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Alternative Medicine for Underserved as a Public Health Problem

Posted Aug 26 2008 4:08pm
On the heels of Maggie Mahar's post about Americans' unnatural and over-reaching expectations for their health care , I came across a study being conducted by the University of Arizona .

They are polling Federally Qualified Health Centers about their use of complementary and alternative medicine (CAM; a term invented to lend credibility to the unfortunate use of unproven health-related interventions.)

Now hold on a cotton-picking second! I have trouble getting people with gallstones their surgery until they have ascending cholangitis, a potentially lethal complication. I find myself working with radiologists to dose radioactive iodine for severely hyperthyroid patients, because there is no endocrinologist available who accepts Medicaid. I have to bend backwards trying to do the best for patients who can't afford basic investigation, and what do you want me to do? You want to find out how often I get them to waste their money on fish oil, black cohosh and star energy?

Dr. Weil , you sure have balls.

I think the argument goes that scientific medicine in the 20th century has gone too far from its traditional healing roots. If there are health disparities amongst under-served populations, then there must be disparities in access to CAM. Many of the under-served are already using complementary and herbal remedies, so we need to better understand them.

But there is a major problem with the argument. CAM is a luxury related to well-being, as defined by the best possible physical, social and psychological functioning. Public Health, while it recognizes the importance of social contributors to overall health status, is most interested in ensuring access to basic health care, prevention, primary care, immunizations and the like.

To waste and divert resources from this population with self-serving, self-promoting clap-trap that will end up exacerbating the health of the most vulnerable. CAM has its place with middle and high income individuals who are seeking to maximize aspects of their life and are willing to go well beyond what the evidence base support. "You pays the money, you takes the chance..." But in the case of under-served populations, such efforts will only further sabotage the required efforts to provide improved health care access for the poorest of our compatriots.

Professor Stern at InsureBlog , would you care to weigh in on what a mandate for covering CAM would do to insurance rates?

Dr. Osler is turning in his grave.

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