Saturday, June 23 , 2018, 9:33 am | Fog/Mist 63º


Victor Dominocielo: The Doctors’ Apology

Sometimes I think that doctors should apologize. to civilization, to all the people on earth and to all the people who have ever lived.  

Kind of a, “Sorry for the last 10,000 years of absolute garbage that has been used for and considered to be 'healing arts,'" type apology.  

Even a simple, “Oops, my bad,” for the last 3000 years of the defunct Theory of the Four Humors and worldwide, multicultural bloodletting would perhaps be a sufficient apology.

How else do we explain the constant wrong turns and incredibly slow progress of medical science over the course of civilization?

Medical doctors and “healers” are among the best people on earth, choosing a profession designed to help those in pain and suffering; however, if any profession throughout the history of human civilization had the best chance of figuring out scientific methodology, it would have been doctors and healers.  

Throughout history, societies gave healers a special status of authority and legitimacy, whether it was in the tribe as a medicine man or in the hospital as an attending physician. 

More was expected of them, and they continue to improve our lives and perform life-extending miracles and quality-of-life improvements in the eyes of their patients and families.  

However, throughout the course of history, they also followed their own particular and peculiar whims and fancies, befuddled by their personal clinical results, allowing them to postulate the strangest and weirdest “healing” regimens, which were dependent upon their individual cultural immersion.  

Isn’t it surprising that no matter what the time period in history, no matter what the specific culture and no matter what the strange and weird medical practice, they all “worked?” 

From the ancient times of tribal witch doctors and medicine men to our exemplary physicians today, doctors could apologize for three processes in the history and development of medical science:

1.  Taking so long.

2.  Not drawing a clear ethical line between science- and placebo-based treatments.

3.  Allowing politics and money (instead of medical ethics) to dictate legitimate medical treatment; further, allowing socialized medicine to dictate the encouragement, legitimization and funding of placebo-based treatments.

What Took so Long?

The reason that it took so long for doctors to develop scientific medical treatment is that, throughout history and continuing in medical practice today, all particular cultural and magical thinking, placebo treatments appear to work. 

The witch doctor’s dance kept these healers employed for thousands of years. Bloodletting “worked,” cross-culturally, for over 3000 years in recorded history.  

Everything and anything “worked” to improve any and every medical condition, but none of these weird practices actually worked.  

Because we are the fittest survivors of hundreds of thousands of years of evolution, we tend, as our evolutionary birthright, to get better and survive disease and injury.  

Also, the ubiquitous placebo effect guarantees that any procedure, process, pill or potion presented in a therapeutic environment will produce a temporary, positive patient report of improvement.

Lack of knowledge of these two processes allowed healers and their patients, from ancient times to the present, to think that all these strange medical procedures worked.  

Even today, supposed “healers” come up with new, exciting and completely silly procedures that appear to work.  

If what passes for the 32 types of acupuncture/moxibustion, including Tong Ren voodoo doll tapping, is considered therapeutic, then anything can be portrayed as such and produce a temporary placebo effect.  

All a supposed healer has to do is allow their beliefs to influence their understanding of Science Based Medicine (SBM) and the germ theory of disease.

For 10,000 years, the sum total that human civilization could produce in the way of clever inquiry and investigation into medical science consisted of whimsical and emotional anecdotal stories, belief, prejudice and bias.  

The criterion for acceptance and believability was the proverbial whine of the anecdotal “…but it works” or the authoritarian “…because I said so” and “might makes right”.  

This became the standard of explanation and accuracy for all natural phenomena from our biology/disease process (the four humors), to our understanding of chemistry (the four elements/alchemy), to our place in the universe and astronomy/physics (the twelve zodiacs/astrology).

By the time our civilization standardized this simple vetting process that is scientific methodology and was able to communicate findings quickly across cultures (approximately from the 1870s onward in America), scientific progress was astonishing.  

Two American bicycle mechanics in North Carolina take to the air (1903) and a mere 66 years later (1969), Neil Armstrong is walking on the moon.  

Doctors stopped bloodletting, following a ridiculous mishmash of pre-scientific, magical energy practices, individual whims and fancy and within a similar time period (1870-1967) were performing successful heart transplants.  

Einstein proposes a mathematical relationship between energy and matter (E = mc2) in his 1905 Theory of Special Relativity and in the incredibly short period of 47 years, mankind had produced and harnessed the process that powers all the stars in the universe (hydrogen fusion, 1952).

Where did all the supernatural and paranormal fears and fancy go? All the magic, the ghosts, goblins, remote viewing, fairies, telekinesis, telepathy, energy medicine, Nesse, psychic powers, energy forces, etc, all of it, where did it go and what became of it?  

