In Washington DC this week, President Obama has been having a summit on Health Policy related issues.
In regards to cost containment and effectiveness issues, I would like to highlight a series of studies performed in Germany on the cost effectiveness of acupuncture for a variety of common conditions.
We have to keep in mind, that in Germany, unlike the U.S., the government has a vested interest in keeping the population well because of the universality of their health coverage, unemployment benefits, and sick pay. But the WHO has determined a level of cost-effectiveness for all geographical areas in the world regardless of their particular health policies. The German series uses these preset values in evaluating acupuncture treatment.
(For more information about my practice, please click here.)
Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain.
Eur J Health Econ. 2008 Aug;9(3):209-19.
"The degree of cost-effectiveness was influenced by gender, with female patients achieving a better cost-effectiveness ratio than men. In conclusion, acupuncture was a cost-effective treatment strategy in patients with chronic osteoarthritis pain.
Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain.
Am J Epidemiol. 2006 Sep 1;164(5):487-96.
"Acupuncture plus routine care was associated with marked clinical improvements in these patients and was relatively cost-effective."
Cost-effectiveness of acupuncture treatment in patients with chronic neck pain.
Pain. 2006 Nov;125(1-2):107-13. Epub 2006 Jul 13.
"According to international cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic neck pain."
Cost-effectiveness of acupuncture treatment in patients with headache.
Cephalalgia. 2008 Apr;28(4):334-45.
"According to international cost-effectiveness threshold values, acupuncture is a cost-effective treatment in patients with primary headache."
Cost-effectiveness of acupuncture in women and men with allergic rhinitis: a randomized controlled study in usual care.
Am J Epidemiol. 2009 Mar 1;169(5):562-71.
"Acupuncture, supplementary to routine care, was beneficial and, according to international benchmarks, cost-effective."
I think you get the idea.
We are grateful to the following team: Witt CM, Reinhold T, Jena S, Brinkhaus B, Willich SN at the Departments of Social Medicine, Epidemiology, and Health Economics at the Charité University Medical Center, Berlin, Germany for performing the above studies.
Friday, March 6, 2009
Americans receive too much radiation from diagnostic scans
Yay for the USA!!
In yet another version of "follow the money..."
(For more information about my practice, please click here.)
"Overexposed: Imaging tests boost U.S. radiation dose
CHICAGO (Reuters) - Americans are exposed to seven times more radiation from diagnostic scans than in 1980, a report found on Tuesday as experts said doctors are overusing the tests for profit and raising health risks for patients.
The findings, issued by National Council on Radiation Protection and Measurement, add to already mounting evidence that doctors are ordering too many diagnostic tests, driving up the cost of healthcare in the United States and potentially harming patients...
"Unfortunately, one of the things we have seen in the imaging world is that many physicians look at imaging as the solution to their financial problems," Thrall, head of radiology at Massachusetts General Hospital in Boston, said in a telephone interview.
He said imaging technology has created a financial incentive for some doctors to cash in by referring patients to get imaging tests on equipment in their own practices. This is one place the federal government and Congress can look in enacting healthcare reform, Thrall added.
A study by the Government Accountability Office in July found Medicare spending on medical imaging doubled to about $14 billion a year between 2000 and 2006, driven largely by increases in high-tech imaging."
There's more at the link about the actual increase in numbers of scans done. But the other part of it is that thousands of NON-radiologists have purchased imaging equipment for their offices. This helps these practitioners with their bottom lines, but helps to drive up the cost of health care and could endanger patients. The number of these tests in self-referred offices has tripled for Medicare patients from 1998 to 2005. And one can only assume that they've continued to increase since then.
from the article ""There is a fundamental problem when the person ordering the study has a direct financial interest in maximizing the use of a particular piece of equipment," Thrall said."
Yup.
In yet another version of "follow the money..."
(For more information about my practice, please click here.)
"Overexposed: Imaging tests boost U.S. radiation dose
CHICAGO (Reuters) - Americans are exposed to seven times more radiation from diagnostic scans than in 1980, a report found on Tuesday as experts said doctors are overusing the tests for profit and raising health risks for patients.
