Doctors are legally required to talk with patients about alternative treatment options to obtain informed consent before prescribing a drug, and patients have the right to choose how they want their health condition treated.
It is, however, challenging for patients to choose alternatives for several reasons, including that doctors often lack the knowledge about the risks and benefits of alternatives, how difficult it can be for alternative products to get approved by government regulators, and the high cost of alternative products and services.
Lack of Doctor Knowledge
Informed consent is the process in which a doctor educates a patient (parents, guardians or caregivers) about the risks, benefits, and alternatives of a given procedure or intervention, including drugs being prescribed. There are four things that a doctor must make sure a patient understands before informed consent can be obtained:
- Nature of the procedure or intervention;
- Risks and benefits of the procedure or intervention;
- Reasonable alternatives;
- Risks and benefits of alternatives.
Many doctors have little, if any, knowledge of alternatives to prescription drugs as a treatment intervention, which makes it extremely difficult for them to obtain informed consent from patients. For example, although nutritional therapy and physical activity are recognized as effective treatment interventions for many physical and mental health conditions; during four years of medical school, most students spend less than 20 hours studying nutrition and less if any time studying physical activity.
A major reason why doctors do not receive adequate training about alternatives to prescription drugs for treating medical conditions is that for decades, pharmaceutical companies have had a dominant influence on medical school curriculums.
It is critical for patients to understand the significance of informed consent on their health, and not to just blindly trust doctors to make treatment decisions for them.
Getting Government Approval
It can be difficult for alternative products to be approved by government regulators. Health Canada, for example, can arbitrarily decide that a natural health product is a “drug” under the Food and Drugs Act, which might require companies to conduct very expensive clinical trials similar to what pharmaceutical companies conduct (e.g., placebo-controlled, double-blind, randomized control trials) to get a Drug Identification Number (DIN). One example is Truehope EMPowerplus, a micronutrient supplement that demonstrated through clinical studies that it can safely and effectively treat mental health conditions, including anxiety, depression and bipolar disorder.
In 2003, even with evidence-based research supporting EMPowerplus, Health Canada directed the Royal Canadian Mounted Police to raid Truehope Nutritional Support Ltd. in Alberta to stop the company from importing the product from its manufacturing plant in the United States. After a lengthy court battle, a 2006 judgment allowed Truehope to continue importing EMPowerplus and selling it to Canadians without a DIN.
Cost of Alternatives
Without a health insurance plan, alternative products and services can be costly, which makes it very difficult for many people to access services from other healthcare professionals such as psychologists, counsellors, naturopaths, chiropractors, nutritionists and personal trainers, for example.
Even the cost of joining a sports program where, for example, coaches are alternative mental health service providers, can be prohibiting to people. Yet, in many countries, prescription drugs are heavily subsidized by governments, which makes it difficult to choose anything other than a prescription drug for treating a physical or mental health condition. In Ontario, Canada, for example, prescription drugs are free for anyone 24 years of age and under, or 65 and over.