Motivations

We received the following letter:

Your blog, the SBM page, has come up for me several times in my research. I’m an RN trying to research cancer treatment, for myself, I am the patient. I’m also a licensed massage practitioner with a 30 year history using “alternative” or “complementary” medicine successfully to treat myself for various things. When your blog has come up I’ve read into it, picking up some useful information.

My question is, why the sarcasm? Why do you and the responders on your site have such disdain and anger? Why do you feel threatened? Your physician status gives you the top of the totem pole, the extensive training, the authority and the privilege. Very doubtful you are going to be knocked off the top of that totem pole in this or any several more lifetimes to come.

I say that I’ve picked up a few useful tidbits from your site, but in the main I am troubled by the anger and disdain that is expressed toward practitioners who obviously are helping other human beings. Patients who have to pay cash for a service because their insurance does not cover it do not keep going back to a practitioner who does not help them. What are you afraid of?

I am served well by a naturopathic oncologist who ordered me some homeopathic cream for my breast surgery, as well as a pharmaceutical grade supplement of multiple vitamins. My breast suffered a hematoma post op, and it turned black. The opposite breast also turned black from blood that drained to it as I lay on my unaffected side. In 24 hours I had one and one-half black breasts. The post op nurse and my PCP both stated it was the worst bruising they had ever seen in their careers, and neither of them are less than 40 years of age.

With the help of the cream and supplements, the bruising is resolving in days. Not weeks. Days. The post op nurse told me to expect this dark bruise to linger for weeks or months. I credit the cream and the supplements, neither of which the surgeon ordered. A top surgeon at a top university hospital.

Something is wrong with the premise or the presentation on your site. If physicians have this much disdain for others who are obviously helping their patients, then something needs to be dialed in, dialed back, or the baby thrown out with the bath water.

First, do no harm.

Since the holidays tend to fill my alleged free time with family commitments and I need to rewrite some RSS feeds (am I lucky or what?), I thought I would take this opportunity to answer the letter since it will require zero research. The other contributors on the team probably have their own motivations for participating in this blog and in science-based medicine in general. Perhaps they will weigh in in the comments. This is why I spend my time working away in the endless field of SCAM.

First, I like to write. I enjoy the process of trying to explain a complex topic but also like to be clever or humorous in the process. I like to make me laugh and, I hope, others. It is an enjoyable intellectual process. This brings up issues of tone in the blog, and there will be disagreements amongst the participants in the blog as to tone. I look at the blog as tending towards the informal and the personal. The entries should reflect the author and the few blogs I read regularly are less due to the content and more due to the personality behind the blog. I want style AND content and the former is rare. Many people can write well organized and reasoned essays; few can do it with personality. So I try to have my entries reflect something of who I am and express my personal reaction to the topics covered as honestly as I can.

It can, and should, come across as disdainful and sarcastic, for reasons that will become clear later in the essay. Disdain not for the people involved, I hope, but the ideas and concepts of SCAM. It is the sin, not the sinner, that I hope is the target of some of my loathing.

I like to learn, and there no is better process to help one learn than to try and explain a topic someone else. It helps in my infectious disease world and it helps as well in the world of SCAM.

I am also endlessly fascinated in the almost-too-numerous-to-count ways humans think and think badly. The variations of human cognitive pathology represented by SCAM proponents are amazing. The SCAM world has endless examples of how to reason poorly and the inability for people to recognize that they are thinking poorly. I remain amazed that humans are consistently horrible at understanding the natural world without the support of the scientific method.

I have become a better physician as a result of understanding all the logical fallacies to which humans are prone and applying them to myself. That, I would suspect, is the main issue that separates the SCAM world from the skeptical world. Those who participate in pseudo-medicine are generally unable to apply the concepts of critical thinking to themselves. I suspect that to do so is an unnatural act that most cannot, or will not, do.

But the main reason I spend my time writing and podcasting on pseudo-medicine derives from why I originally became involved in the SCAM world.

It was in the early 1990’s, my first year or two in practice, when I received a consult for a case of gangrene, not a typical cause of infection in the industrialized West.

The patient was a female in her mid-twenties. Sometime earlier she had been diagnosed with a tumor of her leg; I remember it as an osteosarcoma but that detail could be mistaken. It was some sort of musculoskeletal tumor. Rather than an amputation and chemotherapy, which could have been curative, she opted for the care of a naturopath who treated her cancer with alkaline therapy, since, as the naturopath told her, cancer is due to acid.

The cancer progressed, grew and parts of it outgrew the blood supply, leading to dead, infected tissue. Her naturopath told her this was her body rejecting the tumor. By the time I saw her, most of her leg was black, ulcerated, dead and with a stink that I hope you never experience. There are few smells as foul as rotting human flesh.

