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medpundit |
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Tuesday, August 20, 2002The signs and symptoms of crisis in our health care system have become front-page news in recent weeks. Treatments that were routine -- widely accepted by physicians and embraced by the public -- have proven inappropriate, possibly dangerous and wasteful. The federally funded Women's Health Initiative appears to have demonstrated that the hormone replacement therapy (HRT) that was supposed to prevent heart disease in menopausal women actually increases its likelihood. True, I suppose, but coming as it does after that inflammatory opening paragraph, it suggests that the increase in heart disease is higher than it is. In fact, there was only a difference of seven percentage points between hormone users and placebo users when it came to the incidence heart disease. A well-executed study on the surgical treatment of osteoarthritis of the knee (published in the New England Journal of Medicine) showed that a placebo group -- patients who only thought they had surgery -- actually did as well as those who were operated on. This is true, but the results may be as much a testament to the placebo effect as to the ineffectiveness of the surgery. It’s also a testament to the fact that traditional medicine is willing to let the cold light of truth shine on its treatment approaches. And, a few weeks ago, a lead article in the New York Times reported on several major studies that show that more conventional health care and more medical specialists do not necessarily produce improvement in health status for both older people and newborns. This, too, is true up to a point. What the newborn study actually showed was that communities with with more than 4 neonatalogists per 10,000 births had no improvement in neonatal death rates. Those communities with less than 4 neonatologists per 10,000 births, however, had greater neonatal mortality rates. The specialty care does improve outcomes, it just doesn’t do so infinitely as the supply of specialists increases. It’s true that more specialty care doesn’t necessarily translate into better care, but it’s also true that no specialty care can lead to worse care. This cluster of disturbing findings is simply the most recent and visible manifestation of the limitations and counterproductiveness of an approach to health that places overwhelming emphasis on expensive and often side effect-laden surgical and pharmacological treatments, an approach that has largely devalued prevention, self-care and the perspectives and techniques of the world's systems of traditional medicine and healing. This “cluster of disturbing findings” are only disturbing if one’s mind is already made up that modern medicine is bad. It’s true that modern medicine emphasizes procedures and pharmacological treatments, but it does so with good cause. The “world’s systems of traditional medicine and healing” have done nothing to improve mortality from infectious diseases or cancer, it has been advancements in medication, immunizations, and surgery that has saved lives and improved longevity. “Traditional medicine and healing” may be fine for palliation, but they haven’t, as a body, had the success that modern science-based medicine has had. If they did, the developing world would enjoy the best health instead of the worst. Over the last several years we have learned that the treatments we routinely provide are, even when appropriately used, the fourth leading cause of death in our country. Says who? Certainly not the CDC: Note that “accidents” is listed as the fifth leading cause of death. This includes accidents of all sorts, from auto accidents to people who fall down the stairs and break their necks. Modern medicine can hardly be held responsible for those. Dr. Gordon sees our failure to cure cancer as an indictment against modern medicine, sees potential side effects of medication as a reason not to use them, and sees chronic illnesses of aging such as heart disease and osteoarthritis as further evidence that medicine is failing people. He says that Americans, sick of all of these failures, are turning to alternative therapies: According to one study, published in the Journal of the American Medical Association in 1998, 42 percent of all Americans are using other than conventional therapies as alternatives or complements to conventional medicine. They are making 200 million more visits to "complementary and alternative health care providers" -- acupuncturists, chiropractors, massage therapists and others -- than to primary care physicians. One reason there are so many more visits to “alternative care providers” is that they keep their patients coming back. If someone sees me for back pain, I see them two or three times. In contrast, the chiropractors keep them coming back weekly for months, sometimes even years, for “adjustments.” Ditto the acupuncturrsts and the message therapists. This inflates the numbers of visits without any clear benefit. The difference between primary care physicians and alternative medicine providers is that we acknowledge when our therapy isn’t helping. The good doctor goes on to extoll the virtues of alternative medicine therapies that are even more unproven than the medical treatments he attacks. His commission on alternative health care has done nothing to foster investigative scrutiny of the treatments he praises. In fact, two of the commission members have written a minority report that details their concerns about the lack of objectivity among the commission members, most of whom, like Dr. Gordon, make their living selling alternative therapies to the public. There is much to be improved upon in our current health care system, but Dr. Gordon’s approach, is far from the answer. posted by Sydney on 8/20/2002 08:50:00 AM 0 comments 0 Comments: |
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