Everyone hates health insurance companies. At least, so it seems. Personally, I’ve had my issues with such companies myself, particularly when having to deal with them when they refuse to cover certain medical tests for my patients. Fortunately for me, surgical oncology is a specialty that doesn’t have a lot of tests or treatments that are frequently not covered, particularly for breast cancer surgery, which means that I don’t have to deal with insurance companies that much. It’s a wonderful thing for a doctor.
Still, for all the complaining about insurance companies, if there’s one good thing about them it’s that they usually don’t cover treatments and tests that don’t have a reasonable evidence base for them, and, by and large, they don’t cover much in the way of “complementary and alternative medicine” (CAM) because, quite rightly, they consider it a waste of money from their customers’ premiums to pay for magic. Unfortunately, to some extent this is changing a bit. Some insurance plans will pay for chiropractic care, for instance. That bothers me, although I suppose it can be argued that, as long as a chiropractor sticks to spinal manipulation only for musculoskeletal problems (i.e., functions more as a physical therapist than anything else, rather than a physical therapist with delusions of grandeur who thinks that spinal manipulation can treat, for example, asthma or autism), they probably can help. What bothers me more than coverage for chiropractic is my increasing observation that more and more health insurance companies are covering quackery like acupuncture and other services commonly provided by naturopaths.
So, for all the opprobrium heaped upon health insurance companies, by and large they don’t pay for much quackery, despite intense efforts by naturopaths and other CAM practitioners to persuade them to do so, and that’s a good thing, a public service if you will. That’s why I was disturbed to see a story on Forbes.com the other day entitled Aetna CEO Embraces Alternative Healthcare:
Aetna CEO Mark Bertolini surprised many Techonomists at our conference in Tucson last month with his frank talk about alternative therapies and the need for the current health system to be “creatively destroyed.” Who would have thought the top man at one of the nation’s largest health insurance companies would be an advocate for craniosacral therapy and meditative chanting?
Bertolini’s onstage interview with David Kirkpatrick focused mostly on his innovative approaches to apps and technology at the company. But in a later on-camera conversation, Bertolini described how his progressive personal health practices jibe with his company’s mission.
Here’s the interview:
I think the key statement in this interview is very revealing. Bertolini says:
We know this stuff works. We believe in this, it’s just building the evidence base.
That’s right. He “knows” this stuff works already. He’s just looking for evidence to convince everyone else that it “works.” Also, like any good businessman, he further says, after mentioning quackery like craniosacral therapy, and comfort modalities that aren’t really “therapies” per se (like massage):
It’s a lot of money, and I think people want it, and they find it valuable. That’s how I manage it. I go to a naturopath to get my blood test and I have food sensitivities. I’ve lost 48 lbs, just by having my blood tested. Allopathic doctors will say that’s all crazy, you’re just watching your diet as a result of getting some blood work back. No, I’m not eating eggs, I’m not eating milk. I’m not taking any dairy, and I’ve lost 48 lbs.
Actually, the “allopathic” doctors are probably correct. That’s all that’s likely going on. You can eliminate a lot of calories by eliminating dairy from your diet. If you happen to exercise and, as a lot of naturopaths like to promote, become a vegetarian, you can lose a lot of weight. We have no idea what other dietary changes Bertolini might have made made. He sure is proud of himself, though, and not afraid to let you know it. Particularly obnoxious is his bragging about taunting his “allopathic doctor, saying, “You’re 30 pounds overweight. How’s your nutritional therapy working for you?”
Apparently, Bertolini was converted to CAM by two events in his life. First, of all, his son developed what is normally a fatal cancer. I haven’t been able to find out what cancer Bertolini’s sone developed, but Bertolini frequently makes the claim that his son is the first person ever to have survived this particular “rare, incurable cancer.” Apparently it was Gamma Delta T-cell lymphoma, a form of lymphoma I don’t remember ever having heard of before. It’s described as an “extremely rare and aggressive disease that starts in the liver or spleen.” It is indeed a bad actor. However, there is evidence that not all Gamma Delta T-cell lymphoma is so rapidly deadly, with reports of some cases that show a much less aggressive course. We have no way of knowing whether Bertolini’s son had one such less aggressive form based on the description of his clinical course found in various news reports, which involved a bone marrow transplant, a case of graft versus host disease, and complications including strokes and renal failure that ultimately necessitated a kidney transplant. Be that as it may, I can understand why this experience might have soured Bertolini on “conventional medicine.”
