The Anatomy of Deception: a deconstruction

Hi folks,

I recently came across this advertisement from a naturopath and found it to be an excellent example of the use of  a variety of advertising techniques based upon targeting what psychologists have identified as people’s susceptibility to persuasion.

To be fair and not target one specific individual I have anonymised it, and to
be honest it could be an advertisment for any new age alternative therapist, but as it contains so many examples of these techniques in a single advertisement I thought it worthy of exploration here.

So lets take a look in detail and simply deconstruct this advertisement:

  1. Prominent use of the words “natural” and “science.” This is designed to establish a link between the belief-based practices advertised as scientific, and natural. This exploits peoples assumptions that natural products are good and somehow associated with health, morality and being trusted (naturalistic fallacy). Also, this represents an attempt to establish a notion of postmodern pluralism in that the practitioner is open-minded, trustworthy and accepts both scientific and alternative worldly explanations as valued non-binary viewpoints. Additionally, this also cleverly implies that scientific medicine is somehow focused on non-natural and single-minded practices.
  2. Identification of qualification from a reputable university. Identifying that the practitioner completed a degree in a subject from a good university establishes an appeal to authority, with a genuine academic credential, but followed by:
  3. Conflation of a quackademic qualification from a non-university accredited private college with an authentic academic qualification (see #2). Again, exhibiting an appeal to authority in that the secondary qualification is presented as more advanced than the earlier one. In this case, the award is through a Canadian College but actually accreditation is through a US-based private self-interest group. A bit like an Academy of Wizards conferring a Wizardry qualification after several years of study. Sounds impressive, but in reality is not an independently validated  academic qualification.
  4. Prominent use of the word “interdisciplinary” or “multidisciplinary.”This establishes two things. Firstly, that the practitioner is a team player, and that they work with other health professionals. This seeks to impress professional authentication, but carefully avoids stating which disciplines the practitioner is associated with. In this case new-age disciplines involved here are Therapeutic Touch, Nutrition (n.b. nutritionists not dieticians) and Bowen therapy. I had to look that last one up – but it’s another manipulative therapy supposed to have more generalized health effects (sheesh, Peter Parker, where do all these guys come from)!
  5. A list of generalised and vague health issues cited as key areas of impact. This is a key feature of alternative health practitioners advertising. Being careful to avoid stated efficacy over any specific medical condition is important not to fall foul of advertising and competitive business standards/laws. However, by stating a wide range of (usually) complex chronic conditions that are not well controlled with contemporary medical treatments they have staked a territory where they can make money selling unproven and non-science based therapies. Basically, this is stating they have a cure for non-wellness.
  6. Out of house lab testing implies they use modern scientific practices. Again an appeal to science by faith-based practitioners. In reality many official lab testing services will not accept tests ordered by naturopaths, so many resort to in house testing in which they have very little expertise. Often, they will emphasise this by standing in front of a microscope or other diagnostic equipment in promotional material (also see #13).
  7. Use of a  list of alternative therapeutic practices presenting them all as equally valid therapeutic options.There is often conflation of scientific therapeutics with magical ones, and E.g. vitamins (science based nutrition) and homeopathy (faith based magic). These are usually a list of therapies that are not available from scientific medical practitioners or health services as they are not evidence-based, and have no demonstrable efficacy. Hence, their practice by alternative purveyors. Where scientific evidence is used (e.g. the importance of good nutrition and vitamins) it is usually accentuated with a completely unevidenced implementation; e.g. IV megadose vitamins, or the notion of homeopathic vaccination (actually a contradiction in terms).
  8. A recognition of status by a claim to provide education, at vaguely described educational institutions. Again, an appeal to authority.
  9. Another appeal to authority and status through the use of accolades and awards. Usually these awards will be from the practitioner’s own discipline, and therefore once again of questionable value. If you receive an award for promoting magic, does it make the magic real?  For the public these convey the air of respectability and status.
  10. Prominent use of the word “collaboration” implying as in #4 that the practitioner is a team player, and that they work with other health professionals. Also, this serves to imply that science-based medical health professionals are somehow not collaborative.
  11. Conflating alternative professional awards with another from a respected institution. In this case the award is implied by the use of the term “recognized.” This represents another appeal to authority in the practitioners presentation of their recognized status as a health professional.
  12. Collaboration emphasised once again, but this time in terms of “medical collaboration” firmly linking the notion that this practitioner works alongside physicians on an equal footing. I.e that the practitioner is a medical practitioner. Also, promoting social inclusivity.
  13. Prominent use of a stethoscope in the promotional picture. This is a frequently used method to establish scientific authenticity. Expertise in the use of this diagnostic tool is widespread (our nurses are taught how to auscultate in their first term). Nevertheless, it has a powerful symbolic significance, and once again is used here to imply technical expertise.

