One frequently asked question I receive on a regular basis poses the following dilemma - a skeptic is seeing a physician or therapist who generally seems reasonable and science-based, but then also dabbles in clear woo. What's a skeptic to do?
This is a distressing situation. First let me be clear - I think it is irresponsible and unprofessional for a physician to offer advice or interventions that are pseudoscientific. Obviously there is a spectrum from established standard of care treatments all the way to fringe magical rituals, with a vast grey zone in between. What does it say about a practitioner that they offer an intervention definitely toward the magical end of the spectrum?
The short answer is - it depends, as the devil is in the details. One possibility is that the doctor is simply misguided about the science behind that one intervention. For example, the American Headache Society recently added acupuncture as a recommended treatment for migraine. I believe this recommendation is highly misguided, and based upon a distorted and biased view of the literature. It is a failure that needs to be corrected. But if a physician follows this recommendation we might be charitable and conclude that they are generally science based but fell for a bogus recommendation from a recognized authority.
It is also possible that the practitioner has a philosophy or ideology that is spiritual or "new age" in nature, and they are allowing what is essentially their religious beliefs to color their practice of medicine. This makes them, in my opinion, a witch doctor, faith healer, or shaman - not a medical professional. I would stay far and away from such practitioners. If your doctor starts talking about life energy, chi, or other such superstitions, I would be very concerned.
There are also more subtle philosophers that can intrude into science-based medicine, such as a reverence for all that is "natural." This may seem benign, but it too can intrude on an evidence-based approach to clinical decision-making. The bottom line is that you could never be sure if you are getting the best advice, or just the practitioner's philosophy.
Other unscientific recommendations may not speak to an underlying philosophy, but simply an inability to understand the scientific evidence or how such evidence applies to clinical decisions. I have encountered many practitioners who found their own anecdotal experience more compelling than published scientific evidence. They might respond to a question about the evidence with, "Well, I have seen it work in my practice." That is a huge red flag. It means the practitioner is naive to the various mechanisms of self-deception, including those that would directly apply to their own decision-making.
There are some reliable litmus tests of this phenomenon, in my opinion. Any practitioner that uses homeopathy, for example, either does not understand what homeopathy really is, is profoundly scientifically illiterate, has a profound misconception about the state of homeopathy research, or is simply not listening to the scientific evidence.
It is also possible that a practitioner is not being ideological or pseudoscientific, but just incompetent. They may not have done the proper due diligence in looking into a therapy before using it or recommending it. They may think it is evidence-based when it isn't.
Finally, a practitioner may simply not care about philosophy or evidence but is selling a treatment because it is lucrative. This is always difficult to infer, because they will present themselves as believers in the treatment, when in fact they are only interested in performing a money extraction.
All of these principles apply to the full spectrum of medicine, not just those practices that might be labeled as "alternative." The problem with such behavior is that it is likely not to be isolated to the questionable recommendation. If a doctor cannot sort out for themselves that homeopathy is bunk, then how will they detect the more subtle deception committed by pharmaceutical companies, or sift through the evidence of a genuine controversy?
No matter how you interpret the behavior, it is difficult to fully trust a practitioner who makes a blatantly pseudoscientific recommendation.
I cannot tell you what to do in every specific case - the above are just general principles to think about. I would recommend confronting your physicians about the questionable advice (in a friendly manner). You have the right to question their advice and have them defend it with logic and evidence. Also feel free to educate them by giving them references to check out. (From a practical point of view, I would keep this to a minimum. Don't walk into your doctor's office with a manuscript or list of books. One good reference is more likely to be read.) Perhaps they were just misinformed on one issue. How they respond to the information you give them will also tell you a great deal.
I also think it's important for practitioners to get this feedback so that they know that not everyone out there is interested in alternative nonsense. Patients can be well informed and can also demand scientific standards from their medical professionals. The pro-woo crowd has been a vocal minority that has had a disproportionate affect on the medical profession over the last two decades.
Skeptics need to be vocal also.
Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s Science-Based Medicine project.