There are many complex factors driving up the cost of healthcare, but one major factor is increasing medical technology. Often new expensive technologies provide incremental, or even questionable, additional benefits but can dramatically increase the cost of health care. This is especially true of in-hospital treatments.
There are also, of course, medical technologies that provide significant benefits, and others that improve our ability to make diagnoses. The public clearly wants and expects the latest and greatest medical technology when it comes to their health care or that of their loved-ones.
From this perspective the culture is definitely very pro-medical technology. Nothing is too invasive or heroic if it might save a loved-one. In fact, access to the latest medical miracles is considered a right, and even the suggestion that such technology might be futile is often met with hostility and anger.
Buddhists believe in reincarnation. Some psychotherapists do too.
I recently got an e-mail from a PR firm about an “internationally certified regression therapist,” Ann Barham, who has written a book and who claims to help patients to “heal enduring challenges, release unhealthy patterns and beliefs, and find their way to more happiness and success.” They offered me the opportunity to review her book and/or interview her; I declined, but I was interested in learning more about past life regression therapy, so I elected to “interview Dr. Google” instead.
In past life regression therapy, therapists use hypnosis, leading questions, and strong suggestions to encourage patients to imagine that reincarnation is real and to imagine their past lives. Events and people from past lives are blamed for symptoms and problems in the patient’s current life. Finding a past life cause for current problems supposedly helps patients deal with them. The technique is also used in healthy people to promote spiritual advancement and self-understanding. There is no such thing as reincarnation, and the memories of past lives are nothing but fantasy. (more…)
“This patient’s qi isn’t flowing the way it should. Consult Acupuncture, STAT!!”
Sometimes there is a strange confluence of events that dictate what I feel that I need to write about when my turn here at SBM rolls around each Monday. Last week, a reader sent me a rather bizarre acupuncture study, and I thought I might write about that. Then I saw Mark Crislip’s (as usual) excellent deconstruction of the frequent claim by acupuncture apologists that acupuncture “works” by releasing endorphins and thought, “Maybe another topic.” But then, over the weekend, the Friends of Science in Medicine sent me a link to their latest article, a review of acupuncture entitled “Is there any place for acupuncture in 21st century medical practice?” Not surprisingly, the FSM (Friends of Science in Medicine, not the Flying Spaghetti Monster) concludes that the answer is no. However, in stark contrast to that conclusions are studies like the one mentioned above, studies so ridiculous that, when I discuss it, you will hardly believe that anyone thought it was a good idea to utilize the money, time, and precious, precious human subjects to answer such a ridiculous question. After that discussion, I’ll come back to the FSM’s statement and discuss the evidence base (or rather, lack thereof) for acupuncture for pretty much anything.
Pictured: A great way to get a staph infection, not a great way to get an endorphin rush. Try jogging. Or heroin.*
I was reading, and deconstructing, a particularly awful bit of advice for acupuncture by Consumer Reports. It was the same old same old, but it was the source that made it particularly awful. I expect more from Consumer Reports than the uncritical regurgitation of the standard mythical acupuncture narrative. The report included the quote
One possible reason for the benefits of acupuncture: Studies show that it causes us to release feel-good hormones, called endorphins, that suppress pain.
I have never bothered to go back and see what the original literature was to support endorphins as a potential mechanism for a beneficial effect of acupuncture on pain.
That endorphins are released as a result of a noxious stimulus didn’t surprise me; that is what endorphins are for. And endorphins are unlikely to be the mechanism for all the other diseases for which the WHO suggests acupuncture benefits.
To my surprise, my brief search that day came up with very little information on the endorphins and acupuncture.
