Dr Oppel responds

Issue: BCMJ, vol. 54, No. 3, April 2012, Pages 122-123 Letters
By: Lloyd Oppel, MD, MHSc, FCFP(Em)

Dr Gunn points out that InspireHealth physicians are salaried and that the clinic is a nonprofit society. Our article does not dispute this. Characterizing the approach taken at In­spireHealth, Dr Gunn invokes the laudable concepts of patient-engagement, em­powerment, and a patient-centred approach. We are told that the inte­­grative cancer care program focuses on equally admirable areas such as healthful nutrition, stress reduction, and healthy lifestyle. 

However, such terms are only meaningful if the underlying modalities are truly effective. Dr Gunn is magnanimous in inviting readers to examine the InspireHealth website, but many readers may find the offerings there to be more commensurate with the definition and analysis of “integrative medicine” found on Wikipedia.[1]

The endorsement of InspireHealth by the privately funded Samueli Institute may not surprise those who note that the organization is headed by people trained in “mind/body methods, spiritual healing, electro-acupuncture diagnostics, homeopathy, and bio­energy therapy.”[2] 

Indeed, some readers may find it difficult to marry Dr Gunn’s assertion that InspireHealth does not recommend alternative therapies with the fact that the clinic’s In­te­grated Cancer Care Guide[3] is largely devoted to such offerings (many are in-house) and even lists their prices (for example, injections of 714X are listed at $300 per month).[4] 

Dr Gunn correctly points out that patients attending the clinic could well have been healthier to begin with than the average cancer patient—thus explaining the alleged survival advantage. Sicker patients tend not to participate. Therefore, virtually any voluntary program, regardless of merit, will likely look stellar simply because the most frail aren’t counted in the survival tally. 

It remains troubling that public messaging does not capture this essential caveat. One InspireHealth press release leads with the statement: “Cancer patients… will now have immediate access to cancer care that will enable them to do better, live longer, and have an improved quality-of-life.”[5] 

Some of the advice from InspireHealth is indisputable: avoid smoking and alcohol, get some exercise, eat a balanced diet. Doctors have long given such advice—for free. Should government funding support such messages? Absolutely. Should such programs also direct patients to intravenous hydrogen peroxide, hom­eo­pathic remedies, colonic cleansing, and therapeutic touch? 

Governments owe it to the public to direct resources to areas of proven benefit. Ineffective modalities should be excluded so that scarce funds can be used to generate real benefits.
—Lloyd Oppel, MD
Chair, Allied Health Practices Committee

References

1.    Wikipedia. Integrative medicine. Access­ed 4 January 2012. http://en.wikipedia.org/wiki/Integrative_medicine. 
2.    Samueli Institute. News and Information: Executive Team: Wayne B. Jonas, MD, President and CEO. Accessed 4 January 2011. www.samueliinstitute.org/news/news-home/aboutus/team/86-SIIB.html.
3.    InspireHealth. Integrated Cancer Care Guide. Accessed 4 January 2012. www.inspirehealth.ca/files/Integrated_Cancer_Care_Guide.pdf.
4.    InspireHealth. Integrated Cancer Care Guide, page 66. Accessed 4 January 2012. www.inspirehealth.ca/files/Integrated_Cancer_Care_Guide.pdf.
5.    InspireHealth. Press release: Integrative cancer care comes to Victoria. 13 October 2011. Accessed 4 January 2012. www.inspirehealth.ca/files/Victoria%20Press%20Release%202011%2010%2012%2....

Lloyd Oppel, MD, MHSc, FCFP(Em). Dr Oppel responds. BCMJ, Vol. 54, No. 3, April, 2012, Page(s) 122-123 - Letters.


Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply