REAL WORLD EVENT DISCUSSIONS

No Cure, No Fee

POSTED BY: CANTTAKESKY
UPDATED: Monday, March 12, 2007 06:20
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Wednesday, March 7, 2007 8:50 PM

CANTTAKESKY


In the early 1800's, a German physician named Samuel Hahnemann developed the healing school of homeopathy as an alternative to the orthodox medical practices of his day, which included bloodletting, and the use of chemicals considered toxic today (mercury, lead, arsenic). What is interesting was that he practiced homeopathy under the policy of "No cure, no fee" and actually became quite successful using this policy.

I once consulted a homeopath who charge by the ailment, rather than by the office visit. That is, he charged $125 for any single "disease" or constellation of complaints, which included a large number of weekly office visits until that "disease" is resolved. Obviously, the sooner his patients were healed, the more money he made for his time.

I found this shift in paradigm most intriguing. Imagine a world where physicians got rewarded MORE when their patients got well, as opposed to when their patients continued to be reliant on them indefinitely. Imagine the revolution in medical research towards cures as opposed to treatments.

In my mind, such a revolution would render the national health care debate moot. 1) We wouldn't have the disastrously bloated health care costs to begin with. 2) And when there ARE costs, I personally wouldn't mind paying more taxes so poorer people can be CURED (whereas paying exorbitant sums to keep patients treading water with indefinite treatments would be another story).

No cure, no fee.

Can't Take My Gorram Sky

--------------
Nullius in verba. (Take nobody's word.)


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Wednesday, March 7, 2007 9:20 PM

FINN MAC CUMHAL


Works great when the “cure” is just a matter of convincing the patient that the snake oil worked. When it comes to real cures, it’s more complicated. I imagine that it would produce an incentive among modern medicine to produce successful treatments for some diseases, but what about Cancer or other widely thought incurable diseases? These are likely to be ignored in such a system since no funding would be available for research that might someday produce a cure, but not soon enough to make the research profitable.



Nihil est incertius vulgo, nihil obscurius voluntate hominum, nihil fallacius ratione tota comitiorum.

Nothing is more unpredictable than the mob, nothing more obscure than public opinion, nothing more deceptive than the whole political system.

-- Cicero

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Wednesday, March 7, 2007 10:01 PM

CANTTAKESKY


Quote:

Originally posted by Finn mac Cumhal:
Works great when the “cure” is just a matter of convincing the patient that the snake oil worked.

You know, I never understood the animosity of orthodox medicine towards the supposed placebo effect of alternative treatments. If I have painful bladder infections, and some overpriced sugar pill I bought for $50 triggered the placebo effect, what do I care if I never have painful bladder infections again? See from my perspective, from the patient perspective, I wasn't conned. I got cured for $50.

A cure is a cure is a cure. Results can be measured objectively. An autistic kid now talks and plays normally, gall bladder attacks never come back, arthritis pain is gone, etc. Patients don't really care why they get results (be it through clever "convincing" or otherwise) as long as they get results.

Quote:

what about Cancer or other widely thought incurable diseases? These are likely to be ignored in such a system since no funding would be available for research that might someday produce a cure, but not soon enough to make the research profitable.
That's why this would be a major revolution, a paradigm shift. People would have to start being concerned about loooong-term investments as opposed to what the quarterly earnings reports say.

Can't Take My Gorram Sky

--------------
Nullius in verba. (Take nobody's word.)

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Thursday, March 8, 2007 1:30 AM

SIMONWHO


Quote:

Originally posted by canttakesky:
You know, I never understood the animosity of orthodox medicine towards the supposed placebo effect of alternative treatments. If I have painful bladder infections, and some overpriced sugar pill I bought for $50 triggered the placebo effect, what do I care if I never have painful bladder infections again?



Because a) this hasn't dealt with what caused the original infections and b) if you suffer a reoccurence, what then? You'll probably demand more sugar pills and when they don't work, double doses.

By the time the penny drops that they don't do anything and you got lucky the first time, the damage could be severe.

