Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, 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.

12 Comments:

At Wed Jan 30, 06:23:00 AM, Blogger Sara said...

A generous policy of gifting people with The Demon Haunted World is a good start.

 
At Wed Jan 30, 10:43:00 AM, Blogger Lynn Price said...

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". 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.

Well, yes this is a “what makes them turn to the dark side” essay. You’re sweating the small stuff. It’s like shaking one’s head and ruefully asking, “what makes people become Democrats?” Who knows, who cares? It’s assumed that in both cases, research was done to justify their decisions. Does that make them unbalanced or dangerous? I’m willing that answer will be yes if you’re a Republican or someone who hates alternative methods of healing.

What I’m reading here is that you don’t understand how a scientist can possibly think like anything other than a scientist. Since alternatives require stepping outside that particular corridor, these people are somehow unbalanced and illogical in your mind. Given that caveat, it occurs to me that there are no answers that will satisfy you.

What could make a rational person suddenly believe things that make no sense when thought about rationally?
You’re assigning the term “rational” to fit your particular bias. Again, I could say the same thing about Democrats, and all my liberal friends would string me up and throw eggs at my head. Doctors who utilize complementary alternative methods of healing do so because they’ve seen results. Rather than asking the question here, perhaps it would be helpful to actually speak to these docs, and let them tell you their thought processes. Then again, I don’t see that happening since you’ve already stated that “the "respectability" of those promulgating it is irrelevant.” This indicates to me that you really don’t want to know, but that you’d rather beat your head against the wall.

I don't know.
I’ve seen docs scratch their heads many times and utter the same thing. I can imagine the confusion and frustration. But when you have a patient telling you what course of healing they did on their own and you turn your back on them, then this “I don’t know” turns into, “I don’t want to know.”

Many individuals who [embrace alternative medicine] undergo a midlife crisis, painful divorce, life-threatening disease, or another severely stressful experience.
Now that’s a steaming pile. I can say the same thing about Democrats. Quackwatch backs up this crap with figures. And we all know that statistics don’t lie, right? Please. Why don’t you just call them mentally imbalanced while you’re at it? I’m sure Mehmet Oz would find it amusing. What this boils down to is that there exists a populace within the medical community who want everyone to think like they do and cannot stand the fact that there are those who don’t.

Humans may indeed have sacred energy fields that cannot be measured, but how arrogant of Reiki practitioners to claim they can manipulate them!
Why is this arrogant? Medicine manipulates far more than energy fields, and look at all the good that’s done because of it. You’re making statements off the top of your head without any understanding of Reiki and how it works. I thought scientists had a natural curiosity about how and why things work. Or is that selective?

 
At Wed Jan 30, 12:54:00 PM, Anonymous tom said...

Perhaps the folks you are referencing have always been closet emperics who have finally come out?
or
They have converted from "I'll believe it when I see it" to I'll see it when I believe it".

Perhaps your point is, complementry does not mean substitute.

Having said all of this, and being the cynic that I am, I think many physician converts to CAM are pursuing the green poultice. No TAR's, no prior authorization, no withoholds on payment-just cash from a willing patient-often the same patient who never seemed to have their $10 copay with them when they came c/o "earache".

I enjoy your Blog and read it faithfully

 
At Wed Jan 30, 04:50:00 PM, Anonymous Ami said...

Everywhere around us is the evidence that within God's creation there is order. Observation can be relied on. Certain things can be predicted with accuracy because they always happen that way. Let go of a ball, it drops, and not only that, but one can accurately predict the acceleration and speed of that ball as it drops.

Scientists are curious. Scientific curiousity doesn't necessarily lead to belief, though. It leads to studies, experiments using objective observation.

They have done several studies on Reiki. Just type in Reiki at Pubmed.com. Even in the Journal of Holistic Nursing, they found that Reiki is not effective.

Every marginally well designed study I saw said the same thing. The better the design (Reiki vs mimic-Reiki) the more sure the "not effective" conclusion.

 
At Wed Jan 30, 06:02:00 PM, Blogger #1 Dinosaur said...

Ami, meet Lynn. Maybe you can explain Reiki to her.

Oh, and Lynn: you're completely misconstruing my "respectability is irrelevant" remark. What I mean is that it's the science, not the scientist. If the most "respected" authority in the world told me black is white, none of his credentials would matter. If the lowliest undergrad came up with an elegant proof of the mechanism of diabetes, say, his lack of "credentials" would have no impact on my respect for the science.

 
At Wed Jan 30, 08:15:00 PM, Blogger Lynn Price said...