What I wanted to know was the evidence behind the universal meme that acupuncture releases feel-good hormones. If Consumer Reports says it is so, it must be true, right? So I plugged ‘acupuncture endorphin’ into PubMed and went to work. (more…)
Legislative Alchemy is the process by which state legislatures transform pseudoscience and quackery into licensed health care practices. By legislative fiat, chiropractors can detect and correct non-existent subluxations, naturopaths can diagnose (with bogus tests) and treat (with useless dietary supplements and homeopathy) fabricated diseases like “adrenal fatigue” and “chronic yeast overgrowth,” and acupuncturists can unblock mythical impediments to the equally mythical “qi” by sticking people with needles. In sum, by passing chiropractic, naturopathic, acupuncture, and Traditional Chinese Medicine (TCM) practice acts, states license what are essentially fraudulent health care practices and give them an undeserved imprimatur of legitimacy.
Only 6 of the 50 state legislatures are in regular session now. Many have ended two-year (2015-2016) consecutive sessions in which legislation from one year carries over into the next. The Texas, Montana, and North Dakota legislatures didn’t meet at all in 2016.
During 2015-2016, over a dozen naturopathic licensing or registration bills and at least 15 naturopathic practice expansion bills were introduced. (In some states, companion bills were introduced in each house. These were counted as one bill.) At least 19 chiropractic practice expansion bills were introduced in the same period. Four acupuncture/TCM practice acts were introduced, as were 14 practice expansion bills. This count does not include bills trying to force public and private insurers to cover CAM practitioner services.
Edzard Ernst published an excellent editorial today addressing the question of why pharmacists sell bogus products. Our own resident pharmacist, Scott Gavura, expressed similar points here on SBM a year ago. Their points are worth emphasizing and expanding upon.
The explicit premise of both editorials is that pharmacists, like physicians, are health care professionals. Being a professional means adhering to certain professional standard of quality control and ethical behavior. A profession is essentially a contract with society – the profession gets exclusive rights to certain commercial behaviors, and in return promises to maintain adequate quality control and to act in the best interests of society and their individual clients.
When a profession puts their own commercial interests ahead of society or their individual customers, they have violated that contract.
There are multiple layers of regulation to maintain quality and ethical standards in the health care professions. Once a profession is licensed, they basically self-regulate, with members of the profession establishing the standard of care. Standardized testing designed by the profession is used to establish competence or specialized expertise.
A superb writer, Siddhartha Mukherjee’s books are easier to read than his name is to spell
Six years ago I reviewed Siddhartha Mukherjee’s book The Emperor of All Maladies: A Biography of Cancer. It was hands-down one of the best books I have ever read on a medical topic. Now he’s done it again. His new book is titled The Gene: An Intimate History.
Mukherjee is a superb writer. Much of what I said about his first book applies equally to his second, so I will quote myself:
It is a unique combination of insightful history, cutting edge science reporting, and vivid stories about the individuals involved: the scientists, the activists, the doctors, and the patients. It is also the story of science itself: how the scientific method works…
Beautifully written and informative
Reads like a detective story with an exciting plot.
He links this second book to his first by pointing out that cancer is an ultimate perversion of genetics, and that studying cancer means also studying its obverse: normalcy. He gives the subject a human face by interspersing anecdotes from his own family’s struggles with mental illness and its connection to inherited genes. He sets out to tell the story of the birth, growth, and future of one of the most powerful and dangerous ideas in the history of science: the gene. He says it is one of three destabilizing ideas that have transformed science: the concept that irreducible units underlie matter (the atom), digitized information (the byte or bit), and biological information (the gene). He explains how the consequences of these ideas have transformed our thinking, our language, our culture, politics, and society. (more…)
I was originally going to write this post for the 4th of July, given the subject matter. However, as regular readers know, I am not unlike Dug the Dog in the movie Up, with new topics that float past me in my social media and blog reading rounds serving as the squirrel. Then I got a copy of the movie VAXXED to review last week, and before I knew it this post had been delayed two weeks. Never let it be said, though, that I don’t circle back to topics that interest med. (Wait, strike that. Sometimes, that actually does happen. It just didn’t happen this time.) This time around, I will be using documents forwarded to me by a reader as a means of revisiting a discussion that dates back to the early days of this blog, before discussing the broader problem, which is the infiltration of pseudoscientific “complementary and alternative medicine” (CAM) into VA medical centers.
