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Nov 02 2013

Why the Quack?

The family had just come back from a holiday in a malaria area. I asked whether they had taken prophylaxis.

“No.”

I asked her how she would treat one of her children if he became sick with malaria.

“At the homeopath.”

“And cerebral malaria?” I explained what that was, and the high mortality rate.

“Still at the homeopath.”

“What if your child became ill with meningococcal meningitis, and there was a normal doctor nearby with the emergency antibiotics that would be critical in offering hope of cure?”

She wavered slightly, and I pounced.

“You would rather risk your child’s life than see a normal doctor?”

This is from a conversation that Martin Young had with a friend and it’s rather a scary one.

In that the person genuinely believes that the magic shaken water has properties that can face down one of the deadliest diseases ever to have plagued mankind.

But it begs the point? Why would you even believe such nonsense. After all? I assume the simple sloshing of water around and it’s subsequent homeopathic dilution by the ocean doesn’t mean that water maintains the magical  properties of human urine, yet it does so  when struck with a leather wrapped board?

The faith in quackery is something Martin goes into and I would like to expand on that.

I suspect the following points are critical in the growing popularity of alternative methods:

And some of these are right and I can explain why they are popular and what the issue is.

1. Faith of the patient in the art, method or skill of the healer.

The trappings of medicine have changed a lot. Gone are the white coats associated with doctors and in have come scrubs and other clothes that are better for infection control.

And gone are the jack of all trades doctors. Because one cannot know all of medicine one has to specialise. Experts in specific fields rather than the jack of all trades.

Many a quack exists on the notion that since he is a total expert and a “holistic” care specialist he is the equivalent of multiple fields of medicine. The truth is that most of the alternative medicine brigade are either very shallow in it’s understanding of human biology or worse? Have no understanding of human biology at all.

However? It’s replaced by pseudoscience and as always pseudoscience is easier to understand.

2. No expensive referral to specialists, and no “passing of the buck” between doctors.

This is a dangerous notion. The field of medicine is vast. As is the field of IT. An expert in one sort of software cannot be given another set of software and be expected to perform ideally.

Passing the “buck” and calling specialists are seen are responsible behaviour outside of the alternative medicine industry. Which is why it is so bizarre to see a “homeopath” or a “chiropractor” not call on specialists. It amazes me the number of Chiropractor who make grandiose statements about the state of their patient’s spine with nary an X-Ray or a CT or an MRI.

Of course the alternative medicine brigade dismiss these tools. After all? What mystery remains if you can simply use basic photographic principles, alteration of “light source” and a detector to allow you to look through stuff.

3. No expensive investigations — the method is the art and is complete.

Which again scares me. Do people think you can detect anaemia accurately via pallour and central cyanosis? Must our patients come in exhausted, pale blue and with a hyperdynamic pulse before we correct anaemia when a simple blood test assessing haemoglobin is better, faster and detects anaemia at an earlier stage?

No the problem here is the notion that is flogged. That investigation is unnecessary. All you need for diagnosis is history and whatever passes for examination among the alternative medicine quacks.

4. No need for medical insurance.

See my stance on “socialised medicine” and why I think universal healthcare is important. And you don’t need medical insurance because they aren’t medical. They are quacks. You don’t need medical insurance for a massage either but you pay a masseuse for that. A chiropractor is in effect a masseuse who discovered that they can charge a lot more if they wear a white coat.

5. Time spent in the process and method of healing .

I will grant you that. The quacks have time on their hands. Time enough to sit with patients and take down colossal and detailed histories. The quack looks like he is putting serious effort into fixing you while the doctor doesn’t because medicine treats a variety of diseases in an effortless fashion.

Diseases that once were deadly are no longer so. Once diabetes was a death sentence. Now we wouldn’t give you the time off unless diabetes did something terrible to you.

6. Listening and communication skills.

Again this is something that does separate a lot of good doctors from the bad. You need to learn to communicate and listen to patients.

The problem often lies with patients not thinking some things are important. The quacks have made a killing in recognising minor niggles of age and life and milking them. They have made a killing in taking untreatable syndromes and the like.

They are telling people what they want to hear rather than what they need to hear.

7. No prospect of hospitalisation.

And in order to make this one work the quacks demonise hospitals as places of death. Sure, most of us will probably end up dying in a hospital but frankly that is because the hospital is the place people are making an effort to get you to live. Instead the hospital is portrayed as part abattoir part morgue.

It’s the notion that you can heal yourself with every day objects around the house. You don’t need all those fancy toys, a real doctor can make do with a pointed stick.

Which is the problem in a lot of third world medicine. No Fancy Toys.

8. Limited medication costs.

Actually if one looks at the long term costs of Alt. Med one can often see the medication costs are not high immediately but require regular usage. All those add up. My particular favourite was a woman who proudly claimed her homeopath cured her of a disease in just 2 years and a few months. A disease that should take a few weeks to treat with medicine.

Either she didn’t have the disease or was conned thoroughly. The costs are limited but the overheads are low. After all? There is only so much you can overcharge water for.

If I look at these points I see that modern conventional healthcare has become a frightening place for many where high costs, painful or uncomfortable interventions and uncertainty rule. That alternative healthcare, for all its unproven and mystifying claims, is a safer and less scary refuge, where “healing” is the art and process of enabling the body to heal itself.

The claim is that it is safer but in nearly every single life threatening condition or chronic condition, the medical option has always performed better than the untried, unproven and unscientific.

So what have we, the conventional medical system, lost in comparison? I think it may be the knowledge of the “warm and fuzzy” things about being healers — the mind-to-mind interactions, the common purpose, the reassurance, the art of medicine. We have come to believe that every presenting complaint needs to be analysed, tested and treated, with focus on the problem rather than on the person.

You might say modern medicine is in danger of losing its soul.

The soul of modern medicine is compassion and science. The problem is medicine has exceeded normal understanding making it akin to magic.

In the same way that people feared CERN was going to rip a hole in the universe and destroy everything, medicine is filled with bogeymen.

And it’s hard to actually educate people but we can give it a whirl. But as for now the main draw I see in Alt med is the claim that the patient is responsible for his own cure rather than “medicine”. It’s nicer to think that you personally fist fought cancer to submission rather than hung in there while the medicine and surgery did the job.

But the biggest danger is that the quacks who push alt. medicine are treated as an opposite voice do doctors and when they give bad or even deadly advice they are still considered experts.

2 comments

  1. 1
    Alex C.

    Thanks for sharing Dr. Young’s article. Bookmarked!

    The comments on his page are most interesting. Most have interpreted it as some kind of endorsement of scAM over Modern Medicine!

    My reading is that it presents a good modus operandi for the enterprising physician who wishes to enlarge his practice and compete with quacks or other physicians effectively. Giving the patients what they *want* (white coat, cheerful surroundings, demure, conservative manner, a patient ear) is not necessarily incompatible with what the patient needs (antibiotics? :-)), especially if they’re willing to pay for it! Of course, the cost of medicines and treatment should be low enough, but that is another matter.

  2. 2
    Giliell, professional cynic -Ilk-

    The problem often lies with patients not thinking some things are important.

    Well, they are the patient, not the doctor.
    It’s the job of the doctor to ask for these details.
    If the patient knew that minor detail X combined with details Y, A, Q and F add up to the diagnosis of hipohyperwhatyougot they wouldn’t need to see the doctor.
    It needs a professional to see the pattern in these apparently unrelated things

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