Journal of Holistic Nursing, they found that Reiki is not effective.
Here's what they said in one article:

"Analysis found no significant mean differences between groups over time.

They don't indicate how many Reiki treatments were conducted.

Comparably low baseline anxiety levels (possible selection bias) decreased naturally with time allowing little room for observing treatment effect."

"Decreased naturally over time." How do they know this for a fact? Is it possible the Reiki was responsible for their decreased anxiety? It would appear they went in with a certain expectation and skewed the conclusions to support their bias.

Conversely, George Washington University Medical Center has Reiki teams in their Cardiac Catheterization Lab, and there are Reiki programs in numerous hospitals in the US. These are all volunteer programs, so there is no reason to continue these programs other than the patients seem to like the results.

 
At Wed Jan 30, 11:50:00 PM, Anonymous Dr. Val said...

I think that medical schools do a poor job of teaching research methodology, and therefore the foolishness of most CAM therapies is not as obvious to many doctors. We are emotionally drained by the daily clinical grind, we are frustrated by the broken system, and we have a kind of learned helplessness that snake oil salesmen can take advantage of. In our weakened and perhaps poorly educated state we shrug at scientific garbage until one day we wake up and wonder - why does it stink in here? I think that Barker Bausell's recent book, "Snake Oil: The Truth About Complementary and Alternative Medicine" should be required reading in all med school curriculae.

 
At Thu Jan 31, 11:46:00 AM, Anonymous Ami said...

You know, I think any program that gets human people in to see others who are sick, just to help them out of the goodness of their hearts, is effective in helping patients.

People are scared and uncomfortable in hospitals.

I think if I were to be approached by one of these Reiki practitioners while I was sick in the hospital, I'd let them do their thing even though I had no belief in it. Then I'd talk to them. They've got to be interesting as well as caring. From what little I understand, one of the most important requirements for Reiki is that the person wants to help people, and am I right that they can't do it for money?

That, all by itself, makes the practioner someone sympathetic who will listen. And sometimes, that is exactly what the patient needs when doctors and nurses are too busy because there are so many other patients requiring their attention.

BTW, I've got a post on my site now about mind/body medicine.

 
At Thu Jan 31, 09:45:00 PM, Blogger Lynn Price said...

From what little I understand, one of the most important requirements for Reiki is that the person wants to help people, and am I right that they can't do it for money?
Ami, the desire to help people isn't a requirement Reiki. For many, it's a personal journey where they never intend on using it on other people - just themselves. However, working in the hospital requires that they have a fair helping of benevolence to their DNA.

The volunteers are screened very carefully and must take a series of special classes before they're ever allowed on the floor. You are also correct that they can't do it for money in the hospitals. Outside, they have their own clients just like chiros, shrinks, docs, etc., but they aren't allowed to "advertise" in the hospitals.

An aside about Reiki in the hospitals, I just received word that there are 29 hospitals that have volunteer Reiki teams. There is work under way on several fronts to begin and/or continue scientific research as to the efficacy of Reiki. Here is a direct quote from one of the Reiki groups I belong to:
Reiki is and should be presented as an “evidence based practice.”

 
At Fri Feb 01, 02:04:00 AM, Anonymous Ami said...

How does what one of your Reiki groups say make the statement true? So where is the evidence that Reiki is any better than placebos?

Reiki in hospitals doesn't validate it as medicine. This is like saying that when the hospital allows LDS priesthood blessings (my religion) they believe in it. What they are doing is allowing the patients to practice their beliefs. I suspect in most cases the 'programs' are not run by hospital administrators but allowed, and controlled so they and patients are safe in the hospital environment. The reason Reiki practioners can't charge in the hospital is, I suspect, not altruistic but because it is not medical therapy and the hospitals don't allow them to. They are protecting the patients from being taken advantage of.

Still, this kind of practice is similar to proselytizing.

2 days to become a first degree Reiki practicioner?

Do 2nd Degree Reiki practitioners charge money for healing from a distance by focusing on symbols and attuning themself to the patient?

If a Reiki practitioner comes in claiming this is a medical procedure rather than a spiritualist procedure, they are misrepresenting themselves.

So is this: http://en.wikipedia.org/wiki/Reiki
a good summary?

Rather than coming to a consensus on the methods and training, it looks like Reiki organizations tend to splinter off. I probably came in contact with one of the better intentioned ones, who had said that they shouldn't be charging for a spiritual practice.

 
At Fri Feb 01, 11:28:00 AM, Blogger Lynn Price said...

