Pass the Snake Oil, Doc!

From The Times
September 1, 2007

The rise of a combination of extreme scepticism towards established sources of
authority in science and medicine and anxiety about environmental threats to our
wellbeing has led many to put their faith in self-proclaimed mavericks and
alternative healers and charlatans. The recent outbreaks of measles, which
resulted last year in the first childhood death for 15 years, shows how
dangerous this credulity can be.
As doctors, we are grappling in our
surgeries with fear and confusion, exacerbated by an apparently endless series
of health scares and panics. A campaigner came to me convinced that a local
mobile phone mast was causing her breathing difficulties; later she admitted
that she smoked 30 cigarettes a day. A young man, committed to the “near-death”
experiences offered by inhaling the veterinary tranquilliser ketamine in the
course of weekend clubbing binges, inquired whether I would check his serum
cholesterol level to assess his long-term risk of coronary heart disease.
Patients who consume vitamins, antioxidants and herbs by the bucketful commonly
refuse to take medication recommended for high blood pressure or some other
condition because they “don’t want to get hooked on tablets”. Some patients even
refuse chemotherapy for cancer in favour of homoeopathy, acupuncture or
aromatherapy.

Once upon a time, the writers of science fiction liked to postulate a future in which science was discredited. Human beings, the usual tale went, could not ever travel to outer space, or something like that. Sometimes a worldwide nuclear catastrophe had occurred. In any case, civilization returned to a pre-Industrial Revolution standard, including a total rejection of science and a "rediscovery" of magic and superstition.

There are moments when I think it's happening now. Or at least, to a subculture. But why just now? The strides obstetric and gynecologic medicine has made--just one scientific discipline--since I finished nursing school have been immense. The minimum limit for viability, when I was a new graduate, for a premature baby was somewhere between 28 and 30 weeks; now it is about 23 (although outcomes at this stage are not very good) Forceps deliveries were routine. There was no fetal monitoring or ultrasound. Fertility treatment was crude and not very successful. The first IVF baby had yet to be conceived.

But medicine has also had some notable failures. Nearly all my life I've heard that the "cure for cancer" is right around the corner; AIDS, unknown when I was at the beginning of my career, looms large over us all and has changed sexual behavior. The prospect of Alzeheimer's frightens every person who is approaching an age his grandparents never dreamed of achieving. And medicine has increasingly become complex to the point of unintelligibility to the average person, and no one doctor can encompass ALL the medical knowledge there is. "Disseminated intravascular coagulopathy", said fast enough, sounds a lot like "abracadabra", and "Exubera!" reminds one of a spell in Harry Potter rather than the name of a inhalable form of insulin.

And thereby lies the point. The average guy has lots of jargon thrown at him which he doesn't understand, and is ashamed to admit he doesn't understand. So when someone says something which isn't scientific at all but is really just rubbish, he doesn't see any difference. Add to this that any esoteric or exotic "knowledge" which is supposed to come from a mythic past, some Golden Age (so much better than our own degenerate cultures) or some Far Eastern source (Shangri La, remember, was in the Himalayas) is ipso facto held to be "better" than some modern laboratory concoction, and, as P.T. Barnum said, "there's a sucker born every minute".

A form of massage which claims to massage an organ which cannot be palpated, and is based on the "insights" of a South American "shaman" is one of these totally imaginary "treatments". Like many other panaceas, this "Mayan Massage" can cure numerous different ailments with a single type of manipulation (and is painless and non-invasive--good news for the needlephobic): infertility, prostate trouble, digestive upsets, emotional problems (interestingly, the website refers to the "redirection of blood" to make the chi flow better. Chi is a totally unprovable kind of energy invoked in certain Chinese philosophies. Didn't know the Mayans and the Chinese knew each other) The "shaman" who claimed to be the master of this knowledge died at an extremely advanced age, we are told. I bet he didn't really know how old he really was, just as this folk medicine is completely without any scientific background. But it does sound so nice. And it will cure just about everything, by "readjusting" an organ which cannot be felt externally.

Daniel Ben-Ami, in Spiked, writes:

Imagine an egalitarian world in which all food is organic and local, the air is free of industrial pollution, and vigorous physical exertion is guaranteed. Sound idyllic?

But hold on… Life expectancy is 30 at most; many children die at or soon after birth; life is constantly lived on the edge of starvation; there are no doctors or dentists or modern toilets. If it is egalitarian it is because everyone is dirt poor, and there is no industrial pollution because there are no factories. Food is organic because there are no pesticides or high technology farming methods. As a result, producing food means long hours of back-breaking physical work which may end up yielding little.
There is – or at least was – such a place. It is called the past. And few of us, it seems, recognise the enormous benefits to humanity of escaping from it. On the contrary, there is a pervasive culture of complaint about the perils of affluence and a common tendency to romanticise the simple life.
From the 1790s onwards, in the aftermath of the French Revolution, the prospect of a world without scarcity seemed like a realistic possibility. Humans strove for a day when they could have a guaranteed food supply at all times. It should be remembered that the famous clause in Christianity’s Lord’s Prayer – ‘give us this day our daily bread’ – was meant literally. Our ancestors struggled for a world where we could take abundant food, clean water and adequate shelter for granted. Not only have we achieved these goals, at least in the developed world, but modern technology and economic organisation have improved our lives hugely.

What a shame all these rejectionists of modern technology and science couldn't be transported back just one or two hundred years and see just how awful life really was, when it was all "organic" and pre-sanitation (a bath at birth and a bath at death were quite enough for most, and there was no such thing as clean water or fresh vegetables in cities; indeed the inability of a city to provide services limited their very growth) and pre-antibiotic, when Rh sensitization (oh yes, it happened back then) meant the death of every child a sensitized woman bore (and no way to avoid repeated pregnancies), and diabetes was a death sentence. Or maybe we don't have to build a time machine; just go to the Third World where the maternal and fetal death rates are still astronomical and life expectancy is short, especially for a woman. Where women literally walk for days for the privilege of delivering in a hospital instead of in their own homes, where the Caesarean rate is "admirably" low because it is simply unavailable. Where there are entire hospitals of women with recto-vaginal fistulas constantly leaking urine and feces because of botched births. (In forty years of midwifery, I have never seen a woman so injured)

I get so ticked off at this foolishness. At least be consistent--if you want to espouse primitive knowledge, then espouse the primitive lifestyle. Get rid of electricity and running water, squat over a latrine which is a hole in the ground, don't use refrigeration, no analgesia and antibiotics, and when your labor goes sour, hitch up the horse and buggy, but don't go to a hospital--that's a modern invention--find a "wise woman" somewhere, and pray to some deity that you and the baby survive--and if you do, expect to repeat the experience every couple of years until it does kill you.

I'll stay in the 21st century, thanks very much.