I get e-mail.
Often, the e-mail I get consists largely of rants from various cranks about how I am a "pharma shill" and whether I feel any regret over the babies I'm supposedly turning autistic by my advocacy for vaccines. Much less often, I get e-mails praising me for my work. Sometimes, I even get e-mails that tell me that my blogging was the reason someone turned away from the dark side of antivaccine quackery or other pseudoscience. Those e-mails make my day.
I also sometimes get e-mails like this:
I'm in the VA healthcare system in Los Angeles. I had previously read your article about how 'alternative medicine' is creeping its way into the VA system.
I was referred to the "healing touch" "nurse" because an actual physical therapy appointment takes three months to get. At first I thought this was some massage technique and would help relieve some muscle tension in my shoulder. Well come to find out it they put me in a room with traditional Asian-themed relaxation music and enough aromatherapy that I felt like I was in a nail salon.
She began to tell me how the "energy of the universe" flows through her hands and because of her touch, many many people have had their lives changed. So I guess sort of like the television church shows but this is taxpayer money.
After about 5-10 minutes of anecdotal stories and claims that there have been "studies" that this works, she proceeds with the "treatment" which basically involves her putting her hands on me and saying she is "feeling" that I have had pain in areas. She goes down a list of stomach, leg, back, neck, headaches, anxiety, etc. saying she can "feel this." More like she can read my VA file which is in the computer. Even then she is 50% correct about my problem areas which I can also replicate with a coin toss.
At the end she asked me how I felt and I told her I felt the same. Then she said that it's a "cumulative effect" and that the "healing energy" needs to build up in my body. "Remember to drink a lot of water for 24-48 hours because the energy is still in your body." Unbelievable! I was polite and smiled, but I wanted to scrutinize this so bad.
Normally you could chalk this up to Los Angeles and how we have this anti-science subculture here, but this is the VA. And tax dollars are paying for it. To add insult to injury, these monies spent on crap like energy healing also make it where I can't get the care I need from REAL doctors and physical therapists due to lack of funding.
Just wanted to give you a first-hand account that this quackery has fully made its way into the VA healthcare system. Thanks for the great website and teaching me a lot about science and medicine that would otherwise be more difficult and less entertaining to read.
Later in the e-mail exchange, he said:
By the way, they are also offering acupuncture at the West LA facility and I was offered this to treat migraine headaches. I told them my concerns (info i got from your site actually) that through studies they found that it's entirely placebo and I was wondering if they had any additional evidence. This doctor, who I actually believe is a real doctor, told me that they had been shown evidence that people felt a lot better. I responded with "Well, it's also been documented that when a doctor asks how your day was and demonstrates they 'care' then patient outcomes improve big a noticeable margin as well. So how is acupuncture different than that?" Her response was something about nerve pathways, etc. At least she didn't tell me something about Chi or I'd go nuts. Again, taxpayer money diverted to quackery instead of things that are proven to help and have science to back it up.
I've written on numerous occasions about how quackery (or, as I like to call it now in the age of Trump, fake medicine) has infiltrated military medicine and less frequently about how the same thing is happening in the VA medical system, but there's nothing like an actual personal anecdote to make it really real to me, which is exactly what this anecdote did. Healing touch is a form of "energy medicine." In contrast to reiki, where the reiki master claims to be able to channel "healing energy" into the patient from the "universal source," practitioners of "healing touch" claim to be able to manipulate the patient's "energy field" to produce healing and/or relieve symptoms. I approach these stories from the viewpoint that our veterans deserve the best medical care available, and that that medical care is science-based medicine. "Complementary and alternative medicine" (CAM), "integrative medicine," or whatever the nom du jour is for the quackery masquerading as "wellness" or "holistic medicine" that is currently infiltrating civilian hospitals as renowned as The Cleveland Clinic should have no place in military medicine or the VA either.
In other words, our veterans deserve real medicine, not fake medicine integrated with real medicine.
Spurred by my reader's anecdote, I did a bit of Googling. In addition to finding the usual stuff, such as a VA web page about CAM use for post-traumatic stress disorder (PTSD) that says that there's only "limited evidence about the effectiveness of CAM as a treatment for PTSD" but notes that "89% of VA facilities offered CAM and 1% were in the process of developing CAM programs" and that a recent survey of all 170 specialized VA PTSD centers showed that 96% of respondents offer CAM for PTSD.
