Guest post: A small hardcore of patients who are quite well but think they’re not
Originally a comment by Steamshovelmama on An extended discussion with their homeopath.
This is one of the appealing things about most “alternative therapies”. You’re paying through the nose for the “therapist”‘s time so you get a nice comfy sit down with a cup of tea and have a long chat with someone who is basically there to listen to you talk about your problems. There’s no rush, there’s time to talk about all those neurotic little issues – which we all have but which medical doctors don’t want to hear about because theres’s nothing they can do about them. Then you go home with (or having had) the equivalent of a sugar pill which, yes, probably does do you some good because you’ve performed all the necessary steps to activate the placebo effect. You’ve been spoken to by someone you consider to be in a position of authority, you’ve sacrificed (paid a shitload of money), you’ve undergone/will carry out some ritually prescribed actions (been physically manipulated/massaged/had needles stuck in you, been given magic pills to take a set time every day etc) so it’s no wonder some people swear by them. Between the placebo effect – actually very strong – and regression to the mean (most things get better on their own in a few weeks) people do perceive they are getting an effect.
This has led to suggestions it should be offered on the NHS. Not because it does anything more than placebo but because it’s basically harmless. You see, every GP’s surgery has a small hardcore of patients who are quite well but think they’re not. They have a plethora of physical symptoms, all of which are either self-evidently neurotic or have been investigated in every way possible. They aren’t actually mentally ill as such so referral to the psych services (which are very overstretched) is just bouncing the problem elsewhere. Back in the 1940s and 50s it wasn’t uncommon for this group to be appeased by being prescribed something innocuous – a sugar pill. These days we aren’t allowed to lie to patients (and all medication can be easily looked up on line) so this small coterie of patients often ends up having their symptoms treated because the GP is left with no choice. The suggestion was to employ a homoeopathist or an acupuncturist to deal with these people’s problems. They get their sit down and chat about their issues. They get their sugar pills (or magic water), they go home happy and free up a shit-load of appointments at their GP’s surgery. The GP keeps a weather eye on them to make sure the symptoms that have been interpreted as innocuous don’t transform into something treatable. Everyone is happy – except for the folks who make the argument that the NHS should never, under any circumstances, pay for anything that doesn’t work.
I can see both sides. The problem with the current system is that, in order not to lie to this group of patients, we have to poison them, which also costs the NHS money. Overall, a local complementary therapist might well be cheaper – especially if he/she negotiates a lower rate to ensure regular NHS business. It’s not much different to the “exercise prescriptions” that GPs can give out which may include access to local authority gyms.
If the NHS offer these treatments, it gives credibility to the practitioners. Anyone who sells bogus medical treatments (whether to the NHS or privately) is making money selling treatments that don’t work to people who are sick. Many people have chronic conditions that medicine cannot treat and alternative medicines are always tempting to anyone who just wants to be better. I had the experience of being ill at a young age and everyone wanted to recommend some herbal remedy or vitamin supplement, none of which helped but all of which cost money. I once had a series of tests from a practitioner of some alternative medicine. It might have been kinesiology, I’m not sure. I was told to cut out loads of foods from my diet.
I tried hard with the diet even though all the tastiest foods were now forbidden. I got no better. I became depressed as mealtimes had always been something I could look forward to. Eventually, a friend of mine, who was a medical student, warned me that everything I had been told was nonsense. I did some research and found out that she was right. More recently, my GP told me to avoid special diets “like the plague”. That was far better as it means that I don’t need to worry that my something I’m eating is making me worse.
It drives me mad when people act as though it does not matter whether alternative medicine works. Maybe not if there’s nothing wrong with you anyway (although I think a cognitive behavioural therapist might argue that the treatment feeds the obsession) but for a sick person every new thing is a bit of hope and it hurts when that hope turns out to have been misplaced. It hurts more to learn that a person you trusted has sold you a bogus treatment. And, if you’re a young sick person put on a prohibitive diet, it hurts when your mother tells you that you have to stick with the diet because your parents paid for you to see the therapist in the first place. One thing a lot of people, especially young people, with chronic illnesses find is that so many people want to judge you for the way you handle the condition. People recommend all sorts of things and get disappointed if you don’t take their advice even if you have tried the exact same thing before. You learn to dread the phrase, “You don’t help yourself”.
Dodgy pseudo-medical treatments are just one more bit of crap that people with chronic illnesses have to deal with. What’s more they cost money, which is often in short supply for a sick person. So, when people justify it using the language of social justice, it really sets my teeth on edge.
That’s the thing – it gives credibility. I find Steamshovelmama’s explanation cogent and informative, and I also find the credibility problem insurmountable.
Sounds an awful lot like the arguments that faitheists use for religion: sure, it’s nonsense, but it’s good for the little people to believe in something, and a priest is a nice cheap alternative to psychotherapy….
No it doesn’t, not really. It’s about a specific set of people who are well but think they aren’t. It’s about physical hypochondria as opposed to the spiritual kind.
Exercise does real good.
I’ve had treatments pushed on me that didn’t work for me, and I (illogically) felt guilty I wasn’t seeing improvement. Sometimes I would try harder (replacing a too wimpy physical therapy exercise with something that would build sufficient muscle),sometimes I would give up on the doctor and work out what was wrong for myself (how I figured out I needed to stop having food with garlic and be very cautious with onion), and sometimes I’d just suffer a few more years before getting real help.
I left off my conclusion.
Which is that I, and others like me, if prescribed what was basically a complicated placebo, would probably try for a while and then stop seeing not only the fake therapist, but the regular doctor because they don’t seem to know how to help, and just go on being sick *and then they’d be ignored by the system* because they don’t have the energy and confidence to battle for real treatment. Which is a win as far as some people are concerned, but doesn’t make anyone healthy.
@ #6: It may also result in a loss of input data for those researching possible treatments; where applicable.
There’s another issue here, too.
That coterie of ‘not ill’ patients? I’m willing to bet that they are disproportionately women, not because women are more prone to mild neuroses and hypochondria, but because the medical establishment has a long, well-documented history of underdiagnosing women’s illnesses. This is particularly true of clinical syndromes like fibromyalgia–just getting the medical establishment to agree that something was going on with all these women in pain was a major hurdle, and some doctors still haven’t gotten the memo.
Giving the GPs a side-channel where they can steer ‘difficult’ cases will disproportionately affect women. It’s a surety that some proportion of those fed into the alt-med channel will be genuinely ill (perhaps just being more acutely aware of their own discomfort or pain than most patients), and their condition will get worse–possibly fatally so. Even with supervision by the GP, there will be cases that slip through the cracks, and those cases will be mostly women patients.