Removing non-scientific healthcare from our healthcare system...

[ThatRobGuy]

I know the healthcare debate can be a touchy subject...however, this aspect of healthcare that I'd like to discuss should hopefully be far less emotion-inducing, as it doesn't pertain to "whether or not we should have universal healthcare"

Regardless of whether or not our healthcare is universal, should there be a bigger push to eliminate things that aren't real medicine from our medical expenditures? Whether or not it's state-backed insurance, or private pay insurance, non-scientific forms of healthcare can bleed any system.

I'm sure there are many forms out there, however I'd like to touch on a few of the big ones.

Chiropractic: Medicare alone (this figure doesn't include the enormous amount of money that private insurance shells out) has forked over roughly $475 million per year on Chiropractors. 30 million Americans per year see them on a regular basis, the industry as a whole rakes in revenue of nearly $13 billion per year...~60% of which is billed to the insurance companies (meaning we're all paying for it).

Acupuncture: Surprisingly, there are insurance companies that will cover this in about 20% of cases

Homeopathic/Naturopathic Medicine: There's a kicker with this one...while it's not always covered (because in most cases, it's not a licensed professional doing it), if the person with a homeopathic/naturopathic practice is a licensed professional (many times it's Chiropractors, in fewer cases, it's unscrupulous people with an MD who've found a way to make a lot of money) the consultations can be submitted to (and covered by) insurance companies.

This practice really ramped up over the last few years due to a provision in ACA (I'm not saying this to start an argument over ACA, just pointing out a flaw within the law)

the Affordable Care Act mandates that insurers not discriminate against licensed health care providers, including those who practice alternative medicine, such as naturopaths, homeopathy, and acupuncturists.

Essentially, with the way the law is written, a person can obtain a legitimate medical degree, get their licence to practice as an M.D., DDS, etc... and then turn around and open up a homeopathic practice and can then be allowed to submit the charges to insurance companies.

A lot of times, medical quackery can end up being a double whammy in terms of costs. Money gets paid out to the quacks, and when that treatment doesn't work, and the people eventually go to real doctor to get fixed up, more money has to be shelled out for that.

So I guess this question could be posed two different ways to two different groups?

For those in favor of private pay, should there be a more concerted effort to remove forms of quackery, especially now considering that people are required to have insurance?

For those in favor of switching to a state-backed universal model, should there be efforts to eliminate the forms of quackery prior to cutting over to this model as to minimize the burden on the folks who are paying taxes to fund it?


Thoughts?

 

[Belk]

I know the healthcare debate can be a touchy subject...however, this aspect of healthcare that I'd like to discuss should hopefully be far less emotion-inducing, as it doesn't pertain to "whether or not we should have universal healthcare"

Regardless of whether or not our healthcare is universal, should there be a bigger push to eliminate things that aren't real medicine from our medical expenditures? Whether or not it's state-backed insurance, or private pay insurance, non-scientific forms of healthcare can bleed any system.

I'm sure there are many forms out there, however I'd like to touch on a few of the big ones.

Chiropractic: Medicare alone (this figure doesn't include the enormous amount of money that private insurance shells out) has forked over roughly $475 million per year on Chiropractors. 30 million Americans per year see them on a regular basis, the industry as a whole rakes in revenue of nearly $13 billion per year...~60% of which is billed to the insurance companies (meaning we're all paying for it).

Acupuncture: Surprisingly, there are insurance companies that will cover this in about 20% of cases

Homeopathic/Naturopathic Medicine: There's a kicker with this one...while it's not always covered (because in most cases, it's not a licensed professional doing it), if the person with a homeopathic/naturopathic practice is a licensed professional (many times it's Chiropractors, in fewer cases, it's unscrupulous people with an MD who've found a way to make a lot of money) the consultations can be submitted to (and covered by) insurance companies.

This practice really ramped up over the last few years due to a provision in ACA (I'm not saying this to start an argument over ACA, just pointing out a flaw within the law)

the Affordable Care Act mandates that insurers not discriminate against licensed health care providers, including those who practice alternative medicine, such as naturopaths, homeopathy, and acupuncturists.

Essentially, with the way the law is written, a person can obtain a legitimate medical degree, get their licence to practice as an M.D., DDS, etc... and then turn around and open up a homeopathic practice and can then be allowed to submit the charges to insurance companies.

A lot of times, medical quackery can end up being a double whammy in terms of costs. Money gets paid out to the quacks, and when that treatment doesn't work, and the people eventually go to real doctor to get fixed up, more money has to be shelled out for that.

So I guess this question could be posed two different ways to two different groups?

For those in favor of private pay, should there be a more concerted effort to remove forms of quackery, especially now considering that people are required to have insurance?

For those in favor of switching to a state-backed universal model, should there be efforts to eliminate the forms of quackery prior to cutting over to this model as to minimize the burden on the folks who are paying taxes to fund it?


Thoughts?

That is a tricky subject. Personally I think they are a bunch of twaddle, but there are people who believe them to be valid treatments. Should we dictate to people what kind of healthcare is valid?

