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Pseudoscience is not Cost Effective

Industrialized nations are in the middle of a health care crisis (some more than others), or at least a dilemma. As our medical technology advances, people are living longer, they are living with chronic diseases, and they are consuming more health care. The cost of this health care is rising faster than economic growth, so it is becoming a greater and greater burden on society. Many countries ration health care in one way or another in order to contain costs. Otherwise there is no easy or obvious solution and it’s likely that difficult choices will have to be made.

An interesting side effect of this dilemma is a renewed focus on the cost effectiveness of medicine. Effectiveness alone is not enough. We simply cannot afford, for example, to introduce a very expensive treatment for marginal improvement in outcome in a common disease. Different options can also be compared not only for their safety and efficacy, but for their cost effectiveness. In other words, we need to use cheaper alternatives when available rather than always reaching for the latest and greatest (and most expensive) treatment.

This situation provides an opportunity for science-based medicine. Treatments that are promoted as complementary and alternative (CAM) are often sold as cost effective because they are less expensive up front than standard medical care. We cannot, however, cede this argument to proponents of dubious therapies. Cheap does not mean cost effective. You have to be effective in order to be cost effective, and most of the dubious treatments that are marketed under the CAM umbrella are ineffective.

Regulators in Australia seem to get this. ABC news (that’s the Australian Broadcasting Corporation) recently reported:

Natural therapies found to be clinically ineffective will be cut out of government-funded private health insurance rebates.

Treatments including homeopathy, aromatherapy, ear candling, crystal therapy, flower essences, iridology, kinesiology and naturopathy could be found ineligible.

This is good news, however I think labeling this as focusing on “natural therapies” is counterproductive. Such labels are often misleading, inaccurate, meaningless, and a distraction from what really matters – the scientific evidence. What is “natural” about sticking a candle in your ear and burning it to suck out the toxins (which look suspiciously like burned candle wax)? “Natural medicine” is just a marketing term without a useful or meaningful operational definition. Proponets of these dubious methods are using the label to criticize this measure. Also from the ABC article:

However, Australian Traditional Medicine Society president Dr Sandi Rogers says the announcement came as a surprise.

“It’s a little bit of a shock when we as a profession have not been consulted,” she said.

“If this cost-cut is saying ‘we don’t want to spend taxpayer’s money on natural medicine’, I would be very concerned.”

They are spinning this as an attack on “natural medicine.” Rather, the measure is saying that taxpayer money should not be spent on therapies that are not adequately science-based, whether or not they are thought of as “natural”, “traditional”, or “conventional”. All of the modalities listed above are highly implausible and without evidence to support their efficacy.

Concerns about cost effectiveness and public funding are a great opportunity, in fact, to have a public discussion about the efficacy of such treatments. I want everyone to know exactly what homeopathy is (implausible treatments based on magical thinking diluted into non-existence), and I want them to know what the scientific evidence says – that it doesn’t work. Let us then have a frank debate about whether or not the FDA should be approving homeopathic potions, and whether our limited public health care dollars should be wasted on them.

This comes back to the notion that there should not be any double standard when it comes to medicine. CAM proponents usually try to turn this around, claiming they are not being treated fairly. Dr. Rogers, for example, is quoted as saying:

“We would just like a fair playing field.”

I don’t believe that is true. CAM proponents want a double standard with unfair advantages given to so-called CAM therapies. That is the real purpose of the existence of such labels, all created by proponents in order to argue for the double standard. Defenders of science-based medicine are arguing for a single science-based standard in evaluating medicine. We should apply this same standard when considering cost-effectiveness and public funding. CAM therapies should be held to the same standard of plausibility and scientific evidence, and not be given special consideration because they are “natural.” CAM proponents should also not be allowed to change the rules of evidence as they go along in order to rig the game in their favor.

What is amazing is that public rebates were being given for things like iridology (a completely pseudoscientific form of diagnosis), not that they are now going to be taken away.

The cost effectiveness debate is a good opening for proponents of SBM to make the case to regulators that they should not be wasting taxpayer health care dollars on treatments that are not supported by evidence. I hope this the start of a trend. The principle is very simple – we cannot continue to waste resources on pseudoscience in medicine.