In every scientific investigation of paranormal, psychic or supernatural phenomena, the scientific orientation that, “natural events have natural explanations,” always wins. Always.  

Drawing a Clear, Ethical Line

From day one, every M.D. comes into contact with patients seeking approval of and referral to placebo-based procedures.  

Typically, doctors prescribe science-based treatment and then give offhanded approval for whatever else the patient wants to do.  

“Doctor, I feel better when I take vitamin C (or do yoga, take homeopathic dilutions, drink green tea, eat chicken soup or take an extra shot of whisky in my coffee).”  The doctor usually replies, “Sure... as long as you follow the treatment I prescribed and take the medicine I gave you.”  

Doctors who hold themselves to a higher standard and consider patient/public health education to be a part of every patient interaction, answer in a completely different manner.  

They take a minute or two, really just a single minute, to express what one doctor I know tells her patients when asked about referrals to placebo-based medical treatments: “You came to me for the best, evidence-based medicine available and that’s what we’re going to do. If you want me to recommend or refer you to a placebo-based treatment, I won’t do it.”

It’s just that simple.

Politics and Money: The New Medical Ethics

Well, it’s a good thing we learned our lesson over the last 10,000 years and no longer rely on bias, prejudice, beliefs, stories, opinions and magical explanations when we practice medicine.  

Now we understand our own confirmation bias, false associations, logical fallacies and errors of self-validation, post hoc reasoning and benefits of double blind experimentation, placebo control groups, random controlled trials, peer review and the null hypothesis approach to knowledge.

Can you imagine, after 10,000 years, making the same thinking mistakes over and over again? What would it say about modern medicine and us as a species if we would continue our primitive biases even though we have a simple procedure which prevents us from fooling ourselves?

In addition, it is not difficult to notice that there appears to be an association between the accepted legitimacy of magical, placebo-based energy medicine and government sponsored, socialized "free” medical care.  

This happened in Mao’s China, Blair’s England and is now happening in Obama’s America.  

The rationale seems to be that because it’s impossible to bring high-quality yet incredibly expensive, science-based medical care to everyone, it is necessary  to legitimize these inexpensive, placebo practices, which patients generate themselves and about which they “feel good,” just like in pre-scientific times.  

The political campaign of Sen. Tom Harkin to fund and legitimize his personal pork barrel project, the Office of Alternative Medicine (OAM) in 1991, which became NCCAM in 1998 and most recently NCCIM in 2014, is public record.

“NCCAM officials have spent $375,000 to find that inhaling lemon and lavender scents does not promote wound healing; $750,000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390,000 to find that ancient Indian remedies do not control type 2 diabetes; $700,000 to find that magnets do not treat arthritis, carpal tunnel syndrome or migraine headaches; and $406,000 to find that coffee enemas do not cure pancreatic cancer,” writes Paul Offit in an essay published in the Journal of the American Medical Association.

“The reason for the poor track record is fairly simple to identify — by definition CAM [complementary and alternative therapies] includes treatments that are scientifically implausible, which means there is a low prior probability that they will work. If the treatments were scientifically plausible then they wouldn’t be alternative,” writes Steven Novella of Science Based Medicine.

An Associated Press article from 2009 reported with some alarm that although $2.5 billion of our tax dollars had been spent on CAM “research” at the NIH, no alternative medicine effects were shown to be better than placebos.

Most unfortunately, the current fad is to integrate these magical energy practices into Science Based Medicine in an absolutely unfathomable return to the Dark Ages of medical practice.

Patients are not informed about the lack of scientific mechanism for these magical energy procedures or their placebo nature.

If patients are not satisfied with science-based medicine, they will find their own way to magical-thinking placebos; however, once an M.D. refers a patient to a placebo procedure, the referral, in itself, leads the patient to incorrectly assume scientific legitimacy and validity for the magical thinking, placebo procedure.  

It’s an inadvertently deceptive practice. Don’t do it.

As you can see, this “doctors’ apology” is really not about our wonderful M.D.s. It is more about ourselves as a species and the civilization we have created.  

Why do we continue to make the same thinking mistakes that our ancestors made 10,000 years ago when we have a simple process to make sure we are not fooling ourselves?

Neil deGrasse Tyson was asked what his mentor, Carl Sagan, would be most amazed at given the development of science today. Tyson replied that Sagan would be amazed “...that we still have to argue that science is something important in our society.”   

— Victor Dominocielo, M.A., a California-credentialed teacher for 38 years, is the human biology and health teacher at a local school. He earned his master of arts degree in education from UCSB. The opinions expressed are his own.

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