February 5th, 2008 by Dr. Val Jones in Quackery Exposed
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The financial burden of snake oil
Prickly snake oil seeds are taking root in the soil of our broken healthcare system. Consumer discontent and feelings of helplessness are the manna of charlatans – and they are growing fat in our lean times. Unprecedented opportunity for promotion via the Internet, coupled with chronically short audience attention spans and generalized patient exhaustion (from the treadmill of life) are creating the perfect climate for the spread of pseudoscience.
I must admit that I had turned a blind eye to the whole pseudoscience movement until fairly recently. I figured it was harmless enough – placebos that might engage peoples’ minds in a more optimistic view of disease. But little did I realize that this tumor on the face of medicine would become life threatening to the advancement of science and truth.
Take for example the money that Americans spend on weight loss supplements – 1.3 billion dollars per year, and yet the American Academy of Family Physicians has found no evidence to support the use of a single one. That’s more money than the World Health Organization’s annual budget, and more than Great Britain spends on cancer research in a year. The supplement industry in general rakes in 20 billion dollars a year, which is more than the total amount spent by the US government in the wake of hurricane Katrina.
And what do snake oil salesmen think of this colossal waste of resources? Why, they’re touting it as a new era of enlightenment of course. They weave in “all natural” products, “mindfulness” practices, and “detoxification” programs into a comprehensive feel-good message that is a soothing balm to anxious souls. In reality they are leading the public down a garden path towards a false wellness nirvana, fleecing them as they go, and sowing seeds of mistrust for science-based medicine.
The rise of snake oil salesmen
The strongest potion in the snake oil salesman’s repertoire is the placebo. Placebos are treatments that work based solely on the power of suggestion. A so-called placebo effect occurs when a patient’s symptoms are altered in some way (i.e., alleviated or exacerbated) by an otherwise inert treatment, due to the individual expecting or believing that it will work. If a snake oil salesman is to become truly successful, he must build a case for his wares through anecdotes and testimonials. To obtain these, he must be a master of the power of suggestion, cultivating a small number of “true believers” from which to conjure evidence for the effectiveness of his oil. He need not convince the majority, a small minority of passionate believers will do. As Mark Twain writes, “The most outrageous lies that can be invented will find believers if a man only tells them with all his might.” Therefore, a common denominator with many snake oil salesmen is charisma and charm.
Once the charlatan has developed his small but passionate following, and some miracle cure anecdotes, he will then start playing the role of a victim. He will look for individuals who are willing to challenge his pseudoscientific claims, and then cry out to his loyal followers that he is being persecuted. He will use racism imagery to describe an illusionary bias against himself and the “good” that he is trying to do for those who are open-minded and willing to forsake “paternalistic” science. His followers will be further emboldened to carry the banner of this “downtrodden hero” as they continue to fall for his under-dog psychology.
The snake oil salesman, of course, will not gain traction with key opinion leaders in medicine, so he is left to draw from the Hollywood celebrity pool to further evangelize the masses. Medical leaders will roll their eyes and ignore his obvious pseudoscience, much to the detriment of the general public who have a hard time discerning science from pseudoscience. The charlatan then points to the medical profession’s silence as “proof” that they cannot deny his claims, further convincing susceptible listeners.
Then years later as snake oil salesmen realize that there is further strength in numbers, they gather together to form the first snake oil union. They create a continuum of oily treatments, gathering anecdotes and testimonials from one another in pseudoscientific “meta-analyses” to further strengthen their assault on science and reason. They find wealthy donors and benefactors who are impressed by their growing numbers, and match them with cash-strapped academic centers who will desperately accept funds for any vaguely scientific purpose. The snake oil team now has won a respectable platform from which to grossly inflate statistics about public use of “alternative medicine” (lumping “prayer” into the list of therapies which, combined together, would have you believe that over 60% of Americans are using alternative therapies like homeopathy).
Snake oil goes mainstream
Now that the very same snake oil that medical experts didn’t wish to dignify with a response is being promoted by academic centers, we are obligated to fund research into the potential therapeutic uses of these placebos, wasting countless millions in government funding to study implausible therapies. With a critical mass of snake oil believers, few dare to challenge the wisdom of this approach, and have become passive observers in a downward spiral that is harming the credibility of the very centers founded to promote objective scientific inquiry.
Can good science separate the wheat from the alternative chaff? Yes, but the problem is that few people seem to care about truth any more. While the American Academy of Family Physicians demonstrates that no single weight loss supplement is recommended for public use, the public is spending 1.3 billion dollars per year on these very supplements. Why? Maybe the AAFP is not reaching the public with their message, or maybe people are simply unable to resist the sweet lure of false promises?
