Let’s look at one example.
A unknown number of Functional Medicine adherents broadcast call-in programs on radio stations. One FM physician, a Dr. “D” in Northern California graduated from UC Davis School of Medicine (Central California’s Sacramento Valley.) I find her program fascinating, requiring some attentive listening.
Dr. D’s recommendations for people’s complaints and conditions are often complex, a chimera of standard explanations and therapies, but painted with a variety of views that are anything but standard. The problem I found was that some of each answer was rational – especially the logic of her differential diagnosis – but suddenly spun out into space with unfamiliar methods or some recognizable as one component or another of sectarianism. Some answers had no relationship to the problem at hand, but seemed to be plucked out of a firmament of independent ideas, theories, ideologies, and personal anecdotes – a medical Separate Reality.
One can be carried along by an answer that sounds on surface reasonable because of the confidence and the delivery’s vocal tone. Her voice is medium-low, sort of a mezzo or contralto. It’s a voice ideal for advice; confidence oozes. Some of her separate reality recommendations she precedes with a biochemical or physiological explanation, so the shifting from standard to “separate reality” grids goes so smoothly, the usual recognizable red flags may not spring up.
Lacking those usual audio-cues, I found myself sometimes several sentences into an advice scheme before asking if this is material substantiated or speculative. This doc is well-educated in biology and human physiology. She introduces analogies imaginatively. Yet some principles and relationships were unfamiliar. In order to conclude as to their veracity or applicability I would have to spend time referring to texts and journals.
Here is a condensed record of the program from earlier this year.
Q: My (friend, relative) a 70 year old man has anemia, doesn’t improve on iron, what to do? Is there a Chinese remedy? A: (First gives a short differential diagnosis of anemia and iron absorption.) TCM teaches that the kidney is in charge of the blood – how they came to that conclusion “I don’t know.” Perhaps it’s defective absorption. Take the iron with vinegar or juice. Consult a nutritionist or a naturopathic doctor. Medical school training is defective in nutrition.
Um: The short differential was OK, stressing possibility of blood loss. Defective iron absorption however is not likely. Why not recommend a good internist?
Q: Patient with primary thrombocythemia on agrylin, with not much response, but on black cohosh the platelets decreased, and on ceasing it they increased again…what to do? A: Cohosh could be interact with agrylin through cytochrome P450
Um…perhaps, but most P450 interactions act by activating P450, thus more rapid degrading of the drug. But she could be right. Drug interaction was the key. Good.
Q: What to do for foot fungus? (presumed toenail)
A: Tea tree oil or Non-X.
Um: Perhaps. Medline search for tea tree oil and foot fungus turned up two papers. One using a mix with butenafine (a hexosamine) and another with another combination – 1994 and 1999, both showing effect. One paper on a hypersensitivity reaction to TTO. Most refs are on antibacterial properties and other fungi. Not a good record.
Q: What do you know about the CSA test? The claim is to diagnose cervical Ca and to monitor for advancing disease
A: CSA is elevated in”pre-cancer” of the cervix. Dr. “D” rec’d the Onconix (manufacturer) web site.
Umm: I went there – CSA is a cancer antigen marker, insulin-like growth factor II. A page dated 2006 seemed to be invitation to invest in the company and pay $85 for a 1882 word paper. I do not know much about current standards for its use. I imagine, like most, there are false positives and so forth. I dunno. Lots of papers on Medline.
Q: A young man, returning soldier, gets episodes of hostility to people associated with chest pains. Question also about “burn testing”(?)
A: Mood swings could be due to heavy metal toxicity to higher neural centers. Advise getting lead and mercury blood tests.
Q2: Could metal poisoning be cause hallucinations and nightmares?
And then as an afterthought, “It could be psychological. Try beta-blockers.”
Ummm: (During the first and second Gulf Wars there were claims of MS and ALS being increased in veterans, claimed due to spent uranium dust and fragments – uranium having been used as artillery shell tips for metal penetration (it’s hard.) Plus other unspecified metals and toxins. The fears were akin to those of Hg poisoning from MMR and other vaccines.)
This series of answers locked in “Dr D” to the annals of hysteria and pseudoscience. Here is a combat vet with episodes of expressive anger and somaticism (chest pains) and the doc recommends heavy metal poisoning? I tried to lobby my congresswoman once about quack methods and the NCCAM, and was told by a staffer that she would only consider problems in which there is harm to the patient. How about this one and the harm to the people around him who might be victims of his aggression?
And then the back-up treatment of choice for servicemen with post-combat disorders and anxiety is beta-blockers?
Q: Another question on foot fungus, leading to chiropractic: Caller used tumeric for foot fungus which he/she claimed worked.
A: Balinese medicine uses Golligo (?) for lots of things
Umm: Lots of anecdotal stuff bubbling here – no comment.
Q2: Had back problems secondary to foot problems with back out of place. Asked personal physician to write a TAR (a Medicaid authorization) for a chiropractor referral, but the doc refused.
A2: Doctors are burdened with excess paperwork, – Dr “D” figures paper work costs her about $75K/year. But doctors are inappropriately dismissive of chiropractors. If someone seems to need repeated chiro treatments, then it’s a muscle problem, and that needs physical therapy (implying not chiropractic.)
Ummm: I’ve never heard of that one before. It’s an interesting rhetorical move to deny unnecessary return visits, refer out of chiropractic without calling DCs quacks and abusers, but it’s probably not true.
Q3: Will there be a provision for physician education in nutrition in the health plan bill?
A3: Brief discussion about P. Obama’s plan (who really knows – even he?) concluding it’s premature to speculate. Then the odd comment” If it’s a contest between nutrition and surgery, nutrition will win. Nutrition for back pain? I suppose it’s better than unwarranted surgery, being equally ineffective. But against established effective disc, stenosis, and other surgeries? What kind of statement was that?
Q: The program devolved into less controversial aspects such as “lamosil” for foot fungus, and newly recommended 5% benzyl alcohol for head lice. “Dr D” quit while ahead on that one.
I think one can see at least part of the problem here. A capable, intelligent physician, with a more than usual base in biological and medical research gets principles of differential diagnosis right, but comes up with a mix of standard, sometimes insightful answers, and a set of answers with no factual or knowledge base other than hearsay and hunches. Moreover, she makes recommendations such as for heavy metal testing and for chiropractic in the face of established evidence to the contrary.
This is what I find hard to understand about the crank and quack mind. A mind that functions well in most areas of living but that is diverted into near fantasies, at least into a different or “separate reality.”
We found with Laetrile as with Carlos Castaneda and other literary fraudsters, that frank fraud involves creation of an entire thought system that might even be internally consistent. Their motivations may be different but their phenotypes are similar – even overlays of one another.
But practitioners who make up the bulk of sectarian practitioners thrive on having one foot in reality and the other in theater of the absurd, and seem unable to raise significant meaning or warning signs from claims of the absurd. They are another problem. The former are sociopaths. The latter I have no term for.