Part 2: The Stimulus Package and Health Care Reform: Change We Fear
In our last blog entry, we began discussion of the American Recovery and Reinvestment Act that President Obama recently signed, and the impact it could have on healthcare freedom of choice. This week, we continue analysis of the stimulus package as it specifically relates to alternative medicine.
The Future of Alternative Medicine
Assuming we are moving towards government-controlled healthcare and the NHS/NICE model, as we discussed in our last blog entry, what will the future look like for alternative medicine?
First, we have to be realistic as to what treatments will be assessed and approved by the government as part of the comparative effectiveness research conducted by the Federal Coordinating Council for Comparative Effectiveness Research (“the Council”). Will natural and alternative therapies even be included for testing in the Council’s scheme? Or will only “accepted” conventional therapies be tested? If natural and alternative therapies are tested, how will they be tested? Don’t forget that in addition to “appropriateness,” the Council will also be examining “clinical outcomes” and “effectiveness” of treatments. In our series on insurance coverage of natural medicine posted on this blog, we have already discussed the issue of effectiveness research of natural and alternative therapies. In that series, we pointed out how the White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP) has identified several issues preventing insurance coverage of alternative therapies, including the fact that there is a lack of evidence supporting their “medical effectiveness.”
But as we pointed out in our insurance segment, to say that more research is needed on the effectiveness of alternative therapies is an over-simplification of the issue and does not even begin to address the underlying practical and theoretical problems involved. Aside from the economic barrier that currently prevents widespread research on the effectiveness of alternative medicine, there is also the problem that no universal theoretical model exists as to how to integrate alternative therapies with conventional ones. Before the research process could even begin, practitioners and Council researchers would have to sit down and reach a consensus on which therapies should even be included as the subject of research for treatment of a particular condition, and how such therapies would be integrated with conventional treatments for that particular condition, which would be no easy task.
That leads us to the next logical question regarding effectiveness research of natural and alternative medicine- who will design the studies? And importantly, how will effectiveness be measured? Which research methodologies will be used to evaluate the effectiveness of alternative treatments? While the classic evaluation of the effectiveness of treatment focuses on “response,” or alterations in physical condition, this marker can ignore the serious impairment that such treatments can have on patients’ quality of life or even length of life, such as with cancer treatment, for example. In contrast, alternative medicine often places equal emphasis on the total effect that treatments have on patients, including patient comfort, functionality, energy, sleep quality, pain, and mood. Would the criteria used to assess the effectiveness of conventional medicine be expanded to include alternative medicine’s criteria regarding quality and length of life? Or would alternative treatments, which often operate from a different clinical paradigm, be squeezed into a conventional model in determining which treatments are “effective”? And then, of course, there are the political considerations of whether alternative therapies are “appropriate” methods of treating various conditions.
If natural or alternative treatments are not included in effectiveness research, or if they fail the comparative effectiveness research standards that the Council will set, what will happen to the availability of natural medicine? Will a doctor no longer be able to prescribe a chiropractic adjustment instead of the approved and “effective” pharmaceutical drug or surgical intervention? What will that mean when it comes to malpractice determinations? A centralized healthcare decision-making body that determines the type and availability of care for diseases will mean that the government is inevitably determining the minimum standards of care. If a naturopath is hauled before his medical board, will he be outside the standard of care for not prescribing what the government has decided is appropriate treatment for various conditions? What about clinics that work in an integrated setting and utilize both traditional and natural treatments? They straddle the standard of care in two or more industry settings. If they are held to the standards issued by the Council, it could be the end of integrated practice settings.
Lack of freedom of choice in healthcare is bad for patients, and it’s bad for natural and alternative medicine. As Peter Barry Chowka, an investigative journalist and former advisor to the National Institute of Health, asks, under a universal healthcare system, “What kind of healthcare will we be getting? More pharmaceutical drugs pushed on the public. More conventional medicine. More conventional cancer treatments that kill more people than they cure? Is that the kind of medical system you want?… Because that’s exactly what you are going to get.” (2) Natural medicine will be out in the cold. And if healthcare is determined and controlled by a government that will mandate conventional medicine, there is even more of dividing line between the clearly dominant insider and the rapidly diminishing outsider. Natural medicine will be the latter.
