Congress has bought into organized quackery's main ploy, which is to disguise its promotions in a cloak of consumer freedom of choice. A proposed bill is:
To permit an individual to be treated by a health care practitioner with any method of medical treatment such individual requests...
The law would require the individual to be warned that:
this food, drug, or device has not been declared to be safe and effective by the Federal Government, and any individual who uses such food, drug, or device, does so at his or her own risk.
It is obvious that the only freedom that this act would confer is to health care providers who traffic in dubious alternative / complementary medicine. In the first place, people do not want to be cheated, nor do they want to be harmed. The only reason an individual would want to be treated by an unapproved procedure is that someone has convinced them that it IS safe and effective. Desperate patients are willing to try most anything that a health care provider suggests might help.
Alienation also plays a powerful role in patient behavior. Deviant providers often convince their patients that an oppressive and corrupted bureaucracy is keeping the treatment off the market. Even the language "declared...by the Federal Government" rather than "determined on the basis of evidence" is prejudicial. This bill is a charlatan's dream because it entices patients to sign away their rights. By fulfilling the duty to warn, quacks will be getting the same kind of protection the tobacco industry got with warning labels. After a consumer realizes he has been harmed, he has little chance of redress because of having been warned.
Quackery has perverted medicine by law. The 1994 dietary supplements act, the NIH Office of Alternative Medicine, organic foods certification, widening the public purse to chiropractors (see "New Law Will End Systematic Medicare Fraud and Abuse...,") and the proposed access to medical treatment all pervert consumer protection! And don't be fooled--the people who write, introduce, and pass these bills are lawyers! It is time to for Americans to be alerted to the fact that lawmakers are in league with consumer exploiters, and are dismantling laws of consumer protection and redress.
The Practice and Policy Guidelines Panel of the NIH Office of Alternative Medicine (OAM) published its findings in the Archives of Family Medicine in the March/April issue (1997;6:149-154). The article continues the misinformation upon which much of the attention being given alternative medicine rests, ie, that it is in popular demand. The abstract opens by stating:
An estimated 1 of 3 Americans uses some form of complementary and alternative medicine (CAM), such as acupuncture, homeopathy, or herbal medicine. ...
Eisenberg, et al (NEJM, 1993;328:246-52) is cited for this statistic. In fact, the use of acupuncture was reported at less than 1%, homeopathy was 1% with only a third of respondents seeing a provider (2/3s bought OTC remedies), and herbal medicine use was 3% with only 1 of 10 seeing a provider (90% bought an OTC herbal remedy). The total use of the three types of CAM used by "Americans" was a maximum of 1-in-20 with 1.33%, or about 1-in-75 seeing a provider. The text of the article also lists "relaxation techniques, and various other practices and therapies," but merely tacks them on after again listing these three. By inflating the use of acupuncture, homeopathy and herbal medicine by a factor of 25, the panel condemns itself as guilty of either sloppy scholarship or a deliberate misrepresentation of the facts.
The article reflected the impasse that will always exist between true believers in CAM and those who believe in reliable evidence for any healing technique. If one follows the thinking of the OAM panel, CAM should be widely adopted so it can be studied (which of course it cannot, be using "reductionist" science). From here it looks like OAM is going nowhere fast scientifically, but is the gateway for ideologically-driven, dubious CAM into standard health care. The OAM deserves a national "no confidence" vote.
The idea of having a government sponsored program for testing unusual medical methods is highly desirable. Unfortunately, the present approach of having a separate NIH Office of Alternative Medicine has not worked. The OAM has become a public relations boon for quackery and has yet to yield a single benefit to health care.
The proposal of creating an independent Center for Alternative Medicine is even worse than what is happening now. A solution that should receive careful study is to establish programs within each of the National Institutes of Health and the Centers for Disease Control and Prevention, which offer free counsel and advice, opportunities for on-site testing, and research grants for conditions covered by the various agencies. This would focus the procedures on the diseases, conditions, and disorders rather than on the methods and procedures as is already done in the National Cancer Institute (NCI).
It was determined very early that NCI didn't need the OAM. It already had its own Cancer Therapy Evaluation Program in the Division of Cancer Treatment which tests all sorts of ideas. The main problem is one of visibility. Such programs should be easily accessible. Serious minded people who wish to test promising ideas should not be frustrated by red tape and other obstacles. By the same token, quacks who now present themselves as having been shut out by the establishment would have no excuse for not having their methods tested.
