Alternatives...

On my earlier post on wellness and woo, Eliza R. Snitch left a question that I think deserves a serious answer:

Acupuncture worked for me to get rid of terrible back pain. I'm a fan of alternative treatments. I don't really care if it's placebo-- whatever works, right?

I want to keep everyone guessing, so I'm going to have to say that that's a fairly reasonable solution in this particular case. To find out why, read this article.

In a nutshell, chronic pain (and back pain in particular) is something that's not as well-understood as other conditions. Some research indicates that retraining your brain's pain response is as effective as surgery or more.

Unlike prescription pharmaceuticals, surgical procedures aren't required to pass clinical trials to demonstrate that they're more effective than placebos. (It's not clear that it would be possible or ethical to give your control group sham surgery.) And just because surgery is doing something real, it doesn't mean it's necessarily doing something useful or relevant to your condition. The article explains how it's possible for a surgical procedure to become popular and widespread without ever really being proven effective.

For chronic back pain -- between acupuncture and disc fusion surgery -- here's the score: Acupuncture may be pure placebo effect or perhaps there's something about poking the skin that affects the pain response -- but either way, it's not going to do you any real harm. Disc fusion surgery is also not really demonstrated to help, but it carries a real risk of doing serious, permanent damage. So if you have chronic back pain that resists treatment, and you've decided you're going to try either acupuncture or surgery, the acupuncture may be the better choice. Of course physical therapy is probably a better choice than either of those two.

That said, in general there are serious ethical concerns and dangers associated with promoting "alternative" treatments which are fundamentally bogus. For a simple explanation, see this cartoon about Homeopathy and my new Rational Moms post about placebos.

Wellness and woo

I've recently taken up Yoga, for a number of reasons. First and foremost, it's a type of exercise I enjoy. And it is exercise -- it's basically gymnastics for old people, with a lot of emphasis on flexibility and strength. Plus, it helps with stress relief -- and is probably more healthful that some other stress relief options. So, given the positives, I figure I can overlook it if the instructor occasionally explains things in terms of chakras.

But sometimes I wonder...

I first got the idea to try Yoga from a colleague who was always raving about it. This same guy was horrified by Sarah Palin's young-Earth-creationism and her general anti-science outlook. So I got the impression that Yoga and critical thinking are perfectly compatible. Enough of it is real to be worth the effort.

More recently, however, this same colleague was talking about how he's been taking his dog to get alternative-schedule homeopathic vaccines (instead of real vaccines). Fortunately he doesn't have any kids to endanger. (Actually, I'm a little surprised it's legal to license a dog without real rabies shots -- I know people have a lot of leeway for using faith-based treatments on their own offspring, but it's not quite the same for animals.)

Then, last week, I met a lady who is currently working on some sort of diploma in "wellness." She is an intelligent lady, interesting to talk to, speaks several languages, has had a successful career in finance, and wanted to switch to something else. The first part of the wellness program was an intensive course in different types of massage. She explained that she had to learn quite a lot of anatomy for the class, not to mention learning about a variety of health conditions which might make some types of massage risky for some clients.

Then she explained that the next course will be acupuncture and acupressure.

And part of me wanted to ask, "Um, you know that stuff isn't real, right?"

Yet somehow that didn't seem like an appropriate thing to say, under the circumstances. Even though it's theoretically a secular "alternative" treatment, it's a little like religion. It's like the time I ran into one of my friends at the bus stop and saw that she was sitting there reading the Bible. Obviously it would be impolite for me to say, "Um, you know that's all a bunch of hooey, right? Much of it rather offensive hooey..."

So what do you think I said to the lady who told me she's going to be studying acupuncture and acupressure? Can you guess?

Naturally, my pathological desire to fit in under any circumstances struck again. I told her all about how I'm taking Yoga.

The State of AIDS Today: Elizabeth Pisani's "The Wisdom of Whores"

A.I.D.S. has been with us for a couple of decades now, but how much do we know about it? Its story has unfolded through countless articles across space and time, making it a little hard to follow.

Enter Elizabeth Pisani, an epidemiologist (and excellent story-teller) who's been in the thick of the international fight against AIDS from its earliest days. In The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS, she gives the straight dope on what happened -- where, when, and why -- with a focus on using data and evidence to track how the virus is spread, and on how to use that knowledge effectively to stop it. She has no time for euphemisms. Both liberal hand-wringing about stigmatizing affected groups and conservative/puritanical fear of the realities of sex and drugs can be obstacles to solving the problem.

The central dilemma is whether or not to push the claim that everyone is at risk. Pisani argues (with some impressive evidence to back her up) that HIV doesn't spread efficiently enough to stray very far from the high-risk groups: sex workers, men who have sex with men, injecting drug users, and people in southern and eastern Africa. The problem is that when you admit that AIDS won't kill us all, it's harder to drum up the sympathy (hence funds) necessary to effectively fight it, but when you exaggerate the proportion of so-judged "innocent" victims, you wind up with funds that have strings attached -- strings which tie your hands away from doing the very things that have been shown to prevent the spread of HIV: getting clean needles to drug users (including in prison), and getting sex workers and Africans to use condoms.