As Mr. Chowka writes, “All of these changes will no longer allow for the relative clinical freedom and autonomy that have been the hallmarks of alternative medicine since its inception decades ago. Uncountable numbers of innovative clinical practices will be shrouded in fear and paranoia because what the providers are doing clinically might lack official ‘evidence’ or ‘approval’- and the providers will know this and most of them will act accordingly.” (2) For those who want to employ alternative methods, “their hands will be tied and their clinical options severely limited…As an all-powerful, centralized payment and regulatory system kicks in, with its electronic medical records that will monitor every interaction with a patient, and its provisos that will not cover or will outlaw treatments and therapies not coded and approved by government…” alternative practitioners could become an endangered species. (2)
Even the alternative looks bleak. And perhaps even more so. Consider what will happen if alternative medicine is included in the approved treatment list. According to Mr. Chowka, that could be even worse. Ever since the government entered the alternative medicine setting in 1991 with the Office of Alternative Medicine and in 1998 with the National Center for Complementary and Alternative Medicine, the field has taken a hit. These governmental bodies have “stifled creativity,” “channeled alt med’s thriving progress into bureaucratic quagmires, and ultimately made primary alternative therapies go out of fashion and become much less available.” (3) And that was before the government took over all of medicine.
But the world of alternative medicine has largely been on the wrong side of the debate when it comes to government-controlled healthcare. In part, this support on behalf of the alternative medical community for a move towards universal healthcare seems to stem from naivety and an assumption that alternative medicine will have a seat at the table.
The Board of Directors of the American Association of Naturopathic Physicians wrote a long article endorsing President Obama that appeared in the Naturopaths for Obama membership blog area on the Obama-Biden website. The Journal of Alternative and Complementary Medicine similarly just published an editorial by Daniel Redwood endorsing President Obama and universal healthcare. (4) Mr. Redwood is operating under a grave misconception, as he recommends that in this nationalized system, “practitioners of all types must become conversant with the full range of health care approaches (both conventional and CAM) available in the US healthcare system.” (4) He says that referrals should be made by conventional doctors to CAM practitioners, and vice versa. (4) And “[w]ide-ranging knowledge and mutual respect must be our watchwords.” (4) He also is hopeful that under the Obama administration, chiropractors will enjoy full inclusion into the medical system. (4) What Mr. Redwood doesn’t realize is that if the Council’s comparative effectiveness research moves towards Daschle’s vision and the model described by the House of Representatives in their discussion draft, there will only be referrals being made to alternative practitioners to the extent their treatments pass the “appropriateness” and “clinical effectiveness” criteria. That could end up being none at all.
To see a glimpse of the future of alternative medicine under a state-run health care system, we have only to look to Massachusetts. In 2007, Massachusetts initiated mandating conventional healthcare insurance. Not surprisingly, alternative medicine has been given little attention in this scheme. (5) Alternative medicine now exists in Massachusetts in a very watered-down condition. And as Mr. Chowka points out, even if it was incorporated into mandated healthcare, natural medicine as a true alternative to conventional medicine would no longer exist. (5) It would play a very minor and complementary role. The progression of the field will stop. Natural medicine as a viable and thriving alternative would cease to exist.
That is indeed change to fear.
So what can you do to protect your healthcare choices? We will be exploring that issue in future blog entries.
References:
(1) American Recovery and Reinvestment Act 2009
(2) Chowka, Peter Barry. “Out of the Fog: Health Care ‘Reform’ 2009 Becoming Clearer.” December 1, 2008. Available through naturalhealthline.com.
(3) Chowka, Peter Barry. “Election 2008 and the Possible End of Alternative Medicine.” November 1, 2008. Available through naturalhealthline.com.
(4) Redwood, Daniel. Editorial: The Health Reform Moment: Peril and Possibility in the Obama Era. The Journal of Alternative and Complementary Medicine 2009; 15(1): 1-3.
(5) Chowka, Peter Barry. Alternative Medicine’s End Times Ahead or The End of the Road for Alternative Medicine? November 15, 2008. Available through naturalhealthline.com.
