Here’s a delightful story for your weekend reading. It’s about a doctor who, after practicing holistic medicine for years, “loses it” and turns to the more scientifically rigorous “modern medicine” instead:
(Also known as the “The Adventures of Holistic Harry”)
It’s written like a novel, so it’s a pleasure to read.
The article below gives good excerpts if you don’t want to read the whole “book”.
In the SBM comments section, someone (thanks, whoever you are) mentioned a book about Holistic Harry and I tracked it down and read it. The title is Confessions of a Quack.
It is fiction but is apparently semi-autobiographical; the author is Steven Bratman, MD, who coined the term “orthorexia” to denote an unhealthy obsession with eating healthy food. Holistic Harry is an MD who practices alternative medicine under the guise of “integrative medicine.”
He develops an understanding of the importance of double-blind studies, realizes that what he has been doing is nonsense, loses his alternative medicine beliefs, but finds that it’s impossible to just quit.
The book entertained me, made me laugh out loud, and gave me more insight into the thought processes and motivations of alternative medicine patients and providers. I think anyone who reads the SBM blog would find it enlightening. The book is available free on the Internet.
A patient gave Holistic Harry The Look. “The Look was an affectionate, misty expression that said, ‘You’re every patient’s dream, a wonderful, amazing doctor, a gift from God, a true healer of the sick.’” What had he done to deserve The Look?
He had prescribed butterbur because he’d recently read a study that found it effective for migraines. But the patient didn’t have migraines. And she had developed severe diarrhea and vomiting, along with a litany of other weird symptoms. She “knew it was just one of those healing crisis things” so she kept taking it and now she feels better than she has in years.
He knew she had probably coincidentally come down with stomach flu on the same day she started taking the herb. But it was always possible she had some unique metabolic defect that made butterbur a miracle cure for her; and maybe he had finally hit on the right placebo for her, or she had finally reached a state of readiness to respond to placebo.
He wanted to stop the butterbur and send the patient to a neurologist. So he told her the butterbur had flushed out her triple heater meridian, spilling into Pingala Nadi, flooding her Agnya chakra and setting off a Herxheimer-like reaction. I
t had completed its job, and taking more at this point might over-flush her meridians. He knew she expected him to give her something else, so he said he would prescribe a great many herbs to support the next phase; but some of the herbs were pretty strong, so he wanted her to see a neurologist first, to make sure the circulation in her brain was up to the task.
When she left the office, he thought “I can’t keep this up another day. I’ll go out of my mind.” But then he thought about his financial obligations and living expenses and realized if he didn’t keep it up, he’d go broke.
He is deeply conflicted, because he thinks if he confronted patients with the facts as he now understands them, he would be hurting them, taking away their treasured beliefs and withdrawing the placebos they had come to depend on.
He felt betrayed
…he felt betrayed. Betrayed by all those alternative medicine authorities who spoke as if they knew what they were talking about when they didn’t know a thing. He’d trusted them for so many years, only to find out that they’d misled him on almost every point. How often had he read a citation of fact in an alternative medicine book and traced down the origin, to find that the first book was only quoting another book, which in turn was quoting yet another, and so on?
When he finally reached the origin of the statement of fact he found that it was either a mere opinion propounded by a 19th century crank, or if an actual fact, one that had been twisted or even reversed by the subsequent game of telephone. Alternative medicine wasn’t just bad science: it was terrible journalism too.
He felt betrayed by his patients, too:
They were always couching their questions in such a way as to assume his agreement with alternative medicine theories or techniques he regarded as pure drivel. “What’s the best way to detoxify my liver? Which is more purifying, lemon or lime? How can I remove the damp heat from my spleen? What’s the best way to realign my DNA?” It was too much work to explain that the basis for their questions had no basis in reality. All he wanted to do was take them by the collar and bounce them out into the street.
About people who think they have found The Truth:
Much is given to those whom life has spared critical thinking skills.
The virtue of lying
When Ashley tells people that acupuncture balances the body’s energy, at least she’s believes it. We’re lying consciously. Doesn’t that put us in the wrong?” “Not at all. In medicine, lying is a virtue. It powers the placebo effect.
[Patients] project their desires onto us, and those desires are real. They dream us into being as holy healers. We’re their work of art.
People have a ceremonial need for doctors. What we say to our patients is a kind of liturgy. Whether it’s factually true or not is beside the point.
All the bullshit alternative medicine is just ritual magic. And it works.
Facts don’t feed the soul. It’s better to live in a world where healing wisdom exists. If it doesn’t, someone has to make it up. It’s far better to lie. What we are doing is a holy thing.
When a colleague recognizes a Quackbuster masquerading as a patient, she reports “I gave him that speech about how we only use treatments that are supported by scientific evidence. Like detoxification. I think it confused him.”
As Harry starts to wise up, he comes up with a perfect answer to a patient.
Patient: Your body uses aspartate to make energy, doesn’t it?
Holistic Harry (thinking to himself): Well, yes, and cars use spark plugs to run their motors, but if you dump ground up spark plugs into the gas tank, the car won’t run better.
This is a great analogy that I will remember and use. It applies to so many alternative medicine claims, and to the “structure and function” claims allowed for dietary supplements under DSHEA.
From quack to evaluator
When Harry writes a book, he sprinkles in scientific studies to give the appearance that his recommendations make sense. Then he proceeds to make up testimonials.
When he is investigated by the Medical Board, he hopes they will take away his license and make the decision for him so he can stop practicing quackery.
His dilemma is resolved when the Board suggests he retire from practice and head a commission to evaluate the scientific evidence for alternative medicine. He knows that when science digs deep into alternative medicine it mostly finds elaborate placebos, but the beauty of the solution for him was that he could tell the truth and it wouldn’t hurt anyone.
The book ends with an Appendix explaining double-blind studies.
He goes on to explain confounding factors, the placebo effect, observer bias, regression to the mean, statistical illusions, and many other essential concepts familiar to readers of the Science-Based Medicine blog.
The endnotes to the Appendix are not just references, they are as informative as the text. For instance, there is a detailed account of the history of studies on hormone replacement therapy. In another endnote he tells us,
Conclusion: Worth reading
Fiction can sometimes be more illuminating than nonfiction. Do quacks believe in what they are doing?
Some do, some don’t. If they don’t believe, their patients believe for them.
After reading this book I have a better understanding of what motivates alternative medicine practitioners and their patients, how they think, and how placebo medicine is practiced
Author: Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so), and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel. In 2008 she published her memoirs, Women Aren’t Supposed to Fly.