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.