After my fairly recent awakening from shruggieness (i.e. a condition in which one is largely unaware of or uninterested in CAM) I decided to discuss my concerns about pseudoscience with my friends. One particular friend is a nationally recognized physician who believes in the importance of accurate health information and the promotion of science. However, he sees no urgent need to warn people against snake oil, and so long as it’s correctly labeled he doesn’t seem to mind it co-existing with scientific alternatives.
My friend and I had dinner a few weeks ago, and our conversation was both animated and disappointing. I somehow felt inadequate in conveying my objections (both ethical and scientific) to the promotion of pseudoscience. My best explanations were met with cheerful rebuttals, and while not intellectually convincing to me, those retorts satisfied my friend just fine. I guess the bottom line was that he was more interested in maintaining his position than reconsidering it… and so it left me feeling rather frustrated and a little sad.
First of all he argued that since he couldn’t rule out the possibility that some alternative therapies could have therapeutic value, he had no problem with them being studied. I asked him if he could name one therapy that proved effective in NCCAM trials, and he could not. I then asked him if he thought it was a good use of tax payer dollars to research practices that had a very low probability of being useful. He asked for an example – I suggested energy healing. He responded that since our bodies do in fact generate electrical currents (which can be detected by EEGs or EKGs for example) it was not inconceivable that a previously undiscovered current measurement could provide important information about disease states. I asked what that had to do with waving hands over the body to realign these hidden energy fields, and he said he didn’t know, but that it wasn’t impossible that the act did something to the body. I responded that so far we’ve found no repeatable, reliable, effect of any medical significance associated with hand waving, and he shrugged.
So then I asked him if he had a problem with practitioners who offered both proven and unproven therapies. He said that was fine, as long as they were described accurately by the practitioner. I asked him if he thought that offering pseudoscience alongside effective therapies presented any credibility issues for the provider. (I likened this to offering a hungry patient a bowl of ripe fruit, some of which are real and some are plastic). No, he didn’t see a problem with credibility – so long as the options were described accurately. “If people want to be entertained or believe in placebos, that’s fine. It’s their choice. It’s the physician’s job to present the facts.”
I then asked my friend if a placebo were disclosed to be a placebo, what use would it have? Isn’t the very effect dependent on the belief in its power? He responded that he thought it was unkind to take hope away from people – and that if they wanted to believe that they might benefit from a certain alternative therapy (especially if they’d exhausted all possible proven options) then they should not be dissuaded of their belief. He said it was the same principle that was operating when a friend of his (diagnosed with a devastating neurological condition for which there is currently no good treatment or cure) asked him if his diagnosis might be incorrect. My friend said there was always a small chance that a diagnosis is incorrect and allowed him to hope that his condition was not what it was.
I changed the subject and asked if my friend was concerned about promoting medical practices that had not evolved in their thinking over hundreds of years. Surely that was a warning sign – since our knowledge of nature, physiology, and basic science is continuing to deepen and expand, surely treatments should also become more sophisticated along with that knowledge. My heart sank as he launched into the Galileo gambit… “Everyone thought Galileo was crazy when he said the world was round, but he was right you know. Sometimes things seem unexplainable, but they turn out to be true.”
I quickly responded – “But how many people do you know who are trying to counter Galileo’s round earth ‘theory’ now? Is there momentum growing around a flat earth club that you know of? No. And that’s the same reason why we don’t need to revert back to ancient therapies that have been disproven.”
My friend smiled at me, without comment.
In a final attempt to establish some common ground I suggested that surely he agreed that certain practices like homeopathy had no place in modern medicine. I could tell from his blank expression that he was probably unfamiliar with the theory behind it (that like cures like and water can hold a “memory” of prior exposure to molecules, and that water based treatments are more potent if shaken).
“Well, it’s harmless enough, I guess.” He said, chuckling.
And so we finished our dinner with a clearer understanding of our fundamental disagreements, and no change in our respective opinions of CAM. My friend’s views are probably like those of many other physicians in this country, and I doubt that I’ll be able to do much to change them. And so the two of us will co-exist, him feeling shruggie and me feeling exasperated… until perhaps one day a patient of his will decline curative treatment for a fatal disease in favor of an “alternative therapy,” and he’ll wonder if all these placebos are as harmless as they seem.