DURING an average day in my psychiatry clinic at The Maudsley Hospital in
London, patients bombard me with questions such as: “What exactly is in these
tablets you want me to take, doctor?” and: “Precisely how is this medication
meant to work?”
They peer at me over the prescription with the suspicious demeanour of those
convinced my mission in life is to make them worse, not better, thus keeping me
in business with a full clinic. “I see so many other patients on this same
tablet, doctor. Are you sure they don’t cause the voices rather than take them
away?” has been asked on numerous occasions.
It’s not just psychiatrists who get this kind of thing. Most doctors have an
increasingly tough time persuading patients to take treatments. Between 75 and
90 per cent of heart patients, for example, now fail to stick to their
prescribed medication.
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Some argue that this is a good thing. It’s a sign of healthy scepticism,
critical thinking and inquiring minds, they claim, and could prove a catalyst
for better public awareness of science and medicine—just like the
increasing numbers of patients who queue up outside doctors’ surgeries
brandishing Internet printouts of the latest research on their illness.
If only.
I suspect that my patients’ queries and their interest in research have
little to do with an improved grasp of scientific methodology. It’s more a case
of distrust of authority and a failure to understand evidence-based treatments.
For most patients, personal anecdote or a first-person account is now more
persuasive than a clinical trial. And contrary to what many might think, the
Internet will only make things worse, because what passes as fact on the Net is
usually rumour or hearsay.
The quest for fast-acting cures has led at least one in three in the
“scientific” West to try an alternative therapy in the past year—hardly a
sign that critical thinking is on the increase. Doctors and scientists often
assume that those who gravitate towards unconventional or “alternative”
treatments are less rational or sensible. Yet surveys tell us that users of
alternative or complementary medicine tend to have slightly more, rather than
less, formal education compared with non-users. They also tend to be wealthier,
because most complementary therapies are not available on the National Health
Service.
Therein lies a curious paradox. The growth in non-scientific health is being
fuelled by precisely the social class which should be best equipped to grasp key
concepts such as “evidence”, “placebo effect” and “double-blind randomised
clinical trial”. These are the very issues that make most researchers sceptical
of the claims of alternative practitioners. Yet they appear to have little or no
impact on some of the most educated in our society.
There is a real danger in rejecting the scientific approach and embracing
treatments that are not clinically proven. Ironically, it exposes the better
educated to more exploitation by unscrupulous practitioners, and to the hazards
of delaying appropriate treatment for serious conditions.
Many of my middle-class patients come to me after first dabbling in an
alternative treatment. I don’t mind. But they’d save themselves much time, money
and headache if the question, “Precisely how is this medication meant to work,
doctor?” was redirected to their herbalist or homeopath.