Please, do not think that we are poking fun at Di's tragic death. Princess Diana was highly admirable for setting aside her privileged life and becoming a nanny, a kindergarten teacher, and a crusader for underdog causes. She was a revolutionary when it comes to changing the perspective of the Royal Family--both from above and below.
Unfortunately, she also had an irrational side which led her to visibly practice, and tacitly endorse, certain forms of quackery. The most serious was her reliance upon the advice of psychics. The world has been playing a "blame game" in Di's death. The paparazzi, the tabloid-buying public, the driver, her body guard, and the Royal Family have all been named as sharing guilt.
Add one more to the list: her psychic who failed to forewarn of the accident that took Di's life. Think about it--had the psychic warned her, three people would still be alive, several news photographers would be out of legal difficulty, and millions of us would have been spared from our terrible grief. Di's astrologer stated in a television interview that she had "sensed" that Di would have a short life and a tragic end because of two dreams. However, she stated that she had never mentioned this to Di because she did not want to upset her!
Wow, what chutzpa! Psychics are notorious for claiming credit for having predicted big events after they have occurred, but to claim that life or death information was withheld for fear of upsetting the client is the lamest excuse by a psychic caught in failure that we've ever heard. No one seems to take psychics seriously when the chips are down. When things are going well, they get publicity for their horoscopes, channeling, fortune telling, Nostradamus interpretations, numerology, and so forth. Many common folks patronize the Psychic Hotline because rich and famous people like Di are known to rely upon psychics. Di may have been a wonderful role model for the self-centered rich and famous to learn how to give of themselves, but she also misled people by lending credibility to the idea that psychics are valid. Perhaps the fact that Di's alleged psychic blew the biggest call of her life, her tragic death can demonstrate the reality that there are no genuine psychics--only opportunists who exploit fear of the uncertain future. Psychic advisers engage in a form of mental health quackery:
MENTAL HEALTH QUACKERY: The practice and promotion for gain of methods and procedures, which are not subjected to thorough systematic objective testing for reliability and validity, that are used: (1) to assess or alter personality (aka, character), aptitude, intellect; (2) as a basis for personal, family, or career counseling or advisement (these usually involve health, money, or human relationships); (3) to exploit the uncertainty of the future (ie, predict an individual's future, or future events that will impact an individual's life); (4) to exploit the fear of death, or personal loss caused by death; (5) to exploit personal weaknesses or feelings of inadequacy (ie, loneliness, spiritual emptiness, low self-esteem, personal failure); (6) to diagnose or treat behavioral disorders.
First, understand that it is redundant to say "phoney psychics." True psychic ability has never been demonstrated under scientifically controlled conditions. The James Randi Educational Foundation offers over $1 million for anyone who can do so. Also, understand that there are two general categories of psychics. Type I are con artists--conscienceless scoundrels who prey upon the emotionally vulnerable. They are schooled in the art of deception. Outwitting people is their forte, and the more prominent their prey is, the more satisfying it is to the con man.
Type II are delusional people who really believe in their psychic powers. For instance, one believes that by concentrating on traffic lights she can make them change from red to green; another says that she can guess who is on the telephone before she answers it; another has premonitions that always makes sense to her after the fact. These people confuse coincidence with cause, and work backward from effect to cause. They are fantasy-prone in their personalities and find a deeper reason behind even the most mundane events.
It is sometimes difficult to determine whether a psychic caught in deception is a Type I or II. Some Type II psychics use deception either because their "powers do not always work" and they do no want to disappoint their clients; or, because they believe that it is more important to reinforce the client's belief in metaphysical powers than it is to actually perform them (ie, mind-power is ultimate power, and it must be exercised for it to be strengthened).
Leonard Wood is President of Multi-sponsor Surveys, Inc., in Princeton, NJ. He has over 25 years' experience in assessing public behavior and attitudes concerning food and nutrition. His company conducts the Gallup syndicated surveys in food and nutrition under contract.
