As a member of the skeptical community, I know it must be difficult for you to deal with the fact that some people would rather seek medical advice from people who have not walked the hallowed halls of a traditional medical school. It must hurt your heart to know that some people who are sick may never get well because they put their trust in treatments that have not been proven to medical science to work. I know it hurts my heart to hear about children who are denied life-saving treatment because such treatment goes against the belief systems of the parents – and I’m not even a doctor! Right now, though, I’d like to look at “alternative” treatments that usually don’t involve life-or-death choices, such as chiropractic, offer some theories as to why people choose them, and give some suggestions for attracting these people back to your practices.
First, a story: When I was seventeen, I was in a car accident. It didn’t seem at the time that I had been hurt very badly, but I was taken to the emergency room anyway as a precaution. The doctors there said that nothing was broken, but that I would probably be sore for awhile, and I should take ibuprofen as needed for the pain. However, this prediction proved to be far less serious than the actual results: as days passed, my back became more and more sore. Additionally, I began to “stiffen up,” and I was less and less able to move my back at all (and I certainly could not move without pain). I was taking increasing amounts of ibuprofen, but to very little effect. I was a senior in high school, and for several days, I was reduced to lying on my back in my classes, because it hurt too much to sit upright. My family doctor didn’t want to prescribe anything stronger, but eventually, there was no other choice; I just wasn’t healing the way I should have been.
To make a long story short, after a couple of weeks of excruciating back pain, my mom took me to a local chiropractor. X-Rays of my back were taken, and my X-Rays were shown side-by-side with a “normal” set, to illustrate the fact that my neck had been hyperextended (it’s one of the really cruddy parts of being short – instead of hitting my chest, the air bag in the car had caught me under the chin, which multiplied the effects of the whiplash I would’ve had anyway). The chiropractor manipulated my neck and back to ease the bones back into a more natural alignment. Almost immediately, I felt better than I had at any time since the accident. Fifteen years later, my back has never been exactly the same, but on most days, I’m relatively pain-free.
As a skeptic, I try to always be careful to separate correlation with causation, and I realize that it is entirely possible that the lessening of my pain had nothing to do with the chiropractic manipulation. However, whether or not I was “healed” by the chiropractor really isn’t what I want to talk about – what I really want to talk about is the intangible appeal of this kind of treatment.
Here’s another story: When I was a kid, I had a nasty habit of running off to go swimming in the summer without sunscreen. I love to swim, and every minute spent putting on sunblock was another minute I wasn’t in the water. So I was absolutely awful about skipping it, then staying out for several hours, which (of course) resulted in the mother of all sunburns. To this day, I will never be able to see the photo of my grandparents’ fiftieth wedding anniversary without cringing, because the white dress I was wearing only served to accentuate the terrible sunburn I had that day (before anyone flips out on my mom for neglect, let me state frankly that I was not above telling her I had used sunscreen when I had not – blame for this belongs solely on my shoulders, not hers). When I reached my late teens, I finally began to understand the potential damage to my skin, and I became a fierce user of sunscreen. However, in my very early twenties, I noticed that a large mole on my left cheek would suddenly begin thickening and oozing fluid for no apparent reason. My doctor referred me to a dermatologist for possible skin cancer (and let me tell you – “cancer” is a scary word to hear in your very early twenties). The problem was that the oozing and thickening rarely lasted for more than two weeks, and the dermatologist could never see me in less than three. After the third visit where “everything looked fine,” he finally decided that I had had enough, and we made an appointment to have the mole surgically removed and biopsied. Fortunately, the results were totally benign, but the months of waiting between incidents was completely nerve-wracking.
I realize that the differences may not be apparent based on the limited information I’ve offered, so let me add some details in a comparative format:
- Time spent waiting for an appointment: Chiropractor – less than half an hour from phone call to treatment, including driving time; Dermatologist – over three weeks from phone call to appointment, almost a year from first appointment to treatment. On this, the chiropractor is clearly superior; they fit us into their schedule on a moment’s notice. Critics might claim that this is due to their office being less busy than that of a dermatologist, but I think it has more to do with the fact that the chiropractors I’ve worked with have arranged their schedules to be open at more convenient times, and they have also left time between scheduled appointments for emergencies.
- Time spent with the doctor during the appointment: Chiropractor – usually at least 10-15 minutes; Dermatologist – varied, but usually less than five minutes. Again, the chiropractor is clearly superior. What of substance can be said in five minutes? What questions can be asked, let alone answered, in that kind of time? How thorough will a five-minute physical exam really be? I realize that many doctors are buried under crushing amounts of debt brought on by their extensive schooling, and that this leads them to cram more and more patients into their already-busy days, but at what point do we begin to feel that we’re being brushed off and not getting our money’s worth?
