Alternative medicine: The illusion of control

We humans like control. Actually, we need to feel as though we are in control. Perhaps that’s why, when we aren’t in control–can’t be in control, for whatever reason–we instinctively seek ways of being more in control, or at least of feeling as though we are in control. I’ve often wondered if providing the illusion of control is part of the reason for the appeal of quackery alternative medicine, or, as it’s become known these days, “complementary and alternative medicine” (CAM) or “integrative medicine” (IM). That, and the human need for certainty.

Think about it, taking cancer (my specialty) as the prototypical example. What do those nasty, reductionistic, science-based doctors tell a patient when confronted with a patient with cancer? Even for an early stage, eminently treatable cancer, we rarely use the word “cure.” We speak in terms of five- and ten-year survival and percentage chance of relapse. We almost never, ever tell a patient that we can definitely cure them. That’s because pretty much all of us have been gobsmacked and saddened by cases like that of a woman with a 1 cm breast cancer with no lymph node metastases, favorable histology, and positive estrogen receptor status who came back three years after apparently successful treatment with stage IV disease. The frequency of this sort of thing may only be in the single digit percentage range, but if you see hundreds of patients a year you will see a few of these patients every year, and you will be humbled. Even more humbling is when a patient asks me what caused her cancer. As much as I can pontificate on the molecular and genetic derangements that are associated with cancer, how cancer cells escape the normal controls that keep normal cells in check, only growing when they’re supposed to and then stopping, when it comes to the question “Why?” I can never tell the patient what it is she really wants to hear. That is the cause of her cancer and whether there was anything she could do to prevent it. In most cases, the answers are, to the patient at least, maddeningly vague and hand-waving.

Contrast that to the quack. There’s a famous saying about surgeons, “Sometimes in error, never in doubt.” With quacks, the saying should be, “Always in error, never in doubt.” However, it’s that “never in doubt” part that can suck in patients who are normally skeptical and hard-headed rationalists in other areas of their lives. For instance, when a quack like Tullio Simoncini tells patients that cancer is a fungus and that treating it with injections of sodium bicarbonate (i.e., common baking soda) straight into the tumor will cure it, a surprising number of patients believe. Ditto the late Hulda Clark, who proclaimed that the cause of all cancer is a common liver fluke and that she could “zap” it with her “Zapper.” Indeed, she even proclaimed that she had the “cure for all cancers.” Never mind that as a piece of technology her Zapper looked less convincing than a Scientology E-meter. Or take Robert O. Young, who tells patients that the cause of cancer is “acidity,” that cancer is actually a reaction to cells “spoilt by acid”; and that they can cure their cancer by “alkalinizing” their body with a special diet and, of course, supplements. Regardless of how utterly ridiculous his quackery is, intelligent woo-prone women like Kim Tinkham fall for it and pay the price with their lives.

What the quacks give, I’ve found, is both certainly and control. Well, they actually don’t give patients real certainty and control. Rather, they provide the illusion of certainty and control. Of course, there is a dark side to this message. In fact, Robert O. Young, as goofy as he looks and as goofy as he comes across when you see him on video, is a master at providing a false sense of control, as he demonstrates in a post on his blog I saw the other day entitled Health and Fitness Is A Choice Just As Sickness and Disease Is A Choice. Seldom have I seen the attitude of quacks laid out so baldly.

I’ve pointed out before that Robert Young is a germ theory denialist. In fact, in this post he makes it explicit once again, extolling the virtue of Antoine Bechamp and lambasting Louis Pasteur. After he does that, though, he gets to the heart of the matter, and the heart of the matter is rotten:

More importantly, the germ theory has become a curse because it has encouraged individuals to give up responsibility for their own health over to the medical community. If germs cause disease it stands to reason that control belongs to the medical community whose tireless researchers spend trillions of our money to find the right pill or potion to annihilate disease-causing germs.