 

Posted in: Politics and Regulation, Science and Medicine

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39 thoughts on “Pseudoscience is not Cost Effective

  1. Jan Willem Nienhuys says:

    A treatment like homeopathy just might be cost effective. The reason is that patients (concerned parents of children with upper respirational tract infections) often insist on treatment by antibiotics when science says that this is not such a good idea. It doesn’t
    help a lot, especially for virusses, and there is a risk of creating antibiotics resistant germs. But the physicians give in to thisn pressure and prescribe antibiotics or other medicines. In some European countries doctors will prescribe lots of different pills for ailments that go away by themselves. If they don’t, the patients will go to the competitor.

    In such a situation a doctor that makes the patient believe that taking a single 5 milligram globulus of Silicea C30 (or whatever) will do the trick might be cost effective.

    Of course in a situation like that trying to do it the scientific way may be even more cost effective. But is that convincing for the patient? Especially in a country where science is considered a dirty word? Where half of the people believe in extraterrestrial visitors in UFO’s or in the literal truth of the first chapter of Genesis? Or in astrology?

    There are of course many kinds of unscientific medicine that are quite expensive. All kinds of variants of electroacupuncture or bioresonance (couple of 100 doillars to have yourself ‘analysed’ by a silly machine), for example. Or a bimonthly checkup at the chiropractor.

  2. Eugenie Mielczarek says:

    Thanks for the post on this economic matter which unfortunately has not been of interest to American business journalists. After publishing our study “Measuring Mythology” (Skeptical Inquirer JAN/FEB 2012)we asked economists how to measure and predict future and present health care costs generated by CAM, factoring in the possibility of mandated coverage by the Health Care law with no success. If anyone knows of an economist who is examining this burden on taxpayers, please contact us.

    Eugenie V. Mielczarek, Brian D. Engler George Mason University Department of Physics

  3. BKsea says:

    To echo the first commenter, I have wondered whether the coverage of CAM is actually cost effective. For instance, I have wondered whether the coverage of CAM by health plans is costing me money. I would gladly switch to a cheaper plan that provides no coverage for CAM (my current plan is woo-friendly and comparatively less expensive). Perhaps steering chronic patients to CAM instead of more expensive doctor visits that are not effective either is saving me money.

    This is not really a defense of CAM, but I question whether the economic story holds water. I would like to see the evidence.

  4. cervantes says:

    JWN — You are suggesting that physicians could prescribe a treatment they know to be useless, but at least harmless and relatively cheap, in order to satisfy patients who are demanding a more expensive and potentially harmful treatment. While that may seem pragmatically appealing, it is unethical. Physicians have a duty not to deceive their patients, not just on principle, but because deception can have further untoward consequences. By endorsing quackery, physicians encourage patients to seek it out on their own. Perhaps they will then forgo seeing the physician the next time symptoms appear, and head to the GNC instead; yet this time, they really did have a treatable, perhaps serious, condition. Furthermore, they provide revenue to an industry that deceives people on a massive scale.

    This is really just the lazy way out. Physicians need to take the time, and acquire the skill, to have a conversation with their patients in these situations. They need to properly inform the patient about the futility and potential harm of, for example, prescribing antibiotics for a typical URI or FLI. They are under no obligation to act against the patient’s best interest in order to placate the patient. It’s just the easy way out.

  5. What cervantes said. You sometimes have to talk patient out of tests or treatments that are not indicated. If you give in and prescribe a placebo or unnecessary test to make them feel better you are causing more harm than good. You are reinforcing bad behavior and (in the case of homeopathy) pseudoscientific thinking. This has real costs.

    From what scant evidence I have seen, CAM use tends to be an extra layer of expense on top of science based treatments, and is therefore an incremental (and largely worthless) expense.

  6. daedalus2u says:

    The idea that CAM could possibly be cost effective is nonsense, just as much as CAM is nonsense. Something of negligible benefit but with a real cost has a near infinite cost/benefit ratio.

