Blog | Tuesday, November 1, 2011

Baseball and quackery

I'm sitting here watching my favorite baseball team lose the pennant, but it's been a good season and when they finish losing tonight, I'll still be proud of them. There's one player in particular who I really like despite the fact that they've had to send him down to the minors for a little tune up (and others I'd rather were forced to wear an electronic collar that won't let them leave Toledo).

The Ducks baseball ground, Long Island by Sue Elias via Flickr and a Creative Commons licenseAnd unless you're a Yankees fan, baseball isn't just about the wins. But with the large number of games, it is about hope. Even with a losing team, people often form a bond of affection and hope that is not entirely rational. There's an element of variable reinforcement, but it's not just playing the slots.

We see this in people who seek out so-called alternative medicine. It is objective fact that, for example, homeopathy is a scam based on an incorrect understanding of science, and that acupuncture is an ineffective practice based on the imaginings of people who have forgotten (or never learned) basic biology and physics. The studies on these and other dubious practices are clear: occasional "positive" studies are overwhelmed by those that show no improvement over placebo. They are no different from other forms of faith healing.

But faith healers, at least the ones who aren't consciously plucking the pigeons, succeed from time to time. If enough feverish malaria patients come to the tent, some of them will walk out feeling better. That's the natural course of the disease. I'd love to take credit for fixing my patients' low back pain or colds: they almost always get better after seeing me, but they would probably have gotten better if they hadn't (my role, aside from passing out grandmotherly advice is to make sure the back pain or the cold are really what they appear and not myeloma or pneumonia).

But I can't and won't claim credit for such "cures." Some might, but it's not my style. I prefer to keep it honest and above-board with my patients. Some of the things I do might seem miraculous (like preventing heart attacks) but it's all just applying science to people.

Those who promote various forms of quackery, whether on late night infomercials or in "real" doctors' offices, cross that line: they take credit for nature's own actions, and dress it up to make it look good. It may seem "science-y" to have a hormone replacement program designed just for you, and the doctor may really listen and care about your well-being, but when he writes the prescriptions for the various hormone potions, he hasn't done you any favors. He's simply used a faulty understanding of natural variability and a puffed up sense of his own abilities to understand science, and gone against all the relevant scientific literature. It's theater. Maybe it's well-meaning theater, but it's no more than that at best.

But patients form an attachment to various health interventions, legitimate and otherwise. No matter what I or a Vodun healer might do, it comes with ritual, and sometimes the patient feels better, sometimes worse. If they like us, then we get the credit (and often fail to get the blame when they don't).

In a sense, quacks can succeed not primarily because of a societal failure in education, but because of the failure of our medical system to provide care. I think this is exaggerated, as most doctors do care and their patients know it, but when you work with science as your guide, answers aren't always pretty. ("No, I cannot cure your liver cancer.")

Quackery, without the restraint of science or the ethics of medicine can promise the impossible. It can promise to stop the common cold, to cure the incurable cancer. And if the practitioner is kind enough, the result is less relevant.

Real doctors can help guide people away from fake treatments by showing ongoing care, but sticking with the incurable. It's tempting to ask oneself, "Why would someone bother to come to me with a simple cold?" but the answer is obvious: they want to feel cared for. We can provide that, and better than the quacks. We can give good, common-sense advice, and let them know that it's going to get better.

Baseball fans (and normal people) can lose the pennant race and still look forward to the next season, but woe unto the person who tells them their team will always lose. People know that it's simply untrue. Sometimes a bad ball team pulls off the seemingly impossible. Sometimes a cancer spontaneously regresses. There is always room for hope, tempered by reality.

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.