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IF asked about the biggest clash between reason and faith in our lifetime, most of us will think of terrorism. But a troubling battle is also playing out in modern medicine with a growing number of people who are greatly suspicious or antagonistic about its status.
This year has seen a great deal of debate surrounding groups who refuse to vaccinate their children, with most of the response from commentators and experts focusing on the quality of the evidence for vaccination and calling for unvaccinated children to be kept out of schools and childcare centres.
While for the most part this is appropriate — for the public health dangers we face from unvaccinated children are considerable — the dismissive response towards those who stand against the authorities of science and medicine misses the point that the nature of distrust has more to do with faith than reason and must be engaged as such.
As a psychiatrist, I often have to engage with patients and their families who are deeply religious. Many such patients, when first presenting with troubling symptoms varying from depressed mood, hearing voices or debilitating anxiety, may not view their problems through the lens of mental health.
It is not my job to bash their belief system but to find ways they might accept that the treatment I offer — be it therapy or medications — is not diametrically opposed to their religious beliefs.
I consider these to be adjunct treatments. For example, the priest might be engaged to discuss with the patient how diseases of the mind, while certainly encompassing a spiritual or existential component, might also have a physiological aspect treatable with medicine.
This is not just a religious problem. Greens member of the NSW Legislative Council John Kaye touched on a similar dilemma when he suggested an inquiry to clearly illustrate the benefits of fluoride in dental health in response to antifluoride protests on the NSW North Coast (also a key location of antivaccine campaigners).
Kaye was rapidly howled down by fellow Greens, government and opposition members. But he identified a problem — the growing number of people who are deeply suspicious of the authority of medical science. His mistake was to offer them more of the same.
In the past, many people sought relief for many of their problems in the medical profession and in organised religion. Now doctors are seen as too distracted and technically oriented to care about patients’ everyday troubles, while organised religion is seen as irrelevant and antiquated.
Alternative medicine covers a wide range of disciplines, most of which are rooted by the belief that the human body is not just a material reality. The thinking is that the human body has an energy to it that can be guided by external manipulation, much the way that matter and tissues are influenced by chemicals and radiation in conventional medicine.
Much of alternative medicine relies on physical practices commonly used in conventional medicine — pill-taking, needle-poking, and the application of heat and pressure, thus giving it the cloak of science.
The market is estimated to be worth more than $4 billion a year and it is among the fastest growing segments in the health sector.
According to the National Institute of Complementary Medicine two in three Australians use complementary medicines each year and spend almost four times as much on the out-of-pocket expenses for these medicines as they do on pharmaceuticals. In most cases, the use of vitamins or supplements is unwarranted in healthy people.
Years ago, many people wore garlic around their necks to ward off disease. My patients would baulk at this idea, but when garlic is crushed, put into capsules and swallowed, they are convinced their actions are in keeping with science.
But berating or labelling people as stupid is not going to convince skeptics to embrace modern medicine.
I regularly spend several sessions with a growing proportion of my patients building their trust in my job and chemical wares before they, reluctantly, will accept my authority and treatments. They usually present only at the behest of desperate relatives.
The doubters need to have their beliefs acknowledged, but require gradual convincing that their beliefs do not need to be diametrically opposed to medical science. There also needs to be an admission of the power of placebo, the inherent doubts that are part and parcel of health care, and that the veneer of omniscience within the medical profession is, in part, charade.
For the growing proportion of the populace who channel a religious impulse through their consumption of health care, it is modern medicine that needs to become the adjunct or complementary treatment.
Dr Tanveer Ahmed is a Sydney psychiatrist, author and local government councillor.
Dr Ahmed has given an assurance to MJA InSight that this is his original work.
“Ptolemy”, if you are as wise as your name , you can research the harms of ECT-harm to memory, cognition, brain structure, and harm from stimulant medication-mania, psychosis, drug dependence.
As for evidence-based benefit, I will leave you to provide this, as I remain unconvinced.
Szasz has written his view on each of these, and written about medicalisation of common human conditions.
