Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Saturday, November 27, 2004

The Politics of Health Fraud

In that view, “alternative,” “holistic,” and “New Age” are just euphemisms for the unproven, nonscientific approaches...

The Politics of Health Fraud
Medicine and modern magic
By Bryce Buchanan

The March 8 meeting of Oregonians for Rationality featured Salem Joe Schnabel discussing fraudulent medical treatments. His Doctor of Pharmacy degree from Purdue, hospital experience, and position as a member of Oregon�s Naturopathic Formulary Council have given him expertise in traditional drug therapy, as well as "alternative" therapies. Schnabel has served on the Naturopathic Formulary Council since it was established by the Oregon legislature in 1989. The Council's job is to determine which drugs should be legal for naturopaths to prescribe.

Schnabel defined fraudulent treatment as "the intentional use or promotion of drugs or treatments which have not been proven to be beneficial for the condition for which they are used or promoted." He noted that mainstream medicine certainly has it's share of fraudulent and unscientific practitioners and did not want to imply "alternative" practitioners had a monopoly on fraud. He reported that the total cost of medical fraud per year in this country is 44 billion dollars.

It was surprising to learn there are only two schools of naturopathy in the U.S. and they are both in the Northwest, one in Portland and one in Seattle. There are only eight states which have Naturopathy Practice Acts. Nevada had statutory recognition of naturopaths for a short time but recently repealed the law. Formal legal recognition by the state can be valuable to the profession and broadens their powers. For example, naturopaths cannot prescribe medications unless the state specifically allows it. State recognition also strengthens the claim for health insurance coverage.

Other alternative practitioners such as homeopaths and chiropractors are more widely trained and distributed across the country. In reference to homeopathy the term “trained” may be an overstatement. It may be more accurate to say that you can proclaim yourself to be a homeopath and thus be one. A seminar or two will add to your credentials. Diploma mills are eager to send diplomas (for a fee) in fringe specialties. Schnabel reported on an acquaintance whose cat has a Doctor of Nutrition diploma.

Those who sell alternative treatments often rely on testimonials to give credibility to their methods, Schnabel said.

We have all seen testimonials and anecdotes used to support things for which there is no scientific support. If you pay attention to health fraud stories you notice that when the most outrageous practitioners are shut down by a government agency there is a storm of protest from true-believer patients. This devotion may be partially explained by some of the things Schnabel discussed. He noted that alternative practitioners generally spend much more time with their patients than do traditional physicians. Listening to patients and projecting empathy and concern builds patient loyalty. People who are accustomed to being rushed through a traditional medical office will welcome a health care provider who seems to care more about them as an individual.

There is also a group of patients who are unwilling to accept that modern science does not have a cure for every human ailment. Alternative medicine, on the other hand, does have a cure for every ailment. Or so it seems from their promotional literature. According to a brochure from a fringe physicians’ group in Nevada, “There are no incurable diseases, only ignorant physicians” (Consumer Reports, 1990). The non-ignorant practitioners on the fringe would like to share their wisdom, usually “ancient wisdom,” but the evil monopoly of conventional medicine does not allow this. Alternative providers’ sales brochures often have headlines like, “129 Amazing Medical Secrets Your Doctor Won’t Tell You,” and “Remarkable Cures CENSORED By Knife-Happy Surgeons and Greedy Drug Companies!” (Health and Wellness Today, Summer 1995).

If alternative practitioners successfully portray themselves as caring people with a solution for every problem, then we can expect their power and popularity to continue to grow. Their lobbying efforts have succeeded in establishing an Office of Alternative Medicine in the National Institutes of Health, despite the fact that many alternative health care groups are openly mystical and blatantly anti-science. Schnabel said that in his work on the Naturopathic Formulary Council he noticed the word “science” upset the naturopaths. Their practice encompasses so much more than science, they explained.

Nor do they do not want science to be the judge of the value of the medications they sell. As it now stands, the strict requirements for proof of safety and efficacy that standard drugs must satisfy are not required for such things as homeopathic medicines (see Homeopathy, p.7). Oregon House Bill 3340 attempted to make a nonscientific standard the law in Oregon. The bill stated alternative therapies must be, “shown to be effective in medical literature,” or “in the personal experience of the physician.” So it can either be demonstrated in controlled experiments that a treatment works, or you can just say that you think it works. This bill passed, but was vetoed by Governor Kitzhaber, a medical doctor. The legislature, however, overrode the Governor’s veto, making it the law.

Schnabel also discussed how conventional drugs come to market. There are three phases of testing, followed by a review and recommendation from an advisory panel. Approval is followed by promotion of the drug, which he says can be deceptive. Physicians and pharmacists may rely too heavily on drug company salesmen when they evaluate a new drug. According to Schnabel, the pharmaceutical industry is the number one lobbying group in Salem.

A wise consumer of medical care, advised Schnabel, should be skeptical; ask about the benefits and risks of any proposed treatment; ask for documentation of claims if you want to know more; ask to see the credentials of the care giver whenever there are doubts; and become informed about the proposed drugs, including their specific purposes, their possible side effects, any generic alternatives, the cost, and exactly how and when they should be taken.

Oregonians for Rationality member, Tom Owen, made an astute comment. He asked what the word “alternative” refers to, noting that if a treatment is shown to be effective it becomes part of scientific medicine. He wondered if “alternative” was simply an identifier for non-scientific treatment in an effort to justify the treatment?

In that view, “alternative,” “holistic,” and “New Age” are just euphemisms for the unproven, nonscientific approaches which stand in clear distinction to the rational, scientific approach to medicine.

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