The Antidote

Counterspin for Health Care and Health News

Tuesday, August 29, 2006

Music hath charms and all that... but do you need a study?

An article in August 24th's New York Times describes a musician playing gentle, soothing Celtic airs and lullabies on a small harp in a hospital unit where heart patients are recovering from surgery. Patients and hospital staff interviewed for the article attested to the relaxation they experienced when the harpist played. Turns out it's part of a privately funded research study - staff are monitoring patients' vital signs at regular intervals before, during, and after the harpist's daily visit to the recovery unit.

The benefit of music seems so obvious, and any downside so elusive, that one might question the point of studying it - it's what I used to refer to as "duh" research, used to confirm what you already know. And in the scope of things perhaps competing priorities with potentially higher public health impact might in fact win out.

But quantifying the benefit and the possible risk are important. Try this exercise. Close your eyes, imagine a soothing harp melody, imagine you're a new cardiac care director, and now imagine that the Celestial Guild of Therapeutic Harpists has deep pockets and powerful lobbying connections, and somehow convinces the hospital accrediting organization to bypass its usual scientific review and declare that employment of white-robed, harp-strumming musicians is a high priority in ensuring quality of cardiac care. It's obvious, isn't it? Look how happy those people in the NY Times article are! What's not to like? (And you'd better like it, because your accreditation is in jeopardy if you don't.)

"Hang on a second!" the hospital association barks, shattering your reverie. "That harpists' union has us over a barrel. Forget about the cost of spiral CT for lung cancer screening, we can bill for that; those blithering angels want $500 per patient per day, and Medicare won't cover it."

"Not to mention," the nurses' union chimes in, "we've had three nurses fall asleep on the job under the influence of harp music. An orderly in San Jose got himself so soothed, he wheeled a sleeping patient all the way to the morgue before the patient woke up."

Oh. Um... maybe a little study would be a good idea after all. Let's make sure we have a few hard patient and cost outcomes - and outcomes for effects on staff while you're at it - and standardized measures of musical exposure.

Far-fetched, perhaps, or is it? Such is the paradox of complementary and alternative medicine (CAM). Herbs, supplements - they seem so benign, so... so natural (note: poison ivy is a natural herb; it sure ain't benign...). So... expensive, often. Very likely: Americans spend $34 billion a year on CAM (Herman et al., 2005), which means that we're using a heck of a lot of it (36% of American adults use some form; NCCAM, 2004), or it costs a lot; my guess is that both are true. And about most CAM therapies, we just don't have much evidence for safety or effectiveness (let alone cost effectiveness).

Bottom line: since patients are using this stuff, we do have to ask, in a very directed way, "What's not to like?" and at the same time "What IS to like?" Consumers have a right to know that the treatments they're spending money on are safe and effective - especially in a regulatory climate of, well, complete absence of regulation, at least for dietary supplements. The only way to get to that knowledge is through high-quality research.

What do I mean by high-quality research, anyway? Stand by...


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