Map of life expectancy at birth from Global Education Project.

Friday, July 24, 2009

I'm not going to read Orac for a couple of days

because I expect it's gonna get ugly. Tom Harkin and some unindicted Senatorial co-conspirators are pushing an amendment "that says healthcare plans will not be allowed to “discriminate’’ against any healthcare provider who has a license issued by a state, an amendment Senate aides said was designed to provide coverage for alternative medicine." Unfortunately the Globe's Michael Kranish wrote this story. In his coverage of the Jack Abramoff scandal, he claimed that Abramoff "gave generously to Democrats as well as Republicans," a demonstrable and unambiguous falsehood which the Globe refused to correct. (Abramoff, a lifelong Republican activist, never gave one dime to any Democratic candidate for office, nor did his lobbying firm. Fact.) Kranish is equally fair and balanced in this story.

It is an unfortunate fact that many states do issue "licenses" to people who call themselves naturopaths, homeopaths, etc. And it is true, I suppose, that if a substantial number of people go to such practitioners rather than medical doctors it might cost less money, as some in Kranish's article argue. But it would also cost less to instruct people to bury a clove of garlic under a rock in the back yard at midnight under a full moon, and then swing a dead cat around their head three times. The problem is that if these people really do have a serious but treatable disease, they're going to stay sick or die when they don't actually have to.

I am the first to decry excessive medical intervention, and to FDA policy which approves drugs based on inadequate evidence of long-term safety and no evidence that they are superior to well tested, less expensive remedies already on the market. You all know that one of the motivating forces for writing this blog is to champion greater restraint in medicine, and putting more resources into public health measures that will keep people from getting sick and needing doctors in the first place. That's why my URL means health versus medicine, i.e., as opposed to medicine. Our cultural proclivity to conflate the two is hurting us badly.

How some ever. Homeopathic "remedies" are water. Dihydrogen oxide. In sufficient quantity, they are a cure for dehydration, and that's it. Naturopaths follow a disorganized, incoherent course of training and basically do anything they want, ranging from sensible dietary advice to rearranging the flow of your chi through invisible force fields. If you want to pay these people, go ahead, but there is no reason why an insurance company or federal agency should pay them because it means we all have to chip in and that's making us all complicit in fraud.

I'm all for sensible dietary advice which is why I think that health insurance should pay for nutritional counseling, by properly trained and credentialed nutritionists. I also know that well designed clinical trials have shown that massage therapy can relieve pain and stress in conditions such as cancer and reduce people's use of narcotics. So insurance ought to pay for that too, in appropriate circumstances and delivered by properly trained people. There are many other examples of useful services by people who are not M.D.s. You can call these "complementary" if you like, or even alternative, but they aren't really because doctors, in general, agree with me that they are useful for limited purposes in appropriate circumstances, like all health care practices.

It is quackery, however, when people claim that massage or dietary changes or colonic irrigation or magic crystals can prevent or cure all diseases, or that there are miraculous treatments out there that "they" don't want you to know about. Harkin says that paying for medical care and not for naturopaths or homeopaths is "discrimination," which is true -- it's discrimination between stuff that makes sense logically and scientifically, and which actually works; and stuff that is nonsensical and doesn't work.

That doesn't mean that we should not support a more holistic approach to health care and bring in the nutritionists and health educators and cognitive-behavioral therapists and so on. If we do that we can use less drugs and have healthier and happier lives. But we should base what we do on good evidence. Naturopaths don't do that. Hence I am in favor of discriminating against them.


C. Corax said...

So why do you think Harkin etc are doing this? To ensure health care reform's failure by making it too costly to sustain?

kathy a. said...

we are looking at medical care, and as far as i know, the medical boards of the various states do not license people who are not medically trained.

i think there is a place for supplemental care, if it has proven benefits and generally does not cause harm. physical therapies are widely accepted as helpful.