Overall the advertisement is very cleverly designed to imply that the practitioner is a science-based professional with authentic qualifications and experience comparable to a qualified physician or nurse. They are not, but this sort of thing has even managed to convince some academic institutions to include non-science based therapeutics in integrative medicine programs (sadly on the increase). If these folks simply advertised themselves as magical or faith-based practitioners I would have no problem, but implying they are science-based is simply disingenuous, and deceptive (either that or they have no real understanding of what science is).

In reality, this is a modern version of the snake oil salesman, and the this is a new-age practitioner selling unproven and magical therapies as a business. They may or may not believe in them themselves and that is for the reader to judge, but if you want an insider’s view on the education and practice of naturopaths take a look at Britt Marie Hermes blog on the subject. So, now you know what to look for!

Cheers

Bernie

 

 

 

 

A Tale of Two Cultures: Why integrative medicine is fatally flawed.

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, as Dickens wrote. I thought of those lines when I recently found myself a guest speaker at an Integrative Medicine Conference in Shanghai China.

How on earth did a skeptic like me end up there you may well ask? Well, it’s a long story, but in a nutshell I got an email invite as a guest speaker through a Chinese colleague in IT who asked me at short notice if I was interested in speaking a forthcoming medical conference in Shanghai, all expenses paid. The idea was to present some of our exploratory work on virtual reality (VR) as an adjunctive distraction therapy in pain management. I thought why not, as I happened to be free, it was only for a few days and I had never visited China before. So, a week before I was set to go I finally got sent the official conference literature in Chinese. Using Google Translate I discovered the conference was actually titled the “2016 Design and Implementation of Clinical Trials in Integrative Medicine Conference.” I was somewhat surprised at this to say the least, and wondered if these folks had ever looked at my professional profile or read anything I have written (including this blog)? I could have pulled out at this stage, but thought they had graciously invited me, paid for my flights etc, and I could discuss research techniques to support evidence-based healthcare, and talk about rapid evidence assessments in the context of our work in my presentation. Also, I must admit I was somewhat curious as to what this sort of conference would look like, and am far too past-it in my career these days to worry about negative career impact from attending academically dodgy conferences. So, despite my misgivings, I decided to go for it, and vowed to do my best to give it a fair shake, so to speak.

My hosts were very hospitable, and a day after I arrived I found myself sitting in the front row of the Lecture Room in Shuhang Hospital, Shanghai University of Traditional Chinese Medicine (TCM) ready to deliver my talk. I got a tour of some of the hospital beforehand. I asked several nurses, physicians and other staff how they used TCM here? I was surprised to find they all looked a little uncomfortable discussing it, and several noted that actually all of the hospitals offer science-based medicine with the usual pharmaceutical and surgical treatments found in the west as the primary health care interventions.TCM was used as complementary therapeutics. A few also openly admitted that TCM (which is based on an eclectic collection of a lot of vastly different philosophies and therapeutics, from demonology to acupuncture) was not highly regarded here and was seen as more of a politically sensitive response to health problems by most health professionals.

