I had the pleasure of interviewing the former president of the Society of Nuclear Medicine recently about the financial challenges threatening his specialty. (Reimbursement is not keeping up with the cost of technology).
As I prepared for the interview, I called in to the general society number to be transfered to his line.
The receptionist answered:
I paused for quite a few seconds as my cogs and wheels turned, wondering if I had misdialed. Nope, that’s just how they answer their phones over there. Ahem.
A recent blog post at Terra Sigillata really disturbed me. The author describes how, in the face of increasing healthcare costs, Medicare now declines coverage of life saving medicines for lymphoma patients. This is one example of rationing healthcare that will become ever more common (as it is in other leading industrialized nations) as we move towards further cuts in government programs and funding. In Canada, expensive chemotherapies are not commonly covered by the national health plan, and in Britain, age is a determinant for transplant eligibility.
But what troubles me about the apparent capriciousness of denying coverage to certain types of cancer patients over others, is that government programs are – at the same time – allocating millions of dollars to researching implausible alternative medicine treatments while denying coverage of proven therapies to patients who will likely die without them.
Take homeopathy, for example. The National Center for Complementary and Alternative Medicine lists homeopathy as an eligible area of research, and boasts several ongoing studies in the area of stroke, dementia, fibromyalgia, and prostate cancer. And yet, there is no plausible mechanism of action to support its potential use as anything more than a placebo. Homeopathy operates on the assumption that water has memory, and that once it has been exposed to certain substances, such as arsenic, it obtains curative properties for illnesses that bear resemblance to poisoning from those very substances (though the water itself may no longer contain a single molecule of the substance).
Research into scientifically implausible theories should not be funded by our tax dollars at the expense of offering life saving treatments to cancer patients. It is time for scientists to stand up and point out that the Emperor has no clothes when it comes to homeopathy and other similarly flawed alternative medical treatments.
As we move towards rationing limited healthcare resources, we have a moral obligation to prioritize the money correctly. “Open-mindedness” is no excuse for poor stewardship.
Dr. Wallace Sampson sums this up in a provocative recent editorial. Here is an excerpt:
We now see accumulation of useless information in journals and information data bases — hundreds of clinical trials (RCTs) on implausible methods, such as homeopathy, unrefined plant products, prayer, and acupuncture. Initial plausibility retreats before two 20th-century development ideologies of relativism — a principle that all facts and opinions have equal or similar value, and postmodernism — that regards facts as social constructions.
Once thought to be too esoteric for relevance to medicine, these twin ideologies now mold the thinking of policy makers and granting agency officials. Ancient and traditional cultural practices are not diminished for lack of plausibility, but are investigated by RCTs because they are there.
Plausibility depends on prior reliable observations, physical and chemical laws, pharmacological principles, and advocates’ economic and legal misadventures. The National Center for Complementary and Alternative Medicine spends $100 million/year on implausible research and training grants. In performing RCTs on implausible proposals, clinical research has taken a wrong turn and departed from rationality.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.