July 8th, 2007 by Dr. Val Jones in Quackery Exposed
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The most outrageous lies that can be invented will find believers if
a man only tells them with all his might.
–Mark Twain
I’ve always liked the term “magical thinking.” I first discovered it in medical school when
we were learning about normal childhood development. There is a period of time (about ages 3-6) in
which all children believe in magic – things that are not possible or rational
appear plausible to them. I suppose that
Peter Pan is based on this psychological window – when children grow too old
they can’t go to Never Never Land anymore because they lose their ability to
fly (aka believe in magic).
As adults, we often remember our childhood fantasies with
fondness. We relive the experience with
our kids, and enjoy the carefree wonder that comes along with fully believing
in implausible things. In general,
magical thinking is an enjoyable part of childhood.
But there is a more sinister form of magical thinking – and
that develops when adults abandon reason for implausibility. We see this in medicine quite a bit, as it is
the soil in which the proverbial snake oil salesman can grow his thorny weeds. Preying on fears in a vulnerable victim, the
snake oil salesman leads the person down a common garden path of partial
truths, twisted facts and sheer lies.
Here are some of his favorite tactics:
- Trust
erosion. “Your doctor is keeping
important (if not life-saving) treatment options from you.” Snake oil salesmen love to write books with the
following titles “What your doctor won’t tell you about X.” or “New
scientific break through X that your doctor doesn’t know about…” This tactic is meant to break the trust
between physicians and their patients, causing second guessing and
unnecessary rifts. More often than
not, your doctor doesn’t know about treatment X because it’s so ridiculous
that they wouldn’t give it a second thought or the medical community has
already disproven it.
- Conspiracy
theories. Snake oil hucksters love
to tell you that the government (or your hospital, or your pharmacist, or
your health plan, or your healthcare provider) is conspiring against you
with the pharmaceutical companies (or your health insurance, or your
doctor, etc.) to prevent you from getting the care you need or to coerce
you into getting treatment that you don’t need. Conspiracy theories are ubiquitous in
the snake oil world and they are the most obvious red flag identifier in
their arguments. So if the next
treatment option you’re considering is promoted with arguments that it’s
best for you specifically because the evil government/pharmaceutical
company/hospital/doctor is trying to prevent you from taking it – be very wary indeed.
- Playing
the victim. When rational
scientists poke holes in the snake oil salesman’s pitch, his favorite
argument is “I’m being attacked and suppressed by those who don’t want YOU
to know the truth. This proves that what I’m saying is true – why else
would they want to silence me!?”
- Making
you feel inferior. The snake oil
salesman loves to point to the “wild success” of treatment X in Europe, Asia, or any other country than your own. He wants you to feel that you’re late to
the party, and that everyone else is ahead of you and has already been
enlightened. You feel ashamed of
your ignorance and want to get in on something that has thousands (perhaps
millions) of foreign supporters – so it must be safe/true/right.
- Pseudoscience
jargon. To give their snake oil an
air of credibility, the salesman will use medical-sounding words to
describe its purported mechanism of action. This is where the salesman can
really work his art into the minds of magical thinkers. The more convoluted and implausible the
story, the more magical it is – and the better able to capture imaginations.
- A secret cure. Diseases can be crippling and devastating, leading people to despair. The most serious and life threatening diseases (especially if there is no known cure) are the favorite target of snake oil salesmen. Desperation breeds magical thinking, and opens the door to all kinds of false promises on the part of hucksters who have no qualms making money on fruitless “cures.” They often pitch their snake oil as a secret cure that only a select few people know about (or have access to). If a disease has no known cure, you can be 99.9% sure that a promise of a “secret cure” is an unconscionable ploy to gain financially from the suffering of others.
And so, dear readers, one must never underestimate the power
of magical thinking. It is the bedrock
of bad medicine, can lead people away from life-saving therapies, and will
continue to exist for as long as people are willing to entertain the arguments
of the snake oil huckster. Sadly, I
predict that snake oil will be around for as long as human suffering exists –
and it will inflict its venom most effectively on the ignorant, desperate, and
vulnerable. It can be vanquished,
however, on a case-by-case basis by its only natural foe: the scientific
method. Hold fast to evidence based
medicine, and you will avoid much of the pain of pseudoscience, thorny lies,
and snake oil. I will be there with you,
fighting the good fight.
