The Internet is full these days of eager skeptics, debunkers, anti-crank, and anti-Quack websites. In the harsh, absolutist language full of insults, innuendo, and invented terms like crank, woo, pseudoscience, and quackery. This has in turn led to a proliferation of counter websites using pretty much the same tone. Whether it’s global warming, physics, autism, herbal remedies, homeopathy, acupuncture, or the oldest and most overdone argument of all, God. The insults fly, the adrenaline rushes and the dopamine rewards. What is shut off is logic, understanding, and trust. Welcome to wonderful world of the Internet.
The problem is, this approach doesn’t influence anyone except like minded individuals, who become more stubborn and radical. These skeptics are doing more harm to their cause than good. Most Americans, by a large majority, don’t believe in evolution and it’s not for a lack of loud voices proclaiming the evidence. I think some of this is a natural reaction. Call me crazy, but I don’t think people like being told they are stupid. Not only that, I don’t think people who refuse to take scientist’s word on an issue are stupid at all.
Allopathic medicine emerged in the last couple of centuries from an open competition with osteopaths, chiropractors, snake oil salesmen, and a whole variety of health practitioners. They did so by aligning themselves with sciences. The germ theory of medicine it turns out had some real evidence behind it, by applying it we were able to keep scourges in check, even wiping smallpox off the globe. Three cheers for science. Doctor’s started wearing lab coats to emphasize their scientific grounding. Pharmaceuticals, technologies and procedures have mushroomed. Doctors, even today, are among the most trusted of professionals.
There is a dark side to this sea change, however. Science relies on a suspension of judgement until evidence is weighed. It requires an open mind, active reasoning, and even some healthy skepticism. It just so happens that skepticism may be a good way to approach medical questions of treatment, but it is one lousy way to approach a patient. Patients come to doctor’s sick and vulnerable. They want to tell their story. They want people to listen, spend time understanding them and the narrative of their illness. They want to understand themselves, what is wrong, and what their options are. They don’t want to hear that a diagnosis is uncertain. This will shake their faith in a physician like nothing else. Yet, for all our best efforts, most medicine is uncertain, especially when a healthy dose of skepticism is applied.
Where we have double blind placebo controlled studies, things are usually reasonably certain. However, the benefit of most drugs are relatively small in these studies. What might shock many people is that, especially with rarer conditions, we really don’t have a lot of scientific evidence. Gathering enough people to do a good study becomes difficult. Difficult as this may be for patients, it is often worse for the physicians themselves. Because we are so data driven, problems that are more fuzzy tend to drive the average physician up the wall.
The fact is that most health problems have an emotional or psychological component. Somehow, we have created a medical culture where that is a bad thing. So much of the office visit is learning to handle and help the patient’s (or their parents’) anxiety. This is the art of medicine. This is a vital component of healing, for which science really isn’t very useful. Science cured diseases. Science cannot heal illness, that requires something more in touch with our humanity than logic, evidence and data.
In some ways this is all about time. These days, Doctors don’t have a lot of time. Healthcare economics are such that time taking history, thinking out a differential diagnosis, and following through with a diagnostic plan are not what you are paid for. You are paid for seeing patients and doing stuff. If your specialty does less stuff, then you must see more patients. I belong to the king of history and physical examination specialties. It was a huge draw for me. Imagine a specialty where you get to actually spend more than 15 minutes an office visit. For the data driven crazed scientist, we now even have data that suggests that this factor, taking time to care and communicate, account for a lion’s share of the time tried placebo effect.
This is where the alternative, complementary, or holistic movement made all it’s inroads the past couple of decades. They aren’t limited by our healthcare system because they are free from the bounds of insurance, hospitals, etc. They also are into people. In order to be successful, they must gain the trust of patients. They do this by being understanding, comforting, polite, optimistic and believing strongly in what they do.
They have faith, anathema to many scientists. Sure there is probably a charlatan or snake oil salesman here and there, but I believe most of them believe in what they are doing. We underestimate the power of belief at our own peril. We underestimate the wondrous creation that is the human body if we neglect it’s ability to heal itself. If we ignore the power of the mind and soul, we are doomed to failure. We can cure all the polio we want, we will not heal anyone.
This sets scientists on the warpath. We spiral into a series of debunking propaganda wars. Proper scientists can do nothing but resent any recognition Eastern medicine, herbalism, or homeopathy may gain. Many get ferociously angry just to see grant money looking into these therapies. They rail against the fact that actual medical schools are starting to express interest in these ideas.
This is where a line is crossed, and objectivity is lost. Really and truly there are not natural vs manmade medical remedies, there are only proven and unproven therapies. There is only evidence or its lack. The anti-crank woo fighter movement would do well to remember this. Lack of proof for a therapy does not necessarily mean it isn’t effective.
They would do even better to develop a respect for why these types of therapies are attractive to people. Natural is such a soothing word. It evokes nature, landscape, Earth and simplicity. As society has left its agricultural roots and crowded into cities, it left us with a memory or longing for how we once lived. I can see how that in itself could be healing.
Here is the major question, for those folks who see a way that this approach can be “complementary” rather than an competing either/or choice, as long as it is not actively harmful, why get upset? Even if you take the position that all this stuff is placebo, (and that is far from a foregone conclusion), what is it hurting? If complementary and alternative medicine makes people feel good, isn’t that what doctoring is supposed to be about? I thought that was the goal. It seems scientists can get just as rigid and dogmatic as the fundamentalist religionists for whom they express so much disdain.
As opposed to alternative medicine, science looks unflinchingly at any possible down side to our therapy. We dutifully tally side effects. We develop medicines, usually based on natural chemicals that we then purify or modify. Here is the great secret, these modifications when they aren’t used just to keep a medicine on patent, are actually designed to improve potency and decrease the natural substances side effects. Go figure. There are some things medicine just has not communicated well.
We are losing the information war. Science is suffering. As a scientist myself, I think this is very sad. We need to learn to communicate. We need to learn to connect with our own humanity. I think we need to all borrow a page from Mehmet Oz. I think he is on to something with his fusion of the very best of East and West. We need to find our soul. If we don’t, it won’t matter how much better our data and inferences are. Patients will look elsewhere. No one will be left to fund inquiry. No one will be listening. There will be no one to left to help.