Monday, April 16, 2018

The "lasso of truth"? Dr Jen Gunter and Other Critics--Why so angry, dawg?!

I get regular blasts from various medical sources. Here's one I got today:

There's a link to see this better below.
I know this sort of case. I see these kids in my office and although the remedy Lyssin (also called Hydrophobinum) is useful in some kids (and sometimes adults!) with violent tendencies, as described by Dr Zimmerman in the post Dr Gunter shared on her blog, there are other remedies that are very useful as well.

I looked over her blog and I can point out a few things that are useful to think about:

1. Not everything she has to say is flippant scientific nonsense. She's got things to say about everything from abortion research to fetal tissue to sexual health--and it's all stuff she can lay some legitimate claim to, even if she's doing a lot of editorializing, because she is a gynecologist.

2. A lot of it is flippant scientific nonsense. I say this because having an opinion about a natural phenomenon isn't science. It's editorializing about a point of view. Immediate assignment of a thing to a category "real" vs. "not real" based itself on the fact that the news is in a category (in this case, "homeopathy") just isn't scientific.

3. I think many people forget that being an MD doesn't by itself make a person "scientific." Although the hard sciences (chemistry, physics, biology) underlie medicine, the employment of these sciences is a tool that operates within a model of the world that is fundamentally thought to be material and objective, and that this material world is fully knowable within a framework that is applicable across cultures, societies, and all individuals.

"MD" is a professional degree, not an academic degree; it argues to society that a person has mastered certain skills, not that the person fundamentally understands and routinely employs a strong philosophical razor that at once views all natural phenomena skeptically and  yet admits to the basic "unknowability" of the world. Put another way one ought to view things in the world with both a skeptical reserve and a child's open wonder at the world's as-yet-unknown possibilities.

I've seen young children with ADD/ADHD, anxiety, violence, etc., all appropriately shopped around to all manner of pediatricians, psychologists, behavioral analysts, pastors, and child-life specialists all to little avail (and much expense and work for the parents as they try to modify the kid's behavior). Then I give one remedy to the kid--and keep in mind the kid's spent most of the visit in my waiting room playing with LEGOs (or tearing the place up)--and a few weeks later it's like a miracle.

What am I supposed to do with that?

Medically, and according to "normal science" (in the vein of Thomas Kuhn), I just gave the kid some sugar pellets that contain no useful medicine that doesn't work according to any known model of pharmacology.

Scientifically, we could argue that the kid got better because of some random event--although that seems rather hard to argue, since random events happen all the time. Why this one? Why this time?

We could say it's the "placebo effect"--although that's kind of weird since the child really didn't seem very interested in the case taking (mostly grown ups talking) or the pills (to him, just candy). So that seems rather implausible.

So what happened?

And this is my complaint about Gunter and other critics like her. They are angry. Gunter's blog is sharp, cutting, and dismissive (and issues f-bombs in her blog from time to time). Here are some quotes from this story about a case of child behavior disorder treated with Lyssin:

"This is so ridiculous it is offensive," and "This whole idea would be ridiculous if it were not so enraging."


The Syrian government's gassing of its own civilian citizens is "enraging". The South Pacific Gyre Garbage Patch is "offensive". I have to wonder what fundamental personality issue operates in critics like Gunter that they feel actual anger about these things. She does note that a lot of adherents of natural medicine--which she clearly has an issue with--may make medically unwise decisions. But then what's unwise?

What a lot of docs and medical "skeptics" fail to understand is that each of us is telling a story. We are living that story. People like myself, professionally trained, can be advisers of what to do and what to avoid, what is likely to help and what's likely to harm, but in the end it's still not our story. It's the patient's story. When docs push people to accept what they find unacceptable, it is an aggression against that patient's dignity, an affront to their autonomy. When docs dismiss out of hand the touchstones of a patient's (or parent's) journey toward health, it is itself a social violence.

Their response, "Stop! Stop! Stop! Stop listening to that nonsense! It's bad. It takes your money. It's unscientific. It makes me angry to see you doing something I am sure is stupid!"

If that's your point of view, maybe you're in the wrong business.

Medicine is at its core an empirical science. Despite "evidence based practice" and large population studies, and experiments, and a humongous corporate medical-industrial complex worldwide, in the end, every patient is a new case study. As we say in science "n = 1".

Hippocrates, Avicenna, Qi Bo and other ancient physicians understood this. In the 1500s and going forward, European physicians began to study health and medicine in a more reductionist way. This has led to great things: modern surgery, antibiotics, effective cancer therapies, and vaccines (not all that unrelated to homeopathy, I would point out to both allopaths and homeopaths!)

But it has also led to a hubris, a belief in contemporary views of communal experience versus individual experience, and a dismissive attitude toward the fundamental unknowability of the individual case. When a case doesn't turn out as expected, most of today's physicians throw up their hands and attribute the outcome to chance, to something we don't know yet, to nature's mystery...but they don't go the next step and ask why?

I know, it might be genetics we don't understand yet. It might be subtle environmental toxins. It might be...what? Belief? Mysticism? The fickle hand of God? Astrological influence? Tachyons?

I totally get the notion that there's a lot of stuff out there that's crazy, dangerous, and intentional exploitation. I really do get it. But then to apply that fact to a blanket argument that everything that hasn't been validated in a large population study, or by a pharma company's clinical trial, or that doesn't fit into medicine's current materialistic, objectivist framework is stupid and worthy of actual rage is just, itself, intellectually lazy.

Pundits like Gunter aren't going away. Physician skeptics like Stephen Barrett, Harriett Hall, and Edzard Ernst, I'd argue that they perhaps have reputation (and possibly, money) at issue. Theirs is perhaps an anger at medical alternatives that stems from a vested interest in maintaining a brand. Others, I think their skepticism is better placed: they worry about the waste and loss that may result from people trying things that they don't approve of because they don't fit the model of normal science. It's humanistic, perhaps, and maybe the anger is frustration--after all, any practicing doc loses people to the mysteries of disease, despite all of our "scientific" might.

It doesn't have to be this way.

Taking the phenomena of human experience, studying it with science, recognizing the incrementalism of knowledge, and adding a healthy dose of humility can lead to the practitioner to peace and an acceptance that, in the end, it is the patient's journey.

We're just along for the ride.