In my next post I will describe the power of positive
thinking – which has value in medicine, as do placebos. I will explain the difference between the
placebo effect and snake oil, an often confused but important distinction.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 7th, 2007 by Dr. Val Jones in News
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There is a new diet pill undergoing testing in Italy. The pill expands in your stomach, suppressing
appetite by giving you a false sense of fullness, sort of like those dehydrated
sponges that expand dramatically when you get them wet.
On the surface it sounds as if this pill might be a
reasonable approach – but there are 2 big problems:
- This
method (filling the stomach to give a sense of fullness and reduce eating)
has been tried before and has failed to produce the desired result. Back in the 1980’s scientists attempted
to use an inflated stomach balloon (Garren Bubble) to suppress hunger. Unfortunately it didn’t work, and put
people at high risk for gastric ulcers and other dangerous side
effects.
- There
is a serious risk of bowel obstruction with this pill. Once the tablet dissolves in stomach
acid, the cellulose condenses to produce a bezoar (rock like substance)…
the pill’s contents can then become wadded up like a rubber tennis ball
and not pass through the gut safely.
In fact, the pill could cause a fatal obstruction.
So, as we continue on our quest for the magic pill to cure
our obesity epidemic – we must reject yet another valiant effort. Sorry folks, it’s back to good old diet and
exercise for most of us.
*Many thanks to Dr. Brian Fennerty who discussed this pill’s
safety with me in a recent interview.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 6th, 2007 by Dr. Val Jones in Expert Interviews
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An important new study related to Americans’ use (and abuse) of alcohol was recently published in the Archives of General Psychiatry. I caught up with Revolution Health’s addictions specialist, Bruce Phariss, MD to get his perspective on this very common, yet often disabling addiction.
Dr. Val: Is there anything surprising or new
presented in this study? If so, what is it?
Dr. Phariss: It
isn’t necessarily surprising, but it is striking that 30% of Ameicans have an
alcohol problem at some point in their lives. Alcohol problems often develop
slowly and no one “notices” that it has become a problem until well after the
fact. That’s why it takes 10 years on average for those that get treatment to
actually get the treatment. The study also highlights the fact that a huge gap
exists between those needing treatment and those receiving treatment. We’re
still not doing a very good job in the treatment community of getting the word
out there that treatment is available and that treatment
works.
Dr. Val: Why do you think that only 25% of
people with alcohol abuse problems get treatment?
Dr. Phariss: Three things: First, denial and stigma keep many “unaware” that they have a
problem. The first step in the stages of how people change behaviors is
awareness. If you don’t know you have a problem, you can’t change it. Along
this same line, if alcoholism is viewed as a moral failing instead of as a
medical condition, then good, moral people don’t think they can be alcoholics.
That’s good logic, but unfortunately, alcohol is non-discriminatory and even
good, moral people develop alcohol problems. Fighting through that
generalization of stigma is too tough for many people and they never seek
treatment or attempt to change their behavior.
Second, our cultural still
galmorizes drinking and drugging. Although the hype surrounding the many young
starlets currently in rehab centers appears to say how tough these addictions
are to kick, the overall slant is to add cache to the celebrity. It’s cool to
need rehab, it’s cool to be that out of control with alcohol and substances,
it’s almost synonymous with celebrity of a certain type. Sadly, this message
influences the behavior of many Americans, especially the under 25 crowd, who
are the most venerable to developing addictive behaviors.
Third, many people stop on their
own without treatment. Almost anyone who does find their way into treatment of
any kind (AA, treatment programs, etc.) has tried to stop on their own at least
once, maybe a hundred times. Just think of the many times you’ve heard someone
say “New Year’s Eve is my last day of drinking” or “I’m going to give up booze
for Lent and not pick it up again” or, my favorite, “I can give it up any time I
want….” In fact, some of the 75% of the people who need to deal with their
drinking do deal with it on their own. But many others need help of some kind.
