Common Quackery: The struggle to fight medical nonsense while atoning for our sins
Forgive me, Osler, for I have sinned
Not everyone agrees with what I’m advocating for politically. This shouldn’t come as a surprise. I’m a mere medical student, yet I’m speaking brazenly about the harm being done by misleading medical information in the mainstream media. I’m encouraging the medical profession to make substantial improvements to how we disseminate medical knowledge to the public. In the beginning, I was questioned about whether this issue was really so important. So I started this website to collect first-hand accounts by providers and patients that felt misled by false medical information in the media. Over the following months, I heard from so many people who were outraged and saddened by medical professionals who use the media to spread inaccurate medical advice. There was no question that doctors were being held to a higher standard, yet many in the media weren’t living up to it. But let’s just say I’ve also faced some skepticism. Here’s one less-than-supportive message:
“Who do you think you are? You are a 3rd year med student who doesn’t have a clue about healthcare in the United States. If you want an entity to tackle, go after the insurance companies that really provide the medical care in the US. Why aren’t you tackling the pharmaceutical companies? Why aren’t you tackling the physicians who prescribe medications and use technology because of kickbacks?”
A nurse wrote me that email.
When so many people distrust the profession itself, my stance will inevitably be controversial. Letter writers have confronted me with the tabloid scandals of medical history: organized medicine’s opposition to public health advancements like Medicare, doctors’ persistent habit of recommending therapies that don’t work, our ongoing coziness with the pharmaceutical industry, to name a few of the more infamous parts of our history. One message I received referred to the way most doctors practice medicine as merely “common quackery,” compared to the more interesting quackery of the doctors I’ve criticized.
In light of medicine’s sins and the subsequent distrust patients now have toward us, why do I continue to promote the idea that the medical profession should be self-regulating its public speech? Worse, why am I attacking doctors who “bravely” dare to leave behind mainstream medical dogma, a dogma so often proved wrong? Or as one person asked me, is organized medicine simply punishing doctors who dare to have “original ideas?”
Sure, many of the critical messages I receive lay out the same angry rhetoric you can read on thousands of alternative medicine websites. Like others who have spoken on this topic, I have been subject to ad hominem attacks on my character. I’ve been called, in earnest, a shill. As a medical student receiving no income, I must be the worst-paid shill in history.
But I also receive sad and painful stories from people who feel they and their loved ones have been harmed by doctors. I’m privy to the still-raw memories of patients who are victims of preventable errors and careless attitudes. Some of these stories seem unlikely, the intersection of traumatizing illness and poor communication. But so many are so plausible. I believe people when they write to tell me about the doctor who accidentally prescribed the wrong medication or missed a life-threatening diagnosis. I believe people when they tell me about the callous and over-confident doctors they’ve known. And even the most outlandish stories cannot be dismissed — these experiences are truth to our patients.
Doctors ask for a lot. We ask the government for monopolistic power. We ask patients to let us cut into them while they sleep. We ask for a lot of money. We’ve demanded respect and bequeathed ourselves a title. (This is the last year of my life that I will be merely a Mr.) I’ve received messages from people who are enraged by the magnitude and exceptionalism of this situation. To be clear — I do not want to discourage anger and reflection about the unequal distribution of privilege in society. The fight for authority and even authenticity may be the defining conflict in the issue of “media medicine.”
The dangers of originality
“Over the next several years, I refined my diet and began taking more and more herbs and supplements. It took a long time, but I finally found the right combination and was cured in one week.” — Email message
At this point I’d like to introduce a technical term: Nonsense. Medical nonsense, specifically. I’ll provide a rough definition of medical nonsense: medical treatments that are entirely unvetted by the scientific method, grotesquely implausible according to the most-accepted tenets of the natural sciences, and wed insidiously to commercial interests. These three ingredients combined produce the dangerous yet compelling elixir that is continually served to us by the media. This is what we consume.
And to get this out of the way, yes, a few “mainstream” medical treatments would meet this definition. But only a few, really. There are lots of medicines we use that have thin empirical backing, but they don’t entirely lack scientific data. They also usually work by an appealing mechanism of action that fits into our understanding of the pathophysiology of a disease. Plenty of drugs have the support of powerful for-profit interests. But underneath this slimy corporate veneer lies a reasonable empirical foundation. Walk into most doctors’ offices or hospitals and you’ll be offered a variety of interventions that despite their limitations are decidedly not nonsense.
I’m going to call this an advance for civilization and a moving chapter in the ongoing story of humanity confronting its own suffering.
Medical nonsense is popular and profitable. Millions of people not only consume it but advocate for it with stunning sincerity. So why am I so opposed to it, so absolute in my declaration that the medical profession has a responsibility to fight it in public? In short, it’s because the convergence of all of the deficiencies outlined in the definition of medical nonsense results in a treatment that can’t possibly work. At least, it doesn’t stand a better chance of working than any random substance plucked from the earth. We cannot rest the public face of medicine on this adventitious foundation. The media is charged with presenting “balanced” or “diverse” views, but medical nonsense promotes chaos, which is distinct from these goals. It is destructive rather than constructive, unnecessarily encouraging uncertainty in an already uncertain field.