To those unfamiliar with TCM, although aspects of it have been around for at least 2,000 years or so, it was actually devised by Chairman Mao (see David Gorski’s entertaining summary here), and continues to be promoted by the government. So any critique of it within China is, to say the least, a rather sensitive issue. That is not to say it may have its benefits, as in many rural areas there is no medical care apart from TCM practitioners, so it probably is better than nothing. And, that’s the point really. Whilst much of TCM  appears to have no clinical efficacy, and some is definitely harmful, some of the remedies do actually work, but generally no where near as well as other modern scientifically validated therapies.

The problem I have always had with integrative medicine is that if you throw magical and empirical therapies together with some misplaced notion of “inclusivity,” you end up with  a melange of vacuous nonsense. The scientific medicine that actually works is devalued by being placed on the same platform as magic, whilst the magical treatments supported by pseudoscience and bad science are elevated to academic respectability (but still don’t actually work). Unfortunately, my experience in Shanghai did nothing to divest me of this view.

Before my presentation there was a rather excellent one on the use of electroacupuncture for vagal nerve stimulation by Dr. Luis Ulloa, and its potential to improve outcomes in the treatment of sepsis by reducing the inflammatory response. It was a highly creditable and very well delivered conference presentation of sound scientific work. I was very impressed with the creativity, scholarship and level of work involved; overall typical good science at work. However, to be clear this work’s relationship to TCM and acupuncture was purely in name only. It actually involved the electrical stimulation of the vagus nerve in animal studies through a needle inserted in an identified acupuncture point that corresponded physiologically with the location of the vagus nerve. It used established scientific knowledge of anatomy and neurophysiology, and at no point ever used any reference to meridians to manipulate the flow of life energy (qi) or any other TCM explanations of acupuncture. At this point my hopes were raised. Was this what the future of integrative medicine was to be, replacing mythology and faith-based explanations with sound empirical work? Maybe my misgivings had been premature.

But alas it was not to be, and things went downhill very rapidly from then on. The other presentations stretched credibility beyond belief, and demonstrated surgical ethics that were highly suspect at best. Firstly, the Director spoke proudly of how an open heart surgery operation in 1975 had been performed using acupuncture for anaesthesia, and then a speaker who was one of the  original anesthesiologists in that surgery came on stage to say how they pioneered these techniques. These were even commemorated on this Chinese stamp:

stamp

The hapless patient here was a 15 year old girl, and the reality was that it was later reported, that in addition to acupuncture the patient  also had powerful sedatives and analgesics (midazolam, fentanyl, and droperidol) and also large volumes of local anaesthetic injected into the chest. They also had to be taught abdominal breathing exercises for days before the procedure to maintain ventilation (but they did maintain an endotracheal tube for emergency use – thank goodness).

This added to the mythology of the effectiveness of acupuncture as anesthesia in the west, arising from a 1972 story when journalist James Reston wrote about his emergency appendectomy during American President Nixon’s trip to China. He was initially reportedly as “anaesthetized” by acupuncture needles. But this soon became established as a PR stunt, as again, it turned out he actually had conventional anaesthesia, and acupuncture afterwards to help pain control in the recovery period. if you ever want a patient’s first hand account of the benefits of acupuncture anesthesia I highly recommend professional ballet dancer Li Cunxin‘s autobiography. He is not a fan, having experienced it as a young man.

The presentation went on to outline how they now regularly employed acupuncture anesthesia for open heart surgery as it was shown to save costs considerably both in terms of the costs of anaesthetics and recovery. They also cited a 2011 paper that claimed “during operation, patients were kept on spontaneous breathing.” I took the following picture during the presentation which had some rather gruesome photos of patients they claimed to be undergoing open heart surgery using acupuncture anesthesia.

