This Op-Ed piece I wrote for the GLOBE AND MAIL (Canada's version of the New York Times) ran today. I thought some of you might like to read it.
Physicians' failure to communicate has contributed to the proliferation of alternative medicines, with potentially dangerous results, says MICHAEL SHERMER
Thursday, January 4, 2001
Whatever your religion or faith (or even lack thereof), there is no doubt that the Bible is a font of wisdom from which we may draw moral homilies. My personal favorite is from the Book of Proverbs, in which Solomon warns those who would look outside themselves to assess blame for their own shortcomings: "He that troubleth his own house shall inherit the wind; and the fool shall be servant to the wise of heart."
As a long-time public defender of modern scientific medicine, I have commonly labelled medical scientists as wise of mind, and alternative medical practitioners as fools. The wind of quackery we have inherited, I reasoned, is surely the result of an uneducated public duped by the otherwise risible tactics of flimflam artists preying on the unsuspecting masses. I am no longer sure that this is the source of the headlong rush toward these New Age medical alternatives.
Indeed, the data contradict my "fools" hypothesis: Studies published in the New England Journal of Medicine and the Journal of the American Medical Association reveal that the typical "complementary and alternative medicine" (CAM) patient is white, college-educated, with an annual income exceeding $50,000 (U.S.). Despite the miracles that "traditional allopathic medicine" (TAM) has produced -- the cumulative results of which have led to a doubling of the average life span from just a century ago -- by the late 1990s the number of visits to alternative providers exceeded the number of visits to traditional providers. By the end of the decade, total payments to alternative-medicine providers in the United States averaged a staggering $27-billion (U.S.) a year, 58 per cent of which was out-of-pocket payments. Alternative medicine sells.
In rejecting the "fools" hypothesis, we must consider the possibility that people are going alternative because their needs are not being met by traditional medicine. Before the 20th century, this certainly was the case. Medical historians, in fact, are in agreement that until well into the 20th century it was safer not to go to a doctor, thus leading to the success of such nonsense as homeopathy -- a totally worthless nostrum that also did no harm, thus allowing the body to heal itself. Since humans are pattern-seeking animals, we credit as the vector of healing whatever it was we did just before getting well. This is also known as magical thinking. What are the alternative providers offering that doctors are not? The answer is that all-important component so highly developed in pre-20th century medicine: TLC. By this I do not just mean a hand squeeze or a hug, but an open and honest relationship with patients and their families that provides a realistic assessment of the medical condition and prospects. People are going alternative because physicians have become highly skilled technicians -- cogs in the cold machinery and massive bureaucracy of modern medicine.
This is especially true in Canada, where cuts to your public system have resulted in overloaded doctors and nurses in every aspect of health-care delivery. When an emergency-room physician has to deal with 40 patients a night, bedside manner is the first thing to suffer. Sales of "self-care products" in Canada are worth more than $2.9-billion (Canadian), according to the Nonprescription Drug Manufacturers Association of Canada. That's up from $1.9-billion in 1996.
The shift in my thinking about this problem developed over the past eight years as I became intimately involved in my mother's recurring and malignant meningioma brain tumors. She finally succumbed, but in the process I gained a deeper understanding of why people turn to alternative medicine. Don't get me wrong -- my mother's doctors were brilliant, her care the very best available, and we have no regrets about what might have been. And that's the point. Even under such ideal conditions, I found the whole experience frustrating and unfulfilling: It was nearly impossible to get honest and accurate information about my mom's condition. Neither my father nor I could get doctors to return our calls; misinformation and (usually) no information was the norm. Despite my best efforts, the relationship with her physicians (with one exception, her oncologist whom I befriended), could not have been more detached.
I found it rather telling, for example, that when I identified myself as "Dr. Shermer" I got faster results at the hospital than when I was merely "Mr. Shermer" (a lie merely of omission, since I do have a PhD), but I still could not get calls returned. Neither could the oncologist.
More than anything, patients want information. They don't want jargon. They don't want false hope or unnecessary pessimism. Studies show that patients do better when they know, in detail, all the steps they will have to take in their recovery process -- probably because it allows them to anticipate, plan, and pace themselves. Patients want the power that knowledge brings, and that empowerment cannot be given in the 8.5 minutes the average doctor spends with a patient on any given visit.
Tragically, physicians are not trained to communicate this knowledge. And herein lies the problem -- and the solution.
Physicians tend to have monologues when they should be having dialogues. The reasoning process of diagnosis, prognosis, and treatment all goes on inside their heads, and what comes out is a glossed telegram of truncated lingo. The physician-patient connection is an authority-flunky relationship, top-heavy in arrogance and off-putting to anyone with a modicum of self-esteem and social awareness. If I could reduce all this into a single request, it is this: Talk to patients as if they are thoughtful, intelligent people capable of understanding and deeply curious about their condition.
The real tragedy in this health-care crisis is that alternative providers lack much medical knowledge and (especially) scientific reasoning, making th em dangerous. Studies show that 40 per cent of patients going to alternative providers do not tell their primary-care physicians, thus leading to possibly deadly mixtures of drugs and herbs.
It is not a matter of everything to gain and nothing to lose by going alternative (even if your doc offers no hope), because quack medicines cost money, cause harm, and, most importantly, take away valuable time that could and should be spent with loved ones in this already-too-short stay we have with each other.
Physicians are wise of mind. They must also become wise of heart so as not to inherit the alternative wind, for as Solomon continues in the next passage: "The fruit of the righteous is a tree of life; and he that winneth souls is wise."
Michael Shermer is the publisher of Skeptic magazine (http://www.skeptic.com) and the author of How We Believe: The Search for God in an Age of Science and Denying History: Who Says the Holocaust Never Happened and Why Do They Say It?