August 17th, 2009 by admin in Better Health Network, Health Policy, Opinion
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By George Lundberg, MD
Just as “all politics is local”, so is all medical care personal. One patient; one physician; one moment; one decision. And in this era of balanced physician and patient autonomy, that decision often is an informed joint decision. Many patients now make serious efforts to learn about their conditions both before and after visits to their physicians. Many physicians welcome such informed patients and willingly discuss comparative effectiveness of the available diagnostic and therapeutic options. However, a frank discussion about the comparative costs and charges for the options, whether they be to the insurance company, Medicare, Medicaid or out-of-pocket for the patient, is usually missing.
Many health economists insist that the medical marketplace does not behave like other markets and believe it is fruitless to expect market principles to usefully inform the medical arena. That bias is true in emergencies,
operating rooms or intensive care units, and with patients who are mentally disabled.
Such behavior does not have to persist in an outpatient setting. In my book Severed Trust: Why American Medicine Hasn’t Been Fixed (Basic Books, 2000, paperback 2002), I presented the concept of “the economic informed consent.”
I believe that every patient who is mentally competent and in a non-emergency situation should be informed of the cost of a proposed diagnostic or therapeutic procedure or product, before it is “ordered.” This includes referral to another (often more specialized and costly) physician, no matter who pays the bill. The costs should all be discussed IN ADVANCE decision. This discussion should include whether it is worth it and
whether there a less expensive good alternative.
A recent NPR/KFF/HSPH survey reported that 55% of Americans believe that their insurance company should have to pay for an expensive treatment, even if has not been proven to be more effective than a less expensive
treatment. This attitude underlies the ruling convention, “if insurance will cover it, do it,” that lies at the root of our problem of health care cost inflation. No one is held accountable.
If we as a country could widely apply the “economic informed consent,” physicians and patients would become educated together. They could both become wiser shoppers for the most cost-effective diagnostic tests,
prescribed drugs, and specialists.
With an “economic informed consent,” physicians and patients can reset attitudes toward a healthy concern for the total costs or charges, stifling the usual knee-jerk response, “if the insurance covers it, do it.” No one
knows whether this approach, diligently applied, would actually cut down on wasteful spending, such as choices that drive huge geographic variations, but we do know that pricing an automobile, an airplane ticket, a dinner or a bottle of wine does affect consumer decisions. Why not try it for medical charges as well? Current sweeping proposals for health system reform all state that there must be “cost control” but offer little likelihood of delivering real cost savings.
Now is the time for the US Health Information Technology Initiative to create inter-operative systems that would provide the data to support widespread use of the “economic informed consent” in a timely fashion and
let the medical marketplace speak. Knowing the cost of a medical decision in advance should become a part of a new “Patient’s Bill of Rights”. In a medical care decision, it is the right of a patient to know “who pays whom
how much for what.” All of us in health care laud “transparency”–let that include economic transparency.
George D. Lundberg MD
President and Board Chair, www.lundberginstitute.org
August 13th, 2009 by admin in Better Health Network, Quackery Exposed
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Astrology with Needles
by Ben Kavoussi, MS, MSOM, LAc
The following is an excerpt of an upcoming article called “The Untold Story of Acupuncture.” It is scheduled to be published in December 2009 in Focus in Alternative and Complementary Therapies (FACT), a review journal that presents the evidence on alternative medicine in an analytical and impartial manner. It argues that if the effects of “real” and “sham” acupuncture do not significantly differ in well-conducted trials, it is because traditional theories for selecting points and means of stimulation are not based on an empirical rationale, but on ancient cosmology, astrology and mythology. These theories significantly resemble those that underlined European and Islamic astrological medicine and bloodletting in the Middle-Ages. In addition, the alleged predominance of acupuncture amongst the scholarly medical traditions of China is not supported by evidence, given that for most of China’s long medical history, needling, bloodletting and cautery were largely practiced by itinerant and illiterate folk-healers, and frowned upon by the learned physicians who favored the use of pharmacopoeia.
Heaven is covered with constellations, Earth with waterways, and man with channels.
