MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Have you noticed?

Homeopaths, acupuncturists, herbalists, reflexologists, aroma therapists, colonic irrigationists, naturopaths, TCM-practitioners, etc. – they always smile!

But why?

I think I might know the answer. Here is my theory:

Alternative practitioners have in common with conventional clinicians that they treat patients – lots of patients, day in day out. This wears them down, of course. And sometimes, conventional clinicians find it hard to smile. Come to think of it, alternative practitioners seem to have it much better. Let me explain.

Whenever a practitioner (of any type) treats a patient, one of three outcomes is bound to happen:

  1. the patient gets better,
  2. the patients roughly remains how she was and experiences no improvement,
  3. the patient gets worse.

In scenario one, everybody is happy. Both alternative and conventional practitioners will claim with a big smile that their treatment was the cause of the improvement. There is a difference though: the conventional practitioner who adheres to the principles of evidence-based medicine will know that the assumption is likely to be true, while the alternative practitioner is probably just guessing. In any case, as long as the patient gets better, all is well.

In scenario two, most conventional clinicians will get somewhat concerned and find little reason to smile. Not so the alternative practitioner! He will have one of several explanations why his therapy has not produced the expected result all of which allow him to carry on smiling smugly. He might, for instance, explain to his patient:

  • You have to give it more time; another 10-20 treatment sessions and you will be as right as rain (unfortunately, further sessions will come at a price).
  • This must be because of all those nasty chemical drugs that you took for so long – they block up your system, you know; we will have to do some serious detox to get rid of all this poison (of course, at a cost).
  • You must realize that, had we not started my treatment when we did, you would be much worse by now, perhaps even dead.

In scenario three, any conventional clinician would have stopped smiling and begun to ask serious, self-critical questions about his diagnosis and treatment. Not so the alternative practitioner. He will point out with a big smile that the deterioration of the symptoms only appears to be a bad sign. In reality it is a very encouraging signal indicating that the optimal treatment for the patient’s condition has finally been found and is beginning to work. The acute worsening of the complaints is merely an ‘aggravation’ or’ healing crisis’. Such a course of events had to be expected when true healing of the root cause of the condition is to be achieved. The thing to do now is to continue with several more treatments (at a cost, of course) until deep healing from within sets in.

Many of us want the cake and eat it – but alternative practitioners, it seems to me, have actually achieved this goal. No wonder they smile!

27 Responses to Why do alternative practitioners always smile?

  • I suspect their smiling is also a marketing ploy known as ‘love bombing’. CAM proponents have been known to use that terminology:
    http://chirotalk.proboards.com/post/39695

    It’s said to have originated from the Moonies cult. Its founder and leader, Sun Myung Moon, used the expression ‘love bomb’ in a speech in 1978:

    QUOTE
    “Unification Church members are smiling all of the time…what face could better represent love than a smiling face? This is why we talk about love bomb…”
    http://en.wikipedia.org/wiki/Love_bombing

    Basically, it’s an indoctrination tool.

  • In reply to Edzard:
    Initially I didn’t smile, then I read all your research and blogs and came to the realization that you knew what you were talking about, then I started agreeing with much of what you said, then decided to get involved in the reform process, then I jouined the conversation here and elsewhere, then I smiled in appreciation of the valuable contribution to reform that critical thinkers within and without the profession provide.
    P.S. Carpet Bombing does bring on a serious frown!

    • do you actually know what carpet bombing is?
      my piece may have been a bit general and certainly tongue in cheek but it was not carpet bombing; that’s not my style.

  • Reminds me of this:
    http://youtu.be/R11UBWufmy0

    I could have medicine, or something that may or may not be medicine, but most likely isn’t…

  • A very nice break-down of the con-job that is “alternative medicine.” Smiling smugly is surely part of the big hustle.

  • The smiles by alternative practitioners are in anticipation of a pleasant trip to the bank.

  • Might it be for the same reasons a (used) car salesman smiles?

  • In reply to Edzard:
    The Carpey Bombing reference is in regards to lumping the reformers and evidence based chiropractors into the same boat!
    Have used the term previously in that regard, should have been more clear on this blog. Mea Culpa!