The findings, issued by National Council on Radiation Protection and Measurement, add to already mounting evidence that doctors are ordering too many diagnostic tests, driving up the cost of healthcare in the United States and potentially harming patients...
"Unfortunately, one of the things we have seen in the imaging world is that many physicians look at imaging as the solution to their financial problems," Thrall, head of radiology at Massachusetts General Hospital in Boston, said in a telephone interview.
He said imaging technology has created a financial incentive for some doctors to cash in by referring patients to get imaging tests on equipment in their own practices. This is one place the federal government and Congress can look in enacting healthcare reform, Thrall added.
A study by the Government Accountability Office in July found Medicare spending on medical imaging doubled to about $14 billion a year between 2000 and 2006, driven largely by increases in high-tech imaging."
There's more at the link about the actual increase in numbers of scans done. But the other part of it is that thousands of NON-radiologists have purchased imaging equipment for their offices. This helps these practitioners with their bottom lines, but helps to drive up the cost of health care and could endanger patients. The number of these tests in self-referred offices has tripled for Medicare patients from 1998 to 2005. And one can only assume that they've continued to increase since then.
from the article ""There is a fundamental problem when the person ordering the study has a direct financial interest in maximizing the use of a particular piece of equipment," Thrall said."
Yup.
Wednesday, March 4, 2009
Is electromagnetic radiation dangerous?
This topic has been an interest of mine for a few years. An electrical engineering colleague of mine, Jim Andrews, and I took EMF readings along the route of the wiring for the new Lucas center in the Presidio. We did this so we would have baseline data to compare to once the Lucas center was at full capacity.
February 10th, 2009. Dr. Thomas Rau, Medical Director of the world renowned Paracelsus Clinic in Lustmühle, Switzerland says he is convinced ‘electromagnetic loads’ lead to cancer, concentration problems, ADD, tinnitus, migraines, insomnia, arrhythmia, Parkinson’s and even back pain. At Paracelsus (www.paracelsus.ch), cancer patients are now routinely educated in electromagnetic field remediation strategies and inspectors from the Geopathological Institute of Switzerland are sent to patients’ homes to assess electromagnetic field exposures.
Rau says the removal of dental fillings can be an important early step in reducing electrical sensitivity, allowing some people to live in homes they otherwise could not tolerate.
There are political movements afoot also. Groups for EMF safety are proposing that Congress
1) mandate the FCC lower exposure guidelines to reflect the large body of science showing biological effects at exposures much lower than current standards,
2) repeal Section 704 of the Telecommunications Act of 1996, which rescinded state and local governments right to resist towers on health or environmental grounds
3) stop the roll out of the Wi-Max network until Congress better understands the potential health consequences
4) accommodate citizens unable to function adequately in high EMF environments, including forbidding cell towers on school properties.
Vis a vis these concerns there was a article last week in the wellblog-NYtimes.com concerning demonstrations at the University of California San Diego, campus. One of the literature buildings is being blamed for a cluster of breast cancer cases, raising new questions about the risks of exposure to electromagnetic fields.
Last week, students and professors marched and carried signs to protest what they called a “crisis of safety,” claiming that the university has failed to address worries that the campus literature building is the site of an inordinate number of cancer cases.
At least eight workers in the campus building have been diagnosed with breast cancer since 2000, and a handful of other cancers, including ovarian and salivary gland cancers, have also been reported. The number of breast cancer cases alone is significantly more than would have been expected by chance, according to a June analysis by Cedric Garland, an epidemiologist at the university. In that report, he notes that the risk of invasive breast cancer for employees in the literature building appears to be four to five times higher than that of the general California population.
Building workers and researchers are concerned the source of the problem may be the building’s elevators.
This is a source of illness that is still "under the radar" (pardon the pun) in the U.S. Europe is taking it much more seriously. I think it is significant and helpful that the demonstrations are taking place at UCSD, an institution that prides itself on academic excellence and scientific rigor, and that UCSD's own epidemiologist authored and signed off on the study.
