A short guide to peer review

""I don't know what to believe..." is a short public guide to peer review, published by Sense About Science on 2 November 2005, 8pp."

"Is it peer reviewed?" is what Sense About Science is encouraging everyone to ask about science stories. Our new leaflet, written with input from patients, pharmacists and medical practitioners, among others, lets the public in on the arbiter of scientific quality: the peer review process."


It's written in layman's terms. I thought it might be helpful to just about anyone on this list. Download the PDF file at this location:http://www.senseaboutscience.org.uk/peerreview/shortguide.htm

"...a hernia repair that I DID NOT HAVE..."

(I'm going through this right now, with a surgeon that billed my insurance for a hernia repair that I DID NOT HAVE, and that my insurance correctly refused to pay for, which now the doctor'soffice is chasing ME into collections for, over $3000)

Hello, Julia

Without knowing anything about your situation, here is one possible scenario. The surgeon recognized the hernia caused by the incision was a complicated closure. (An incision into the abdominal cavity causes a hernia, so you probably did have one, created when the surgeon entered your abdominal cavity.) He took extra care and used mesh in the surgical closure, and documented this in his report. Mesh is expensive, and not a routine part of an abdominal surgery, so in order to compensate for this supply, and the surgeon's extra work, the billing staff reported it on the claim. The insurance company's automated claims editor recognized a hernia procedure as "incidental" or part of the primary abdominal procedure and denied that portion of the claim.

I occassionally see insurance claims that describe a person having had an open abdominal procedure, or even sometimes a closed one (laparoscopic) in conjunction with a hernia repair. In most cases, surgical correction of a hernia is a routine part of any abdominal area operation, even if the hernia existed before the operation, and is not related to the primary procedure (i.e. gall bladder removal). As such, it is not eligible for separate insurance reimbursement aside from the primary operation.

There are a couple of correct reasons why the hernia repair will still be reported and put on the insurance claim. One is when the hernia is in a different place entirely than where the operation was performed, and the surgeon had to all but prepare a separate surgical site in order to do the surgical correction. Another reason could be that the surgeon had to take extra means and attention in order to close (correct) the hernia. Even if the hernia was caused by the operation procedure itself (called incisional hernia), a complicated hernia may require the surgeon to use a mesh substance and extra means for suture. In this case the surgeon will report this extra work for the hernia, and his billing staff will likely put it on a claim form.

Many insurers allow some extra reimbursement for using mesh, or for surgery with such complications. These can even be in an agreement between insurers and "participating" surgeons. In all such cases, the claim has to be submitted correctly. And some insurance companies do not allow extra in these circumstances. In such cases, the denial usually does not become the patient's responsibility.

It is unfortunate you have been put in the middle.It is this kind of red-tape money game that is part of the problem with the U.S. health system, maybe moreso than most the blames tossed around on this list. Sliver lining: here is your chance to learn and do something about it first-hand.

Good luck.

How to Argue for Your Favorite Alternative Medicine

Argument 1. It is Science
An argument used by business and manufacturer's, fringe practitioners, and others posing as, or seeking mainstream legitimacy.

"There are over 50 studies supporting ________ , which is more than the ones you say are against it."
"Of course it's based on science, __________ cites over 250 scientific references in his book."
"So what if the studies aren't published in NEJM, they are still scientific studies."
"You read Nature, an article about __________ was in there."
"________ is a Nobel prize laureate."
" __________ takes what is scientifically known and applies it in a revolutionary way."

Argument 2. Science doesn't matter
An argument used by spiritualits and others seeking converts to a product.

"If is works for me, that's all I care about."
"There's more to being healthy than scientific proof."
"Clinical trials won't disprove anything."
"Published health reports are wrought with bias and/or conspiracy and are not trustworthy."

Argument 3. It's a Choice
Uses an often emotional freedom-of-choice to substitute or supercede any other common sense, scientific or moral argument. Also used to discredit mainstream science as simply one alternative belief system.

"For health, you place importance on your Science, I place importance on harmony of the body mind and spirit."
"Do you really think everyone should be denied their right to whatever health practice they choose?"
"___________ can be just as right as any other idea about (health.)"

Comments on Calvinism by an Illiterate

I have a relevent (I hope) comment about whether free will truly exists. I once watched a PBS Nova episode that spent a whole hour discussing whether there was a distinguishing difference between the human species and the rest of the animal kingdom. They went off on artistic expression, communication, psychologic behavior and even religion, but none could be scientificantly equivocable as being exclusive to the human species. (I guess it's hard to know whether certain animal behavior isn't demonstrating worship to Diety.) But, they did find the answer; an indisputable, scientifically derived difference!! Among all organisms on planet earth, the human species is the only one that the individual, when given the oppurtunity (and no other choice), can CHOOSE whether or not to procreate. Wow, the ability to make seemingly a moral decision.

I bet this is as close as science can come in supporting the existance of free will. I am skeptical as to whether such unresolvable philisophical debate has much value. If you want the all important and epic question Who am I? answered, you're much more likely to find the truth in religion than in the humanities and sciences. After all, isn't the cause of such debate boil down to things like accountability, dissonance, feelings of remorse, etc?


That we are "who we are due to the combined result of our learning and our genes" is what (so-called) alternative medicine [chiropractic in particular] advocates preach is the philosophy of the science behind (so-called) allopathic medicine. I've found it odd that a philosophical argument is used to attack a very practical approach to the practice of medicine. I don't think science professes to be the one true religion. Like I've said above, the truth on these things are available from religion, not science.


dras