img_5422

The trouble with all this is it includes some science mixed with half-truths and a large dose of pure propaganda. Firstly, I have no doubt it is possible to do thoracic surgery with minimal conventional anaesthesia and adjunctive pain control measures,but that doesn’t mean it’s a good idea. Scientifically we know pain is multifactor complex neurophysiological and psychosocial phenomenon. Placebo and distractive effects can be very powerful here. In all likelihood a range of alternative placebos together with pharmaceuticals would probably have had similar effects to those claimed for acupuncture here. However, experimenting with these during major surgical procedures is completely unethical by any modern medical standards (and I would suggest borders on medical torture). Some may deconstruct this as an old-colonialist view of a very different culture, but to suggest it is reasonable to use low doses of established  anesthetic drugs with acupuncture and keep the patient conscious to save money is simply morally indefensible, and hardly patient-centred medicine. As a nurse I would have to say that anyone who has witnessed open chest surgery, and thinks it is good for the patient to be conscious during the procedure is either a sadist or has no respect for human suffering.  I’ll leave it to your imagination to think what it would sound and feel like as the surgeon saws through your sternum. Certainly, there is always the: “but what if there is no alternative” argument but the problem here is – there are good alternatives (and that argument really does represent an old-colonialist viewpoint). There are many better proven anesthetic and pain control measures that could be used than this, and this falls far short of the “do no harm” principle.

Secondly, a cursory review of the actual work reveals the whole thing is a politically motivated sham anyhow. Even one of the Chinese doctors I spoke with there thought the whole thing was politically driven nonsense. By mixing ancient chinese magical theories of qi energy, meridians and needles with doses of modern sedatives, local anesthetics and narcotic analgesics it is impossible to determine what effect the actual acupuncture is having compared to the drugs, let alone any placebo effect. Use of sham acupuncture was cited as being inferior in some of the work presented, and the presentations on acupuncture anesthesia all contained copious statistical reports with p values supporting positive outcomes. No one could claim the researchers were not statistically competent. In fact, I have never seen so many P values and positive results presented in a single medical presentation. Nevertheless, apart from the well established problems with P values, statistical inference relies on robust methods and hypotheses to be meaningful. It’s a case of garbage in, garbage out, and I have never seen such demonstrations of overt confirmation bias as I experienced here. If the findings claimed here were actually true and replicable, I guarantee anaesthetists all over the world would be throwing out their Boyle anaesthesia machines and embracing acupuncture as the technique of choice.

Unfortunately, evidence for the basic theory and science of acupuncture in TCM just isn’t there, and by adding multiple confounding variables in studies any possible effect is completely obfuscated. In our own initial work with VR and pain, we are at an exploratory phase and although it looks promising as a distractive therapy, the reasons why it seems to work are unclear. Also, we have found the effect size varies considerably with individuals, and we are far from identifying if it will turn out to be a useful therapeutic adjunctive. This is for a new technique, and yet the results of the first ever well-controlled study of acupuncture (claimed to be over 2000 years old) for back pain were only published in 2007 in the Archives of Internal Medicine. This study found:

  1. Both acupuncture and sham acupuncture appeared to work better than conventional drugs, physical therapy, and exercise alone.
  2.  However, acupuncture worked no better than sham acupuncture.

So, clearly there was some effect but most likely placebo. It well established that pain perception is hugely impacted by psychological factors, but magical theories of qi and meridians have never been independently empirically demonstrated. Following further studies even NICE in the UK has now rejected the use of acupuncture for low back pain.

So overall, the whole conference experience was very dispiriting. Mixing good scientific work with myth-based bad science and pseudoscience is going to get us nowhere fast. From my perspective the experience was akin to me going to an aviation conference and watching a presentation on the latest developments in carbon-fibre technologies to create improved aerofoil designs, followed by one explaining how to weave charmed threads into a magic carpet to gain maximum levitation. At the end of the day only one of these approaches is ever going to get off the ground. Sadly, the whole integrative science/medicine enterprise is academically bankrupt, and the sooner universities here promoting it realize this, the better.

Oh, and how did my presentation go down? Well, it was politely received (probably didn’t state enough P values – even with my small samples – for this audience).  I did find one of the audience kept eying me with a death-ray glare throughout though. So I suspect at least one person had actually looked up my background.