Yellow Emperor’s Canon of Medicine (黄帝内经, huang di nei jing)1
Acupuncture is presumed to have its origins in blood ritual, magic tattooing and body piercing associated with Neolithic healing practices.2,3 The Neolithic origin hypothesis is supported by the presence of nonfigurative tattoos on the Tyrolean Ice Man–an inhabitant of the Oetztal Alps in Europe–whose naturally preserved 5,200-year-old body displays a set of small cross-shaped tattoos that are located significantly proximal to classical acupuncture points. Medical imaging shows that the middle-aged man suffered from lumbar arthrosis and the cross-shaped tattoos are located at points traditionally indicated for this condition.4,5 Similar nonfigurative tattoos and evidence of therapeutic tattooing, lancing and blood ritual have been found throughout the Ancient world, including the Americas.6,7,8 Health-related tattoos are still prevalent in Tibet, where specific points on the body are needled with a blend of medicinal herbs in the dyes. These practices appear to be largely intended to maintain balance with the natural and spiritual worlds, and also to protect against demonic infestation and malevolence. Seemingly, this Neolithic and Bronze Age lancing heritage, which was intertwined with magic and animism has evolved in various cultures into codified systems of lancing and venesection for assuring good health and longevity. In addition to treating the impurity or superabundance of blood, in various cultures lancing was also believed to affect the flow of a numinous life-force that is, for instance, called qi (or chi, 氣, pronounced “chee”) in Chinese, prāna (प्राण) in Sanskrit, pneuma (πνεύμα) in Greek, etc.9 In many instances, elements of metaphysics, mythology, mysticism, magic, shamanism, exorcism, astrology and empirical medicine intimately intertwined, making it difficult for modern scholars to interpret them as mutually exclusive categories.
In China, for instance, the numinous force was believed to mirror the Sun’s annual journey through the Ecliptic-meaning its apparent path on the celestial sphere–and to circulate in a network of 12 primary jing luo (經络) known in English as the chinglo channels or simply channels or meridians (a term coined in 1939 by George Soulié de Morant, a French diplomat). These imaginary pathways run from head to toes and interconnect around 360 primary points on the skin.10 There is a strong possibility that the web of these channels was a rudimentary model of the vascular system that was conceptualized according to an episteme-meaning a set of fundamental beliefs-that was based on astrological principles and solar mythology. This episteme also indicated that a person’s health and destiny are determined by the position of the Sun, the Moon, the 5 Planets and the apparition of comets, along with the person’s time of birth.11 In this worldview, each body segment corresponds to one of the 12 Houses of the Chinese zodiac system di zhi (地支) known in English as the Earthly Branches, and which consists of 12 two-hour (30°) divisions of the Ecliptic. The channels are therefore named according to their degree of yin (阴) and yang (阳), from tai yang (太阳) to jue yin (厥阴), which are terms that describe the phases and the positions of the Sun and the Moon.12 Each has five special points designated by the characters 水 (Water), 木 (Wood), 火 (Fire), 土 (Earth) and 金 (Metal) which are also the Chinese terms for Mercury, Jupiter, Mars, Saturn and Venus13, and seem to correspond to the transit positions of these Planets in the matching House. Each point is also associated with a color, which comes from the visual appearance of the matching Planet in the night sky. Venus is white, Jupiter blue-green, Saturn golden-yellow, Mars red, and Mercury “black,” for it appears to be the dimmest of the five. Each of these points has also an occult connection with a direction, a segment of time, a season, a number set, a taste, a musical note, an internal organ, a body region, etc, in an ancient Chinese metaphysical cosmology often referred to as “correlative cosmology”14 and reminiscent of the esoteric and mystical beliefs held by Pythagoras of Samos (c. 580-c. 490 BC) and his followers, the Pythagoreans.15 In his occult and magico-mystical worldview, the nature of the life-force qi is often described in such terms16:
The major premise of Chinese medical theory is that all the forms of life in the universe are animated by an essential life-force or vital energy called qi. Qi also means “breath” and air and is similar to the Hindu concept of prāna. Invisible, tasteless, odorless, and formless, qi nevertheless permeates the entire cosmos. Qi is transferable and transmutable; digestion extracts qi from food and drink and transfers it to the body, breathing extracts qi from air and transfers it to the lungs. When these two forms of qi meet in the blood-stream, they transmute to form human-qi, which then circulates throughout the body as vital energy. It is the quality and balance of your qi that determines your state of health and span of life.
