“If there is an effect, there has to be a side effect.”
– Rajeev Jayadevan, Think Like Your Doctor
Now that we’ve covered expensive, let’s tackle the dangerous side of medical bullshit. There is a general misperception that alternative therapies are safer than conventional medicine. Part of this ties to the myth that things that are natural must be safe (see number 8 in the Medical Bullshit Detector). Part of this ties to the fact that when people are trying to sell you a health product or service they emphasize only the potential benefits, many of which are often unbelievable or untrue, and neglect to mention any side effects. It is a rule that if something has an effect it must have side effects. Take exercise for example. Despite its clear benefits, any exercise you choose has some risk of injury. Even placebos can cause side effects, the so-called nocebo effect.
Myth 1: Alternative medicines don’t have side effects.
Truth: My initial motivation for getting into the world of anti-bullshit was seeing several of my own patients going to Mexico or Costa Rica and spending tens of thousands of dollars on stem cell treatments that had no proven benefits but had well-documented harms, particularly a risk that the injected cells could become a cancer. There were over 20,000 emergency room visits a year related to supplements in 2015, (1) a number that has certainly grown if you add cannabis-related products to the mix, and many of which are serious enough to require hospitalization.
Myth 2: There is no harm in stopping conventional treatments.
Truth: When you stop treating something treatable or curing something curable it gets worse. Some of the worst tragedies of medical bullshit are people who died from illnesses we now have reliable treatments for who stopped them because they fell victim to a charismatic quack. In my own practice, I’ve had patients take a break from medications to try various diets and supplements only to come back months or rarely years later much more disabled. The miracle treatments they hoped would cure their illness accelerated it by stopping conventional treatments that worked. Unfortunately, the damage of these experiments is often permanent.
Myth 3: My doctor doesn’t need to know about my alternative health choices.
Truth: Your doctor and healthcare team should know about your alternative health treatments and supplements. For one thing, supplements can interact with prescription medications and either decrease their effectiveness or increase toxicity. Second, side effects from supplements or other treatments can mimic symptoms of illness and may lead your doctor to order unnecessary tests or start unneeded treatments. As one common example, medical marijuana can cause low blood pressure, falls, confusion, and nausea. Finally, hiding things from your doctor over time affects the openness of your relationship which in turn makes it more difficult for you to get the most of your doctor visits.
Myth 4: Doctors don’t recommend medications or other treatments unless you really need them.
Truth: The rule that everything looks like a nail to a hammer applies here—doctors prescribe and surgeons cut. In my own research, I’ve found that some patients don’t share symptoms with their doctors for fear that it will result in another prescription. (2) Common instances of overtreatment include prescribing antibiotics for self-limited viral infections, pushing surgery for back or knee pain in the absence of a surgically correctable cause, (3) and almost any aggressive intervention in people with a terminal illness nearing the end of their life. (4) These treatments are not merely expensive, but also dangerous, contributing to antibiotic resistance, unnecessary surgical complications, and avoidable suffering for dying patients and their families.
References:
1. Geller AI, Shehab N, Weidle NJ, et al. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med. 2015;373(16):1531-1540.
2. Boersma I, Jones J, Carter J, et al. Parkinson disease patients’ perspectives on palliative care needs: What are they telling us? Neurol Clin Pract. 2016;6(3):209-219.
3. Stahel PF, VanderHeiden TF, Kim FJ. Why do surgeons continue to perform unnecessary surgery? Patient Saf Surg. 2017;11:1.
4. Cardona-Morrell M, Kim J, Turner RM, Anstey M, Mitchell IA, Hillman K. Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem. Int J Qual Health Care. 2016;28(4):456-469.