White Coat Underground

I’ve frequently written that alternative medicine beliefs are much like religion, and often cult-like. When reading about alternative medicine, you’ll often encounter charismatic leaders, faith in the unknowable, and conversion experiences. A fine example of the latter is currently up at the Huffington Post. It’s written by “Dr” Patricia Fitzgerald, HuffPo’s “wellness editor”. Just to remind you of her credentials, she is a “Licensed Acupuncturist, Cert. Clinical Nutritionist, Homeopath, [and] Author.” In other words, she’s not a doctor in any well-recognized sense of the word.

Her reasonably interesting interview is of Susan Smalley (who could rightly be called “Dr”, having a legitimate PhD). Smalley is a former scientist who had a typical conversion experience parroted credulously by Fitzgerald. Unlike actual medical knowledge, Smalley’s knowledge is “received” rather than rationally developed. It is faith, not science. That’s just fine, except that UCLA is actually paying good money to sponsor this new religion under the guise of science.

This new faith is called “Mindful Awareness” or “mindfulness”. It is, “the moment-by-moment process of actively attending to, observing and drawing inferences from what one experiences.” That sentence leaves me feeling unsatisfied—it doesn’t actually say anything. We are all “mindful” in that we, as sentient beings, continuously attend to our environment and draw inferences from experience. When it comes to forming valid hypotheses, these inferences are subjected to rigorous testing so that we do not rely overmuch on our intuition, as it frequently deceives.

Smalley is a geneticist who unfortunately developed malignant melanoma, which she survived thanks to modern medicine. This mortal threat seems to have driven her to this new faith with the zeal of the newly converted. This zeal has obliterated any signs of logical thought. For example:

Patricia, I received a real wake up call when I was diagnosed with an early stage melanoma. It was a big shock. I thought I was going to die. I really reevaluated my life. I realized that I was doing everything Western medicine said keeps you healthy (working out, diet, etc.) and yet I was not preventing myself from getting ‘sick’. The shock of the diagnosis and the fear of death really brought me to a heightened awareness.

One of the core assumptions here is that melanoma can always be prevented; it cannot. Often it can be, by scrupulous attention to sun avoidance. But it’s no guarantee. There are many diseases (most in fact) that are not entirely preventable, and the blame cannot be hung on “Western” medicine, as any geneticist should know. But her conversion was rapid and complete, allowing her to ignore the facts before her eyes:

The medical treatment for my cancer was successful; however, I felt that there was something deeper going on with my overall health.

So, “western” medicine, having failed to help her prevent all disease, did manage to cure her. But that wasn’t enough. There must be some deeper secret, right?

I decided to go back to an East-West doctor that my husband had recommended earlier. I had started going to him 10 years before, but I didn’t believe in him. I just would roll my eyes. I was so skeptical. He would give me suggestions of ways to improve my well being, and I didn’t follow through.

But when the melanoma was diagnosed, I thought, something’s not working. I thought I was doing everything right, but something’s off.

So for the first time, I listened to what he said and started doing everything he recommended. This included massage, acupuncture, taking herbs, different forms of yoga. On my own, I decided I would explore dietary changes, too. I looked into all of the diets and I went really hardcore into macrobiotic. I did all of those things simultaneously. And I started meditating.

Here is that same streak of punitive thinking seen again and again in alternative medicine. If you get sick, it can’t be a simple twist of fate—you must have done something wrong.

No amount of meditation, no amount of prayer, no type of diet will protect you from all disease (Smalley started a strict macrobiotic diet; wasn’t cancer bad enough?)

Human beings love to claim control over the uncontrollable. Sometimes the seemingly uncontrollable isn’t. For example, we can cure many melanomas. But some tragedies are neither predictable nor avoidable. Sometimes lightning strikes you even if you don’t go golfing in a thunderstorm. Life can be terribly cruel and contingent. Still, it’s better than the alternative.

If following health religions makes the world seem less scary to you, fine, but proselytizing is dangerous. Many feel that faith has it’s place, but in medicine, reason must not be surrendered to imagination. Our decisions can kill, no matter how good our intentions.

Comments

#1 lwwalker
July 15, 2009

It is always disappointing to me when an author like “Dr” Fitzgerald or Dr. Smalley take a perfectly reasonable practice — like using meditation, yoga, acupuncture or general “mindfulness” as a tool to cope with stress and try to imbue it with magical qualities. In fact, Smalley accidentally points out exactly what these practices are good for:

“I was in therapy for stress, worry, parenting. I felt stressed, and wanted to do the best I could do with my kids. Therapy helped me open up on one level.”

and then . . .

