Woo in the medical profession?

I just got around to reading Bart Farkas’ article in Swift concerning the growing problem of woo infesting the medical profession. Is this problem limited to schools of homeopathetic “medicine”, Reiki and the like, or is crap like this(or even worse, Therapeutic Touch) being taught in standard medical schools? If so, this worries me.

My own primary doctor is an MD, and he is pretty wooful. He believes in wooey things like adrenal insufficiency and systemic yeast infections in non-immunocompromised people. If he’s really insistent, I do let him check me for things like this, but otherwise I just tell him to skip it, I just want the “real” medical checkups. I put up with his wooeyness because he’s incredibly kind and helpful and very knowledgeable besides the woo. Dr. Andrew Weil has done a lot to influence MDs in favor of woo, especially here in his hometown.

Another doctor’s take on Andrew Weil and “Integrative Medicine”.

I used to work for a group of 4 doctors, one of whom was very much against Dr. Weil’s philosophies. Once, as a practical joke, one of the other doctors had a nametag made up that said “Dr. Andrew Weil” and surreptitiously attached it to the first doctor’s lab coat. The first doctor saw patients for a whole day with the nametag on before noticing. Ha! I love doctor practical jokes!

I am sure I have linked to this book before, but Bousill’s Snake Oil Science offers some good theories as to how doctors fall for woo. Doctors are human beings and, unless they are trained and practiced in scientific methodology and statistical analysis, they can fall prey to the same fallacies as anyone else. Confirmation bias, post hoc ergo propter hoc, and other logical fallacies, as well as a cluster of placebo like effects that make double blind experiments a must in medical research. In the book Bousill uses a hypothetical doctor to illustrate all the traps that can occur to reinforce an erroneous belief.

Say a doctor has a patient with chronic back pain who has been to other doctors already and tried every proven medicine with no relief. In desperation, he tries something wooish. Lo and behold, the pain recedes and he think it worked. He tries it on other patients and it works on them, too. He starts telling other doctors about and working on a paper.

Meanwhile the first patient’s pain has come back, but since this treatment didn’t work, she decided to seek out yet another doctor for help. And the second patient has gone back to the doctor because his symptoms came back, so the doctor increases the dose or repeats the treatment, still convinced it works. As time goes by, he treats more and more people, convinced he is doing a good thing. Meanwhile many patients that don’t improve just quit, or exaggerate their improvement, or forget that the pain always went away on its own for a while eventually.

Bottom line is practicing doctors are usually not research scientists and their practices are far from controlled studies. They are more consumers of science than originators. It is to be hoped that they have a higher resistance to woo on average, but at least some of them are going to fall for it.

First off, that article seems to be specific to nursing, not the MD part of the equation. It really says nothing about the problem among physicians or medical education.

That said, yeah, woe is woo. Yes, doctors are all sorts of folk and some do buy into all kinds of stuff. Some also recognize that there is a market demand for using some woo in their practices and minimally there is a real need to treat the woo our patients use and believe in with something less than disdain. And the thing is that we Western MDs would be in error to dismiss the woo out of hand; sometimes woo works (even if not for the reasons the woo-meisters think); sometimes it doesn’t; sometimes it is harmful; sometimes it at least gives a patient some sense of control. You know that something is up when Harvard has this:

The justification for it? More a response to the market demand of course than anything else, as the featured quote lets on:

The problem is letting your mind stay open without it becoming a sieve.

I think woo is a perfectly valid method of incorporating the placebo effect into one’s practice. You can’t ethically give someone a sugar pill for fibromyalgia, but if the patient believes that acupuncture will help ease their pain, and woo-hoo, it does, I think that just makes you a better physician.

I’d rather the physician found out what caused the pain in the first place. Using fake science does harm in the long run, to the patients and to the physicians.

I thought it would be obvious that it would only be done as “adjuvant” therapy.

Also, I picked fibromyalgia for a reason - the causes are still unknown. There are some theories on the matter but nothing that is generally recognized. So in a case like that, of course you would be treating the symptoms as best you could, but if reishi or whatever means the patient can use less morphine, I see that as a win-win.

The place of the placebo effect in medicine is a real conundrum. As I understand the research, the effect is real, it is caused by the brain releasing opiate binders, and it only works if the patient is deceived. It is really only the last point that gives me pause. We treat most pain with medication that only treats that symptom. Morphine and Vicodin don’t treat the causes of pain, they just relieve it. But how ethical is it to treat someone by lying to them? And by its very nature placebos rule out informed consent.

Another problem with using crap science as a placebo is the backlash if the patient does any research at all on the fake medicine given. The patient might very well start distrusting the medical profession as a whole.

