ALTERNATIVE MEDICINE
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Pelletier, 1997
SWISS EXPERIMENT
Sommer, 1999
• 7500 OF 677,000 SUBSCRIBERS WERE GIVEN FREE CAM COVERAGE
• RESULT: NO EFFECT ON SUBJECTIVE STATE OF HEALTH
HISTORY
SCIENCE +MEDICINE=?
• USE NEW DISCOVERIES TO IMPROVE TREATMENTS (openminded) • COOPERATION WITH SCIENCEBASED PROFESSIONS:
– PHARMACISTS – NURSES – PUBLIC HEALTH INITIATIVES
CURRENT USE IS LIKELY TO UNDERREPRESENT UTILIZATION PATTERNS IF INSURANCE COVERAGE FOR ALTERNATIVE THERAPIES INCREASES IN THE FUTURE.”
EISENBERG D, 1998
EFFORTS TO RATIONALIZE HEALTH SPENDING
• B.C. PHARMACARE BUDGET • PRACTICE GUIDELINES
• THERAPEUTICS INITIATIVE
Summary
• Alternative Medicine is without a scientific basis. • Many elements are identical to old movements. • Regulation is not = effectiveness • Comes at the same time as funding pressures mount on health care.
HOW MANY VISITS ARE THERE?
EISENBERG 1998
WHO SEES THE MOST PATIENTS?
OF ALL VISITS TO ALTERNATIVE PRACTITIONERS….
HALF
WERE FOR
CHIROPRACTIC OR MASSAGE
WHAT‟S GROWING THE FASTEST?
• UNPROVEN • GENERALLY UNAVAILABLE IN HOSPITALS
• NOT USUALLY TAUGHT IN MEDICAL
SCHOOLS
DEFINITIONS
WHY IS IT „ALTERNATIVE‟?
REASONS RANGE FROM….
• NO RIGOROUS PROOF, BUT NOT PREPOSTEROUS (e.g. some herbal remedies)….
Insurers want to know whether or not a particular therapy is cost effective.”
Canadian Data 94/95
• • • • • Female Age 45-64 ‘Higher income’ 1 Chronic illness - 9% consulted a provider >2 Chronic illnesses - 26% consult provider
• • • • FEAR OF TECHNOLOGY MISTRUST OF ESTABLISHMENT NEED FOR HOPE DESIRE FOR COMFORTING PHILOSOPHY
HISTORY
NEW VARIATIONS
• GROWTH OF „JUNK SCIENCE‟ • PROMOTION IN POPULAR PRESS AND INTERNET • COLLEGE „COURSES‟ • RELAXED REGULATIONS
WHO USES IT?
WHO USES IT?
• 73% DURING LIFETIME • 50% IN THE LAST YEAR
FRASER INSTITUTE, 1999
WHAT‟S BEING USED?
• • • • • CHIROPRACTIC - 36% RELAXATION 23% MASSAGE 23% PRAYER 21% HERBAL 17%
ALTERNATIVE MEDICINE IN GERIATRICS
• DR. LLOYD OPPEL
ALTERNATIVE MEDICINE
•WHAT IS IT? •WHO USES IT? •DOES IT WORK?
WHAT IS IT? • DEFINITIONS • HISTORY
DEFINITIONS
?fearoftechnology?mistrustofestablishment?needforhope?needforhopehistory?desireforcomfortingphilosophynewvariations?growthofjunksciencepromotioninpopularpressand?promotioninpopularpressandinternethistory?collegecourses?relaxedregulationsregulation?variableacrossstatesandprovincesprovinces?validityisnotacriterionforregulationpoliticalhotpotato?publicpressure?governmentwantstocontrolhealthcostseffortstorationalizehealthspending?bc
• • • • • • • HERBAL (380%) MASSAGE SELF-HELP VITAMINS FOLK REMEDIES ENERGY HEALING HOMEOPATHY
EISENBERG, 1998
WHAT DOES IT CO$T?
