The phrase “evidence-based medicine” is pervasive in health care now. As the phrase becomes more and more common, there seems to be a growing chasm between those that utilize the scientific method, and those that don’t. It’s creating a rather intriguing problem for patients and practitioners.
In one corner, we have those that are utilizing evidence-based strategies in the care of the patient. Using the scientific method doesn’t eliminate what many call “the art of health care”. The clinician still has to have clinical reasoning skills (which are deeply rooted in the scientific method) and the ability to use their communication skills effectively to establish rapport with the patient.
In the other corner, we have the “gurus”. These are the people that will tell fellow providers that science has yet to explain what they do and besides, it doesn’t matter anyways. Experience is critical, and there are plenty of stunning anecdotal results that make it all the more obvious. The “gurus” are the ones armed with methods that have minimal scientific plausibility as a foundation. And when speaking to other practitioners eager to learn their “methods”, they will be the same people that will proclaim that one could be so lucky to attain their level of understanding, unless of course you want to take their 3 week course and pay a few thousand dollars to do so.
And though we might have once thought that the gurus were exclusively found amongst practitioners of “complementary and alternative medicine”, they are now rampant amongst “mainstream” health care providers (such as physicians and physical therapists).
But here’s the problem: you can’t live in a world in which you selectively choose when you want to live with evidence and science, and when you don’t. You cannot ride the coat tails of science while advocating for the cult of personality, mysticism, or the power of the placebo.
So do I need evidence? And why does it matter anyways?
The question has reared it’s ugly head once again: has Lance Armstrong been cheating all these years? Floyd Landis is the latest in a long line of people to point the finger at him. But before you even think of passing judgment, there are some rather important pieces of this puzzle that lend a great deal of context to what is becoming a made-for-TV-reality-show.Or a circus.Or both.
I’ll be the first to profess openly that I am a fan of cycling. I was introduced to it in my youth, and watching the Tour de France on TV has been an annual extravaganza that closely resembles March Madness in it’s ability to draw my attention. So it’s safe to say that I come into this discussion with a love of cycling.
I think it’s also safe to say that when discussing the issue of doping in cycling (or any other sport), we need to consider the context of the debate, the personalities involved, and the motives underlying the debate. We need to utilize the sports sciences research, and we need to examine our own belief systems. More on that later.
But back to Lance Armstrong. Over the years, Armstrong has faced accusations from a number of people that have been close to him in the cycling community.The most recent, Landis, has a rather intriguing and perhaps sordid tale. Here’s the storyline:
For those who have forgotten, while using his pointer and hand-held charts, he resolutely stated that “In America, we have a problem”. He may not have been talking about health care specifically, but he certainly could have been.
Consumers have somehow been lead down the garden path in the discussion of quality, cost, and access in health care (including allied health professions such as physical therapy, chiropractic, and alternative therapies). In any business realm that we can think of, our task is to find the greatest quality of product or service at either an affordable price, or a price that we feel is directly related to the quality of the service. But in health care, the system is currently driven by some very anti-consumer principles.
As Dick Cavett once noted, "As long as people will accept crap, it will be financially profitable to dispense it". Health care is no different. So what are the underlying mechanisms and motivators that are currently working against the health care consumer?
I have spent most of my career working with athletes, be they recreational or elite. They have run the gamut from endurance sports to power sports, and all points in between. Over 12 years ago, I completed the highest level of training in the McKenzie Method. Since then, I have been one of the few practitioners worldwide that has been actively applying this approach to a sports population.
With all of the approaches to care available, especially with athletes, why head down this path?
First of all, the McKenzie Method has a very intuitive “fit” with an athletic population. First and foremost, the active populace is typically in the “mind set” of self-treatment and training. Athletes, be they recreational or elite, seek treatment methods that are active and patient-centered. These patients are highly responsive to such measures and typically prefer approaches that facilitate “empowerment” and self-treatment.