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Thursday, March 8, 2007 4:08 AM

CANTTAKESKY


Quote:

Originally posted by SimonWho:
Because a) this hasn't dealt with what caused the original infections and b) if you suffer a reoccurence, what then?

If the "cure" obtained by the placebo effect is temporary, then it really isn't a cure. This is no different than temporary relief of symptoms caused by orthodox medicine. (For example, steroids or pain killers don't address the root problems either, and physicians prescribe them all the time at double the dose when symptoms recur. So again, I don't see why temporary relief by placebo is singled out as anything worse.)

If the paradigm shifts to "No cure, no fee," if symptoms recur, at least you don't have to pay for the failed cure (be it caused by placebos or other mechanisms).

Quote:

You'll probably demand more sugar pills and when they don't work, double doses.
Chances are if it worked the first time.... But with a "no cure, no fee" mindset, if it didn't cure the first time (offered only temporary relief for whatever reason, be it placebo or otherwise), people are more likely to try something different in search of the cure.

Can't Take My Gorram Sky

--------------
Nullius in verba. (Take nobody's word.)

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Thursday, March 8, 2007 4:37 AM

FINN MAC CUMHAL


Quote:

Originally posted by canttakesky:
You know, I never understood the animosity of orthodox medicine towards the supposed placebo effect of alternative treatments. If I have painful bladder infections, and some overpriced sugar pill I bought for $50 triggered the placebo effect, what do I care if I never have painful bladder infections again? See from my perspective, from the patient perspective, I wasn't conned. I got cured for $50.

If you assume that patient is an idiot, the patients’ ailments were purely psychological, or the placebo had a non-placebo effect, which may or may not be a good assumption, then yes. Persuasion can be powerful, but people will eventually realize that they’ve been conned, and want their money back. We see this kind of stuff all the time in faith-healing. The patient believes they’ve been healed as long as the commotion continues, not because they have, because they want to believe it. The doctor has done nothing but provide the stimulus to allow the mind to convince itself that the cure has happened. In such a system, the doctor always has an urgent house call in a faraway town, never to be seen from again, so the patient can’t demand his or her money back when the cure has turned out to be a con.
Quote:

Originally posted by canttakesky:
That's why this would be a major revolution, a paradigm shift. People would have to start being concerned about loooong-term investments as opposed to what the quarterly earnings reports say.

We already do that, hence the long-term research in to cancer. But if a doctor only gets paid if he cures someone then there is no longer any market for research to help people with incurable diseases.



Nihil est incertius vulgo, nihil obscurius voluntate hominum, nihil fallacius ratione tota comitiorum.

Nothing is more unpredictable than the mob, nothing more obscure than public opinion, nothing more deceptive than the whole political system.

-- Cicero

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Thursday, March 8, 2007 1:05 PM

CITIZEN


Quote:

Originally posted by canttakesky:
In the early 1800's, a German physician named Samuel Hahnemann developed the healing school of homeopathy as an alternative to the orthodox medical practices of his day, which included bloodletting, and the use of chemicals considered toxic today (mercury, lead, arsenic).

Kind of Ironic that some homoeopathic remedies now include arsenic, eh.
Quote:

What is interesting was that he practiced homeopathy under the policy of "No cure, no fee" and actually became quite successful using this policy.
In the 1800's people who sold boot lacquer as toffee and lead as flour were rather successful.
Quote:

I once consulted a homeopath who charge by the ailment, rather than by the office visit. That is, he charged $125 for any single "disease" or constellation of complaints, which included a large number of weekly office visits until that "disease" is resolved. Obviously, the sooner his patients were healed, the more money he made for his time.
Health is absolutely nothing like a court case. No win no fee can't work on a generalised scheme:
Quote:

You know, I never understood the animosity of orthodox medicine towards the supposed placebo effect of alternative treatments. If I have painful bladder infections, and some overpriced sugar pill I bought for $50 triggered the placebo effect, what do I care if I never have painful bladder infections again? See from my perspective, from the patient perspective, I wasn't conned. I got cured for $50.
I get the feeling you think that if someone is ill for more than a short course of treatment the evil doctors are merely keeping the customer coming back for more, like the Coca Cola corporations original inclusion of cocaine into their product.