Wood says that the late 1970s and early 1980s were dominated by "avoidance behavior," (ie, not eating preservatives, food colorings, possible carcinogens, etc.). The late 1980s and early 1990s saw consumers becoming more knowledgeable about the relationship between diet and health. Aging baby-boomers are coming to terms with their own mortality, and are influenced by publicity about the potential benefits of antioxidants to prevent cancer and heart disease, and slow the aging process. Consumers are more proactive, taking action now and willing to sort out the details later. The sorting out of the details by consumers does not bode well for herbal supplements. Marketers are not off to a good start. The 1996 survey of herbal supplement users found that most of the growth was coming from "first time tryers" who, compared to more traditional users, were:
Wood warns that new users can easily be disappointed if near-term results do not live up to expectations and claims. The need for "education"* by herbal marketers is emphasized. He also states that the high cost of herbal supplements is discouraging to consumers.
[Wood L. "Today's proactive consumer and herbal supplements," HerbalGram #40, Summer, 1997, pp.50-1]
* "Education" by the health food and supplement industry usually means indoctrination with misinformation through books, magazines, and other media wherein the purveyors are protected by the First Amendment.
Stephen Barrett reviews the history of hype behind today's popular products used by athletes and body builders in an attempt to enhance their performance in the May/June Nutrition Forum. Bob Hoffman and Joe Wieder played key roles in selling the myth of "ergogenic aids," and both were enriched by the market they helped create. Durk Pearson and Sandy Shaw played a role in expanding the market as well. Barrett provides the straight facts on muscles and protein. He describes the work of NCAHF's David Lightsey who has probably done more investigations of company claims than anyone. It is clear that this invalid industry thrives on the basis of misinformation promoted by the industry and inaction by the regulators.
The hot herb today is St. John's Wort (SJW) which is being used to treat depression. Unlike many herbal remedies, the UCB Wellness Letter (9/97) says that there is clinical evidence of the effectiveness of one of its active ingredients, hypericin, on mild depression. The herb does have side-effects. Because it may work by increasing serotonin levels, the Pharmacist's Letter (9/97) advises against using it in combination with Prozac or other antidepressants. The Lawrence Review of Natural Products (1/95) says that SJW is a powerful monoamine oxidase inhibitor which provides a pharmalogical reason for its activity.
Free market ideologists are fond of the idea of letting the marketplace decide the relative value of alternative/complementary medicine (ACM) vs standard care. The primary reason that the libertarian approach of having a completely unregulated health marketplace is unworkable is because alternativists traditionally engage in unfair competition by making claims of benefit without substantiation while standard medicine builds upon evidence. Health insurance data might be used to test ACM vs standard medicine in the marketplace.
An insurance policy is strictly a contract between a consumer and provider. Insuring an item does not validate its worth scientifically. Policies could be written to cover only either standard medicine or alternative medicine. If a person desires both, he or she would simply need two policies. Some flexibility could be allowed for alternative medicine, such as a checklist of what products and services one wished to have covered. Those who abhor standard medicine would not have to pay for it and vice versa. People who want to cover all of the possibilities could do so by purchasing both kinds. Insurance companies are generally regulated like a public utility. They are permitted to charge premiums that pay their costs of operation and show a reasonable profit for investors.
Having separate insurance policies would offer several advantages. Actuarial data is often used to make public policy. Such a plan could soon produce outcomes data on cost-effectiveness. After all, there is an argument that can be made for the "end of science"a in health care. To wit: Most of the real progress in survival and longevity that is reflected in life expectancy (LEb) is due to public health environmental factors, rather than clinical medicine per se. Granted, the fact that the United States has the best life expectancy for people over 80c is said to be due to its superior medical care. However, recalling the sage observation that "all desire to live a long life, but none wish to be old," the idea of extending old age is not an attractive idea. So, let us theorize that those who opt not to use standard health care would end up with 2 to 3 years lower LE--say, 72 instead of 75 at birth, and 3 or 4 at age 80. Having information on the cost-effectiveness of various standard versus ACM methods would provide a rational basis for deciding to either do nothing, employ useless--but pleasing--ACM, or go for all one can be and take on the benefit-risk of standard care.
aEnd of science refers to the point at which science has provided all of the useful information that it can. This evokes Jahoda's dictum of the psychology of superstition: where chance and circumstances are not fully controlled by knowledge, man is more likely to resort to magic.
bLE = the average number of years an individual is expected to live at any stated age based upon death rates for all age-groups. In 1992, the US white LE was 76.5 yrs at birth; however, while the years left to live diminishes over time, the expected terminal age rises; eg, in 1992 a 65 yr-old's LE = 17.6 yrs w/terminal age = 82.6; a 75 yr-old LE = 11.2 w/terminal age = 86.2.
cUS News & World Report, 11/13/95:28.
