…and this is a 
Tom Harkin is up to his usual tricks: he wants to expand the role of 'alternative therapies' by allowing them to be covered by insurance. The quacks are cheering him on, too — every naturopath, homeopath, acupuncturist, crystal healer, shaman, meditator, and iridologist wants their slice of that great big health insurance pie. It's a disgrace. Strangely, the insurance companies aren't complaining. This comment explains that, though.
Harvey Kaltsas, president emeritus of the American Association of Acupuncture and Oriental Medicine, said the country could save billions of dollars by shifting care for a number of conditions away from pharmaceutical treatment and toward acupuncture. Kaltsas said the number of licensed practitioners has grown to 20,000 from just 300 in 1971, indicating that many people are sold on the practice's effectiveness.
I think that last word should be stricken out and replaced with the more appropriate term, "profitability".
The country could also save billions of dollars if, instead of treating cancer with chemotherapy and surgery and all those expensive Big Medicine remedies, they instead used my personal tickle therapy cure — the only expenses are the cost of feathers and my personal time, at $500 an hour. It is so much cheaper than those overpriced medicines! And instead of putting the patient in a state that requires months or years of sustained expense, and years and years of regular doctor's visits and diagnostic examinations, my therapy is fast — depending on how far the cancer had progressed, I only need to be employed for weeks or months…and then no more medical expenses at all. Ever. I can guarantee it.
The insurance companies should love me.
Medicine & Health
Comments
Posted by: Bostonian | July 24, 2009 12:50 PM
This is one of the dangers of a fully socialized healthcare system - what gets covered becomes a matter of national policy, and is therefore open to a lot of lobbying. It happens in Britain, where the homeopaths are trying to turn the NHS into this:
http://www.youtube.com/watch?v=HMGIbOGu8q0
I have an idea: we would save even more money by not treating illnesses at all! Or on second thought, maybe we should rely on outcomes studies ...
Posted by: Lynna | July 24, 2009 12:51 PM
Ah, yes, Iowa, where it's hot enough in the summer to cook the corn in the fields. I suspect steamed neurons in the case of Harkin.
A big contributor in Iowa to the market for and use of alternative treatments is centered in Fairfield, Iowa. Marharishi University of Management, TM Movement, Ayurvedic medicine centers, etc.
http://goldendome.org/
Posted by: Raynfala | July 24, 2009 12:54 PM
And the malpractice lawyers will love it, too...
Posted by: Casper | July 24, 2009 1:01 PM
Congratulations on your $500 an hour gig. Now you can afford the imaginary $600 bluefin from your previous post.
Posted by: Novparl | July 24, 2009 1:01 PM
Medicines do more harm than good. Alternative therapies are pointless but harmless, unlike drugs with their side effects.
If medical treatment is so great, how come so many Mercans are in poor shape?
Posted by: H.H. | July 24, 2009 1:06 PM
To think that tickle therapy could replace conventional cancer treatments is folly. Tickle therapy is a complimentary treatment meant to be used in conjunction with conventional cancer treatments. But when a patient's cancer goes into remission, at least some of the credit should be given to tickle therapy, thus justifying its extra cost. Not sure how paying for an extra treatment saves insurance companies money, but tickle therapists assure me that it all works out somehow.
Posted by: Shamelessly Atheist | July 24, 2009 1:07 PM
As Dara O'Briain would say to Tom Harkin, "Get in the fucking sack!"
Posted by: Teleprompter | July 24, 2009 1:08 PM
Novparl,
Just because something is "natural" doesn't mean that it doesn't have side effects. Any time you put something into your body there are risks. It's not intelligent at all to put random things into your body without consulting a physician, especially if they can react with other medications.
But yeah, keep pumping "alternative" therapies into your body with no awareness of what they'll do. See how that works for ya.
Posted by: inkadu | July 24, 2009 1:08 PM
H.H. -- Complimentary therapy is when a patient has a fever and the doctor says, "Hey, baby, you are smoking hot."
Ahem.
Posted by: Sven DiMilo | July 24, 2009 1:09 PM
But wait.
If a significant number of medical complaints can be satisfactorily (to the patient) dealt with in a non-pharmaceutical fashion, what's wrong with that?
Everybody knows that if you see a physician, you'll leave with a prescription, even if it's Tylenol or an antibiotic for a probable virus. That's not a good thing from anybody's perspective except the pharmaceutical corporations.
I'll give the anecdote that prompts my comment as an example. An acquaintance of mine is afflicted with (apparently) hereditary osteoarthritis for which Western medicine can as yet do little. It causes her a lot of chronic pain in joints that are not replacable and has a huge effect on her life in terms of what she can and can't do. Physicians can only offer anti-inflammatories and painkillers, which they unfailingly do even while admitting that the drugs are hell on your liver. She gets acupuncture instead, and reports significant pain relief associated directly with her needling sessions.
So naturally (heh) I suspect it's all placebo effect, to which her retort is: maybe--probably--but so what? If it helps me it helps me.
The placebo effect is not something to sneer at; double-blind placebo-controlled studies are required for pharmaceuticals for a reason.
What's wrong with exploiting it for the public good?
Posted by: Eamon Knight | July 24, 2009 1:09 PM
Medicines do more harm than good. Alternative therapies are pointless but harmless, unlike drugs with their side effects.
I'll take Wild Generalizations for $500. As Orac points out: in order to cure, a drug must have some chemical effect in the body. It is impossible in general to guarantee that the therapeutic effect is the only one (though some smart chemistry can improve the therapy-to-side effect ratio). Alternative "medicines" (particularly homeopathic ones) have no side effects because they have no effect of any kind (except for the ones that permanently fry your olfaction, of course....)
