Friday, June 25, 2010

Professional Integrity for Sale? “Sure,” Says Medscape!

Some chiropractors also practice homeopathy. According to Frank King, D.C., many more should be doing just that:

Homeopathy is an energetic form of natural medicine that corrects nerve interferences, absent nerve reflexes, and pathological nerve response patterns that the chiropractic adjustment alone does not correct. The appropriate homeopathic remedies will eliminate aberrant nerve reflexes and pathological nerve responses which cause recurrent subluxation complexes.

Not only does homeopathy correct nerve interferences, it empowers the doctor of chiropractic to reach the entire nervous system. What this means is that we can now better affect the whole person, and all of the maladies that affect us. Homeopathy’s energetic approach reaches deep within the nervous system, correcting nerve interferences where the hands of chiropractic alone cannot reach. Homeopathy is the missing link that enables the chiropractor to truly affect the whole nervous system!

But that’s not all:

Financial Rewards

Homeopathy means a multiple increase in business. Personally, I have been able to see and effectively help more patients in less time. The additional cash flow from broadening your scope of practice, increasing your patient volume and selling the homeopathic remedies is a wonderful adjunct. Better yet are the secondary financial benefits:

  • Homeopathy is like an extension of you that the patient can take with them to apply throughout each day in between visits. The actual therapeutic benefits of homeopathy along with the inner comforts of the patient as they connect you with each dose they take.
  • The dynamic broadening of your effective scope of practice multiplies the number of patients you can help and the multiple problems that each patient usually has. As you correct one set of problems, there are commonly other problems most patients don’t even tell their chiropractors. This doesn’t have to be the case anymore. Homeopathy empowers the chiropractor to correct conditions ranging from allergies to warts with incredible effectiveness!
  • Obviously, the rule of multiples will exponentially increase when a homeopathic procedure is properly implemented into your practice. Many of the conditions people are suffering with have no viable solution without the dynamic duo of chiropractic and homeopathy.
You can be the doctor people will seek out, travel long distances to see, and pay cash for your valuable services. Take it from someone who has experienced it first hand, it’s a great position to be in.

This is no surprise. Most chiropractors relinquished whatever ethical integrity they might have had when they bought into the “subluxation” myth, and the field as a whole has a fine tradition of “practice building.”

Naturopaths, likewise, don’t mind winking at practice ethics in order to make an extra buck. Nor do MD quacks, of course. Hey, it’s getting harder and harder to make a living just by slogging through the morass of needy patients, onerous third-party billing requirements, diminishing payments, increasingly cumbersome practice guidelines, next-to-impossible-to-keep-up-with (nothing to say of tedious and technical!) medical literature, and all the rest. Why not sprinkle your practice with a little ‘diagnostic’ sugar that will appease those clingy patients—for a while, anyway—and that you won’t have to find billing codes for (because there aren’t any)? Heck, why not check out this offering from “bio-pro, inc. Amazing Anti-Aging Solutions (Healthier Patients, More Patients)”:


The “must do” seminars for those who own or are managing a Complimentary [sic]Medicine Practice.

Three day course teaches you:

How to relate to the patient, evaluate, test and diagnose

How to use solutions, mixtures, methods, supplies and equipment

How to protocol administration for Chelation, Oxidation, Chelox, TriOx, Ascorbates, UVBI

How to design and organize your office

How to hire and fire staff and to computerize

How to use public relations and marketing

How to manage compliance with Medicare, State Medical Boards and governmental regulatory agencies

Manuals included…

Each attendee receives one set of training materials, including:

Protocol Manual

Physicians Manual

Office Procedure Manual

Forms Book

Marketing Manual

Patient Results Manual

Employee Manual

Audio tapes

and other related material.

Bio-pro was founded in 1978 by the late Charles H. Farr, MD, PhD, the self-styled “father of oxidative medicine,” who was also a founder of the American College for Advancement in Medicine, the Mother of All Pseudomedical Pseudoprofessional Organizations (PPO). But none of this is surprising, right? After all, quacks quack.

What may have come as a surprise to beleaguered physicians who still play by the rules was this offering, just a few days ago, from Medscape Business of Medicine:

Six Ways to Earn Extra Income From Medical

You’re chasing after claims but watching reimbursement sink.

It’s a common story, and primary care doctors and even specialists are keeping their ears to the ground for other ways to boost their bottom line. Luckily, doctors have some fairly lucrative options that can help them maintain their income — and perhaps even increase it.

We looked at 6 avenues that physicians have taken to earn extra revenue. None of these activities require a tremendous amount of time. Participating in just 1 or 2 activities can put enough money in your pocket to allow you to breathe a little easier when the bills come in.