    The problems of the cost of medical care in the US are mainly due to the gatekeepers of access (the health insurance companies) extorting a monopoly premium on access to health insurance. The actions those health insurance companies are taking to continue their monopoly are distorting the market and preventing alternatives that would be better and cheaper.

    The reason that patients have the idea that there is a pill for everything, and that they should get a pill when they go to the doctor, is because of the distorted idea of what constitutes good health care. That distortion has been fostered by drug companies, advertising companies and main stream media.

    The idea that price equates to value is also a problem. One of my favorite jokes is a man asks his girlfriend what she wants for her birthday. She replies “something expensive that I don’t need”, so he gets her radiation treatments.

    Expensive things that are not needed are luxuries. We should not be using public resources to fund luxuries for some while there are many who do not have basic necessities.

  7. Harriet Hall says:

    One example from chiropractic: even if treatment of an acute episode costs less, what if the chiropractor then talks the patient into a series of visits for “maintenance adjustments”? What if the patient develops a “chiropractic neurosis” and thinks he needs to consult the chiropractor for a readjustment every time he gets the sniffles or feels unwell? What if he is so bamboozled by the chiropractor’s philosophy that he agrees to have his babies adjusted at birth, right in the delivery room? Those costs can add up, and they aren’t factored into any study I’ve seen.

  8. BKsea says:

    So, the question here is whether CAM coverage is cost effective, not whether it works. You answer that the evidence is “scant” and throw out a few hypothetical anecdotes. I would really like to agree withyou, but there really needs to be concrete evidence. Has anyone looked at whether CAM coverage truly increases costs and by how much? I come back to my private healthcare plan question: Do these plans often cover CAM in an effort to attract customers or because it lowers their costs? This would be a strong argument against CAM if it could be backed up with some actual facts!

  9. Harriet Hall says:

    @BKKsea,

    “there really needs to be concrete evidence.”

    Isn’t that the point? That CAM is being “sold” as cost effective without concrete evidence?

  10. David Weinberg says:

    …patients (concerned parents of children with upper respirational tract infections) often insist on treatment by antibiotics when science says that this is not such a good idea…..In such a situation a doctor that makes the patient believe that taking a single 5 milligram globulus of Silicea C30 (or whatever) will do the trick might be cost effective.

    Saying that an ineffective treatment is less expensive than another ineffective treatment makes it cheaper, not more cost effective.

  11. David Weinberg says:

    Blockquote error, take 2:

    …patients (concerned parents of children with upper respirational tract infections) often insist on treatment by antibiotics when science says that this is not such a good idea…..In such a situation a doctor that makes the patient believe that taking a single 5 milligram globulus of Silicea C30 (or whatever) will do the trick might be cost effective.

    Saying that an ineffective treatment is less expensive than another ineffective treatment makes it cheaper, not more cost effective.

  12. annappaa says:

    I really don’t get why treatments that, if they worked, would overturn the laws of nature get to be called “natural.” These proponents of “natural” cures don’t seem to have much respect for the natural world at all.

  13. windriven says:

    “Regulators in Australia seem to get this.”

    Legislators in the State of Washington … not so much. I’ve spoken with sympathetic legislators here but the crackpot lobby is powerful (“these are not the budget cuts you’re looking for” they whisper in the legislature’s ear). There does not seem to be the stomach for a battle where a constituency with money to spend will lose and only the public treasury will benefit.

  14. Jan Willem Nienhuys says:

    One of the reasons I brought this up is that CAMers, especially homeopathic and anthropsophic physicians, are bringing this up. Look for example in Homeopathy in Healthcare – Effectiveness, Appropriateness, Safety, Costs. G. Bornhöft and P.F. Matthiessen (eds.), Berlin etc., Springer 2011 (the book that Dana Ullman was so elated about in The Huffington Post).
    The book probably is utter garbage (I have only read chapter 10), but all the same it is necessary to explain in some detail why, and then please a little more detail than ‘doctors may not lie’.

    A little bit more about that book. It was part of an invited advice to the Swiss government about reimbursement of altmed (by physicians). The Swiss government decided to stop this reimbursement, but much later they were forced by popular vote to reinstate it.