If medical treatment is so great, how come so many Mercans are in poor shape?
'Cuz they eat too much, eat the wrong things, smoke, and don't exercise enough?
Posted by: Tophe | July 24, 2009 1:09 PM
"You know, medicine is not an exact science, but we are learning all the time. Why, just fifty years ago, they thought a disease like your daughter's was caused by demonic possession or witchcraft. But nowadays we know that Isabelle is suffering from an imbalance of bodily humors, perhaps caused by a toad or a small dwarf living in her stomach."
http://www.hulu.com/watch/3529/saturday-night-live-theodoric-of-york
Posted by: ??? | July 24, 2009 1:11 PM
the country could save billions of dollars by shifting care for a number of conditions away from pharmaceutical treatment and toward acupuncture
Or by just letting the patient die.
Oh, wait, that's what happens with these woo-meisters anyway. Never mind.
Posted by: SC, OM, Blogmistress | July 24, 2009 1:14 PM
Feeling a need for intense anger?
Watch this segment by Sajay Gupta on CNN a few weeks ago:
http://www.cnn.com/video/data/2.0/video/health/2009/07/06/gupta.alt.medicine.mainstream.cnn.html
Posted by: Cheryl | July 24, 2009 1:23 PM
In the mid-80's, I was working with an insurance brokerage firm in Nashville, TN. I had the opportunity to talk to one of the senior VP of Connecticut General which later became part of CIGNA. When I mentioned an issue on claims payment problems he responded: "We are in the business of collecting premiums, not paying claims."
The only reason insurance companies want to include these alternative treatments is to increase premiums. They really don't care if it actually works. Just read the fine print on benefit coverage for these services. The carriers can and will manipulate things so they don't have to pay.
Posted by: Parse | July 24, 2009 1:27 PM
Tell me about it. At my job, we're in the process of implementing an FSA plan. Seeing what covered and what isn't makes my inner scientist cry:
Covered ("If Conditions are Met"):
- Acupuncture
- Alternative Remedies
- Cayenne Pepper
- Chinese Herbal Doctor and Herbal Treatments
- Chiropractors
- Christian Science Practitioners
- Eggs / Embryo Storage
- Holistic or Natural Remedies
- Massage Therapy
Not covered:
- Anything for 'General Health', including gym fees.
Whatever happened to "ounce of prevention / pound of cure"?
Posted by: Rev. BigDumbChimp | July 24, 2009 1:28 PM
http://www.youtube.com/watch?v=HMGIbOGu8q0&feature=player_embedded
Posted by: inkadu | July 24, 2009 1:30 PM
In the 90's I worked at a marketing department of an insurance company. They wanted to offer alternative-to- medicine not because they thought it worked or because it saved money, but because it tended to attract a younger and wealthier (and therefore healthier) demographic.
Placebo therapy has probably gotten popular enough across demographics that the reasons have shifted.
Posted by: tsg | July 24, 2009 1:35 PM
That certainly isn't true of my doctor. And if it's true of yours, then you need a new doctor.
That isn't what the placebo effect is, and certainly not why they use it for double-blind studies.
Posted by: tsg | July 24, 2009 1:37 PM
In their defense, it may have a lot to do with the fact that most people who pay for a gym membership stop going after a couple of weeks.
Posted by: Lynna | July 24, 2009 1:38 PM
SC, OM @14: To add to the Gupta video, here's David Lynch and John Hagelin discussing the "science of consciousness" and world peace. "Technology" and "Science" as buzzwords.
http://www.youtube.com/watch?v=bC_hXwdCf-A
And here's Hagelin on quantum physics and biology/health/neurology (among other subjects): http://www.youtube.com/watch?v=OrcWntw9juM
And here is a story about Harkin visiting Maharishi Vedic City:
http://www.globalgoodnews.com/government-news-a.html?art=11001119023678394
Connecting the dots.
Posted by: Marcus Ranum | July 24, 2009 1:39 PM
how come so many Mercans are in poor shape?
Compared to, what? Compared to 200 years ago, we're doing great. Compared to a few decades ago, we're doing better.
Or by "poor shape" do you mean 'dying'? Everyone is, always, dying. It's a question of putting it off for a good long time, and we're doing pretty well in that department.
Posted by: Sven DiMilo | July 24, 2009 1:40 PM
tsg: thanks for the informative reply.
Posted by: Lynna | July 24, 2009 1:41 PM
I'd like to see independent tests confirming the ingredients of ayurvedic herbal medicines. Some of the sources are in India, and I'm thinking there may be more than a "does no harm" issue here for alternative medicine. One would expect fluctuations in the amount of active ingredients, but what about accidental inclusion of harmful substances? I looked for a few minutes online, but couldn't find anything but guarantees of "purity" from the sellers. Anyone know of any independent analysis of ingredients?
Posted by: Dr P | July 24, 2009 1:41 PM
No, this is happening now, with private insurance hopping on board to save a buck;whether its a problem somewhere else with a different sytem is at this point irrelevant.novparl, can you say "nonsequitor"?Posted by: tsg | July 24, 2009 1:43 PM
What were you expecting?
Posted by: raven | July 24, 2009 1:43 PM
One of the reasons patients are flocking to alternative therapies is real simple.
