One of the hardest things about practicing medicine is being compassionate and dispassionate at the same time; acknowledging a person’s pain, but standing aside enough to view the problem with a degree of objectivity. This is one of the easiest mis-steps to make in medicine, and is the root of the problem of many so-called alternative medicine practitioners. Take a look at this email from a fan:
I find it interesting and short sighted that you (and many medical providers) require published research in order to be convinced that a new medical condition exists. Have you ever considered that prior to the discovery and research related to PCN (or any drug or any medical condition) didn’t make it a worthwhile treatment??? I am a medical provider and happen to know someone with what appears to be Morgellons and has been belittled and discounted trying to get help with our peers. Shame, shame – on you and most of our peers for being so closed minded.
I know a lot of people with a lot of horrible problems, and I allow that to feed my passion for medicine, but I cannot allow it to distort my view of how the science of medicine works. This will lead me to wrong conclusions, and in medicine, wrong conclusions hurt real people. This is one of the main reasons that it’s a bad idea to treat family members, and for that, I have a brief example.
About a year ago my daughter was on rounds with me at the hospital and we stopped for a cookie. A little while later she started whining and complaining of not feeling well. She started coughing, and complaining of a stomach ache, so I took her home. Her cough got worse and she started wheezing, so I gave her a breathing treatment. Then she got hives, and we gave her some benadryl. (We did call her doctor during all this.) I thought that she was simply getting one of the many respiratory viruses that she loves to catch, but my wife correctly diagnosed her as having a severe allergic reaction.
After the breathing treatment and the benadryl she was fine (it turns out she’s allergic to nuts) but it was remarkable how easily my connection to the “patient” overcame my ability to recognize a common medical problem. Cultivating objectivity is not “closed-mindedness”—it is an essential tool in the practice of medicine. If we allow our passions to rule our thinking rather than inform it, we will injure and kill people.
And speaking of allowing our passions to overcome the cold, harsh light of science, the Connecticut legislature has done something rather foolish—-it has decided to take a try at practicing medicine. They have a good model for this in their attorney general, who tried something similar and lost his little battle, all the while claiming victory.
To remind you again of the particulars, the Infectious Disease Society of America publishes guidelines to treating many infectious diseases. These are non-binding, expert recommendations. They recommend against long-term antibiotics for so-called chronic Lyme disease (CLD), where people have a host of vague symptoms and no microbiologic evidence of current infection. The paranoid host of chronic Lyme disease boosters, led in no small part by far-from-dispassionate “Lyme-literate doctors” who stand to benefit financially, lobbied the CT AG to go after the IDSA. He charged them with some sort of “anti-trust” violation, and when his case was shown to be ridiculously hollow, he backed away, having gained nothing (except for future votes). The IDSA agreed to re-evaluate their guidelines, but not to change them.
This having failed the CLD boosters, they turned to the CT legislature. Remember, there is nothing binding about the IDSA guidelines. CLD docs will claim that these guidelines affect what insurance companies will pay for, and they are probably right. Insurance companies don’t like to lose money on disproved, dangerous treatments (or anything else for that matter). In one of the few cases in which I will side with an insurance company, it would be folly for them to waste money on treatments that are not even experimental, just wrong. But this doesn’t make them illegal.
So the legislature has passed a bill which is supposed to protect physicians who treat CLD. Exactly what this means isn’t clear to me. It essentially forbids the state from going after doctors for prescribing long-term antibiotics for Lyme disease as long as they document that they think the patient has it, and their treatment plan.
I’m not sure how that’s any different from the status quo. Currently, there is nothing to prevent a doctor from deciding that a patient has Lyme disease and then treating it however they see fit. The law give a lot of room for quackery. I could, theoretically, decide that a patient has Lyme disease and treat them with long-term antibiotics, mushrooms, or lawn clippings, and the only real consequence would be a malpractice suit. State medical boards are very reluctant to interfere with physician autonomy.
CLD advocates are declaring an important legislative victory, one which accomplishes nothing. It lends neither scientific nor legal status to their putative illness. It does, however, show how passion can be mistaken for compassion; how people’s real suffering can be so compelling that doctors allow themselves to lose their objectivity, succumb to unscientific ideas, and strangely enough, manage to profit from it.