    The propaganda says that general practitioners who practise this kind of thing in the long run make health costs lower. I don’t know whether is this true and also not whether it is really relevant. Limiting health care to sprinkling holy water probably would be even cheaper. I guess that talking about costs is a ploy used in the face of the mounting scientific evidence that all this CAM doesn’t really work.

    Here are two instances of the purported cost reducing effect:
    1. De Lange-de Klerk, E.S.M., Blommers, J., Kuik, D.J., Bezemer, P.D., Feenstra, L. (1994). Effects of homoeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections. British Medical Journal 309:1329-1332. ( http://www.bmj.com/content/309/6965/1329.full ) In this research homeopathy was used as an adjunct (not in place of) the care of general practitioners, and the effect was a halving of antibiotics use. Whether this is cost effective is dubious, as this research cost about $2000 per child.

    2. Chiropractic is nonsense. No mistake about this. Many people with slipped discs are better of when they don’t get surgery. Some of them visit the chiropractor (without the surgeon advising them) and this tends to delay the moment that they think surgery cannot be postponed any longer. But this type of complaint has the tendency to go away spontaneously and the longer people postpone a costly operation, the greater the chance that the operation isn’t necessary anymore. What could an SBM physician do or advise that works as well as the suggestion of the chiro?

  15. Harriet Hall says:

    The cheapest option is the one followed by some religious faith-healing cultists who avoid any kind of medical care for their children. That option also has the added benefit of reducing the population, because some untreated children die.

    We shouldn’t pay for anything just because it costs less or is popular. We should ask whether a treatment actually provides objectively measurable benefits to patients at lower cost.

  16. PharmDee says:

    In the example given for antibiotics prescribed for say viral bronchitis, it is true that use of an antibiotic is in many of these cases totally innefective, costly, and can add greater costs to the healthcare system by causing increased resistance patterns.

    I think there is definately *some* truth to the matter that doctors feel pressured to prescribe antibiotics at times when they do not want to….but based on my experience in primary care….I find it to be a bit of a straw man argument perhaps? Sure if you assume that in every case, the patient who does not need an antibiotic (but they just need rest and time) DEMAND it, and will not listen to reason, logic, and evidence from their physician, and if they do not do so, then that patient will go somewhere else….if I assume all of this to be true, and that providers are so frequently unduly forced to give out placebo antibiotics that cost the healthcare system…getting them to take instead an inactive placebo would net save money…however…

    I do not buy into this straw man argument really….it has too many flaws in reality:

    1) thinking about the urgent care facility where people frequently go to for something like bronchitis – they run every possible test including CXR, full blood work, and prescribe z-pack, inhaler, and cough syrup…this whole setup they have encourages just a routine of this to move people in and out as fast and easy and as profitable as possible…I think they would not ever be interested in prescribing homeopathy for these patients because it would require some amount of time and effort to sell patients on taking the placebo…believe it or not, many people would be skeptical of homeopathy for bronchitis…if they were the type to DEMAND an antibiotic, they will unlikely settle for 30c of goose liver or whatever. In the end, these doctors that were ok with prescirbing the antibiotics without much thought for every cought that walks through the door, will simply continue to do this unless they recieve proper education or a change in perspective/attitude.

    2) in many situations where an antibiotic is not needed, plenty of patients will go along with no antibiotics if they are properly explained what is going on….this can take a bit of time, something many primary care physicians lack in, but it simply is necessary…it will also take time to sell them on the CAM therapy and it would be unethical for the MD to suggest that it would actually work, so that of course is an issue.

    So really in the case of CAM to prevent these costs, there are just a ton of assumptions that are likely faulty….and I think it is perhaps overly cynical of the provider patient relationship we see in primary care….or I am being overly optimistic…or it is based on only my VA primary care experience, which perhaps ? may be different….

    Either way, even if we entertain the premise, it is unethical to prescribe 30c bullshit without telling the patient that it is indeed bullshit.

  17. Jann Bellamy says:

    @ BKsea: “I come back to my private healthcare plan question: Do these plans often cover CAM in an effort to attract customers or because it lowers their costs?”

