February 5th, 2008 by Dr. Val Jones in Quackery Exposed
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The financial burden of snake oil
Prickly snake oil seeds are taking root in the soil of our broken healthcare system. Consumer discontent and feelings of helplessness are the manna of charlatans – and they are growing fat in our lean times. Unprecedented opportunity for promotion via the Internet, coupled with chronically short audience attention spans and generalized patient exhaustion (from the treadmill of life) are creating the perfect climate for the spread of pseudoscience.
I must admit that I had turned a blind eye to the whole pseudoscience movement until fairly recently. I figured it was harmless enough – placebos that might engage peoples’ minds in a more optimistic view of disease. But little did I realize that this tumor on the face of medicine would become life threatening to the advancement of science and truth.
Take for example the money that Americans spend on weight loss supplements – 1.3 billion dollars per year, and yet the American Academy of Family Physicians has found no evidence to support the use of a single one. That’s more money than the World Health Organization’s annual budget, and more than Great Britain spends on cancer research in a year. The supplement industry in general rakes in 20 billion dollars a year, which is more than the total amount spent by the US government in the wake of hurricane Katrina.
And what do snake oil salesmen think of this colossal waste of resources? Why, they’re touting it as a new era of enlightenment of course. They weave in “all natural” products, “mindfulness” practices, and “detoxification” programs into a comprehensive feel-good message that is a soothing balm to anxious souls. In reality they are leading the public down a garden path towards a false wellness nirvana, fleecing them as they go, and sowing seeds of mistrust for science-based medicine.
The rise of snake oil salesmen
The strongest potion in the snake oil salesman’s repertoire is the placebo. Placebos are treatments that work based solely on the power of suggestion. A so-called placebo effect occurs when a patient’s symptoms are altered in some way (i.e., alleviated or exacerbated) by an otherwise inert treatment, due to the individual expecting or believing that it will work. If a snake oil salesman is to become truly successful, he must build a case for his wares through anecdotes and testimonials. To obtain these, he must be a master of the power of suggestion, cultivating a small number of “true believers” from which to conjure evidence for the effectiveness of his oil. He need not convince the majority, a small minority of passionate believers will do. As Mark Twain writes, “The most outrageous lies that can be invented will find believers if a man only tells them with all his might.” Therefore, a common denominator with many snake oil salesmen is charisma and charm.
Once the charlatan has developed his small but passionate following, and some miracle cure anecdotes, he will then start playing the role of a victim. He will look for individuals who are willing to challenge his pseudoscientific claims, and then cry out to his loyal followers that he is being persecuted. He will use racism imagery to describe an illusionary bias against himself and the “good” that he is trying to do for those who are open-minded and willing to forsake “paternalistic” science. His followers will be further emboldened to carry the banner of this “downtrodden hero” as they continue to fall for his under-dog psychology.
The snake oil salesman, of course, will not gain traction with key opinion leaders in medicine, so he is left to draw from the Hollywood celebrity pool to further evangelize the masses. Medical leaders will roll their eyes and ignore his obvious pseudoscience, much to the detriment of the general public who have a hard time discerning science from pseudoscience. The charlatan then points to the medical profession’s silence as “proof” that they cannot deny his claims, further convincing susceptible listeners.
Then years later as snake oil salesmen realize that there is further strength in numbers, they gather together to form the first snake oil union. They create a continuum of oily treatments, gathering anecdotes and testimonials from one another in pseudoscientific “meta-analyses” to further strengthen their assault on science and reason. They find wealthy donors and benefactors who are impressed by their growing numbers, and match them with cash-strapped academic centers who will desperately accept funds for any vaguely scientific purpose. The snake oil team now has won a respectable platform from which to grossly inflate statistics about public use of “alternative medicine” (lumping “prayer” into the list of therapies which, combined together, would have you believe that over 60% of Americans are using alternative therapies like homeopathy).
Snake oil goes mainstream
Now that the very same snake oil that medical experts didn’t wish to dignify with a response is being promoted by academic centers, we are obligated to fund research into the potential therapeutic uses of these placebos, wasting countless millions in government funding to study implausible therapies. With a critical mass of snake oil believers, few dare to challenge the wisdom of this approach, and have become passive observers in a downward spiral that is harming the credibility of the very centers founded to promote objective scientific inquiry.