“Reiki is and should be presented as an “evidence based practice.”
How does what one of your Reiki groups say make the statement true? So where is the evidence that Reiki is any better than placebos?
This is a Reiki group, so they’re already convinced that it is evidenced based due to the many medical professionals who belong to the group, or who write to them giving their observations of Reiki. They aren’t the only ones attempting to create data that will satisfy the scientific community. Arizona State University, The Continuum Center for Health and Healing (an offshoot of Beth Israel Hospital in NY), GW Center for Integrative Medicine (an offshoot of GW University Medical Center – where I did the bulk of my research for my novel) – are also working on testing. Their goal is to present evidence that it’s better than placebos.

Reiki in hospitals doesn't validate it as medicine.
This is true. But the only way those Reiki teams have been allowed into hospitals is because those pitching the idea were able to come up with enough compelling evidence to convince the board. Hospitals don’t allow just anyone to roam the hallways offering treatments. Religion is a different case and can’t be compared to Reiki. Hospitals will always allow faith to enter their halls. Reiki isn’t faith and has nothing to do with any particular dogma.

What they are doing is allowing the patients to practice their beliefs.
No, they aren’t. The extensive research I've done bears out that most hospitalized patients who accept treatments have never even heard of Reiki.

I suspect in most cases the 'programs' are not run by hospital administrators but allowed, and controlled so they and patients are safe in the hospital environment.
They most certainly are run by hospital administrators. It’s incredibly difficult to get a Reiki team into a hospital, and the entire board is involved in the decision making. No hospital will throw open their doors to just anyone. You have to prove your worth. That’s why they’ve become very popular in the cardiothoracic wards. Once permission is granted, the volunteers have to go through a rigorous training program given by the hospital, and they are under the close scrutiny of the administrators at all times.

The reason Reiki practioners can't charge in the hospital is, I suspect, not altruistic but because it is not medical therapy and the hospitals don't allow them to. They are protecting the patients from being taken advantage of.
If hospitals were worried that their patients would be “taken advantage of,” do you really believe they’d allow such a practice to take place in their facility? Of course not. They don’t allow therapies they don’t believe in under the guise of “let’s allow it so we can make sure our patients are protected.” They’re too busy taking care of patients. They have to trust and believe in what those teams are doing.

As for the charging bit – as I said, they’re volunteers. It has nothing to do with altruism.

Still, this kind of practice is similar to proselytizing.
You’re kidding. Here’s the definition of proselytizing:
To induce someone to convert to one's own religious faith or doctrine.

Where do you get the idea that practitioners espouse the only way to salvation is through Reiki? Have you seen this? Heard it somewhere? If a hospital found out one of the volunteers were doing this, the entire program would be shut down – and rightly so. All of this is discussed in the meeting between the Reiki coordinator and hospital administrator.

2 days to become a first degree Reiki practicioner?
Some Reiki Master-Teachers spread all their initiations out to two days.

Do 2nd Degree Reiki practitioners charge money for healing from a distance by focusing on symbols and attuning themself to the patient?
I imagine some do. I don’t know of any 2nd Degree practitioners who have practices. Most I know are nurses, chiros, a few docs, and massage therapists.

If a Reiki practitioner comes in claiming this is a medical procedure rather than a spiritualist procedure, they are misrepresenting themselves.
I would agree with this to a point. It is not a medical procedure, but it’s not a spiritual procedure either. It’s a complementary alternative procedure to be used in conjunction with traditional medicine.

So is this: http://en.wikipedia.org/wiki/Reiki a good summary?
I think this one is better.

Rather than coming to a consensus on the methods and training, it looks like Reiki organizations tend to splinter off.
This is true. However, they do have the same foundations. It’s not unlike the medical community where a portion of the populace integrate alternative healing methods into their medical practices. In both cases, they practice the foundations.

I probably came in contact with one of the better intentioned ones, who had said that they shouldn't be charging for a spiritual practice.
If the intent is spiritual, then I agree with you. Not quite sure what you mean by “better intentioned.”

Ami, you’ve made a lot of assumptions about Reiki and the role they play in hospitals. I’ve researched this for four years and been a Reiki master for two. Why not simply ask questions rather than presume to know the answers? Assumptions breed disinformation and contempt. Is that your intent?

 
At Sun Feb 03, 08:43:00 PM, Anonymous Anonymous said...

"This is a Reiki group, so they’re already convinced that it is evidenced based .... Their goal is to present evidence that it’s better than placebos."

In other words, they've already decided that it works, and are searching for evidence to support that conclusion--which is precisely backwards. Evidence leads to valid conclusions. Starting from the conclusion & searching for evidence to support it leads to self-deception.

 

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