Medicine is an old profession, but not the oldest profession

Medicine is a very old profession. Ancient and honorable. Sadly, for the vast majority of recorded history, honor was pretty much all it had. The Hippocratean ideals of “first do no harm” and putting the patient first and all held special importance when medicine truly had nothing to offer. Make no mistake: up until the last two centuries, the vast majority of what passed as “medicine” almost always did more harm than good.

The advent of scientific understanding of the universe, including the structure and functioning of the human body, finally let doctors do what we’d been honor-bound to merely try and do for all those preceding centuries: actually ease suffering and cure disease. Oh, there’s still plenty of “art” in the practice of medicine, not the least of which involves convincing patients to do things like exercise, eat right, and stop smoking. But the essence of modern, effective medicine is based on science.

There is another profession that is just as old as medicine; probably older, given its moniker of “the oldest profession.” Its aim is to make people feel good — for money, of course. Once money changes hands, pleasing the customer is all that counts. Whatever it takes.

Lying is usually involved:

  • “You’re the best!”
  • “You’re so big!”
  • “I love you.”

Whatever the customer wants to hear, the prostitutes deliver; because that’s what they’re paid to do. Press-Ganey would be proud.

Many so-called practitioners of “complementary”, “alternative”, and “integrative” medicine claim that their modalities are popular. Patients want acupuncture, homeopathy, reiki, and a host of other magical practices that, after rigorous scientific study have been shown time and time again to be nonsense. Even the most scientifically implausible schemes have been submitted to actual experiments — sort of like an engineering department testing perpetual motion machines because Eastern Engineering claims to have created one and, yanno, they don’t want to be culturally insensitive — and in every case have been demonstrated to be, well, nonsense.

Still the naturopaths, the homeopaths, the acupuncturists, the chiropractors, and all the rest peddle their lies; and people buy them.

Why?

Can it really be that people are so desperate they will pay good money (considerably more than my scientifically based services would cost them) to hear comforting lies, rather than the truth, however compassionately presented?

Sadder still, why do so many doctors with supposedly rigorous scientific training prostitute themselves, buying into the magical thinking of “alternative” medicine, just to make a buck?

It has been suggested that I do just that; augment my income by selling supplements and “nutraceuticals”, perhaps doing some acupuncture or reiki. It sure would help with the bottom line, which has been dwindling alarmingly of late.

I can’t do it.

I won’t do it. I won’t lie to my patients. And I won’t lie to myself, telling myself there are five lights when there are only four, or that there are such things as meridians and qi, or energy fields that can be felt and balanced by touch.

I have nothing but contempt for my colleagues who whore themselves out, pushing magic and nonsense in a vain attempt to please their patients instead of educating them. I am a member of a very old profession, but not the oldest profession.

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.

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  • Doc99

    “It has been said that politics is the second oldest profession. I have learned that it bears a striking resemblance to the first. ”
    Ronald Wilson Reagan

  • http://www.academicobgyn.com Nicholas Fogelson, MD

    I once was being haranged by an insurance company, and kept on hold for almost 30 minutes. After a while, I swear I could actually see five lights.

    “THERE…ARE..FOUR…LIGHTS!!!”

  • pkoon24

    Let’s not belittle things about which we know nothing. Some of what you call “magic” and “lies” have been use for thousands of years. Who are you, a physician with little to no experience in such things, to accuse others of peddling falsehood? It’s true that Western medicine is wonderful for the treatment of a certain group of ailments, but they pale in comparison to the number of illnesses against which it is helpless. We need to recognize alternative medicine and the things for which they constitute effective treatment. There is only one profession of medicine. Be they chiropractors, acupuncturists, herbalists, apothecaries or witch doctors, our goal is a common one. Let’s not forget that we’re all on the same team.

    • bw

      With these treatments that have been around for thousands of years, what is your understanding of the quality of health for people during that time? I am genuinely interested in your answer. I am prone to romanticize earlier times, but every once in awhile I am acutely aware that a condition that I have would most likely have resulted in my crippling and probable death by not being able to work at a young age. I have a unique situation that makes me aware of that. How does your unique experience affect your understanding of the quality of health during those thousands of years?

