Each day I receive a compilation email from the NY Times that lists all the articles about healthcare and medicine that are included in that day’s edition. I know, pretty lazy, but at least it enables me to stay up-to-date on the latest and greatest medical topics deemed worthy of coverage by the Times without having to go through the laborious task of unfolding it myself.
Today’s email had seven healthcare articles listed, a pretty typical number. But what struck me about today’s list was that 3 of the 7 articles dealt with issues that are clearly outside of what would be considered mainstream medicine. The first article, entitled Weekdays, the Adman Worked. Sundays, the Shaman Healed, is about a guy who is an advertising executive by day and who, in his free time, practices shamanistic healing for all manner of chronic illnesses and other serious conditions. For those of you unfamiliar with the practice, Shamanism encompasses the belief that Shamans are intermediaries or messengers between the human world and the spirit worlds; they treat ailments/illness by mending the soul.
My favorite part of the article:
“…Itzhak Beery began seeing clients about a decade ago, and gradually moved into teaching courses on shamanism, creating a New York association of Shamans and building a Web portal for Shamans worldwide. “
I checked out this portal and it allows you to locate the perfect Shaman, matched by geography and specialty (with or without animal healing?!). Impressive. We haven’t managed to get Western medicine physicians that organized. You can go to what is, for all intents and purposes, shaman.com and find an appropriate practitioner in seconds, but if you need to find the appropriate cardiologist or neurologist in America, there is no such central authority.
There were 2 medical marijuana articles, but the one that drew my attention was entitled V.A. Eases Rules for Medical Marijuana. This article discusses how hospitals and clinics in the Department of Veterans Affairs (VA) system will now formally allow veterans to use the drug in states where it is legal, though they will not prescribe it. Apparently, it has heretofore been the VA’s practice to deny prescription painkillers to patients who admit to using medical marijuana even in states where it is deemed legal to do so. The VA is now recognizing that medical marijuana may be an appropriate treatment alternative or at a minimum, should not be denied. Best line in the article:
“Veterans, some of whom have been at the forefront of the medical marijuana movement, praised the department’s decision. They say cannabis helps soothe physical and psychological pain and can alleviate the side effects of some treatments. “
Grateful dead fans everywhere have issued a collective, “Duh.”
Millions of people in the U.S. are firm believers in what is generally lumped into a single category called “alternative medicine.” Alternative medicine is used as a moniker to encompass everything from well-accepted treatment interventions, such as chiropractic care, to treatment approaches that are accepted some places, questioned in others (e.g., acupuncture) to interventions that are considered well outside the mainstream. I’ll go with Shamanism as my example here of a quintessential example of seriously alternative medicine.
It just struck me as interesting that the country’s most recognized news authority (unless you are a fan of Glenn Beck) spent so many of their column inches on this topic in a time when reform of the “establishment” medical system seems to suck up even more press resources than Brad and Angelina’s marriage. I had a sudden realization that none of the discourse on health reform so far, at least that I have seen, has incorporated any thought about how to improve quality of care or reduce cost of care through the adoption of alternative approaches to treatment not currently in the mainstream.
There is no question that the current health reform efforts have within them an undercurrent of intention to reduce the numbers and types of available covered treatments in an effort to reduce healthcare costs. The concept of comparative effectiveness is rooted in that idea. Funded to the tune of $1.1 billion by passage of the American Recovery and Reinvestment Act (ARRA), the newly created Patient-Centered Outcomes Research Institute is charged with figuring out precisely what is worth paying for based on clinical efficacy (and maybe cost-efficiency too).
It is certainly possible that opening the discourse to include “alternative” treatment modalities could expand costs further by adding more things to pay for, particularly if such treatments do not come packed with evidence of their efficacy–not a whole lot of randomized clinical shaman trials out there today. There is also a lack of available evidence about the efficacy of medical marijuana, which is generally ascribed to barriers to performing studies due to the inconvenience of the drug being illegal. Anxiety is one of the primary diagnoses for which both medical marijuana and shamanism are used. Now there’s the comparative effectiveness study I want to see.
But seriously, the idea that there are valid and valuable alternative treatments that should make their way into the mainstream is definitely not going to go away and perhaps it is something that should be more openly examined. There are many examples of interventions once thought impossible or even silly that are now part of mainstream medicine. Once upon a time, if you told a cardiac surgeon that you were going to treat heart disease by punching a hole in a patient’s groin, threading a tube with a balloon in it up into the heart, blowing the balloon up, deflating it and then pulling it all out, voila!, the surgeon would have had you locked up for being insane. Today, that is pretty much the definition of modern angioplasty and there are over 2 million of them done each year.
In fact, in my favorite recent history example, in 2004 the FDA approved leeches for use in treating wounds. Yes, those leeches. The ones you see in movies about 19th Century doctors where they are dressed in potato sacks and working out of dark caves using leeches to “bleed” people out of their illnesses. Turns out that that whole bleeding thing doesn’t work, but leeches have a real utility, even today, in cleaning particularly difficult wounds.
Even better, maggots were approved for similar use, also in 2004 (a good year to be vermin). Monarch Labs touts itself as the country’s “exclusive provider of medical maggots.” I guess I am not surprised that there isn’t a rush of competition.
So where does alternative medicine fit in our new healthcare paradigm? It has traditionally been paid for by patients themselves, who willingly expend more than $34 Billion per year on a variety of alternative medicine therapies (while complaining about paying $10 for a physician visit copayment to their internist). To put this in perspective, some estimate that the amount paid directly by patients to “alternative” practitioners adds up to nearly 25% of those same people paid out-of-pocket to see their regular doctors.
Under the recently passed Affordable Care Act, there are many provisions that suggest that patients must get more engaged in their own healthcare and must be encouraged to take responsibility for their own health. If that is the case, we are likely to see even more demand for alternatives to generally accepted medical interventions when traditional medicine doesn’t do the trick. I am curious to see how this is integrated into the discourse about comparative effectiveness as the landscape evolves. Will those engaged to oversee what will and won’t be covered in our healthcare system represent a broader perspective than what tends to come from a room full of traditionally trained physicians? Maybe there should be a Shaman in the mix.