    My understanding is that much of CAM coverage results from state legislative mandates requiring health insurers to cover CAM. Once CAM providers get licensed in a state, they go for mandated coverage as their next step.

    Yes, mandated coverage for CAM treatments does increase insurance premium costs according to one insurance industry group, but I can’t put my hands on their figures right now. As I recall, chiropractic increased premiums on the average about 3% and acupuncture was >1%.

  18. pmoran says:

    Yes, mandated coverage for CAM treatments does increase insurance premium costs according to one insurance industry group, —

    Yes, it must, if only because CAM users tend to be very high consumers of health care services, and they mostly use CAM as an optional add-on, not as a substitute, for normal medical care. Insurance schemes should not cover CAM unless at a special, higher, premium.

    Savings are likely with CAM if its numerous over-the-counter options can, at patient expense, keep people with minor or self-limiting complaints out of doctors’ (and other practitioners’) offices altogether. That reduces some of the risks, as well as the costs, of medical care.

  19. BKsea says:

    Thanks Jann Bellamy for some somewhat concrete data on point.

    To Harriet Hall’s point on faith healers etc., I agree completely. But, you could not argue against faith-healing cults by saying it drives up costs. I want to be able to argue against CAM coverage by saying it drives up costs. My concern is that taking away CAM coverage might lead to increased visits to real health providers and overall higher costs. Whether this is good or bad is not relevant to my concern about costs. I just don’t want to make an invalid argument.

  20. stanmrak says:

    Why not eliminate annual breast cancer screenings for women and prostate exams for men? Statistics from long-term studies show that these procedures haven’t made ANY difference in the overall health of the patients — and may even cause more harm than good. Therefore, they could also be considered “pseudoscience” and should not be covered by insurance. Yet our “healthcare” industry continues to push everyone over 40 into getting a screening every year.

  21. Chris says:

    Stanmrak, my doctor has already told me I should not do the annual breast exam. Perhaps every other year or so.

    Unlike pseudoscience, real medicine changes with new data. Which is baffling why people still try to sell homeopathy and random supplements.

  22. stanmrak says:

    The frequency of cancer screenings will never decrease, no matter what the data shows, simply because there’s too much profit in it. Scare tactics used by the industry will keep the customers coming. It has nothing to do with science.

  23. mousethatroared says:

    stanmrak
    “The frequency of cancer screenings will never decrease, no matter what the data shows, simply because there’s too much profit in it. Scare tactics used by the industry will keep the customers coming. It has nothing to do with science.”

    Yup, cause us women just looove having our breasts pancaked between a couple of cold plates?

    I cut back on the annual mammogram the minute I heard it was safe to do so.

  24. Harriet Hall says:

    @stanmrak,

    “The frequency of cancer screenings will never decrease”

    Nonsense: it always decreases when there is credible new evidence. Annual chest x-rays were entirely discontinued as a screening test for lung cancer in response to evidence. The USPSTF regularly updates its recommendations. Europe screens less frequently than we do. Everyone over 40 is NOT “pushed into screening every year.” Read the current recommendations and the reasons for them before you make false statements.

  25. Necandum says:

    @stanmrak
    Dude, that already happened:
    http://scienceblogs.com/insolence/2009/11/really_rethinking_breast_cancer_screenin.php

    The USPSTF published recommendations that regular mammography should be both delayed and less frequent. Change enough for you?

  26. ConspicuousCarl says:

    stanmrak on 09 May 2012 at 8:13 pm

    The frequency of cancer screenings will never decrease, no matter what the data shows, simply because there’s too much profit in it. Scare tactics used by the industry will keep the customers coming. It has nothing to do with science.

    This coming from a guy who has a disproved medical claim registered as a domain name:

    Domain name: ANTIOXIDANTS-FOR-HEALTH-AND-LONGEVITY.COM
    Registrant: Stan Mrak
    Record expires on 16-Feb-2013.
    Record created on 16-Feb-2009.

