Nov 19 2008
Freedom is a cherished commodity in our culture, as it should be. Our laws are largely based upon the premise that individuals should have the liberty to do what they want, unless there is a compelling public or governmental concern that overrides such liberties.
It is therefore no surprise that freedom is a common marketing theme – selling the idea of individuality or personal freedom of choice.
The marketers of dubious, unscientific, or fraudulent health care products and services are savvy to the marketing theme of freedom and have used it to great effect. It is all ultimately, however, a deception. There is an ulterior motive that has nothing to do with the freedoms of the public but rather is an end run around regulations meant to protect the public.
Health Care Regulation and the Standard of Care
The primary deception of the health care freedom movement is that it pretends to be about the freedom of the individual consumer, but rather it is about the freedom (from regulation and the standard of care) of the seller or provider. Health care freedom is ultimately anti-consumer and pro-industry.
To understand this you have to understand the contract that health care providers have with society and the role of regulation. Selling health care services or products is not a universal right. Rather it is treated as a privilege, one that is earned by adhering to a certain quality control standard. The obvious purpose of this is to protect the public from useless, harmful, or fraudulent health claims or practice.
Practitioners earn this privilege through licensure, which requires completion of a proscribed training program, the passing of exams, and adherence to a set of ethics and guidelines. Most people would agree that not anyone should be allowed to hang up the proverbial shingle and start performing brain surgery. Conversely this means that the public should be protected from untrained charlatans trying to pass themselves off as brain surgeons.
This regulation of practitioners is also tied to the concept of the standard of care. This means that if one is licensed as a medical physician, they should practice medicine. Having a license as a specific kind of professional should not allow one to do anything under that umbrella. In health care this means staying within the broadly defined standard of care.
Practitioners who stray too far from the accepted practices of their profession can be disciplined by the states who grant them their license. This is reasonable because the license to practice is a privilege that comes with specific strings attached, including the requirement to stay within the scope of practice of your profession.
For products there are federal regulations meant to protect the public from fraud or harm. The FDA in the United States controls drugs and medical devices and has very rigorous standards of evidence for both safety and effectiveness.
Health Care Freedom
There are those with a libertarian political bent who argue that all this quality control is not necessary, that the free market can sort it all out, or that individual freedoms are more important than protecting the public from bad medicine. Although I strongly disagree with this position, I grant this is largely a political position – which means it is partly a personal choice. What do you value more – protection or freedom?
However, there is another group promoting health care freedom, and not because of their libertarian ideology. Specifically these are practitioners who wish to be freed from regulation or the scope of their license and those who wish to sell products that either violate FDA regulations or that are simply fraudulent.
These two camps have found common cause (for example). Libertarian Ron Paul has embraced so-called alternative medical practices and made it part of his campaign against “unbridled government regulation.”
(As an aside, recently, to add a bit of confusion, the term “health care freedom” has been adopted by several organizations who are promoting freedom to choose one’s own insurance plan and physician. This has nothing to do with the health care freedom movement I am discussing.)
Health Care Freedom Laws
Sixteen states in the US have so-called health care freedom laws. Essentially what these laws do is create a double standard. The wording in each state is different, but their effect is the same – a practitioner of unscientific methods cannot have their license taken away or acted against because they are practicing substandard care as long as that care is deemed “alternative.” In other words, if an MD is practicing “conventional” medicine but what they are doing is significantly below the standard of care (it is demonstrably unsafe or ineffective), the state can act against their license. If, however, the same physician practices the same incompetent medicine, but labels it “alternative” they are immune from any action.
I have personally encountered exactly this situation. I was asked to give standard of care testimony against a Florida neurologist who was practicing, in my opinion, outright quackery. It was determined by the court, after hearing all the testimony, that indeed the physician was practicing substandard care. However, he appealed under Florida’s health care freedom law, claiming that what he was doing was alternative, and this appeal was successful. So now he is free to practice his unmitigated quackery, unhindered by any quality control.
Unfortunately these laws are making steady progress. There are groups who relentlessly lobby for such laws, usually under the public radar. Slowly, the standard of care is being erased from medical practice.
Essentially, con artists, charlatans, and snake-oil salesmen have discovered that they can shield themselves from regulations meant to protect the public from their malfeasance by simply cloaking what they do in the flag of freedom.
They have found common cause with those who are sincere, but simply misguided – they believe that their treatments are effective and valid and are frustrated by the fact that they are not validated by science and do not meet the standard of care. Failing to win acceptance for their modality with research, they then dismiss the standard of care as biased against them, and seek to subvert it.
The promoters of dubious indications for chelation therapy, for example, have been on the forefront of the health care freedom movement.
Finally, they have joined forces with the ideologically libertarian,who oppose government regulations of all kinds. At least libertarians are honest about their agenda – they want less government regulation.
Ultimately issues of regulation vs freedom are societal and political. They are not strictly about science, although with regard to medicine the standard of care is (or at least should be) based upon scientific evidence. My point in this post is not to take a political side. Rather, to point out the real agenda and implications of the health care freedom movement.
Health care freedom laws are about giving practitioners and marketers freedom from regulations and the standard of care. It is not about the public’s freedom of choice. It is about eliminating scientific standards for those who want to engage in unscientific practices.
There is also a parallel to be made with other recent “freedom” movements, such as creationists promoting academic freedom. Science teachers and professors who want to teach their religious views or simply nonsense that is not accepted by the mainstream scientific community as science, are playing the same “freedom” card. They confuse (or at least pretend to confuse) legitimate measures to ensure academic quality with oppressing academic freedom. But what they really want is to subvert academic quality to their own ideological agenda.
I don’t mind honest and open discussions about the proper balance between freedom and regulation for quality control. But the health care freedom and academic freedom movements are not honest and open. They are deceptive about their true intention. To them “freedom” is just a marketing ploy.
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