Provider Nondiscrimination Update

My editorial on the Affordable Care Act’s section that prohibits insurance companies from discriminating against classes of health care providers is now posted at Health Insights Today.

When fully implemented, this federal nondiscrimination policy will for the first time forbid any American health insurance company from refusing to cover services legally provided by a class of licensed health care practitioners (e.g., chiropractors, acupuncturists or clinical social workers) acting within the scope of their state licenses, if it covers those services when provided by a different class of practitioners (e.g., medical or osteopathic physicians). While the Affordable Care Act does not mandate equal payment for equal work (i.e., paying a chiropractor providing a service the same rate as an MD providing the same service), friend and foe alike understand that Section 2706 would make it illegal for insurers to cover any health service for one class of providers licensed to perform it while rejecting coverage for another also licensed to do so. (This nondiscrimination policy does not apply to the two largest government insurance plans—Medicare, which offers partial chiropractic coverage nationwide, and Medicaid, where coverage varies from state to state.)

This part of  the law goes into effect on January 1, 2014. Because it applies to all services that a practitioner is licensed to provide under state law, the implications are quite broad. I’ll be writing more about this in the near future, and presenting on the prevention and health promotion part of this equation at the March ACC-RAC conference in Washington, DC. (ACC-RAC is the annual Association of Chiropractic Colleges Research Agenda Conference).

Medical Doctors Teaching Nutrition

Hopefully this is a sign of good things to come.

David Eisenberg, MD, is director of the complementary and alternative medicine program at Harvard Medical School and a long-time leader in the field.

From the Well Blog at the New York Times:

This isn’t neurosurgery,” Dr. Eisenberg said as he whacked a garlic clove with the cleaver. “This is hearty, affordable, cravenly delicious food.”

The son of a Brooklyn baker, Dr. Eisenberg is the founder and chief officiant of “Healthy Kitchens/Healthy Lives,” an “‘interfaith marriage,” as he calls it, among physicians, public health researchers and distinguished chefs that seeks to tear down the firewall between “healthy” and “ crave-able” cuisine. Although physicians are on the front lines of the nation’s diabetes and obesity crises, many graduate from medical school with little knowledge of nutrition, let alone cooking….

To Dr. Eisenberg, flavor is a health issue. Now in its eighth year, the sold-out event is in the vanguard of a major shift in attitude among a young generation of medical professionals who grew up with farmers’ markets. Their ranks include students at the Baylor College of Medicine in Houston, who have hired a chef to teach cooking skills, and a doctor in suburban Chicago who was so inspired by “Healthy Kitchens/Healthy Lives” that he went home and installed a demonstration kitchen in his medical office.

 

 

 

Congressman Tim Ryan on Mindfulness Meditation

An excellent story from the Washington Post.

In “A Mindful Nation,” published last week, Ryan details his travels across the country, to schools and companies and research facilities, documenting how mindfulness is relieving stress, improving performance and showing potential to reduce health-care costs. It is a prescription, he says, that can help the nation better deal with the constant barrage of information that the Internet age delivers.

“I think when you realize that U.S. Marines are using this that it’s already in the mainstream of our culture,” he says. “It’s a real technique that has real usefulness that has been scientifically documented. . . . Why wouldn’t we have this as part of our health-care program to prevent high levels of stress that cause heart disease and ulcers and Type 2 diabetes and everything else?”

The whole article is well worth reading.

h/t The Schwartz Report 

 

 

 

Homebirth Midwives: Better Outcomes, Moving Toward Broader Acceptance

From John Weeks in the Huffington Post, positive news from out west:

“Midwives have a central focus in our strategic plan. We are hoping Washington State can double out-of-facility births in the next two or three years.”

The speaker was Jeff Thompson, M.D., MPH, chief medical officer of the state of Washington’s Medicaid program. He spoke in a taped interview for Symposium 2012 — Certified Professional Midwives and Midwifery Educators: Contributing to a New Era in Maternity Care. The gathering took place at Warrenton, Va.’s Airlie Center on March 18, 2012.