Season’s Greetings to all

Onwards and upwards.

Bernie

 

 

 

 

 

 

 

 

 

Are Nurses in British Columbia Licensed to Practice Magic?

Seasons greetings to all.

An Interesting Case

This year I decided to pursue a complaint against a practitioner with the College of Registered Nurses of British Columbia (CRNBC) for a nurse who was using their Registered Nurse (RN) title to market their own private Therapeutic Touch (TT) business. To those outside of the nursing profession this might seem a little confusing, but in other countries where I have worked as a nurse it is an established professional principle that you do not use your professional qualifications/status to promote your own for-profit activities outside of your role as an RN. The reasons for this would seem fairly self-evident. For example adding RN to your name gives you some professional credibility and it would be disingenuous to use it for personal gain, such as by selling something (be it real estate, car parts, vitamins or personal life-style counselling). The CRNBC has established standards governing use of title, and has even produced  guidance for practitioners with a case example to explain this. See: Can she Use her Title? where they note that having “RN” after your name may be seen as “…important in gaining the public trust and selling more product.”

Indeed, it was this very article that incited me to make the complaint as a test case, as I came across a TT practitioners website where the title of RN was explicitly used next to the practitioners name. I used the exact format and language in the guidance for the complaint and cited the relevant “Use of Professional Titles” standard and College Bylaws (sections 4 & 8)  in the complaint, and asked that the CRNBC to ask the practitioner not to use the RN title on their website. I had been in contact with this individual on other occasions and suggested that the use of RN was inappropriate to endorse this business activity. Unfortunately, I had a completely negative response, so a simple complaint to the CRNBC on appropriate use of title seemed an appropriate next step.

At this stage it is probably worth a quick recap on what the professional regulators function is. Basically, the regulation of nurses includes licensing, the creation of professional standards, enforcement of those standards, disciplinary measures and nursing education approval. Overall, the key principles that underpin the statutory professional regulation of nursing may be considered as:

(a) maintaining the safety and quality of the care that patients receive from health professionals;

(b) sustaining, improving and ensuring the professional standards of health professionals and identifying and addressing poor practice or bad behaviour;

(c) providing systems and legislation that sustain the confidence of both the public and the healthcare professions through demonstrable impartiality; and

(d) ensuring that the integrity of health professionals is sufficiently flexible to effectively meet the different health needs of the public and healthcare approaches can adapt to future changes and demands (Hewitt 2007; ICN 2014; Walsh 2012; WHO 2002).

To ensure that regulatory standards are effective, the regulatory process itself also needs to be seen as impartial and independent from the government, the professionals themselves, employers, educators and all the other interest groups involved in healthcare (Hewitt 2007). I.e. the CRNBC should represent the interests of the public at large rather than the profession or government (this is an important point, which we will come back to). So, one would think that in terms of public protection this complaint would represent a fairly straightforward case of inappropriate use of title to support a commercial enterprise.

Another consideration here is that in this case the title was being used to help market a completely unscientific, non-evidence based and “unverifiable” practice (as indicated by the CRNBC’s own Bylaws, 2012; Section 8.04). We have discussed the merits of TT on this blog before, and it is of course, pure magic in the terms it is portrayed (remote healing using undetectable energies) with no-scientific evidence to support efficacy. A 1999 review of the physics of complementary therapies states that the existence of a “bio-field” or “bio-energetic field” directly contradicts principles of physics, chemistry, and biology (Stenger, 1999). A recent Cochrane systematic review found “no robust evidence that TT promotes healing of acute wounds (O’Mathúna et al, 2012). The American Cancer Society stated in 1999, “Available scientific evidence does not support any claims that TT can cure cancer or other diseases” (AMA, 2012).  Lastly we have the youngest person ever to get a paper published in the Journal of the American Medical Association ( the nine year old Emily Rosa) presenting a study that debunked the claims of TT practitioners in a simple study where twenty-one practitioners of therapeutic touch failed to detect her aura (Rosa et al, 2009). TT is then, complete mystical woo-woo, and fails to meet any test of scientific credibility in that 1) the underpinning theory is tautological nonsense, and b) practitioners can demonstrate no efficacy better than placebo. No respected university will touch TT practical training with a barge pole. Nevertheless, we should note it is a highly profitable enterprise  (the overheads are minimal) and many nurses do support it. The professional regulator would seem to have some responsibility to ensure practitioners are using evidence-based practices, and TT (based on current evidence) clearly falls outside that scope.

