B-Movie Medicine

By Neuroskeptic | November 16, 2009 10:47 pm

We all know about movies that are so bad, they’re good. But could the same thing apply to doctors?

As I described last week, Desiree Jennings is a young woman from Virginia who developed horrible symptoms, including muscle spasms and convulsions, after getting a flu vaccine. It looked a bit like a form of brain damage called dystonia.

Numerous neurologists concluded that her illness was mostly or entirely psychogenic. A certain Dr Rashid Buttar, however, said that she was suffering from neurological damage caused by toxins in the flu vaccine.

Buttar gave her chelation therapy to flush the toxins out. Within 15 minutes, she was cured. Biologically speaking, this is ludicrous. It’s flat-out impossible that chelation could reverse brain damage in 15 minutes, even if Jennings did have brain damage in the first place.

But Buttar’s treatment worked, amazingly well by all accounts. This is not surprising, because the illness was psychological in nature, and Dr Buttar’s treatment was, psychologically, very effective. Jennings was admitted to Dr Buttar’s private clinic; she had IV lines put in to her arm; Dr Buttar attached the chelation treatment to the IV drip and, in a textbook example of how to produce a placebo effect:

I told her “Now the magic should start”, prepared her for what I expected to happen. (interview with Dr Buttar, 05:30 onwards)

The magic did indeed happen, precisely because Dr Buttar convinced Jennings that it would.

*

What would have happened to Jennings if there were no Dr Buttars in the world? Her doctors would have run scans and tests to check if Jennings had any neurological damage. The results would have been normal. Jennings would probably have interpreted this as “We don’t know what’s wrong with you”, although experts would have suspected that the symptoms were most likely psychogenic.

At some point, someone would have had to raise that possibility with her. But the point about psychogenic illness is that it’s not “faking”, “acting” or “made up” – the patient believes they are ill. The symptoms don’t feel psychogenic. This is why people often interpret the suggestion that symptoms are psychogenic as saying “you’re not really ill” and hence “you’re either lying, or crazy”. Of course, patients suffering from psychogenic illness are neither, and they know it.

So, without complementary and alternative medicine, Jennings might have ended up believing herself to be suffering from an illness so obscure that doctors were unable to diagnose it, and hence, unable to cure it. A hopeless situation. A worse thing for someone with psychogenic symptoms to believe is hard to imagine.

Dr Buttar’s treatment was psychologically very powerful – precisely because he believed in it, so he was able to convince Jennings to believe in it. A doctor who realized that Jennings’ symptoms were psychogenic would have found it much harder to achieve the same result. In order to do so, they would have to lie to her, by pretending to believe in a treatment which they knew was just a placebo. This is hard – the doctor would need to be an excellent actor as well as a medic – not to mention ethically tricky.

Interestingly, 100 years ago, this problem wouldn’t have arisen. Doctors knew much less about diagnosis and there were few laboratory tests or scans in those days, so there was usually no way to prove that some symptoms were organic and others were psychogenic. Everyone got the same treatment. Of course, the treatments back then were less good at treating organic illnesses, but that wouldn’t necessarily have made them any worse as placebos. Ironically, as mainstream medicine gets better and better at diagnosing and treating disease, it may be getting worse at dealing with psychogenic symptoms.

[BPSDB]

CATEGORIZED UNDER: bad neuroscience, ethics, placebo, woo
  • Anonymous

    What caused the condition in the first place? Is she going to need a placebo every time it reoccurs?

    Daniel J. Andrews

  • kitty

    I have enjoyed your posts about this case, and totally get your point. My only quibble is with characterizing chelation therapy as a complementary and alternative therapy. In one sense, you are correct. This is clearly a treatment sought as an alternative to conventional medical care. On the other hand, CAM (complementary and alternative medicine) therapies should optimally be subject to the same empirical assessments as conventional medical therapies. From this perspective, calling chelation a CAM gives it undeserved credibility.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    I agree that ideally CAM would be as evidence-based as other medicine, given that it's generally not however, I think it's fair to say that chelation is CAM. (Except, of course, when chelation is used for genuine heavy metal poisoning, when it is mainstream.)