  • Thinking Chiro: A word of advice to you, and meant most sincerely. Please don’t be offended.
    Your efforts to look like the good guy are laudable but please be aware that the likes of Ernst and the major portion of contributors to this blog are not the least bit interested in your opinions. There is NOTHING you can do or say to justify the continuing existence of Chiropractic. Quite simply they want one thing only and that is the total eradication of Chiropractic and the sooner the better. There is no place in any health system for any Chiropractor no matter what honey spills from their lips and you wont change it. So continue to engage with them if you please but remember you are tarred with the same brush as all other Chiropractors and no matter how many references you quote nothing written by any Chiropractor, Professor from a respected University or not, will ever be taken seriously. Have a great day.
    Ray Haupt: ever seen a poor Medical practitioner??

    • Bill – I have to say that you are quite wrong about this! There *really* is something that anyone can do that I am quite sure would make Professor Ernst turn in his tracks and alter his opinions on any alternative medical practice you care to mention: Produce some real evidence that it works. That’s closed – minded scientists for you: Show them some evidence and they change their minds. Now then… what does it take to make a Chiropractor change their mind….?

      • precisely! this is how science generates progress. just look how much medicine has progressed since D D Palmer did his first neck manipulation to restore the hearing of a deaf janitor, and compare it to the progress of chiropractic during the same time period.

  • In relpy to Bill:
    I read quite a large percentage of what Edzard has written before venturing onto this blog. There are articles where he cautiously gives credit to good research when he sees it, so there is hope. Every profession needs its critics both internal and external as this pushes the reform process forward. Some like Blue Wode are quite challenging when it comes to supporting the reformers within my profession, but thats fine, I’ll continue to work on him! The chiropractic subluxation love fests where they are constantly giving seminars on practice building/management/distorted philosophy with diddley squat research content should be held up to ridicule. If they were 20-30% how to run a small business and 70-80% research, then I would go to them and support them. Look at COCA seminars as the right way to do it! Total research and speakers from medical, physio and chiro backgrounds! The critics can often be frustrating but I would rather engage with them than resort to Ad Hom attacks and bury my head in the sand!

  • Thinking Chiro: I’m not sure if you were implying it but I wasn’t aware I had made an actual ‘Ad Hom’ attack….and I am not burying my head in the sand !!
    As regards ‘COCA’ seminars, yes they most certainly are the right sort of pg seminars. But there’s nothing new there though, the UK was hosting WHO endorsed events with international speakers from the world of Spine Surgery, Psychology, Manual therapy, Ergonomics etc etc way back in the 80’s, perhaps before your time (?). But somehow this has been superseded and like you I abhor the bullshit spouted by the vitalism peddlers and practice builders. I also abhor the perpetual remarks from various bloggers who have the audacity to suggest that chiropractors have some sort of monopoly on mercenary practice and other health-care professions are free from such tainting….because they most certainly are not!

    Pin: I’m all for science. I believe myself to be a Scientist. I don’t sell snake oil and don’t promote bullshit medicine. And I imagine Ray Haupt and his pals have far more healthy bank accounts than mine. I wholeheartedly believe that Chiropractors MUST prove they are better than placebo’s and so MUST do the right scientific trials. So too must other physical therapy groups of which some 6500 UK members promote -and use within the NHS- what Professor Colquhoun refers to as theatrical placebo. And yet they remain under the radar and seem to be taken seriously.
    What would make me change my mind? Ok, the development of a think tank that incorporates Professor Ernst -if he wishes-and other sensible Scientists and Chiropractors, which will design trials of calibre which will show once and for all whether there is anything worth keeping in Chiropractic and if not, throw it out. And, no, that doesn’t frighten me. Is that ever likely to happen?

  • Professor Ernst: Excellent. I suggest the best place to start is with Alan Breen at the Institute for MSK Research, in Bournemouth. I believe he is a rational and objective Research Scientist and not influenced by bullshit. But you may know somewhere else to start. Perhaps you could send him an invitation to enter into dialogue with you?

    • I know Alan and have had several dialogues with him in the past. I suggest that you and other chiropractors take the initiative by starting a discussion as to what research question you feel is the most urgent one and what methodology might be best for answering it. My role can be only an advisory one: I would be happy to give advice and bring other experts into the panel as soon as there is something concrete to discuss.

  • Professor Ernst: I will contact Alan directly.