The Outcome

Anyhow, in the end the CRNBC disposition on this case earlier this year sided with the practitioner, and that they were perfectly entitled to use their RN credentials to market their TT business as they found that:

a) the regulations are not intended to apply to RNs providing education services. The CRNBC regarded this registrant as providing an educational service, as the website identified was aimed at a TT consultation service.In other words they viewed an educational service as not being a product (even though it was a commercial, for-profit enterprise)!

b)  Alternative and complementary therapies are considered within the realm of holistic nursing.

Given the CRNBC’s position on CAM in general, I was not unduly surprised with this outcome, but am concerned this represents a particularly troubling precedent as point a) represents a very narrow view of what a commercial product is, and also implies you can sell health education on anything (whether good or bad) and simply tag your RN credential to your marketing materials. Point b) is even more worrying as it represents an “anything goes” approach to the regulation of RN practice (as long as you don’t physically hurt anyone; it’s all good). This completely ignores the responsibility to make sure practitioners don’t financially or emotionally exploit the public, and tarnish the reputation and credibility of the nursing profession.

Let’s examine a comparable example. If I want to promote my business as a tarot or astrology based health practitioner, and make good money selling my advice and education to the public who believe in this. Then I can tag on my RN credential to give it an air of professional respectability, better market my magical consultation services and improve my profits. Its all good!

I can’t help but ask; how does this approach protect the public rather than the profession? The finding here does nothing to protect the public from exploitation, and seems to give carte blanche for RNs to practice magic. To illustrate this, I have just acquired a practising Witchdoctor (WD) certification from the Canadian Association of Witch Doctors (it was a tough program, and examination I can tell you)! So, with my new magical powers, apparently using my title in the following advertisement is perfectly within my scope as an RN:

Loco Advert

Click here to see the full size Locomatic Energy Inc Advert

This advert covers the same ground as the website I originally made my original complaint against (well, apart from the cat, services being free and the windsurfing). The use of the RN title to support this sort of activity is clearly nonsense, and to be frank, supporting it is a travesty of regulatory practice and represents an example of where our professional regulatory body is failing miserably. Regulators traditionally err on the side of caution, remain impartial, and represent the public interest, not those of the professionals they regulate. In this case I would argue they clearly failed to meet their regulatory obligations in this respect.

Other nursing and health professional regulators I have observed seem to do a much better job in this area. The College and Association of Registered Nurses of Alberta (CARNA) Standards on CAM, 2011 notes:

“Registered nurses cannot use the title ‘RN’ or ‘NP’ in association with the endorsement or promotion of products or services. Endorsement of a product or service occurs when a nurse uses their credentials to lend credibility to a commercial product or service (CNO, 2009). The endorsement of a product or service without providing information about other options could mislead the public and may be considered a conflict of interest.”

Likewise the College of Nursing of Ontario, Professional Misconduct Regulations, 2014 states:

“It is not acceptable for a nurse to use her/his registration status to promote personal interests such as commercial products or services. Endorsement occurs when the nurse inappropriately uses her/his credentials to lend credibility to a commercial product, product line or service. The endorsement of a product line or service without providing information about other options has the potential to mislead the public and compromise trust.”

Both clearly indicate services (such as educational consultation) are to be treated the same as products in this respect. In the UK, The Nursing and Midwifery Council Code of Conduct 2014, is similarly clear, requiring practitioners to:

  • not abuse your privileged position for your own ends.
  • ensure that your professional judgement is not influenced by any commercial considerations.
  • uphold the reputation of your profession at all times.
  • ensure that the use of complementary or alternative therapies is safe and in the best interests of those in your care.

