Fools & the Wise of Heart
Whatever your religion or faith (or even lack thereof), there is no doubt that the Bible is a font of wisdom from which we may draw moral homilies. My personal favorite is from the wisdom book of Proverbs, in which Solomon warns those who would look outside themselves to assess blame for their own shortcomings: “He that troubleth his own house shall inherit the wind; and the fool shall be servant to the wise of heart.”
As a long-time public defender of modern scientific medicine, I have commonly labeled medical scientists as wise of mind, and alternative medical practitioners as fools. The wind of quackery we have inherited, I reasoned, is surely the result of an uneducated public duped by the otherwise risible tactics of flimflam artists praying on the unsuspecting masses. I am no longer sure that this is the source of the headlong rush toward these New Age medical alternatives. “The fault,” Shakespeare correctly identified in another context, “is not in our stars, but in ourselves.”
Indeed, the data contradicts my “fools” hypothesis: studies published in the New England Journal of Medicine and the Journal of the American Medical Association reveal that the typical complementary and alternative medicine (CAM) patient is white, college-educated, with an annual income exceeding $50,000. Despite the miracles that traditional allopathic medicine (TAM) has produced — the cumulative results of which have led to a doubling of the average lifespan from just a century ago — by the late 1990s the number of visits to CAM providers exceeded the number of visits to TAM providers. By the end of the decade total payments to CAMers averaged a staggering $27 billion per year, 58% of which was out-of-pocket payments. CAM sells.
In rejecting the “fools” hypothesis we must consider the possibility that people are going alternative because their needs are not being met by traditional medicine. Before the 20th century this certainly was the case. Medical historians, in fact, are in agreement that until well into the 20th century it was safer not to go to a doctor, thus leading to the success of such nonsense as homeopathy — a totally worthless nostrum that also did no harm, thus allowing the body to heal itself. Since humans are pattern-seeking animals we credit as the vector of healing whatever it was we did just before getting well. This is also known as magical thinking.
What are CAMers offering that TAMers are not? The answer is that all-important component so highly developed in pre-20th century medicine: TLC. By this I do not just mean a hand squeeze or a hug, but an open and honest relationship with patients and their families that provides a realistic assessment of the medical condition and prospects. People are going alternative because physicans have become highly skilled technicians — cogs in the cold machinery and massive bureaucracy of modern medicine.
The shift in my thinking about this problem developed over the past eight years as I became intimately involved in my mother’s recurring and malignant meningioma brain tumors. She finally succumbed, but in the process I gained a deeper understanding of why people turn to alternative medicine. Don’t get me wrong — my mother’s doctors were brilliant, her care the very best available, and we have no regrets about what might have been. And that’s the point. Even under such ideal conditions I found the whole experience frustrating and unfullfilling: it was nearly impossible to get honest and accurate information about my mom’s condition; neither my father nor I could get doctors to return our calls; misinformation and (usually) no information was the norm; and despite my best efforts, the relationship with her physicians (with one exception — her oncologist whom I befriended), could not have been more detached.
I found it rather telling, for example, that when I identified myself as “Dr. Shermer” I got faster results at the hospital than when I was merely “Mr. Shermer” (a lie of omission, not commission, since I do have a Ph.D.), but I still could not get calls returned. Even worse, when my mom’s oncologist (one of the country’s best-known and well-respected in his field) called her surgeons, he too could not get a return call. If physicians show such a remarkable lack of professional courtesy with their own colleagues, what are the rest of us to expect?
More than anything patients want information. They want to know what is really going on. They don’t want jargon. They don’t want false hope or unnecessary pessimism. Studies show that patients do better when they know in detail all the steps they will have to take in their recovery process — probably because it allows them to anticipate, plan, and pace themselves. Knowledge is power, and physicians are the modern-day shamans. Patients want the power that knowledge brings, and that empowerment cannot be given in the 8.5 minutes the average doctor spends with a patient on any given visit. Patients want a relationship with their primary caretaker that allows them to ask the important questions and expect honest answers.
Since I have a doctorate in the history of science, professional training in statistics and research methodologies, and some internet skills, I was able to answer a lot of questions on my own by doing research. But how many people are so equipped to conduct their own medical investigations? And isn’t this what physicians are trained to do?
Yes, of course; but, tragically, they are not trained to communicate that research. And herein lies the problem…and the solution. Physicians tend to have monologues when they should be having dialogues. The reasoning process of diagnosis, prognosis, and treatment all goes on inside their heads, and what comes out is a glossed telegram of truncated lingo. The physician-patient connection is a one-way street, an authority-flunky relationship top heavy in arrogance and off-putting to anyone with a modicum of self-esteem and social awareness. If I could reduce all this into a single request, it is this: Talk to patients as if they are thoughtful, intelligent people capable of understanding and deeply curious about their condition.
The real tragedy in this health care crisis is that CAMers lack much medical knowledge and (especially) scientific reasoning, making them dangerous. Studies show that 40% of patients going to CAMers do not tell their primary care physicians, thus leading to possibly deadly mixtures of drugs and herbs. It is not a matter of everything to gain and nothing to lose by going alternative (even if your doc offers no hope), because quack medicines cost money, cause harm, and, most importantly, take away valuable time that could and should be spent with loved ones in this already too-short of a stay we have with each other.
Physicians are wise of mind. They must also become wise of heart so as not to inherit the alternative wind, for as Solomon continues in the next passage: “The fruit of the righteous is a tree of life; and he that winneth souls is wise.”
This opinion editorial was originally published in Toronto Globe & Mail.