So what are those ‘6 avenues’? Let’s see:

  • Work with Attorneys
  • See Nursing Home Patients
  • Serve as a Medical Director

So far, so not necessarily bad…

  • Team Up with Pharmaceutical Companies

What??! Team up with pharmaceutical companies? Couldn’t that mean, like, just doing legitimate research and trying like hell to do it right? Uh, nope:

Drug and device companies spend billions of dollars each year to discover and promote new medicines and treatments, and they rely heavily on doctors to participate in these endeavors whether through clinical trials or serving as a speaker or consultant. It’s not uncommon for physicians to earn a minimum of 5 figures a year either speaking or doing clinical studies within their medical practice. Some doctors make in excess of $100,000 annually — on top of their income from seeing patients.

O’course, you gotta watch out for those pesky ethics killjoys, warns Medscape:

Although some extra money is nice, too much can turn heads — and not in a good way. In late January, The Boston Globe reported on an allergy and asthma specialist who was issued an ultimatum by his hospital, the prestigious Brigham and Women’s Hospital (Boston, Massachusetts): Stop moonlighting on behalf of pharmaceutical companies or resign from your staff position.

What it all comes down to is this:

Pros: With typical payments running about $1500-$2500 for a single talk, there’s substantial opportunity to supplement your regular income…

Cons: These arrangements are coming under increasing scrutiny from hospitals, legislators, regulators, and the media. In fact, some of the doctors whom we contacted for this article declined to talk about their involvement with drug companies.

Uh, no kiddin’. Funny that the “increasing scrutiny” doesn’t seem to come from organized medicine, medical schools, mainstream medical journals, state medical boards, or doctors in general. A couple of years ago I lamented the publication of a couple of book reviews, in the lofty New England Journal of Medicine, that celebrated trendy pseudomedicine. Shortly thereafter I received this from an emeritus editor:

I think the incursion into the bastions of medicine has to do with the fact that everything nowadays—absolutely everything—has become a market. If quackery appeals to the readers of the NEJM, it will be there. ”Is it true?” is no longer the question anyone asks, but “Will it sell?” And I think that applies to the editors of most major journals, as well.

True, dat. As for Medscape, this isn’t its first ethical gaff, and I agree with Bernard Carroll that it seems to have “a right hand – left hand problem.”

Oh yeah: what were the other 2 “avenues”? Those would be:

  • Become a Media Personality
  • Consult for Wall Street


james gaulte said...

It has gotten to the point where nothing surprises me anymore.It is definitely not your father's medical ethics anymore.The Medscape list ranges from the unethical to the absurd.

Anonymous said...


But wait, there is more!

This sound like a very bad commercial, one thing I am sure everyone forgets is the company selling all of this material is not actually in the business of providing the service. They provide the material so that you can provide the service.

I have been following a thread on another blog that asked the question: Do doctors game the system?

The answer is No, but, and there is always a but. Listed as not gaming the system was:

• Opening an in house lab.

• Investing in a stand alone testing facility so as to avoid self-referral issues.

• Limiting patients to two medical issues per visit.

• New medical issues must accompany a physical.

• Moving from a 90 day patient cycle, four times a year, to a 70 day patient cycle, five times a year.

Other post has commented on doctors who see 50 patients a day.

What this creates is an environment where “everyone is doing it” and “I deserve more.” The problem becomes: Where does the patient stand? We are regulated to the position of being an ATM kicking out money for co-pays and insurance payments.

These doctors are not terrible people, but when the practice of medicine becomes the business of medicine, doctors need to reveal their conflicts and inform their patients they no longer represent their best interest. Doctors then represent the best interest of the practice.

Steve Lucas

Joseph P. Arpaia, MD said...

I have to strongly disagree with what I perceive to be an unhelpful and superior tone toward chiropractors and naturopaths in the first part of the post.

I think this damages your argument in two ways. First, it misses an important point about chiropractors and homeopaths, and by missing that point it then criticizes the Medscape advice from an incorrect perspective.

My understanding is that most patients who see chiropractors have at least average intelligence. They are also paying a significant amount out of pocket for those services, often more so than they would be willing to pay their allopathic MD for a visit. This leads to the conclusion that the people perceive the treatment as helpful; they feel better.

The argument that double-blind studies show chiropractic and homeopathy to be no better than placebo is scientifically irrelevant, because the patient is not in a double-blind study. They are receiving the treatment in a different context, and that context changes the physiologic effect of the treatment.

This suggests that we should look at the context in which the treatment is provided as the source of the perceived effect, rather than the treatment itself (which I agree is inherently useless).

The successful chiropractors I know come across as wise, nurturing people who really have their patients' well-being at heart and are willing to go the extra mile to find something that will benefit their patients.

This perception has a powerful and beneficial effect on the patient. It doesn't matter if the chiropractor is really like that. The patient's perception is their reality.

Now most of the conditions patients go to chiropractors for are conditions which respond well to limited care and lots of reassurance. (No one goes to a chiropractor for acute abdominal pain.) Back pain is a great example. Anti-inflammmatories, gentle activity, specific exercises, and lots of time are far better than invasive treatments. So the chiropractor satisfies that part of the patient which is terrified and needs something to be done, and does so by avoiding anything harmful. The perceived atmosphere of caring reassures the patient and may even augment their self-healing processes. This is not a trivial effect.

