Published April 28, 2010
Patients should demand to see the science behind recommendationTHE OLYMPIAN
Have you ever seen those TV commercials where some vaguely familiar character actor comes on wearing a white lab coat, with a stethoscope around the neck, and says: "I'm not a doctor, but I play one on television?" I don’t quite get the point. Does that mean that she or he is more or less qualified to endorse whatever product is being hawked? My suspicion is that the reason bad actors get this job is because they are more convincing about pretending to be qualified to dispense medical advice than actual doctors. I wonder about this because, in my excursions across the Internet, I’ve found that the old time medicine show, snake oil salespersons of days gone by, have not disappeared. They merely evolved into rather sophisticated website profiteers. Whatever ails you, you can probably find some dot.com site selling a remedy. Looking to restore your youthful vim and vigor? Hormone replacement therapy pills are available at various online markets. Does your colon or digestive system need cleansing? No problem: Just Google a search and you’ll find several sites that promise emetic natural healing methods and services. What about magnetic therapy, or distance healing, or something called vitamin O? There are many online sites willing to help with all of the above — just give them your credit card number. There is even my personal favorite, which sells mail-order, do-it-yourself laser eye surgery kits. OK. Sure, some of these sites are hoaxes (and that, too, is objectionable), but most will gladly take your money. What to do about this? Probably, nothing. After all, the glory as well as the peril in the Internet is that it is mostly unregulated. Quacks do a careful job of walking the line between making their products seem miraculous while avoiding unsupportable claims. Note, for example, how many of these sites contain small print disclaimers followed by glowing testimonials from satisfied customers, instead of references to actual clinical literature. I’m always stunned, though, when people who wouldn’t buy a coffee maker without first checking its consumer report will nonetheless gratefully give up their credit card numbers for any nostrum that promises to soothe an irritated bowel or stifle acid reflux. This phenomenon says a lot about dissatisfaction with the health care profession. Whom can you trust, anyway? According to a recent study in the British Medical Journal (“Prescribing Placebo Treatments: Results of a National Survey of U.S. Internists and Rheumatologists”) between 46 percent and 58 percent of surveyed American physicians admit to having prescribed placebo to their patients. Why? Presumably, just to placate them. Another study in the Journal of the American Medical Association (“Contraindicated and Initially Stronger Effects in Highly Cited Literature”) found that 32 percent of a sample of major biomedical studies got different results than initially reported, 44 percent were replicated, and 24 percent went unchallenged. There may be good reasons for prescribing a placebo, and for why so many studies are never verified, but as a patient and not a lab rat, I’d like to hear them. There is a concept that you might have heard physicians (including TV doctors) talk about called evidence based medicine. I interpret that to mean that treatments and prescriptions should be given according to what science and clinical experience has proven to work. (Does that include placebo?) To me, that just makes common sense, but it also provides a standard — a kind of Occam’s razor tool — against which to separate the claims of the quacks from those of the Nobel Prize winners. In classes and workshops that I’ve taught on health information literacy, I always stress that patients should demand that they be shown the science. Even when the person prescribing the medicine is a real physician, instead of some website witch doctor, don’t be afraid to ask what the biomedical literature says about their recommendation. It takes more time and may require translation, but it is more reliable than faith healing. But, then, what do I know: I am not a doctor, and I can’t even qualify as one who pretends to be on TV. Gregg Sapp is a freelance writer and a member of the Pacific Northwest Science Writers’ Association. A member of The Olympian’s Board of Contributors, Sapp can be reached at email@example.com.