 

[Hetta]

I honestly did not know that you could get acupuncture paid for by medical insurance. Some say it works, so who am I to complain if a heavy smoker quits by attending acupuncture where a wide variety of scientific methods of helping her to quit have failed?

 

[Belk]

I honestly did not know that you could get acupuncture paid for by medical insurance. Some say it works, so who am I to complain if a heavy smoker quits by attending acupuncture where a wide variety of scientific methods of helping her to quit have failed?

You can get naturopathic visits paid for by insurance. I have a friend who's wife is a naturopathic doctor. I have to bite my tongue when she starts talking about work.

 

[dogs4thewin]

I feel ( private pay here) that insurance should in fact cover treatments other than medication. For one thing it allows more options to people who may either want to go the natural way, distrust medication, or even have had issues with various medications in the past in terms of reaction either with their bodies or to other medications.

Secondly, if the natural options work they tend to be healthier than medication or at least allow people who must take several medications to take fewer.

 

[ThatRobGuy]

That is a tricky subject. Personally I think they are a bunch of twaddle, but there are people who believe them to be valid treatments. Should we dictate to people what kind of healthcare is valid?

Short answer to your question, yes! There should be defined limits as to what is and isn't valid healthcare based on scientific information.

...for a couple reasons.

A) We're paying for it (whether it's private pay; through our premiums...or if it's universal; through our tax dollars)
B) There's actual danger attached to it. There have been numerous stories where people, sometimes children, have gotten very sick or died because of people choosing quackery over valid medicine.

It'd be like any other form of spending. I wouldn't want healthcare funding going toward homeopathy for the same reason I wouldn't want education funding going toward teaching creationism in the science classroom (my apologies to my Christian friends on CF if that comes off as snarky).

I think there should be a desire to have funding being used properly...

 

[ThatRobGuy]

I feel ( private pay here) that insurance should in fact cover treatments other than medication. For one thing it allows more options to people who may either want to go the natural way, distrust medication, or even have had issues with various medications in the past in terms of reaction either with their bodies or to other medications.

Secondly, if the natural options work they tend to be healthier than medication or at least allow people who must take several medications to take fewer.

It's important to keep in mind that "private pay" isn't truly private. It's pooled funding with you, and millions of other people.

Also, a distinction needs to be made when discussing "natural options"

If a person is diagnosed as having high cholesterol in their 30's and it's not a "you're going to have a heart attack next month if you don't get it lowered immediately"...and they want to try to control it with diet and exercise before they go on prescription statins, that's one thing...

It's another thing to have the insurance company shell out $120/month so that a guy can twist your neck because they believe "all human ailments stem from misalignment of the spine" (no joke, that's what chiropractic teaches), and consider that to be a "natural remedy" (void of any scientific backing), simply because it doesn't involve the use of drugs.

 

[ThatRobGuy]

I honestly did not know that you could get acupuncture paid for by medical insurance. Some say it works, so who am I to complain if a heavy smoker quits by attending acupuncture where a wide variety of scientific methods of helping her to quit have failed?

My grandma insists that she had an ear infection cured from a Benny Hinn prayer cloth she purchased (no kidding, she literally believes that...you can't talk her out of it...I tried).

Do we base our expenditure allowances on anecdotal "this person swears it works" types of reasoning?...or do we restrict that to peer reviewed scientific information?

 

[Kersh]

http://vignette4.wikia.nocookie.net...ylinder.png/revision/latest?cb=20100426233453


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[USincognito]

RE: OP - Hear hear!

 

[super animator]

I am all for improving efficiency and all. But what about those who can't afforded it?

 

[jayem]

the Affordable Care Act mandates that insurers not discriminate against licensed health care providers, including those who practice alternative medicine, such as naturopaths, homeopathy, and acupuncturists.

Strictly speaking, it's left up the state. This is the language of the relevant section of ACA:

The Patient Protection and Affordable Care Act, Section 2706, "Non-Discrimination in Health Care," page 42, signed into law on Mar. 23, 2010, available at www.thomas.gov, states:

"(a) PROVIDERS. - A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures."

Insurers can't discriminate among providers, as long as said providers are recognized and licensed by their state. I know chiropractors are licensed in all states. I suspect acupuncturists are licensed in most all states. But I'm not sure about homeopaths, naturopaths, or some other alternative practitioners.

Personally, I'm skeptical of "alternative" medicine. To my knowledge, peer-reviewed, published evidence of efficacy is skimpy, or dubious in many cases. As someone said, if alternative medicine really worked, it would just be called "medicine."

 

[mark46]

So the idea of this thread is to continue to rely on high priced drugs and surgeries for the bulk of our treatment of chronic illnesses? Perhaps folks need to take the lead from our top hospitals, all of which use some forms of alternative medicine.

You should certainly list meditation as an abuse. There are many, many others.

 

[pgp_protector]

Question.
Does the placebo effect Work?

 

[Armoured]

That is a tricky subject. Personally I think they are a bunch of twaddle, but there are people who believe them to be valid treatments. Should we dictate to people what kind of healthcare is valid?