- Demeanor of the doctor during the appointment: Chiropractor – warm and friendly, careful and methodical; Dermatologist – clinically detached, rushed. This ties into point #2 as well. I don’t mind paying for medical care, but I do mind spending my hard-earned cash for “care” that doesn’t make me feel even the slightest bit cared for.
Do I need to elucidate further, or have I made my point?
Doctors of America, I don’t want it to be this way! I want to get science-based, peer-reviewed treatment, but I want to get it from someone who genuinely cares for me as a person, not just as a case file or a set of diagnoses. I want to be listened to, with your whole attention – that whole distracted “uh huh, uh huh” gets old really fast, especially when you then proceed to ask me questions I just answered when you weren’t listening.
To be fair: Over the course of my thirty-three years, I have been fortunate enough to have several “doctors” that were wonderful – wait times were short, doctors were friendly, and visits didn’t feel rushed. However, in almost every case, the “doctor” was not an M.D. – these “doctors” were physician’s assistants, nurse-practitioners, and osteopaths (D.O.s). Doctors, if you’re not quite comfortable taking advice from the “alternative” set, there are people doing simply amazing jobs in your general field that you could use as role models.
I realize I’m just one person, with just one opinion. Please feel free to treat my opinions with the very same level of skepticism I expect from you – survey your patients and see what they say. I’m not an expert in surveys, but I have written one recently for my thesis project, and I would be happy to share what I’ve learned about constructing surveys (although I suspect that there are professionals in surveys who have already built such surveys – I’m less-expensive, but they’re probably far better at what they do).
One more thing: In my dealings with the skeptical community, I have noticed that there seems to be a bias against alternate ideas – so much so that many so-called “alternative treatments” aren’t even given the dignity of a double-blind study before being dismissed out of hand. “Lack of research” seems to equal “lack of evidence,” when in fact, lack of research means only that we do not know if something works, not that it automatically doesn’t. Just off the top of my head, I can think of two “alternative treatments” that proved effective: one is the use of ginger root for nausea, and the other is the use of chiropractic manipulation for chronic low-back pain (but don’t take my word for it – look it up for yourself). As your patient, I certainly don’t want you to be so open-minded that your brains fall out, but I also don’t want you to be so closed-minded that you’re incapable of considering alternatives – sometimes hoofbeats really do indicate zebras, not horses.
Please permit me to leave you with one more story (and please be gentle with this one – it’s a bit of a tender spot for me). I have had trouble sleeping for as long as I can remember. At the same time, I have had a constant, usually low-level feeling of fatigue – sometimes bad enough to keep me in bed for 24 hours straight. I don’t usually miss work or school over it, because I’ve learned to push through it, but I’ve canceled many optional activities from being “just too tired.” Coupled with this is another low-level feeling that something “just isn’t quite right” with me physically. I’m afraid I just can’t put my finger on it any more clearly than that – trust me, I wish I could! I have discussed this with a variety of doctors, and in every case, the sole suggestion has been antidepressants. Folks, I’ve taken so many different kinds of antidepressants that I can’t remember them all. Most have simply had no effect. A few have offered minor, short-term improvements, but nothing lasting or meaningful. Many that have not worked have also come with side effects, most of which are far worse than the original feelings I wanted to treat. Please, please, could we have a conversation about what else could be causing these symptoms? Is it even remotely possible that there’s something else going on here? I’m iron-deficient anemic and hypothyroid, and those treatments have made small but lasting differences – if there are two actual, physical, measurable causes, could there not be more? Could we at least check, rather than just assuming I’m a hypochondriac? I don’t have much money, but I have shown that I’m more than willing to pay out-of-pocket for even the remote possibility of answers – heck, I’ll pay for NON-answers, if they give even the slightest possibility that I might feel better.
And that, my dear medical community, is why people continue to pay out hard-earned money for what may be nothing more than attractively-packaged snake oil: because some people have been brushed off for so long by so many doctors that they are desperate for anyone to listen to them and tell them they’re not crazy. As Lewis Rothschild said in The American President: “People want leadership, Mr. President, and in the absence of genuine leadership, they’ll listen to anyone who steps up to the microphone. They want leadership. They’re so thirsty for it they’ll crawl through the desert toward a mirage, and when they discover there’s no water, they’ll drink the sand.” Substitute good health for leadership and you’ll see what I mean. In the film, President Shepherd responds to Lewis’s criticism by saying: “Lewis, we’ve had presidents who were beloved who couldn’t find a coherent sentence with two hands and a flashlight. People don’t drink the sand because they’re thirsty. They drink the sand because they don’t know the difference.” And this is the crux of the problem – many people don’t know the difference between real medicine and snake oil. What they care about is how they are treated.