A couple of years ago, a friend who is a social worker became very involved in learning about and eventually helping teach stress management techniques at a Boston hospital. She served as a volunteer in helping conduct classes, hoping to carve out a position for herself as the hospital expanded its services in this emerging arena. After about a year, she departed, quite discouraged. It seemed that all the positions of responsibility were taken over by physicians, and non-MDs were shunted aside.
So I think Linda Diane Feldt has reason to be “more than a little concerned about being co-opted,” as she puts it in her comment on yesterday’s post.
There definitely is a growing movement of people both discouraged by traditional healthcare and intrigued by the possibilities offered by holistic therapies and local food sources. Much of the interest in the alternatives is below the radar, as Suzanne Nelson describes so well in her blog posting today.
Just because there is upheaval doesn’t mean there will be fundamental change. The powers that be—the established medical profession—won’t give up their entrenched positions without a fight, a very serious fight. If people want a little stress management and nutritional advice, well, the doctors may take a couple of weekend courses and, presto, they are meditation and nutrition experts. The drug companies will buy some nutritional supplement companies and play both ends of the market. (Many major food corporations have already bought health-oriented small specialty food businesses.)
So while it’s encouraging to see more people open up to the possibilities offered by alternative medical approaches, real change won’t occur without a serious struggle. The medical profession has worked very hard for many years to make “M.D.” the gold standard of medical treatment. It won’t just walk away from such “brand equity.” Suzanne is correct in pointing out that many alternative providers are super-quiet, and their patients reluctant to talk about their providers too loudly. I think these providers and others like Linda are going to have to do more to toot their own horns—which doesn’t come naturally, since they tend to be modest and self-effacing. They’ll also need to defend themselves against the inevitable encroachments by the medical establishment.
If you want to get an idea of the stakes involved, from the medical establishment’s viewpoint, take a look at the lead article in today’s New York Times. It is about how doctors are earning hundreds of millions of dollars giving their patients anemia medicines—often dangerously overdosing their patients to maximize profits. One medical practice comprised of six cancer doctors received $2.7 million last year for prescribing $9 million worth of Amgen drugs…all in addition to invoicing insurance companies and Medicare for administering the drugs, and in addition to all their other treatments and services. It’s disgusting stuff, but you can be sure that the people getting rich off the existing system won’t get off the gravy train without a very big shove.
Those times ahve changed, but that fuzziness of when are you qualified and what training is needed is still very unclear and differs state to state, and from technique to technique, and sometimes even within techniques. Cranialsacral therapy is very popular – but with a number of different standards for competency.
I have two stories that I find illustrative of the strange interface between alternative medicine and conventional. After nine years of not very successful alterntiave work with a huge fibroid tmor, I decided to have the fairly new medical treatment of a uterine artery embolization. When I went for the initial consult the GYN MD came in and said "I understand you are a holistic health practitioner. It is a real honor to meet you". She was excited about what I might bring to the procedure, and agreed with and was curious about everything I did to support the conventional treatment. Including my theories and direct exerience of what was happening – the effect on the liver that no one had commented on so far, alternative pain relief, etc. It was an extremely positive experience.
Around the same time a family member had the conventional hysterectomy. I prepared a letter for her MD outlining my experience and training, and what herbal support we planned to use. The anesthesiologist told her not to use anything at all, she argued with him and got a different anesthesiologist. Her surgeon talked with me directly as I went in to be the person in teh waiting room. Her comment? She didn’t know much, but wanted to make sure I wasn’t using any of those "herbs that began with the letter G"
I’m not making this up. There had been a recent talk about herb drug intereactions at the hospital and what she cmae away with was to be concerned with all herbs that started with a G.
The MD world is a culture and a whole other place. When the medical people step outside of it strange things can happen – with unpredictable results. Sometiems they just look foolish, sometimes the partnership provides amazing care that couldn’t have happened otherwise. I am cautious and am tracking the trends I see carefully, but mostly hanging out at this edge of acceptance/integration/utilization of alterntive therapies and health understandings is tremendously exciting and validating and gets more and more interesting every day.
HSAs, at least in their pure form, are a way to bring market forces to play in healthcare. That translates into cost competition and the opening of markets to alternative providers.
What is a pure HSA?
1. A tax-free investment account, set aside to pay–and large enough to legitimately cover–anticipated first-dollar healthcare expenses. (HSA owners would necessarily also own a catastrophic health insurance policy, to protect against financial ruin in the event of a serious illness or injury.)
2. Full and complete account ownership by the patient, meaning that the patient and only the patient determines spending rules. Very few limitations placed on what constitutes a healthcare expense–what the patient wants, the patient gets.
3. Wealth creation as a reward for good management by the patient, through utilization control, price shopping, and health maintenance. If the HSA owner does not spend the account downward (by, for example, staying healthy) the accounts investment income surplus belongs to the accounts owner.
4. No bailout if the account is mismanaged.
To decentralize healthcare decision making, begin with the money stream.
I understand the logic, but it is dangerous nonetheless.That sort of sloppy thinking wouldn’t work in any other area of medicine. It was weird to encounter in all seriousness from a surgeon who wasn’t going to look any further.
Thanks for noting that Kirsten.