as disgraceful, dishonourable, and unprofessional. The tribunal also found that he failed to maintain the standard of practice of the profession and displayed a lack of knowledge, skill, and judgment of nature to the extent that demonstrated that he was unfit to continue his medical practice.
Use of complementary/alternative medicine (CAM)
Dr. Khan appealed the tribunal's decision to the Ontario Superior Court of Justice, which noted that the fact that CAM treatments may fall outside of conventional medicine does not relieve doctors who prescribe these therapies from looking for, relying on, and ensuring that they are based on valid, reliable, and tested science.
The court further said that using DCA, LDN, and SAFE chemotherapy as treatments for cancer is not accepted as conventional medicine. Their use in Ontario requires adherence to the CAM policy. The tribunal found evidence and science were insufficient to support the use of DCA to treat pediatric patients with medulloblastoma. Accordingly, the tribunal concluded that Dr. Khan failed to maintain the standard practice of the profession when he used DCA to treat a pediatric patient.
Furthermore, the Ontario Court noted that there was plenty of evidence upon which the tribunal could find that Dr. Khan's use of LDN as a primary treatment for cancer did not meet the requirement in the CAM policy that a recommended therapeutic option be informed by evidence science.
Finally, the tribunal found it "shocking that Dr. Khan began treating patients with SAFE chemotherapy based on what appeared to be nothing more than Dr. Matsumura's word." The court noted that while Dr. Matsumura said he had been working on the SAFE chemotherapy since 1992, none of his findings have been published, nor was there any information available on any patients he has treated since the first four in 1992.
Breach of the standard of practice
Dr. Khan primarily argued that the tribunal found he had breached the standard of practice of the profession when none had been enunciated. He also claimed that the tribunal improperly relied on the CAM policy as establishing a legal standard, even if it did not.
The court noted that the authority to regulate professional misconduct is permissive. The court further said that the CAM policy assists in understanding the concerns raised by Dr. Khan's actions. While a policy may not prescribe the law, it could help to assess physicians' actions. Accordingly, the court concluded that the tribunal did not commit an error in law when it relied on the CAM policy.
The court agreed with the tribunal's finding that Dr. Khan's treatment of his patients breached any responsible understanding of his professional obligations to them. The court noted that he prescribed a drug with no quantitative benefit and was not informed by evidence or science. The court also found that he failed to obtain proper and informed consent. The court pointed out that despite a conventional bone marrow biopsy showing no signs of leukemia or cancer, Dr. Khan refused to accept the results and did not explain the situation to the patient clearly and rationally. He confused the patient by suggesting other possible diagnoses, including lower-grade cancer, and prescribed a drug with unproven benefits.
The court also agreed with the tribunals' finding that Dr. Khan did not provide his patients with the information necessary to make decisions and give informed consent for their treatment with SAFE chemotherapy, DCA, and LDN.
The court ultimately ruled that the tribunal did not commit any palpable and overriding error in its decision. The court concluded that Dr. Khan failed to maintain the standard of practice of the medical profession, and his actions demonstrated that he was incompetent.
