MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

We were recently informed that Americans spend more than US$ 30 billion per year on alternative medicine. This is a tidy sum by anyone’s standards, and we may well ask:

Why do so many people opt for alternative medicine?

The enthusiasts claim, of course, that this is because alternative medicine is effective and safe. As there is precious little data to support this claim, it is probably not the true answer. There must be other reasons, and I could name several. For instance, it could be due to consumers being conned by charlatans.

During the 25 years or so that I have been researching alternative medicine, I got the impression that there are certain ‘tricks of the trade’ which alternative practitioners use in order to convince the often all too gullible public. In this series of posts, I will present some of them.

Here are the first three:

TREAT A NON-EXISTING CONDITION

There is nothing better for committing a health fraud than to treat a condition that the patient in question does not have. Many alternative practitioners have made a true cult of this handy option. Go to a chiropractor and you will in all likelihood receive a diagnosis of ‘subluxation’. See a TCM practitioner and you might be diagnosed suffering from ‘chi deficiency’ or ‘chi blockage’ etc.

Each branch of alternative practitioners seem to have created their very own diagnoses, and they have one thing in common: they are figments of their imaginations. To arrive at such diagnoses, the practitioner would often use diagnostic techniques which have either been found to lack validity, or which have never been validated at all. Many practitioners appreciate all of this, of course, but it would be foolish of them to admit it – after all, these diagnoses earn them the bulk of their living!

The beauty of a non-existing diagnosis is that the practitioner can treat it, and treat it and treat it…until the client has run out of money or patience. Then, one day, the practitioner can proudly announce to his patient “you are completely healthy now”. This happens to be true, of course, because the patient has been healthy all along.

My advice for preventing to get fleeced in this way: make sure that the diagnosis given by an alternative practitioner firstly exists at all in the realm of real medicine and secondly is correct; if necessary ask a real healthcare professional.

MAINTENANCE TREATMENT

As I just stated, practitioners like to treat and treat and treat conditions which simply do not exist. When – for whatever reason – this strategy fails, the next ‘trick of the trade’ is often to convince the patient of the necessity of ‘maintenance’ treatment. This term describes the regular treatment of an individual who is entirely healthy but who, according to the practitioner, needs regular treatments in order not to fall ill in future. The best example here is chiropractic.

Many chiropractors proclaim that maintenance treatment is necessary for keeping a person’s spine aligned – and only a well-serviced spine will keep all of our body’s systems working perfectly. It is like with a car: if you don’t service it regularly, it will sooner or later break down. You don’t want this to happen to your body, do you? To many ‘worried well’, this sounds so convincing that they actually fall for this scam. It goes without saying that the value of maintenance treatment is unproven.

My advice is to start running as soon as a practitioner mentions maintenance treatments.

IT MUST GET WORSE BEFORE IT GETS BETTER

Many patients fail to experience an improvement of their condition or even feel worse after receiving alternative treatments. Practitioners of alternative medicine love to tell these patients that this is normal because things have to get worse before they get better. They tend to call this a ‘healing crisis’. Like so many notions of alternative practitioners, the healing crisis is a phenomenon for which no or very little compelling evidence was ever produced.

Imagine a patient with moderately severe symptoms consulting a practitioner and receiving treatment. There are only three things that can happen to her:

  • she can get better,
  • she might experience no change at all,
  • or she might get worse.

In the first scenario, the practitioner would obviously claim that his therapy is responsible for the improvement. In the second scenario, he might say that, without his therapy, things would have deteriorated. In the third scenario, he would tell his patient that the healing crisis is the reason for her experience. In other words,  the myth of the healing crisis is little more than a ‘trick of the trade’ to make even these patients continue supporting the practitioner’s livelihood.

My advice: when you hear the term ‘healing crisis’, go and find a real doctor to help you with your condition.

 

 

 

 

22 Responses to The tricks of the quackery trade (part 1)

  • Chronic Lyme is an interesting variation on treating a non-existent condition: not only do the quacks get to treat something that is incurable (read: offers limitless opportunity to sell “treatment”), but you also get to portray the reality-based community as evil for “suppressing” the disease and its “cure”.

  • Patients hear what they want to hear.
    The words used by camists (those who practice CAMs) can be taken in more than one way.
    ‘Integrated medicine’; ‘natural’; holistic’…you know the rest.

    Why did the Royal London Homeopathic Hospital change its name to ‘The Royal London Hospital’?
    We already have such an institution in Whitechapel.
    (I know our homeopathic friends added ‘…for Integrated Medicine’, but that is an adjectival phrase and can be set aside without altering the sense of the noun. And is meaningless in any event).

    Magicians, who are mostly honest enough to admit they dupe and deceive their customers, call this technique ‘dual reality’ and use of ‘wonder words’.

    I am not sure how to distinguish a magician’s deceptive techniques from a camist’s.

    Richard Rawlins
    Consultant Charlatan
    Member of the Magic Circle
    Author, ‘Real Secrets of Alternative Medicine’.

    • Richard wrote: “I am not sure how to distinguish a magician’s deceptive techniques from a camist’s.”

      A trainee magician knows full well that they are learning the art and craft of deception, for the purpose of creating fascinating illusions in front of an audience. Each member of the audience knows full well that they are paying the magician to deceive/trick them by using techniques that are fascinating because they are unfathomable.