• CANADA: $1.8
•
BILLION - PROVIDERS CANADA: $2.0 BILLION - REMEDIES
HISTORY
• Mackay: Popular Delusions and the
Madness of Crowds
• Mesmer: “Don‟t listen to reason”
• Ben Franklin did a critical appraisal
HISTORY
WHY THE RESURGENCE?
USA:$27 BILLION
EQUALS OUT-OF-POCKET EXPENSES FOR ALL DOCTORS IN THE USA
INTERNATIONAL EXPENSE?
• AUSTRALIA1992/3 $621 million (AU) for remedies.
$309 million for providers Compare with $360 million for patient drug contributions
• Psychotherapy
•HypnotherΒιβλιοθήκη Baidupy
*To any extent under any policy by 9 or more of 18 insurers
Was CAM Coverage “Successful”?
“Although cost-benefit analyses are hotly debated there are little empirical data brought to bear on whether CAM will indeed decrease costs, or whether coverage of CAM will be an added expense.”
• Pelletier, 1997, AM J Health Promotion • Interviewed 18 insurers offering CAM • Surveyed seven hospitals offering 3 or more CAM programs • Wanted to know what the criteria were for inclusion
(WITHIN THE LAST YEAR)
FRASER INSTITUTE, 1999
USER PROFILE?
• • • • CHRONICALLY ILL WOMEN MORE THAN MEN ?PSYCHOLOGICAL DISTRESS? SOME POST SECONDARY EDUCATION
• NO DISCERNABLE EFFECT ON OVERALL SPENDING, BUT CAM USE WAS A POWERFUL PREDICTOR OF TRATMENT COSTS
“BECAUSE THE DEMAND FOR HEALTH CARE (AND PRESUMABLY ALTERNATIVE THERAPIES) IS SENSITIVE TO HOW MUCH PATIENTS MUST PAY OUT OF POCKET,
Factors Influencing Coverage
• MARKET DEMAND
Factors Influencing Whether to Increase Coverage
• Proven Effectiveness (#1)
• High Market Demand
• Coverage Mandated by State Law • Potential Cost Savings
“However, until there is clear scientific proof of the efficacy of particular CAM therapies,
Each insurance company is left to decide for itself whether the effectiveness may exceed the costs of covering a particular therapy.
REGULATION
• Variable across states and provinces
• Validity is not a criterion for regulation
POLITICAL HOT POTATO
• PUBLIC PRESSURE • GOVERNMENT WANTS TO CONTROL HEALTH COSTS
HISTORY
WHERE HAS THIS GOTTEN US??
• IMPROVED LIFE EXPECTANCY:
– LOWER INFANT MORTALITY – IMPROVED CARE OF DISEASES OF MIDDLE AGE – VACCINES
• BETTER TREATMENTS FOR (AS YET) INCURABLE DISEASES
TO...
• COMPLETELY UNSUPPORTABLE (e.g. homeopathy)
History
• PRE 1900: CAVEAT EMPTOR • FLEXNER REPORT • MEDICINE SHOULD BE SCIENCE-
BASED
• GROWTH OF MODERN MEDICINE
MacLennan A, 1996
TO WHAT EXTENT IS IT COVERED BY PRIVATE CARRIERS?
• EISENBERG: MOST VISITS NOT COVERED • SAME AS IN 1990
WHAT MAKES AN INSURER COVER IT?
What was Being Covered?*
• Physical Therapy • Osteopathy • Chiropractic • Biofeedback •Acupuncture •Preventive Medicine •Nutrition Counseling •Massage
Millar, W Can J Pub Health, 1997
WHERE DO ILL PEOPLE GO?
6% 14% 35% NEITHER DOCTOR ONLY DOCTOR PLUS ALT. MED 45% ALT. MED. ONLY
F RASER INSTI TUTE, 19 99
HISTORY
“NEW AGE” =RECYCLED OLD AGE
• • • • • Spiritual Healing Herbal Medicine Magnets Chiropractic Religious and Cultural Beliefs (TCM, auverdic medicine)
SWISS EXPERIMENT
Sommer, 1999
• 7500 OF 677,000 SUBSCRIBERS WERE GIVEN FREE CAM COVERAGE
• RESULT: NO EFFECT ON SUBJECTIVE STATE OF HEALTH
HISTORY
SCIENCE +MEDICINE=?