Then there was this gem of an article published last year in The Journal of Alternative and Complementary Medicine by a couple of heavy hitters in the world of integrating quackery into medicine, including Richard C. Niemtzow MD, PhD of the U.S. Air Force Acupuncture and Integrative Medicine Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD, as first author and Wayne B. Jonas, MD of the Samueli Institute as well. We've met both of them before, particularly Dr. Niemtzow, who is best known for wanting to bring acupuncture to the battlefield. (No, I'm not making this up.) Jonas, of course, is the President and CEO of the Samueli Institute, one of the foremost proponents of integrating fake medicine into medicine.
Along with the usual drivel about how acupuncture is ancient and effective (it's neither), Niemtzow et all note:
Acupuncture is well known in Eastern cultures for its analgesic benefits. Many medical practices in Western countries have focused not only on this modality but on other integrative approaches to combat pain. As addiction to prescription opioid medication is skyrocketing in the United States, Western physicians are rapidly exploring the benefits of acupuncture for the relief of pain. In particular, BFA, which uses a specific sequence of five ear points for rapid pain relief, is the most popular and “go-to therapy” utilized by military medical acupuncturists around the globe. This is because of its history of providing rapid, safe, and effective pain relief in wounded warriors over many years. As a consequence, and also influenced by the APMTF, a $5.4 million DoD–VA Joint Incentive Fund (JIF) project—“Acupuncture Training Across Clinical Settings (ATACS)”—was funded by the DoD–VA Health Executive Committee in April 2013. The ATACS Program provides BFA [battlefield acupuncture] instruction to DoD and VA healthcare providers (HCPs) and gathers relevant information to ascertain its impact on pain and, in particular, its ability to reduce opioid use.
Successful implementation of an IM [integrative medicine] program by any healthcare system requires a disciplined multistep process. The first step involves selecting a modality that is evidence-based, safe, and has the potential to demonstrate its value in achieving desired outcomes. Selection of appropriate modalities may be ascertained by a combination of a review of available clinical trials, published literature, and/or by empirical clinical experience. Such was the argument for BFA. A second key step, particularly in a large and/or complex healthcare system, is to ensure that HCPs receive a systematic and standardized training program from experienced and well-qualified instructors. This is particularly critical when rolling out an IM modality, for which practitioners may have never been trained.
See what I mean? There is an active effort to train HCPs in the VA in acupuncture and to promote fake medicine under the guise of real evidence-based medicine. As much as advocates claim that acupuncture is evidence-based, it's just not. It's a prescientific medical modality that is rooted in vitalism and nothing more than a theatrical placebo, with the "best" clinical evidence indistinguishable from the normal "noise" in clinical trials that occasionally produces false positive results. Of course, CAM advocates don't like it when it is pointed out that acupuncture is fake medicine. Unfortunately, because acupuncture involves sticking needles into the skin, many physicians think there might be something to it, leaving aside all the mystical mumbo jumbo. Certainly, a decade ago I was in that group. Heck, even someone I admire as much as Paul Offit fell victim to the acupuncture narrative in an otherwise excellent article on quackademic medicine by seeming to argue that it is more than a placebo and citing the "endorphin" explanation, even as he got it right that it doesn't matter where you stick the needles in or even if you stick them in. That's how powerful the narrative can be.
Reading e-mails like my readers angers me. Remember, the reason he was referred to a "healing touch" quack is because the wait for a physical therapy appointment was three months, which is an unacceptable length of time. In other words, the Los Angeles VA doesn't have enough physical therapy resources to meet the needs of its veterans, but it has energy medicine quacks willing to fill in the gaps. I can't help but wonder if this situation comes as a result of the failure of the federal government to invest enough resources into the VA Medical System. More physical therapists and fewer quacks, I say! Unfortunately, since the VA hired Dr. Tracy Gaudet as director of the VHA’s Office of Patient Centered Care and Cultural Transformation, fake medicine has become increasingly entrenched (or should I say "integrated") into the VA. Naturopaths are even now lobbying to be employed by the VA. Nothing has come of their efforts that I'm aware of thus far, but if there's one thing I know about naturopaths, it's that they're persistent. They'll keep trying.
With all the problems the VA health care system has, shortage of resources and long waits have always been among them. Unfortunately, in response to the shortage of real medicine, the VA seems to be taking a page from the Mao-era Chinese playbook and trying to "integrate" fake medicine with real medicine to paper over the problem.
Our veterans deserve better.