(For more information about my practice, please click here.)
February 10th, 2009. Dr. Thomas Rau, Medical Director of the world renowned Paracelsus Clinic in Lustmühle, Switzerland says he is convinced ‘electromagnetic loads’ lead to cancer, concentration problems, ADD, tinnitus, migraines, insomnia, arrhythmia, Parkinson’s and even back pain. At Paracelsus (www.paracelsus.ch), cancer patients are now routinely educated in electromagnetic field remediation strategies and inspectors from the Geopathological Institute of Switzerland are sent to patients’ homes to assess electromagnetic field exposures.
Rau says the removal of dental fillings can be an important early step in reducing electrical sensitivity, allowing some people to live in homes they otherwise could not tolerate.
There are political movements afoot also. Groups for EMF safety are proposing that Congress
1) mandate the FCC lower exposure guidelines to reflect the large body of science showing biological effects at exposures much lower than current standards,
2) repeal Section 704 of the Telecommunications Act of 1996, which rescinded state and local governments right to resist towers on health or environmental grounds
3) stop the roll out of the Wi-Max network until Congress better understands the potential health consequences
4) accommodate citizens unable to function adequately in high EMF environments, including forbidding cell towers on school properties.
Vis a vis these concerns there was a article last week in the wellblog-NYtimes.com concerning demonstrations at the University of California San Diego, campus. One of the literature buildings is being blamed for a cluster of breast cancer cases, raising new questions about the risks of exposure to electromagnetic fields.
Last week, students and professors marched and carried signs to protest what they called a “crisis of safety,” claiming that the university has failed to address worries that the campus literature building is the site of an inordinate number of cancer cases.
At least eight workers in the campus building have been diagnosed with breast cancer since 2000, and a handful of other cancers, including ovarian and salivary gland cancers, have also been reported. The number of breast cancer cases alone is significantly more than would have been expected by chance, according to a June analysis by Cedric Garland, an epidemiologist at the university. In that report, he notes that the risk of invasive breast cancer for employees in the literature building appears to be four to five times higher than that of the general California population.
Building workers and researchers are concerned the source of the problem may be the building’s elevators.
This is a source of illness that is still "under the radar" (pardon the pun) in the U.S. Europe is taking it much more seriously. I think it is significant and helpful that the demonstrations are taking place at UCSD, an institution that prides itself on academic excellence and scientific rigor, and that UCSD's own epidemiologist authored and signed off on the study.
(For more information about my practice, please click here.)
Sunday, March 1, 2009
Acupuncture effective for migraine prophylaxis
The same authors as in my previous post also did a survey of the literature for migraine prophylaxis.
MAIN RESULTS: Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment.
The authors conclude that available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001218
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR.
So, of course I'm biased because of my practice experience, but it seems to me that with the potential dangers of any medication, and the derivative benefits of acupuncture, the use of acupuncture treatment becomes more and more cost effective.
(For more information about my practice, please click here.)
MAIN RESULTS: Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment.
The authors conclude that available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001218
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR.
So, of course I'm biased because of my practice experience, but it seems to me that with the potential dangers of any medication, and the derivative benefits of acupuncture, the use of acupuncture treatment becomes more and more cost effective.
(For more information about my practice, please click here.)
Acupuncture effective for tension-type headache
Yet another study, this time from Germany, shows that acupuncture is more effective than routine care for headaches, this time for tension headaches specifically. This is another study looks at studies already performed and compiles the data. Two large trials compared acupuncture to treatment of acute headaches or routine care only. Both found statistically significant and clinically relevant short-term (up to 3 months) benefits of acupuncture over control for response, number of headache days and pain intensity. There were other studies included also.
"AUTHORS' CONCLUSIONS: In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches."
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007587 Linde K, Allais G, Brinkhaus B,Manheimer E, Vickers A, White AR.
(For more information about my practice, please click here.)
"AUTHORS' CONCLUSIONS: In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches."
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007587 Linde K, Allais G, Brinkhaus B,Manheimer E, Vickers A, White AR.
(For more information about my practice, please click here.)
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