I have a very complicated relationship with medicine. Anyone who comes at me from either side of the mainstream sceptic to alternative magic spectrum claiming they have the one true answer is to me a Believer incapable of subjecting their dogma to conscious reflection. Human medicine is never that easy.
I have a BSc in Cell Biology and a Diploma in Herbal Studies. I have worked in Auckland Medical School, in the immunobiology department, alongside doctors studying psycho-immunobiology. I have several favourite plants I use for my health and well-being. I have friends who are medical doctors and nurses, osteopaths, massage therapists, hospice workers, sceptics and conspiracy theorists and all sorts of questioning in between.
Why mainstream medicine does not always represent the best or only options for health
I recently listened to this You are Not So Smart podcast and was surprised they took Tim Minchin’s view that alternative medicine that has been proven by science is called medicine. Such a small step for legitimacy, right? Except it is not that easy to get. Scientific proof requires a proper scientific study, which takes a lot of money, and uses a very finite resource of scientific laboratories and trained staff. Getting funding for a study that might prove an easily grown plant could substitute for a current medicine that makes someone a lot of money can be difficult, especially if the owners of the medicine start using their money to get in the way (lobbying, anyone?). Or if everyone knows it already. Or if the predicted outcome is that the cure might be so cheap and easy to make it’s not worth producing commercially, so how would you pay for your study? There are also political agendas that affect scientific research eg in cannabis and psychedelic studies. Even if you do it all, you should have your study reproduced by someone else to show that the claimed effects are real. You would have to be very motivated to scientifically prove, for example, that kawakawa (a NZ plant used in a lot of herbal remedies) has the actual effects Maori have been claiming it has for the 8-900 years they have used it.
What does “strong evidence to support…” mean to the average person? Most don’t know where their science comes from, or the validity of it, and they don’t stay up to date with advances. The famous food pyramid introduced in the early 1990’s and included in school curriculum is officially out of date and replaced by new guidelines, but posters can still be seen in health professional waiting rooms and classrooms. There is a lot of scepticism around the once popular ideas that breakfast is the most important meal (campaigned for by breakfast food companies), we need to drink 8 glasses of water a day (campaigned for by bottled water companies), we need to cut fat out of our diets, we need dietary supplements to fill out our deficiencies (brought to us by the dietary supplement industry) and yet all of these ideas were given to us with the backing of pseudo-science that pretends to a legitimacy that the average non-science trained person cannot tell from the real thing. If you can make money out of it, you can pay someone to make a scientific sounding claim that makes you more money, and makes the population more ignorant.
And then there is the placebo effect. Belief in your medicine / procedure / magic can produce a cure, so predictably all medical science has to have a control to show that cures from the drug under test are statistically significantly more than background cures. Treating ailments with placebos is accepted medical practice in many parts of the world. According to Radical Remission: Surviving Cancer Against All Odds by Dr Kelly Turner, people who have experienced spontaneous remission from cancer commonly attribute that to such things as using herbs and supplements (supplements are commonly snake oil in the US) and deepening your spiritual connection. This is of course Survivorship bias at work, but if you get a cancer diagnosis and you don’t want to have cancer and you change something about your life to beat the cancer and the cancer is beaten it’s easy to think the correlation of the change with the cure is the same as causation. I wonder why they don’t explore the “don’t want to have cancer” mindset more closely? If you’re willing to do anything to beat it, does it give you better odds?
Distrust of mainstream medicine is not a rare or entirely stupid thing. The times when people have saved their own lives by insisting on a second opinion are the stuff of urban legend, which doesn’t mean it happens as often as people think, but when we get AI GPs I’ll be the first there, because:
- an AI will know my entire medical history, and that of my genetic relatives, and won’t miss any relevant detail like the possibility of an allergy to a drug, or if I have my immunisations up to date or not. On the other hand, I still have doctors asking when I last had a cervical smear when I had a full hysterectomy about 20 years ago.
