American Specialty Health Network Excludes
Many"Complementary" Methods

Stephen Barrett, M.D.

American Specialty Health, Inc. (ASH) has published detailed clinical practice guidelines for 81 "complementary" techniques and procedures, most of which are used mainly by chiropractors. The documents indicate:

• 68 of these methods would not be covered under the plan because they are considered unsubstantiated, unsafe, or both.
• 67 of the methods are classified as experimental or investigational because credible scientific evidence is inadequate to support their claimed applications.
• 48 of the methods are scientifically implausible because they require the existence of forces, mechanisms, or biological processes that are not known to exist within the existing framework of scientific knowledge.
• 11 of the methods are considered unsafe, either directly or indirectly. The potential harm can be:
  • Direct: Injury caused by a physical or psychodynamic property of a procedure.
  • Indirect: caused by substituting a procedure of unknown safety, unknown effectiveness, or known significant risk for one of known safety or effectiveness.
  • Non-specific: caused by the transmittal of misleading information that can cause emotional harm, cause a false sense of security, or create beliefs about one's health that are manifestly untrue.
• 53 of the methods would render the practitioner ineligible to participate in the network.

ASH administers benefit programs for 12.1 million members and affinity discount programs for over 80 million members. Its practitioner network includes more than 28,000 acupuncturists, chiropractors, dietitians, massage therapists, and naturopaths. A few of the reports are not sufficiently critical. However, the rest are remarkable because (a) many of the implausible practices—most notably applied kinesiology—are widely used, (b) chiropractic organizations almost never criticize them, and (c) managed care companies almost never use implausible practices as a criterion for excluding providers.

This article was posted on March 14, 2007.

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