  • http://www.BocaConciergeDoc.com Steven Reznick MD FACP

    I have great respect for you not caving in to a cash cow and pushing unproven supplements. For some reason the supplement market has been given a free pass to market directly to consumers without doing any supportive studies. I suggest if you do not already have it, purchase a copy of the ACP’s Guide to Complimentary and Alternative Medicine. It analyzes what research does exist and if the studies answer the question they ask. It is a great beginning of exploring what actually works.
    Within our profession unfortunately we run with data and implement it often before the full story is known. Take the Vitamin D story. We all know that low vitamin D levels have been linked to many systemic processes. We also know that at a reimbursement by Medicare of $250 per test , the vitamin D level is the most ordered test in the Medicare lab system. Commercial office packages exist for measuring Vitamin D even though experts are still unsure if what the measurement reflects true readings.. They are also unsure what role the low Vitamin D level plays in the disease process or if correcting it, reverses the disease process, prevents the disease process or is the low level a reflection of a generalized ongoing disease process. They can’t even agree on an optimal replacement dose yet. In some studies of replacement the group receiving Vitamin D does worse than the placebo group with low levels? Despite this ” scientific” physicians draw Vit D levels and supplement it regularly. It reminds me of the hoopla over homocysteine levels and their relationship to cardiovascular disease. Patients were being given large doses of folate and Vitamin B supplements to normalize the homocysteine level. The problem was it didnt reduce the cardiovascular risk despite normalizing the homocysteine numbers.
    My suggestion is keep an open mind but a cynical approach until research in an area is performed and is easily reproducible whether it be with vitamins, minerals, supplements, herbs , eastern medicine or traditional science. Dont compromise your beliefs for profit and control what you can control. Keep up the good work Dr. Hornstein!!

  • http://www.pacificpsych.com/ pacificpsych

    Good post.

    I share your frustration about naturopaths et al. I have a somewhat different take, though, on all this. In my specialty, the ‘mainstream’ is the bogus pseudo-scientific bunk, while the true essence of the profession, the psychological part, the art, has been relegated to the junkyard. “Chemical imbalance”, anyone? How about “imbalanced humours”? The difference? Not much.

    I think doctors in general would do good to adopt some of the so-called alternative style, without compromising their ethics or giving in to illogical thinking. Anything that can increase the serenity of the setting, for example. Psychotherapy. Relaxation. Biofeedback. Hypnosis. These should be the core of what a psychiatrist does, instead of doling out Pharma junk, but every doctor in every specialty can do some of these.

    Patients go to ‘healers’ because of a mix of unscientific thinking and a need for hope. We can do better with the second part, without lying or introducing false hope.

    • http://www.twitter.com/alicearobertson Alice

      I share your frustration about naturopaths et al. I have a somewhat different take, though, on all this. In my specialty, the ‘mainstream’ is the bogus pseudo-scientific bunk, while the true essence of the profession, the psychological part, the art, has been relegated to the junkyard. “Chemical imbalance”, anyone? How about “imbalanced humours”? The difference? Not much. [end quote]

      You are right about the perceptions on treating the human emotion. It’s thought to be intangible, therefore, up for grabs. Science is making inroads there though, and this can be helpful in weeding out the guesswork (and, possible, exonerating some doctors who are considered brilliant, but strange by current standards). Diseases that were once thought to be purely of the patient’s mind, are now being captured with technology. It’s fascinating! That’s why the new movie Inception is so popular….some are saying it’s doable. If it is it will leave the category of “junk science” and move into a type of trepidation science. I tend to think that just because something is possible……doesn’t always mean we should do it.

  • http://www.milanmooremd.com Milan Moore MD, MPH

    Dr. Reznick,

    If you have an open and scientific mind, visit the Univ of California based website, http://www.grassrootshealth.net , explore the data, ask yourself whether your credentials exceed those of the scientific panel on the left (including Walter Willett from Harvard and Michael Holick from BU,) and read some of the articles yourself. At this point, speaking out against Vitamin D supplementation puts you in the company of the physicians of the 1950′s who dismissed criticism of cigarette smoking as unscientific and unfounded. I do not mean to be critical, but ignoring Vitamin D in your patient population, or worse, being dismissive when a patient attempts to address their Vit D deficiency, does violate the principle of do no harm. If you actually explore the website and take in a fraction of the data presented, I would welcome criticism of my position.