- an AI will have access to every possible registered drug in the world, and could see if, for my illness and genetics and demographics etc a drug registered 15 years ago and only available in Thailand would be the best for my condition. They won’t be biased towards the latest drug they saw at a pharma con and oblivious to the existence of the option, and they won’t feel any pressure to offer me antibiotics for a viral infection (true story).
- an AI will have access to the entire medical knowledge in the world. It won’t forget some obscure condition, or miss possible diagnoses for a set of symptoms. It will know the tests that need to be run to confirm one diagnosis over another, and the specialists anywhere in the world that could treat the condition if it requires human intervention.
- an AI won’t get tired, distracted, have a bad hair day, or suffer biases like fatphobia (not considering other causes past the BMI of a patient), misogyny (underestimating the seriousness of female illness because women are soft and always complain), familiarity (oh, it’s just the normal complaints) etc. They won’t make human mistakes.
Don’t get me wrong – if I get sick or injured and I don’t know how to treat it, the first person I will see is a doctor, and they usually see me right. Odds are they will be better at it than someone not trained for 5-7 years. Second opinions are strange things to me. You don’t like the first expert’s opinion (where an expert is someone who has knowledge you don’t have, and you consult them because you don’t know enough in that field, and you trust they are professional and likely to be right) so you ask a second expert, and they might have a different opinion, because not all experts are correct all the time… Imagine you’re feeling good, and go get a checkup, and the doc says you’re fine. You won’t get a second opinion because you have heard what you want or expect to hear. You’d only get a second opinion if it’s not welcome news, or you are suspicious of something. That’s motivated reasoning. When you get your second opinion, if it differs from the first, that’s a 50/50 split – on what grounds do you decide you trust one expert’s opinion above another? Bias? Fallacy? Coin toss?
We can all point to examples of failures in the mainstream. We know:
- not all drugs are good. Thalidomide was a disaster (but it’s fixed now, and available again), there’s an opiate dependency crisis in the US, and drugs for mental health issues can be badly prescribed
- that doctors can be convinced to exonerate smoking and buy in to unscientific diet trends and in the end, even if they try really hard and are really competent and nice, they are only human
- the goal of pharma is to make money
- government support does not necessarily mean the best options nor the only options
- medical research was done for the longest time on men, and applied to women as an afterthought, and continues to be done on unrepresentative sample groups, depending on how they incentivise people to participate.
Why should we believe that the main-stream medical profession holds all the answers, and only the correct answers? That’s unscientific in itself: science would say that they have the best answer currently available, but they are working hard to disprove it.
Alternative medicine gives hope, but is that well placed?
As you might know from previous blog posts, I have cancer, and I’m currently in my second round of chemotherapy. When I tell people about it they commonly tell me about the non-medical cures they or their friends have experienced. Colour therapy, the healing power of mushrooms, scalar vibration therapy, intermittent fasting and my parents pray for me. A very sceptical doctor friend sent me this:
Benson et al.[37] described a triple-blind, randomized controlled study that examined whether remote intercessory prayer influenced recovery after coronary artery bypass graft surgery and whether the certainty of being prayed for was associated with better outcomes. The sample comprised 1,802 patients in six hospitals in the USA. These patients were randomized into three groups: 604 were prayed for after being informed that they may or may not be prayed for, 597 were not prayed for after similarly being informed that they may or may not be prayed for and 601 were prayed for after being informed they would definitely be prayed for. Prayer commenced one day before the surgery and continued for 14 days. Three mainstream religious sites prayed daily for patients assigned to receive prayer. Assessment of outcomes was made by nurses who were blind to the group assignments. The primary outcome was the presence of any complication within 30 days of surgery. Secondary outcomes were any major event, including death. The study sought to examine the efficacy of intercessory prayer and not to test the presence of God. The design was described by Dusek et al.[38] In the two groups that did not know for certain whether or not they were being prayed for, complications occurred in 52% of patients who received intercessory prayer and in 51% of those who did not. In contrast, complications occurred in a significantly larger proportion of patients (59%) who knew for certain that they were being prayed for. Major events and 30-day mortality rates, however, were similar across the three groups. This study therefore showed that remote intercessory prayer did not improve outcomes after coronary artery bypass graft surgery. In fact, the knowledge of being prayed for was associated with a slightly but significantly higher rate of postsurgical complications.