Some doctors believe that we can diagnose and cure unhappiness and other common human conditions , but sadly, depression and “ADHD” seem to be epidemics that we fail to control -as opposed to Malaria-reduced by mosquito nets and draining swamps in some areas.
So when our treatments are rejected , why are we dismayed at the growing reliance on alternative treatments? While some (like manure pits)may be quackery, are they worse than lipid-lowering drugs when dietary modification may suffice in many cases, or Fluvax in children who convulsed in WA?
Dr. Ahmed, I would suggest offering the desperate relatives treatment for themselves. You recognise the right of relatives to demand treatment for a relative, yet have a problem with the right of a relative (parent) to refuse vaccination- a philosophical enigma?
The Hippocratic oath may inspire humility.
Astronomers knew that the earth was not flat, long before it was declared flat, and now it is again no longer flat.
It would be useful and prudent to make attempts to restore the credibility of medical science and turn into ‘science’ based medicine as one would expect. In today’s MJA InSIght: “the Australian and New Zealand Clinical Trials Registry will not be signing up” !
“Professor Paul Glasziou, director of Bond University’s Centre for Research in Evidence-Based Practice, told MJA InSight that it was well established that about half of all clinical trials conducted worldwide go unpublished.
“And the half that are published are biased in favour of positive results”, he said. “So not only are we wasting money and time on trials that aren’t published, but we’re also distorting the research.” https://www.mja.com.au/insight/2013/30/push-full-trial-results-ramps
Truly disappointing ‘development’.
The “New Paternalists” do not have such a hard job. I do not believe that patients are as needy as Dr Ieraci suggests. They turn to CAM when traditional medicine is clueless and fails to treat them.
Rose, please provide evidence to support your statement regarding harms of ECT and stimulant medication, as well also as current evidence for the benefits thereof (given that both harm and benefit need analysis for a balanced assessment of any treatment).
While shrinks precribe ECT and stimulant medication which evidence indicate cause harm, and evidence shows do no good, you lack credibility in your own profession. My Irish grandmother precribed an onion in a sock around the neck – no harm, and no less good.
Did ”On Equilibrium” read the same article as the rest of us? He/she says ”Attempts to win the day by force, to assume that patients should grant you any credibilityjust because you are a doctor, are only going to worsen your position.” And yet, in his article, Tanveer Ahmed says ”The doubters need to have their beliefs acknowledged, but require gradual convincing that their beliefs do not need to be diametrically opposed to medical science. There also needs to be an admission of the power of placebo, the inherent doubts that are part and parcel of health care, and that the veneer of omniscience within the medical profession is, in part, charade.”
Dear Dr Ahmed,
you make the fatal mistake that you believe that your authority as a medical practitioner should be enough to carry the day. Be confident in your wares, understand your end of your trade well, and be prepared to make a persuasive case to each patient and family as to why your views are worth considering.
Attempts to win the day by force, to assume that patients should grant you any credibilityjust because you are a doctor, are only going to worsen your position.
We have seen a series of disasters where drugs like Vioxx, Avandia and some of the anorectics, for instance, have been seen to get to market only by suppression of research data that was unfavourable to their FDA applications. Though I support vaccines, the idea that manufacturers of vaccines enjoy legal protection against lawsuit for any vaccine related adverse reactions is hardly a good look, and does nothing to support public confidence.
Given these difficult realities it is time we all understood that expecting to carry the day just through the authority of our profession is an attitude that belonged to the 19th century, not the 21st.
It’s important to distinguish the ”religious” anti-vaccinationists from people who are just uncertain and seeking information. The zealots can create confusion and concern through the spread of misinformation. WHile the zealots themselves are unlikely to respond to an understanding approach (and often get secondary gain from their extreme position), those concerned parents who want the best for their children can respond to having their concerns taken seriously and responded to. As far as the attraction to CAM practitioners goes, I wonder if this is some sort of response to medicine becoming less paternalistic. Doctors are encouraged to express doubt and involve patients in a decision-making partnership. I wonder, however, whether some part of us as humans deeply desires the comfort of a parental approach and simple, directed advice. I believe many CAM pracitioners have become the ”New Paternalists” – giving simple answers, an ongoing relationship, lots of time, and generally a ”remedy” of some sort. If people were prepared to pay out of pocket for long consultations with their GP, they might benefit from both clinical skill AND the reassurance of the therapeutic relationship.