They can't afford real medical care. I think the number of uninsured is 15-20% of the population and going up rapidly. People lose their jobs, can't get coverage because of preexisting conditions, companies are always cutting back or dropping the eligible employee numbers for temps. Copays go up, employee contributions go up, coverage goes down, and even the insured end up spending a lot more these days.
At some point, some cheap supplements that might work but probably don't or some quack therapy becomes more affordable.
The problem with evidence based medicine isn't that it doesn't work or the demand isn't there. We can't pay for it very easily anymore.
Posted by: Marcus Ranum | July 24, 2009 1:43 PM
I have an idea: we would save even more money by not treating illnesses at all!
Isn't that how acupuncture got its second wind? When Maoist China realized that they had no medical infrastructure for the masses, it was politically expedient and cost-effective to "let them eat quack" The rich, of course, get real doctors and medical care.
When I see the invasion of "complimentary and alternative" quackery into 1st world countries, I wonder sometimes if real medical care will eventually be something that's only available for the wealthy or powerful.
Posted by: 386sx | July 24, 2009 1:44 PM
I'm sure the alternative therapies won't raise their prices when they see all that money coming their way. More money means lower prices, of course.
Posted by: Marcus Ranum | July 24, 2009 1:46 PM
tsg writes:
What were you expecting?
Well, I didn't expect a kind of Spanish Inquisition...
Posted by: icusmiling | July 24, 2009 1:48 PM
Having formerly lived in Iowa for many years, I'm sorry to say that Harkin is not going anywhere, anytime soon. He and Grassley are basically "Senators for life" and are so entrenched that no one wants to run against them. Every election the opposition throws someone in the ring as a sacrificial lamb, but it's accepted that they won't win from the start. And no one from their own party dares challenge either of them.
Unless there is some huge scandal or a retirement, Iowa's senators will be there for a long time.
Posted by: tsg | July 24, 2009 1:48 PM
Nobody expects the Spanish Inquisition! Oh, wait. I was.
Posted by: Marcus Ranum | July 24, 2009 1:50 PM
386sx writes:
I'm sure the alternative therapies won't raise their prices when they see all that money coming their way.
No! NO! Only "big pharma" is in business to make money. All the alternative therapy practitioners accept is donations and the occasional scrap of meat that falls to the floor. Some alternative therapy practitioners survive on pure love and light, alone.
I have a former friend who blows about $1,500/month on acupuncture. To me the most amazing part about the treatment regime is that the acupuncturist manages to convince his sheep that he really gives a shit about them and is just doing it out of the goodness of his heart. He doesn't take Visa or Mastercard, of course - probably because if he takes checks or cash it's harder to track his income for tax purposes...
Posted by: Lynna | July 24, 2009 1:50 PM
PalMD talked about Harkin on scienceblogs earlier. See
http://scienceblogs.com/whitecoatunderground/2009/03/harkins_war_on_science.php
Excerpt:
The "ancient" ways, or "lost over time, but now restored" memes seem to pop up in alternative medicine, as well as in religion.
(quote from http://www.mum.edu/premed/ayurveda.html#top)
Posted by: Paul Lundgren | July 24, 2009 1:51 PM
Harkin isn't the only Iowa jackass in the "hallowed halls." Chuck Grassley, Mr. "Just get a job with the government like me and you'll have health care for life" also needs to be put out to pasture.
And don't get me started on Steve King.
Posted by: Haar | July 24, 2009 1:55 PM
While I agree Tommy Harkin has been flogging the woo a bit more than is good for any of us I know what you're trying to do here PZ. You just want us to run Harkin out of office so your short-tenured senators from MN can more quickly advance in seniority. I will say this in defense of Harkin, though, he serves one of the best rubber steaks you'll ever get at a political fundraiser. And he's from Cumming, and who doesn't love Cumming?
Posted by: stogoe | July 24, 2009 2:00 PM
Harkin's a fool, but would you rather have Senator Steve King? The biggest problem is that there's currently no feasible way to remove a moron Senator of the Slightly-Less-Corrupt Party without basically giving the Insane-Jabbering-Droolmonkey Party the seat for six years. Primaries are basically broken, with the leaders of the political machine in the tank for the guy who already has the job, and without the institutional support the incumbent pretty much has to eat a kitten whole and then poop it out into someone's mouth on live tv to lose a primary.
Posted by: James M Buchanan | July 24, 2009 2:03 PM
here come the public choice issues. A national healthcare plan is a potential bonanza for every interest group that can afford a lobbyist.
you all are fools if you think simply finding a better guy than Harkin will stop this from happening. Its a simple matter of incentives
Posted by: Sastra
|
July 24, 2009 2:04 PM
Sven de Milo #10 wrote:
One problem with doing this has to do with ethics. It would essentially encourage lying.
Consider two models of doctor-patient relationships: the authoritarian 'parent-child' model, and the 'informed consent' model. In the first one, the doctor gives orders, and the patient obeys. In the second one, the doctor gives the patient as much accurate information as they have, and helps them select between treatment options. Virtually every person who embraces alt-med would claim that they want to go with the second model.
But if the doctor is knowingly administering a placebo that only works if the patient believes it will work, that's the paternalistic (or maternalistic) model. Mommy tells little fibs to the kiddies, because the truth isn't good for them. They're happier -- and feel better -- being told sweet little lies. Better a comforting fable, than a hard truth. If it's "for their own good," the lie doesn't count as a lie.
It won't work for the big stuff, or make any real objective difference -- but it will jolly most people along on their perceptions of subjective symptoms, and it is tailor-made for the "worried well." Tell the woman with 'fatigue' and 'aches in the joints' to see a reiki master, he's very spiritual They eat that stuff up, and want to please and be pleased just like with religion. Nine times out of ten, the problems are just old age anyway. Right.