Nonetheless, there is a growing movement in medicine to reclaim scientific territory stolen while we shrugged passively at the snake oil lobby. Blogs like Science-Based Medicine and Respectful Insolence are uniting physicians who believe in the importance of objective scientific inquiry as the foundation for the best therapeutic decision-making.
As the healthcare budget crunch looms, further pressure will be placed on providers and pharmaceutical companies to demonstrate the efficacy of their treatments in order to be eligible for coverage. This will be a boon to scientific medicine, as therapies that actually work will (by budgetary necessity) be preferentially selected for reimbursement. While Big Pharma undergoes further scrutiny, they will also turn to science to demonstrate the utility (or lack thereof) of their drugs. Therefore, those in search of truth will not be completely thwarted by pseudoscience.
Yet patients are free to pay out-of-pocket for any number of alternatives to scientifically proven medicine. I predict that further healthcare access limitations will drive more people to look for placebos than ever before, much to the detriment of those who have diseases that are treatable or curable through proven therapies. I worry far more about missed therapeutic opportunities than the dangers of the snake oil itself.
So my final advice is this: eat a well-balanced, calorie controlled diet, engage in regular exercise, stay within a healthy weight range, sleep well, participate in loving relationships, don’t smoke, do drugs, or drink in excess. At least 60% of your medical problems will be prevented if you do these things. You do not need to waste your money on supplements and snake oil – put that money into a savings account that you can access in case you become seriously ill and your insurance doesn’t cover all the best, evidence based care that you need.
Do not tithe to the snake oil salesman. Resist the dulcet tones of the false promises. Save your money to do good, and listen to your own voice of reason.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 31st, 2008 by Dr. Val Jones in News
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Tonight (Jan 31, 2008) the CBS evening news will be airing a segment about a tragic case of a young Marine who died of melanoma. According to the news transcript, an unusual mole was diagnosed as a melanoma in 1997, but no follow up was scheduled, and no explanation given to the young man about his diagnosis or treatment plan. Eight years later in Iraq he complained to medical personnel of the mole growing larger and he was told it was a wart which would be treated once he returned to US soil. He slipped through the cracks somehow, and tragically died in 2008 of stage IV melanoma.
One interesting issue raised in the segment is that the Marine was not eligible to to sue for negligence in his case. There is a law, the Feres Doctrine, that denies military personnel the right to sue the government in cases of perceived or real medical malpractice. The rule was established in 1950 after a case was brought to the U.S. Supreme Court (Feres v. United States) in which servicemen who picked up highly radioactive weapons fragments from a crashed airplane were not permitted to recover damages from the government.
While I do understand (in theory) the purpose of this law – if every battle injury allowed soldiers to sue the government, we’d bankrupt our country in the span of a year – it does seem to be over-reaching in this case. The Marine was not injured in battle, but his life was indeed compromised by sloppy medical follow up. In my opinion, the doctor who correctly diagnosed him in 1997 should be held accountable for lack of follow up (if that’s indeed what happened). As for the military personnel who thought the Marine’s advanced melanoma was a wart, that is a tragic misdiagnosis, but hard to say that there was malpractice at play. With limited access to diagnostic pathology services, it is difficult (in the field) to be sure of the diagnosis of a skin lesion. And yes, I can imagine that an advanced melanoma could look wart-like. This is a tragic shame, but since the young man had the melanoma for 8 years prior to the misdiagnosis of the “wart,” in the end I doubt that a correct diagnosis at that point would have changed his terminal outcome.
But I wonder if the Feres Doctrine should be modified to allow for more accountability amongst military physicians in caring for diseases and conditions unrelated to military service? Although I am not pro-lawsuit, it does seem unfair that this Marine was denied the opportunity to pursue justice in his case. What do you think? Check out the segment with Katie Couric tonight and let’s discuss.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 29th, 2008 by Dr. Val Jones in Celebrity Interviews, Opinion
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I’ve been wrestling for some time about whether or not it’s appropriate to blog about celebrity news (particularly health issues). On the one hand it seems like an invasion of privacy – what gives me the right to speculate on their health? Shouldn’t I leave the poor celebs their privacy, hen pecked as they are by the media? Yet, on the other hand, when the country is abuzz about an important health issue, there is a “teachable moment” in which doctors can perhaps influence patient lifestyle choices for the better, or encourage some preventive screening if needed.
I did decide to blog about Heath Ledger’s sad passing, and thought it might be important for people to know about autopsies and how they work. Although I had mixed feelings about the post, it was one of my most popular in a long time. So that led me to conclude that I shouldn’t shy away from celebrity news. Nonetheless, I confessed my squeamishness to a friend of mine, and his answer was so insightful that I thought I’d share it with you:
The other way I think
of it is this: health is really personal. Almost everyone who writes about
health does it from the perspective of a personal story – the most common health
blogs are health blogs by patients / survivors about their own experience, the
next most common is by doctors talking about patients. You could have written
yesterday’s entry [Heath Ledger] about the death of a friend or a patient under unknown
circumstances. The problem is that a blog that begins every time with, “I had a
friend who had ALS…” is very concrete to you – you know the friend – but not
concrete to the reader – they don’t know your friend. The use of celebrities
creates a shared vocabulary – people we all “know” that we can converse about.
