The good and the ridiculous in the Washington State Health Board

[elfs]

In an article in the Seattle Times recently, a reporter reviewed the work of the Health Technology Assessment Committee, a board empowered by the state to go through procedures and processes item by item, evaluating the evidence around their efficacy, and accepting or rejecting them for coverage under the state's various healthcare programs, including Medicaid.

I approve. They're not doing anything different from insurance agencies, but they're doing it with taxpayer dollars. Just as I once struggled, in the most brutal confrontation allowed by law, to advice someone on her medical choices, I approve of people reviewing all the evidence and recommending the most informed course of action.

I had to giggle, though when I read this:

The seven doctors, a nurse, a chiropractor, a naturopath and a speech therapist who make up the committee are, by design, not experts in the technologies they review. [Emphasis mine]

A naturopath? Really? The people who practice homeopathy, "qi energy flow management," stabbing their patients with tiny sharp things to balance the body's humours, and "biotherapeutic drainage?" These are the guys who talk about "blood detoxification" and "colon cleansing?"

This is the guy entrusted as an "expert in evaluating evidence?" Yeah.

Look, I'm all for improved patient-practitioner relationships, but that seems to be the only thing naturopaths provide above and beyond ordinary medical care. The biggest study of acupuncture, for example, found "Perceived acupuncture outcomes seem not to be related to placebo effects and patient expectations." Looking through PubMed, I can't find a single study of a CAM (complementory and alternative medicine) modality that isn't just the placebo effect writ repetitiously.

You know what they call "alternative medicine" that works?

Medicine.

You know what they call people who use medicine that works?

Doctors.

Comments

[rick-bannerman.livejournal.com]

Opinions vary, my friend, but I'm not going to get into an argument about it.

My naturopath ND helps me with the vitamins and supplements for general wellness and health maintenance that my allopath MD doesn't understand. My allopath is better at fixing the things that have gone wrong. Together I feel better served.

[lucky-otter.livejournal.com]

Opinions may vary, but evidence doesn't.

[blaisepascal]

I'd go ahead and lump the DC into your rant, but that's just me.

What got me was the idea of creating a committee to evaluate medical technology they aren't experts in -- by design! Wouldn't it make more sense to use folks who know what they are looking at?

[shunra.livejournal.com]

1/11 of the team is dedicated to the placebo effect. That sounds just about statistically correct. :-)

[drhoz.livejournal.com]

I was rather amused by the situation when some researchers went over to China to investigate claims that surgery could be done with acupuncture instead of anesthetic. The guy asked his translator what the patient was moaning over and over during the procedure. It was "Pain.. Pain!" and the surgeon/acupuncturist yelled at him to shut up.

[edichka2.livejournal.com]

Speaking as an allopathic medical practitioner, I've worked with some credible patients who have had much more impressive success with naturopaths then with my kind. THere's plenty of subtle, insidious stuff in particular that flies under our radar. Nutritional problems and allergy/dietary sensitivities, for example, are more within the comfort zone of naturopaths than of most allopaths. It's not that we couldn't master that stuff, but it's not a big part of our training. We're pretty good at diagnosing discrete disease states, but when it's not easily measurable or testable, when it's more nebulous, we're often at a loss or frankly disinterested. I could do without the crystal healing and pyramid power and all that, but I think there's some useful stuff in there somewhere.
- E

[edichka2.livejournal.com]

Of course, there was also the case when a naturopath had spent months telling a patient that his symptoms of precipitous decline were due to all those nasty medicines his cardiologist had given him. Then I saw him once and it was obvious that he had a brain tumor.

[anthologie.livejournal.com]

What do you think of this?

http://nccam.nih.gov/

[elfs.livejournal.com]

I think it's a terrific waste of money.

I think if Americans want to pay for a medical establishment that spends more time actually listening to the patient and then saying, "Look, if you want to be healthier and happier, here are very specific steps you can take, and I'll have a nurse check in on you once a week to make sure you're making progress," I'm all for it. I'm all for the kind of health care system we see in countries like The Netherlands, or France, or Belgium. It'll never happen in this country because too damned many people are terrified that "busibodies" might tell them how to live, nevermind the vast number of people who are already failing at life.

But NCCAM is promoting that through a back-door of selling Big Placebo to people who have grown wary of black-box warnings (http://en.wikipedia.org/wiki/Black_box_warning) and terrified of Big Pharma. In the process, they and their woo-stained Knight Errant in Congress, Tom Harkin, have managed to waste some $120 million per year on this silliness.

[zanfur.livejournal.com]

"Perceived acupuncture outcomes seem not to be related to placebo effects and patient expectations."

That statement, if I parse it correctly, states that it is *not* placebo, as it states that the outcomes are unrelated to placebo. Was that your intended point? It seems to contradict the general concepts presented elsewhere, and I got the impression that you had lumped acupuncture in with CAM.

That said, "naturopath" is a huge umbrella term that covers both quacks and scientifically verified practitioners. Nutritionists, for example, are commonly called naturopaths. So are osteopaths, and chiropractors, which I think do more than placebo. Then again, so are homeopaths, which I think are solely administering placebos. C'est la vie. I would want to know the discipline of the naturopath before condemning. Also, if they actually got their doctorate, and where. Many (though I'd wager not "most") of them are actually doctors.