On a case by case basis, most doctors will do a little bit of this, often as a last resort. But as a general health-care model, I think administering placebos is not only dishonest, but dangerous. And regressive. You will never build new and better treatments by working on how you package sugar pills more attractively.
Posted by: Orac | July 24, 2009 2:06 PM
Oh, really? Do tell.
Got any evidence to back that up?
Posted by: Marcus Ranum | July 24, 2009 2:10 PM
The "ancient" ways, or "lost over time, but now restored" memes seem to pop up in alternative medicine
That's because if the "ancient ways" weren't lost for a long time, they'd have to explain why there was no obvious spike in longevity in whichever culture relied on whichever "ancient medicine." That'd be tough, since life-spans worldwide were pretty even until Pasteur. If ayurvedic medicine (Motto: "showing no effect since 300BC!") worked, don't you think everyone would have noticed that the Indians were outliving the rest of the world by a dramatic margin?
I posted this observation in Orac's blog (regarding acupuncture) and got several angry Emails from woo-woos, and even a phone call at home. Nice! Some of the counter-arguments were:
- Now that we have a bacterial model of infection, Acupuncture is really starting to show its value
- New scientific advances show that chakras/qi are real (which would mean that practitioners admit they had no idea what they were doing for the last 2,000 years and just stuck needles in people at random until MRI was invented?)
- It was lost but now it's found again. (Which doesn't explain the current lack of obvious survival value in ayurveda, acupuncture, or whatever when stacked up against evidence-based medicine)
One fun thing to do is ask a woo-woo what the relationship between qi and ayurvedic marma is, and why you put needles into qi versus applying pressure to marma. If they commit to the notion that both are somehow involved with "life force balance" you can point out that claims for qi and marma contradict eachother about where the vital centers actually are, i.e.: at best, only one can be right. Another is to ask the woo-woo if they believe in reflexology. If they do, stomp on their foot and run off laughing.
Posted by: Marcus Ranum | July 24, 2009 2:14 PM
Addendum to my previous: one woo-woo asserted that life-spans regularly exceeded 100 years in ancient China. I was quite nonplussed by that one; how do you refute it? It says so in a book.
And, of course Methuselah lived 900 years. Probably all that reiki.
Posted by: AJ Milne | July 24, 2009 2:24 PM
I must confess this does make it sound like a career choice with some rewards, anyway...
'So, you say you believe this stuff? Great... Just great... Sign here... Aaaaand let me just get some extremely long, sharp, steel needles out... Oh, hey... I'll be a sec... Looks like I gotta sharpen some of 'em again... Ancient wisdom sez I gotta do this, honest...'
(/Does this make me a bad person?)
Posted by: Sarah | July 24, 2009 2:34 PM
I voted for him in 2008, even though I didn't know then that he was so into alternative medicine. Harkin's position on this issue is bad, but overall, I agree with most of his views. He's pro-choice, pro stem cell research, and he doesn't support overturning our new law legalizing same-sex marriage.
Considering all this, I'll allow him to hold his crazy alternative medicine views with only minimal eye rolling. After all, the Republican candidate would have surely turned into a Chuck Grassley Jr. We don't need another one of those.
Posted by: Joe | July 24, 2009 2:39 PM
re: "Medicines do more harm than good"
Here's some anecdotal supporting evidence for this statement. I had a roommate who contracted pneumonia. He had chest xrays and an MRI to get a diagnosis. He took a cycle of antibiotics, and now he's dead. Oh, wait, the other one. He's fine now and is playing on the football team.
Although it's admittedly anecdotal, everyone I know that has been treated has been treated (and healed) with medical science. My mother with a kidney stone. My grandfather with prostate cancer. My other grandfather with knee replacement surgery. And a half dozen or so family members with diabetes. A good number of the people I know would have been dead had it not be for real medical treatment instead of some overpriced placebo.
Posted by: raven | July 24, 2009 2:42 PM
In the 1900's the US average lifespan was 47. Death was common particularly among children who would die of Scarlet fever, TB and diseases that most have never even seen.
Now it is 77. Three decades longer. Much of this is attributable to antibiotics and vaccines. Half the people reading this blog probably wouldn't be alive without modern medicine.
It works. We just don't have the historical memory or control group to put it in perspective. Try Afghanistan. Average lifespan is 44 years and going down.
Posted by: David Wilford | July 24, 2009 2:44 PM
"here come the public choice issues. A national healthcare plan is a potential bonanza for every interest group that can afford a lobbyist."
We already have Medicare as a model for dealing with such public choice matters, so it doesn't seem that scary. And private insurers/HMOs have also had to deal with them. Those paying into whatever system there is also have an incentive not to pay for care of dubious worth.
Posted by: Marcus Ranum | July 24, 2009 2:46 PM
AJ Milne writes:
Aaaaand let me just get some extremely long, sharp, steel needles out...
They're available really cheap on Ebay. That's where I got mine. I also got a chart that I could hang on the wall, but it's in Chinese and I can't read it. But WTF; it's all wrong anyway.
It was cool playing with the needles; they are incredibly thin and are slightly squared-off at the end. So if you spin them and press, they drill right through flesh quite easily. I put one needle 1/2" into the ball of my thumb with no pain at all - it was freaky, really. The reason I wanted to try was because I had wondered about the alleged "it doesn't hurt!" aspect of acupuncture. I theorized that a thin needle could be placed where it didn't hit a nerve, and I was right. As you search for where to drill, you instinctively shift away from places that give a flinch response - I'm sure acupuncturists learn how to do that, too. The needles are so thin that the wounds close up instantly and leave only a tiny red mark that fades in a few hours.