The return of the revenge of “battlefield acupuncture”
Today’s topic is the Veterans Health Administration (VHA) and its embrace of pseudoscience. VA Medical Centers (VAMCs) provide care for over 8 million veterans, ranging from the dwindling number of World War II and Korean War veterans to soldiers coming home now from our wars in Iraq and Afghanistan. Although there have been problems over the years with VAMCs and the quality of care they provide, including a recent scandal over hiding veterans’ inability to get timely doctor’s appointments at VAMCs, a concerted effort to improve that quality of care over the last couple of decades has yielded fruit so that today the quality of care in VA facilities compares favorably to the private sector. Unfortunately, like the private sector, the VA is also embracing alternative medicine in the form of CAM, or, as its proponents like to call it these days, “integrative medicine,” in order to put a happy label on the “integration” of pseudoscience and quackery with conventional medicine.
An acupuncturist and acupuncture anesthetist perform robotically-assisted acupuncture on a patient who has been feeling kind of tired lately
Developed over many thousands of years (or maybe a little less), what has come to be known as traditional Chinese acupuncture has proven capable of curing or at least ameliorating the symptoms of a variety of medical conditions. But one of its greatest strengths, the intimate connection between the practitioner and the acupuncture needle, is also one of its most significant weaknesses. Taking advantage of the robotic technology being used by surgeons to perform an increasing number of minimally-invasive procedures, cutting edge acupuncture providers are now able to provide relief for patients that were once felt to be either poor candidates or had failed to improve despite treatments with traditional acupuncture by hand. (more…)
Natural and herbal remedies are often promoted as a substitute for drug therapies. But do they actually work?
The idea of taking medication can be frightening. And as consumers and patients that want to make our own informed health decisions, it’s understandable and even appropriate to question our physicians when they recommend drug treatments. We need to understand the rationale for any medication that’s recommended or prescribed, the benefits of therapy, the side effects, and if there are any other approaches that might be more appropriate. Dietary supplements and natural health products are widely marketed as being safe and effective, and are occupying more and more shelf space in pharmacies, usually right beside the pharmacy counter. Many of my patient encounters in the pharmacy have included a discussion on the merits of drug therapy, versus the supplements that may have flashy packaging and impressive claims of effectiveness.
One encounter from my time working at a local pharmacy still sticks with me. I met a new patient who was anxious and eager to get my advice. He’d been cautioned by his family doctor that he was on the borderline of being diagnosed with diabetes. He had come to the pharmacy seeking a supplement that could help him avoid diabetes and medication. Rather than recommend any supplement, I suggested that the best approach he could probably take would be to lose some weight and get some exercise – it could be more effective than any supplement or drug, and would definitely help his health. He agreed, and then asked me what supplement he could take that could help him with some weight loss.
This type of discussion occurs all the time, and seems more common when there’s a lack of trust in the physician, or when the goals of treatment aren’t understood. The patient, reluctant to accept the physician’s recommendation, heads to the pharmacy for what they believe is a second opinion. In some cases, the patient may question the physician’s advice: “All my physician wants to do is prescribe drugs,” is a statement I’ve heard more than once. In those that are reluctant to accept medical treatment, there’s often a willingness to consider anything that’s available without a prescription – particularly if it’s perceived as “natural.” Natural products and dietary supplements are thought to be gentle, safe, and effective, while medicine may be felt to be unnatural, harsh, and potentially dangerous. Yet when I explain to patients that there’s actually little evidence to suggest most supplements offer any meaningful health benefits, I am sometimes met with puzzled or dismissive looks. The supplement industry’s marketing has been remarkably effective, glossing over the fact that the research done on dietary supplements is overall unconvincing and largely negative when it comes to having anything useful to offer for health. (more…)