Stop wasting money on fake medicine

The United States arguably has the most innovative and successful biomedical research community. Through our universities, corporations, and our ability to recruit native and imported talent, many of medicine’s most important breakthroughs have come from the U.S..  But by many measures we have a chaotic, expensive, and ineffective healthcare system.

One of the many faults of our system is our unstoppable desire to provide futile and unnecessary care, but the savings to be gained by changing our approach may be minimal (about 3% by some measures). But small numbers do eventually add up, and waste may eventually bankrupt us.  Rationing care saves money but Americans fear it; we want what we want and we want it now, no matter what the cost, no matter what the science says.

And that’s where reality meets fantasy.  While millions cannot afford the most basic of care, millions more are choosing to buy care that is futile, barely regulated, and often dangerous.

Americans spend about $25 billion dollars yearly on supplements produced in a “wild west” mish-mash of factories which are effectively unregulated.  We spend additional billions on other so-called “alternative therapies” such as chiropractic, energy healing, homeopathy, and other superstition-based treatments.

People are of course free to waste their money in an legal way they wish, but too often insurance companies pay for these therapies despite lack of evidence.  It’s common for my patients to be denied coverage for important tests and medications while these same insurance companies easily pay for chiropractic, naturopathy, and acupuncture.

Most people have heard of these therapies and assume them to be relatively mainstream and effective, but the evidence is disappointing. Chriropractic, while popular, is based on a failed 19th century theory of “subluxations” that block the flow of vital energies. While some studies have found modest efficacy for low back pain, the bulk of the evidence shows chiropractic to be useless, and sometimes harmful. Naturopathy is another failed hypothesis about vital energies that somehow affect our health.  Naturopaths often bill themselves as primary care doctors and claim that their education is “medical school plus”. The evidence shows that nautropathic education is not only deficient in science-based medical facts, but the practice is a chaotic “hodge-podge of mostly unscientific” therapies.

Acupuncture is becoming more and more popular, and is increasingly offered by mainstream medical centers, but the evidence for it’s effectiveness is anemic. In controlled studies, “real” acupuncture has been found inferior to “fake” acupuncture.  Like chiropractic, while some studies show benefit, the bulk of the evidence shows no effect. Blind acceptance of unproven therapies can lead to some pretty horrific results.

I support the freedom of any fool to be parted from his money, but our healthcare dollars are a precious resource and when we waste it on dreams, we all become fools.

20 Comments

  1. In Britain. the NHS supposedly spend 500 millions pounds a year on alternative medicine, although it’s clearing up
    http://www.telegraph.co.uk/comment/3557651/The-last-rites-for-alternative-medicine.html

  2. Michael

     /  August 29, 2012

    Have to disagree about the chiropractor. A doc wanted to put me under the knife for back problems that had me down, here and there for a few years. Someone talked me into going to a chiropractor first before making a final decision. Three treatments later and no more back pain. Six months later, as good as new. That was four years ago and haven’t had problems since. My experience of relied from chiropractor, as well as a doc who was too eager to fill his purse with his surgical knife, is all the evidence this one needs.

    • JScarry

       /  August 29, 2012

      You seem to forget that anecdotes are not evidence.

  3. Tom Stunk

     /  August 29, 2012

    Chiropractic is effective.

  4. ac

     /  August 29, 2012

    Prove that alternative medicine is “Fake”. You have just assumed the burden of proof.

  5. Barbarella

     /  August 30, 2012

    To my thinking, the real problem is developing understanding of the scientific method and what constitutes “proof” when teaching about science in our schools. Sadly, working with the public, I have lost confidence in believing that adults can re-educate themselves to think more rationally (or scientifically, if you prefer). Most schools have cut so much from their budgets that it is up to us as parents to educate our own children–in my case, I just released one more skeptic into American society. One at a time is an awfully slow rate.

  6. Robert Downey

     /  August 30, 2012

    I am dissapointed that you have lumped chiropractic treatment in to the mass of ineffective and hocus alternative therapies. Personal experiance indicates otherwise. Seven years ago I was in a car wreck. I was hit while sitting at a Stop Light. I began suffering terrible headaches. My regular Doctor could find nothing but, was happy to prescribe all the NSAIDS and mild muscle relaxers I wanted. A Chiroprator, Dr. Jeffrrey Standifer in Dallas TX took X-Rays and observed that I had a misalignment of the skull and neck vetebra. Nerve impingement in the neck vetebra caused me severe headaches. X-Rays revealed my skull had shifted on the Atlas joint by a significant amount. One treatment alleviated my condition. I conclude that Chiropractors are not based on superstition.