The only reason she was in the hospital was that she had fainted from anemia and continued to refuse any medical or surgical interventions for her leg, which she told me was going to be cured. She believed in the pseudo-medicine she was receiving. She bet her life on it. That night the tumor eroded into a major artery and she bled to death in her sleep.

One of the curious phenomena is the demonization of those of us in science-based medicine: we are big pharma shills or insurance company shills or we are motivated by fear of our position being removed. Or we are angry. Yeah. I will cop to that last one. Anger. At people spending their time, their hope, their money, their health and their lives on worthless nonsense.

Reality, as I have mentioned in the past, is a honey badger. It don’t care what you think, if you misstep or are unlucky, reality will hurt or kill you. Life is short. Health is rare.

There is a reality that proponents of pseudo-medicine deny but we are all subject to its rules. You may think you can harness the energies of the universe to make yourself invulnerable to harm. The sword don’t care, it still cuts. That martial artist is the archetype of all believers in un-reality. We have not evolved to understand or comprehend reality. For understanding we need science.

The SCAMs about which we write on this blog and elsewhere are based on fantasy and the endless ability for people to fool themselves and others. And if you spend your time treating illness with fantasy you could end up bleeding to death in the middle of the night from what could have been a curable cancer.

Yes. I know. Medicine kills. But less so every day. Since 2006 in my hospital system we estimate that we have prevented over 2 000 infections and 200 deaths. How? By applying reality-, science-, and evidence-based medicine to the treatments of our patients. As Chair of Infection Control for my hospitals I have seen the enormous work we have done to improve care and make medicine safer. None of the infections we have prevented or the deaths we have avoided have been in any way due to any SCAM.

As far as I know there has yet to be any quality improvement in any SCAM except for the use of disposable acupuncture needles. Then just watch a video of acupuncture and see if you can see anything that resembles good infection-control techniques. A key feature of reality/science-based medicine is that it reacts to information and changes slowly, painfully, erratically, for the better. What we do works. Sometimes. And when it doesn’t it is abandoned or improved.

I am a doctor. As I mentioned in another entry, I see medicine as a calling. I, and many of my colleagues, have literal responsibility for the health, life and wealth of people. We see people every day who lose all three because of bad decisions or a lack of insurance.

I am always more than a little saddened by the intravenous drug users I see. There are those whose main attitude is that IVDUs made a choice and get what they deserve. I see a life wasted and it is sad. Or the AIDS patient who does not come in due to a lack of insurance until the immune system is beyond salvage. Or the middle-aged black female whose first manifestation of high blood pressure is a large stoke. Every day can be a reminder of how fragile and transient life is.

I am not worried about me and medicine. I am not worried about my position, I worry about the next person who may needlessly die or be injured by a treatable illness because they opted instead to treat their cancer with alkaline or deny that HIV causes AIDS or treats their diabetic foot infection with honey.

So when people throw away their life, their health and their wealth pursuing alternative interventions that do not work, that cannot work, it tends to be a motivator. Most SCAM is based on fantasy and fantasy kills and maims and bankrupts. And that makes me angry. And so I continue to always, scribble, scribble, scribble.

Often we get the phase ‘do not throw the baby out with the bathwater’. In the world of SCAM, I am not certain what is the baby (the result?) or the bathwater (the SCAM therapy?). It is a non sequitur. There is no pseudo-medical bathwater that will clean any baby. A more apt cliché concerns emperors and his new clothes.

And as to the idea of ‘first, do no harm’, it is a concept that has never been true in medicine. All actions, and inactions, can have consequences that can lead to harm. There is no way to avoid harm. Glib aphorisms may be a nice way to avoid considerations of complex phenomena, but, like much of SCAM, have little to do with reality.

My job, my responsibility, my calling as a physician is, to the best of my ability, diagnose and treat your illness. That cannot be done by applying ideas that are based on fantasy to problems that come from reality.

I do not doubt that most of those practicing pseudo-medicine have nothing but good intentions. That does not make what they do good, correct, or effective. This blog and its cousins exist because we care that people suffer and die and lose money and hope and time by participating in nonsense. It is a waste of lives that will never have a surfeit of the characteristics that pseudo-medicine steals from the people who use them. As Terry Pratchett noted:

The road to hell is paved with good intentions. (This is not actually true. The road to Hell is paved with frozen door-to-door salesman. On weekends, many of the younger demons go ice skating down it.)

Others have summarized my position far more elegantly than I am able:

No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend’s or of thine own were: any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bells tolls; it tolls for thee.