How To Spot A Quack
Recently I shared my take on a controversial book that’s a scathing takedown of alternative medicine: Do You Believe In Magic? The Sense And Nonsense Of Alternative Medicine. The author, Dr. Paul Offit, dismisses alternative medicine practitioners as nothing more than charismatic charlatans and claims that acupuncture and homeopathy are no better than placebo. He also unpacks the science (or lack thereof) behind vitamins, chiropractors, and the madness of alternative cancer cures.
As the author of Mind Over Medicine, which examines the science behind why many of these alternative techniques work, I had some issues with this book. My biggest complaint is that it misses the bigger point: People are seeking alternative medicine treatments for a reason. For many, Western medicine lacks not only results, but actual care.
And many people are getting results through alternative treatments, which Dr. Offit often dismisses as “no better than placebo.” In other words, he seems to say, If it’s no better than placebo, it doesn’t work.
To which my response is, Who cares if alternative medicine is no better than placebo? If it’s working and we have no better treatment in our Western medical arsenal, what’s wrong with that?
As a Western-trained doctor and scientist, I know that such a statement rings of heresy to other science-minded individuals. After all, the basis of what scientists term "evidence-based medicine" requires that we show that treatments are more effective than the very powerful placebo in order to prove that they work. Supposedly, evidence-based medicine is how you tell the real doctors from the quacks (defined by proponents of evidence-based medicine as those who practice "anecdotal medicine," whereby you make treatment decisions based on your personal history of what works with individual patients).
I find myself questioning the very principles that define evidence-based medicine as I consider them in the context of age-old medical values such as "harmlessness" and "commitment to the relief of suffering." How is it OK to offer a powerful chemical intervention that only works 40% of the time and might make 15% of the people who take it blind or sterile—or have some other yet unknown long-term negative effect? Yet it's somehow not OK to offer a harmless treatment that helps 70% of patients?
When it comes to knowing what's really "right" in medicine, we're all in kindergarten, and any effort to suggest that we don't is pure arrogance. The kindest, most harmless approach we can take is to view all attempts to help another heal with what Buddhists call "beginner's mind."
What we know for sure is that the body has an incredible power to heal itself, and if alternative medicine techniques can trigger this powerful phenomena—even if such techniques don't hold up to the ruler of evidence-based medicine, I think we need to open our minds to what it really means to help another heal, without dismiss the real results because they don't stand up to the limitations of modern clinical trials.
One question Dr. Offit examines, which I think is perhaps the most useful part of the book, is: What separates a practitioner of placebo medicine (who is harmless and potentially quite helpful) from those who practice “quackery?”
Dr. Offit says the line is drawn in 4 ways. Those who practice quackery:
1. Recommend against conventional therapies that are known to be helpful.
2. Promote potentially harmful therapies without adequate warning of the risks.
3. Drain patients' bank accounts by selling false hope.
4. Promote "magical thinking."
I totally agree with numbers 1 through 3. But the more I think about it, the more I question whether there’s anything wrong with promoting “magical thinking.” As I wrote about here, I’ve been studying the “4 Technologies of Magic” with my mentor Martha Beck. And I’m finding that promoting magical thinking is sometimes just what the doctor ordered.
I’m NOT talking about misleading the patient or withholding necessary information. But I am talking about instilling in the patient the positive belief in the possibility of radical healing, even when the odds may go against a positive outcome. As I describe in Mind Over Medicine, in many ways, it was magical thinking (aka "hope") that helped me cut back from 7 medications to less than one in my own life.
How Practitioners Can Stay In Integrity & Still Help Patients Heal
It's a fine line to draw. Many alternative therapies have been well studied and demonstrated to be no better than placebo—and yet this placebo effect can be highly effective. Things start to get sketchy when practitioners are profiting from recommending such treatments in lieu of more effective conventional treatments, or when they make promises that don't hold up in clinical trials, or when they recommend unproven treatments that may actually cause harm.
I do believe that there are things we don't quite know how to test for in modern clinical trials. And I'm willing to suspend disbelief for things I admittedly don't understand. But I think we have to be careful not to go too far into the territory of questionable ethics, especially when we're dealing with sick people who are desperate for anything that might help them heal.
Along the way, let’s not forget the body’s power to heal itself and the practitioner’s capacity to activate this power. We’re capable of so much more than we know, and so much more than science can (so far) explain.