Healthy weight expert Frances M. Berg has taken on one of the most important health problems of our time: Many of today's children are afraid to eat! Berg says that it's a fear that consumes them, shatters their lives, and even kills. It's an obsession that dims children's joy, curiosity, energy, and sense of what is normal. Berg discusses: (1) why teenage girls "hate" their bodies; (2) how eating disorders destroy lives; (3) why one in five teenagers is overweight; (4) how daily humiliation persecutes kids; (5) why 1 in 12 girls vomit or take laxatives to lose weight; and, (6) takes on the challenge of promoting wellness and wholeness in every child of every size.
Berg tackles some of the toughest issues plaguing our society: The role models used in advertising and entertainment media who create unattainable image goals for our girls and women. Berg addresses size prejudice, which is one of the last strongholds of socially-accepted discrimination. She also tackles the animal rights zealots and their anti-animal food agenda while telling how lifestyle choices increase problems. Best of all, Berg provides many practical solutions to the problems she addresses.
This is more than a penetrating analysis of a major public health problem; it is also a "how to" book of solutions. This a book on healthy living that goes beyond the physical to mental and social health. People interested in eating disorders will love this book. It is must reading for people who don't know about eating disorders, but do have daughters or know other young women they are concerned about.
Price: $17.95 + $3 P&H; Order from: Healthy Weight Publishing Network, 402 S. 14th St, Hettinger, ND 58639; fax: 701-567-2602; phone 567-2646.
Frances Berg, MS, is editor, publisher and founder of the Healthy Weight Journal. She is a licensed nutritionist, family wellness specialist, and adjunct professor at the University of North Dakota School of Medicine. She coordinates the NCAHF Task Force on Weight Loss Abuse.
When President Clinton signed the Balanced Budget Act of 1997, among other things, he eliminated the requirement that chiropractors submit an x-ray showing a "subluxation" in order to be reimbursed by Medicare. The new policy will not take effect until 1/1/2000, but when it does it will end more than 20 years of intentional, systematic Medicare fraud designed by nonchiropractors but committed by DCs.
Chiropractic is built upon the theory that "subluxationsa," ie, minor deviations in vertebral alignment, are the fundamental cause of most diseases of the body. DCs do not diagnose disease as do physicians, rather, they "analyze" the spine for "subluxations" and "correct" these by manipulative therapy. State practice acts reflect this theory in their descriptions of what chiropractic is, and what DCs do.
DCs have never been able to pass a test in which they are challenged to identify the subluxations alleged to exist on an x-ray submitted by other DCs, such as the test conducted by the National Association of Letter Carriers in the 1960s:
At our invitation, representatives of both the American Chiropractic Association (ACA) and International Chiropractic Association (ICA) met in our office with one of the most reputable radiologists in the area, whom we had engaged on a temporary consultant basis. Our doctor (medical) presented 20 sets of x-rays that had been submitted by chiropractors. Each film was purported to show a subluxation; in several instances, four to six subluxations had been diagnosed on a single x-ray. One after another, each film was placed in the view box. The chiropractic representatives, including a radiologist of their own selection, were invited to point out the subluxations. Not a single one was identified. Nor did the chiropractic representatives offer a solitary comment.
In 1972, Congress caved in to political pressure to include chiropractic in Medicare, but it stipulated the x-ray provision described above. The time period coincided with the time when NCAHF president William Jarvis was doing his doctoral dissertation on chiropractic. The Dean of the Faculty of Western States Chiropractic College told Jarvis at the time that he believed the x-ray provision to be a trap laid for DCs by the same people who had embarrassed the chiropractic profession in the Letter Carriers union test.
The 1972 Houston Conference
To avoid the trap, in a matter of days after President Nixon signed the law authorizing payment for:
the Chiropractor's manual manipulation of the spine to correct a subluxation (demonstrated by x-rays to exist) which has resulted in a neuromusculoskeletal condition for which such manipulation is appropriate treatment. ...