Put another way, in an
era before blogs, where health conversations were held around kitchen tables and
over the back fence, there was probably less discussion of celebrity health
because the discussants all shared a common stock of people about whom to chat:
Doris down the street has breast cancer; Trudy two doors down has a pregnant
teen; Francine on Maple Street has a mom with Alzheimer’s. The internet and
blogs are an attempt to create a similar conversation with people all over the
country – the planet – who don’t know any people in common. Celebrities are the
only folks we can all discuss, because they are the only folks we all
know.
What do you think? Is it ok to blog about celebrities? Should I do more of it? Less of it? Does my friend have a point? Please share your thoughts.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 21st, 2008 by Dr. Val Jones in Uncategorized
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Health tips
Are you struggling with depression? Mira Kirshenbaum suggests that talk therapy may be more effective than medications.
Does your child have mono? Dr. Stacy Stryer explains that mono has very different symptoms depending on a child’s age.
Be careful of vitamins and supplements – some of them may negatively affect your other medications. Dr. Julie Silver offers a list of the most common supplements that interact with medications.
If you see flashing lights or floating objects in your visual fields, see an ophthalmologist right away. Dr. Jackie Griffiths explains why the symptoms of retinal detachment can be quite ominous.
Are you about to have surgery? Dr. Jim Herndon suggests some questions to ask your surgeon before and after the operation.
Don’t be shy about asking for help when you have cancer. Dr. Heinz-Josef Lenz highlights some great advice from the Colon Cancer Alliance.
Looking for ways to enhance your sex life? Mira Kirshenbaum has some creative suggestions.
Do you have diabetes? Exercise might be the most important “treatment” for type 2 diabetes. Dr. Jim Hill explains.
Did you know?
Fertility decreases by 5% for every 1 point increment in BMI over 29. That means that getting pregnant becomes more and more difficult as you gain weight! Dr. Mark Perloe explains.
Men can suffer from post-vasectomy pain. Dr. Joe Scherger describes this problem and what to do about it.
Could having children increase a man’s risk for prostate cancer? Dr. Mike Glode reviews the evidence.
Your brain needs sleep to recharge its neurotransmitters. Dr. Steve Poceta explains the exact reasons why sleep is so important for the health of the human brain.
Approximately 1 in 25 children will have at least one febrile seizure in their lifetime. Dr. Olajide Williams explains that a seizure that occurs during a time of fever does not mean a child has epilepsy.
Siestas and/or power naps could reduce your risk of heart disease. Dr. Joe Scherger highly recommends this regular form of stress reduction.
There are fat zip codes and skinny zip codes. Dr. Jim Hill explains why thinner people congregate in certain places. Think upper east side, Manhattan!
A recent study suggests that calcium supplements may put older women at higher risk for heart attacks. Dr. Jim Herndon explains why he’s skeptical of this potential link.
Medicare will not pay for in-hospital complications believed to be due to errors. Kelly Close wonders how they know for sure that an adverse outcome is related to an actual error or not.
Do you know someone who engages in repetitive, jerky movements? Dr. Olajide Williams is a neurologist who explains what “tics” are and what can be done about them.
Around the globe
China: How many autism experts are there in China? About 30 for 1.3 billion people. Robin Morris describes how bleak the prospects are for parents of children with autism.
United States: In an outrageous court ruling, a physician was held responsible for the death of a young boy who was run over by a patient (while driving his car) on blood pressure medicines. Dr. Cole Brown wonders how much of a patients’ actions can be blamed on his physician?
Africa: “River blindness” is caused by a parasitic invasion of the eye. These parasites can be killed with a medicine called ivermectin, but apparently the wily larvae have developed a genetic mutation that renders them resistant to the only known medicine that can kill them. Dr. Jackie Griffiths reminds us all how tenuous our antibiotic victory over microbes and parasites really is.
Personal perspectives
Some people use diet coke in their CPAP machines! Dr. Steve Poceta tells the story of how one of his patients preferred this type of humidified air. Not sure what that will do to your lungs…
Ever wonder how to weigh the pro’s and con’s of chemotherapy in a terminally ill patient? Dr. Mike Rabow describes how he advises patients about this difficult decision.
Dr. Rabow describes some tear jerking true stories from a hospice in Florida.
