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The CAM Practitioner As Enabler (Or Death by Pseudoscience) PDF Print E-mail
Swift
Written by Dr. Steven Novella   
As James Randi himself once said, “It is a very dangerous thing to believe in nonsense.”

This is true on many levels. Often I am asked, “what’s the harm” of believing in and using fanciful or magical medical treatments. If it makes people feel better, who cares if it’s not real? Well, there are many kinds of harm, but perhaps the most insidious is simply instilling and reinforcing in people a belief in nonsense and a simultaneous distrust of science and reason.

In medicine, putting one’s faith in demonstrable baloney can lead to a delay in getting proper care. One might argue that the individual has the right to choose his or her own care and interventions, but this (while true) minimizes and even dismisses the role of the alternative practitioner in this decision-making process.

A recent example of the dangerous role the CAM practitioner can play in patient’s decisions came to light from New Zealand. Yvonne Maine noticed a lesion on her scalp that was painful and oozing. She was concerned about it, but also feared doctors and hospitals, so she ignored the scary lesion as long as she could. To her ultimate detriment, she sought the care of naturopath and iridologist Ruth Nelson.

Naturopaths are a diverse group of CAM practitioners, in various stages of licensing and regulation in different countries, and without a coherent philosophy of practice except that, it seems to me, they use any discarded, failed, unscientific or pseudoscientific modality out there. They seem to be united only in their distaste for science-based medicine. If you want to get the demonstrably wrong treatment for any condition, it’s a safe bet to visit a naturopath.

In this case, Nelson used as her primary diagnostic tool the practice known as iridology. This is based on the absurd notion that the flecks of color in the iris of the eyes indicate the health of all the various parts of the body. There is no biological basis for this belief, and it has been conclusively demonstrated that iridologists cannot diagnose their way out of a paper bag. At best they provide a medical cold reading – they are the medical equivalent of palm readers or astrologers.

Nelson, according to reports, acknowledged that the scalp lesion looked suspicious for cancer, but did not refer Maine to a real doctor or encourage her to seek proper care. Instead, she treated it herself:

“Her treatments, which included washing out the lesion with colloidal silver and picking out dead skin with tweezers, increased to the point where they were spending several hours together every day, so Mrs. Maine rented a house close to the clinic.”

Nelson treated Maine for 18 months, until the pain became intolerable and a combination of family pressure and her pharmacist noticing the high use of pain medication eventually lead Maine to genuine medical care. The lesion, which had eroded through the skull exposing the dura, or lining of the brain, was surgically removed. This improved Maine’s quality of life, but she died a year later.

Nelson justifies her treatment of Maine this way:

Mrs. Nelson acknowledged that Mrs. Maine needed to see a doctor, but said her philosophy was to put patients' wishes first.

"The mistake I made was not anything to do with the skills or knowledge, it was caring too much," she told the commission.

No, her mistake was in being a dangerous charlatan. But the attitude she offers to justify her neglect is revealing – of a profound unprofessionalism. Health care professionals are supposed to put ethics and the best interests of their patients ahead of the patient’s wishes. Ultimately adult patients are in control of their health care and do make the final decisions, but a health care provider should be their advocate. This means telling patients what they might not want to hear, giving them proper informed consent, and giving them the best advice, even if they do not like it or choose to follow it.

Professionals should also be properly trained in the psychology of illness, and use that knowledge to help their patients in their decision-making process. Nelson was not acting like a health care professional advocating for her patient’s best interest, but rather was enabling her fear-motivated denial and avoidance.

In my opinion the mere existence of alternative “professions” and practitioners enables fear and irrationality in health care decision-making. They subvert the purpose of informed consent. They provide an illusion, a false choice, that distracts and lures patients away from rational health care by tempting them with magical wish-fulfillment right when they are most vulnerable.

They justify this as consumer choice – but it is the same as placing a delicious cheesecake in front of an obese diabetic about to eat their meal of salad and vegetables. Yes, the choice is ultimately the diabetic’s, but what are the ethics of not only placing the cheesecake in front of them when they are hungry, but lying to them and telling them that the cheesecake is just as healthy as the vegetables? In fact, the salad and veg are secretly dangerous, and diabetes isn’t exacerbated by excess sugar anyway.