    • palmd

       /  August 30, 2012

      Personal experiance indicates otherwise

      cf above
      The plural of anecdote is not “evidence”. And if a chiropractor told me I had a significant shift of my skull relative to my atlas, i’d probably run to a neurosurgeon and have them take a look to see if that’s even remotely true.

      • Tara S

         /  September 5, 2012

        If allopathy or traditional medicine solved everyone’s disease; (whether YOU personally acknowledge it as disease or not) why would any alternative practices persist – and sort of flourish? Science is wonderful – it is a powerful framework for attempting to reach the ‘truth’ I have trained in it myself – however we are perhaps realizing more and more the limits of reductionist science. People are not as simple as tissue in a petridish. Even tissue in a petridish isn’t really always simple depending on what you’re looking for… We live whole in a complex world – arguably that we have evolved to be fairly reasonably adapted to.

        Sure it’s exciting to find synthetic or biologically extracted little molecules that when packaged into little white pills, or injectable liquids make the human body whir or tick in a particular way – vaccines were bloody clever, antibiotics even more so…

        Disease itself – as defined by the person who’s body it manifests itself in – is a lot more complex than a bacterial infection however – as obviously you know much better than I do. With all the great study and much success of traditional modern medicine, many questions remain. Why do some people react to certain drugs? Why are allergies brought on by psychological stress? Heart disease? Why are people anorexic? Why is there no relief or cure for menstrual cramps? Rheumatoid artheritis? Why are massages so relieving? Why do excorcisms and demon-banishments have high patient reported ‘cures’ in the regions where people believe in shamans? Does yoga really control asthma? How? Are antidepressants better than depression? Why with all that we know about pain – does pain still persist in the modern world? Why do placebos work?

        Do you as an MD garauntee life to anyone who follows the treatments you prescribe? Can anyone garuntee that? Not a better likelihood of living – but an actual fail proof garuntee. If you did – why would you need liability insurance?

        The problem that people have with traditional medicine is not where it works – but where it doesn’t. Where people’s diseases – as defined by them – have not been alleviated – or where the treatment options offered by traditional medicine are not acceptable to them – for instance – having a hysterctomy to cure menstrual cramps.

        More than anything I would question most strongly the ‘scientist’ that does not leave room for open and honest enquiry, Not biased opinion mongering. If a patient says spinal manipulation/whatever else not – worked it is the doctors job to listen. The disease they experienced was resolved. That is all the evidence a single human being needs for their own body – regardless of what you think they should feel like or need.

        • neverdefiled

           /  September 17, 2012

          No relief for menstrual cramps? Do you live in the Fifties?

          First off, you can’t eliminate cramps altogether. That’s like saying “Why can’t we cure contractions during labour, huh? They’re the same thing. Rhythmic contractions of the uterine musculature to expel the contents of the uterus, endometrium or baby. No contractions (cramps), no period.

          Treatments for painful cramps include mefenamic acid, tranexamic acid, cox II inhibitors, ablation, fitting an IUS, using Nexplanon, meptazinol… Want me to go on?

          • Chris

             /  September 17, 2012

            I liked ibuprofen. It was so nice when that came out. It complemented the pillow under the knees and hot pad on the abdomen.

            Now I have the perfect cure for cramps: menopause. A few hot flashes, but it beats cramps.

  7. Robert Downey

     /  August 30, 2012

    I saw the X-Ray myself. Why this was not discovered by my regular Doctor is beyond me. X-Rays are not hocus or superstion to me. Nor are real results which allow me to stop living on pain killers, muscle relaxants and NSAIDS for the last seven years.

  8. Karen

     /  August 30, 2012

    I, too, have a “helpful chiropractor” anecdote — albeit one recommended by a GP, in a case where there was really nothing conventional medicine could do for my father — but I also have an “unhelpful chiropractor” anecdote. I’ll elaborate neither of them here, for I too believe anecdotes are not data. On the whole, I would rather be treated by people who at least have some real science behind them.

  9. g2-8cc6b52a22fca03cb35836f2c5d50979

     /  August 30, 2012

    OT: I understand the importance of ads to keeping a blog afloat, but an ad for a Wendy’s fried chicken sandwich??? Be still my quaking arteries!

    • While I cannot as a physician recommend the advertised sandwich, I can, as a midwesterner, recommend the frosty.

  10. Beccy

     /  September 3, 2012

    I’m a massage therapist and a dedicated reader. I wonder why we MTs always escape the (valid) criticism that comes from here, Orac, SBM, and other reputable sources? There is plenty we are doing weirdly, I can tell you that.

    I love this blog, btw.

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