It supposedly takes skill and training for an acupuncturist to insert needles without pain and bleeding. My observation is that ignorance and a couple beers can do it just as well.
Unfortunately, my self-acupuncture didn't work: I am still an asshole. I'd hoped it'd cure me.
Posted by: David Wilford | July 24, 2009 2:48 PM
FYI, Harkin was the Senator most responsible for the enactment of the Americans With Disbilities Act back in 1990, which has improved the quality of life for many disabled Americans. That he is partial to some woo is unfortunate, but Harkin is still one of the good guys.
Posted by: BeamStalk | July 24, 2009 2:51 PM
@40 - Yeah just look at Zicam... Oh wait nevermind...
Posted by: MikeDaniels | July 24, 2009 2:57 PM
From the article:
I'll be the first to object to homeopathy and the like, which have no proven effects whatsoever. But what of these?
If I were a massage therapist or counselor, I'd be mighty pissed to be lumped in with crystal healers and gong-whackers as "alternative".
Posted by: Hypocee | July 24, 2009 3:02 PM
It's OK, nobody can afford insurance and we're all going to lose our jobs anyway.
And a few people here need a trip to http://www.whatstheharm.net
Posted by: Marcus Ranum | July 24, 2009 3:06 PM
For example, acupuncture has proved beneficial to reduce nausea from chemotherapy, according to the center’s co-clinical director, Dr. David Rosenthal.
...What he carefully left un-said was that acupuncture performs as well as a placebo.
Posted by: scooter | July 24, 2009 3:06 PM
This would explain why arch Conservative wingnut, Orrin Hatch is keeping an 'open mind' on reform.
Those kooky Mormons make a fortune selling remedies, jittery herbal stimulants, suppliments and snake oil to easy white trailer-hippy marks
Posted by: Tim | July 24, 2009 3:16 PM
Okay, I've refreshed twice. If this double-posts...
@#2 Don't forget that Palmer started chiropractic in Davenport and Harkin is well loved in the Quad Cities. And to think, he married a Minnesotan...
@#31 I'm from Iowa formerly, and I too think that Grassley and Harkin are too entrenched in Iowa politics. They're pretty much gimmes, unfortunately. It's like they know not to challenge each other...
@ PZ- I always find it refreshing to see a Dem take on a Dem (or a Repub take on a repub) instead of just apologizing for them. I know you're never afraid to do this, so it's not anything new, but it still seems to be unique in society as a whole... Glad that reason still beats partisanship in some arenas.
Posted by: Mary Q Contrary | July 24, 2009 3:26 PM
Iowa is home to Palmer College of Chiropractic. Ground zero for that particular woo. We have a lot of Palmer-educated chiros voting here in eastern Iowa. I don't hold out much hope.
Posted by: SC, OM | July 24, 2009 3:30 PM
Zelaya is walking into Honduras!
Go to my blog for the link to watch live on Telesur!
Posted by: the pro from dover | July 24, 2009 3:33 PM
Why health care reform is going to fail in the USA. There is a paradox in American health care that must be answered. Why do wealthy people from all over the world come to the USA for heath care if our health care system is so bad? This is usually demonstrated by statistics of life expectancy and infant mortality. It will not be possible to provide even near to universal coverage without restrictions to access (read rationing) unless the core causes of our excessive costs are addressed. Eliminating bonuses to insurance company executives is the ultimate in bandaids-on-the-brain-tumor solution. These causes are: defensive medical practices, futile end-of life interventions, higly desirable but none-the-less elective procedures that improve "the quality of life" (a unique American concept) without impacting life expectancy and infant mortality, and the relentless product of unfettered entrepreneurship to create, fill and expand medical markets and make them the standard of care. In fact we have a medico-legalo-consumero-victimo-celebrity advocateo-pharmaco-technico-insuranceo-investoro-educationo-alternativeo-ancillaryo-complementaryo-mediao-marketo-entrepreneurial comlpex that will not stand to see any of their portion of the pie reduced and will push for even more diagnostic entities requiring intervention than are already present. Most countries ration patient autonomy, physician accountability, and entrepreneurial medicine in some way to control costs. Wealthy people know this and come here because we have what most people want: unrestricted access to the most expensive and spectacular interventions ever developed. In fact it is easier to get an MRI than a pap smear most places here. In the end what is needed are outcome studies to tell what really works on a statistical basis, but as long as testamonials rule in our scientifically illiterate society, this will carry little weight. My estimation of the cost of universal healthcare with no fundamental change in our delivery system (such as using primary care instead of narrowly focused technical interventionalists for all problems) 35-40% of our GNP. Back to life expectancy. I would guess that we're really good at getting 70 year olds to 85 but bad at getting 10 year olds to 25. All the healthcare coverage in the world isn't likely to help this. The reasons?? gunshot wounds, Vehicular accidents and military conflicts.
Posted by: Attila | July 24, 2009 4:03 PM
I haven't done much with acupuncture needles, but have played with putting 21 and 27 gauge hypodermic needles through the skin. Those do hurt and definirly produce a fun endorphin response for the victim.
Posted by: SC, OM | July 24, 2009 4:11 PM
If you're interested but can't get through to TeleSUR via the link at my blog, try this one (you might have to wait a minute):
http://bit.ly/7bq3u
(They're also having a strange echo problem.)