From the blogosphere at large: this week’s grand rounds is hosted by Alvaro Fernandez at SharpBrains.com. The theme is: briefing the next US president on healthcare. Some really important information in there folks, so go ahead and have a good read!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 9th, 2008 by Dr. Val Jones in Uncategorized
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I’m so excited and honored to have been nominated – and now selected as a finalist – for the “Best New Medblog, 2007” award! Thank you MedGadget team! If you’d like to vote for me, please go to this page. The winners will be selected based purely on quantity of votes. The polls are open until midnight, January 20th.
I’ve also collected the best posts from 2007 below so you can get an overview of what my blog is like – where else can you join a weight loss group, read weekly round ups of the best posts from medical experts, stay in touch with breaking medical news, and have a generally cathartic experience with true health stories?
The Best “Feel Good” Posts
A Baby’s Life Is Saved – a young mother forces a doctor to reconsider his diagnosis, saving her baby’s life.
Do the Right Thing– a young intern fights to save the life of a patient that everyone else has written off.
The Wounds of Childhood– how I might have made a difference for a little girl who was marginalized.
Medicine: Face-to-Face– the story of how I treated a child for the same injury I had at her age: being mauled by a dog.
Informed Consent and the Animal Guessing Game– my reflection on the emotional side of consenting for a procedure.
Thanks to Surgeons– a heartfelt tribute to the surgeon who saved my life.
Fly the Ball– the life and times of a Pakistani doctor who builds a successful career in the US.
The Best Infuriating Posts
The Last Straw: My Road to a Revolution– the true story of a child with cerebral palsy who died because he was denied a wheelchair part by Medicare.
The Benefit of the Doubt– how my friend was labeled as a drug seeker and mistreated in the ER.
VIP Syndrome: A No-Win Situation – the story of how a young man with “connections” demanded and received inappropriate and expensive medical tests, leaving the doctors holding the bag.
The Case of a Predator in the Hospital– how one drug user managed to game the system, wreaking havoc on her fellow patients.
Don’t Believe Everything You Read in a Medical Chart– the story of how a misdiagnosis resulted in a patient being wrongly labeled as a drug seeker.
The Real Dangers of Pain Medicine – a woman who died of opiate induced constipation.
The Best Sad Posts
The Scream– how a cavalier end-of-life decision destroyed a family member.
The Size of Unhappiness– a reflection on America’s obsession with thinness.
Baking Cookies– that’s all I could do as a doctor in Manhattan on 9/11.
Unencumbered by Prognosis– my dear friend handles her diagnosis of stage 4 colon cancer with optimism and grace.
Alzheimer’s Dementia: A Life Lived In Reverse– the story of my grandmother’s dementia and her slow mental decline.
The Best Humorous Posts
Conversations at the Spa– the true story of my recent trip to a high end spa in California.
Kids Say the Darndest Things– these are some pretty good ones.
The Christmas Miracle– a “miraculous” icicle forms on a Christmas tree and pandemonium ensues.
Medical Haiku– some irreverent poems I created a few years ago.
Is that Your Real Skin?– the silly conversations that arise when you’re really pale.
Dudes– a quick look at how men perceive a new hairstyle.
The “Perfect” Wedding– the story of how my hair was transformed into an alien head on my wedding day.
The Best Healthcare Policy Posts
Why I Worry about a Government Sponsored Single Payer System – previous experience with government rulings make me distrustful of population based healthcare savings initiatives.
Pay for Performance: More Red Tape without Improved Quality of Care – the title pretty much sums this post up.
Are Physician Salaries Too High? – compare them to health insurance and corporate executive salaries.
Concierge Medicine for the Masses?– my physician is part of an “off the grid” movement in healthcare.
Rationing Healthcare and the Emperor’s New Clothes – I take a look at some of the funding allocation decisions being made by the government.
End of Life Care: Healthcare’s Big Ticket Item– I explore some of the high costs of end-of-life care and the ethical dilemmas that rationing it creates.
Posts That Make You Go…Hmmm
My First Day as a Doctor– it was a baptism by fire.
The Great Unveiling– who are we deep down inside?
Night Float in the Hospice– what it feels like to care for the dying.
Dying with Dignity– I refused to practice intubation on a deceased patient as his family members waited for news in the next room.
Face Transplants: Ethical Dilemmas– should they be covered by health insurance?
The Man Who Couldn’t Speak– a strange diagnostic dilemma solved by a doting mom.
The Best High Brow Posts
Cancer: Do We Really Understand It?– a wonderful post by guest blogger Avrum Bluming, questioning if we really do know as much as we think we do about this formidable foe.
Hormone Replacement Therapy: A Critical Review– another wonderful post by Dr. Bluming.
Good Science Makes Bad Television– a series on research methodology and why the public should care about it.
The Power of Magical Thinking– describes how to recognize snake oil salesmen.
What You’ll Learn in Pre-Med Classes– a rant about how irrelevant some of the course work is that is required for admission to medical school.
What the Heck is a Rehab Doc?– the history of my medical specialty: PM&R.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