Of course, I tend to doubt that in the entire history of science-based medicine the amount of money spent on medical research has even approached “trillions” of dollars, but let’s not quibble over numbers. We do spend a lot of money on medical research, certainly billions a year. (The NIH budget is, after all, around $31 billion a year.) But note the complaint against Pasteur. It’s only partially a fallacious claim that Pasteur’s science was wrong. More importantly, it’s an appeal to self-determination, the claim that the real problem with Pasteur’s science was that it led to patients abrogating their control over their health to doctors. “If germs cause disease,” according to Young, then it takes practitioners knowledgeable in how to combat these germs (like, for instance, Mark Crislip), not shamans-cum-pseudoscientists like Robert O. Young telling their patients that they can cure themselves if they just eat the right foods, take the right supplements, and do the right exercises. In fact, it goes beyond that, as Young makes clear:

Our body in its wholeness is an ingenious creation of nature, It has been given all mechanisms to not only sustain its life but also to create new life. Every healthy person has innate regulatory mechanisms to maintain its alkaline design and self-healing powers, which ensure or reestablish the natural balance of the bodily functions, the homeostasis. It is not the doctor that heals us, nor the medication, but our own innate alkaline regulatory mechanisms. Our body is able to fully regenerate itself. Therefore, it is advised to use great discernment before labeling any disease as “incurable” or “untreatable.” If doctors come to the conclusion that a disease in incurable, they would be more accurate in saying that with their knowledge and experience, they are not able to offer any further help. The word “incurable” conveys fear, or false evidence appearing real, which stifles and weakens our body’s innate alkaline mechanism.

In other words, believe it or not, Young is arguing that telling a patient her disease is incurable, even if it is, somehow makes it so. Wow. If doctors really had that power, then if we lied to our patients and told them that their disease is curable even when it is not then we should be able to “strengthen our body’s innate alkaline mechanism” and cure even the incurable. Of course, Young is spouting a load of nonsense, but it’s a telling load of nonsense. It tells us that what he’s selling to his marks clients is hope. It’s a false hope built on pure pseudoscience, and it involves telling patients they are curable when we know they are not, but it’s hope. It’s also certainty, as well, in that he’s telling patients that they are completely in control of their health. Just look at the title: Health and Fitness Is A Choice Just As Sickness and Disease Is A Choice.

Think about the implications of that for a moment. Ignore, for the moment, all the nonsense, the “science-y” sounding gobbledygook about energy, matter, homeostasis, Hippocrates, and the usual topics that quacks like to use and abuse that Young ladles on his prose like so much gravy on meat loaf. (I’m amazed that nowhere in his article does there appear the word “quantum.” It must have been an oversight.) In fact, if you want to get a flavor of the historical misinformation that Young delivers, just look at this statement:

In 1788 vaccinia was the bacteria that medical science suggested caused cowpox.

Except that in 1788 medical science had not yet discovered that bacteria cause disease, and vaccinia is a virus, not a bacterium. The germ theory of disease came nearly many decades later. The rest of Young’s essay is peppered with errors in fact and interpretation like this.

It’s all either utter nonsense or a twisting of what is currently understood, much of which I’ve applied some not-so-Respectful Insolence to not just once but many times over the last seven years. To an extent, a lot of it’s a straw man argument. No physician would deny that lifestyle, such as diet and exercise, can have a major impact on health. However, unlike the impression that Young gives, there are some conditions and diseases that just happen, no matter how “perfect” or “healthy” a lifestyle you lead. Cancer is one of them. You can decrease your chances of developing cancer somewhat through diet, exercise, and avoiding things that are highly carcinogenic, like smoking tobacco products, but no matter what you do you will never decrease your risk of cancer to zero or anywhere near zero. This is particularly true given that cancer is a disease of aging, and, thanks to science-based medicine, people are living longer and longer these days. Since we all have to die some day, it follows that we all have to die of something, and diseases of old age, such as cancer and heart disease, are the two most common killers of the elderly. In any case, the implication of Young’s idea is that if you are sick it is your fault. Period. You are to blame. Not nature. Not a “germ.” Not genetics. You. This is the message of Robert O. Young and so many other quacks. In other words, the flip side of his message of control is that your illnesses are your fault.