Tanveer, The majority of your colleagues are still disbelievers in your sincerity and apology for knowingly deceiving the public and your peers for many years in plagiarising your articles. I’m not defending the religious but perhaps you could inject yourself with a good dose of honesty and humility. Although psychiatry is branched under medicine it cannot be said that it is strictly speaking a science (not that science offers all the answers). Why shouldn’t people be skeptical when 97% of psychiatric disorders are not underpinned with EBM.
Dear Tanveer
Let’s start with the old aphorism, “Physician, heal thyself”
Begin with your own profession, Psychiatry and a subject in which you should, by this stage, be passingly knowledgable, ADHD
Why does the bulk of the profession seemingly reject the bulk of published knowledge (in a very well researched field) in favour of the lunatic ideas of a handful of pseudoskeptics around the world who would deny the veracity of ADHD. I refer particularly to the failure to ratifiy of the 2009 Draft Guidelines for ADHD which, seemingly were overturned on the opinion of one opinionated “expert” and a faceless commentator with the proven spurious explanation of “professional misconduct” by one international author.
This leads us to the inescapable conclusion that Kuhn was correct, paradigm shift occurs funeral by funeral. Why were the published comments by the professionals in relation to the substandard, opinion based Clinical Practice Points, which replaced the peer reviewed, evidence based Draft Guidelines, overwhelmed by commentary from proponents of the Church of Scientology. Does not this suggest to you that if there is a clash between reason and faith then that clash is surely sheeted home to the ascendency of “faith” over reason within the profession itself?
Space does not allow me to comment further (4 paragraphs deleted)
And you wonder why we think your profession is on the nose?
You raise an important issue. Of greater concern is psychiatrists who adhere to outdated/ unscientific/populist approaches. In the past, astronomy and astrology were indistinguishable. They differentiated as paradigms as scientific knowledge grew. There is a tendency in psychiatry to gaze in wonder at the old diagnostic constellations so that there is inattentional blindness to new knowledge and and unifying explanations for seemingly insoluble mental health suffering. Doctors are fallible, however, medical training is scientific in nature, so it is difficult to excuse this approach.This tendency misleads, results in mis/missed diagnoses, inappropriate/inadequate treatments, and harm by neglect. References http://www.ukaan.org/getfile.php?type=documents&id=Kooij-conensus-2010.PDF http://www.ukaan.org/getfile.php?type=documents&id=Asherson.pdf
Spot on! It’s a Herculean task to take on someone’s belief system in an attempt to change behaviour/attidudes to therapy; no matter who irrational those beliefs might seem to us. Much better to work with that person rather than simply directly confront them over their beliefs, as that is rarely (if ever) going to work. It’s also much better for everyone’s blood pressure!
Dr Ahmed is correct in his assertions that an approach to a patient needs to be placed within the context of patient beliefs to maximise the effectiveness of that approach. The principals of motivational interviewing loom large here. An excellent article by Julie Leask and Hal Willaby in The Conversation http://theconversation.com/with-vaccination-rates-stable-no-jab-no-play-rules-are-beside-the-point-14522 further outlines why a dismissive approach is not the right way to go
Dear Dr Ahmed thank you for the article. I have been a Naturopath for nearly 25 years. From my experience people are driven towards CAM because they are dissappointed with the medical management of their chronic condition and find that CAM works. Its really that simple. We could argue all day about what is “scientific” and what isn’t. For example, Electric Shock Therapy has been used on and off for decades with very limited hard science to support its use. Many herbs and supplements have good science behind them, but these studies are generally regarded as inconveniences by those in contempt of CAM. At the end of the day, I really believe that modern medicine and CAM have so much to offer. I don’t need to imagine the successes in patients who embrace both as I see it every day.