The worst advocates for modern medical and scientific advances are the people who sell them. I hope this isn’t an extraordinary claim. While the invisible hand of the market is a necessary driver of scientific progress, its inherent amorality generates a chronic, simmering disgust in most who encounter it. Patients are nauseated and angered by the selfish way pharmaceutical and agricultural companies behave. But here’s the thing: so are doctors. This shared ethical outlook should be strengthening the alliance between doctor and patient, yet instead we’re drifting apart.
I have argued against so-called “alternative” and “natural” medicine both in public and in countless private conversations. It can be a bit of a struggle just to overcome the clever naming. After all, what’s bad about “alternatives” and “nature”? Of course, the culture of “alternative medicine” is not really about these things. Traditional doctors can give you plenty of alternatives. It’s one of our flaws that we never seem to run out of pills, tests, and lifestyle changes to offer you. And there’s not much natural about the factory production lines and multi-billion dollar industry that are behind most of the “holistic” products you buy in stores. Instead, much of alternative medicine culture is based on hatred of for-profit medicine and science. Alternative medicine culture seems more about reaction against the corporatization of medicine and nutrition and less about proposing their own reasonable, evidence-based “alternatives”. As I’ve written elsewhere, this culture is about generating fear and uncertainty about an already fear-inducing and uncertain topic.
The response by alternative medicine culture to my campaign to promote evidence-based health information the media has been simultaneously extreme and typical. I have been called a shill for the pharmaceutical and agricultural industries. Here’s the thing: I’m not. Obviously. I’m a poor medical student. I don’t get paid for any of this and I’m not in a position of authority to effectively shill for anything. I’m simply idealistic and trying to advocate for patients about issues I feel are important for their health. Yet anyone who attacks particular unproven “natural” treatments or promotes the scientific study of health interventions is routinely called a shill for big corporations. These articles detail in extreme terms the unethical behavior of corporations and a false association between us is repeatedly implied.
As I said earlier, the major pharmaceutical and agricultural companies, in fact, have been profoundly unethical and selfish. Pharmaceutical companies have time and again skewed clinical trial results for their benefit and to the detriment of patients. They price drugs to maximize profit rather than maximize the number of people they can help. They do sometimes give kickbacks and bribes to physicians. They invent new diseases just to sell a pill rather than address a real need. Agricultural companies for their part have exploited farmers, resulting in unnecessary starvation and poverty, all to make a few extra bucks. Both industries lobby for increasingly unfair intellectual property laws. When alternative medicine culture discusses these problems they’re not wrong, though the details get exaggerated.
There is a distinction, though admittedly it’s muddled, between advocating for a particular treatment and advocating for its seller. In short, bad people can sell good things. This is the underlying justification for market-based economies and why we permit much of the selfish behavior present in our society. And I don’t think it’s a fatally flawed justification. Greed and profit can drive useful advances for society as long as the greed is regulated and limited by that society. (Easier said than done.) When doctors recommend a patient take a particular drug, they are nearly always doing it because they want to help the patient and not because it will enrich a corporation or themselves. True pay-offs of physicians by the drug companies are relatively rare in comparison to the millions of prescriptions doctors write every year.
When we recommend a drug, however, the drug company does happen to get rich. How closely does this ethically tie us to the large corporations? If a life-saving drug is manufactured by a corporation that engages in unethical behavior, is it subsequently unethical for doctors to prescribe that drug? I think most doctors would say no. After all, our primary duty is to help patients and the unfortunate side effect of enriching an unethical company is probably unavoidable. But the economic contribution doctors make to drug companies is real, even if we are ethically obligated to do so. And market-based economies do require us to “vote with our dollars”.
When we abstract away from specific medical treatments and talk about scientific discovery and advancement the situation becomes even less clear. Modern science proposes an external reality and learnable truth. We can make discoveries that allow us to better understand reality and share those discoveries with civilization. These truths then become owned by society rather than the people who discovered them. Take genetically-modified organisms, the maligned technology that drives alternative medicine culture into an astonishing frenzy. We are learning valuable information about the genetic underpinnings of biology, and how to modify that genetic code to better serve our needs. This knowledge has practical applications to so many problems. It also allows us to better appreciate the transcendent creations of nature and enhance our awe and joy. Of course, Monsanto is selling GMOs in exchange for dollars and cents, not awe and joy. If history is any guide, Monsanto, like most corporations, will not exist in perpetuity. Their fortunes will rise and fall over the years. But the knowledge created in part through capitalist enterprises will enhance civilization for as long as it manages to exist.
Read the publications of alternative medicine culture and you will see none of this nuance. The thesis will inevitably be that these corporations are thoroughly evil, that they’re willing and able to go to any length to enhance their profits, and that any physician or scientist who endorses their product is morally equivalent to these evil organizations. We are not inadvertently empowering them through our recommendations, but actively colluding with them and sharing in their profits. This is the big lie that’s getting between us and our patients.
Doctors need to ally themselves with patients and against amoral corporations as best as they can. Our profession needs to be vocal in criticizing the true flaws of the industrial-medical complex. We must find innovative ways to address the fact that we are inadvertently enriching corporations when we appropriately prescribe helpful drugs to our patients. But we also need to address the false conflation alternative medicine culture makes between corporations and physicians. It is ruining the doctor-patient relationship and producing real, measurable harm to patients.
For their part, alternative medicine culture needs to stop propagating conspiracy theories that essentially liken us to Nazis. There are more productive conversations to be had. Unfortunately, profits drive much of this culture as well. These publications sell ads and often their own treatments for massive profits. The natural and alternative medicine industry produces billions of dollars in profit every year. Passionate alternative medicine advocates who aren’t doing this for money need to recognize that their work is also inadvertently enriching unethical corporations. There is a new alliance to be made between doctors and patients in addition to the usual one that takes place in the clinic — together we can address the unethical behavior of large corporations, whether they peddle traditional or “alternative” remedies.