Oxygen Concentrators in Chiro Offices

I just saw the agenda for the next meeting of the Washington State
Chiropractic Quality Assurance Commission. They are considering adding
oxygen concentrators to the list of approved devices for chiropractors. Can
anyone tell me why a chiropractor would need such a device? The very idea
blows my mind... but maybe I'm missing something?

[HH]

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>



This will be a great new product for chiropractic office marketing!!! Think of all the angles. Take a lesson from these guys: http://www.thebigox.com/index.html

Oxygen from the concentrator as the latest sCAM medium for health restoration is going to be big, big, big.

We can flavor it. We can put the patient in hyperoxygenated rooms. It will look high-tech; there will be tubes and masks, and dials, gauges, and buttons. We can fill appointment books with repeating treatments and programs. We can list all the beneficial effects for it: it helps heal wounds, it sharpens the senses, and restores vitality. We can tout Oxygen as the fountain of youth, the giver of life, the ultimate detoxifier, the all-natural remedy for whatever ails you. We can put a picture on the wall of our favorite NFL star on the sidelines toking on it. We can even buy a pulse oximeter and show how that number goes up from 96, all the way to 100 when they're on oxygen therapy. PROOF.

Wow, and think: we can expose everything we have and sell in the office to oxygen and thus it will be "hyperoxygenated" for added potency and efficacy. We can even sell our own brand of freshly-brewed "oxygenated water" right out of our own tap!

Best of all, oxygen from a concentrator is fairly benign. At around 89% concentration up to a typical 4-liters per minute, concentrator oxygen is essentially non-toxic, and fairly safe aside from its risks associated with fire. Physician-prescribed commercial home oxygen concentrator machines are everywhere treating those with chronic lung disease. They have become fairly reliable with simple maintenance. And, best of all, oxygen concentrators are relatively cheap thanks to poor Medicare and private insurance reimbursement that has driven the technology to keep the prices down.

The time is truly ripe for the oxygen concentrator in the Chiropractors Office.

There might be a few questions the sCAM practitioner needs to learn to answer before taking this new idea on, for example:
1. How does the oxygen therapy interact with all those anti-oxidant supplements you've been selling me for years?
2. What's that tingling sensation in my fingers I got the first time I had oxygen therapy in your office, and why did I have a headache when I got home?
3. What's the difference between your $30 per hour oxygen, and Grandma's $30 dollar per week oxygen?
4. Why have MD's been prescribing oxygen for generations, but not in any way that you prescribe it?

Honestly, if I could give the Washington folks some advice, DON'T DO IT. I've hinted at all the illegitimate, phony, needless and expensive ways it will be used and abused. Plus, oxygen can be toxic (it's a poison in nature), and there is a good scientific basis as to why it is regulated as a prescription only medicine in our country. I can't think of any legitimate use for oxygen in a chiropractors office that can off-set the risk of one fire, one hyperventilation mishap, or one CO2 rebreathing mishap from faulty use or equipment.

dras (Registered Respiratory Therapist)

Socialized Medicine (reply)

[D-]> Evidence-Based Medicine will fade with more socialized medicine. The
> bureaucratic committees and legislative sessions of socialized medicine
> will base decisions more on a consensus of what can be believed as right
> and wrong, and rely less on what is provable, probable or fallacy.

[BR] Socialized medicine exists in several countries around the
world. Are there any data to support the above assertions?


[D-] My assertion is that when there are public representatives, politicians, and delegates making the decisions about what is and is not provided as medical care, scientific analysis will tend to take a back seat because these people are accountable to the general will of their constituents. These decision-makers must ultimately choose the popular decision among those who hold them accountable, whether or not it's based on evidence, or is fiscally responsible. A private carrier is accountable to it's members, employer groups, participating hospitals and physicians, and sometimes stockholders. Scientific evidence is the impartial trump-card used when a coverage decision is unpopular with the majority or minority who hold them accountable.

[D-]
>"Experimental" and "medically necessary" are touted as the evil tools of
>Health Insurance. Currently, and more so each day, these definitions are
>meticulously based on principles of EBM by Insurance Companies. But, be
>sure these "denials" will go-away with our new-found freedom in socialized
>medicine.
>
[BR] Again, is there any evidence for the above?

