Why do some registered medical practitioners promote CAM interventions?

Posted 27 June 2020

An opinion, published in the Friends of Science in Medicine newsletter.

Why do some doctors, equipped with a science-based degree offering so many opportunities for a satisfying  professional  career,  join  the  ranks  of  raggle-taggle  quacks and  self-proclaimed experts?  These  range  from  outright  shonks  (eg  Gwyneth  Paltrow)  to  the  sincere,  but  befuddled, followers of rigid, ancient, pre-scientific belief systems.

I offer some thoughts on what might or might not answer this question.

  1. Science is hard work
    Learning can be described as ‘shallow’, ‘deep’ or ‘strategic’. Some students manage to scrape through  their  medical  degree  without  a  genuine  understanding  of  biomedical  science.  How  else could one explain their willingness to embrace pseudo-science?
  1. ‘Transactional’ medicine is unsatisfying
    Rather  than  simply  expanding  their  concept  of  good  medical  care,  some  make  a  ‘mind-body’  connection  through pseudo-science. They don’t realise that psychological medicine is as heavily reliant on science as is physical medicine, and  that  social  ills  outside  the  remit  of  Medicine  will  not  be  fixed  by  reference  to  pseudoscience. George Engel’s biopsychosocial  model reminded  us,  more  than  40  years  ago,  that  good  clinical  practice  is  both  compassionate  and scientific.
  1. Finding a niche
    Because  scientific  medical  advances  are  relentless,  no-one  can  abreast  of  everything.  Group  practices  can  encourage GPs  to  sub-specialise – in women’s health, paediatrics, aged care, minor procedures, etc. Stepping into the simplistic world of CAM might feel like just another niche.
  1. The lure of authority
    To be “just a GP” often, considering the challenges of generalisation, offends – so  much  so that the RACGP makes a point of challenging this expression. Garnering   respect   from   a   sub-group   of   patients   who   embrace   alternatives   is   another temptation  to  authoritarian  personalities.  Certain  large,  lucrative  practices,  underwritten  by Medicare, have developed this way.
  1. A discourse community
    The  need  for  answers  to  the  complex  biopsychosocial  questions  posed  by  ill-health can lead doctors into a ‘discourse community’,  especially  via  social  media,  within  which  they  find  other  doctors  speaking  the  same  language  and reinforcing one another’s unscientific ideas.
  1. A streak of rebellion
    Being different can be attractive. We all have a streak of rebellion against doctrinaire medical experts who show scant regard for GPs at the frontline. It can feel good to say “You don’t know everything. Your biomedical model is lacking, mine is holistic (therefore complete).” And because it is, by its very nature, unscientific, it is beyond evidence-seeking scrutiny.
  1. The mystery
    We  are  surrounded  by  Nature’s  mystery.  We  don’t  know  why  patient  A  develops  a fatal  brain  tumour,  or  why  B became much more ill with COVID-19 than C, who didn’t even know they’d had the infection. We can determine some reasons, guess at others, and still be left with residual mystery.

CAM  enables  its  practitioners  to  play  a  sacerdotal  role  in  a  world  where  priests  and  priestesses  are  becoming  rarer  as western  conventional  religions  lose  authority.  It  can  be  highly  lucrative,  with  some  practitioners  promoting  and  then selling ‘treatments’ and ‘medicines’ in which they have a commercial interest.

Conclusion

All in all, the lure of CAM, from a practitioner’s social and psychological perspective, is relatively easy to understand.

The  economic  side  is  also  tempting – including  applying  or  selling  the  bogus  interventions,  and  using  Medicare  item numbers for consultations to hide bogus practices.

The cure? “You can take the horse to water, but you cannot make it drink.”

It  is  too  much  to  expect  of  these  medical  fraudsters  that  they  will  work  with  humility,  read  widely  and  gain  a  deeper understanding of what the sciences (biomedical, psychological and social) can provide in helping to meet patients’ needs? Intervention by Medicare, to exclude rebates for such consultations, is, regrettably, the only practical solution.

Dr Richard Gordon
MBBS FRACGP Dip Health Law. General Practitioner

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