Industrialized nations are in the middle of a health care crisis (some more than others), or at least a dilemma. As our medical technology advances, people are living longer, they are living with chronic diseases, and they are consuming more health care. The cost of this health care is rising faster than economic growth, so it is becoming a greater and greater burden on society. Many countries ration health care in one way or another in order to contain costs. Otherwise there is no easy or obvious solution and it’s likely that difficult choices will have to be made.
An interesting side effect of this dilemma is a renewed focus on the cost effectiveness of medicine. Effectiveness alone is not enough. We simply cannot afford, for example, to introduce a very expensive treatment for marginal improvement in outcome in a common disease. Different options can also be compared not only for their safety and efficacy, but for their cost effectiveness. In other words, we need to use cheaper alternatives when available rather than always reaching for the latest and greatest (and most expensive) treatment.
This situation provides an opportunity for science-based medicine. Treatments that are promoted as complementary and alternative (CAM) are often sold as cost effective because they are less expensive up front than standard medical care. We cannot, however, cede this argument to proponents of dubious therapies. Cheap does not mean cost effective. You have to be effective in order to be cost effective, and most of the dubious treatments that are marketed under the CAM umbrella are ineffective.
Regulators in Australia seem to get this. ABC news (that’s the Australian Broadcasting Corporation) recently reported:
Natural therapies found to be clinically ineffective will be cut out of government-funded private health insurance rebates.
Treatments including homeopathy, aromatherapy, ear candling, crystal therapy, flower essences, iridology, kinesiology and naturopathy could be found ineligible.
This is good news, however I think labeling this as focusing on “natural therapies” is counterproductive. Such labels are often misleading, inaccurate, meaningless, and a distraction from what really matters – the scientific evidence. What is “natural” about sticking a candle in your ear and burning it to suck out the toxins (which look suspiciously like burned candle wax)? “Natural medicine” is just a marketing term without a useful or meaningful operational definition. Proponets of these dubious methods are using the label to criticize this measure. Also from the ABC article:
However, Australian Traditional Medicine Society president Dr Sandi Rogers says the announcement came as a surprise.
“It’s a little bit of a shock when we as a profession have not been consulted,” she said.
“If this cost-cut is saying ‘we don’t want to spend taxpayer’s money on natural medicine’, I would be very concerned.”
They are spinning this as an attack on “natural medicine.” Rather, the measure is saying that taxpayer money should not be spent on therapies that are not adequately science-based, whether or not they are thought of as “natural”, “traditional”, or “conventional”. All of the modalities listed above are highly implausible and without evidence to support their efficacy.
Concerns about cost effectiveness and public funding are a great opportunity, in fact, to have a public discussion about the efficacy of such treatments. I want everyone to know exactly what homeopathy is (implausible treatments based on magical thinking diluted into non-existence), and I want them to know what the scientific evidence says – that it doesn’t work. Let us then have a frank debate about whether or not the FDA should be approving homeopathic potions, and whether our limited public health care dollars should be wasted on them.
This comes back to the notion that there should not be any double standard when it comes to medicine. CAM proponents usually try to turn this around, claiming they are not being treated fairly. Dr. Rogers, for example, is quoted as saying:
“We would just like a fair playing field.”
I don’t believe that is true. CAM proponents want a double standard with unfair advantages given to so-called CAM therapies. That is the real purpose of the existence of such labels, all created by proponents in order to argue for the double standard. Defenders of science-based medicine are arguing for a single science-based standard in evaluating medicine. We should apply this same standard when considering cost-effectiveness and public funding. CAM therapies should be held to the same standard of plausibility and scientific evidence, and not be given special consideration because they are “natural.” CAM proponents should also not be allowed to change the rules of evidence as they go along in order to rig the game in their favor.
What is amazing is that public rebates were being given for things like iridology (a completely pseudoscientific form of diagnosis), not that they are now going to be taken away.
The cost effectiveness debate is a good opening for proponents of SBM to make the case to regulators that they should not be wasting taxpayer health care dollars on treatments that are not supported by evidence. I hope this the start of a trend. The principle is very simple – we cannot continue to waste resources on pseudoscience in medicine.