Posted by: Sastra
|
July 24, 2009 4:16 PM
Marcus Ranum #48 wrote:
Try coffee enemas. A lot of assholes find that, after inserting a little coffee in the morning, they're better.
from the article:
"Integrated medicine" is a bit like "theistic evolution." People may like it, but we all know which part is doing all the real work.
MikeDaniels #51 wrote:
This is their standard tactic. Alties try to re-appropriate perfectly reasonable practices (massage, exercise, diet, tested herbs) which have long been part of standard medicine, and label them "alternative." The goal is to piggy-back the worthless nonsense to legitimacy on top of therapies which have demonstrated value.
To carry the analogy with religion along, it's like claiming that "morals and meaning" lie in the domain of religion. Pulling a fast one.
Posted by: j Dubb | July 24, 2009 4:16 PM
Tophe (#12), you know who wrote that famous Theodoric of York sketch? I'll give you a hint: he's now a Senator.
Posted by: mothra | July 24, 2009 4:35 PM
"The quacks are cheering him on, too — every naturopath, homeopath, acupuncturist, crystal healer, shaman, meditator, and iridologist wants their slice of that great big health insurance pie."
What about the sociopaths? Oh wait, never mind.
Posted by: Kagehi
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July 24, 2009 4:37 PM
lol Yeah. Here that argument all the time. And, no, what is needed isn't a bunch of studies to determine what works best, to lower costs. That just isn't feasible, since it drops all the oddball cases through the gaps, who **need** the specialized stuff that only works in 10% of cases. We can't just slap someone in one machine and determine everything (or even most) of what is wrong with them. You could treat 4-5 conditions that all look serious, but are "triggered" by some underlying genetic condition or infection you missed, and if its rare enough... not doing one of those expensive, and less "overall" effective tests could blind you to what is really happening. It turns medical care into modern car mechanics, or electronics repair. Who gives a crap what is really going on, just start replacing parts and sensors, until the problem seems to go away. If the problem is some underlying design flaw, and it went away because your "test conditions" altered to state enough that the problem didn't appear, you will never know, until the next time it comes up to be fixed, with the same damn problem, and you fix it the same way (only, you didn't fix it the first, second, or 50th time). We can't afford that kind of sloppy BS with human health, so lowering costs via studies to determine which things we should and shouldn't do, based on cost analysis... As a potential patient, screw you!. lol
But, seriously, I wish morons, most of them, as usual, Republican, would stop using the argument that we have the best (in theory), so we don't need to change anything (in practice). Its stupid, for the same damn reason that Germany makes Porche racing cars, but ***most*** people in Germany drive:
VW Golf, VW Passat, BMW 3er, Opel Astra, Audi A4, VW Touran, VW Polo, Audi A3, Ford Focus, etc. Just listing some I found with a quick google.
It doesn't frakking matter if we have the best medications, the best equipment, and the best knowledge, if a) the best medications are not what the average person is getting, b) the best equipment is found *only* in 2-3 hospitals in the country, where they test/train for the things, c) the best knowledge can *only* be found at that same tiny number of places, and d) the only way in hell you can get into one of them is being *rich*, *local to the hospital*, or *lucky enough to be in the city when you got the diagnosis. But, the rich political idiots don't quite grasp this.
And, it doesn't matter if you are talking about some new technique or widget that 90% of the country hasn't even heard of yet, and the people that have don't *quite* know how to use effectively yet, or something common place, but so expensive that 60% of the hospitals don't have one, the problem isn't that they exist, or they may be effective only in a narrow number of cases, or that its expensive, its that *most people will never see one*, sometimes even if they *can* afford it, while the rich people will go looking for the damn things every time they stub a toe (which hardly gives anyone a huge incentive to lower the cost to where other people can afford them).
There is no paradox. No more so that that someone can work in a designer clothing factory, but buy all their *own* clothes at K-Mart. Its just the reality of how much things cost before you have knock offs and/or cheaper, and one hopes, better versions, which everyone can get at. Its expensive to provide the "best" of anything to people, so only those that can afford it, get it. And, invariably, the rich are all Marie Antoinette types, too stupid to figure out that, "If they can't afford an MRI, let them have an NMR!", or some similar BS, makes about as much sense as her proclamation that, "If the people are starving, then let them eat cake!"
Posted by: TitforTat | July 24, 2009 4:45 PM
#51
I'll be the first to object to homeopathy and the like, which have no proven effects whatsoever. But what of these?
If I were a massage therapist or counselor, I'd be mighty pissed to be lumped in with crystal healers and gong-whackers as "alternative".
Im curious, is all spinal manipulation useless? Is the same true for all acupuncture? Has there not been proven some benefits from some of these alternative therapies. As a Massage Therapist I believe its important to know what your scope is and where it can be effective. Alternative therapies may not work across the board, but does that mean they should be eliminated totally?
Posted by: Fallsroad | July 24, 2009 4:47 PM
This is really sad. Harkin has been a friend to working people all of his political career, taken many very unpopular but useful positions, and done some really great work.
To find him injecting this sort of woo-advocacy into the health care reform process is nauseating to behold. It is counter-productive to good health, which is allegedly what this massive bill is suppose to be about, and it encourages an irrational belief in alternative medical therapies that remain proven useless.
Wow. I like Harkin, met him once (he bought an amplifier from me - he's got good taste in audio gear), and admired him for many of the things he has tried to accomplish, but this kind of wrecks all of that.
