The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease."
- Thomas A. Edison (1847-1931)

INFORMATION ABOUT DR. JOZEF KROP'S PRACTICE

The College of Physicians and Surgeons of Ontario (CPSO) has required that physicians who use complementary tests and treatments provide information about their practice methods to their patients according to recommendations of the Ad Hoc Committee on Complementary Medicine (1997).

EVIDENCE BASED MEDICINE:

All physicians, including Dr. Krop, refer as much as possible to well-designed scientific studies which offer objective evidence to help them decide which tests are most capable of accurately detecting specific health problems, and which treatments are most likely to do more good than harm. There are various levels of evidence available for specific tests and treatments, depending on the level of knowledge about, and prevalence of the health problem of interest, and the availability of funds and skilled researchers to mount studies. The medical profession has not yet fully agreed on how to categorize levels of evidence, but there is general consensus that the most unbiased evidence results from randomized controlled clinical trials. However, because such trials are very expensive and often methodologically difficult, there is a lack of evidence for many medical practices. Our questions about tests and treatments far exceed our capacity to answer them!

Trials have been most easily employed to compare the effects of a new medication to the best current medication in otherwise well subjects who have a well-described single disease. A survey of the efficacy of all conventional medical care conducted by the Office of Technology Assessment of the U.S. Congress (1978) concluded "Only 10 to 20% of all procedures currently used in medical practice have been shown to be efficacious by controlled trials". More recently, Grimes, in the Journal of the American Medical Association (Grimes DA, Technology Follies. JAMA 1993; 269(23): 3030-3033) stated, "much, if not most, of contemporary medical practice still lacks a scientific foundation". For example, psychotherapy or surgical techniques such as laparoscopic vaginal hysterectomy or episiotomy have not been evaluated by randomized, double blind controlled trials, because it is impossible and/or unethical to do so. Most patients who come to Dr. Krop have complex, multifactorial illnesses, and so, even if trial-based evidence for use of a particular therapy for a specific disease is available and is good, it may not be applicable for an individual patient.

Dr. Krop and his colleagues in the Canadian Society for Environmental Medicine use the Levels of Evidence categories suggested by the Canadian Medical Association (Can Med Assoc J, Feb.10, 1998; 158 (3 Suppl), S2), which indicate the nature of the evidence being used, but do not directly describe the quality of the evidence:

Level I evidence is based on randomized, controlled trials (or meta-analysis of such trials) of adequate size to ensure a low risk of incorporating false-positive or false-negative results.
Level II evidence is based on randomized, controlled trials that are too small to provide Level I evidence, and are associated with a high risk of false-negative results.
Level III evidence is based on non-randomized, controlled or cohort studies, case series, case-controlled studies or cross-sectional studies.
Level IV evidence is based on the opinion of authorities or that of expert committees as indicated in published consensus conferences or guidelines.
Level V evidence expresses the opinion of individuals based on their experience, knowledge of the relevant literature and discussion with their peers.

To assist you in deciding on whether to undertake tests or treatments offered by Dr. Krop, he has placed what he believes is the current available level of evidence in brackets after his description of the diagnostic and therapeutic options he offers in the following pages. A few of the available references are noted for your interest.

TRAINING

Dr. Jozef Krop is a licenced medical doctor with over 30 years of clinical experience. He undertook his undergraduate and graduate education in Europe and North America, was a pediatrician in Poland, and earned a Fellowship in Environmental Medicine from the American Academy of Environmental Medicine (AAEM), whose training program is accredited by the Council on Continuing Medical Education of the American Medical Association. Over the past 20 years, in addition to his conventional and environmental medicine practice, Dr. Krop has taken post-graduate training in order to be able to incorporate various complementary healing methods which would enhance options for his patients. Dr. Krop's full curriculum vitae is available on request.

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