    …and that being the same website where he still has the moronic claim that saturated fat can’t be bad for you because all of those people who ate lard and undercooked pork in 1911 and died from infections at age 50 did not die from heart attacks in their 70s. That’s about as stupid as it gets, and yet it is still there on his website. Everyone point and laugh.

  27. @stanmrak, I guess you haven’t heard about the changes in breast cancer screening and prostate cancer screening, eh?

    @conspicuouscarl, thank you for posting the link to stan’s website. There’s a funny page (well they’re all funny) where he attempts to make the point that “all science is wrong!” so that he can try to shove worthless supplements down healthy people’s throats: http://www.antioxidants-for-health-and-longevity.com/about-me.html

  28. Jan Willem Nienhuys says:

    pmoran writes

    Insurance schemes should not cover CAM unless at a special, higher, premium.

    I am not familiar with the US situation, but in the Netherlands there is universal almost compulsory health insurance (almost, because if your religion forbids insurance then you can be exempted, I believe). The government – of course with approval of parliament – determines what exactly is covered in this basic insurance. All insurance companies offer their own policies. Apart from this basic insurance (which does not include any altmed) most or all insurance companies offer additional insurance policies. Most of these additional insurances cover altmed to some extent. For example: homeopathy (if done by a physician) up to 250 euro per year, and no more than 30 euro per consultation. But these additional insurances not only offer altmed but a wide range of benefits (the basic insurance pays for maximally 9 times fysiotherapy per year, but an additional package will pay for 9 more; an additional package might also cover the cost of assistance for mothers that have difficulty in breastfeeding.). One insurance company even offers cheap organized bus travels to Lourdes once in two years.

    Some people oppose this inclusion of altmed on the ground that it ‘sells’ altmed as if it were equivalent to ordinary medicine. But it is difficult to tell insurance companies how to conduct their business, i.e. earn money. Personally I think insurance companies have ways of their own to find out what is profitable. In a large package the altmed part only is worth a few euro. But if it is optional, then it is only taken by people that are interested in such things and then the price of such a ‘module’ is much larger than a few euro.

    Several reasons are conjectured why insurance companies do this. One is that they cannot very well compete with the standard basic insurance, and they have found that customers will go to their competitors if they don’t offer altmed. Another conjectured reason is that believers in altmed usually are young and higher educated, which in itself means that they spend less time in hospitals (which is the main cost for the insurers). The difference in life expectation between higher educated and lower educated is considerable, about 10 years or even more when you count ‘healthy life expectation’. So anything that attracts young highly educated customers means attracting customers that pay the insurance premium but don’t cost a lot of days in hospital.

    All these reasons are speculative. Recently one insurance company announced they stopped reimbursing bioresonance, tibetan medicine, diet cure for cancer, neurolinguistic programming and 18 other therapies, and another large one had a list of 40 items such as chelation therapy, colonhydrotherapy, cosmetic acupuncture, neurofeedback, massage and ‘fees for appointments where the patient failed to appear’. The reasons for these exclusions are not given, but I suspect that the companies think that too many frivolous claims (‘fraud’) are made in these fields.

    It just might be possible that the ineffectivity is also taken into consideration, but then they might cut all altmed. It has to do with money matters, I guess.

  29. Stanmrak, I don’t think pseudoscience means what you think it means. Science is open to the bright light of criticism, re-analysis, and change. It assumes that it is wrong by always testing the null hypothesis, which usually provides more evidence of the original hypothesis.

    Pseudoscience works in a wholly different way. It personalizes issues. It doesn’t provide evidence to support a hypothesis. It rarely progresses, because there is no research supporting it. And they use silly logical fallacies like utilizing a strawman argument (that cancer screening is a pseudoscience) when in fact like others have said, science changes with new evidence.

    But I’m sure that your useless antioxidants will sell very well, because people get sucked into pseudoscience all the time.

  30. JMB says:

    Patients ought to be interested in cost effectiveness… what they are spending their hard earned money on actually works. However, governments are interested in resource efficiency. While a patient might consider $100,000 for 4 months more of life cost effective, the government may view it as resource inefficient. $1000 for alt med for no more months of life is more resource efficient than $100,000 for 4 months more of life.