I have not told my parents.
Besides the prayers, I have looked at each of the things people have referred me to. Some I can see the possible benefits, some I have dabbled in more or less, but all could easily have made someone’s life better if through nothing but belief, and when it comes to health, feeling better, in control, enabled, and trusting your cure is likely (I dunno if they have proved it, past placebo studies) to be far better for the person with the problem than an insistence on only doing things the mainstream way, and being told they’re gullible, credulous and stupid. My oncologist is ok with pretty much everything I experiment with – what’s the worst that could happen?
The problem is when you have a somewhat rational distrust of mainstream answers, a desperate urge to feel better, and a willingness to believe anything else could help. What kind of medicine would you accept, if it came with recommendations from people you trust? Bleach gargles? Stag penis pills? Exorcism? What would you pay to feel healthy again? How much money, or time, or relationships, or social inclusion, or actual lifespan? Remember people were more willing to face real death by Covid to avoid social death by getting a vax. Once upon a time people would drink mercury as a tonic (please don’t try it, it’s very toxic) and nowadays we inject botulism into our face to look pretty.
How do you know if it worked? How often have you told someone (including Dr Google or ChatGPT) about a symptom (maybe not even discussed with the mainstream doctors), and they have recommended a supplement, and you have tried the supplement, and then tried to remember how you did feel then to see if this makes you feel better now? We don’t do scientific tests on ourselves, as a rule. If a change happens to correlate with a positive experience we’d likely think it was the cause. It’s not hard to think of someone trying a vegan diet, winning the lotto, and deciding the gods have given them a sign that they’re on the right path. We’re commonly not very good at cognition, especially when we’re freaking out about our body betraying our trust that it was going to be awesome forever, as it does, over time, past about the age of 23.
What does it all mean, in the end?
In the end, no matter if you use science or magic or both, we don’t get to experience two lifetimes at once to directly compare the effects of our wellness choices, and we don’t know when we’re going to die, to see if one choice or the other will improve our lifespan, and nothing will keep us alive forever (not even prayers). Each of our choices reflect our beliefs about how we can affect the odds in life’s lottery. But chasing hope can beggar you, no matter which path you choose, and you sooner or later have to accept the inevitable or die disappointed in futility.
Death is seen as the ultimate health failure. No matter what your health choices; if you make a conscious effort to pursue health, if you die before 85 years, health-ignorant bystanders will blame that for your untimely demise. If you take your health for granted for 50 years and finally decide you’d better do something to get your fitness back if you want to live another 30, if you die of a heart attack 2 years in, the 2 years of exercise is what killed you – not the 50 years of neglect. After all – you had 100% not died while getting unfit. In my case, I think I’m more fit than average for my demographic in NZ, but to some obviously the strain I have put on my body throughout my life has brought about my cancer (just world fallacy – the oncologist says I didn’t do anything to deserve it). Ironically insurance companies increase your premiums for participation in contact physical activities but I’m pretty sure they were not anticipating the cancer outcome or they would have charged more. Other people will say I will die early because I haven’t made the right treatment decisions, or chased all the rainbows of hope. It’s not giving up. It’s about what I believe and value (quality over quantity), and where I think my finite energies and resources are best spent.
Given all the options and pressures and uncertainties it’s not surprising either that so many people decide to take it easy, do nothing for their health, and passively accept what life throws at them, or actively dare life to mess them them up (why else take up smoking?). They don’t fail to find eternal health, and can laugh at people trying, and might live to a ripe old age never having had a concern or never paying for the privilege of health. Plenty of people are that lucky. Or they could die of ischemic heart disease instead (the #1 killer in NZ) but this might be preferable to jogging, especially if you jog and then die of a heart attack. Someone from my past told me they say if you practice yoga regularly you can extend your lifespan by up to a third (I do not know if anyone has really said this) and it could be true, he said, because time spent in pain passes more slowly, and yoga is painful (he said – I don’t do yoga), so you slow down your life and extend your lifespan.
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