Those Wacky Health Insurance Companies!

As soon as I got my first real job, I finally got to experience the wonder of having my own real health insurance benefits, not as a dependent.

Actually, I think I technically may have had health insurance as a grad student, but I never used it because I wasn't sure that it was a serious policy that actually covered anything. So as a grad student I had always just gone to the cheap student clinic on campus. I found the service there to be pretty good, but I can't really judge it because I was healthy the whole time and really only went there for contraceptives, which I understand usually tend to be the main specialty of a university campus clinic.

But once I had a real job working as a programmer for a real company, I had real health insurance!

Or at least I thought I did. And since I was still young and healthy, I didn't have much reason to test it out.

After almost a year of working as a C++ programmer, I decided I wanted to switch to Java, which was impossible in the job I was in (since the company didn't do any Java). And since I also didn't care for the hour-and-a-quarter-each-way-through-heavy-traffic commute, I decided to quit my job so that I could train myself to program in Java.

Since I was planning to be unemployed, I said to myself "What the hey, maybe I should go out and have a check-up first before joining the ranks of the uninsured."

This was a really stupid idea, and I'm only telling you about it so that you can learn from my foolish example.

The lesson to be learned is that the correct sequence is as follows: (1) Go to the doctor, (2) wait until you receive evidence that your insurance has paid the bills as they were supposed to, then (3) quit your job. Important: Do not invert these last two steps.

When the insurance company refused to pay the bill, I called up their customer service department and found that not only was I not currently insured according to their database, but in fact their records showed I had not been insured by them at all.

I had papers to show that I was indeed insured by them, but unfortunately such proof is irrelevant when complaints are apparently placed on automatic redirect to the circular file.

And here's where having quit my job became a problem. When I called the H.R. person at my old job, she assured me that she had all the paperwork necessary to show that the check-up should have been paid for by the insurance company, and told me she'd contact them and straighten it out. But obviously she didn't want to waste her day on hold with the insurance company any more than I did. So each call I had to make to "remind" her to help me when she didn't contact them was a bit uncomfortable since my former employer hadn't wanted me to quit my job in the first place.

So I mailed the bill back to my doctor explaining what the error was, and included copies of all of my insurance papers as evidence, and requested that his office redirect their billing inquiry to the insurance company. My considerate and understanding doctor responded by sicking a collection agency on me.

So I heard from the collection agency next without even a note from my doctor's office as to why the complaint in my letter was ignored, which was in my mind a rather humiliating example of adding insult to injury. The only bright side of it was the chuckle I got from the collection agency's return envelope, which in the return address area explicitly included a line for the victims to write down their telephone number. Ha ha! Does there really exist anyone on the planet dumb enough to fall for that?

I of course sent my whole packet of evidence and explanations to the collection agency, which of course they ignored. As if they want to waste their time on hold to my insurance company any more than the rest of us!

So what do you imagine I did?

I paid the bill out of my own pocket of course. The time and stress of worrying about it was more costly to me than the $100 or so requested on the bill. I would have continued pursuing it on principle if I'd thought my efforts were anywhere near as inconvenient for the insurance company as they were for me. But it turns out that sacking your customer relations department and replacing it with a perma-hold answering machine is a very cost-effective solution for them.

Two months later I got another job, closer to home and using Java this time. This new one also theoretically had health insurance, but I didn't dare find out. Kind of like the experience one gets from a "scared straight" program, I was "scared healthy." Any disease or injury I might seek out medical care for had to pass muster of being scarier than the collection agency. None were, so I mostly just relied on my trusty immune system.

My only other experience with American health care after that was when I brought my husband and kids to visit my folks. My toddler threw up, and my husband thought it would be prudent to take him to a pediatrician. Of course the receptionist at the pediatric clinic was terribly worried when she saw we had no U.S. medical insurance, and made us sign a paper that we would pay on the spot.

For a bunch of random tests and about two minutes of having a doctor look at our boy, it came to $400.

Then the punch line is that after we paid this in person, two days later the clinic sent a new bill to pay the amount again for the same services! Fortunately I had saved the receipt that showed I'd paid, and mailed a copy of it to them. If the clinic went on to hire a collection agency at that point, I don't know about it since I went pack to France and my parents haven't forwarded me any mail to that effect.

This episode was a bit of a shock to our French sensibilities, being accustomed to having a real doctor come to our house and give a kid a proper exam for closer to $40 (which is paid anyway by some combination of our insurance or the state).

When I was a kid, I'd occasionally hear jokes about "house calls" and how doctors don't make them. I always wondered why this was even a joke since of course doctors don't make house calls. Duh!

Interestingly, in France they do.

Actually, I have to be honest here. Aside from that one dentist (see last week's column), I haven't had any complaints about the health care here in France. Both of my sons were born in a state-of-the-art facility, with tons of top-notch prenatal and follow-up care. And all of it without having the positive health benefits cancelled out by a sticker-shock-induced stroke.