Posted by: Michael Simpson | July 24, 2009 4:51 PM
I think Tom Harkin is annoying, but he's still a liberal. Like a lot of liberals, he believes in the alternative medicine crap, which makes no sense. Remember Creationism=Alternative medicine=Alien abduction from a scientific point of view. If science had a point of view, which it doesn't.
Posted by: Fallsroad | July 24, 2009 4:54 PM
I think Tom Harkin is annoying, but he's still a liberal. Like a lot of liberals, he believes in the alternative medicine crap, which makes no sense.
I'm a liberal, and I don't believe in this crap. Most of my extended family are liberals, and none of them buy this garbage either.
Bill Maher is a quasi-libertarian, and he does believe a lot of this crap. So much for your theory.
Posted by: Scott P. | July 24, 2009 5:14 PM
Given this post, I thought it would be good to link to the odd story of Serbian war criminal Radovan Karadzic's strange second life as an alternative medicine practicioner:
http://www.nytimes.com/2009/07/26/magazine/26karadzic-t.html?pagewanted=1&_r=1&ref=magazine
Posted by: Lynna | July 24, 2009 5:21 PM
Scott P. @69: Ha! That photo of the guys holding "neutralizers" over the heads is classic! Looks like the Serbs have a war against irrationality to fight within their own ranks.
Posted by: Tophe | July 24, 2009 5:28 PM
No, I knew he wrote for SNL, but I didn't know he wrote the Theodoric skits. Too cool!
Posted by: Rev.Enki | July 24, 2009 5:57 PM
Well, Harkin's Republican opponent last cycle was a man (Christopher Reed) who, during a televised debate, called him the "Tokyo Rose of Al-Qaeda and Middle East terrorism" and declared that Harkin was "anti-american". In another incident, he wrote in a blog post about Harkin that said he "wants marriage to be between any 2, 3 or multiple people of any and all sexes. Heck, as far as he is concerned, you could marry your horse if it makes you happy."
Posted by: defective robot | July 24, 2009 6:04 PM
...did nothing at all!
Oh wait, that would be the same thing as Harkin is proposing, wouldn't it?
Posted by: Gold Dragon | July 24, 2009 6:16 PM
http://www.youtube.com/watch?v=HMGIbOGu8q0
Homoeopathic ER
Posted by: Gold Dragon | July 24, 2009 6:21 PM
http://www.youtube.com/watch?v=Xfqht0LEOWQ&NR=1
Posted by: amphiox | July 24, 2009 6:43 PM
There shouldn't be a distinction between "mainstream" and "alternative" medicine. The only distinction that matters is "medicine that works" and "medicine that doesn't work".
So called "integrated" therapies, if they work, whatever their providence, are part of regular medicine (or should be).
For example, if chiropractic for short-term pain relief of mechanical low back pain works (and last I heard the most recent data says that it does), then chiropractic for mechanical low back pain is not alternative medicine or mainstream medicine, but simply, medicine, and if acupuncture for chemotherapy induced nausea really is effective, then it too is not alternative or mainstream medicine, but just medicine.
As for the placebo effect, some of it might have something to do with the psychology of believing one is being treated, etc, and require deception to work, but the rest of it, and probably most of it, is simply natural history of the disease and the resilience of human physiology. In short, some people simply will get better on their own, no matter what you do to them, whether you give them a sugar pill or a pat on the back, or exorcise their demons, or even flat out tell them they're doomed and should get their affairs in order.
Posted by: amphiox | July 24, 2009 6:52 PM
One of the most egregious things that "Big Pharma" has a tendency to do is to take a drug that is already known to work, but is either owned by a competitor, or public domain (say, such as omeprazole), for which all the hard work and cost outlay has already been done, do some minor insignificant chemistry to alter the drug, just a little bit, sticking a methyl group or some other moiety onto the compound at some insignificant place that doesn't alter the active site, give it a new name (say, nexium, as a hypothetical example), then fund a study to demonstrate some statistically significant but biologically not so relevant difference between the new drug and its older parent, allowing them to get approval to market it as a "new" drug, which of course they charge at least twice as much for.
Then they go on a marketing blitz, targeting primary care physicians and the general public, and generate a preference for the newer, shinier version of the drug (who wouldn't want the most recent version?).
They get to generate massive profit for minimal cost this way. It's not unlike Windows Vista and Windows XP.
Posted by: Jake | July 24, 2009 7:18 PM
Once again you lump meditation in with the rest of the quackery. Have you looked at this PNAS paper:
http://brainimaging.waisman.wisc.edu/publications/2007/Brefczynski-LewisNeuralPNAS.pdf
or this PLoS paper:
http://brainimaging.waisman.wisc.edu/publications/2008/LutzRegulationPLoSONE.pdf
Have you decided meditation is worthless while ignoring evidence from highly respected peer reviewed journals? Or conceivably you've read the papers but don't find them compelling? If so why? If you can't offer arguments against these papers but persist in describing meditation as pointless along the lines of crystal healing and such, you are making yourself vulnerable to a criticism that has been levied against you, previously without merit: that you are a fundamentalist in your own right, not truly responsive to the facts.
Posted by: hje | July 24, 2009 7:57 PM
He's long been big on alt meds and food addtives BS. I wish we could find his replacement--but for now somebody has to cancel out free-Tweetin' Grandpa "NOT A NAIL" Grassley's votes. Most irritating: Harkin/staff never responds to my letters, but Grassley & Co. always do (even if their illogic is stupefying). Plus Grassley has some sense of humor-such as, "Conrad looks shocked and laughingly replies, "I used to like you [Grassley]," before saying, "Oh, you are good. Without missing a beat, Grassley responds: "Your wife said the same thing."