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Your correspondent has every right to be unhappy about the state of affairs. "Healing touch" is so obviously ridiculous that a then nine-year-old girl saw through it, did a study as a science fair project, and got the study published in a leading medical journal. Why are we spending taxpayer money on such nonsense, especially when doing so prevents our veterans from getting real healthcare?
Doesn't this sound like China in the 1950's? Too poor to provide real medical care, that government fobbed off the peasants with minimally-trained practitioners of traditional Chinese medicine. The present-day VA, too poor/understaffed to provide timely physical therapy, fobs off the veterans with minimally-trained practitioners of hand-waving, er, therapeutic touch.
Successful implementation of an IM [integrative medicine] program by any healthcare system requires a disciplined multistep process. The first step involves selecting a modality that is evidence-based, safe, and has the potential to demonstrate its value in achieving desired outcomes. In other words, send in the clowns, starting with long-nosed ones first.
Talk about a nightmare of Fractured Fairy Tale! Like so many other products from China, such as the fake parts installed in U.S. Air Force jets, the fakery of acupuncture and other pseudoscientific nonsense parading as medicine is placing the health of America's military personnel at serious risk. Not a dime should be wasted on any of it, unless the expense is for its outright ban and removal. And naturopaths? I wouldn't trust anyone of them to apply a bandage, let alone treat a veteran. But it's not just the veterans; we all deserve better and effective treatment.
Is there any reason, any at all, while the “richest, most powerful nation on earth” (as we so often hear) cannot fully fund the VA? I really would like an answer to that one, especially given that every politician wears a flag on the lapel these days--even before the current clown act.
What’s most disturbing about the veteran’s letter to you is that the doctor defended the acupuncture with the “nerve pathway” nonsense. Doctor’s need to know better and get off those fences they’re perched on.
“richest, most powerful nation on earth”, not anymore.
Maybe in a few years, they'll get real medicine.
@darwinslapdog: It's because many of the politicians who wear those flag pins on the lapel are only doing it for show; they don't really care about the soldiers. It's hardly a new phenomenon:
What frustrates me is the VA's funding problems are inflicted by Congress. They keep cutting the budget and failing to fund mandates. Then they blame managers who try to make Congress thing everything is OK when it's not . . . .because of Congress!
That's because Paul Ryan would like to privatize the VA just as much as he wants to privatize Medicare. So when the VA "fails" because Congress doesn't fund it, he can claim the VA is "broken" and the only way to "fix it" is to privatize it.
Which is not what our veterans want. They like the VA and want to keep it.
As a nurse and a veteran this infuriates me.
I'd love to know what this "therapist" was paid. A local children's hospital has a kook doing this in the hospital but at least there is no charge for her quackery.
I wonder how long it'll be before "Asian-themed relaxation music" is mandated in the O.R. (I've heard various music being played in there, but none devoted to enhancing Healing Energies).
As far as cancer centers/institutes go, are there any otherwise respected ones that do NOT promote some form of this nonsense (i.e. healing touch, reiki etc.)?
It's fairly uncommon. I can say with some pride that the amount of that sort of stuff at my cancer center is much lower than it is at much bigger, more famous centers, like M.D. Anderson and Memorial Sloan-Kettering. There's a smattering of it around, but we have no formal integrative oncology program. That makes me happy. I guess that's one advantage of not being where I am now. However, I'm always waiting, always on my guard that, sooner or later, someone will get the bright idea to set up a formal integrative medicine program here.
Honestly it should be privatized. The problem is when the government is controlling the entire system it becomes easier for lobbyists and special interests, such as alternative medicine groups, to influence decision making that affects the entire nation. Allow competition, and every facility is pushed by competition or the chance of competition to appear to be as effective as possible.
Corollary to that point: laws should exist to declare charging patients for nonscientifically supported medicine as fraud. And the standard for scientific support should be from scientists, not the government.
The Cleveland Clinic is a private institution, and that didn't stop it from fully embracing fake medicine in its Wellness Institute. There is a big private hospital in my area that's done the same. It's arguably easier (and more tempting) for private hospitals to embrace woo because it's seen as a potential profit source, without all that nasty mucking about with insurance reimbursement.
Privatizing the VA would not fix the woo problem. There's an argument to be made that privatizing the VA would have the potential to make the woo problem worse.
A key difference: 1950s China did not have the resources to deploy fully trained doctors throughout the country. Mao decided instead to deploy TCM practitioners in the countryside. There are plenty of reasons to disagree with that choice, but in context I can understand why it was done: better a placebo than nothing at all, at least from a typical patient's point of view.
