Jenny McCarthy not dumb enough for ya?

Yes, that's right, the Huffington Post, that broadsheet of blarney, that tabloid of medical trumpery has done it. Not content to risk our mental health by lending legitimacy to all kinds of pseudoscientific charlatans, they just let Jim Carrey write a piece on vaccines and autism. Yes, the boyfriend of uber-fukwit Jenny McCarthy has drunk her Kool Aid, but that's no surprise. I'll leave a good fisking to others, because a few of the commenters showed signs of higher cortical function, and this deserves some coverage.

Take this one for example:

I think Jim and Jenny McCarthy are instilling more guilt and fear in parents and the end result is the children do not get the inteventions they need to help them. If the energy was placed in offering and providing autistic children proven therapies that help them participate in a full life (i.e. ABA) then all our kids would benefit. Instead a very vocal celebrity is focusing the attention on psuedo/junk science and her child who may have actually been misdiagnosed. Just one more thing for anxious parents to feel guilty about? Very irresponsible and I spend much of my time reassuring parents that they are doing the very best they can and to NOT read anything Jenny publishes or rants about on Larry King. Jenny is selling books and making non-proven theories very profitable for her quasi-doctor friends on the backs of autistic kids and their parents.

I'd like to expand on an important point made by this commenter, who is a parent of an autistic child. There is a punitive tone to much of so-called alternative medicine. I agree with the commenter that this idiocy helps engender a useless sense of guilt in parents. It makes them feel they have to choose between protecting their kids from infectious diseases and protecting them from autism. If they've already vaccinated their kids, then it makes them feel they've harmed their children.

This punitive approach takes a couple of forms. Take these comments from earlier threads:

Yes, presciptions are easier and cheaper to prescribe. But often, they are an attempt to undo the damage that the patient constantly inflicts upon themselves.

In this case, the commenter expresses a common sentiment, that the patient has caused their illness. This may be true, but what is the corollary? Let's ask a naturopathic doctor. With regards to a diabetic patient:

I send him home with "Dr. Richard Bernstein's Diabetes Solution" ...He has to read at least the chapters on the diet. He does a diet diary for a week and records his fasting, and 1.5 hr post-prandial glucose levels as well. ... I'm not too concerned with his 230 blood sugar; with my protocol that will come down substantially ...I'll send him away with blood work orders at local lab, diet diary, chart to record his blood sugars, prescriptions if necessary, Bernstein's book, a clearly detailed Treatment sheet.

He'll come back next week when I'll go over the blood work with him, describe the strict Low Carb diet he must follow via a very detailed handout I have, which includes components of eating healthily as well. I also go over the supplements I'll put him on (vitamins, minerals, fish oils, herbs, accessory nutrients), recommend exercise (if he has been cleared by the cardiologist), stress relaxation techniques which resonate with him, if necessary. Let's say he's NOT on insulin, so I don't have to describe all the comprehensive ways I deal with that. I give him directions that if his blood sugars go down frequently below 100 mg/dl to call me ... I will see him weekly or every two weeks until he is stable and we have dealt with all problems, which usually just takes 2-3 visits. We will lower or remove medicines, as necessary...

So, if the patient's behavior is a major factor in their illness, what happens when they don't change their behavior? What if the patient can't do all that she recommends? What if the patient tries to follow her guru's diet book but fails? What if he doesn't even try? What if he starts smoking? Will she view that as her failure? As his?

The first day of my Pathology class, my professor asked, "Why do people come to the doctor?" People gave lots of answers, but he held up his hand and said, "Because they hurt," and he meant this in a very inclusive way---physical pain, worry, loneliness---all of these things drive people to the doctor. Few visits to my office fall under the "just checking in" category.

Patients come to see us to feel better. They often care little about how they get there. In medicine, there are many ways to become ill, many of which involve poor health practices on the part of the patient. These poor health practices often continue no matter how well you educate and support them. How should we treat our patients when they fail to heed our advice? Should we berate them? Should we tell them we have nothing else to offer?

Yes, we should try our best to help our patients change, but when we tell them that we have only one best way to help them, and then they fail, we've lost them. This is about real people, real lives, real suffering, and it frustrates me to no end that others are blind to this.