It's interesting that you give a pass to a man that sold you a useless sugar pill for an inflated price, literally a con man, yet you seem to portray a doctor who is treating you honestly and not just peddling the quick fix western culture so damagingly craves as the real con man, like some legalised drug dealer wanting to string you out on drugs forever.

I don't see much tangible 'profit' (though I'm sure there would be a great amount of profit) to be gained from taking on the charlatan quick fix fallacy as a health care system.

Editted to add:
And lest we forget one minor point about the placebo effect, for a drug to be considered effective it has to be proven to be more effective than the placebo effect at curing whatever ailement it is to treat.



More insane ramblings by the people who brought you beeeer milkshakes!
No one can see their reflection in running water. It is only in still water that we can see.

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Thursday, March 8, 2007 3:02 PM

FREDGIBLET


Quote:

Originally posted by canttakesky:
I found this shift in paradigm most intriguing. Imagine a world where physicians got rewarded MORE when their patients got well, as opposed to when their patients continued to be reliant on them indefinitely. Imagine the revolution in medical research towards cures as opposed to treatments.



This is a problem with private health care in general, not with the traditional style of treatment vs. alternative treatment. In capitalist countries with private health care there is a monetary incentive to keep people in treatment instead of curing them. In a public health care system it is cheaper for the system to cure than just treat and so the system is more likely to push for cures.

Quote:

In my mind, such a revolution would render the national health care debate moot. 1) We wouldn't have the disastrously bloated health care costs to begin with. 2) And when there ARE costs, I personally wouldn't mind paying more taxes so poorer people can be CURED (whereas paying exorbitant sums to keep patients treading water with indefinite treatments would be another story).


Eh, there will always be expensive health care, there will always be people who can't afford it, there will always be diseases that can't be cured, so there will always be a need for national health care. A shift to cures instead of treatments would decrease the costs but they still won't likely drop to the point where they are moot.

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Thursday, March 8, 2007 4:57 PM

FUTUREMRSFILLION


But what about people who can't be cured? Then the Doctors would make nothing.

Personally I think the answer is somewher in between our current health system and the UKs.


----
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Thursday, March 8, 2007 9:06 PM

SERGEANTX


Health care in the US is completely and totally doomed. The only solutions that the public imagination can accommodate will only make matters worse.

SergeantX

"Dream a little dream or you can live a little dream. I'd rather live it, cause dreamers always chase but never get it." Aesop Rock

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Sunday, March 11, 2007 6:38 PM

CANTTAKESKY


Quote:

Originally posted by fredgiblet:
This is a problem with private health care in general, not with the traditional style of treatment vs. alternative treatment.

Correct. I used Hahnemann as an example, but it doesn't much matter if a treatment is alternative or conventional or "placebo" if it leads to a cure.

My question is why can't private health care subscribe to the same standards of accountability and customer satisfaction as other private industries? We are accustomed to money-back guarantees and warranties in most other private industries. If a customer finds that a product does not work, he can return it for a full refund. Why can't we apply the same standard to health care?

For example, private plumbing services work just fine without nationalized plumbing plans. You call a plumber; he either fixes your plumbing or he doesn't. If he "fixes" it, and it breaks a week later, it is completely unacceptable to the customer. Yet health care customers routinely accept this lower standard of service from the health care industry. That is the point I'm trying to make. Why nationalize the industry at this lower standard of service? I'm saying I'd be more inclined to nationalize the industry if it fixes itself to higher standards first.

Can't Take My Gorram Sky

--------------
Nullius in verba. (Take nobody's word.)

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Sunday, March 11, 2007 6:48 PM

CANTTAKESKY


Quote:

Originally posted by FutureMrsFIllion:
But what about people who can't be cured? Then the Doctors would make nothing.

Yes, but wouldn't making nothing motivate them to look for a cure? If they keep making a comfortable living with temporary symptom relief, what would motivate them to look for more permanent solutions?

While I believe "No Cure, No Fee" is ideal, I am not opposed to transitional policies that are not so drastic, as long as they are headed in that direction. For example, maybe a "No Cure, Small Fee. Big Cure, Big Fee" is the way to go until cures are found. The point is to raise the standards for customer satisfaction in this industry (to expect products that cure or approach a cure), and to not reward doctors EQUALLY whether the services are substandard (offering only temporary relief) or not.