The US does have sufficient resources to provide adequate medical care to everybody who wants it. The issue in this country is a lack of political will: providing health care costs money, and too many politicians would rather put that money toward reducing taxes for wealthy donors to their campaigns. (There are lots of other things that I would consider better uses of that money than tax cuts for rich people, but I digress.) So the VA gets shortchanged.
Yet here in the UK we have a system which mostly eschews this drivel, because there is a central demand for cost-effectiveness which isn't reliant upon insurance companies' profits. Our system has its faults, as all do, but at least we can all get access to healthcare without having to go bankrupt. There may be regular political interference in terms of emphases of outcomes, but even our current Secretary of State for Health apologised for his personal beliefs about homeopathy once the issue was described to him in full. Can you imagine a Trump appointee doing that?
Privatizing it would work as well as all the other hospital privatizations that have occurred in the US. Costs go up, and profits go up, and care is second place to all of the above. I have issues with the Canadian Health care system (Too much administration and not enough physicians, Provincial in-equality in coverage and care, wait times, etc), but for all that, all Canadians are a lot better off than all but the wealthiest Americans. We should have our prescriptions covered by the government as well, but even so, no-one goes bankrupt because of illness. Well no-one who isn't paying for rank BS like the Deathness Centre in Florida or Burchin-ripyouoffs quack centre in Texas.
This pisses me off so much. The VA doesn't have money for PT but they have money for a hand-wiggler?
Story time: For one of my MPH classes we had to design programs to implement in the facilities we work in (it was a program planning class). My partner (VA shrink) and I developed a peer-education program to reduce HepC infection rates among injection drug using vets.
The program we designed was based on scientifically designed programs to prevent HIV infection (called SHIELD), and as it's a peer-education program it would have been relatively inexpensive to implement.
We did a ton of work and research, got a great grade, sent it to his superiors who were like "nope".
No to preventing HepC infections, but they have time for "energy healing"? That's some grade-A BS right there.
I served from 1982 until 2009 and watched the VA budget get cut each and every year, counting the first year of the wars in Iraq and Afghanistan.
I've watched Congress divert money from the VA into private practices, which were utterly unqualified in dealing with veteran specific issues.
I've also watched the VA spend, or I should say waste, millions of dollars in ineffective TENS units, while never having enough flotation beds, requiring a board to approve each patient who could be assigned to one, pressure ulcers not withstanding.
Each and every year, we hear politicians tell us that veterans are number one, but we ignore the fact that it's the third digit being raised toward veterans causes and needs.
We know how this administration feels toward veterans, as quite well illustrated by federal hiring freeze, which will guarantee that the VA medical system remains understaffed.
But, with less people, we'll just get more ineffective woo, rather than real treatment.
In short, SSDD.
Anyone else getting a weird vibe that all this new "Integrative Medicine" is really just old "Paternalistic Medicine" making its comeback in a hip new patchouli-scented coat; much as Post-Modernism proved to be nothing but all the Pre-Modernists exacting their revenge?
Or is it just my chi needing rebalanced again?
I dunno about your chi, but my energy needs replenishing.
Fortunately, the chicken is in the oven, the veggies on the stove and the potatoes will go into the oven shortly.
Hey, food delivers chemical energy to the body. ;)
Eric Lund's post @ #6 reminded me of the song, Brother Can You Spare a Dime. Here's a passage:
Once in khaki suits, gee we looked swell
Full of that Yankee-Doodly-dumb
Half a million boots went sloggin' through Hell
And I was the kid with the drum
Say, don't you remember, they called me "Al"
It was "Al" all the time
Why don't you remember, I'm your pal
Say buddy, can you spare a dime?
@Anonymous Pseudonym #15: A Canadian just sent me a link to an article about the dismal state of affairs in senior care homes in B.C. By allowing private contractors to flip contracts and hire fewer people at poorer rates of pay, the government of B.C. has managed to erode the care of seniors to the point that 90% of facilities now fail to meet staffing requirements. Placing more stress on existing staff while threatening the health of the seniors may be profitable for the scum-bag contractors, but it's a recipe for disaster.
has@18: I'm not qualified to assess the status of your qi, but you may be on to something there. Homeopathy admits to being "only" a couple of centuries old. A lot of the cow pie portion of "integrative medicine"'s cow pie-apple pie blend is claimed to be thousands of years old, even when it isn't (TCM and reiki being two such, "ancient" systems dating all the way back to the 20th century, and in the case of TCM the latter half of the 20th century). What "integrative medicine" and pre-scientific medicine have in common is an emphasis on bedside manner; neither has much else going for it.
