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.
- 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?
- ‘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.
- 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.
- 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.
- 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.
- 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.
- 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.
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