[D-]"Experimental" and "medically necessary" as tools for insurance villains to deny needed care are a theme I've read in reviews on the SiCKO film. Nevertheless, they are common and recurring expressions of disdain for private insurance companies when a claim is denied. That carriers use EBM in their definition of these terms is well-expressed in their documentation. BCBSA affiliates commonly use The Technology Evaluation Center analysis http://www.bcbs.com/betterknowledge/tec/tec-assessments.html, Aetna uses EBM in creating Coverage Policy Bulletins http://www.aetna.com/cpb/cpb_menu.html. That these elaborate mechanisms for creating coverage policy will go away with socialized medicine goes back to my first point. There is less accountability in socialized medicine and therefore less need for such elaborate and expensive systems, when it's much easier to base a coverage decision on the popular choice.

[D-]
> Which brings us back to having less use for EBM in socialized medicine.
>We have Medicare and Medicaid, and the VA system as current representatives
>of socialized medicine.

[BR] VAs associated with medical schools provide considerable
research. I've sat on some of those committees and know how busy the VAs get
doing research.

[D-] My assertion wasn't that these entities do not contribute to research. I should have been more succinct in stating that with just one (or three) huge bureaucracies in charge of all the healthcare payments, it becomes easier for those who want epic influence, or a piece of the overall pie, to focus in and "buy" it. With all the new control and power, I'm thinking it will be harder for the government healthcare bureaucracies to keep their focus (and funding) on such things as research enterprises. They will be too busy being manipulated by legislators, unions, and others with a stake in healthcare dollar.

[D-]
>What will qualifying everyone for one of these mean? If I'm a nurses union,
>I probably gain more power to direct wages, hours, etc., and have more
>political clout in other health-related issues. Congratulations, California
>Nurses Association. Can we trust a nurse's union to back the science to
>determine coverage for health care? Based on the record of the ANA in
>backing science, I'd say it will be no more a priority than for any other
>political lobby.
>
[BR] Does the ANA exist to foster research? Do you argue they are
opposed to research or think it irrelevant?

[D-] The ANA exists for many of the same reasons other professional occupation associations exist. http://www.nursingworld.org/ In particular, the ANA has let EBM take a back seat to other motives in regards to their endorsement of therapeutic touch and healing touch. The ANA will continue to avoid any initiative that jeopardizes the support of their constituents, like any other political lobby. In socialized medicine, their voice is much louder than it is among the current hundreds (thousands?) of private health care institutions.

[D-]>>snip<<

[BR] Arguing by asking questions sheds no light but makes points,
again, without evidence.

[D-] Agreed. But, points that can be arrived at based on common sense or practical reasoning can be as credible as the well-referenced ones. My intent is to get new thoughts and ideas considered, not necessarily proved. Proponents of a US socialized medicine system don't seem to practically consider what will influence and drive the healthcare dollar in such a system. My assertion is that EBM will be less meaningful. Clinical trials are expensive. A popular vote can take the place of study results. EBM is not needed as an impartial arbitrator when practice and payment decisions are based on an accountability to the system rather than accountability to the payor and patient.

[D-] >>>snip<<<

[BR] Can you provide more information about the kind of system you
would prefer?

[D-] I mentioned in a prior post that I do not know where is the best place between federal-run healthcare and a total free market; the happy medium between socialism and anarchy. Hopefully, I don't let my established bias against socialized medicine prevent a true understanding where that is. At present, I see a benefit of our current system where the market holds provider, payor, and patient collectively accountable for the healthcare provided.

Respectfully,

dras

Nurses and Michael Moore's Sicko

I received a brochure via US post mail from the California Nurses Association complete with paid postage "Business Reply Mail" requesting that I "educate [SiCKO] moviegoers about Guarenteed Healthcare in America" by sponsoring a SiCKO screening. (see: www.guaranteedhealthcare.org/sicko) Even though I'm sure the movie is entertaining and full of facts that are well presented, I'm not sure this presentation should represent a medical organization. I question the political sales tactics of the above web site, and this one as well: http://americanhealthcarereform.org/.