No to be crass, if I was offered "healing touch 'therapy'" in a hospital or other medical facility, I would be happy to tell the therapist exactly what kind of touch would make me feel much better, and I would tell the acupuncturist where to stick the needles.
Either of those would make me feel better and raise my endorphin levels.
I was a clerk in a VA hospital in the '70s. The hospital itself looked kind of ugly, but I saw many competent and caring physicians , PAs, and nurses. (The psychiatrists were kind of weird, but the patients loved them.) I used to take my father to an outpatient facility where they offered him care for problems he had never thought about. including PTSD, and two hearing aids and 10% disability for hearing loss due to combat. He was very happy with the care he received there. All this was after the scandals during the Vietnam war when it was clear the VA was operating very poorly, much worse than the recent problems.
I am bothered by what is going on now. The docs I knew there would never have put up with this kind of nonsense.
Lighthorse,that song was a pointed reference to the Bonus March of 1932. World War 1 veterans had been given certificates that would be redeemable in 1945. With the Depression in full swing, many were in dire condition and wanted the payout immediately. Thousands camped out on the Anacostia Flats in DC with their families. President Hoover, running for reelection, wanted to show a firm hand to those Communists (Reds under the bed scares were not invented in the 1950s.),
He gave carte blanche to Army Chief of Staff Douglas MacArthur and his aide, George Patton. MacArthur claimed that they were there to overthrow the government. Those two lovelies went all out - cavalry swinging sabers, tear gas, bayonets. Tanks crushed their tents and shanties which were then burned. There were a few deaths and many injuries. Men who had served under Patton and MacArthur in France were there, and before the assault, some attempted personal appeals to no avail.
It played a significant role in Hoover's defeat that November.
Thank you, ORD, I have learned something new today.
It's great when the government abdicates its responsibilities. There's been a recent report on a nurse at some nursing homes in Wood-stock, Ontario who has been helping the residents off to the nether-realms (http://www.cbc.ca/news/canada/windsor/woodstock-nurse-first-degree-murd…). We have our issues with the Public health-care system, but it is no-where near as dysfunctional as the US system. It's also no-where near as good as the UK's or Norway's medical care. As I mentioned, it's the down-side of it being a provincial responsibility instead of federal.
Some hospitals provide inanities like "Healing Touch" via their chaplaincy/spiritualism programs. That's where it belongs!
Change.org is running a petition in Canada to lower the costs of medications. Here's part of the letter:
Canada is the only country in the world that prides itself on universal healthcare, yet contradictorily does not have universal medication access. Canada has 19 publicly funded drug plans and over 1000 private insurance programs: a fragmented, non-equitable patchwork that leaves many uncovered. We spend 30% more on drugs than nations with Universal Pharmacare programs!
Canadians spend more than $700 US per capita for prescription, non-prescription, and personal health supplies, whereas the average per capita expenditure for OECD countries is $500.
In a recent Angus Reid Institute national survey nearly 1 in 4 Canadians did not take a prescribed medicine because she/he could not afford it. Food and shelter costs undermine medication costs when it comes to day-to-day survival. Inadequately treated chronic disease inevitably decompensates. Hospital admission for acute disease management then culminates in hefty inpatient costs.
Our generic drug prices are dependent on patented drug prices, established as the median of seven comparator OECD nations. This list includes the four places in the globe where drugs are most expensive.
Prices for the same medicines vary depending on province or territory of residence. In order to make drug prices more appealing to provincial and territorial governments, pharmaceutical companies artificially inflate prices to present the government with a “discount price,” whilst channeling the cost burden to third party insurers (10% higher costs compared to government costs) and most significantly to out of pocket purchasers, many of whom are the working poor.
Take the price of the common cholesterol medication, atorvastatin, which is cheapest in Ontario and costs 31 cents. Compare this to that same pill in New Zealand, which costs 2.6 cents!
Thanks for bringing that to light. I wonder if anyone today would dare to re-enact the event in a movie.
If you think that story is worth retelling, look up the Businessmen's Plot of 1934.
Then think about the lengths they were ready to go to, and what is happening in the US today, and how easily it was brought to be.