Other texts refer to qi as a “cosmic spirit that pervades and enlivens all things”17 and “from which the world was created.”18 For instance, the alchemist Ko Hung (葛洪, 2nd – 3rd Century AD) writes that “Man is in qi and qi is in each human being. Heaven and Earth and the ten thousand things all require qi to stay alive. A person that knows how to allow qi to circulate will preserve himself and banish illness that might cause him harm.”19, 20 The belief in a “cosmological correlation” between its pathways in the body and the Houses of the Chinese zodiac seems to be based on health and safety beliefs in geocentric cosmology and the related doctrine of “as above, so below” which stipulated that everything in the Heavens has its counterpart on Earth and also in man.
The episteme of “as above, so below” and correlative cosmology were prevalent throughout the ancient world, from the Eastern Mediterranean cultures to Northern Europe. It is notably found in the relics of a collection of occult writings called the Corpus Hermetica which are believed to be compiled in Hellenistic Egypt during the 1st or 3rd century AD and are attributed to Hermes Trismegistus (”Thrice-great Hermes”), the Greek equivalent of the Egyptian god of wisdom, Thoth. The original text was presumably lost or destroyed during the systematic annihilation of non-Christian literature between the 4th and 6th centuries AD. Nonetheless, a section of it known as the Emerald Tablet survived and was translated into Arabic by the Muslim conquerors and later into Latin by John of Seville c. 1140 AD and by Philip of Tripoli c. 1243 AD. An Arabic version of the Tablet by the Muslim polymath and alchemist Abu Musa Jābir ibn Hayyān (أبو موسى جابر بن حيان , c. 721-c. 815 AD) states “That which is above is from that which is below, and that which is below is from that which is above, working the miracles of One.”21 Given the prevalence of this set of fundamental beliefs throughout the ancient world, it seems that the natural philosophy that has given rise to the underlying theories of acupuncture in China stems from the same set of beliefs in that were also prevalent along the Silk Road in Persia, Mesopotamia, Egypt and in Greece and that have influenced the health and safety beliefs of pre-Christian Europe, such as the Eastern Mediterranean mystery cults22, or the early Gnostic Christianity.23 This hypothesis is supported by a statement by Gregor (Gregorius) Reisch (c. 1467-1525) in Margarita Philosophica (Pearl of Wisdom), first published in 150324:
The pagans believed that the zodiac formed the body of the Grand Man of the Universe. This body, which they called the Macrocosm (the Great World), was divided into twelve major parts, one of which was under the control of the celestial powers reposing in each of the zodiacal constellations. Believing that the entire universal system was epitomized in man’s body, which they called the Microcosm (the Little World), they evolved that now familiar figure of “the cut-up man in the almanac” by allotting a sign of the zodiac to each of twelve major parts of the human body.
Figure 1: European medieval Zodiac Man form John de Foxton’s Liber Cosmographiae, published in 1408. It indicated the repartition of astrological influences on the body which physicians used to determine the auspicious time to let blood. Images courtesy of The Master and Fellows of Trinity College, Cambridge, UK.
Given this fundamental belief, European physicians Read more »
*This blog post was originally published at Science-Based Medicine*
August 5th, 2009 by admin in Better Health Network
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I have not posted a blog in a week because we were on vacation and truly wanted to be on vacation and not be tied to doing any “work.”
We went to north Georgia for a few days then up to the mountains in western North Carolina. How gorgeous! It was so nice to escape the humidity of Florida for a week!
I had an observation on my vacation that I thought I would share. I have talked in previous blogs about mindless eating and how we multi-task while we are eating. When we are not conscious of what we are eating, we don’t fully enjoy it. In addition, we eat more than we realize.
