05 April 2013

PACE 2013 Bioethics conference, day 2

The PACE conference continues to go well, as far as I can tell. I was not able to spend as much time at the conference today, but a panel on the business of healthcare early afternoon was filled to the brim. I apparently should have been there, because a pharmaceutical representative was apparently making all manner of... interesting... claims about the efficacy of brand name versus generic drugs, among other things.

Cross border shopping for health care: The panel started off with this segment from The Daily Show, which the audience seemed to enjoy.

I polled the audience as to how many of them had gone to Mexico for some form of health care (including buying medicine), and at a rough count, slightly more than half had. Dental work of some sort seemed to be very popular, and one of the panelists said that the main reason people went to Mexico was the lack of insurance.

I told the story story of Celltex, a company offering experimental stem cell treatments that have not been approved by the US Food and Drug Administration. The company's first patient was Texas governor Rick Perry. Despite Perry's high profile support, the company has continued to be on the receiving end of controversy. In February, Celltex packed up and moved to Mexico, where it didn't have to put up with the FDA regulations. This raised questions about whether patients should be allowed to seek unproven treatments in other countries. Would a patient who went on medical tourism could lose insurance. Could a physician refuse treatment to that patient if complications ensued?

Another issue of cross-border comparisons that arose from an audience question was the relative pay of doctors. For instance, in 2008, the average wage of an American physicians was about $189,000 after expenses, but a Canadian physician made about $125,000. Thus, not only are patients "cross-border shopping," physicians are, too.

Yerberias: Oh, but this turned out to be an interesting panel. I was moderating it, and it turned out to be an interesting challenge.

"Yerberias" are, as far as I can tell, a distinctly Hispanic cultural institution. They might be described as an intersection of magic shops, herbal remedies, and Christian paraphernalia (note the saint on the door in the picture at right). So the idea was to talk about traditional compared to science-based medicine.

One of the scheduled panelists said that asked someone who knew more about this to replace her, and the replacement turned out to be a naturopath practicioner, Shirley Layton. I mentally did a double take when she started talking about homeopathy as effective treatment. Later, she started talking about "double helix" water that was "aligned" to better pass into cells of the body. I think she also had some unconventional ideas about root causes of cancer. And toxins.

Another panelist was discussing "energy healing."

On the other hand, I was there as moderator, and I am skeptical of these things, to say the least. But my job is to ensure the conversation kept going, the audience members had a chance to ask questions, and not pull a Bill O'Reilly style, "I'm unplugging your microphone."

As it happened, we had another faculty member from biology, Andrew McDonald, who has lots of experience in ethnobotany. He characterized things like "double helix water" as "nonsense," (which was also my take) and spoke strongly about the importance of the scientific method. If you don't have reproducible results, you are involved in faith, not science.

At one point, Layton said something along the lines of, "I have knowledge, but not proof," and McDonald replied, "That is something a quack might say." Layton responded, "I am not a quack" in a way that stopped the poster session in the next room. McDonald said, "I didn't say you were a quack, but that is something a quack might say."

I also brought up the point that a Google Scholar search for "yerberias" returned several papers on things like lead and arsenic poisoning. Layton agreed that this was a problem. This might indicate that there might be a role for greater regulation.

Honestly, I loved this panel because there was a frank exchange of views from people who did not agree with each other. After last year's conference, I thought there was too much agreement, which kind of defeats the purpose of panel discussions.

Photo by cobalt123 and houston mamacita on Flickr; used under a Creative Commons license.

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