Thus were the seeds sown that later grew into Bertolini’s embrace of the quackery that is naturopathy, but more was needed. This additional trigger that was needed came in the form of a life-altering serious injury. Bertolini, although an expert skiier, had a skiing accident in 2004, in which he wiped out badly, suffered a severe concussion, and broke five vertebrae in his neck, ripping the nerve roots on the left out of the spinal cord. The results were severe pain:
For the first year, Bertolini used a plethora of narcotics for the pain such as Oxycontin, Vicodin, and Fentanyl and still barely slept at night. He says he didn’t get hooked on the drugs, insisting he’s more of an “adrenaline-endorphin junkie.” At his wit’s end, he went looking for better treatments.
The solutions include weekly cranial sacral massage, which involves the head all the way down to the tailbone, aimed at getting a flow of spinal fluid that calms the nervous system, Bertolini said. The massage got him off narcotics in four months, and he says he now takes nothing but Tylenol for the pain.
He also got acupuncture in Boston for a year and now keeps needles at home and when traveling to self-administer the treatment.
Ashtanga yoga, he says, also helps him deal with pain and restore a sense of well-being he used to get from daily 5 a.m. 4-mile runs, which he can’t do anymore.
Does it need to be repeated that cranial sacral massage is one of the rankest forms of quackery? There are also parts of this story that are very common in testimonials for alternative medicine. For example, he attributes his getting off of narcotics to the craniosacral massage, but more likely it’s just the tincture of time, and he would have gotten off the narcotics in four months regardless. We have no way of knowing, but I do know that correlation does not equal causation. Of course, once someone has developed the tendency to believe in woo, if he’s doing conventional therapy and woo when his condition gets better, he’ll attribute the recovery to the woo, not to the conventional medicine. It’s quite possible that the yoga might have helped, basically because it’s a set of stretching exercises, but I’ve also heard a neurosurgeon tell me that yoga is not good for injured spines. Be that as it may, now Bertolini is a full-fledged believer in naturopathy to the point where was the keynote speaker at the New York Association of Naturopathic Physicians’ annual conference:
The first part of the video is a dry discussion of Obamacare, but at around 3:30 the mistress of woo who runs what I like to refer to as a “wretched hive of scum and quackery” (i.e., The Huffington Post), Arianna Huffington, pops in to ask about “mindfulness” and CAM. In response, Bertolini basically repeats the same talking points that he has before, emphasizing his introduction of yoga and mindfulness, the preliminary data of his uncontrolled pilot study, and how he knows this stuff “works.” One thing that he inadvertently reveals is that he still has chronic pain from his neuropathy that sounds quite difficult to deal with, which he describes as “terrible pain down my left arm all day long.” This rather conflicts with what he says later in his account, namely that craniosacral therapy, acupuncture, and naturopathy have rendered him mostly “pain free” without drugs. He also points out that the program he put together for Aetna for its employees involving mindfulness and yoga was put together for the express purpose of “proving” that these modalities work. That’s the difference between a scientist and a non-scientist. Non-scientists try to prove what they already know, or prove their hypothesis. In contrast, scientists usually design their experiments to test their hypothesis by trying to falsify it and remain open to the possibility that their hypothesis will fail. Let’s just put it this way. Mark Bertolini might be a good businessman and corporate manager, but he is no scientist. He knew what result he wanted, and, make no mistake, that attitude could easily bias the “research.”
Right now, Aetna does not cover much in the way of alternative medicine. It does cover acupuncture for a few indications, biofeedback, chiropractic, and TENS, which for some reason it lumps under CAM, maybe because of how often acupuncturists try to pass TENS off as being “electroacupuncture.” One can’t help but wonder if that will change under Bertolini’s leadership. Certainly, he speaks as though he wants to try to see that it does.
Ironically, back in the 1990s Aetna was the insurance company that actually stood up for evidence-based medicine by taking a stand against Stanislaw Burzynski, a frequent topic of this blog because of his ineffective and dangerous “antineoplaston” therapy for cancer. It sued Burzynski. I know, I know. It really sued to recover payments for Burzynski’s treatments far more than it sued to stand up for science, but it’s odd to look at the contrast now. Aetna has a CEO who is thoroughly steeped in quackery and wants to promote it. If he wants to have Aetna pay for naturopathy, I would be surprised if, sooner or later, he doesn’t get his way.