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The Power of Magical Thinking

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:

  1. Trust
    “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.
  2. Conspiracy
    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.
  3. 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!?”
  4. 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.
  5. Pseudoscience
    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.
  6. 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

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One Response to “The Power of Magical Thinking”

  1. Anonymous says:

    Charlatan or authentic practitioner.. you would have people believe if the doctor hasn’t heard about it then it’s snake oil. 

    While there are certainly plenty of charlatans out there, your blog posting offers a naive perspective on healthcare delivery and doctors in general.  You reason that when a doctor doesn’t know about a therapy, it’s because it’s snake oil.

    It is possible that doctors are human too and they don’t know about a therapy because a) s/he has not read the study  b) the therapy is outside his/her area of expertise c) the therapy was never taught in medical school and therefore s/he is not likely to read an article about it  d) therapy was never taught in medical school and even if he did read the study, his/her expectation is that it doesn’t work so even if the study says ‘it works’, s/he still has doubts.  e) and to your point, there is little or no science behind it…. but does that mean it’s snake oil??  There is little research to support injecting steroid into joints but we do it all the time…. snake oil?    There is little research a great deal of health care that we deliver that has not been rigorously evaluated…. are we snake oil salesmans ourselves??  

    Ironically enought, your very own blog posting erroneously creates the magical thinking that if your doctor doesn’t know about it, it MUST BE MAGICAL THINKING (snake oil).  As such, people should assume the doctor knows everything and in so doing you would have people lump together 

    There are many more holes in this argument that you put forth….. but for now, I’ll let you tackle this one.

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