Can't Take My Gorram Sky

--------------
Nullius in verba. (Take nobody's word.)

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Sunday, March 11, 2007 6:54 PM

CANTTAKESKY


Quote:

Originally posted by Finn mac Cumhal:
so the patient can’t demand his or her money back when the cure has turned out to be a con.

I appear to be having a hard time communicating this point. I will try one last time.

If the "cure" turns out to be a con, that is the disease returns for whatever reason, then it wasn't a cure. Thus it should not justify a fee under the "No Cure, No Fee" policy.

A cure can be objectively and empirically measured. It is not a subjective experience.

It seems your view of the "placebo" effect is that it is temporary and subjective, by definition. For me, the burgeoning field of psychoneuroimmunology is revealing that placebo healing can be every bit as permanent and objective as drugs. So in my view, placebo is not necessarily temporary and subjective--and people shouldn't assume that it always is. In cases where the placebo delivers objective and permanent results, I don't see why it should be seen as substandard.

Can't Take My Gorram Sky

--------------
Nullius in verba. (Take nobody's word.)

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Sunday, March 11, 2007 10:46 PM

RUE

I have a vote and I'm not afraid to use it!


"For example, private plumbing services work just fine without nationalized plumbing plans. You call a plumber; he either fixes your plumbing or he doesn't. If he "fixes" it, and it breaks a week later, it is completely unacceptable to the customer."

But just try to get your $$ back. This isn't a good example of no cure, no fee. Another fine NON-example is car repair. The fact is, I know of no private business that guarantees a repair. And I DO know of many unhappy customers. AHH, the beauty of unregulated business.

Mebee you need to put a little more thought into this.

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Monday, March 12, 2007 4:18 AM

DANFAN


"While I believe "No Cure, No Fee" is ideal... The point is to raise the standards for customer satisfaction in this industry (to expect products that cure or approach a cure), and to not reward doctors EQUALLY whether the services are substandard (offering only temporary relief) or not."

As an engineer, I've always had to keep an eye out for secondary and tertiary effects to any design decision. The same thing applies here.

If you require a front line physician to cure everything he treats else provide a refund, then he is far more likely to turn cancer patients and the elderly away... because so many cancers are fatal. And ALL old age is fatal. So, the only people treated will be young to middle aged. The physicians will treat minor to moderate infections that are responsive to current antibiotics. They will set broken bones. If you had anything much more complex than that, you would essentially be on your own.

Another thought... front line physicians do not develop cures. They administer cures developed in laboratories. If the cure doesn't exist, then there's nothing the front line physician can do about it. And if the problem looks intractable to the researcher who DOES develop cures, and he doesn't get paid if he can't develop a cure for it, then he too will move on to something easier to fix. Again, kiss your cancer and AIDS research good bye.

And finally, trying to compare plumbing or car repair to human repair is simply wrong. The complexity of the human body is many orders of magnitude more complex even than a car... much less pipes and simple valves buried in the ground. Complex systems like an organic body frequently do not yield to simple, or absolute, solutions. They require trades to be made... improve this to the detriment of that. It is inescapable. And as someone else in this thread pointed out, even for comparatively simple systems like plumbing and cars, there are no gaurantees.

Our lot is to deal with that.

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Monday, March 12, 2007 6:20 AM

FREDGIBLET


Quote:

Originally posted by canttakesky:
My question is why can't private health care subscribe to the same standards of accountability and customer satisfaction as other private industries? We are accustomed to money-back guarantees and warranties in most other private industries. If a customer finds that a product does not work, he can return it for a full refund. Why can't we apply the same standard to health care?



Because of the enormous amounts of money and frequent complete lack of assurance that treatment will work. Lots of medications, surgeries, and medical equipment are very expensive and don't give 100% assurance of success. Additionally many illnesses will take several different expensive treatments before a cure is found. Hahnemann was likely able to offer that assurance because his treatments were extremely cheap to make.

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