CAM proponents frequently dispense comforting or appealing misinformation, luring people away from the often hard choices and scary options provided by honest science-based medicine, and then scream “consumer choice” whenever any standards or quality control threatens to restrict their ability to extract money from the public.

Occasionally dramatic cases like that of Yvonne Maine come to light, but this practice is happening every day in the world of CAM. In New Zealand naturopaths are not licensed. The Maine case is therefore leading some to call for regulation of naturopaths, for quality control. This is a tragic mistake. The call comes mainly from naturopaths who want to create a monopoly for themselves through licensure and getting rid of competition from those who are not a member of their guild.

Such regulation of unscientific philosophy-based health professions, however, has never resulted in actual quality control or protecting the public from nonsense. It actually makes the problem worse, by legitimizing pseudoscience and providing plausibility to the enablers. Licensing pseudoscience makes the government complicit in fraud and medical harm.

 

Steven Novella, M.D. is Senior Fellow at the James Randi Educational Foundation and director of the its Science-Based Medicine project.

Dr. Novella is an academic clinical neurologist at Yale University School of Medicine. He is the president and co-founder of the New England Skeptical Society and the host and producer of the popular weekly science show, The Skeptics’ Guide to the Universe. He also authors the NeuroLogica Blog.

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written by Lancelot Gobbo, September 08, 2012
I live in a rural community and, faute de mieux, represent the science/evidence based view of the world as a general practitioner. We have a free local paper, and in each issue there is a column written by a local naturopath. I have spoken to the publisher, who is a patient, and expressed my displeasure that she should be promulgating nonsensical and potentially dangerous rubbish. She seemed to agree, but didn't indicate any intention to change the arrangement. I suspect she hopes I will start a war in the letters column that will increase the 'buzz' about this somewhat pathetic local rag. Frankly, I don't have the energy to start any wars (unlike naturopaths, I work all hours, have my home number in the phonebook, don't have call display and have left the village a total of four times this year, each for just a few hours for necessary matters such as dental treatment). As a result, my frustrations bubble up to the surface when a patient comes in and asks (actually, tells) me to arrange the tests that this naturopath has demanded. I confess it makes me angry, and I may not be an absolute exemplar of the best public relations for the reality-based community in my reactions. Subtle suggestions, such as 'there is a reason why I can order this test and she can't - have you thought about that?', are completely lost on most people. Simply saying 'no, this is not indicated and will not give you the answers you seek' only give the impression of defending turf, which is always attributed to financial reasons. Has anyone developed any useful tricks or strategies for opening the eyes of such patients? I hate to see them wasting money on nonsense when they can have evidence-based medicine for free (I live in one of those countries that uses taxes for 'socialised' (Yay!) medicine) and would like to do more to divert such individuals from mumbo-jumbo. Talking of which, I always talk about evolution and bacterial resistance when explaining why a culture must be done before prescribing for a UTI, even if 'Dr X always just gave me some Septra'. I guess I'm just expressing the fact that it takes ten times more energy to do it right than to do what the customer wants. The burden of belonging to a profession, of course. But since the capitalist naturopaths have discovered a niche which gives them profit and takes patients away from EBM/SBM, how can one chap in the frontline best fight back? I have a couple of colleagues here, and they mostly think I'm crazy to care. Give 'em what they want and get paid anyway. I think that attitude is as despicable as that of the naturopaths.
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@ Dr. Lancelot
written by stag, September 09, 2012
Don't fight it out in the letter columns. You just come across as bitter. Keep in mind that her columns are her advertising method. What might work would be to create your own column and request that it be published in the paper as well. This would mean you would have to write an attractive column because of course, nobody wants to read an unattractive column! Let her waste her time and effort defending her views. As you stated, you don't have time to write such columns, but do you suppose that there is "somewhere" a collection of newspaper columns which support your world view which could be submitted for publication? Dr. Novella, do you have such a collection? In that case, your workload would be reduced to obtaining permissions and short editorials on the content. I think there would be a LOT of communities with struggling newspapers which would benefit by such an approach. The added benefit is that by using a third party medical advise column, you don't come off as fighting a raging turf war in your own community, you would take the higher ground. You would be the "moderator".
And not just newspapers, here in Ottawa on CFRA, we have a radio talk show called "ask the doctor" which gets a lot of good information out and shuts down a lot of the la la stuff. Perhaps your local radio station might like to carry Dr. D's radio show. They might if YOU asked them to.
I have no connection with Dr. D in any way, but I like the cut of his jib. And Doctor Gobbo, this might be the approach you are looking for. Doctor D.'s web/blog site is here... http://www.drbarrydworkin.com/ His tolarance for woo woo is VERY low. Please let us lurkers know what you have come up with.