Heh, Smedley Butler managed to monkey wrench that plan up quite effectively.
@ORD,Wzrd1: The question is, do we have a Smedley Butler today?
Much of Silicon Valley (though not all: Peter Thiel and Uber, to name two prominent examples) is opposed to what Trump is doing. I've seen a secondhand report that Sergei Brin, who came to this country as a Russian Jewish refugee, was among the protestors at SFO last night.
But lots of other money people (e.g., the Koch brothers) are on board, so far, with President Scheisskopf (or, as some others have called him, Dolt 45). And it's an open question which way the US military will go if the feces intersects the rotating blade.
The feces has already hit the rotating blade. CBP is in open contempt of multiple federal courts by refusing access to attorneys to those unlawfully detained in our airports. Contempt filings have been made.
So, we'll end up with federal marshals enforcing the federal court orders, placing the DOJ and DHS into open conflict.
As for the military, their loyalty is to their Constitution and if a Commander in Chief disobeys that Constitution or issues unlawful orders, they'll ignore the unlawful orders.
re 'Dolt 45' ( hah!)
Supposedly he will fix up ** veterans' care by adding private practitioners.
Does anyone imagine that the line between woo and reality will not be clearly drawn in this instance as one does not exist at all in the Dolt himself?
re faeces / rotating blade
Right. It's happening now at various airports.
** more likely, f@ck up
We can settle this with a tennis match (kidding).
But seriously, what is ORAC's deportment like when he is forced to converse with woo peddlers? Does it ever come to blows?
Just curious. I know the language can get kind of heated ,online at least.
Can you post your most negative e-mail?
There is a typo in your first paragraph by the way: "Sometimes, I even get e=mails that tell me that my blogging was the reason someone turned away from the dark side of antivaccine quackery or other pseudoscience."
Now, perhaps "antivaccine" has become a proper word in the blogosphere, but "e=mail" is an obvious typo.
Not a big deal.
Integrative medicine? Let's see what we get when integrating real medicine (☤) with woo (☯) cubed:
∫☯³d☤ = ☹ + C
You see, you get a sad face plus a constant.
This is not good. You don't need to be a Ramanujan or Euler to know this.
Yes, I know that is how it is supposed to work in theory. Also in theory, the US military is not supposed to involve itself in domestic affairs. I see a much-higher-than-I-would-like probability that these two principles will come into conflict sometime in the next four years. What happens then? I'd prefer not to learn the answer to that question, but as the great philosopher Mick Jagger noted, "You can't always get what you want."
Not a theory at all, military officers careers have spectacularly ended for violating the Posse Comitatus Act.
Note the exclusions and limitations.
I agree with the wizard -- but a lot of things that were unthinkable two and a half months ago are no longer unthinkable.
I'll say! First, acting director DOJ is fired for not defending an unconstitutional executive order, now the director of ICE was fired and replaced (even money, the back story will be that the acting director was going to comply with the five different federal court orders to let detainees have access to attorneys, which were ignored all weekend.
Next up, DOJ will refuse to send federal marshals to enforce the orders of the court, perfecting a constitutional crisis via violation of the checks and balances between the judicial branch and executive branch, leaving even Congress' powers undermined.
In the hospital for combat injures located in San Antonio, TX they have booths advocating mindfulness. Again diluting the care received by active duty military. Quackery is so much more cost effective and the army runs on the lowest bidder.
Okay, I know I am really late to the party here, but I wanted to add my experience with quackery in military medicine/the VA. As a medical retiree, I am eligible for both military insurance (Tricare) and VA care. As treatment for chronic migraine, 5 separate neurologists and pain management specialists have recommended Botox, which is now FDA approved for this indication. Neither Tricare nor the VA is willing to pay for it, however, despite it being much cheaper than ER visits, which they would pay for even if I went weekly (despite the fact that ER treatment for migraines is totally inappropriate in most cases). The VA, however, would be happy to let me try accupuncture as part of a pilot program. Tricare is less generous; they have also suggested acupuncture, but at my expense! Sadly, even some civilian specialists have offered accupuncture as a valid treatment, as well. Sigh.
Triptans aren't effective for your headaches?
I've had both Zomig and Imitrex for migraines and they were exceptionally effective on mine.
My wife didn't have quite as good an experience with that class, but ergotimine was effective.
I am surprised at the botox bit though, as it's not exactly an expensive treatment. Did they state the reason for declining that specific treatment, such as calling it experimental or claiming a lack of efficacy?