I think that is both the beauty and elegance of this approach. The patient would have to be predisposed to some form of alternative medicine. This could be solicited during the interview. You then provide all of the normal care you would otherwise provide with the addition of offering a referral.

As long as you choose other practitioners who will not try to subvert your treatment and will not create false hope for the patient, then there is no ethical issue whatsoever. You also add the other health care provider (or whatever they should be called) as an additional source of information about the progress (or lack of same) of your patient. That alone can be very beneficial since people will tell their acupunturist or reishi practioner things they might not tell their doctor. Obviously all HIPAA regs would be observed.

Not if they are predisposed to the technique they themselves select. You would only provide a referral to a known party you would be able to work with and who would not oversell the alternative approach.

Providing fake “evidence” that real medicine is next to useless, while at the same time promoting woo-brilliant idea. The patient who has been deceived then goes on to tell his friends about how the woo works, and that it is even supported by real doctors.
No, thank you.

People seek out alternatives on their own anyway. Aren’t you a better doctor by providing some supervision of the process? And if you’re only able to spend 15min with patient, isn’t the additional source of info valuable in treating that patient?

You don’t have to be an overt supporter of whatever other treatment approaches a patient chooses, you just have to have an open mind. Saying, ‘I see you have an interest in Reishi. Would you like me to refer you to a practitioner I work with? I have no opinion on it’s effectiveness but if it is something you would like to pursue, I’m open to that idea.’ Is a lot different than saying ‘Even though you indicated no interest in alternative treatments, I think you should try Reishi since I know it really works.’

I don’t want to beat this idea to death, I’m just saying that since the placebo effect is real but can’t be used overtly, why not find ways to use it covertly that also happen to be ethical.

The fact of the matter is that no one knows for certain how or why it works - just that it does for many people. Also, in some cases things that were believed to be bogus turn out to be good science. I take 2 meds that 20 years ago would have been poo-poo’ed by mainstream medicine (Lovaza - a pharm grade fish oil and Niaspan - high-dose, timed release niacin). So you can’t say for certain that any given technique is completely bogus. The mere fact that results are not reproducible, while suspicious, does not mean that the technique is purely fraudulent. I would reserve such harsh judgment for things like “psychic surgery” and the like. I would be less inclined to dismiss techniques practiced for thousands of years and which are still widely used.

Back before I made the jump to academia, I was employed by a large private clinic. The clinic opened a “medical spa” as part of its services (over my mild objections), and one night they brought in some people to present a line of “supplements” they wanted to sell through the spa.

The presentation was downright insulting. These supplements were supposed to do everything from cure cancer to take off weight; they even said that certain combinations might help someone live to be 150 years old. Really, they said that. They offered to fly all of us to their training seminars. They had a thick folder of “supporting literature” that was not exactly fraudulent, but was carefully designed to look authoritative to people who couldn’t really understand it. It was a bunch of basic science studies from the Northeastern Scandinavian Journal of Nobody Cares that didn’t even really support what they were trying to say. Not a real clinical study in the bunch.

When I first heard about this, before the presentation, they assured me that it was only going to be sold through the spa, and that I wouldn’t have anything to do with it. But the folder of literature had our clinic’s logo right on the front.

I threw a fit. My bosses couldn’t understand why I was so upset about it–if people want to give stuff like this a try, and it’s their own money, what’s wrong with that? The problem, I said, is that all I really have is my reputation, and if I get behind one product line that’s obviously bullshit, people would be justified in assuming that everything else I say is bullshit.

I don’t know if they started selling the stuff or not. Within a couple of weeks I was putting out feelers for a new job. It really was the last straw.

All that said, if you look at the long history of our profession, the amount of woo is probably at an all-time low. I’m reading a book right now about a doctor in the early 1900s who made a fortune implanting goat testicles in men to improve their potency. People came from all over the country with $750 and a goat to have it done. Enzyte really doesn’t look so bad in comparison.

Well, I see several problems with that. 1)acupuncturists and reishi practitioners are usually not covered by HIPAA, are usually not interested in sharing information with doctors unless they are believers, and are delusional* and therefore not a good source of information even if they were willing. 2) by referring patients to practitioners who actually believe in their fake treatments you are siphoning money that could be spent on real treatments into fake ones. Sugar pills are cheap, most CAM treatments are expensive.
*Well, they are either delusional (because they believe in their woo), or they are frauds. Either way, not very trustworthy.