I hope I can convince you that there is nothing more dangerous than treating a patient with an “original idea.” If a doctor in the media is zealously promoting an original idea, then it’s probably nonsense. Originality means a lack of reproducible evidence. It means the risks are unknown. It means “taking more and more herbs and supplements” until a disease naturally remits and never knowing which of your remedies did the trick. It means any promise is necessarily a false promise.
Medical witch hunts
“They will be shopping in the Market of Miracles and always finding an abundance of eager sellers.” — Email message
Doctors need to approach our past sins with humility. We shouldn’t eagerly trumpet the latest pharmaceutical without careful examination of the science behind it and the yet unknown long-term effects. I’ve received many “pot calling the kettle black”-style emails that chastise me for criticizing bogus medical information. Not only patients but prominent physicians have urged me to recognize our own deficiencies. But I argue that our deficiencies (though many and dangerous) are fundamentally of a different character.
I tried to be clear about the definition of medical nonsense because I think it is, in fact, the most humble distinction the profession can adopt when deciding what is appropriate to promote in the mass media. After all, how many doctors need to agree before we advocate for a new treatment? Does a pill need to be 50% effective or 90%? How strong does the evidence have to be? Are retrospective studies enough? Do we wait for a randomized trial? Physicians have trouble answering those questions in their own practice. So I think we’d all be better off if as a profession we said to the media, “at the very least don’t promote nonsense.” At this point, that’s all I’m asking for.
Without this kind of standard, we’ll become a ravenous mob, searching in the dark for that elusive but captivating medical advance. Consider a legal analogy. A jury may free a defendant on the basis of a “reasonable doubt” that the story the prosecution put forth is not entirely true. But this outcome does not permit us to then go out and accuse every person who walks by of the crime. Our desire for justice should not take us to such an absurd end. In common vernacular, this would be called a “witch hunt.” Yet I have heard from many patients who sincerely tell me that since medicine has deficiencies, we need to accept and even laud the doctors who earn their money by going into the media to promote every form of alternative medicine that seems momentarily promising. We should stay quiet when doctors promote ahistorical or outright fictional stories about the ancient origins and healing powers of medical nonsense. We should concede to the profitable “the body can always heal itself” lobby, even while every day we watch bodies in hospitals abjectly suffering from senseless but “natural” processes.
So with all due respect to the people who write me: doctors must bear witness. We can’t continue to let medical witch hunts be televised in the name of good entertainment. What the medical community should be proposing would be the equivalent of an orderly investigation and fair trial. As the long-running show Law & Order proves, this can still make for good TV.
Billions of injustices
“There are a lot of people of color that listen to Dr. Oz cause we have no health care, unlike all the handsome and pretty doctors on the shows.”
“I am in my sixties and have had a life long struggle with my weight. When I saw Dr. Oz touting green coffee bean extract and weight loss, I bought in to it. I bought eighty dollars worth of worthless pills. I took them as Dr. Oz directed and…I lost nothing but eighty dollars.”
— Email messages
Lastly, a comment on the relative importance of this issue. Why take on this aspect of healthcare and not the others that people have, with varying levels of civility, suggested I tackle? I could continue quoting messages written by the many patients who feel taken advantage of by alternative medicine. But I think I can make the point more concisely, if with less color. There are a lot of poor people and a lot of sick people in this country. And millions of those people purchase alternative healthcare at a cost of many billions of dollars every year. Nonsense medical treatments are making our most vulnerable citizens poorer and sicker.
Bogus alternative practitioners have boosted their sales by laying heavy blame on the very real inadequacies of conventional medicine. Doctors do not, in fact, spend enough time on prevention and the psychosocial aspects of health and well-being. Yet many so-called integrative and alternative practitioners claim monopoly over these ideas as a soothing pablum to better help the nonsense go down. One does not need to be subjected to supernatural treatments in order to deserve a patient-centered, caring physician. At my own medical school, we practice the “biopsychosocial” method of medicine. This practice was developed here in the 1970’s by traditional physicians who thought we could do a better job of addressing the interpersonal and cultural dynamics of health. No homeopathy needed.
So my anger is not directed at those physicians who believe in humanistic medicine, though I would urge them not to use the phrases “integrative” or “holistic,” as these terms have too much associated medical nonsense baggage. My anger, and I hope the medical profession’s actions, should be directed at those who sell false hope and non-scientific remedies in order to make a lot of money. Billions of dollars is no small thing. And when you cut through the philosophy, some of it reasonable and some of it insane, you’re mostly left with a bunch of salesmen trying to sell patients something for the same reason we’re sold iPhones and Toyotas — they want us to give them our money.
I talked recently with a patient who was committed to living a healthier lifestyle. It was important for her to avoid diabetes through diet and exercise. She told me that in her commitment to better health, she decided to watch the Dr. Oz Show as often as she could to stay informed and motivated. What a powerful story. This low-income patient, having seen the devastating effects of diabetes on her family members, was using every resource available to her in order to help herself. The media could do her so much good. But instead they will feed her nonsense.