Unfortunately, triptans work for me moderately well, but using them as frequently as I have migraines would lead to rebound headaches (they are often worse than the original!) and deleterious cardiovascular effects.
VA's denial of Botox is done with "we don't do that here" and ignoring further inquiries.
Hilariously, while I was still in the Army, the neurologist at Walter Reed told me with a straight face that they had found Botox to be ineffective for treating chronic migraine. This while outside the exam room was a poster (presented at a recent conference by colleagues in her own department) showing moderate efficacy for that same indication. When I pointed this out, I got the usual "shut up, soldier. I'm a doctor and an officer and arguing with me is insubordinate," spiel. When I countered that, before enlisting, I finished two years of PhD research (as a National Science Foundation Research Fellowship awarded) in biophysics/neuroscience, she sneered that I must be lying since nobody that smart would be dumb enough to join the Army, much less as a lowly enlisted person...Nothing like the sweet scent of prejudice in the morning...
Tricare tries a more subtle approach to denial. I actually managed to get the administration of the Botox covered fairly easily, after only four attempts. Getting the actual drug proved more difficult. The pharmacy benefit argues that they are not responsible for paying since it is administered at the doctor's office and is therefore not within the scope of their contract (even though other drugs, like DepoProvera, administered at the doctor's office, are covered). The medical benefit contractor says they are not responsible because Botox is a drug and thus outside their coverage area, as well.
Even more cleverly, these sorts of denials are not appealable, because they are not actually denials but "administrative rulings on contractual obligations".... Attempts to get both the medical and pharmacy benefit contractors on a conference call and let them duke it out between themselves are met with utter failure.
After two years of this idiotic merry-go-round, I have not given up, but I hold little hope of actual success :-(.
Bet you didn't expect to open such a can of worms with your question, no? ;-)
Heh, I actually did expect a can of worms, actually a case of cans of worms.
We are talking about tricare and the VA, after all.
As for Army doctors, I tend to talk shop with them and it gets instantly obvious that I have a clue about what I'm talking about. I'm also pretty good at being insubordinate while still staying out of trouble.
You don't put in near 28 years without learning how to hand it right back to an officer, respectfully, of course. ;)
Even at Wally Reed.
I'm fortunate in that my old migraines were rare, typically every couple of years apart and now, they're a painless variety.
Painless and passes in about a half hour, while I still am sensing the aura.
I need to take lessons from you, I guess, Wzrd1. There does seem to be a gender and age component to willingness to listen. I was only 27 when I got my PEB/MEB decision, and every time my husband drove me to a Walter Reed or VA appointment, everyone assumes he is the veteran/servicemember. This is somewhat hilarious, because my nerdy, engineer husband would not be military material in a thousand years!
Talking shop as a 27-year-old female vet tends to get skeptical looks and an admonition to "stop thinking Google is a good resource for medical info". Telling the doc I use PubMed and subscribe to Science and Nature gets a "yeah, right!"
One memorable night, when Relpax had just come in the market, and the brigade surgeon had special ordered it for me due to issues with other triptans, my platoon sergeant hauled me down to the ER because I was badly dehydrated from all the vomiting. The ER doc tried to give me DHE, only two hours after my last dose of Relpax.
All I wanted/expected was some Zofran and fluids, not a dangerous and potentially lethal drug interaction, but the doc wouldn't believe me that Relpax was a triptan, saying he'd never heard of it,
It ended up in me physically covering the IV ports while a tech, a nurse, and the doc hollered at me. Eventually I managed to escape AMA, only to get raked over the coals by my company commander the next morning!
The CO insisted that I should stop trying to second guess doctors, after all I was only a staff sergeant, and next time I better just shut up and do what I was told. When I tried to explain about my educational background, he said I must be lying due to my young age. Trying to explain to him that I graduated college at 18 and thus had 2 years of PhD work under my belt when I enlisted at 20 was futile.
He was a former enlisted infantry soldier who had gone OCS a few years back with one of those online bachelor's degrees where you get three years of credit for "life experience". Commanding a company full of "MI weenies", more than 60% of whom had bachelor's degrees and some 15% of whom had at least some graduate education was deeply threatening to his ego.
I never really mastered the technique of getting officers to listen to me if I was dismissed as ignorant because of my age. I think that perhaps if I had been able to serve until retirement age, it might have been easier to not be summarily dismissed.