Can good science separate the wheat from the alternative chaff? Yes, but the problem is that few people seem to care about truth any more. While the American Academy of Family Physicians demonstrates that no single weight loss supplement is recommended for public use, the public is spending 1.3 billion dollars per year on these very supplements. Why? Maybe the AAFP is not reaching the public with their message, or maybe people are simply unable to resist the sweet lure of false promises?
Nonetheless, there is a growing movement in medicine to reclaim scientific territory stolen while we shrugged passively at the snake oil lobby. Blogs like Science-Based Medicine and Respectful Insolence are uniting physicians who believe in the importance of objective scientific inquiry as the foundation for the best therapeutic decision-making.
As the healthcare budget crunch looms, further pressure will be placed on providers and pharmaceutical companies to demonstrate the efficacy of their treatments in order to be eligible for coverage. This will be a boon to scientific medicine, as therapies that actually work will (by budgetary necessity) be preferentially selected for reimbursement. While Big Pharma undergoes further scrutiny, they will also turn to science to demonstrate the utility (or lack thereof) of their drugs. Therefore, those in search of truth will not be completely thwarted by pseudoscience.
Yet patients are free to pay out-of-pocket for any number of alternatives to scientifically proven medicine. I predict that further healthcare access limitations will drive more people to look for placebos than ever before, much to the detriment of those who have diseases that are treatable or curable through proven therapies. I worry far more about missed therapeutic opportunities than the dangers of the snake oil itself.
So my final advice is this: eat a well-balanced, calorie controlled diet, engage in regular exercise, stay within a healthy weight range, sleep well, participate in loving relationships, don’t smoke, do drugs, or drink in excess. At least 60% of your medical problems will be prevented if you do these things. You do not need to waste your money on supplements and snake oil – put that money into a savings account that you can access in case you become seriously ill and your insurance doesn’t cover all the best, evidence based care that you need.
Do not tithe to the snake oil salesman. Resist the dulcet tones of the false promises. Save your money to do good, and listen to your own voice of reason.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 24th, 2008 by Dr. Val Jones in Health Tips
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I loved yogurt when yogurt wasn’t cool.
In fact, I grew up on a small dairy farm in Canada where our sole product was yogurt. My parents bought a cow (Daisy) “in an unguarded moment” and ended up having to get creative to get rid of all the extra milk that she produced for our family. One thing led to another – and I wound up as the VP of Sales and Marketing for a growing yogurt company taking Canada by storm. So when I saw today’s news release about Dannon being sued for exaggerated health claims for their yogurt, my dairy ears perked up.
First of all, if it’s true that Dannon is claiming that their yogurt has greater health benefits than other yogurts with active cultures, that’s false advertising.
I also think it’s pretty sneaky that they (allegedly) ran ad campaigns exaggerating the health benefits of yogurt, and then marked up their product by 30% to make consumers feel that they were getting added value from what was there all along. Typical big business move, right?
Secondly, yogurt bacteria do have beneficial uses (eating yogurt may decrease colon infection rates in hospitals, and can reduce the chance of vaginal yeast infections after antibiotic use). There is no conclusive evidence that yogurt treats or prevents diarrhea. However, it’s silly to extrapolate that these friendly bacteria will improve the health of your entire immune system – so you’ll never be sick – or that they will perfectly regulate your bowels – regardless of your underlying disease. As with many foods that have been shown to have some specific health benefits (green tea, blueberries, flax seeds) the media tends to blow them out of proportion.
And finally, what should you know about yogurt? Know that for those who are not allergic to milk products, it is a healthy nutritional option (especially the low fat variety without too much sugar) that may be especially important if you’re in the hospital or have received any antibiotics recently. Yogurt contains protein and calcium, which are important components of a healthy diet. But beyond this nutritional benefit (and the infection reduction in at-risk populations), I wouldn’t ascribe any particular magic powers to this tasty treat – as much as I’d like to.
1. Look for the “active cultures” sign on yogurt containers. The National Yogurt Association (NYA) established its own criteria for live and active culture yogurt in conjunction with its Live & Active Culture seal program. In order for manufacturers to carry the seal, refrigerated yogurt products must contain at least 100 million cultures per gram at the time of manufacture. Don’t pay extra for a yogurt because they have live cultures. The majority of them do!