• USE NEW DISCOVERIES TO IMPROVE TREATMENTS (openminded) • COOPERATION WITH SCIENCEBASED PROFESSIONS:
– PHARMACISTS – NURSES – PUBLIC HEALTH INITIATIVES
CURRENT USE IS LIKELY TO UNDERREPRESENT UTILIZATION PATTERNS IF INSURANCE COVERAGE FOR ALTERNATIVE THERAPIES INCREASES IN THE FUTURE.”
EISENBERG D, 1998
EFFORTS TO RATIONALIZE HEALTH SPENDING
• B.C. PHARMACARE BUDGET • PRACTICE GUIDELINES
• THERAPEUTICS INITIATIVE
Summary
• Alternative Medicine is without a scientific basis. • Many elements are identical to old movements. • Regulation is not = effectiveness • Comes at the same time as funding pressures mount on health care.
HOW MANY VISITS ARE THERE?
EISENBERG 1998
WHO SEES THE MOST PATIENTS?
OF ALL VISITS TO ALTERNATIVE PRACTITIONERS….
HALF
WERE FOR
CHIROPRACTIC OR MASSAGE
WHAT‟S GROWING THE FASTEST?
• UNPROVEN • GENERALLY UNAVAILABLE IN HOSPITALS
• NOT USUALLY TAUGHT IN MEDICAL
SCHOOLS
DEFINITIONS
WHY IS IT „ALTERNATIVE‟?
REASONS RANGE FROM….
• NO RIGOROUS PROOF, BUT NOT PREPOSTEROUS (e.g. some herbal remedies)….
Insurers want to know whether or not a particular therapy is cost effective.”
Canadian Data 94/95
• • • • • Female Age 45-64 ‘Higher income’ 1 Chronic illness - 9% consulted a provider >2 Chronic illnesses - 26% consult provider
• • • • FEAR OF TECHNOLOGY MISTRUST OF ESTABLISHMENT NEED FOR HOPE DESIRE FOR COMFORTING PHILOSOPHY
HISTORY
NEW VARIATIONS
• GROWTH OF „JUNK SCIENCE‟ • PROMOTION IN POPULAR PRESS AND INTERNET • COLLEGE „COURSES‟ • RELAXED REGULATIONS
WHO USES IT?
WHO USES IT?
• 73% DURING LIFETIME • 50% IN THE LAST YEAR
FRASER INSTITUTE, 1999
WHAT‟S BEING USED?
• • • • • CHIROPRACTIC - 36% RELAXATION 23% MASSAGE 23% PRAYER 21% HERBAL 17%
ALTERNATIVE MEDICINE IN GERIATRICS
• DR. LLOYD OPPEL
ALTERNATIVE MEDICINE
•WHAT IS IT? •WHO USES IT? •DOES IT WORK?
WHAT IS IT? • DEFINITIONS • HISTORY
DEFINITIONS
?fearoftechnology?mistrustofestablishment?needforhope?needforhopehistory?desireforcomfortingphilosophynewvariations?growthofjunksciencepromotioninpopularpressand?promotioninpopularpressandinternethistory?collegecourses?relaxedregulationsregulation?variableacrossstatesandprovincesprovinces?validityisnotacriterionforregulationpoliticalhotpotato?publicpressure?governmentwantstocontrolhealthcostseffortstorationalizehealthspending?bc
• • • • • • • HERBAL (380%) MASSAGE SELF-HELP VITAMINS FOLK REMEDIES ENERGY HEALING HOMEOPATHY
EISENBERG, 1998
WHAT DOES IT CO$T?
