Thank you to Lobelsteve for calling this to my attention. Every evidence-based pain physician should learn from the Oregon experience. Our State's failure to thwart pain quackery is largely attributable to politics, the influence-peddling of a former MD-Governor and his "pet project" of a state Medicaid system called OHP, and a lack of rigorous thinking among policy-makers. If you participate in ANY pain care policy-making activities (task forces, committees, etc) in your State, you have a duty to stand up and say "no" to moo-shu pork medicine, psuedo-science, and quackery. These are not "harmless" interventions that reduce risk. They drain real resources from real patients with real pain. Non-content experts, meta-anlyticians, and soft-headed policy-makers deserve ridicule and contempt for wasting money and perpetuating nonsense. These policy determinations have been facilitated by "thought leaders" like Roger Chou and Rick Deyo. Their activities should not be supported. Here is how it works : research changes policy, policy changes payment, payment changes practice. http://sfsbm.org/index.php?option=com_easyblog&view=entry&id=693&Itemid=649 More Metastasis of Pseudo-Medicine Friday, 31 July 2015 0 Comments Oregon has a problem with prescription pain pills. Oregon leads the nation in the abuse of such drugs, federal statistics show, with the state's rate of prescription drug abuse 39 percent higher than the national average. Why that is, I do not know. As an Infectious Disease doctor I prescribe a narcotic about once a year. There are a real problems with the treatment of chronic pain and while I am aware of the issues and the changes over the last 25 years, it does not impact my practice, so my knowledge of the issues is basic I am also well aware of the Oregon Health Plan, OHP. OHP was intended to make health care more available to the working poor, while rationing benefits. Given limited resources, part of the plan has always included a prioritization of treatments and diagnostics, paying for interventions that give the most bang for the buck. Not a perfect way to ration care and as is always the case, no good deed goes unpunished. Another effect of limiting care, according to the Bend Bullitin, may be that OHP members who suffer back pain have been left with no choice but to take drugs, and the policy could be contributing to Oregon's high rate of narcotic abuse since other interventions are not paid for. New guidelines were recently updated by the Health Evidence Review Board and as a result The new guidelines open the door to acupuncture, chiropractic, cognitive behavioral therapy, osteopathic manipulation and physical and occupational therapy. To be picky, they do not say chiropractic, but "spinal manipulation", although the codes suggest chiropractic manipulation. As best I can tell, they relied on two reviews Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society from 2007 and Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline from 2007. They evidently did not review the literature to show that acupuncture is a theatrical placebo, has no basis in reality-based medicine and that most positive effects are probably due to bias results should be interpreted in the context of the limitations identified, particularly in relation to the heterogeneity in the study characteristics and the low methodological quality in many of the included studies. and that chiropractic is no better other therapies High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain. not as was mentioned in the newspaper that Large, randomized trials have shown that for chronic back pain, acupuncture and chiropractic therapy are equally helpful, said Dr. Richard Deyo, professor of evidence-based medicine at Oregon Health & Science University. He served on a task force that advised the Health Evidence Review Commission. "Different people respond to different things," he said. "The outcomes tend to be very similar, in the short term at least." Of course, short term improvement is just what one would expect from a placebo that does nothing to the underlying process. As noted many times here and at Science-Based Medicine, evidence based medicine is inadequate at evaluating interventions that are not based in reality And this also ignores the question of the state paying for practitioners of magical pseudo-medicines and all the associated useless interventions and beliefs espoused by chiropractors, naturopaths and traditional Chinese medicine practitioners. Hardly seems like a good use of Oregon resources. They suggest possible benefit The expense of a broader range of treatments could be offset by a decline in narcotics use, and I hope they do some epidemiologic studies to show benefit of adding pseudo-medicines to OHP.