2. Yogurt bacteria don’t live forever in your gut, so you’ll need to eat yogurt (or take active cultures) regularly to repopulate the colonies. I can’t find any data to support an exact consumption frequency. I guess it also depends on how many bacteria are contained in the yogurt or supplement you’re taking.
3. Acidophilus pills (one of the most popular yogurt bacterial strains) are available at health food stores for those who’d rather not eat yogurt but still want the benefits of the culture. These pills must be refrigerated to keep the culture alive (kind of like keeping milk cool) – and make sure you check the expiration date too. For more information on acidophilus, check out this supplement database.
4. The most common side effect of eating live yogurt cultures (in pill form or in yogurt form) is bloating and gas.
So don’t be surprised if you encounter it!
And I think that’s a nice thought to end on.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 19th, 2007 by Dr. Val Jones in News
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Thanks to MedGadget for bringing this to my attention. Did you know that as many as 1 million fake diabetes test strips (manufactured in China but imported via Canada) made it onto the US market? About 10 million Americans use the One Touch Ultra system for measuring their glucose and titrating their insulin doses. Bloomberg news had this to say:
“Growth in counterfeit medicines and devices is probably
the biggest health threat besides infectious disease,” says
Peter Pitts, director of the Center for Medicines in the Public
Interest in New York and formerly an FDA official investigating
knockoff drugs.
The court filings disclose, for the first time, that China
is the source of about one million phony test strips that have
turned up in at least 35 states and in Canada, Greece, India,
Pakistan, the Philippines, Saudi Arabia, and Turkey.”
The test strips don’t measure glucose levels reliably and could result in patients dosing their insulin incorrectly. So be careful out there, folks… make sure that the test strips you use are not counterfeit. Check the lot number on your package to make sure it’s not one of these fake numbers.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 12th, 2007 by Dr. Val Jones in News
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I was reading a news story about how medical fraud is becoming more frequent in Australia. They attribute this to the recent transition to electronic record keeping, which makes it easier to file fraudulent claims. Although these tactics are old news in the US, I think it’s worth a little summary (from the article) here – stay on the lookout for overcharges and fraud! The best way to protect yourself is to review your bills with vigilance. It’s sad that it has come to this…
Fraudulent tactics
Supply companies:
* Upcoding of items and services where, for example, a medical supplier may deliver to the patient a manually propelled wheelchair but bill the patient’s health fund for a more expensive, motorized wheelchair, or where a routine follow-up doctor’s office visit might be billed as an initial or comprehensive visit.
* Billing for medical services or items that are in excess of the patient’s actual needs. These might include a medical supply company delivering and billing for 30 wound care kits per week for a nursing home patient who only requires one change of dressings per day, or conducting daily medical office visits when monthly office visits are adequate.
Providers:
* Duplicate claims, where a certain item or service is claimed twice. In this scheme, an exact copy of the claim need not be filed a second time. Rather, the provider usually changes part of the claim so the health insurer does not realize it is a duplicate.
* Unbundling, where bills are submitted in a fragmented fashion so as to maximize reimbursement for tests or procedures that are required to be billed together at a reduced cost.
* Kickbacks, when a healthcare provider or other person engages in an illegal kickback for the referral of a patient for healthcare services that may be paid for by Medicare.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 1st, 2007 by Dr. Val Jones in Medblogger Shout Outs
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Dr. Rob, the author of “Musings of a Distractible Mind,” is really good at explaining difficult concepts. If you haven’t read his description of healthcare’s coding system, you should take a peek. It explains why documenting care is so complicated, how doctors try to “game the system” and what happens to them if they do.
Here’s a small excerpt:
“You see, what you get paid for an office visit is not based on what you do at that visit, it is based on what you document. The more you can document, the higher you can bill… There are several responses to this situation by physicians:
· Undercode to avoid the accusation of fraud
· Use EMR to document more and bill at a more appropriate level
· Code at the higher level without documenting higher and risk audit, jail, etc.
· Stop accepting insurance and just accept cash up front based on your own criteria
· Do other things besides office visits – such as surgical procedures, labs, x-rays, or other procedures that pay much better than the office visit. The pay for EKG with interpretation is nearly as high as that of the decision making that the physician makes that may save the life of the patient.”
So next time your doctor is delayed in seeing you… she’s probably trying to document all the right check boxes and codes for the last patient she treated!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