Yes. Based on science.

 

[Quid est Veritas?]

Sorry to burst your bubble, but there are two problems not yet addressed.

1: Multiple studies have shown that Acupuncture actually works better than placebo to relieve certain pain. There are theories regarding a Pain-Gate to disrupt neuronal pathways with a separate stimulus to explain it. Regardless, they aren't completely in the same league as the others you mentioned, holding a middle ground.

2: Now the big problem. Modern medicine is no longer Scientific. The dominant system in medicine at the moment is Evidence-Based Medicine (EBM), as invented in the 90s. This is a non-scientific method.
Basically, Scientific method is Hypothesis then attempts to disprove it. The hypothesis is never established as fact, just not disproven. It is driven by the researcher seeking to undermine his own hypothesis and if failing to do so, he will have found corroborating evidence and results predicted by his hypothesis.
EBM says that we are too biased so it uses double-blind studies, Randomised control trials, Meta-analyses etc. to exclude it. So data is collected and based thereon a deduction is made, which is then treated as true. If more studies on the question is done, then they are all collected together in a Meta-Analysis to establish the statistical probability between the multiple studies.
In order to be non-biased, the hypothesis was removed and replaced with ideas like Drug A versus Placebo testing or Cholesterol lowering in diet A versus standard diet etc. It is deduction from accepted data, which is then established as fact. New testing cannot disprove this conclusion and is treated equally in follow up meta-analysis, so the conclusion of a study is therefore non-falsifiable. The only way to exclude the result of a study, would be to show that it was biased and therefore falls outside the scope of EBM.
While EBM can be used to falsify a scientific hypothesis, if you set out to answer a scientific hypothesis you would be showing unacceptable bias and that research would be excluded by EBM and therefore largely by modern Medicine. Therefore, research should be done in fields you are interested in and to try and answer pertinent questions, but trials are done to collect data from which conclusions are drawn, not to attempt to disprove hypotheses. New trials are then done based on questions raised from previous trials or to repeat them for further data, but this is just data-collecting and not attempted falsification of a pre-set hypothesis.

So I am sorry, if you want to exclude all Non-Scientific Medicine, you would have to exclude all Medicine as currently practiced in the western world.

 

[revanneosl]

I think you're mischaracterizing Evidence-Based Medicine when you call it "non-scientific", because you're using the most simplistic definition of the scientific method. Evidence-Based Medicine does have its shortcomings, but it's a bit of a canard to say that it's not scientific.

Re: the OP. It's a bit of a muddle, isn't it?

1. States need money. One way they get money is by issuing licenses (with fees attached) to all sorts of persons engaging in all sorts of endeavors. You need a state license to tend bar, to handle food, to do hair, to practice acupuncture or chiropractic...
2. Health Insurance corporations don't want to be the ones to say, "this is real medical treatment, but this is not" because that would put them in the position of having to hire expensive experts, and then defend their conclusions, in court, a million times a day. So instead, they just say, "If the state says it's licensable medical treatment, then we agree that it's valid medical treatment."
3. So we end up with states licensing everything under the sun because they need the money, and Health Insurance corporations going along because it's cheaper than defending against the lawsuits.

 

[Quid est Veritas?]

I think you're mischaracterizing Evidence-Based Medicine when you call it "non-scientific", because you're using the most simplistic definition of the scientific method. Evidence-Based Medicine does have its shortcomings, but it's a bit of a canard to say that it's not scientific.

Actually I am not. EBM is a system based on Empiricism, but not on Scientific method. Philosophically speaking it is a non-scientific system. By any definition of Science, a system that establishes conclusions based on deductions and which treats said conclusions as established non-falsifiable fact, falls outside its scope.
AR Feinstein, one of the inventors of EBM, objected vehemently when people wanted to call it Scientific Medicine as he acknowledged that it was not. Hence Gordon Guyat coined Evidence-Based medicine as an alternate name.

PS. I am not saying there is anything wrong with EBM, just that the OP's statement was actually poorly phrased. I actually use EBM daily. Don't take offense that I call it non-scientific. That doesn't mean it is false, nor does saying something is scientific mean it is true.

 

[revanneosl]

I find this absolutely fascinating, and will read farther into the subject. Thank you so much for pointing it out to me.

 

[Armoured]

Actually I am not. EBM is a system based on Empiricism, but not on Scientific method. Philosophically speaking it is a non-scientific system. By any definition of Science, a system that establishes conclusions based on deductions and which treats said conclusions as established non-falsifiable fact, falls outside its scope.
AR Feinstein, one of the inventors of EBM, objected vehemently when people wanted to call it Scientific Medicine as he acknowledged that it was not. Hence Gordon Guyat coined Evidence-Based medicine as an alternate name.

PS. I am not saying there is anything wrong with EBM, just that the OP's statement was actually poorly phrased. I actually use EBM daily. Don't take offense that I call it non-scientific. That doesn't mean it is false, nor does saying something is scientific mean it is true.

What medical "facts" are non falsifiable?