After questioning your doctor about the side effects of a prescription drug and doing your own research, before you decide not to get a prescription filled, it is important to know how difficult it might be to access an alternative product or service for treating a physical or mental health condition. You might have little choice but to get the prescription filled, largely because of the dominant influence that the pharmaceutical industry has on the healthcare system.
The challenges of accessing alternatives include doctors not knowing the risks and benefits of alternatives, which they need to know to obtain informed consent, how difficult it can be for alternative products to get approved by government regulators, the high cost of alternative services, and the risk for doctors of being disciplined by professional colleges, and even having their medical license suspended or revoked, for providing or even just suggesting alternative treatments.
Lack of Doctor Knowledge
Informed consent is the process in which a doctor educates a patient about the risks, benefits, and alternatives of a given procedure or intervention, including drugs being prescribed. It is an ethical and legal requirement for medical treatment. 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 an intervention, which makes it almost impossible 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 time studying physical activity. A review of 118 of 170 accredited medical schools in the United States found that 51 percent offered no physical activity coursework, 21 percent offered only one course, and 82 percent of the schools did not require students to take any physical activity related training.
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 treat and prevent 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 judgement allowed Truehope to continue importing EMPowerplus and selling it to Canadians with a Natural Product Number instead of a DIN.
Cost of alternatives
Without a health insurance plan, alternative services can be costly. It is very difficult for many people to access services from other healthcare professionals, including psychologists, counsellors, chiropractors, naturopaths, nutritionists, and personal trainers.
Even the cost of joining a fitness club 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 or preventing 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.
Risk for doctors
Many doctors have been disciplined by their professional colleges for providing alternative treatments or even suggesting alternative treatments. In some cases, medical licenses have been suspended or revoked.
In Montreal, Canada, for example, integrative medicine doctor Barry Breger had his license suspended for three years by Quebec’s College of Physicians in 2016 for practicing orthomolecular medicine, which is the practice of treating and preventing diseases with natural nutritional supplements. The College decided that orthomolecular medicine was “not consistent with scientific finding.” Dr. Breger also allowed patients to have input on choosing their dosage level of prescription drugs.
Know Your Drugs 