The other day, I took a nephew to see the new Spider Man
movie, “Far from home”. No review here; just to say that a big part of the plot
revolves around the bad guy using a high-tech virtual reality system to project
fake images that everyone takes to be real. Several times in the film he and
his henchmen say “people will believe anything”. The parallels to the daily
reality of our times, to “fake news” and distrust of science, are too obvious
to be coincidental. Of course, in the movie the bad guy loses and the good guy
(Spider Man) wins.
It is still far from clear if the “good guys” (and here I
speak not of specific individuals, but of those who advocate for truth, a real
reality, and science) are going to win in the actual world. The forces of
darkness and reaction, wearing the face of Donald Trump and facilitated by the
Republican Party, but actually representing and funded by the corporate elite –
gangster capitalists – may not wear capes and fly around or use astral
projection, but they have enormous resources to control the dialogue, provide
misinformation, and serve themselves. They are resilient not only because of
their wealth and power, but, sadly, because so many people are happy to try to
deal with their own oppression by hating, oppressing, and believing bad things
of others.
Health and medicine are clearly not immune from the reach of
“fake news” and false beliefs and those willing to exploit our willingness to
believe what we want to be true
rather than what is. This is often a result of also a logical fallacy, wishful
thinking (which is only a fallacy when it is expressed as true; not when it
is expressed as a hope or wish) but may be more appropriately called “magical
thinking”, a developmentally appropriate stage for young children that is
always pathological in adults. Those who promulgate false scientific, medical
and health theories and advice can be doing so to make money, to exert power
and control, because it derives from a pre-existing belief (sometimes but not
always religious). Sometimes it is also self-delusional, especially when the
proposed solution is easier, more palatable, less painful, and requires less
discipline than the medical alternative (take these simple pills – or snake oil
-- and you won’t have to diet/exercise/stop smoking or drinking/have radiation
or chemotherapy or surgery and you can be more youthful or beautiful or
sexual). I once wrote about a patient who was obsessed with getting mammograms
for breast cancer, a condition for which she was not at elevated risk and was
far too young for routine screening, but was uninterested in addressing her
actual risks resulting from heavy smoking, uncontrolled high blood pressure,
and unprotected sex with multiple partners (Healthful
Behaviors: Why do people adopt them? Or not?, October 8, 2011).
Because, I inferred, it was easier, and would require no real effort or difficulty
on her part. This is why it is an attractive option. But it is not a good idea.
The trend toward getting health and medical advice from
those who are not medically trained has always been with us, but the same easy
dispersion of information (or misinformation) through the Internet that allows
us to hear anything we want and, to a large extent, only what we want, impacts health care as well as politics. The “anti-vax”
movement is very popular, and promoted by celebrities. (Why should we not get
our health advice from those whose qualification is that they are celebrities?)
In addition to being wrong, it is very dangerous to the public health. I say
that with absolute certainty. The anti-vaxxers are wrong. Period. There is some
risk that individuals will have a reaction, very rarely a serious one, but this
impact is totally miniscule compared to the benefit of preventing disease
through vaccination. Indeed, vaccination is one of the few areas in which we
actually can prevent, and thus not
have to treat, diseases!
Some celebrities deserve a special call-out for their
comprehensive and ubiquitous denial of fact, reason, and science – amazingly,
often in conjunction with a profit motive from the brand of snake oil that they
are selling; Gwyneth Paltrow is the exemplar. Of course, Ms. Paltrow deserves
some credit for being able to convince people that they should do things that
are actually unpleasant and painful for the sake of their health and beauty, like
getting
stung by bees, even though these are of no actual value to her clients.
Obviously, they are of financial value to her. And, while I admire much of what
she does in the world, Oprah Winfrey is also a big proponent of false health
information.
Sometimes, bad policies are advocated by the self-righteous,
as is the case with the
current Israeli Education Minister, the most recent bigot coming out for “conversion
therapy” for gay people. This is an example of falsely medicalizing a
condition by suggesting it requires therapy, something that should not be. Sometimes,
as in Paltrow’s case and many others, it is at least in part motivated by the
opportunity for profit. Often, and this is sad, it is motivated and believed
because people do not trust doctors and other health professionals. One reason it
is sad is because people eschew treatments that could be of benefit to them in
favor of those that will not help and may even hurt. But another major reason
is that many doctors and other health professionals have been themselves guilty
of pushing treatments that do not benefit, and may hurt, their patients. They
do this for the same set of reasons as those I criticize above: to make money
themselves, to make money for drug and device makers who pay them directly or
in gifts including drug samples, because they are too lazy (or “too busy”) to
actually read and evaluate the evidence and so taking the advice of drug or
device salespeople is easier, and because they think that because they are
doctors everything they think is
right. I wish this were not true, but it often is. Holding physicians to a
higher standard than non-medical people is appropriate, but this is not an
argument for believing people because they are not doctors, no matter how confident. Iit absolutely in no way
justifies listening to the advice of non-medical people who know even less!
It is also the case that some “alternative” suggestions for
treatment are helpful, and many others are probably benign (except for the
cost), even if the evidence is that they are not helpful; one example is taking
vitamin supplements. If you can afford them, and don’t take excessive
doses, they probably don’t hurt. It is certainly a better way to waste your
money than on cigarettes, but if you can’t afford them, skip them. Other
medical interventions can be good, and of benefit, but the benefits are often
overstated, or reified as totally important. This is especially true when it is
promoted as more “natural”, a word so overused as to have almost no consistently
definable meaning. One example might be the use of birth attendants, called doulas. For many people, especially
those who do not have a support system such as a spouse or parents or siblings
or friends (and, likely for some who do) it is very helpful to have a
knowledgeable, supportive person during your labor, focused entirely on you. But
they are neither magic nor necessary.
Having someone who can help you deliver your baby, like a
midwife or physician, is often necessary. A birth support attendant is a nice
addition. Nurse-midwives train as registered nurses then do additional years of
midwifery training and attend many births, including many doing deliveries
under supervision. They can deliver babies as well as support women in
labor. In contrast, becoming a doula, according
to https://www.naturalhealers.com/midwifery/doula
requires a total of about 2-3 weeks including the need to attend a few births.
So what scientific basis could there be for NY State Gov.
Cuomo is advocating the expansion of the use of doulas to decrease maternal
mortality, something for which there is not only no evidence, but no
rational basis for thinking.
Come on, Governor! Come on, people! Not harmful is good,
helpful is even better, not breaking the bank is important, and sometimes
natural is nice. But let’s not choose magical thinking over science. That helps
no one, except the snake oil vendors.
3 comments:
On this same topic, Paul Krugman: https://www.nytimes.com/2018/08/21/opinion/partisanship-parasites-and-polarization.html
Another widely-held false belief: https://www.nytimes.com/2019/07/16/science/5g-cellphones-wireless-cancer.html
And more, anti-aging medicine: https://www.medscape.com/viewarticle/915408?src=WNL_infoc_190718_MSCPEDIT_AntiAging&uac=328234MR&impID=2032379&faf=1
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