ࡱ> ikj'` bjbjLULU 70.?.?ce  """8"#4 SB#B#B#B#B#---SSSSSSS$UhW7S 03--03037S B#B# LS\5\5\503p 8B#> B#S\503S\5\5M&  6]RB#6# wh"3QlRtbS0S RPxXd4xX]R]RxX qR,-dB/\5@0 1$---7S7S4p---S03030303   $         1 December, 2010 Medical Council of New Zealand PO Box 11649 Manners Street Wellington6142 Attention: Michael Thorn Senior Policy Adviser and Researcher Response to the request for comment on the review of the Statement on complementary and alternative medicine, on behalf of the Paediatric Society of New Zealand. Dear Medical Council Key concerns The main changes that we would like to see are recognition of the fact that children are especially vulnerable in the context of complementary and alternative medicine (CAM), and a statement that evidence based treatments should be the preferred approach for children and where CAM is proposed particular attention be paid to possible risks. Reasons for concern There are a number of reasons that children are vulnerable: CAM treatments are sought for children by their parent(s) or guardians. Particular care is therefore needed to ensure that any treatment provided is in the best interests of the child. Childrens ability to give informed consent develops with age. However, children with disabilities may never be able to be fully involved in the consent process. Some procedures are particularly distressing for children. A good example is blood tests. Unnecessary blood tests (i.e. those for which there is no scientifically valid evidence base) should be avoided. Children are growing, unlike adults. The provision of appropriate nutrition is critical, as is the monitoring of growth. CAM involving particular diets are common, and the diets often involve removing certain foods. This places the growing child at risk of nutritional deficiency (e.g. of calcium if milk and other calcium fortified beverages are excluded) and in more extreme cases can lead to failure to thrive which can have long term effects on future health and development. Parents of children with chronic conditions are extremely vulnerable to exploitation. Conventional treatment may not offer a cure. There is good evidence that a large proportion of families of such children use CAM at some point. There are significant numbers of such families. For example, Autism Spectrum Disorders affect up to 1 per 100 children, while Attention Deficit Hyperactivity Disorder affects around 5 per 100. Additional Responsibilities CAM practitioners therefore in dealing with families, in addition to the steps outlined in the statement, need to: be particularly aware of consent issues with children as many of the treatments lack an evidence base. need to minimise blood tests, or unproven therapies that necessitate blood tests, or other distressing or expensive investigations. weigh and measure their paediatric patients, and plot these measurements on standard centile charts to ensure any growth failure is detected and remediated. take particular care to be honest about the proven benefits and risk of any treatment, or lack on any such evidence. Doctors referring a child to a CAM practitioner or when asked about CAM need to: be under an express duty to explain to families the concept of evidence based medicine, how to assess possible treatments, and how to evaluate the qualifications and capabilities of CAM practitioners. continue to take responsibility for monitoring the childs growth, especially if a change of diet is recommended. Suggested amendments We have some suggested amendments to the track changes version on your website. We are not sure quite how all our concerns can best be covered in this statement and would be happy to discuss it further. Consider adding a paragraph such as: Children need special consideration, for example monitoring of growth. Where evidence based treatments are available for children these should be used as the primary treatment modality, and any other treatment modality in this setting is considered secondary and potentially experimental. Where no evidence of treatment efficacy is available, then due consideration of adverse effects of any treatments, including CAM, needs to be considered paramount and discussed with the childs caregiver. In paragraph 4 we would suggest inserting at the end of the sentence: and has followed the standards of practice expressed in this document. In paragraph 9 we suggest deleting the reference to a CAM practitioner because it gives the appearance of endorsing all CAM practitioners as good unbiased sources of information. Communication with Practitioners We note that a number of our members were unaware of this statement. We think it is an important statement for all medical practitioners and recommend that it be widely circulated to inform practitioners of their obligations with respect to CAM. Regular reminders of the existence of this statement and other guidance issued by the Council are essential. Although the Statement is directed at doctors, it is also relevant for other health professions. This submission has been prepared by Drs Phillipa Clark, Garth Smith, and Rosemary Marks on behalf of the Paediatric Society of New Zealand. Thank you for the opportunity to comment. We are happy to be involved in further discussion if needed, and can be contacted through our secretariat. Yours sincerely,  Rosemary Marks President      THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz  Health of our children: Wealth of our nation Health of our children: Wealth of our nation dep}~E ] ^ k    ac(I FGóҥߙߓ߆z߆߆eXjhbihbiUaJ)hrhrB*CJOJQJ^JaJphhrhr6]aJhrhrCJ^JaJ hX*oaJhrhr5\aJhrhr@\^JaJhrhr6@\^JaJhrhr@OJQJaJhrhr@^JaJhrhraJhrhr56\]aJhrh$ aJ"6DTep~G H ] ^ k   $ d*$a$gdrgdrc-/ p A $aMbc~$ & F%da$gdr dgdr  & F$dgdr$ & F$da$gdrgdr$ & F#da$gdrt'(I 34EFHIJYcefhiklnos $ !n#a$gdrgdrGIYcdfgijlmorstuvw!"#$%(+,-aƯxhxhZjhbiUmHnHuhbi5B*CJOJQJphhbiB*CJOJQJphhbi5B*CJ(OJQJphhbi5B*CJ$OJQJphhbi5OJQJ%jhbi5OJQJUmHnHuhbih$ jh$ UmHnHuh7jh7Uhrh$ 5aJhrh$ aJhrhraJ#stuw "  $Ifgd$  $Ifgd$  !Sn#$Ifgd$  !Sn#$Ifgd$ $ x$Ifa$gd$  $Ifgd$ "#$%)*+,-./01~x !gdbi $ !n#a$gdbihkd$$If\u+#ayt$ 1`abc $ !a$gdbi  !gdbi $ !a$5 0&P :pbi. 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The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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