I can’t find the source of this quote. Maybe philosopher Bertrand Russell, but I’m not sure. Once, when asked how he’d respond if given evidence that went totally against something he’d believed for years, he answered,
“I would change my mind, of course. What, sir, would you do?”
It’s too bad the same can’t be said for the medical profession.
When presented with information that’s not in synch with what doctors learn during training, it seems a majority of physicians stop thinking altogether. Of course, a change of mind is possible eventually. A doctor may see an article or overhear a colleague saying “Did you hear the latest on…” and a glimmer of new thought is sparked. The entombed brain cracks opens to let in a little light.
A single reality tunnel
The entire medical profession seems to have a single reality tunnel and, inside it, a healthy hostility toward change. Sometimes there’s a shift in beliefs (bleeding patients with leeches doesn’t work for everything) while other times deeply held beliefs seem ossified (homeopathy is nonsense). Since the 19th century, psychologists have referred to this as “herd mentality” and it’s never viewed in a positive light.
You’d be surprised how many people have suffered needlessly or died as a result of the medical profession’s herd mentality. In the 19th century, Hungarian physician Ignaz Semmelweiss realized the high infection and mortality rate among women who had just delivered babies was being caused by physicians not washing their hands before delivery. When he proposed compulsory hand washing, he was summarily drummed out of the profession and later died in an insane asylum.
In the middle of the 20th century, the AMA’s official stance was that cigarettes were a harmless pleasure, not associated with heart or lung disease, but actually good for you because they reduced stress.
It’s a shame that access to medical information on the internet has actually further narrowed the tunnel vision of many physicians. Just watch your doc’s facial expression or body language when you begin a sentence with, “But doctor, I read on the internet that…” See the look of dismay when you hand her a few pages of reading material.
Why does this rigid thinking occur? It’s because in medical education, young physicians succeed by being obedient. A medical textbook is gospel, the wisdom of professors written in stone. Any out-of-the-box thinking (“Why not try chiropractic?”) is mightily discouraged.
The med school price of a controversial opinion might be a poor letter of recommendation that ends a young doctor’s chance for a particularly desirable residency. (“He’s a good student, but prone to some unusual and unscientific opinions” can kill a career.)
Want to experience some of this narrow-mindedness?
Be a patient with chronic symptoms and normal lab tests and be told there’s nothing wrong with you. Go online and read about some of the conditions contemptuously called “fad diagnoses.” Over the years these have included candida (yeast) overgrowth, chronic fatigue syndrome, fibromyalgia, leaky gut syndrome, chronic Lyme disease, multiple chemical sensitivity syndrome, adrenal fatigue, subclinical hypothyroidism, toxic mold syndrome, electromagnetic field sensitivity, hypoglycemia, and others.
Perhaps you’ll read an article and think, “Hmmm…this sounds like what I’ve got.” You may even buy a book on it. But what will truly sabotage your case with your physician is to have learned about it from an alternative practitioner–your chiropractor, nutritionist, or naturopath. Maybe you even had some tests done, paying out of pocket: Lyme antibodies, stool for candida, lactulose/mannitol ratio for leaky gut.
Present this evidence to your doctor and her face hardens. You sense the negativism, hostility even. She tosses down the paperwork with barely disguised contempt. You know immediately the book you’ve purchased for her will go unread. “I’ve never heard of any of this. These tests you paid for are meaningless. We never use them. Can’t you just stay off the internet?” And then, the coup de grace, “I realize you’re really tired of feeling poorly, but I think a lot of this is depression. Here (handing you a business card), why don’t you make an appointment with this psychiatrist.”
For example
Let’s take the controversial diagnosis “leaky gut” (intestinal hyperpermeability) to give you an idea what you’re up against. In leaky gut, an overly porous/permeable intestinal wall leaks large molecules of food and triggers an immune reaction that causes a variety of seemingly unrelated symptoms. I’ll devote a whole Health Tip to leaky gut syndrome in the future.
Here’s Wikipedia, in an article likely written by Stephen Barrett, MD, of Quackwatch. Leaky gut is called “a dishonest ploy designed to make money from the sale of supposed remedies for it.” On the other hand, an apparently open-minded gastroenterologist on WebMD says “We don’t know a lot, but we know it exists.”
However, if you Google “intestinal hyperpermeability” an immense article in the conventional medical journal Gut from 2006 goes into detail about the physiology, testing, and treatment. A 2003 article from East African Medical Journal concludes “The occurrence of increased gastrointestinal permeability is probably vastly underestimated.”
Now picture your doctor with a rivet in the back of her neck, unable to look to the left or to the right, just rigidly straight ahead. Her narrow-mindedness, her utter lack of intellectual curiosity–her total commitment to a single belief system–is very costly to your health and well-being.
Change is possible
If there’s a dim light at the end of this tunnel thinking, it’s that physicians can eventually change their minds. It was tough for Louis Pasteur to sell the idea that germs caused disease. It took the advertising power of Big Pharma, which had developed mediocre drugs for fibromyalgia, to convince many (but not most) physicians that fibro actually existed.
Today patients with stomach ulcers are prescribed antibiotics to kill off Helicobacter bacteria, but the scientists who discovered the bacterium’s role in ulcers had an uphill battle convincing doctors that ulcers weren’t caused by stress. You’d be even more shocked to learn how difficult it was to convince physicians to recommend folic acid during pregnancy to prevent spina bifida. The connection between low folate levels and spina bifida had been known for years, but then, as now, nutritional supplements were regarded with suspicion by doctors who had been taught in med school that the US diet was the best in the world and that vitamins were a waste of money. How many babies were born with spina bifida unnecessarily because of the rivets in the neck of the medical profession?
Yes, change is possible. Pregnant women receive folic acid to offset fetal growth deformity. The AMA stopped encouraging cigarettes for relaxation more than 50 years ago. But if you’re chronically unwell and not getting help, don’t hold your breath waiting for a shift in medical thinking.
Rather, do some internet research on functional medicine and integrative medicine. Many websites have a Find a Physician tab. Of course you’ll need to do your homework when you select one of these physicians as well. It takes real work to be a patient.
Be well,
David Edelberg, MD