  31. Jan Willem Nienhuys says:

    $1000 for alt med for no more months of life is more resource efficient than $100,000 for 4 months more of life.

    And $1 for a vial of holy water for no more months of life is even more cost effective. But what about people spending $100,000 of their own in Tijuana for just the promise of ‘more life’ but actually less life and more misery and pain?

  32. @MichaelSimpson,

    I think CAM either progresses or regresses, depending on how you look at it. It definitely is getting dumber, seeing that it progressed (or regressed) from being worthwhile placebo effect to now proudly claiming to “harness the power” of the placebo effect. Indeed, in the USA it’s almost a trend to believe in dumber and dumber forms of CAM. On Twitter, nut jobs brag about their use of spooning, or their regurlar (funny my iPad autocorrected that to ‘regurgitation’) chiropractic visits, and essentially congratulate themselves for pursuing these “natural” treatments.

    CAM is definitely moving. Towards further stupidity.

  33. JMB says:

    “But what about people spending $100,000 of their own in Tijuana for just the promise of ‘more life’ but actually less life and more misery and pain?”

    The problem with Tijuana is that it is a different country, which limits applications of legal remedies available in the USA. But what about an integrative oncologist within the USA who profits the same amount from the sale of alt med?

    Charging 1 cent for a sugar pill might not be fraud. Charging $100 for a sugar pill is clearly fraud (from the perspective of a medical professional). At what point does an integrative medicine practitioner become guilty of fraud (increasing the cost of a treatment increases placebo effect)? Is it when the doctor’s profit from selling alt med exceeds a certain dollar amount? In the hypothetical example, should the integrative oncologist profit $10, $100, $1000, $10000, or $100000 from an individual before it is considered fraud? Should states outlaw the sale of alt med remedies in physicians’ offices to prevent the profit incentive from perverting the doctor patient relationship (as they did with prescription medicine)?

    Patients should be interested in cost effectiveness. Governments are interested in resource efficiency. The legal profession might be interested in the defining the fine line between integrative medicine and fraud. The old ethics was that in the uncommon event that a placebo was used, there would be no profit for the physician from use of the placebo.

    In regards to some of the comments about breast cancer screening, the supporting article included with the USPSTF recommendations did include the statement,

    “Using a $50,000 (USD) per life-year saved acceptability threshold, a recent cost-effectiveness and computer modeling study suggested screening was equitable when starting at age 35 and ending at age 85.8″.
    AHRQ Publication No. 10-05142-EF-1 November 2009

    The USPSTF went beyond the traditional cost effectiveness paradigm to arrive at their recommendations.

  34. herbalgram11 says:

    In the ABC article cited above it was stated that “public money should only go to those classes of therapies that have got reasonable evidence to support them.”

    Then why are flu vaccines, found by the Cochrane database to be ineffective in a recent review, and chemotherapy, also debunked as being less than efficaceous (Australian Prescriber Editorial: The emperor’s new clothes – can chemotherapy survive? http://www.australianprescriber.com/magazine/29/1/2/3/ ; original study: Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol 2004;16:549-60 http://www.ncbi.nlm.nih.gov/pubmed/15630849 ) still publically funded?

    It’s long since been known that the degree of efficacy of most conventional treatments have been misrepresented (and side effects downplayed).

    “…only 15% of medical interventions are supported by solid scientific evidence…(and)…only 1% of the articles in medical journals are scientifically sound…many treatments have never been assessed at all…”
    (Smith R. Where is the wisdom…? The poverty of medical evidence. Editorial. British Medical J 1991;303(Oct 5):798-799 )

    This suggests that 99% of published trials, or at least the reporting of them – cannot be relied on.

    “…only 5% of published papers reach minimum standards of scientific soundness and clinical relevance…” and that “…in most (medical) journals the figure is less than 1%”.
    (O’Donnell M. Evidenced-based illiteracy: Time to rescue “The Literature”. The Lancet 2000;335:489-491).

    “…Only 6% of drug advertising material is supported by evidence…” (British Medical Journal, February 28, 2004, p. 485 P Rome)

    Patients suffering adverse reactions to their prescribed medications, with around 20,000 deaths per year, take up one third of hospital beds in Australia.