You'll probably say "Well, sure the French can handle routine procedures like births, but if something really bad happened to you, you'd wish you were back in the US!" I can't really answer that charge either way since fortunately nothing really bad has happened to me.

Plus you might point out that I'm paying for it anyway, just through taxes. I can't really comment on that one either since my husband does my taxes. I know I'm being a bad feminist to allow that, but I guess my feminist spirit doesn't extend to the point of jumping up to volunteer to do some annoying paperwork when it looks like somebody else might do it instead.

That's just one person's experience though, so take it however you like.


Published in the Utah Valley Monitor January 19, 2006.

Adventures in Dental Care: French dentists put me at a floss for words

My first trip to the dentist after moving to France was kind of a rude awakening. To protect the dentist's identity, for this column let's just call her "Dr. Dominatrix."

As soon as I arrived in her office, Dr. Dominatrix immediately noticed that I was pregnant (at the time -- not now, thank heavens!) and started telling me all about how she was serving on a committee to give pregnancy-nutrition recommendations. Then, without the slightest encouragement, she launched into a whole elaborate lecture about how pregnant women should not drink skim milk. Her reasoning was essentially that skim milk tastes yucky, so either you won't drink enough or you'll compensate with unhealthy things.

I was listening and nodding with a blank smile on my face, but my tiny brain was saying "Um, I came here to see a dentist. Are you a dentist or what?"

And since I really wasn't in the mood to explain and debate my own equal-and-opposite wacky theory about how pregnant women should drink at least one full liter of skim milk per day, that was strike one in my mind against Dr. Dominatrix.

Then she determined that it was necessary to install some sort of crown-like thing on one of my teeth. Unfortunately, she put it on in such a way that the new piece (and/or the cement to attach it) extended past the relevant tooth and was actually touching the adjacent tooth.

During the follow-up visit, I pointed this problem out and mentioned that I could no longer pass dental floss between the two teeth. Dr. Dominatrix responded with shock and horror:

"Who told you to floss your teeth?!" she asked (in French). She then explained that you should never floss your teeth because flossing can hurt your gums.

She was probably right that it is possible to hurt your gums by flossing if you do it very badly. But it's not like it's rocket science. I like to imagine that if I haven't mastered the basics of flossing safety yet, I could theoretically be trained to do it.

That was strike two against Dr. Dominatrix.

Strike three was more of a general complaint about her bedside manner. I'm not going to say that she seemed indifferent to the possibility that some procedures she performed might cause pain. I think it would be more accurate to say she seemed annoyed by her patient's pain reaction.

The odd thing was that she was a real Americophile, if such a word exists. It should exist, because it's surprisingly common among the French -- contrary to the popular stereotype of French people snootily looking down their noses at Americans. During every single visit she would tell me stories of all of the conferences she'd attended in the U.S. and the latest dental technology she'd learned there. It just kind of amazed me that in all of these conferences she'd never picked up on this exciting American innovation involving the use of dental floss.

After a few years of being treated by Dr. Dominatrix, I finally broke down and decided that I was just going to go to a different dentist. In France you can just do that with no restrictions. Crazy, huh?

I suggested it to my husband as well, but oddly he opted to continue with Dr. Dominatrix. If this means there's something he's not telling me, I'm not sure I really want to know.

For myself I picked a new dentist using the same scientific criterion as I had used to pick my first one, namely proximity to where I live. Since I had moved since choosing my earlier dentist, this algorithm yielded a different result this time.

I am happy to report that I didn't have any problems with my new dentist, whom -- again to protect his identity -- I will call "Dr. Kindly-Gent." I made sure to ask him up front whether he was for or against flossing, and I was relieved to hear that he was in favor of it.

I don't want to give the misimpression here that I'm some sort of flossing fanatic or something. It's just that it was so weird. It would be like if I went to a cardiologist who recommended that I take up smoking and eat more potato chips or something -- I would get this vague sense that there's something not quite right here.

Also, I don't think the typical American necessarily flosses regularly. It's just that if you go six months without flossing between checkups, an American dentist will at least have the decency to lay a major guilt trip on you about it.

Actually it surprised me when I discovered that various French boyfriends seemed unacquainted with the practice of flossing, and even Dr. Kindly-Gent seemed kind of indifferent toward it. It made me wonder why it caught on in the U.S. and not so much in (parts of?) Europe.

I figure it's probably just one of those things, like the fact that it somehow became popular to routinely circumcise all baby boys in the U.S., which I've found they don't do outside of a religious context in Europe. That conclusion didn't stop me from coming up with a theory about it though. Like most of my theories, this one is pure armchair speculation, totally unadulterated by any sort of facts or evidence.

My theory is that flossing first became popular in the U.S. because of the practice of eating corn-on-the-cob. It's tasty stuff, and if you believe that necessity is the mother of invention, you'll agree that it's not too far-fetched to see corn-on-the-cob as naturally spawning the idea of dental floss.

Then -- still according to my entirely made-up theory -- I imagined some clever health professional saying "Hey, this has some health and hygiene benefits."

And who knows? Maybe one day it will catch on in France too.


Published in the Utah Valley Monitor January 12, 2006.