  • http://www.blogger.com/profile/07742439126260863921 uncle joe

    Both camps of allopathic and integrative medicine have their charlatans or deluded practitioners. Some of “evidence based medicine” is also corrupted.
    Few modern doctors prepared to be skeptical of so called evidence that is often a clever spin on propaganda. It is not safe to do so for them and risk to their careerer prospects.
    Yet many allopathic physicians study and embrace the values of alternative wisdom. When cooperation exist between both directions the good outcome is maximised. Competition and hostility is not the same as to critique each tenet.

    I believe a clinical trial investigating chelation therapy still in progress despite aggressive attempts to shut it down. A 75 year old man I personally known had 3 heart attacks and after the last one took intravenous chelation that he kept silent about to his cardiologist. He lived some more years while his doctors were incredible he is still alive and function as he does despite hardly any heart muscle left intact! He was lucid and gained comfort from his religious faith that certainly minimised the levels of his stress hormones injuring further the lumen of his arterial system provoking inflammation. Believers and atheists equally benefit from their spirituality and support of friends and family, the meaningful human connection that include the doctors and nurses as well.

    The above vignette is anecdotal evidence which is not necessarily only testimonials. Testimonials can be anecdotal evidence or can be fake. To dismiss anecdotal evidence when no scientific one exists is arrogant and stupid. The results speak for themselves, undeniable, pure speculation, conjecture is not valid to include.

    Complementary medicine respect the value of the placebo effect. Few allopathic practitioners do.
    Trusting in the efficacy in some modern drugs is 40% of their total effects.

    Some of the responses to this article displays ignorance, superficial knowledge or hostility to the placebo effect and alternative medicine. If no individual benefactors or governments step up financing clinical trials testing homoeopathic and similar modalities of healing and substances no evidence based results will validate them. The drug industry (few ethical exceptions) are profit driven and compete for market share of already effective medications, bringing out slightly altered formulas to circumvent the patent. Some of their trials are underpowered with selection bias excluding populations that would put a dent to their glowing conclusions. Statistical gymnastics to confuse even the FDA preferred use of relative risk data which is numerically more impressive but a distortion of the absolute risk figures showing the true, often insignificant benefit. Known negative side effects also minimised or omitted!

    What hope do the sick in third world countries have,- too poor to pay for life saving drugs? Also where no research is commissioned to find medicine for huge populations afflicted by local diseases that does not guarantee mega profit, so the need is ignored while the first world engineer their sickness by overindulgence, inactivity and willing victim of the food industry poisoning them with additives, denuded produce, residues. Economic rather then health principles drive these businesses. The drug industry is alert and jump to develop drugs to cater for the indulgence-produced afflictions!

    And we are too laid back about it!

    Be well! joseph.

  • http://www.doctormisha.wordpress.com Michael Levin, MD

    Uncle joe,

    You packed many passionate topics in your reply and it won't be possible or prudent to respond to all of them.

    I will only comment on one. If a physician or charlatan controls one variable, then all changes in patient's status can be easily attributed to that variable (for example chelation). If the charlatan or the physician has vested interest in that variable, then only positive changes will be reported but all the negative and neutral – ignored.

    That is the reason why we should not give much credence to testimonials.

  • canukistani

    Uncle Joe

    I respectfully submit but one question for you:

    If there are “charlatans and deluded practitioners” in medicine of any kind, how would you tell the difference?

    In other words, you admit there are people that could fake their evidence for whatever modality of treatment one could mention.

    Given this admission, how does Uncle Joe separate the wheat from the chaff?

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Daniel J. Andrews: impossible to say really. For one thing I'm no expert, but even if I were, we'd need to know much more about her life story to answer that.

    uncle joe: I agree with you about the drug industry – but there is also a CAM industry and it often behaves just as badly. I try to be skeptical of both. As for being hostile to the placebo effect I don't see anyone denying that it helped Jennings and the whole point of this post was that mainstream doctors would find it hard to achieve the same benefits!

  • http://www.blogger.com/profile/07742439126260863921 uncle joe

    To you all: I appreciate your comments. Part of my ongoing education. One of my motto is the acronym LTD (not the car badge), Learn-Teach-Do. I keep learning so I can teach so I can help (do). To humour you I also have another one: “I cure you even if it kills you!” I would of course not tell this to clients only friends who don't seem to appreciate it to say the least…Should I wonder why?- Talking about being passionate!….

    Be well!

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About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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