Alternative Health Concerns at the Western Nevada County Health Care Community Discussion
How will the coming changes in our health care system affect alternative health providers? This question was addressed both directly and peripherally at a Health Care Community Discussion held in Nevada City on December 22nd. Thousands of such discussions were held throughout the nation over the holidays at the request of the Obama Transition Health Policy Team headed by former Senator Tom Daschle.
The main focus of the discussion concerned problems in providing conventional care and health insurance coverage to all Americans (see www.healthascent.com/HHCD.html for a synopsis of the entire discussion). But this was Nevada County, and as you might suspect, the topic of the role of alternative care in our health care system came up repeatedly in the discussion. Here are some of those comments (with my own comments in italics):
On health care coverage
· If the government is paying for health care services, I’m concerned that alternative providers will not be covered. This will leave me to pay extra for the health services I actually want or need as well as for my share of the public system, however that’s funded.
· I’m concerned about the costs of a system that doesn’t include alternative or natural medicine. Today the conventional system doesn’t have to compete with alternatives. Without competition, prices will be high. They’ll continue to pay huge amounts for back surgery but nothing for chiropractic or acupuncture.
· Today patients don’t have direct access to adjunct therapies. They have to keep going back to their primary physician in order to continue receiving care, such as on-going physical therapy. A direct access system was tried in Massachusetts, and it saved millions.
On preventative screenings
· The Participant Guide listed 3 examples of recommended preventative screenings: mammography, flu shots, and cholesterol screenings, with the ages and frequency recommended for each. The unspoken assumption being that these screenings are beneficial and should be provided. As the moderator, it wasn’t my role to present my own viewpoint, but I didn’t want participants to assume that I support flu shots. So I said, “I’m taking off my moderator hat for a moment. As a homeopath, I don’t recommend that my clients get flu shots. OK, now I’m putting my moderator hat back on.” People laughed. The experience made me think about possible conflicts if alternative modalities were “inside the system”. Would I be able to challenge the conventional assumptions so easily? What if I were working for a clinic that depended on revenue from flu shots? Then would I be able to say what I really believe?
· An M.D. who practices alternative medicine stated that cholesterol screening is “false advertising” by the pharmaceutical companies. The purpose is to sell statin drugs, which are harmful. Another M.D. who practices conventionally said that the data show that cholesterol screening does pay off.
· I don’t want these screenings. If the screenings find something, my insurance company will be able to access the records and they will raise my premiums.
· I’m concerned that if the government takes a bigger role in providing care, screenings may be forced.
· Participants didn’t directly address the role of alternative medicine in regard to prevention. There was clear agreement that the conventional system does not adequately address prevention. It was suggested that doctors need more training in prevention, particularly in nutrition.
· Maybe we should reward doctors for keeping people healthy. You get a discount for being a good driver, for not smoking, why not for staying well. Our system wants us to be sick.
· Make lifestyle changes first, use drugs as last resort.
On evidence-based medicine:
· More than one person spoke of the need for “evidence-based” medicine. They were concerned that ineffective modalities could gain acceptance as part of the conventional care system. My reaction to this thought is that what is considered to be evidence changes over time. For example, the astronomy of Galileo was not considered to be “evidence-based” at the time, because it was “against scripture” and therefore could not be true. From a Wikipedia article on Alternative Medicine:
[Some] scientists advocate a classification based on scientific evidence, and claim that "[w]hat most sets alternative medicine apart, in our view, is that it has not been scientifically tested and its advocates largely deny the need for such testing." The US Institute of Medicine analyzed this approach to defining alternative medicine, which it called normative, and found it problematic because some CAM is tested, and much of mainstream medicine lacks strong evidence. The IOM noted that in a study of 160 Cochrane systematic reviews of mainstream techniques, 20% were ineffective and 21% had insufficient evidence. The IOM therefore defined alternative medicine broadly as the nondominant approach in a given culture and historical period.
In conclusion, it was clear that a significant number of the participants were concerned about the way changes in the health care system will affect alternative care. Some wanted access to alternative providers. Others wanted the cost savings that alternative medicine and/or the competition between conventional and alternative medicine can provide. I was left wondering if alternative providers can best serve their clients from within the system or as a loyal opposition to drug-oriented health care.
Maureen Shepard is a Certified Classical Homeopath and Bowen Therapist practicing in Penn Valley. For contact information and additional articles, visit her website at www.HealthAscent.com.