Letters to the Editor

Readers respond to previous coverage about mergers of large insurance companies, and with concerns about our coverage of complementary care.

More merger mania

The column “Merger mania, merger blues,” by Robert B. Doherty (ACP Internist, February 2016) succinctly summarizes the case insurers make for seeking specific mergers and some of the consequences that may ensue if mergers proceed.

A statement from an insurance company spokesman quoted in the column, that “This will actually improve efficiencies and reduce costs for consumers down the line,” constitutes what should be a mandatory condition for approving such mergers. The proposed merging partners should be required to present a specific plan for achieving such results and a default penalty if they fail to achieve stated goals after mergers are approved. In addition, the plan should include a blueprint for “de-merger” if the approved goals and savings are not achieved within a specified period.

L. Julian Haywood, MD, MACP
Los Angeles

Opposing opinion on complementary care

I was surprised and disturbed by the article “Integrative therapies may complement care” in the March 2016 ACP Internist. The article cites a 1993 study published in the New England Journal of Medicine dealing with the percentage of adults using unconventional care, which had many problems that have been thoroughly discussed in the medical literature. I was particularly bothered by the article's mention of “energy medicine” and “healing touch,” as this might suggest to some that these practices are of value.

As for acupuncture, a June 2013 editorial supporting the con viewpoint in Anesthesia & Analgesia stated that “the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance. It seems that acupuncture is little or no more than a theatrical placebo.” The editorial's authors also noted that although 1 meta-analysis published by the BMJ on Jan. 27, 2009, found a difference of 10 points on a 100-point scale in favor of acupuncture versus no acupuncture for treatment of pain, a consensus report on interpreting the clinical importance of group differences in chronic pain trials, published in the December 2009 Pain, concluded that such a change should be considered “minimal.”

I agree with David Gorski, MD, PhD, of the blog Science-Based Medicine, who has called integrative medicine “a specialty that seeks to ‘integrate’ pseudoscience with science, nonsense with sense and quackery with real medicine.”

Brian Berman, MD, properly pointed out in Ms. Durkin's article “that there are certain limitations to the available research on nontraditional therapies, such as small sample sizes and a lack of postsurveillance safety data.” Obviously, many more limitations could have been listed.

I would suggest that internists with potential opposing views be included in any future articles on this topic.

Carl E. Bartecchi, MD, MACP
Pueblo, Colo.