      Similarly, a really good joke doesn’t make people laugh because the joke is intrinsically humorous: our laughter is at ourself when we suddenly become aware of our total failure to predict the punch line — a punch line that is so blindingly obvious with hindsight that only an utter fool would be incapable of predicting it 🙂 This is why it is so difficult to maintain a straight face while we are relaying a really good joke.

      A trainee camist, in the vast majority of cases, is deliberately kept unaware of the simple fact that they are learning an aspect of the art and craft of deception. They are not made aware that they are paying to learn how to become a modern vendor and promotor of snake oil.

      One way to distinguish a magician’s (and a comedian’s) deceptive techniques from those of a camist is to observe the outcome: who ends up having a good laugh. How often do we hear: I was diagnosed with cancer, I didn’t fancy undergoing the medical treatment so I went to a camist. It didn’t cure my cancer, but don’t worry, ha ha ha, now that I’ve got the joke I can’t stop rolling on the floor with laughter; and it’s really difficult to maintain a straight face while telling others who have cancer to visit a good camist.

      • Many thanks for that.
        Most helpful.
        But why do students choose to study camistry?
        Have they no insight?

        • I shall never attempt to answer the question “Why do students choose to study camistry?” because, I think, asking such a question is committing, primarily, the fallacy of composition, and secondarily, the fallacy of hasty generalization (or vice versa):
          https://en.wikipedia.org/wiki/Fallacy_of_composition

          The only in-depth knowledge I possess is the answer to the question: Why do *some* people decide to study camistry? However, I refuse to share this knowledge in a public arena because I’m fairly certain that it amounts to the worst three words on this planet: “In my experience, …”

          I think the answer to your question “Have they no insight?” is a resounding: Yes, but not as we know it!

  • i had an angry discussion with a mother who declared she was a good one because she let doctors treat her daughter’s asthma and only after she was cured (?) went to a homeopath for maintenance treatment. Hope the girl is OK and mom will see the doctor if needed. however why waste money on “maintenance treatment”?

  • Practice management Guru’s often talk about PVA or Patient Visit Average and the higher the number the better as if it is a badge of honor or gives you bragging rights! This really gets up my nose as it represents a toxic dependency instead of helping the patient to be healthy and independent! When discussing treatment goals and time frames I tell my new patients that I look forward to the day when they tell me “Get Nicked!” They laugh but it gets the message across!
    My PVA is around 6.8. My referring doctors know how I practice so I end up seeing more patients and I see them less!

  • If one goes to a PT or a DO, is what they manipulate a made up condition?

    It appears what you describe as maintenance care may be better defined as preventative care.
    …Maintenance care is the attempt to keep a condition from worsening or relapsing once treatment for the condition has plateaued.
    …Preventative care, as it implies, is for healthy individuals to prevent a condition from occurring or to discover early signs.

    As far as “healing crisis”
    Talk to a PT and a patient who has had rehabilitation of an adhesive capsule. Ask if the patient went through an early stage of “healing crisis”.

    • If one goes to a physical therapist, a diagnosed musculoskeletal condition is treated.

      Preventive care does make sense, so long as it can be demonstrated that it does, indeed, prevent deterioration or further illness.

      I’ve seen no evidence that this is the case for chiropractic.

      • Sue: If one goes to a physical therapist, a diagnosed musculoskeletal condition is treated.

        Yep, same thing with most chiropractors. Icd10 lists it as “segmental and somatic dysfunction”. The problem is that some chiropractors want to attach other stuff to the condition.

        Sue: Preventive care does make sense, so long as it can be demonstrated that it does, indeed, prevent deterioration or further illness.

        I’ve seen no evidence that this is the case for chiropractic.

        It comes down to how “preventative” is defined, but generally, yes the research is lacking in this area.

        • do chiros even want their own definition for ‘preventative’?

          • EE: do chiros even want their own definition for ‘preventative’?

            Not that I’m aware of.

            It’s more of an issue of the overlap that can occur between/within preventative care and maintenance care and determining which one the chiropractor is referring to.

  • I would add to this list “PROVIDE THE TOUCH”

    Touch and warmth are two of life’s necessities. Just ask your dog 🙂
    Many people suffer from lack of real, warm human touch, both physical touch and mental. A caring practitioner who is kind, considerate and reassuring and on top of that provides ample skin to skin contact is sure to get many returning customers.
    This need, especially when it is advanced as in lonely, friendless rich people, has been called “skin hunger”.

  • Two-thirds of GP referrals for child mental health lead to no treatment.

    Figures obtained from 15 mental health trusts reveal that 60% of GP referrals to child and adolescent mental health services (CAMHS) lead to no treatment and a third are not even assessed.

    The situation for young people with mental health issues appears to be worsening, with the numbers of referrals that progress to treatment decreasing from 44% in 2013 to 39% in 2015.

    Dr Dominique Thompson, a GP in Bristol with special expertise in young people’s mental health, said the findings show the system is ‘failing the next generation’.

  • “Each branch of alternative practitioners seem to have created their very own diagnoses”

    Thanks for that…absolutely priceless. 🙂

  • Overuse, Overdose, Overdiagnosis… Overreaction?
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097773/?tool=pmcentrez

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