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Healthcare Reform Bills Legitimize Quackery

snake-oil-20I’ve been warning folks about this for years – and alas, fake medicine and quackery has finally oiled its way into the healthcare reform bills. We are in the midst of a growing primary care shortage, and on the brink of vastly expanding health insurance coverage without increasing the supply of physicians and nurses. How will our country solve the supply/demand mismatch? Potentially by allowing people without appropriate training in science and medicine to become your “medical home.” That’s right – your next doctor or nurse may be someone with an online degree in snake oil salesmanship.

I know it’s hard to believe… But please read this press release (reproduced below) for more information – and call your Senator to complain. Maybe we’ll be able to get these sections removed before a bill passes?

The newly formed Institute for Science in Medicine (ISM; expressed its concern today about provisions in current Congressional health care reform bills that require reimbursement of ineffective and potentially unsafe care.

The proposed legislation promotes a wide range of therapies and practitioners under the poorly defined term “Complementary and Alternative Medicine” (“CAM”). The “CAM” umbrella lacks a clear definition of its scope and philosophy, and thereby allows for the inclusion of unscientific and invalidated medical practices. In fact, free from any science-based standard of care or scope of practice, it attracts unscientific methods.

The House bill gives recognition, long-sought by special interest groups, to a host of unorthodox practitioners. Chiropractors, licensed “CAM” providers, and “integrative health practitioners” would be included as “health professionals” in the nation’s health care workforce. By legitimizing ill-defined and unscientific “professions,” the provision opens the door to a wide array of unsound diagnoses, useless and potentially dangerous practices, and unjustified additional expenditures.

Both the House and Senate bills provide for a “medical home” model, in which teams of health professionals provide primary care, but the Senate bill unfortunately requires that each medical home make “CAM” available.

Both bills mandate insurance reimbursement for state-licensed “CAM” providers and chiropractors equal to that of physicians or other health providers. Currently, all states license chiropractors; some license acupuncturists, homeopaths, and a subset of naturopaths. A reimbursement requirement would put additional pressure on other states to extend licensure to more and more non-science-based health “professions.”

Congress may not fully appreciate the significant costs imposed by these mandates. In 2007, consumers spent nearly $34 billion out-of-pocket on “CAM.” According to an NIH survey, most Americans who use “CAM” do so in addition to conventional care, not as a replacement.

The House and Senate bills would require government to shoulder much of the additional cost of unscientific and dubious health care through Medicare, Medicaid, and premium subsidies. With the passage of these bills, Congress will be giving a green light to practitioners who are unrestrained by professional ethics, the requirements of scientific evidence, or a defined scope or practice, thus paving the way for further waste, fraud and abuse.

ISM hopes that legislators and the public take note of these provisions in bills before Congress. The current administration promised a renewed dedication to science. Nowhere is science more vital to the well-being of every citizen than in the delivery of health care.

ISM Board Chairman Steve Novella, MD, a professor of medicine at Yale University, states, “The political process should not be used to subvert or override the scientific process of determining which medical interventions are safe and effective.”

Contact: Linda Rosa, RN, Executive Director
Institute for Science in Medicine
Loveland, Colorado; 970-667-7313

About Institute for Science in Medicine:

Forty-two prominent physicians, researchers, scholars, and other professionals created ISM, an international policy institute that seeks to promote science as the best and only way to ensure not only safe, quality healthcare for the public, but cost effectiveness, as well. ISM sees an ongoing threat in the growing number of fringe practitioners and their medically dubious diagnoses and treatments. Part of ISM’s mission is to alert the public and policy makers to the dangers of ignoring scientific validation of medical interventions.
Additional Comment by ISM President Mark B. Johnson, MD, MPH:

“I find it extremely unfortunate, and even alarming, that at a time when the house of medicine is focusing its efforts on re-establishing an evidence-based foundation to improve quality and patient safety, so many influential politicians and celebrities are lending support to unproven therapies, unscientific principles and outright quackery. Recent examples of this are the firestorm of protest against the U.S. Preventive Services Task Force’s recommendations on the use of mammography and the CAM mandates in the health-reform bills. In the current state of confusion that many in the general population find themselves as to what constitutes good medical practices, the last thing we need is the licensure and governmental support of more substandard (CAM) practitioners.”

Provisions of Concern:
Healthcare workforce and professionals:
Senate Bill (HR3590): Secs. 5101(h)(3)(i)(1) and (2)[p. 1295, line 2, to p. 1297, line 2]
House Bill (HR3962): Sec. 3101(4)(10) [p. 1669, lines 10-19]
Medical-home model:
Senate Bill (HR3590): Sec. 3502(b)(4) [p. 1068, line 21, through p. 1069, line 5], and
Sec. 3502(c)(6)(F) [p. 1071, lines 15-17]
House Bill (HR3962): Sec. 1833(p)(3)(A) [p. 702, line 21, through p. 703, line 9]
Insurance reimbursement:
Senate Bill (HR3590): Sec. 2706 [p. 95, line 8, through p. 96, line 2]
House Bill (HR3962): Sec. 238 [p. 133, lines 3-13]
Use of the derogatory term “allopathy”:
Senate Bill (HR3590): Sec. (g)(1)(B)(i) [p. 1038, lines 15-16], and
Sec. 775(c)(1)(B)(ii) [p. 1322, line 6]
House Bill (HR3962): Sec. Sec. 3101(4)(10) [p. 1669, line 11]

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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