• CANADA: $1.8
•
BILLION - PROVIDERS CANADA: $2.0 BILLION - REMEDIES
HISTORY
• Mackay: Popular Delusions and the
Madness of Crowds
• Mesmer: “Don‟t listen to reason”
• Ben Franklin did a critical appraisal
HISTORY
WHY THE RESURGENCE?
USA:$27 BILLION
EQUALS OUT-OF-POCKET EXPENSES FOR ALL DOCTORS IN THE USA
INTERNATIONAL EXPENSE?
• AUSTRALIA1992/3 $621 million (AU) for remedies.
$309 million for providers Compare with $360 million for patient drug contributions
• Psychotherapy
•HypnotherΒιβλιοθήκη Baidupy
*To any extent under any policy by 9 or more of 18 insurers
Was CAM Coverage “Successful”?
“Although cost-benefit analyses are hotly debated there are little empirical data brought to bear on whether CAM will indeed decrease costs, or whether coverage of CAM will be an added expense.”
• Pelletier, 1997, AM J Health Promotion • Interviewed 18 insurers offering CAM • Surveyed seven hospitals offering 3 or more CAM programs • Wanted to know what the criteria were for inclusion
(WITHIN THE LAST YEAR)
FRASER INSTITUTE, 1999
USER PROFILE?
• • • • CHRONICALLY ILL WOMEN MORE THAN MEN ?PSYCHOLOGICAL DISTRESS? SOME POST SECONDARY EDUCATION
• NO DISCERNABLE EFFECT ON OVERALL SPENDING, BUT CAM USE WAS A POWERFUL PREDICTOR OF TRATMENT COSTS
“BECAUSE THE DEMAND FOR HEALTH CARE (AND PRESUMABLY ALTERNATIVE THERAPIES) IS SENSITIVE TO HOW MUCH PATIENTS MUST PAY OUT OF POCKET,
Factors Influencing Coverage
• MARKET DEMAND
Factors Influencing Whether to Increase Coverage
• Proven Effectiveness (#1)
• High Market Demand
• Coverage Mandated by State Law • Potential Cost Savings
“However, until there is clear scientific proof of the efficacy of particular CAM therapies,
Each insurance company is left to decide for itself whether the effectiveness may exceed the costs of covering a particular therapy.
REGULATION
• Variable across states and provinces
• Validity is not a criterion for regulation
POLITICAL HOT POTATO
• PUBLIC PRESSURE • GOVERNMENT WANTS TO CONTROL HEALTH COSTS
HISTORY
WHERE HAS THIS GOTTEN US??
• IMPROVED LIFE EXPECTANCY:
– LOWER INFANT MORTALITY – IMPROVED CARE OF DISEASES OF MIDDLE AGE – VACCINES
• BETTER TREATMENTS FOR (AS YET) INCURABLE DISEASES
TO...
• COMPLETELY UNSUPPORTABLE (e.g. homeopathy)
History
• PRE 1900: CAVEAT EMPTOR • FLEXNER REPORT • MEDICINE SHOULD BE SCIENCE-
BASED
• GROWTH OF MODERN MEDICINE
MacLennan A, 1996
TO WHAT EXTENT IS IT COVERED BY PRIVATE CARRIERS?
• EISENBERG: MOST VISITS NOT COVERED • SAME AS IN 1990
WHAT MAKES AN INSURER COVER IT?
What was Being Covered?*
• Physical Therapy • Osteopathy • Chiropractic • Biofeedback •Acupuncture •Preventive Medicine •Nutrition Counseling •Massage
Millar, W Can J Pub Health, 1997
WHERE DO ILL PEOPLE GO?
6% 14% 35% NEITHER DOCTOR ONLY DOCTOR PLUS ALT. MED 45% ALT. MED. ONLY
F RASER INSTI TUTE, 19 99
HISTORY
“NEW AGE” =RECYCLED OLD AGE
• • • • • Spiritual Healing Herbal Medicine Magnets Chiropractic Religious and Cultural Beliefs (TCM, auverdic medicine)