Val Jones: How not to revolutionize healthcare

The following is a reader take by Val Jones.

As a new member of the National Press Club in Washington, DC, I am taking full advantage of my opportunities to get an inside look at what people are saying about healthcare, and how policy makers and advocacy groups are proposing to improve it.

Three of the presentations that I witnessed last week were some of the most flawed, anti-physician, and anti-science bunk that I’ve heard in my recent memory. The gist of the arguments were that a “revolution in healthcare” will come once we’ve established billing codes and payment processes to support alternative medicine practices, including things like Indian shamanism and Christian Science prayer. In essence, health insurance companies and our tax payer dollars (in the opinion of the lecturers) should fully support any medical treatment proposed by a “practitioner” whose treatments have a historical basis and some evidence of an effect (presumably placebo).

And why should we fund therapies that have not been shown to be effective beyond placebo? Because the lecturer experienced a “miracle cure” when 18 months of specialist investigation revealed that there was nothing physically wrong with her, and yet an alternative medicine practitioner miraculously understood (within 30 seconds) that she was the victim of total body candidiasis by examining her tongue. She was treated with a special diet and lots of yogurt. Now she is on a mission to create a new coding system that would allow billing for most CAM services.

Another speaker described the miraculous healing (via prayer) of a trauma patient two weeks after he sustained multiple limb fractures and lacerations. Excuse me while I doubt the veracity of this claim.

A third speaker suggested that “doctors shouldn’t be managing non-critical care” and that the problem of access to physicians could be immediately solved if CAM practitioners were recognized as legitimate healthcare professionals. She went on to say that “nurses needed to become outspoken” in order to eliminate barriers to advanced practice, suggesting that they should have decision-making authority equal to physicians in the ICU setting.

In essence, the speakers propose that the healthcare crisis can be solved by cutting physicians out of the equation, diverting funding to shamans and placebo peddlers, and giving allied health professionals the authority to practice medicine.

As I shifted uncomfortably in my chair, I began wondering what was behind this anti-physician, anti-science movement. It seems to me that a lot of the personal frustration that these lecturers experienced with the healthcare system was that they had a psychological problem that was not addressed by physician specialists. Of course an endoscopy is not going to diagnose depression, of course blood tests can’t detect “supra tentorial” issues. Gastroenterologists are ill-equipped to assist patients with psychological concerns, and the result is that these patients ping-pong from specialist to specialist until at last they’re offered the placebo solution that assists with their (usually) legitimate psychological problem.

What we see here is that the fragmentation of care – and a shift away from having a medical home with a primary care physician who follows a patient from cradle to grave – is creating a marketplace for alternative solutions. People need their psychological needs met, and they’ll get help under the banner of CAM if necessary.

What I’d rather see, and what would potentially obviate the need for this complicated placebo dance and false diagnosis syndrome that we’ve created, is better coverage for mental health services. This generation of Americans is under incredible stress, producing high rates of anxiety, depression, eating disorders, attention deficits, and adjustment disorders. At the same time, primary care physicians are under pressure to see more and more patients in shorter time intervals. Health insurance offers notoriously poor mental health service coverage, and so we end up with growing psychotherapy needs in an environment of diminishing treatment availability.

If we do not address the mental health needs of our citizens, “total body candidiasis” may become the new “adjustment disorder NOS.” I can’t think of a greater waste of our resources, or a poorer solution to the healthcare crisis.

Val Jones, M.D. blogs at Getting Better with Dr. Val and is a regular contributer to Science-Based Medicine.

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  • Dr. Val

    Please note that I wrote this reader take just prior to the news about the bailout plan including better coverage for mental health services. I guess I wasn’t the only one who felt the way I do! See this article in the NYT for more information:

  • #1 Dinosaur

    Well said. Of course, I already said it, way back on 8/9/07. Sad that it needs to be said over and over.

  • NurseExec

    Excellent post! It’s my hope that with Mental Health Parity finally a reality, that more people WILL be able to access mental health care. Thanks for your commentary :)

  • dr_dredd

    I think part of the reason we’re seeing this is that the country in general has become more anti-intellectual over the years. Physicians with their many years of school and training, are met with suspicion because of their “ivory-tower” ways. Bring in an alternative practitioner who can create a placebo response, and that’t it.

    It’s akin to what I observed in the debates. We don’t appeal to “Joe Six-pack.”

  • Nurse K

    In my nursing program, we were expected to learn and understand the basics of bizarre things like Reikki and Healing Touch with the understanding that it “helps” people.

    Nurses needs to back away from crayzee stuff like this and not think of it as some way to become an independent practitioner. Makes us look bad.

  • Norman

    When I worked in Rx sales I often thought, that when I retired I would get a job in the health food/supplement industry. I could then “help” the patient with their needs. And who better than someone that sold “poison” for 27 years. I could make all sorts of claims, not having to worry about that pesky FDA. I can just visualize all of that money rolling in.

  • Sara E Anderson

    Misdiagnosis is not just a delusion. Plenty suffer because no one actually knows what they can do about their illness, or even what it is.

    Dr. Dinosaur really has the right angle on this, I think.

    People are a attracted to simple solutions to big, complicated problems. “Oh, so I just need to stop eating gluten!” A good example of intelligent people getting sucked into what I might call medical conspiracy theories is Linus Pauling going gaga for vitamin C. He wasn’t an idiot. You don’t have to be a moron to be wrong. We’ve all lived in bodies our entire lives, so we feel like we know a lot about them.

    People aren’t ever going to be happy – they’re always going to get sick, and at least some of the time stump the doctors.

  • Moof

    “She went on to say that “nurses needed to become outspoken” in order to eliminate barriers to advanced practice, suggesting that they should have decision-making authority equal to physicians in the ICU setting.”

    Shades of the NHS … :o(

  • Matt

    You’re suggesting better mental health coverage, but if fragmentation of care is a primary cause along with a lack of mental health coverage, wouldn’t improved primary care be a better solution? Primary care has gotten the short end of the stick. Although an involved primary care doc sees the whole patient and all treatments, reimbursement has gone down, so those PCPs that are out there can’t spend the requisite time to understand the entire patient and treatment spectrum. Furthermore, the system has started to shortcut the PCP, because of poor communication mechanisms among specialists and PCPs.

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