Yes, it’s the same dark side that is shared by The Secret.

Oblivious to that irony, Young engages in a massive case of projection:

Of course, we perceive that these ideas about disease are no longer widely believed, which makes it all more the ironic that Pasteur’s germ theory has had and still has a stranglehold on 19th, 20th and now 21st century medicine. As medical writer Alberto Seguin described in an article entitled, “The Concept of Disease,” the demonic idea of disease reached its full height with the germ theory. It became possible to bring together rational and scientific thought with irrational tendency to personalize disease. The germ in what ever name it is called, West Nile Virus, Ebola, Hunta, HIV, Anthrax, SARS and now AVIAN, are the scientific demon, the curse, the lie and the fraud that is said to attack and kill!

I would argue that Young is the one who personalizes disease. By declaring with such certainty that whether we are sick or healthy is entirely up to us, he personalizes disease at the level of the patient. If the patient is in control of his health, then if he becomes ill it must be somehow his fault. Blame is personalized. Think I’m exaggerating?

Think again:

Now, I pray and hope that you will realize that we are all responsible for our own health – you alone. A medical practitioner can only help to relieve symptoms. Ultimately, you are the one who has to take charge. Health is a choice just as disease is a choice. You are responsible for what goes into your mouth and what comes out of your mouth, as well as for what you think, feel and do. Health is all about choices and consequences.

Yes, to some extent it is, but this goes too far. If, for instance, you have a genetic condition that causes hypercholesterolemia or hyperlipidemia, you can eat as healthy a diet as you like and exercise all you like, but you probably can’t stop the inevitable march of cardiovascular disease. If, for instance, you are a woman who carries a cancer-predisposing BRCA1 mutation, you have as high as an 80% lifetime risk of developing breast cancer, and there is very little you can do to decrease that risk. In other words, as important as healthy lifestyles are for treating or alleviating so many conditions (type II diabetes, for instance), there are still a lot of diseases and conditions where genetics trumps lifestyle.

The same is true of infectious diseases. No matter how healthy you are, no matter how fanatically you adhere to the “right” foods and the “right” lifestyle, if you’re unlucky enough to have the right pathogenic microbe insinuate itself into the right cells in your body, you will become ill and you might even die. Indeed, that’s one reason why quacks like Young hate germ theory so much; it goes so radically against their own radical idea that you alone are completely responsible for whether you are ill or healthy. Microbes, as I like to say, don’t care how perfect your lifestyle is.

In the end, Young merely echoes what I’ve read over and over and over again on quack websites, blogs, discussion lists, and other places where supporters of quackery congregate. Basically, he provides simple answers. All cancer is caused by a single thing, namely “too much acidity.” In fact, pretty much all disease is caused by the same thing. That makes the cure simple; all you have to do is to “alkalinize,” whatever that means. Never mind that some of the dietary recommendations to “alkalinize” involve eating fruits with a lot of acid in them (such as citrus fruits). Just don’t think too hard about it. the second element, of course, is pure certainty. Young tells patients he can cure them with a very high degree of probability, even if they have cancer. Actually, he tells them that they can cure themselves, which is even more powerful, and that all they have to do is a relatively simple set of lifestyle modifications. Of course, by “simple” I don’t mean “easy.” The sorts of dietary changes Young and others of his ilk recommend are radical, the more radical, it seems, the better. By doing so, when patients adopt his “miracle pH” lifestyle and don’t get better, he can duck responsibility. Obviously, if a patient isn’t getting better, he isn’t doing it right.

After all, if Health and Fitness Is A Choice Just As Sickness and Disease Is A Choice (as Young entitled his post), then if you are sick it is by your own choice.

That’s the real toxic message of quacks like Young.