The College of Surgeons and Physicians of BC are also much clearer on how we should consider CAM in respect to public healthcare:

“Practitioners must not misrepresent the safety or efficacy of any therapy or procedure.”

“Complementary and alternative therapies differ from conventional medicines because they are generally unproven. When an alternative treatment undergoes rigorous testing, for example in a controlled and randomized trial, then the results dictate whether the alternative treatment becomes conventional treatment, whether the unorthodox becomes accepted, and whether the unproven becomes proven. Assertions, speculations, and testimonials do not substitute for scientific evidence.”

I did briefly pursue this CRNBC disposition on this case with the BC Health professional Review Board (HPRB), but have dropped it, as there is really nothing they can do in such a case as the HPRB are focused on interpretation of process and the law and are very unlikely to intervene in what they see as “professional jurisdiction” unless there is clearly evident harm arising. Astonishingly, it appears guidance published in CRNBC newsletters and advice has no real legal grounding anyhow, so can be completely different from interpretation of the actual standards by the disciplinary board. This doesn’t seem to reflect a well coordinated organization to me though. So, my next action is another formal approach to the CRNBC (I have raised this issue with them before) requesting they review their regulations and toughen them up in this respect.

Finally, although TT is generally harmless, we should be reminded these are serious concerns and not the trivial issues they are often taken as. Firstly, financially exploiting vulnerable people is a serious issue. Secondly, where the public are advised to consider alternatives to conventional evidence-based treatments, life-threatening results occur, as exemplified by the recent cases of the parents of two children with acute leukaemia seeking CAM remedies, and with people being advised to take homeopathic vaccines rather than actual vaccines. If we continue with this  approach to regulation and CAM practices, and allow them to be marketed with implied professional support, sooner or later deaths or injury will result from people In BC choosing CAM over medical alternatives on the advice of a nurse using their professional title to support their CAM practice. Effective regulation can help prevent this.

So, are nurses in BC licensed to practice magic? What do you think…

Bernie

References

American Cancer Society (2012) Therapeutic Touch.  Retrieved 20 October 2014.

Hewitt, P. 2007. Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century. London: H.M. Stationary Office

International Council of Nurses (2014). Regulatory Board Governance Toolkit.  http://www.nurse.or.jp/nursing/international/icn/report/pdf/2014m/04-04.pdf. Retrieved July 29, 2014.

O’Mathúna, D. N. P.; Ashford, R. L. (2012). O’Mathúna, Dónal P, ed. Cochrane Database of Systematic Reviews (Online) 6: CD002766

Rosa, Linda; Rosa, E; Sarner, L; Barrett, S (1998). “A Close Look at Therapeutic Touch”. JAMA 279 (13) 1005–10

Stenger, Victor (1999). “The Physics of ‘Alternative Medicine’ Bioenergetic Fields”. The Scientific Review of Alternative Medicine. 3(1) 79-84

Walsh, P. 2012. “Health Professional Regulation.” AvMA Medical and Legal Journal 18(3): 3–4.

World Health Organization (WHO). 2002. Nursing and Midwifery: a Guide to Professional Regulation. Cairo: WHO Publications Eastern Mediterranean Regional Office.

Other Relevant Sources

1. The CRNBC has a self-identified mandate to “protect the public through the regulation of registered nurses and nurse practitioners: https://www.crnbc.ca/crnbc/Pages/Default.aspx

2. Registrants are required to use their title(s) in ways that comply with the: CRNBC Standards of Practice. See: https://www.crnbc.ca/Standards/Lists/StandardResources/343AppropriateUseofTitlesPracStd.pdf

3. CRNBC October 2013 case study “Can she use her RN title?” which was subsequently amended – current version is at: https://crnbc.ca/Standards/resourcescasestudies/beinganurse/selfemployment/Pages/marketing.aspx .