Mark Crislip has a nice piece up at Science-Based Medicine about the battle against the medical “de-lightenment”. In his post, he looks at some data about what sorts of criteria anti-vaccinationists use in their propaganda. Not surprisingly, appeals to emotion and to pre-existing beliefs are much more common than actual facts. The question then becomes, “Why bother?” We on the side of science-based medical humanism tend to believe that education is the best solution to problems such as implausible health claims, but since these things function more as belief systems than as opinions informed by facts, what’s the use? Do we seriously think we can de-program the victim of a medical cult?
Certainly there are those who are nearly beyond our reach, but only nearly. As I allude to in my Quack Miranda Warning, there are a number of categories of people we need to reach. There will probably always be those who are quite beyond redemption, but my optimistic side believes (without too much data, granted) that there is a large group of those who, while not experts, and relying on their own interpretations of their own observations, are humble enough to be swayed by facts. I view the population as being in a dynamic equilibrium of sorts, with perhaps a core of unalterables, but a vast pool of those who might be swayed by fact or emotion into one camp or another. Our job is to help them favor the right side. And their is a right side. It is not a matter of two paths to the same destination because some things make and keep people healthy, and some do not.
The science of medicine is quite specialized and detailed, and much of it relies on at least a basic knowledge of biology, statistics, and probability. These skills are naturally not going to be the everyone’s strength. When we discuss ideas such as “plausibility” we sometimes mean something quite different from the lay public. And while we all view reality through the prism of our emotions, those of us devoted to a science-based medical humanism try to at least ascertain the facts in a way that is as objective as possible. This dispassionate approach can be difficult for those who are not used to it.
Many of us view being a healer as a calling of sorts. This adds a somewhat odd spiritual quality to the work, and makes us susceptible to confounding helping with deception. Our responsibilities to our patients are complex, and while deception is not always wrong, it is nearly always wrong and the bar of justification is quite high. When a dispassionate approach is applied in a humanistic way, it is oddly no longer entirely dispassionate but compassionate. As caregivers, it is easy for us to confuse that which makes us feel good with what is actually good for the patient. When we tell patients that a certain treatment is going to help them, knowing that it will not, we feel that we have done something, and we have—we have used the patient to fulfill our own needs to feel competent and caring.
In combating the promotion of fake medicine, we can still appeal to emotion, and we must. If, as Dr. Crislip showed us, we rely only on facts, we will be talking to ourselves and a small coterie of the dispassionate. We must remind people why we care about real vs. fake medicine. We must be Spock and Kirk, because this is not about utilitarianism, it’s about individual patients. We must remind people that this is about real people and real problems, that when you avoid vaccination you and yours may be harmed, and that the harm of avoiding vaccination is much more likely than any putative harm of vaccination itself.
But we must also attack the charlatans, because they are hurt people. They are immoral. True belief is not exculpatory. Those who promote useless practices such as acupuncture, homeopathy, and reiki are sapping people of resources and turning people away from the hard truth: there is no magic. Health and healing are difficult and capricious. No lasers, no hypnosis, no magic potion will stop smoking or cure obesity, or shrink a tumor. Anyone who suffers from these problems or treats them daily knows how difficult it is, and has seen our patients and loved ones reaching for any light in the darkness to help them find a way out. And we’ve seen the disappointment and self-loathing when they “fail” to be cured.
So-called alternative medicine hasn’t been shown to work—that is what is “alternative” about it. And it is cruel. It teaches people that if they are would just believe, close their eyes, and tap their heels, all will be well. When it doesn’t work, it isn’t the failure of the nostrum but of the patient who didn’t believe enough, didn’t pray hard enough, or just needs a few more treatments. This is the reason we care. We care because we want to help, and are willing to admit that we there is no cure for the arrow of time, an arrow which will pierce us all. We help people dodge the arrow as long as possible, but ultimately we all lose. Fantasies to the contrary are the tools of priests and shamans, not real healers.