"Evidence-based practice" and "Standard of care" are important concepts
in medicine that are strongly related to Current Procedural Terminology
(CPT) code based reimbursement for health care services. If you do not
provide an evidence-based standard of care, you will not get reimbursed
for services. This is basically a good idea because physicians,
dentists and others were providing all kinds of essentially ineffective,
unusual therapies in order to maximize reimbursement. Restricting
reimbursement to the effective treatments will obviously reduce health
care costs. Clinical psychologists have joined the chorus and a number
of groups are working on specifying the standard of care for
psychological disorders. I was peripherally involved in this regarding
neuropsych assessment and the CPT codes used for clinical fMRI.
I would like to make two points about this. The first is the cognitive
behavioral therapists are using this to further criticize psychoanalysis
and other therapy schools that are not their own. The second point is
that the standard for empirical validity in medicine treatment is the
randomized, double-blind clinical trial. There has never been one of
these for any psychological treatment, including cognitive-behavior
therapies and psychotropic medications. By not examining the blinding,
the drug companies have been very crafty in convincing the FDA that the
studies were actually blind when a simple survey of the subjects would
probably reveal that they know whether they were in the treatment
condition or placebo. The onset of dry mouth and constipation are sure
signs you are not getting the placebo.
Mike Williams
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