  • In reply to Bill:
    Ad Hom not in regards to you, just general obs.
    I like the way you think. I’m game as well! Too many evidence based chiropractors I know roll their eyes when I talk to them about talking reason to the subluxationists saying “Why bother they won’t listen”. P.S. They said the same in regards to engaging Edzard here! 🙂 But they need to get off their backsides and be more involved. Their business as usual which involves ignoring the subbies is as bad as the subbies themselves for our profession.
    The research agenda meeting in Europe here is a step in the right direction:
    http://www.chiromt.com/content/22/1/9/abstract
    I also like this in Canada:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924502/?tool=pmcentrez&report=abstract
    The whole issue is discussed here and the Scott Haldeman quote is an absolute Gem!
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154060/

    In reply to Edzard:
    If they take you up on that offer, I own shares in the Sydney Harbour Bridge. Would you like to buy it? I would give you a very good price!

  • There are extremes on both sides of this issue. I know a multitude of people that get relief from chiropractic care, without resorting to drugs. There are good chiropractors and bad, just like MD’s. Feeling less pain and stiffness, increased mobility is proof enough. Leave the good ones alone because they are helping people daily.

  • The smiling therapist is ‘discouraging’ you from disagreeing with him/her. Its a very simple social conformity technique. Like when Mother smiles at you as she ‘helpfully reminds’ you how cranky and irritable you get when you dont finish your dinner/play out too late/watch too much TV/disagree with Mother.

    Its about defying you to ruin the nice friendly mood by disagreeing. Especially since the therapist is there to help you, so why dont you ‘want’ to be helped, mm?

    I have been sort of ‘encouraged’ to try alternative therapies by my NHS doctors/nurses, both within the psychiatric sector (for bipolar1) and an orthapaedic dept (at the hospital where the Oswestry questionnaire was developed, actually!) – and a few times I have gone along with it just to appear co-operative.

    Aromatherapy did nothing, except it was a semi-OK massage, but did nothing medically effective or therapeutic
    Acupuncture made me extremely grumpy due to all the half-baked nonsense talked by the practictioner (whom my taxes were funding, grrrr)
    Hopi ear candle therapy, after watching another person having it I made my excuses and fled laughing – what a con!
    Homeopathy was offered and occasioned a 45-minute stand up row in the doctors office due to my utter refusal to succumb to such unscientific reasoning inside a clinic
    Crystal massage (suggested by a support worker) was hilariously daffy and insane (and I have bipolar 1!) – and this was hence the smiliest therapist of all –

    – so maybe the ultimate reason for the smile is in unconscious apology for the money-grubbing sales pitch they have to deliver non-stop? Its a kind of ‘tell’?

    Christine

  • Professor Ernst: just so that you know, I have contacted Alan Breen, as I said I would. The research IMRCI is currently involved with is in accurately identifying sub-groups of BP sufferers. Such research seems fundamental and preceding any future clinical trials. I guess that despite all the various groups dealing with spinal pain over the last 100 years or so very few are singing from the same diagnostic hymn sheet so sensible research must begin at grass roots level. So maybe the important research would be to get a multi-disciplinary group together to develop a standardised diagnostic schedule and collate the information from practitioners in the field. I’m not much of a researcher, but I’m sure something appropriate could be developed with like-minded physical therapy practitioners. I was involved in the now infamous MRC trial many years ago and that seemed to work reasonably well, at least in terms of collating data. Maybe that’s the sort of trial platform we need ultimately.
    Thinking Chiro: isn’t it time we somehow separated the men from the boys, so to speak, and organise a new association?

  • In Reply to Bill:
    We have such an association here in Australia, COCA. Its journal had been picked up by the Royal College of Chiropractic and the European Academy of Chiropractic. I think the most important thing is this increased collaboration extending to large scale trials. The Danish and Swiss are doing a good job and I like the research coming out of Canada. Even Palmer college is producing some good research from the likes of Pikar. The evidence based chiropractors are becoming more vocal here which is good to see! Long overdue!
    You on this list of authors?
    http://www.ncbi.nlm.nih.gov/pubmed/18165754

  • Thinking Chiro: Not on any author list yet I’m sorry to say, but who knows, one day! I believe Paul Searle is/was very active in COCA, yes/no? If so say hello from Bill from the UK.
    We need a similar association here, something that would attract the sensible scientific minds from all the physical therapy professions. The problem is there is so much animosity between the groups that the barriers between them all just seem to get higher and higher.

  • In response to Bill:
    COCA has some very gifted and persistent founders. Also having the patronage of Dr David De La Harpe, Chiro ond Orthopod helps. I’m sure you have similar chiro/medical doctors there. Gifted individuals that bridge the gap! COCA has been on message for years and has earned the cross profession respect. Their upcoming research day has Prof Chris Maher of the George institute giving the keynote speech is a good example.

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