How to Counter the Circus of Pseudoscience
Maybe one day, once I have decades of experience as a doctor and further training in my area of specialization, I will be able to speak about health matters with the tone of authority of the average naturopath.
That was the thought that crossed my mind recently while I waded through the online world of alternative-health practitioners, wellness bloggers, whole-food chefs and Gwyneth Paltrow.
I did not seek it out at first; it came to me through a social-media algorithm. Facebook offered up a video advertisement from a “female hormonal health specialist” with her own “practice.” Not an endocrinologist but a naturopath. She lectured with confidence on thyroid testing, though much of what she said was wrong. And down the internet rabbit hole I went.
One traditional view of the medical profession is that doctors are commanding and authoritarian, even arrogant. Though some individuals fit that description, in fact, the profession is built on doubt.
Most doctors, especially the good ones, are acutely aware of the limits of their knowledge. I have learned from those much more experienced and qualified than me that humility is something to be cultivated over time, not lost.
Our field is built around trying to prove ourselves wrong. In hospitals we hold morbidity and mortality meetings trying to show where we have failed, what we need to change, how we can do better. Our hospital work is audited to identify where we fell short of our ideals. Through scientific research we try to disprove the effectiveness of treatments. Our failings are exposed from the inside.
The nature of evidence-based health care is that practices change as new evidence emerges.
That is also the case for other health professionals whose practice is based on science, like qualified dietitians, physiotherapists, occupational therapists and psychologists. Guidelines are revised, advice is reversed — on blood pressure, diet, hormone replacement, opioid prescribing. This can be immensely frustrating for patients, even though it is what we must do to provide the best possible treatment.
In the face of such doubt, it is not surprising that some individuals, even those who are intelligent and well educated, are swept away by the breezy confidence of health gurus, who are full of passionate intensity while the qualified lack all conviction, to borrow from Yeats.
It is a cognitive bias known in psychology as the Dunning-Kruger Effect. In short, the less you know, the less able you are to recognize how little you know, so the less likely you are to recognize your errors and shortcomings. For the highly skilled, like trained scientists, the opposite is true: The more you know, the more likely you are to see how little you know. This is truly a cognitive bias for our time.
This may explain how an Australian celebrity chef named Pete Evans cannot only promote the health benefits of a Paleo diet but also feel knowledgeable enough to make pronouncements on fluoride, sunscreen and vaccinations. He responded to criticisms in a television interview by saying: “What do you need a qualification for? To talk common sense?” He added, “Why do you have to study something that is outdated, that is industry backed, that is biased, that is not getting the results?”
Engaging is difficult when the alternative-health proponents are on such a different astral plane that it is a challenge even to find common language for a conversation, especially when they promote spurious concepts such as “pyrrole disease,” which they can speak about in great, false detail, drawing the well-informed physician, dietitian or scientist into a vortex of personal anecdote and ancient wisdom, with quips about big pharma thrown in for good measure.
It is kind of like an aerodynamics engineer trying to argue about alien spacecraft with the founder of a U.F.O. museum. How can an aerodynamics engineer speak with authority on the matter when he or she has not even bothered to research the events at Roswell and is not even aware that there are alien dissection videos freely available on the internet?
Countering the online health gurus is especially difficult when they offer the irresistible cocktail of medical language muddled with a much more pleasing aesthetic than medicine, far from the clinical world of linoleum and antiseptic, a better place where patients’ conditions are diagnosed with metaphors (“adrenal fatigue”) and treated with poetry (holy basil, bone broth, Himalayan sea salt).
Just like that naturopath on Facebook describing herself as a “specialist” with a “practice,” alternative-health gurus harness the language of medicine to seem authoritative. They order investigations, adopt protocols. And of course what they say is always half right, which is how pseudoscience works.
But it is not the vocabulary of science that is important — it is the methodology. It would be much better if they left the language and took the rigorous approach to evidence instead, which might mean, for example, Goop choosing not to sell an $84 water bottle with amethyst quartz to “infuse water with positive energy.”
In the face of this circus, we doctors must hold tight to evidence. We must hold tight to our doubt, our knowledge of our fallibility as individuals and as a profession, knowing that humility is a strength, not a weakness.
But we must also as a profession engage in the public conversations about health, including on social media, along with our colleagues in allied health fields. If we do not, the discussion will be dominated by the passionately uninformed, who build trust only to sell false cures. And we must listen to patients, as we are taught to do, showing care and understanding. We must take on the difficult challenge of inspiring and motivating with the truth.