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written by Lancelot Gobbo, September 09, 2012
Thank, I shall think on it. I can't see that canned columns presented as if by me will impress anyone. All it would take is the answer to all her assertions "And how, exactly, do you know that?" As it stands I have to look at another section of the paper to know if I am winning - there are cards of thanks when people die. It's probably silly, but I do feel some sense of being appreciated when the families bother to mention me. I haven't yet seen a naturopath mentioned in the cards of thanks (!) and I take that to mean something.
Oh, btw, neither Lancelot nor Gobbo should be construed as belonging to the doctor thing; Shakespeare would be annoyed if we didn't recognise the minor character in The Merchant of Venice who had an angel on one shoulder and a demon on the other. I must be some sort of dualist to feel an affinity with poor Lancelot.
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@Dr. Lancelot
written by stag, September 09, 2012
I am sorry I was not clear...I was not suggesting that you publish a canned column with your name on it...that would be plagarism. Rather, that you moderate a series of such columns. This was of course just to address the difficulty in finding the research time involved in writing a series from your own pen. Also, there is no point in going "head to head" with the woo woo (as fun as this might be), but rather a general attempt to educate the reading public.

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written by Peebs, September 09, 2012
Just curious, but why have 'Stag's' comments been voted down?
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written by Otara, September 09, 2012
She hid the lesion condition for years though.

"After several years of treatment for various ailments, Mrs Maine revealed a lesion on her scalp that had been diagnosed by a GP as a harmless cyst nearly 40 years earlier."

I dont think conventional medicine was going to do much here no matter what. She had a massive fear of doctors, and it was only because she saw this person for years that it seems to have even been admitted then - she took that long to even trust the woo she preferred, let alone doctors.

Its a bit chicken and egg in my view - if the naturopath had better boundaries, she'd probably have never showed the lesion to her. On the other hand her lack of better boundaries is probably what let her to colluding with her denial.

I loathe naturopathy in general, but this case seems to be a bit messier than the usual 'talked them into taking herbs for cancer' shtick. Be interesting to know how much money she made out of her I guess.
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written by Peebs, September 09, 2012
Sorry, I cannot agree.

She may have had a phobia about proper doctors, but the fact she went to a woo merchant who actively discouraged her visiting one hastened her death.

Even if terminal SBM could have made her final days easier and, if a little earlier, given her more time with her loved ones.

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written by Otara, September 09, 2012
I think we can conclude its never good to tell someone not to see a doctor for issues like this, for legal liability if nothing else.

I dont agree that its a fact her death was hastened with the story as given. But its certainly possible.
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SCAM
written by garyg, September 10, 2012
The current issue of Consumer Reports lists the 20 biggest scams out there, but didn't list Alternative Medicine.
I wrote a letter suggesting it as 21., pointing out that NCCAM has spent over $1 billion and a decade unsuccessfully
trying to prove the efficacy of any of these modalities, even though it's staffed and backed by advocates.
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written by rosie, September 10, 2012
I'm no medic, but surely the lesion may very well have been a harmless cyst 40 years ago? Or there may have been a harmless cyst somewhere nearby that confused the patient.
I know from personal experience that showing a doctor something harmless and being (effectively) laughed at, is very off-putting. For a patient who is already frightened it can be crippling. Doctors should be very wary of pooh-poohing patients' concerns, however silly: each of them has an individual fear and is not jumping on the bandwagon of the fifteen other worried-wells you saw this morning.
At some level, the whole point of "consulting" a naturopath is that she will not tell you anything frightening. So that's all right then. Although to persist with the anodyne naturopath while the lesion eats through her skull suggests Darwin-award material.
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