“This was like a mega retreat on my own. Then I’d pick my kids up from school and do the normal mom stuff.”

She treated her stress with alternative “medicine” and her cancer with advanced real medicine. Why can’t they just leave it at that?
#2 JustaTech
July 15, 2009

I, too, have had a real PhD suggest that I use “mindfulness”. But the difference is that it was my shrink who suggested it, as a way to help me deal with how I think about my self. It was never suggested that this would “treat prevent or cure” anything. It was just a tool for how I think about myself. For that, it’s great. But for anything else, well, I’d need to see some studies.
#3 DVMKurmes
July 15, 2009

“Human beings love to claim control over the uncontrollable. Sometimes the seemingly uncontrollable isn’t. For example, we can cure many melanomas. But some tragedies are neither predictable nor avoidable. Sometimes lightning strikes you even if you don’t go golfing in a thunderstorm. Life can be terribly cruel and contingent. Still, it’s better than the alternative.”

I couldn’t agree more. I often have to explain to people that a pet’s cancer is not their fault, and buying a more expensive food or whatever would not have prevented it. This is a natural tendency in people that the alt-med crowd take advantage of all too often. At it’s worst in the veterinary field, this type of guilt can result in needless suffering when misplaced guilt leads to attempts to prolong life beyond all reason or searches for a miracle cure. Fortunately most people will listen and understand that they were not at fault, but on occasion I have run into people who were into one type of woo or another and really did a disservice to their pets.
#4 Anon
July 15, 2009

The Psych literature on perceived control suggests all sorts of health benefits from a perception of control over events in one’s life. (I am away from books, but if memory serves it is even the case that) When events are genuinely uncontrollable, secondary control (“I can’t control it, but god can, and I can pray”, or “I can’t control it, but I can try to be one with the Karmic forces that do”) or even post-hoc control (“If I had only taken a different path home, I would not have been attacked”) can give benefits over the painfully true recognition that bad things can and do happen to you even when you do everything right.
#5 Denice Walter
July 15, 2009

Being punitive fits hand-in-glove with their “religiosity”:if you break the *Law*,be it Mosaic or vegan or enzymatic, you will know the “Anger of the Living God” (or Living Vegetable?or Live Food?).I characterize some of our “favorite” woo-meisters as “preachers”,trying to attract converts, preventing “backsliding”,threatening punishment if you “sin”(i.e. eat meat,wheat, dairy, or chocolate),promising *salvation* if you obey(Nearly eternal life!No cancer!).I suspect some see themselves as latter day Messiahs, or at least new age Moses’ leading the poor lost children of Eve to the promised land of unprocessed food.(Interestingly, when Wm.James described the “Varieties of Religious Experience”, he contrasts the incredible fervor of the “unschooled” revival preacher, enraptured in his own “revealed truth” compared to the more reflective,studious minister.)Wash away those sins,I mean toxins. Resist temptation, sugar is so totally not “kosher”.
#6 mlb
July 16, 2009

“Health religions” is a great term for it. It has all the features of religion, strong faith in the irrational, the attitude that your more enlightened than the rest of the world, the “I used to be a sinner then I saw the light” line, the fact that practitioners of it get extremely anger if you question their logic, and the proselytizing.
#7 Denice Walter
July 16, 2009

Oh, and every *true* religion needs an enemy,a satan,a Great Fallen Lucifer,a hierarchy of depraved demons to preach *against* vorciferously.That’s us.
#8 Rainbow Scientist
July 16, 2009

Great Post! Like any religion, this health religion gives people abstract hope and is good for that quality. It is no alternate to modern medicine/methods but should be used as a complimentary method.
#9 ebohlman
July 16, 2009

Denice and mlb: In fact, the notion that all or most disease is the result of “unhealthy lifestyle choices” is nothing more or less than the old-fashioned notion that disease is the wages of sin (it’s no accident that the hyperreligious call homosexuality a “lifestyle choice”). The simple fact is that once you get past the “heavy hitters” like not smoking, not driving under the influence of psychoactive substances, and not having unprotected sex, the impact of one’s behavior on one’s health and life expectancy is much more limited than most people believe.
#10 Jane
July 17, 2009

PaMD writes that he is interested in why patients get taken in by charlatans. Webster’s online dictionary defines a charlatan as a quack, n., A person who makes elaborate, fraudulent, and often voluble claims to skill or knowledge; a quack or fraud.