    “…At least 80,000 hospitalisations related to medications occur in Australia each year. Between 32% and 69% of these are considered to be avoidable.” (Malpass et al. An analysis of Australian adverse drug events. J Qual Clin Prac 1999; 19: 27-30)

    “The number of reviews indicating that the modern biomedical interventions show either no effect or insufficient evidence is surprisingly high. …. a surprising degree of subjective interpretation involved in systematic reviews. Where patterns of disagreement emerged between authors and readers, authors tended to be more optimistic in their conclusions than the readers. Policy implications are discussed.”
    http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=101041

    A more detailed expose of the lack of evidence in conventional medicine / EBM can be found in this book:
    Tarnished Gold – The Sickness of Evidence-based Medicine, Steve Hickey & Hilary Roberts.

  35. WilliamLawrenceUtridge says:

    herbalgram11, thank you for that lengthy selection of slightly dated articles showing modern medicine’s efforts to improve itself, generate more reliable data and improve the safety and effectiveness of its treatments and interventions. Indeed, medicine as a field is certainly filled with vigorous disagreements and considerable research on the best way to achieve the greatest outcomes for its patients. While it certainly would be nice to practice medicine using only perfectly safe treatments with no adverse effects, sadly that is not a reality. It’s awfully hard to tell a dying patient you can’t do anything for them because the latest data is not yet in on the effectiveness of a drug or procedure for someone with their particular set of comorbidities. In the meantime, medicine and doctors must deal with the realities of noncompliant patients, adverse effects, complicated clinical presentations, sub-optimal evidence and cost constraints that are ubiquitous in modern hospitals.

    Thank the FSM however, that they are still doing research and debating how to best implement their treatments. If they didn’t, they might be like the CAM industry which prefers its evidence anecdotal and historical, and refuses to ever admit their treatments are unproven (or in some cases, disproven). Thank the FSM we aren’t limited to herbs as medicine, which present uncertain doses of uncertain ingredients of uncertain potency with no known pharmacokinetics – further complicated by the complete failure to test many of the ingredients used.

    Unfortunately the failings of herbal medicine do not prove that real medicine works, for that we must rely on the hard work and dedication of the doctors and researchers currently slaving away in labs and hospitals. A toast to them, for testing whether they are actually improving lives.

  36. Chris says:

    Dear herbalgram11, how would herbal medicine treat hypotension due to obstructive hypertrophic cardiomyopathy? Provide the title, journal and date of the PubMed indexed paper that shows the particular herbal treatment is effective. Thank you.

  37. WilliamLawrenceUtridge says:

    Chris, think we’ll see instead a citation about the adverse effects of drugs? Or possibly just an assertion?

    I do.

  38. Chris says:

    Because the “logic” is that some drugs cause bad effects, therefore herbs are safe.

    I wonder if he/she would like some foxglove tea served with hemlock cake (the root does look like a white carrot) with those logical fallacies.

  39. lilady says:

    Okay herbalist, I’ve got your first citation about chemotherapy…but I have the original article, not the citations:

    http://www.burtongoldberg.com/home/burtongoldberg/contribution-of-chemotherapy-to-five-year-survival-rate-morgan.pdf

    The study looked at 5 year survival rates attributed to chemotherapy in 1998, from mostly solid tumors, in Australia and in the United States. The 5 year survival rates attributed to chemotherapy were poor…with the exception of just a few solid tumors; cervical cancer (12 %), ovarian cancer (8.7 %) and testicular cancer (41.8 %). However the survival rate for Non-Hodkins Lymphoma (10.5 %) and Hodgkins Disease (35.8 %), were far better.

    Where by the way, are the 1998 survival rates attributed to chemotherapy for ALL and CLL…which do respond well to radiation and to chemotherapy?

    “It’s long since been known that the degree of efficacy of most conventional treatments have been misrepresented (and side effects downplayed).”

    (citation, desperately needed)

    So Herbalist, what herbs do you have to offer, in lieu of evidence-based chemotherapeutic drugs?

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