Breaking down barriers to treatment — access and psychological and financial
barriers — remains the goal of the treatment community.
Dr. Val: What sorts of interventions might be
most useful (on a personal and on a national scale) to reduce alcohol abuse and
dependence?
The debate on a national level as to how to intervene to reduce alcohol
abuse and dependence is ongoing and heated at times. However, many intervention
and prevention programs focus on underage, college age and the under 25-year-old
drinkers. If you don’t a drink until age 21 you are four or five times less
likely to develop an alcohol problem than someone who drinks before the age of
21. But underage and college age drinkers are becoming more numerous, not less,
so we must be doing something wrong. A few colleges have taken an approach I
like: in addition to providing counseling, supporting AA meetings by providing
space, a few colleges have taken to trying to change the “perceived norm” about
drinking on campus. Although in fact most kids on campus do not binge drink on
a regular basis, the perception by incoming freshman is that everyone drinks
more than they do. This holds true for the guy who drinks two six packs a day
(clearly way too much)….he actually thinks that the majority of students drink
more than he does. What is a motivating emotional factor for college students:
they want to be accepted, to be a regular, normal guy or girl. If the
perception is that normal is to drink a bucket, then as a group they will be
more likely to drink heavily. A few colleges have taken the simple step of
making the student body aware that, in fact, most students do not drink to
excess. That simple step has helped to curb the trend of more and more alcohol
on campus.
Dr. Val: What’s the take-home message to be
gleaned from this study?
Dr. Phariss: The take-home message is that the medical profession has a long way to go in
de-stimatizing treatment for alcohol use disorders and that the substance abuse
treatment community remains too distant, too inaccessible and too timid in
announcing that treatment works. As the AA slogan says: “It works if you work
it, so work it, you’re worth it.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 2nd, 2007 by Dr. Val Jones in Medblogger Shout Outs
1 Comment »
I was really touched by Signout’s blog post about a charming octogenarian. It’s patients like these that make you glad to be a doctor… Signout writes:
I have a secret crush on one of my patients, an 85-year old man
who’s recovering from a bad pneumonia. After a weeklong stay in the
intensive care unit, he has recovered at a remarkable pace: the day
after he was extubated, he was out of bed with a physical therapist,
making his way slowly around the ward with a walker and a big smile.
What motivates him to work so hard at recovery, the
nurses say, is his love for his wife. They have been married 60 years.
She comes in to see him every day, wheeled around by their daughter.
The whole time she is there, they say, he holds her hand as if it is
the last time he will see her…
This man is the cutest patient ever… and the dear fellow reminds me of my husband (only a little bit older – the patient is older, not my husband – er, you see what I mean). One of my single friends asked me how I knew that Steve was the man I wanted to marry, I told them this:
“One day it suddenly occurred to me that if I had a traumatic brain injury or suffered from severe dementia and was totally incapacitated – Steve would faithfully care for me, never leave my side, and devote his entire life to my recovery or best quality of life. When I realized that he would do this for me without a second thought… I knew I had to marry him.”
Now, I’m not sure that Steve finds that image particularly romantic – but I do. It’s a doctor thing I guess.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 2nd, 2007 by Dr. Val Jones in News
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New research suggests that people with allergies to molds, pollen, and dust mites but NOT cat dander, may have heightened asthmatic reactions to their usual triggers in the presence of cats. This is unfortunate news for cat owners or anyone who is fond of kitties but has environmental allergens. Researchers note that :
Avoidance of cat exposure would be beneficial to a much wider
population than previously expected. Furthermore, cat allergen levels
were ubiquitous in cat-owning communities, and their results showed
effects of cat allergen exposure at lower levels than generally
regarded necessary to produce a measurable result.
So basically, if you live in a “cat-owning community,” their airborne fluff will probably make your pollen and mold-induced asthma worse. Aside from declining to pet and/or play with them, I doubt that there’s much you can do to completely avoid their dander. But there is some cause for all allergy sufferers to eye cats with suspicion… time to trade in Tiger for Fido?
[View cat allergy cartoon]This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
