What is the Best “Standard of Care”?

April 21, 2009
Category: Uncategorized

Several weeks back, Pulse of Health Freedom focused on the issue of electronic medical records, mentioning a Wall Street Journal opinion piece authored by two Harvard educators who disputed the administration’s claim that electronic medical records would save our healthcare system $80 billion.

Jerome Groopman, MD, a member of Harvard’s medical school faculty, and one of the authors of the article about medical records, has published another Wall St Journal Op-Ed—this time on the failure of a one-size-fits-all medicine. He notes that “treating the test results” often yields very poor results.

Dr. Groopman’s article focuses especially on measures of “quality care” for diabetics, measures that are often demanded by insurers and by peer-review medical organizations. Until recently a fasting “normal” blood sugar level could range from 80–120 mg/dl. Newer guidelines have narrowed that range to 80–100 mg/dl. Yet a recent study in the New England Journal of Medicine reported that more critically ill patients died in the group whose blood sugar level was tightly regulated than in the group cared for with a flexible approach. In fact, the ACCORD study of more than 10,000 diabetics with cardiovascular/heart disease was halted when so many diabetics died in the group with tightly controlled blood sugar.
Integrative physicians have been cautioning about aggressively treating the fasting blood sugar level. Cutting-edge research suggests that a fasting insulin level, which is linked to insulin resistance, is often more significant clinically in connecting the dots between the patient’s waistline, blood pressure, blood sugar, and blood lipid levels. Loren Cordain, PhD, of Colorado State University, has brilliantly demonstrated those connections both in research and in clinical practice.
Many an integrative practitioner has faced regulatory board charges for practicing “outside the standard of care for the practice of medicine” in that respective state. The charge may involve the use of a nutrient, a therapy, or a diagnostic tool like the Heidelberg gastrogram. The practitioner, backed by the weight of scientific literature and his or her own clinical experience, made an informed recommendation to the patient, who then followed the recommendation. Yet charges are proffered even when there is no harm alleged—the approach is simply different from the allopathic “standard of care” guidelines. But what if the “standard of care” doesn’t fit the patient’s unique needs, or doesn’t work as well as alternative approaches? Why should patients and practitioners alike be penalized for doing what works, instead of doing what a regulatory board mandates?

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