Sep 03 2009
I will write occasional posts instead of being on a regular schedule. The reasons: There are more contributors than positions. Newer people to the field have more ambition and belly fire. I have a number of projects and papers to finish in increasingly limited time and decreasing efficiency. So have at it. Meanwhile, some non-random thoughts.
I am as concerned with social and political expression of pseudoscience as with its errors. Health care reformers can be just as pseudoscientific as sectarians who want to restructure the scientific edifice. Political ideologues want to centralize the medical system without solid evidence that their substitute would work, let alone work better. Sectarians already see a national government system as an opportunity for expansionism. Mark Hyman, the Functional Medicine promoter, met with the White House staff, displaying his vision of medicine under a federal plan. Word is out that other sects have also had input. Many hold suspicions that the proposals front for more ambitious formulations. I am suspicious of their confidence – that they can fix a complex, fluxing system using epidemiology, mathematical models, treatment paradigms, and top-down control. I might accept some proposals if it were not that all constructed systems are intrinsically inefficient, political, and corruptible. The closer the agents of control are to the controlled, the more control the controlled have over the controllers – if you can follow that.
Centralized medical systems are based on the assumptions that physicians cannot control costs and their own behavior, and are self-serving at others’ expense. That is true to some extent. But any correction of abuse must demonstrate that itself will have fewer abuses.
I’ve been on both sides of the control line – a review corporation CEO, a medical director of another, a private insurance and HMO utilization reviewer, a Medicaid (Medi-Cal) reviewer, consultant to the state, and co-designer of computerized diagnostic paradigms. At the time I thought medical practice could be disciplined and subject to templates. I concluded that one can only design generalized paradigms. One cannot successfully replace physician thinking and patient perceptions and desires. In this country, anyway.
My point here is that pseudo-medicine and pseudoscience can anchor themselves in government controlled systems in ways not available in the private area. They resist ousting. Homeopathy in Europe, now a folkway, had a headlock on the European Union medical systems and the physicians there have struggled to convince the EU commission to deny payments for it. It’s the same in UK. In Canada, some provinces allow payment for acupuncture, chiropractic, and herbalism, some not. In the US, these sects have inserted themselves into legitimacy through political pressures. It’s through political systems that sects seek equality and can bypass science and reason.
In the 1960s – 70s, Laetrile was not legal, and use was driven south of the border. But it was gradually legalized in 27 states, and it took years and a Supreme Court decision to send it back. A US District Court judge in Oklahoma contributed to one of the largest monetary scams in US history. Before legalization, insurance companies denied payment for Laetrile. During legalization, traffic became a national scandal, reaching the tens to hundreds of millions of dollars. Physicians and private insurance had previously made decisions of non-payment and illegitimacy with few challenges .
Licensing of chiropractors, acupuncturists, naturopaths in US states lends legitimacy. Those occupations got licensing through political pressure and a lot of campaign contributions.
Once included in a federal system, they will be more difficult to expel. If we can meet sectarianism in the open field, I think they have lesser chance for success. But once entwined in the net of the law, they are barely reachable.
This is why I am interested in some of the “higher order” sociological and political manifestations of sectarianism. I hope for a better understanding of how sectarians operate on that level, and how the public perceives, welcomes, or rejects them. How they operate and gain their benign face before they approach legislatures. We have to study sectarian strategies while we meet them on their playing field. I‘d like to identify other territories where they are more vulnerable, and other methods of dislodging them.
Sectarians are busy devising their new strategies – the concept of “CAM” was one, the funding of medical schools another, and others – the domination of funding and government agencies, the capturing of the Press through the “pantomime horse“ technique. New strategies will have to be based on the behavior and plans of the sectarians and their funders, and their ideological agendas, their designs on the system. While this study proceeds, their incarnations will still have to be met head-on in blogs such as this. Have at it.
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