Many alternative patients and practitioners see MD’s as making elaborate, fraudulent, voluble claims to skill and knowledge. MD’s have some knowledge, and are indispensable for emergency medicine and some surgery. But they overestimate their knowledge and underestimate the knowledge of alternative doctors.

PAMD’s criticism of mindfulness is a case in point. I have cleared many symptoms by being aware of my body and mind. Over time, I become aware of patterns, this symptoms happens when I eat that, or drink this, or smell paint or gasoline, or take this or that vitamin or herb. If a connection between environment, food or vitamin. herb or chemical happens once, I may notice it, twice, I suspect a connection, third time I become more certain. I check and recheck and recheck. My body may change, so I continue checking. This is true inquiring empiricism. Yarrow makes it harder for me to pee, as does tea. I say this in case anyone wants to accuse me of the natural must be good fallacy. Wheat makes me constipated and depressed and hungry.

The reason my own personal mindfulness is an end in itself and not a mere preface to “real” research is that people are different. Just because yarrow makes it hard for me to pee doesn’t mean it will make it hard for you. Because wheat doesn’t agree with me doesn’t mean it won’t agree with you. Each person needs to be aware of research that covers large numbers of people, but also needs to make personal observations about his or her own body and mind. This is also science. If PAMD wants to denigrate that, that is his decision. My decision is that he has wants to increase the power of conventional MD’s at the expense of infantilizing patients, not because he is power hungry but because he has an exaggerated, faith based notion of the rightness of his medical denomination.

The interview PA md quotes sounds sort of dippy to me too, although as PAMD points out, the woman had a difficult and frightening experience. I say, if you want to criticize your opponents, you should choose their most capable, not their less capable representatives.

I also say that (see above paragraph), we do have huge power over our symptoms. Environmental doctors have found that a host of chronic illness symptoms can be controlled by finding the allergic triggers and avoiding them, whether they are sugar “bad,” or garlic “good,” or oats “good,” or green peppers “good” or white flour “bad.” Each person is different. Many people can discover their allergic triggers by themselves, and others with more complicated allergies can do so with help from alternative and environmental doctors. People have been cleared of diabetes, rheumatoid arthritis, asthma, ear infections, irritable bowel, acne, back pain, ADHD, depression (try avoiding coffee), anxiety, schizophrenia, by discovering and avoiding allergic triggers. I suspect that macrobiotic diet helps many people because it avoids so many of the common foods people are allergic to. I have also been helped by some homeopathic medicines, but not all, by chiropractic, removal of mercury fillings, all treatment modes frowned on by conventional MD’s
Anyway, the claim that people have almost no control over their health through diet and environmental controls or non allopathic treatment is quackery. Quackery is in the eye of the beholder.
#11 MonkeyPox
July 17, 2009

Quackery is in the eye of the beholder.

Um, no, it’s not. Real doctors don’t make extravagant, non-evidence-based claims (at least, not usually). Quacks like Neustatdt make stupid-ass unverifiable claims. That’s objective quackery. Your multi-paragraph, touchy-feely goat-fuckery is non-sensical. What you choose to believe has little to do with reality. If you really believe you can magically cure heart disease with your mind or whatever, great…you’ll save us all precious resources.
#12 Igor
July 17, 2009

@10: Brilliant insight. Diabetes – an inconvenient allergy.
#13 Blake Stacey
July 17, 2009

Her reasonably interesting interview is of Susan Smalley (who could rightly be called “Dr”, having a legitimate PhD).

What kind of disease is “philosophy”?

</old-joke>
#14 Matthew
July 23, 2009

I’m a research PhD sort and clinical psychologist – this is a hotly debated topic in mental health research at the moment. “Mindfulness” inspired therapies may (according to Teasdale, Zindel, et al.; Mindfulness-Based Cognitive Therapy) be effective in preventing major depressive episodes among those with chronic recurrence; additionally, it may actually play a curative role in Dialectic Behavior Therapy, the first in a growing body of evidence-based treatment to successfully mitigate the once-thought-untreatable Borderline Personality Disorder. There may be some there there, as they say.

That said, even Teasdale and the MBCT crowd wind up spending a lot of time, so far as I can see, at professional conferences trying to tone down the fervor, remind psychologists that the initial data didn’t support MBCT for those with few or one depressive episode, etc. There’s something very cultic that has arisen side by side with the mindfulness-based therapies that is a little scary. If you want some additional fodder on this front, look into behavioral therapists critical of Acceptance & Commitment Therapy (ACT) – another therapy on the mindfulness spectrum that attracts quite of a few hopefuls sure of miracles due any day now!