Actually these days we have a pretty good idea why how the placebo effect works. In the book I mentioned before, the author outlines some of the current research into the placebo effect itself. The two best lab studies were one that showed that the placebo effect went along with activation of the same area of the brain that is activated by opiates and one that showed that placebo effect went away when the subject was given opiate blocking drugs.

Bolding mine. Not reproducible means worthless, at least in the manner tested. If I give a patient drug A for migraines and it seems to work, but it never works better than placebo in trials, it means it is literally and actually not better than a sugar pill for migraines. If latter studies find it works well for migraine like symptoms of glaucoma, then that is a legitimate use proven by science.

The thing about alternative medicines is that as soon they are proven to work, they stop becoming alternative and just become medicine. Take yoga and mindfulness. Both have been proven to be effective against stress. That makes them real medical practices when used to combat stress. But someone telling you to use them to cure cancer is using alternative medicine.

My point in my post was not that doctors should embrace CAM (complimentary and alternative medicine). In the U.S. a few decades ago the doctor could write you a prescription for a wide variety of sugar pills and saline solutions. Doctors in some countries still do it. They did/do it because it is a cheap way to get the patient some relief when no real medicine will work. The practical problem is nowadays patients can look up any drug on the internet, so that makes it a lot harder to do. There is also the ethical expectation that doctors are honest with their patients.

It seems a shame to waste something that could provide even a little relief to those with no other alternatives. But that doesn’t mean we should keep shoving billions of dollars at charlatans who seek to undermine real medicine for the sake of lining their own pockets and boosting their egos.

And I should accept your gross generalizations because . . . you’re a doctor? Yeah. That’s “authoritative” enough for me. Fo’ shizzle.

Way to see the trees and not the forest sir. You still have no clue WHY those centers are activated - do you?

precisely. It may not be reproducible since it doesn’t work for everyone. I doubt it would work for me since I think it’s all ka-ka, but don’t tell my SO that if you expect to keep all of your appendages. I’m exaggerating. She’s really very sweet . . . and intelligent (Mensa, grad degrees, etc.) - believe it or not. She’s convinced that it helps her. I can’t prove her wrong and medical science has been wrong enough times in the past that I’m not going to take the absence of proof as being equivalent to saying these methods have been DISPROVED.

Yes, and for how many years were those same practitioners told they were full of shit? But as long as you say you’re sorry later, it’s OK? Right?

No argument here - so don’t tell people that they do cure cancer and if you find out that is what is claimed, disabuse your patients of that notion with all due speed.

Honesty includes admitting what you DON’T know.

You’re preachin’ to the choir.

Unfortunately Strassia, much of what we regular docs accept as the usual and customary also fails to have a solid evidenciary basis. We were taught to do it that way so we don’t think it is woo, but from a proven efficacy POV? Woo baby. Not everything we do is hard science.

You dismiss acupuncture out of hand, yet Cochrane has found it effective for some indications. Which is more than they say for lots else of what we all do and believe works.

Look I am a pathologically cynical but I will also keep an open mind that something may work even if the proposed mechanism makes no sense and even if the evidence for its efficacy is still scanty. I would rather have my patient families feel comfortable sharing with me what alternative approaches they are doing, have them respect my thoughts on which ones may actually cause harm and should be avoided, be open to evaluating the evidence that is available on the others, and be part of a discussion, than have them just assume that I will deride anything else they are doing. And if they are going to see an alternative provider then damn straight I’d like to get them to one who keeps their claims more narrow than one who sells the idea that their woo can do it all and that btw, vaccines cause autism.

This article details the extent to which “quackademic medicine” has infiltrated large university centers.

The major reason why woo has been adopted by some mainstream medical providers has to do with marketing - some practices have achieved sufficient popularity that there’s concern about losing patients to alt med practitioners, plus there’s money to be made in offering these treatments.

My opinion is that medicine is taking a big risk in co-opting or tolerating woo. It’s a rejection of the principle that therapy should be evidence-based, and it makes it easier for quacks to steer patients to useless and potentially harmful treatments for serious conditions. (“See, that University doctor endorses homeopathy, now try my 30C dilution to cure your malignant tumor”).

Those who defend woo on the basis that “medicine has been wrong before” are, in addition to citing often invalid or comparatively ancient examples, are missing the point. Potential breakthroughs that are initially questioned are accepted by the medical profession when good evidence is provided to back them up (through careful research and quality clinical trials). Woo cannot meet these standards and has to fall back on anecdotes, mantras like “medicine has been wrong before” and conspiracy-mongering.

Rather than my doctor trying to show his “open-mindedness” and caring by offering an array of woo, I’d rather he/she demonstrates those qualities by listening to me as a patient and practicing quality evidence-based medicine.