The Houston Conference of November, 1972 took place. Representatives from 8 chiropractic colleges, the American College on Chiropractic Roentgenology, the Council on Chiropractic Orthopedics, and others agreed upon a classification of subluxation, particularly the radiological manifestations, "to be uniformly used in Medicare reporting." The conferees stated that:
The advent of chiropractic inclusion in Medicare has brought the absolute necessity of a uniform method of describing, documenting, and reporting spinal subluxation so that those who will administer the law will not be confused by the present lack of uniformity and differences in reporting terminology, to our detriment.
Standard medical terminology defines a subluxation as an "incomplete or partial dislocation," but does not recognize the chiropractic version of the concept. In what can easily be construed as a conspiracy to deceive Medicare, the conference developed a set of diagrams to be used to report alleged "subluxations."
Review by the HHS Inspector General
In 1986, the Inspector General of the Department of Health & Human Services reviewed chiropractic. The report stated:
Because chiropractic theory regarding illness differed so greatly from mainstream medicine, the x-ray requirement was written into the benefit as an attempt to "control program costs by insuring that a subluxation actually exists" (from a 1978 GAO review of Medicare coverage of chiropractic). The consensus, from the chiropractic community as well as representatives of the health care field, is that the x-ray requirement has not served this purpose. ..Medicare expenditures for chiropractic services have increased at an annual rate of 18.7% between 1975 and 1984.
The responses in the telephone survey (supported by information gathered during the field visits) brought into question some of the other basic assumptions inherent in the coverage. There was no clear consensus as to what a subluxation is; furthermore, in the telephone survey:
- The majority (81%) stated that, on an older person's x-ray, more "wear and tear" osteoarthritis and osteoporosis will show up, and not subluxations per se.
- The majority of respondents (84%) said that there are subluxations that do not show up on x-rays.
- Nearly half stated that, when billing Medicare, they "could always find something" (by x-ray or physical examination) to justify the diagnosis, or actually "tailored" the diagnosis to obtain reimbursement.
- Many respondents ... volunteered that the majority of their Medicare patients had chronic conditions that would never be corrected, and were receiving what was essentially palliative or maintenance care for those conditions.
These responses raise serious questions as to the extent that Medicare is paying for conditions that do not meet the original intent of the law.
From the foregoing, it is easy to conclude the likelihood that nearly all of the money paid to DCs by Medicare since 1972 has been based upon fraud and abuse. We challenge the U.S. Justice Department to test the validity of a random sample of the x-rays that have been submitted for Medicare reimbursement under blinded conditions. NCAHF wonders if the submission of invalid x-rays by DCs over the past 20+ years is the basis of a Qui Tam lawsuitb to recover taxpayers' money taken under false pretenses. (Qui tam stands for a Latin phrase meaning "he who brings an action for the king as well as for himself." It is an application of the False Claims Act passed in 1863 at the urging of President Lincoln to stop war profiteers from defrauding the Union by such practices as selling crates filled with sawdust instead of muskets, and reselling the same cavalry horses two and three times.)
Effect of the new policy
The up-side of the new policy is that patients may be somewhat less likely to be exposed to ionizing radiation now that DCs do not have to submit x-rays. This is uncertain because many DCs use x-rays as a way of increasing income (see The Health Robbers, pp.93-6). Always alert to the public relations angle, at the request of the ACA, the House and Senate conferees also inserted language stating:
Nothing in this section shall be interpreted as legislative indication that x-ray findings are not important and can serve a purpose in the practice of chiropractic.
In other words, DCs can still abuse x-rays -- and be paid for them; they just are no longer mandatory.
The major down-side is that DCs will have greater access to the public purse. White House budget estimators projected that the new policy would increase chiropractic reimbursement by more than $200 million over the next 5 years. The Congressional Budget Office estimated that the proposal would cost more than $900 million. Nevertheless, grass roots lobbying and Rep. Phil Crane (R-IL) pushed the bill through the House. The Senate estimated that the new policy would increase chiropractic reimbursement by $2 billion and nearly killed the bill. However, aggressive support from Orrin Hatch (R-UT) and Charles Grassley (R-IA) got it passed. Don't be surprised if the new policy costs even more. Experience has shown that DCs are experts at milking the money cow.