On the recommendation of several members of the blogosphere, I’ve been watching a new British TV Series called “The Enemies of Reason” hosted by Richard Dawkins, a noted atheist and evolutionary biologist at Oxford. The series offers a skeptical review of the claims of alternative medicine practitioners, strung together with Michael Moore-like skill, and designed to showcase the fringiest believers as they concoct wild, pseudoscientific explanations for the mechanism of action of their therapies. It is entertaining and whimsical – though Dawkins himself appears dogmatic and cold as he ultimately builds a case for science as a religion.
Although I agree with Dawkins on many points, I think his approach is somewhat superficial and unnecessarily adversarial. Instead of unmasking kookiness and labeling people as “enemies of reason,” I think it would be more interesting to ask: why are people seeking out pseudoscience? What is the deeper need that scientific medicine is not satisfying? Why are billions spent on alternative therapies? (Please note that the “alternative therapies” that Dawkins evaluates include things like quantum homeopathy, magnetic healing, angelic guidance, and other treatments that don’t have evidence-based underpinnings.)
I think that at the very heart of the matter is that we humans want to feel in control. For millennia we’ve been conjuring up bizarre theories in order to believe that we can influence our destinies and our health. Just take for example the elaborate Egyptian religious myths (health was controlled by one’s ka which required regular food and drink offerings – not to mention all the elaborate embalming rituals to influence a good afterlife). All of these rituals provided the Egyptians with a sense of control over their lives, deaths, and reincarnations. I’m not entirely sure that we humans today are much different in our desire to control our lives. We just manifest it in other ways.
Ironically, science feeds pseudoscience – the more we know, the more definitive we can be about a disease or its prognosis – and the greater the desire to buck against that. And so as we advance in medical understanding, it is not surprising that there is renewed interest in magic as a means of influencing our clinical course as the inalterable progression becomes clearer and clearer. Add to that the fact that the physician-patient relationship has been undermined by a series of unfortunate historical circumstances (the rise of health insurance middle men, decreasing reimbursements, administrative red tape, etc.) and you have a group of dissatisfied patients with chronic diseases that have predictable complications – all seeking alternative outcomes at the hands of any compassionate person who promises to give them some control back. Of course, our “quick fix” culture also gives rise to a preference for simple solutions, rather than complex (though effective) ones. Is there any wonder that snake oil has emerged as a major player in this climate?
Dawkins makes the convincing argument that certain alternative medicine practices rely entirely upon the placebo effect. If this is the case, practitioners of these therapies cannot admit that their remedies are placebos – in so doing they would undermine their potential effects. Therefore, one cannot expect a rational response from them when confronted with evidence that their strategies do not work or are implausible. For the remedies to have a perceived effect, they only need to be believed in by the recipient. The millions of dollars spent by the National Health Service and National Institutes of Health attempting to uncover the mechanism of action of implausible therapies (such as homeopathy) will not influence the millions of faithful believers who turn to such practices for their health. I suppose that once the placebo effect has been scientifically proven, only the skeptics will be convinced by the data.
In the end however, Dawkins’ “war” is not between the evidence based medicine camp and the placebo based medicine group, it’s really an internal battle that each of us faces about our own mortality. The process of coming to terms with health and disease is uniquely personal – some want to be (as Dawkins puts it) coddled, others want the cold hard facts. As for me, all I want is for patients to be able to make informed decisions, not to be misled about therapeutic safety or efficacy, and not to be guided away from known effective treatments and towards known ineffective treatments. I suspect that this is what most people want as well.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.