I observed this phenomenon in my little boy who just turned 2 years old. We were in the car a lot for hours on end, so snacking and fast food were part of the trip. Also, because he is 2 and difficult to entertain in a car, we had the DVD player set up for him to watch his favorite Elmo, Clifford, and Thomas the Tank Engine videos.
It was quite amazing that whenever he was glued to the TV, he ate whatever snacks or meals in his carseat without even looking down. He just picked up a piece and put it in his mouth. And he would ask for more. Whenever he was not glued to the TV, he wasn’t asking for food or eating as much. Hmmm…..very interesting.
From now on I am going to be very careful about two things. First, how much TV he is watching. He normally doesn’t watch much but on this trip he got very spoiled with watching his DVD’s and I am afraid it will lead to more asking to watch now that we are home. Second, I am going to only let him snack when he is fully conscious of what he is doing. No food in front of the TV so that he can be very conscious about what and how much he is putting into his mouth.
As a fairly new (2 years) parent, I am still learning these lessons first hand on how to feed children. I just had to share my story because our children learn habits, both good and bad, at a very young age!
This post, Do 2 Year Olds Engage In Mindless Eating?, was originally published on
Healthine.com by Brian Westphal.
August 2nd, 2009 by admin in Better Health Network, News
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I have been bombarded with questions about this new study released yesterday about organic food being no healthier than conventionally grown produce. The study is in the September issue of the American Journal of Clinical Nutrition.
Organics have been growing in the marketplace at a very steady rate of about 20% for years. Are they worth the higher price tag?
This particular study was a review of scientific papers published in the past 50 years on nutritional quality of organic foods. They found that there was no statistically significant difference between organic and conventional produced foods in terms of nutritional value.
Many people were disappointed in this news, but remember that they just studied nutritional value. They did not address in this study the difference between pesticide and fertilizer residue, environmental impact, hormone levels, etc. When you make the decision of organic vs. conventional, there are many issues to consider.
If you want help making this decision, check out this link to the 12 “dirtiest” foods that tend to have the most pesticide residue and the 12 “cleanest” foods that have very little. Spend your organic dollars on the dirtiest and save your money on the cleanest.
The Organic Center has a different take on the study recently released and believes organic food does have higher nutritional quality, especially when talking about antioxidants. Read their response here. You can also link to their study from 2008 that found organic food with higher nutritional quality.
This post, Organic Food Not More Nutritious – But May Have Different Pesticide Exposure, was originally published on
Healthine.com by Brian Westphal.
July 6th, 2009 by admin in Better Health Network
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Have you noticed that many products on grocery shelves are bragging that they do not have high fructose corn syrup (HFCS)? HFCS has been demonized by many people in the public as well as the medical community in recent years. But how much different is it from just plain old sugar? The answer is up for debate, but I will do my best to present the facts.
HFCS has been used for many years, but the use really became much more common in the 1980’s. Food companies use it because it makes a desirable end product and is fairly cheap. HFCS comes from corn and is refined to get the sweet taste into a syrup. But is it worse than sugar?
Many experts believe it is no different than sugar. Both are high in calories and are considered “empty” calories, meaning they don’t have vitamins, minerals, or other healthy nutrients in significant quantities.
The American Medical Association and other scientists have agreed that both sugar and HFCS both contribute to risks of obesity, diabetes, heart disease, and other illnesses if eaten in large quantities. In other words, there is no proof to date that HFCS is more harmful than sugar.
So why are so many companies eliminating HFCS? It is all consumer perception. Consumers have heard that HFCS bad so companies are spending time and money eliminating it from it’s products? What are they using instead? Sugar.
Is HFCS natural? The Corn Refiners Association says that HFCS is natural. The FDA does not define the term “natural” so we really have no way of seeing whether something is natural on a food label. Food companies can use this word without repercussion from the FDA since they have not defined it.
For more information on HFCS, check out www.sweetsurprise.com
This post, Is High Fructose Corn Syrup Worse Than Sugar?, was originally published on
Healthine.com by Brian Westphal.
