Posted by: notdeaddinosaur | January 30, 2008

Why do Doctors Fall for CAM?

Medical training is, by definition, steeped in science. Given this as a starting point, there is a great deal of puzzlement about why doctors — supposedly intelligent and scientific to begin with — turn to forms of “alternative medicine” that require magical thinking to buy into their purported mechanisms of action. This is not intended as a snarky “What makes them turn to the dark side” essay, but an honest attempt to understand the relative roles of emotion and logic in medicine.

I’m going to begin by giving these physicians the benefit of the doubt by assuming that their “conversion” to CAM principles is intellectually sincere, and not purely for the monetary gain of producing a cash-only practice, independent of insurance constraints. Granted, such a practice shift is virtually certain to produce a financial windfall. Still, I’d prefer to believe most doctors are above such base and cynical motivations.

I’m also going to assume that the primary motivator is not the emotional one of acceptance into the warm, fuzzy, welcoming world of CAM. Without doubt there is a large, passionate population eager to welcome such physicians with open arms. Praise for “having such an open mind” and being so “different from all those other doctors who just won’t listen to reason” is powerful, and its emotional effects should not be underestimated. While just being liked probably isn’t reason enough to endorse magical thinking, it is still a very real and important secondary benefit.

What I’d like to address specifically is the physician who, after many years of conventional practice, decides that one or more of the magically based alternative modalities are in fact true and correct. Why? What could make a rational person suddenly believe things that make no sense when thought about rationally?

If you practice medicine long enough, you will see things you cannot explain. Cancers that go into spontaneous remission; documented infertile women becoming pregnant; asthma, arthritis, psoriasis that spontaneously improve or abate completely. I do not deny that these and other phenomena defy our scientific understanding. When out patients say to us, “How did this happen?” we are forced to answer — if we are being honest — “I don’t know.”

I don’t know.

Difficult words to utter; more difficult still to live with, especially as an inquiring, curious, scientific physician. Dealing with uncertainty can be downright painful; a pain known as cognitive dissonance. Because doctors are human, they can’t be blamed for trying to deal with the discomfort of not knowing. Along comes a knowledgeable, reasonable patient experiencing one of these inexplicable events who discloses that they have utilized alternative medicine; perhaps homeopathy or Reiki. Neither physician nor patient can figure out what else could have “caused” the miraculous result, and so two skeptics are converted. The doctor goes on, cautiously perhaps, to utilize the new modality. A combination of confirmation bias and the fallacy of correlation and causation turn him into a true believer. The same process can occur more quickly when the physician has a close emotional relationship with the patient, such that the “miraculous healing” is experienced as a spiritual awakening. In fact, an article on Quackwatch has this to say about what they call the “conversion phenomenon”:

Many individuals who [embrace alternative medicine] undergo a midlife crisis, painful divorce, life-threatening disease, or another severely stressful experience. The conversion theory is supported by a study of why physicians had taken up “holistic” practices. By far the greatest reason given (51.7%) was “spiritual or religious experiences.”

Far from gaining a new “faith” in alternative medicine (that requires magical thinking), I believe that these physicians have lost their faith. Faith that science and rational thinking are the best way to understand the physical world around us, including the human body. How easy it is to relieve the pain of not understanding by giving in to the idea that there are answers after all; energy fields; water with memory; the “mind-body connection.” That there is also an enormous, enthusiastic, welcoming community — cult-like — merely reinforces all the new “paradigms.”

For what it’s worth, I happen to have a deep faith and a rich spiritual life. But despite that — or because of it? — I am not willing to give in to the idea that magical explanations must be accepted when scientific ones cannot be produced. I believe in a soul, but I do not accept neurosurgeons flaunting PET scans claiming they have found it. Humans may indeed have sacred energy fields that cannot be measured, but how arrogant of Reiki practitioners to claim they can manipulate them! Faith and science surely interface in the art of medicine, but not via alternative medicine paradigms. Reiki is as inappropriate in an ICU as a geologist barging into synagogue on Simchat Torah complaining as we read the Genesis creation story from the Torah that it’s a bunch of scientific bunk. If nothing else, I have faith that although science may not YET know the answers, rational thinking is the only way they can be eventually found.

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