Shana Moore wrote:
In a quick review of the original posts, I see a lot of discussion about cost and profit as the importance in asessing value and benefit. I see little discussion about side effects, patient choice, the benefit to patient AND practitioner of quality interaction...not all incentives are or should be based on money or balancing an accounting equation.
The Institute of Medicine agrees with you. Several landmark papers on quality in medicine have come out in the last decade.
When I use terms like "evidence-based medicine" and "medical necessity", I'm dealing with process quality issues. Quality opportunities involve the over-use, under-use, and mis-use of health care services (as defined by the IOM).
And then we get to patient choice. Indeed that is another vector to consider in the multi-dimensional space we use to evaluate health care services. I've done studies which show that the dimensions of quality, cost, and satisfaction sometimes align, and sometimes they don't. For example... If you put a gatekeeper MD in-between a group of individuals with low back pain and the orthopedic surgeons (or not), you get the following.
WITH GATEKEEPER (restricting choice)
* Lower cost (factor of 4)
* Higher quality and better outcome (as measured by patient-reported health status via a survey tool like the SF-36)
* Lower patient satisfaction
WITHOUT GATEKEEPER (giving patient complete freedom)
* Higher cost (because surgeons LOVE to cut and patients get what they ask for)
* Lower quality (higher pain scores on the SF-36)
* Higher patient satisfaction (because they got what they wanted)
So which is better??? The truth is that in some cases, choice for the uneducated consumer isn't necessarily a good thing for that consumer as measured either by cost or by clinical outcome. And yet of all things about our health care system, we Americans love our choice. So... we get what we get.
Be careful what you ask for...
Shana Moore wrote:
It also sounds like you are saying alternative medecine only treats symptoms..and I think that is a possible bias and misjudgement on your part...unless I'm misreading your intent?
I was trying to address the issue of addressing the patient's needs before picking the therapy rather than look for a way that any given therapy (whether it be surgery, Rx, acupuncture, herbs, or whatever) can treat a patient. But often this doesn't happen. To a hammer, everything looks like a nail.
EVERY branch of medicine has issues with treating the symptoms rather than getting at root causes. I could treat Mrs. Jones' mild hypertension with an anti-hypertensive. Or... I might see if losing 50 pounds will decrease all metabolic syndrome symptoms (hypertension, hyperlipidemia, Type II diabetes, etc.).
In my book, NO branch of medicine (West or East) gets a break. It's all medical care. It all should be evaluated based on the needs of the patient. And we should be trying to get at root causes first rather than trying to make any particular therapist or therapeutic modality reap more profit. Profit should come naturally from a system where the customer has his/her needs met.
If all that makes sense...
As for "alternative" medicine, well... This reminds me of a friend of mine (Tara Lane) who used to be lead singer and songwriter for several local bands (e.g. In Clover). Tara used to joke about the "alternative" label given to her music. As she used to joke, "What happens if my music becomes mainstream? Does that mean I can't call it alternative anymore?"
It's a sloppy label, Shana. IMO we should throw it away.
There's medical care that works, and medical care that doesn't work.
There is evolved medical care, and medical care still evolving.
There are myriad sources of care (Europe, Asia, the Americas, etc.).
There's allopathic medicine, osteopathic medicine, etc.
Just remember that money is the mother's milk of the health care system. Without it, things don't happen.
As for herbs... Just remember that all that fits into the broader class of pharmaceutical intervention. The thing about herbs (both good and bad) is that you're dealing with the active ingredients in a more raw form, and sometimes existing in a family of compounds. Modern Pharma tends to be inspired by herbal medicine, but takes it a few steps further. Folks working supercomputers in Pharma labs will isolate the active ingredients in herbs, figure out how they work, manipulate the active sites of the compound or compounds, purify it, standardize the concentration to make dosing more precise, etc., etc. Meanwhile, an herbalist is dealing with a lot of variability and unknown. There's a random element to what they are doing, and that isn't always good.
But it's ALL pharmaceutical intervention in my book.
Just ask the oncologist who prescribes medical marijuana to help a chemotherapy patient improve his/her appetite.
We could go on and on about this. But my bottom line is I like to be agnostic about medical care from any venue. It should address the needs of the patient, the patient should be made happy and healthy (if possible), it should be timely and accessible, and cost should be reasonable.
Americans want what they want. And the libertarian in me says "Go for it!"