The long-time leader of the True North integrative center in Falmouth, Maine, integrative and functional medicine doctor Bethany Hayes, MD, sent a response that touches both on the debate over NCCAM’S name and the Integrator column Take the Pledge: Never Say “Healthcare System” When You Are Describing “Disease Care” or the “Medical Industry”. True North is in its 12th year. Hayes is a veteran.
The long-time leader of the True North integrative center in Falmouth, Maine, integrative and functional medicine doctor Bethany Hayes, MD, sent a response that touches both on the debate over NCCAM’S name and the Integrator column Take the Pledge: Never Say “Healthcare System” When You Are Describing “Disease Care” or the “Medical Industry”. True North is in its 12th year. Hayes is a veteran. She writes:
“I am reading with interest and some flash-backs the whole debate about renaming NCCAM, what’s in a name and are we calling ourselves and others by the right name. Among the many concerns I have as someone who has never made much money in my professional life, is the apparent separation of the ‘medical industry’ from ‘CAM’ providers, many of whom are making just as much money individually as some of the individuals doing ‘medical industry’ medicine. Examples include overcharging for supplements, using marginally valuable laboratory tests and a whole panoply of various treatments and machines whose value is unproven.
“Now I prescribe supplements, use some of those lab tests and recommend some of the treatments that other physicians might put in the categories I have just named so I know this is a slippery slope. I just want to make the point that the ‘industry’ extends well into Complementary and Integrative practices. Maybe we need a name for the industry that takes money out of patients’ pockets and puts it in practitioner’s pockets without returning value for value. ‘Valueless medicine’? Or to be more positive ‘Valuable Medicine’. And perhaps we should spend some time, which I think is the point of the renaming NCCAM, to REALLY look at the value people get from various practices, procedures and treatments (including of course, relationship and spiritual support) on the full span of what people are doing to address their suffering and health.”
Comment: In a world in which one unnecessary bypass operation can cost more than a few years of unnecessary supplements, it’s easy to shrug off the lesser corruptions of business-based patient care decisions in integrative practices. I note this in my original post: “Clearly, some therapeutic choices made by all types of practitioners, including ‘CAM’ and integrative providers, are stimulated by concern over business returns and personal income. I think of programs for patients with more visits than may be necessary and of sales of some products or tests.” Our houses are of glass, just more like terrariums than the other medical industry’s sky-scraping glass homes on the hill. Still, as Hayes suggests, we can only help ourselves by engaging the practice of knowing what drives us so that we can then drive more energy toward systems of health creation.
Additional note on the “medical industry” and use of language from Beth Sommers, LAc, PhD
The co-founder and research leader at Boston’s Pathways to Health, Elizabeth Sommers, LAc, MPH, PhD, the co-chair of the integrative health group at the American Public Health Association, writes: “Love your dedication to proper verbiage! [See Take the Pledge“, noted above.] In homage to Dwight Eisenhower, my votes for nomenclature of US ‘healthcare’ system are: medico-industrial complex or pharmaco-industrial complex.”
Comment: For you who are not familiar, the Republican Eisenhower’s used his farewell speech in 1961 to rail against the “military-industrial complex.” A perspective on that phrases application to the medical industry is here.
Preventive treatment: when doctors are “more like a life insurance sales team”
“When we offer statins, or any preventive treatment, we are practicing a new kind of medicine, very different to the doctor treating a head injury in A&E. We are less like doctors, and more like a life insurance sales team: offering occasional benefits, many years from now, in exchange for small ongoing costs.”The author of the British Medical Journal editorial, Statins are a mess: we need better data and shared decision making, began discussing statins as preventive drugs, with all their individualized adverse effects, and launched into general commentary about evidence needed for preventive interventions. He concludes: “Crucially, the benefits and disadvantages [of using statins or other drugs preventively] are so closely balanced that these individual differences really matter. Because of that, this new kind of medicine needs perfect information.”
Comment: It is a wonder that this author, or anyone who isn’t still wet from the womb, could even suggest the possibility of “perfect information.” After all, we live at a time when yet 25% of what is done has quality evidence, “and we only do that half the time,” according to recent comments from a medical leader at the U Pittsburgh system. Never happen, so why act as thought it’s possible? We’ll never get close, for years or decades, given the individualized nature of the human systems into which these agents are dropped. To hold out this promise is to practice a Chekovian yearning for an unattainable ideal. To admit that anything near “perfection” may yet be 7 generations away would suggest an even more conservative approach to chronic administration of agents such as statins as preventive measures. (Thanks to Deb Hill, MS for the link.)