Posted by: Scott P. | July 24, 2009 8:04 PM
For example, if chiropractic for short-term pain relief of mechanical low back pain works (and last I heard the most recent data says that it does), then chiropractic for mechanical low back pain is not alternative medicine or mainstream medicine, but simply, medicine, and if acupuncture for chemotherapy induced nausea really is effective, then it too is not alternative or mainstream medicine, but just medicine.
If the chiropractor insists that pain relief is caused by 'unblocking energy flow' and the acupuncturist that he is helping free the 'chi lines' then yes, it still is woo. If your whole theory of applying the therapy relies in a foundation known to be false, that can't help but hinder any therapeutic effect, not to mention the scientific understanding of why it might work and how to make it work better.
Posted by: Rick Schauer | July 24, 2009 9:30 PM
Rev. BDC @ #17
That video: priceless! Side-splitting ROTFLMAO!!!
Posted by: Rod | July 25, 2009 12:04 AM
It's hard to give up on Harkin (I live in Iowa). He has done much good, including co-sponsoring the ADA, which benefits my disabled daughter. He may be a little loopy these days, but I believe he tries to advocate for the best for his constituants.
Makes me sad to think he is likely past his best days.
Posted by: Dan W | July 25, 2009 12:31 AM
Harkin may be accepting of some woo, but he's not too bad compared to some politicians from Iowa. Grassley's pretty bad, and I'm convinced Rep. Steve King is completely insane. Unfortunately, one of the two western districts keeps re-electing that loon every couple years. Fortunately, the three other districts have considerably better representatives in office.
Posted by: tsg | July 25, 2009 2:31 AM
"There's no such thing as 'alternative medicine'. If it works, it's medicine. If it doesn't, it's not."
Posted by: Gilian | July 25, 2009 6:33 AM
*Why do wealthy people from all over the world come to the USA for heath care if our health care system is so bad?*
Because wealthy people going to private clinics does not equal a good general health care system.
Now if the poor people from all over the world came over to the USA for the health care you might have had a point.
Posted by: Hypatia's Daughter | July 25, 2009 8:39 AM
The dirty little secret is that Americans also go to OTHER countries for healthcare (and not just for the unapproved cancer therapies, etc.)
Twenty years ago, our Canadian doctors began to insist that we had to bring in our healthcards for every visit - despite the fact they had all the info on file - because so many Americans were presenting false ID numbers.
Border hospitals were hard hit because Americans walked in, got treatment (especially obstetrics) and were long gone when the payment refusal came back.
Posted by: Paul A. | July 25, 2009 1:53 PM
I meditate. What is your problem with it? I know some practitioners make outrageous claims such as they can levitate, but all it really does is help me relax and maintain a peaceful state of mind.
Posted by: David Marjanović, OM | July 25, 2009 2:59 PM
Just for the record, I (living in Europe) have got a lot of spam advertizing pharmacies in Canada and Mexico. Clearly tailored to US patients who are not well served by the US healthcare system...
Really, comment 58 is a monument to ignorance and stupidity. Hint: you can't say anything about the relative quality of a healthcare system from a sample size of 1.
Posted by: Rob | July 25, 2009 4:15 PM
Jake:
In defense of PZ, neither of those papers show that meditation is a clinically proven treatment for any specific disorder. They merely show that meditation has some measurable effect on brain activity. Meditation may have some benefits, but insurance coverage should be based on clinically proven treatments for specific conditions, not vague claims or anecdotal evidence.
Posted by: Elayne Riggs | July 26, 2009 10:31 AM
I'm with titfortat, I've derived much greater benefit from massage therapy and physical therapy (with a very educated therapist skilled in lots of different techniques) than I ever did from taking pills. I miss PT. I try to self-administer whenever I feel something in my body's out of whack, but I'm not a trained pro so I don't get nearly as much out of it. Had acupuncture once (again, from the same trained PT) and didn't think much of it, but it doesn't seem all that different from PT involving pressure points. If you push something hard enough, it will fall over -- no, wait, that's Fudd's Law of Opposition. What I meant to say was, if you know the right bits on one's body to push and otherwise manipulate, you can definitely make a difference in that person's physical health, and that's got nothing to do with "woo woo" stuff about energies and qi and so forth.
Posted by: Shawn Wilkinson | July 26, 2009 2:44 PM
Ah yes. The 'free market' version of insurance coverage/HMOs would NEVER lead us to the cheapening of the field of medicine and promote quackery over science. Never...
*rolls eyes*
Posted by: Jake Basson | July 26, 2009 4:21 PM
Rob,
Thanks for the reply. You're right that meditation has by no means been proven to have effects that are beneficial or targeted to a specific disorder. However a) it certainly has been proven to have SOME real effects who importance is under active investigation (those papers were lead by Richard Davidson at the University of Wisconsin, for more on what those effects do mean, check out more of what he's published), and b) I wouldn't, yet, argue that meditation should be part of our health policy. PZ, on the other hand, is lumping it in with the pure quackery of crystal healing, shamans, etc. His attitude is cavalier and dismissive and in direct opposition to his stated position of commitment to the evidence: the evidence suggests meditation is, at the very least, a real phenomenon with real consequences which deserve to be explored.
Posted by: Rob | July 26, 2009 10:58 PM
I personally wouldn't lump meditation in with crystals or qi either. It does seem to be something worthy of further investigation.