The McKenzie Method also provides a great screening process – to understand the mechanical loading strategies, directional preference, and thus safe aspects of training that can be resumed early on in the injury recovery process.
The sports medicine world is traditionally very “pathology-driven”, so my first forays with McKenzie into this world were like speaking a foreign language.
Six months from now, we’ll be reflecting back on the landmark passage of HR 3590, the Patient Protection and Affordable Care Act.
Six months from now, the average American will have a much better understanding of the truth behind the bill. For your reading pleasure, you can refer to the actual bill language here or review a summary in plain English here or some bottom-line issues here.
Six months from now, with any luck whatsoever, the vitriol and misinformation will have died down. Even from the Tea Partiers – maybe.
Six months from now, the bill will slowly be phasing in.
And you know what? I suspect that that same average American is going to start to say “hey, this health care reform thing isn’t really a bad idea after all”. We’re already seeing a shift in public opinion. In a poll conducted by USA Today within days of the vote, 49% of Americans stated that the health care reform bill was a “good thing” and were “enthusiastic” and “pleased” with it. Four of seven major polls showed an increase in the numbers favoring the health care reform. The Kaiser Family Foundation’s latest poll found that 28 percent of respondents were now ‘strong’ supporters, up from 19 percent in January. And that was within days of the greatest attempts put forward to kill the bill.
I think that trend will continue once people fully realize what this bill means to them, and not what it means to the special interests.
Imagine this – even the stakeholders are supporting it. [insert sarcasm here] What? How could that be? It’s evil incarnate, isn’t it? Armageddon. Blasphemy!
And the political intrigue has only just begun. November is election time. What say ye, oh American voter?
Thinking and legislating. You would have to start to wonder if these were just two divergent ends of the same political spectrum. No, really, you can think and be a legislator at the same time - unless someone is in your pocket. Some fat cat special interest. Then it’s really tough to maintain your focus on reason with someone groveling around in your trousers. But I digress. More on that later.
The United States has recently joined the rest of the world’s industrialized nations in addressing the issue of health care reform. A little slow to the party perhaps, but still there nonetheless. There are now signs that efforts are actually being made to resolve a problem that is spiraling out of control.
It hasn’t been without it’s share of spewing of vitriol, hate and fear. In the lead-up to voting, you heard plenty of misinformation. It went well beyond the bill itself. You had conservative pundits and talking heads making statements about the demise of democracy. You might have even heard mention of the impending onset of Communism and, yes, even Armageddon. Hysteria. Fear. Chicken Little was actually making a 21st century appearance of sorts.
But it gets even more humorous.
If you want a fine example of where this country’s health care system is headed without reform, just take a look deep in the heart of Texas. It’s not a very rosy future. As I have mentioned many times before, the key elements to the discussion focus on cost, quality, and access – all issues of significant importance to Texans.
Let’s start off with some terrifying numbers. Consider this: 25% of the population of Texas are uninsured. Nationally, 20% of all Americans under the age of 65 are uninsured. As they say, everything is bigger in Texas. Ah but it gets better. The Austin American-Statesman has recently reported that 500,000 state workers – those with some of the best healthcare benefits in the state – are facing a $143 million deficit in their health care fund. That amounts to a budget increase of 14% over the next year. By 2015, the plan that provides health insurance for 193,000 retired public school employees will be insolvent. This all amounts to increases in premiums and greater out-of-pocket expenses for state workers. And when state workers are impacted (those that already have good health insurance coverage), what happens to those that have lousy or no coverage at all?
Along similar lines, Texas and California have the highest healthcare costs in the nation. In Texas, you might even be one of the 3.4 million people that forego treatment because they can’t cover the cost of care. This is second only to California, at 3.6 million.
Thus far, coverage is shrinking and costs are rising. That’s not a very healthy outlook. But, again, it gets worse.
Allan Besselink, PT, DPT, Ph.D., Dip.MDT has a unique voice in the world of sports, education, and health care. Read more about Allan here.