Monday, September 27, 2010

What's the latest excuse for introducing woo into hospitals?

The reduction of health disparities.

And, despite this disingenuous disclaimer at the end of the article---

The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation.

---it is, from all appearances, being endorsed by the AHRQ. Just look at the introductory paragraph:

The following is a profile of a practice innovation presented by The Health Care Innovations Exchange (HCIE) from the US Agency for Healthcare Research and Quality (AHRQ). HCIE is a comprehensive program designed to accelerate the development and adoption of innovations in healthcare delivery. It aims to increase awareness of innovative strategies and activities among health care providers in a timely manner. This program supports the agency's mission to improve the safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity of care -- with a particular emphasis on reducing disparities in health care and health among racial, ethnic, and socioeconomic groups.

So what kind of woo is being promoted? It's the use of shamans for Hmong patients when they or their families request their presence at Mercy Medical Center Merced, an acute care hospital in Merced, California.

So what's the big deal? Anyone's free to visit a patient, right? Right. And you wouldn't prohibit a patient's Hmong spiritual advisor or healer from visiting anymore than you would prohibit a Catholic priest or a Baptist minister from visiting, would you? Of course not. But this program is different. The shamans become members of the hospital staff. They are given hospital badges. They perform healing rituals based on their own pseudoscientific traditional medical principles. The ceremonies are even approved by the medical center!

Approved ceremonies. The medical center has preapproved 9 ceremonies that can be conducted in the patient's hospital room, emergency department, or preoperative unit. The ceremonies are brief, quiet and do not require a private environment.

Even worse, the shamans periodically “educate” physicians about their pseudoscientific traditional methods. A shaman even serves on the hospital advisory board.

But thank goodness for this (my italics):

Hmong shamans receive a 40-hour intensive orientation on Western medicine where they learn about Western biomedical practices, germ theory, and disease symptomatology;

So if the shamans buy into this Western notion of germ theory maybe they'll at least wash their hands.

And what level of evidence backs up this AHRQ program? A few anecdotes:

Anecdotal reports suggest the program has reduced cultural conflicts and miscommunications between Hmong patients and physicians, and increased Hmong support of Western medicine, physician acceptance of traditional medicine, and satisfaction among Hmong patients.

And what was the anecdotal evidence that the shamanistic rituals were effective?

The concept for the shaman program stemmed from an incident in 1996, when a prominent 55-year old Hmong businessman with gastrointestinal problems refused surgery because of cultural and linguistic communication difficulties between his extended family and his physicians. This patient postponed medical care until all of his body systems failed; many Hmong gathered outside of the patient's room and requested that a shaman perform traditional healing ceremonies and blessings. These community members ultimately succeeded and the ceremonies were performed. While physicians had no hope that this man would survive, he did, which had a powerful impact on hospital administrators and providers regarding the potency of traditional medicine.

Well, so much for evidence based medicine at AHRQ!

Medicine must address cultural disparities. There are many ways this can be done without promoting and adopting pseudoscientific woo. Adopting shamanistic rituals in US hospitals to address cultural disparity may fit right in with Donald Berwick's notion of patient centered care. I contend that it's disingenuous, unethical, and undermines the scientific integrity of mainstream institutions. Were this nutty idea to be applied consistently across all the cultures represented by our patients, American health care systems would have to abandon their scientific foundations and become institutions of the eclectic healing arts.

It's just the latest pretext (and, unfortunately, a very politically correct one) for the abandonment of science based medicine.

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