There are two common themes at the above sites. One: Our healthcare system is full of problems. Shocking problems, too horrible to think about problems. And the biggest blame goes to the Health Insurance Companies. Two: socialized medicine ("guaranteed healthcare" - to use the more palliative, new age term) is all-American, it's patriotic, it's right, and it's about breaking the bonds of tyranny for freedom. These strike me as the same kind of sensationalistic / feel-good emotion-based arguments like those we see all the time that hack EBM in support of sCAM.

Evidence-Based Medicine will fade with more socialized medicine. The bureaucratic committees and legislative sessions of socialized medicine will base decisions more on a consensus of what can be believed as right and wrong, and rely less on what is provable, probable or fallacy. "Experimental" and "medically necessary" are touted as the evil tools of Health Insurance. Currently, and more so each day, these definitions are meticulously based on principles of EBM by Insurance Companies. But, be sure these "denials" will go-away with our new-found freedom in socialized medicine.

To digress for those who believe Insurance Companies have a sick and twisted sense of EBM. I must say, yes, some companies sometimes do. But, it's much more complicated than that. First, "Investigational" and "medically necessary" are subjective terms, even in the strictest sense of EBM. Our courts and legislative sessions argue them all the time. There is no sure line when something crosses over to being accepted and proven; it's a place of opinion. Second, Insurance Companies process hundreds of thousands of claims per day. The systems must be automated, thus based on analog logic of a computerized system, where all aspects and descriptions of medical care are forced into sets of numbers put into fields on a Medicare-based claim form. I attest to having years of first-hand knowledge of the difficulty of making this kind of complex system accurately and fairly identify, adjudicate, and pay for the medical care provided. (Not the least of problems is the shear potential for human error, and intentional fraud and abuse by any party with a touch in the system.) Even when all works flawlessly, there will always be the occasional square peg in a round hole, where a claim is accurately but wrongly denied. Finally, third, Insurance Companies are beginning to give up the "investigational / medically necessary" fight. They too often lose in courts and in lobbying, despite having the best EBM science backing them up. So instead, they're beginning to write and broadly apply more "exclusions" to benefits. These allow them to contractually carte-banche deny claims and services no matter how necessary they are, or how senseless the exclusion is applied. Remember, this is happening ironically because we are taking EBM out of the payment-process of health care, and the alternative is proving to be unscientific, often nonsensical and more money-driven.

Which brings us back to having less use for EBM in socialized medicine. We have Medicare and Medicaid, and the VA system as current representatives of socialized medicine. What will qualifying everyone for one of these mean? If I'm a nurses union, I probably gain more power to direct wages, hours, etc., and have more political clout in other health-related issues. Congratulations, California Nurses Association. Can we trust a nurse's union to back the science to determine coverage for health care? Based on the record of the ANA in backing science, I'd say it will be no more a priority than for any other political lobby.

If Insurance Companies are beginning to rely less on EBM to adjudicate claims anyway, what's wrong with taking them out of the picture? Because doing so will do nothing to re-emphasize EBM. The burden of being the evil denier of care will now be the US Government. We can no longer gripe at our employer who gave us the benefits in the first place, or call the insurance to give them a piece of our mind, demand independent medical review of the claim, or threaten to sue. Can we expect a legislator, who is no longer in the pocket of the Health Insurance Company, to lend us an individual ear? Or, will s/he now be in the pockets of other remaining commercial entities in the globally capitalistic health care industry? Can we expect the Government bureaucracy to run the tighter ship than commercial companies? Will the primary goal be to altruistically provide medical care that is fair to the patient and provider? Will it operate with financial responsibly and appropriately address errors, fraud, and abuse?

Personally, I like the accountability inherent in a private health care system, admitting to the horribleness we see in it currently. Even though I know the AMA has made statements in support of socialized medicine, I'm on board with their current recommendation for public health policy that advocates a consumer driven, market based system. http://www.ama-assn.org/ama/pub/category/7834.html)

dras