Alternative medicine is very profitable. Herbs and supplements are a multi-billion dollar industry. The practice of primary care medicine is not terribly lucrative, and adding on some “integrative medicine” can turn that around. A primary care doc can significantly increase their income by selling supplements and offering unproven tests and treatments. These are not covered by insurance, so patients must pay cash—and who doesn’t love cash? But how can you get your pigeons to fly in the door?
The folks out there selling miracle cures and spreading the ideology to support them have some serious reach. Regardless of whether one is a “true believer” or simply a cynical leech out to make a buck, it’s easy to spread the word and bring in the suckers. Supplement companies fund tons of advertising, the government allows all sorts of unproven claims to be made, and certain media outlets (such as the Huffington Post) vigorously spread the good word.
There are many myths that help spread the gospel of alternative medicine. Most of them are negative statements about real medicine rather than affirmative evidence for an alternative. It sometimes seems the fight against quackery is never-ending. It’s been a while since we’ve reviewed some of the tactics of the opposition, so let’s go over a few.
The Turf Battle Fallacy
A common accusation is that real doctors are simply protecting their best interests. If we don’t criticize alternative medicine, we’ll lose business to those enlightened enough to embrace the future.
There are several reasons that this argument is a bucket of guano. First, primary care physicians aren’t hurting for business. We might not always get paid as much as we think we should, but we can only see so many patients in a day, and with the current shortage of PCPs, many offices have waiting lists.
Second, this argument assumes that most doctors are primarily motivated by profit. We all need to make a living, but most doctors who choose to practice primary care are aware of the fact that our incomes are more limited than our specialist colleagues and people in some other professions. And while the barrel may contain a couple of bad apples, most doctors prefer to practice ethically and altruistically. One study from the Journal of the American Medical Association found that:
Rather than declining income, threats to physicians’ autonomy, to their ability to manage their day-to-day patient interactions and their time, and to their ability to provide high-quality care are most strongly associated with changes in satisfaction.
Most doctors are in this profession for the right reasons, and when we rail against quacks, we do it to protect our patients, not ourselves.
The Pharma Shill Gambit
Orac coined this term several years ago, and it’s probably the silliest idea that quacks have come up with—and one of the most effective. This lie works because it contains some truth. There have always been unscrupulous doctors shilling for industry, but most of us think we are uninfluenced by, say, a free lunch. Our own literature has shown repeatedly that doctors’ prescribing habits are influenced by seemingly innocent interactions with drug company representatives, even when we think we are not being influenced. This insidious level of influence is very different from the accusations thrown around by many altmed advocates who accuse us of purposefully mistreating our patients to benefit industry.
Still, we must strive to eliminate even unconscious influence, and that’s exactly what we’re doing. Two years ago, the Association of American Medical Colleges called for the elimination of pharmaceutical gifts at medical schools and teaching hospitals, including free lunches and support for continuing medical education (CME). CME is particularly problematic because it is a requirement for all physicians who wish to maintain their licenses, but it isn’t cheap. The data show that the pharmaceutical industry understands how to influence us. And we increasingly understand how we are affected and are working to limit this. In addition to the AAMCs efforts to protect trainees, our own organizations and publications are calling for stricter and stricter limitations on our interactions with PhARMA.
Industry influence on doctors is rarely a quid pro quo phenomenon. It is a subtle influence which we are working hard to purge. To argue that doctors, for example, prescribe vaccines because we are in the thrall of Big PhARMA and need the money is simply false. We have been influenced by, but have rarely profited in a direct, monetary way from industry influence, and this is changing for the better.
Medicine, and the world in general, is a bit more complicated than the quasi-religious altmed crowd would have us believe, and doctors much less sinister.