Thompson, a member of the National Advisory Council for Healthcare Research and Quality, works in the state with the most evidence-based exploration of the value and risks associated with direct-entry, licensed, non-nurse, midwives. His state’s heightened interest began with a state requirement in 1996 that health plans cover midwives. Washington, like 11 other states, presently also covers midwives via Medicaid.

If the certified professional midwives (CPMs) get their way in Congress, CPM services will be reimbursed by Medicaid in all 26 states where CPMs are licensed. Passage would significantly expand access to low-income women across the country. The Access to Certified Professional Midwives Act was introduced in the U.S. House of Representatives in 2011 by Congresswoman Chellie Pingree (D-ME). Passage would energize a slight bump in home births captured in recent data from the Centers for Disease Control.

Why Adjust the Dosage on a Useless Drug?

Merrill Goozner is among our nation’s best health policy reporters. His concern about this FDA decision is one that makes a great deal of sense.

Professors Lisa Schwartz and Steven Woloshin of the Center for Medicine and the Media at The Dartmouth Institute for Health Policy and Clinical Practice are raising alarms about a recent Food and Drug Administration decision to approve a new dosage for the  best-selling Alzheimer’s drug Aricept (donepezil). The decision “breached the FDA’s own regulatory standard” and has led to “incomplete and distorted messages” about the drug, they warned in the latest British Medical Journal.

Aricept has become a $2 billion-a-year blockbuster in large part because people caring for elderly patients with dementia are desperate for something, anything to slow their loved ones’ inexorable decline. The original dose for the drug, which was approved in 1996, provided a short-term improvement in memory that faded to insignificance within six months. With its patent due to expire, the companies behind the drug — Eisai and Pfizer — went to the FDA with a clinical trial in 1,400 patients claiming a higher dosage showed better results. The FDA agreed, which gave the companies another three years of marketing exclusivity based on a use patent for that new, higher dose.

Here’s the medical problem with that higher dosage, according to Schwartz and Woloshin. While the clinical trial showed that patients did slightly better in cognition (like recognizing numbers), the drug had no impact whatsoever on their actual functioning in day-to-day life, at least none that their caregivers could notice. Yet the major side effects of the drug — nausea and vomiting — increased significantly. The article claimed that the FDA had said specifically to the trial sponsors that the higher dose had to have an impact that caregivers could notice to win approval. Schwartz and Woloshin charged the FDA with violating its own standards.

White Rice Joins White Bread and Sugar in Increasing Diabetes Risk

Whole, unprocessed foods are best. This is just one example.

Because diabetes is intimately linked to heart disease, hypertension, and obesity (as part of the Metabolic Syndrome), this is really about far more than diabetes.

Patients who ate the greatest amounts of the grain had a 27% greater risk of developing the disease than those who ate the least, and the relative risk was higher among Asian patients, Qi Sun, PhD, of Harvard, and colleagues, reported in BMJ.

“Although rice has been a staple food in Asian populations for thousands of years, this transition [to more sedentary lifestyles and greater availability of food] may render Asian populations more susceptible to the adverse effects of high intakes of white rice, as well as other sources of refined carbohydrates, such as pastries, white bread, and sugar sweetened beverages,” they wrote.

The glycemic index of white rice is higher than that of other whole grains, largely due to processing. It’s also the primary contributor to dietary glycemic load for populations that consume rice as a staple food, such as Asians.

My Full Interview with Harriet Washington Now Available in PDF

A PDF version of my Harriet Washington Interview with Harriet Washington is now available. This was previously posted in four parts. Her book, Deadly Monopolies, is a powerful and thorough indictment of corporate greed and overreach, particularly as this affects our health, well-being and personal autonomy.

Thanks to my wife Beth Lily Redwood for the graphic design.