As a medically qualified doctor, I felt I must respond to the contents of a monthly magazine,
What Doctors Don't Tell You (WDDTY). It contains many 'absolute judgement adverts' for many products for which only anecdotal evidences were common and mechanism of action were unclear. If any product makes people feel better, does the mechanism matter? Yes. Very much, if there are to be further developments. Otherwise we are stuck with traditional therapies with no obvious mechanism that have, and will, remained unchanged.
Some traditional therapies have been investigated, the mechanism elucidated, and have entered mainstream medicine. Digoxin for heart failure (originally from foxgloves), Quinine for malaria (originally from Cinchona tree bark) and Colchicine for gout. I have had gout and Colchicine was effective. Even as a cynic, I have to confess that knowing that Colchicine was originally produced from autumn crocus conferred unscientific psychological benefits unrelated to its medical effect.
In WDDTY, numerous speculative recommendations are featured. Everyone needs vitality and there are hundreds and hundreds of authentic, compelling testimonials that PolarAid, a product using 'electromagnetic frequencies, restores vitality' (March 2023). 'A Living Water Vortex Jug (£257), a leaf-shaped paddle from the jug lid stirs two litres of water anti-clockwise, producing a powerful vortex which brings the dead, chemically polluted water we get out of our taps back to life' (April 2023). 'Super Oxygenated Spring Water uses nanotechnology to infuse vibrational spring water with more bio-available oxygen to advance Pet Vitality' (March 2023). 'The Basic rule is to eat the rainbow, which means to include as many different coloured fruits and vegetables in your diet as you can' (May 2023). Some of the claims need independent confirmation, using trials (not anecdotes) and need to have an underlying logical and verifiable explanation.
In the April 2023 edition, the magazine's conclusions about face masks are clear: 'Face masks do not stop Covid spreading'. However, the quoted Cochrane Review states: 'The variable quality of the studies hampers drawing any firm conclusions… there is a need for large, well‐designed randomised clinical trials addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of acute respiratory infections'.
I don't know whether face masks are a good or bad thing to counter Covid and its variants, past, present and future. Even if masks turn out to have been irrelevant, in retrospect, it might have been appropriate to plan for possible events rather than to await developments. In prospect, those responsible for promoting face masks adopted a reasonable risk assessment that wearing a mask 'Just in case' was a safer bet than 'Waiting to see what happens'.
Doctors may hide their ignorance from their patients and possibly themselves by using descriptive labels, usually with Greek or Latin names, that suggest that they know everything about some diseases – they assume you must realise this. You have red lumps on your shins: that will be erythema nodosum. You have an itchy red rash: that will be urticaria.
You are tired most of the time without an obvious cause: that will be myalgic encephalomyelitis (ME). In most cases of ME, there is no evidence of encephalomyelitis (inflammation of the brain and spinal cord) but this does not mean it is a non-illness. There must be several causes or trigger factors for the ME syndrome. With some cases of long Covid there is evidence of such organic damage. Some doctors have opined that ME is mostly psychological and occurs in psychologically vulnerable people without realising that the psychologically vulnerable almost certainly will be just as likely to get organic problems.
For some diseases, everything is known apart from the cause and cure. Crohn's disease and ulcerative colitis and multiple sclerosis are examples (they are almost certainly rare reactions to a common infection or a common reaction to a rare infection).
You are anti-vaccinations? Really? Against all vaccinations? To be against well-established vaccines is a poor bet. Getting measles is far riskier than a measles vaccination. Many serious diseases have been almost abolished (polio, whooping cough and diphtheria, for example). Doctors are reluctant to mention that, whilst they advise that vaccines are a good bet for whole populations, for a sociopathically minded individual it may be superficially reasonable to avoid receiving new vaccines but to let others take the risks and hope that the vaccine-induced herd immunity of others will protect them. The benefits and risks of new vaccines may not be quantifiable, especially when vaccines have to be urgently developed.
Most things in medicine are based on probabilities rather than absolutes. Doctors do not tell you that most medical interventions are mostly driven by probabilities. Each patient is an individual and whether or not they will benefit from a treatment is based on studies of large groups. What is normal is not an absolute judgement. If there is a bell-shaped standard distribution curve (as in most biological data), then normality is often arbitrarily described as lying between two standard deviations from the average that covers 95% of observations. Whether you are normal depends on your deviation(s).
IQs have a normal bell-shaped curve and this means that 50% of the population have an IQ of less than 100. If you have a result within normal limits, this does not necessarily mean you will not benefit from reducing that parameter. Other definitions of what is normal can be paradoxical. Over 50% of Americas are overweight as defined by Body Mass Index. Over 50% could be thought to represent normality.
Doctors, like patients, are not a homogenous lot. There will always be bright-eyed self-appointed authorities who are convinced they are correct and conventional wisdoms wrong. Sometimes they are right. For the rest of us, evaluation of clinical interventions, whether mainstream or alternative, should use a doubting discipline to separate beliefs and scientifically sustainable facts.
If a doctor is supremely self-confident, ask how certain they are. I would prefer a doctor who was worried that he or she might be wrong in my particular case. As well as asking about expected improvements and side effects of a treatment, also ask the number needed to treat (in other words how many people have to take the treatment for one person to benefit). Ideally the answer should be one.
Most treatments have side effects as a risk (illogically the occurrence of side effects might be seen by patients and some doctors as reassurance that the treatment is having a powerful and beneficial effect). Risks of side effects need to be compared with the risks of everyday life. Crossing a road carries a risk. Road traffic collectively has the highest fatality risk per passenger kilometre. The risks of medical treatment are almost certainly less than the risks of riding motorcycles. Interestingly, elevators are probably the safest mode of transport per distance travelled. In the US there are five deaths each year from over 18 billion elevator trips.
Most doctors do not tell you that brains are like thick mud, physically if not mentally. Pictures and models of brains look solid but in life brains are like white cheesecake – wobbly – and you would not want to shake up cheesecake. So boxing and repeated heading of footballs carry a risk, but doctors are reluctant to point this out as this seemingly would be unpopular.
Finally, and importantly, that an intervention makes people feel better does not imply a direct and specific effect. Give me money and I will feel a lot better. Generous and gullible readers should please note that this effect is dose related.
Philip D Welsby is a retired consultant physician
