Recently I was challenged by the idea that health care competition was limited to standard, state sponsored conventional medical care, but additional fields such as homeopathy and chiropractic were excluded. Such competition allegedly unfairly limits the choices to the public. However, to reach accurate conclusions, some historical facts are required:
Before the Nineteenth Century, health care was provided through various unproven methods that included a series of “cults,” such as homeopathy, allopathy, osteopathy, chiropractic, and several others. Causes of maladies were poorly understood, and the proposed “treatments” were not only ineffective, but often lethal, as exemplified by the widely used practice of bloodletting for a variety of conditions. To provide proof of benefit, these methods were not subjected to contemporary scientific proof as provided now by microbiological analysis, statistical population studies, controlled interventional evaluations of efficacy and toxicity, and many others.
Beginning in the early 1900s, scientific methods were developed and applied to diagnosis and care, and this resulted in the emergence of what was originally labeled “allopathy” into modern medicine. A study released by the World Health Organization (WHO) in 2001 designated allopathic medicine as “the broad category of medical practice that is sometimes called Western medicine, biomedicine, evidence-basedmedicine, or modern medicine.” Qualifying for these methods then required trainees to be educated rigorously in state-sponsored and other accredited, scientifically grounded medical schools, following which MD degrees were awarded. Graduates are now subjected to state-sponsored examinations that would allow them to practice modern, conventional medicine. Further specialization is conducted by the various specialty groups such as general medicine, American Academy of Family Physicians (AAFP), the American College of Surgeons (FACS), and many others. In recent years, osteopathy, which was originally a cult focused on bone and joint disorders, has now joined modernity, and is currently training students in the same standard scientific disciplines that include the various same subspecialities. Graduates are now certified as Doctor of Osteopathic Medicine (DOs) and are fully licensed to practice the full scope of medicine and surgery in all 50 U.S. states and the District of Columbia.
But the similarity ends at this point. Other fields now generally fall under the category of “alternative” medicine, and they include unconventional methods rather than contemporary modern, science-based ones. As such, they are not subject to the currently rigorous scientific standards of proof. Among others, categories include homeopathy, chiropractic, naturopathy, herbal remedies, diet-based therapies, traditional Chinese Medicine (TCM), reflexology, and many others.
Since it is widely available through many local promotions, chiropractic treatment requires separate attention. Although not recognized as a conventional scientific discipline, this field has reached limited — but inexplicable — acceptance by Medicare, in which Part B covers certain “medically necessary” chiropractic services, limited to manual manipulation of the spine to correct a subluxation (misalignment) of this structure, but it generally does not cover other non-spinal conditions or services ordered by a chiropractor, such as X-rays or laboratory tests. Private insurers also generally provide similar coverage of this field, varying by insurer and state location. With regard to methods of manually treating spinal disorders, there is no convincing evidence that chiropractic is superior to standard physical therapy as employed by conventional general and hospital medical facilities.
So, these are the various health care methods facing the public. My advice is, before opting for any of these alternative choices, first consult with one’s own physician (MD or DO)!
Fort Myers resident Morton Tavel, MD, FACP, is Clinical Professor Emeritus, Indiana University School of Medicine.
This article originally appeared on Fort Myers News-Press: Understanding competing fields for obtaining health care | Opinion
Reporting by Morton Tavel MD / Fort Myers News-Press
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