I think this perceived atmosphere of caring is very important because many of my patients tell me they get the opposite perception in their allopathic physician's office especially when their physician is part of a corporation. The perception they get, rightly or wrongly, is that the company is much more interested in their money than their health and this has a detrimental effect on the therapeutic relationship.

I've lost count of how many patients have complained to me that their doctor's office dropped them because they lost their insurance coverage, refused to see them because they were behind on co-pays, or sent them to a collection agency. (I'm in solo practice because I refuse to treat human beings like that and in solo practice I make my own rules.) They often realize that its not their doctors fault, but it ruins the relationship.

How does this relate to the Medscape advice? In general their suggestions are not going to cause their patients to perceive them as more caring. In fact, some of those suggestions might lead patients to see the physician as more distant and less interested in them as people.

So, the advice to the chiropractors will make them appear as more caring and more interested in their patients, and the Medscape advice will make the physicians appear less caring and less interested in their patients.

This is the problem. The "complementary" practitioners appear more and more caring and the allopathic practitioners appear less and less caring. I think most physicians do care, but the system we work in is suffocating us in that regard.

I apologize for the long-winded post.


Anonymous said...

Not to mention Medscape's recent suggestion that physicians participate in office-based clinical trials. Not that this is bad, but they led with a headline something like "how to make more money by participating in clinical trials." Now if that's the doc's primary motivation, how careful and thorough do you think s/he's going to be?
I am becoming disgusted with Medscape.

bev M.D.

Anonymous said...

Oh, and I forgot to mention the link to the dangers of profit-minded clinical trials on Paul Levy's blog:

bev M.D.

Kimball Atwood, MD said...

@ Joseph Arpaia:

You make several points; I'll try to respond to some of them.

First, you are certainly correct that many people who go to chiropractors or other 'healers' perceive the treatments as helpful. This has been true throughout history, no matter whether the treatments have been 'gentle' or toxic. It continues to be true whether or not the person is in a double-blind study, which is why such studies ideally have placebo arms (and why such studies exist).

Yes, seeing a chiropractor in the usual context is different from seeing one in an RCT, but does that that context "change the physiologic effect of the treatment"? How can you know that? How would you even find out? An RCT, perhaps? (Oops)

Your description of chiropractors as "wise, nurturing people" is curious. You write that "it doesn't matter if they are really like that," as long as patients think that they are, but you also write that their treatments are "inherently useless." Does that mean that you approve of quackery? Is it OK only if the practitioner believes in it, or need he merely be a good actor? If the former, would it be OK for Benjamin Rush to materialize in the here and now and begin a neo-popularization of bleeding, purging, and scalding? (Heck, Harkin and Burton would probably insist that those be 'validated' by the NCCAM!).

If the latter, should MDs strive to become the slick salesmen that chiropractors are?

Hey, I'm giving you a verbal jab in the ribs, because I don't really believe that you are advocating those things; but there are some fairly well-settled medical practice ethics that bear on the topic. Look here for a summary:

I and everyone else in medicine agrees with you about how difficult it is to give adequate time and attention to patients in this era of third-party payers, but that is a separate issue from whether quackery is acceptable.

No more time now, but lemme try to put a couple of bees in your bonnet:

Yes, most people who go to chiros do so for back pain, but most chiros claim that they can do much more. They don't always "avoid something harmful," either (which reminds me: how can you be sure that chiropractic reduces the number of unnecessary invasive back procedures?). Look at some of the other chiro articles on Quackwatch. Consider vertebral artery lacerations in young, healthy people. And don't try the "medicine is more dangerous" ploy, because the whole deal is risk vs. benefit. For methods that are "inherently useless," any risk > 0 is unacceptable, no?

Another risk is that of being fleeced. Sometimes that is exactly why people claim to be pleased with quacky treatments: they don't wanna admit otherwise ("cognitive dissonance," for the snobs out there). For other alternatives to your "may even augment their self-healing processes" hypothesis about inert treatments (got any evidence?), look here:

There is no such thing as an "allopathic" physician.

Don't assume that the Benjamin Rush example is a stretch. Google "Indian Systems of Medicine" and check out "Unani."


Revenue Management said...

I hear many times that Homeopathic remedies are more effective or friendly to the patient but this is a long term process, but hear this first time that it is more helpful in collecting a large number of patients.

InformaticsMD said...

In my former capacity as Director of Occupational Medicine in a regional public transit agency and in a hospital, I came to see chiropractors as worker's comp fraud whores. Bus gets hit by moped, drive needs six months of chiropractic, and the chiropractors were all too happy to oblige.

The repeated back film series, exposing the young drivers' genitalia to several rads (grays these days I believe) of ionizing radiation were also quite profitable, ignoring the long term effects of searching for "subluxations."

-- SS

InformaticsMD said...

"Revenue management" wrote:

"I hear many times that Homeopathic remedies are more effective or friendly to the patient but this is a long term process"

The motto of homeopathy, whose remedies dissolve a molecule or two of chemical in liter of "medicine":

There's one born every minute.

-- SS