  • Marc Gorayeb, MD

    Great post, Dr. Horstein.
    Let’s just see what happens with government involvement in health care. Obama promised a ‘scientific’ approach to health-related public policy. Considering that placebo-therapy is usually much cheaper than psychotherapy, I predict that it will be reimbursable.

  • Dr Lemmon

    First, I agree with Dr. Moore that Vitamin D supplementation is a good thing in those with low levels. But, though I have read many articles, I am no expert. I am happy to read articles arguing against supplementation in those with low levels. The Cochrane reviews note at least this:
    “There is evidence that multifactorial interventions reduce falls and risk of falling in hospitals and may do so in nursing care facilities. Vitamin D supplementation is effective in reducing the rate of falls in nursing care facilities. Exercise in subacute hospital settings appears effective but its effectiveness in nursing care facilities remains uncertain.”

    I believe in evidence based medicine. Alternative medicine is fine when it passes muster as safe and proven effective by scientific evidence. Much of it has been scrutinized and fails to pass muster. When I see physicians employ it despite this, I feel the same way Dr Hornstein does.

    Excellent post by Dr. Hornstein.

  • http://www.twitter.com/alicearobertson Alice

    It has been suggested that I do just that; augment my income by selling supplements and “nutraceuticals”, perhaps doing some acupuncture or reiki. It sure would help with the bottom line, which has been dwindling alarmingly of late.[end quote]

    You have exposed a real problem in medicine, and you seem to have a type of integrity for your job, and yet…..I think in your commendable passion you may have went too far. As much as I fear quackery, I fear doctors with closed minds too. Such a wide sweeping condemnation may not be completely accurate. Our son’s bestfriend is an honest chiropractor, so I know that a lot of what you share is true (his stories are really discouraging. They involve both bad doctors, and some bad patients whose chief goal is a false claim), but it’s just too broad.

    There are some doctors who slam supplements, but that isn’t helpful when the vast majority of patients believe in the public perception… that doctor’s gain from writing prescriptions. As long as a doctor is writing prescriptions many patients will view them as steering them towards prescriptions that may eventually harm them, and they will turn to those who will help them naturally (whether it be supplements, childbirth, inflammation, migraines, or back problems). This is, obviously, not true for all doctors, but it remains in the public’s mind as a stereotype that will be hard to reverse. Basically, as much as most people will agree with you, as long as we have a small minority of doctors behaving badly the public perception of some doctors being charlatans will remain.

    I think the public expects many doctors to the pro-type of Dr. Oz, and he recommends alternative treatments. He’s quite an act to follow, and I think sometimes patient’s expectations are too high because patients often expect doctors to be a type of magician. Who knows maybe some want a type of unrealistic fantasy. Maybe some of these people give a certain type of patient what they really want? It’s not what I want, but a few of my friends seem enamored with the false claims and dreams they are being sold. In truth, it’s exactly what they want and are willing to pay for. No expose will convince them otherwise.

  • Kay

    Remember there is zero tolerance when dealing with women patients. The doctor is to set the limits. Seems it does not work that way.The oath they take makes no difference to their behavior. It is a shame one cannot trust most doctors! They all seem to want to touch me inapporate.I have started seeing a woman doctor.

  • http://www.epmonthly.com/whitecoat WhiteCoat

    Always love DinoDoc’s posts.

  • Anon EM doc

    If the placebo effect of an alternative treatment makes someone happy and keeps them and their B.S. chief complaint that I can’t fix out of my ER, I’m all for it.

  • oopah

    A bit harsh, but mostly true as far as i’m concerned, i wouldn’t be so quick to trash accupunture, it seems to have some benefit and i reccomend it to patients when other modalities have failed them, you really do hit the nail on the head with what you are saying. You are right in whoring ourselves but in the end everyone has to in some way, you have to sell yourself as a primary care doctor, (especially in a competitive market such as new york, new jersey, chicago), the first is to make the patient believe in you and that involves being friendly and understanding. It also involves being somewhat compromising , once you have the patient believing in you, they will believe in the treatment. I think us as practitioners should do more research into different modalities and “herbal” treatments. The more we know about them the more we can inform the patient on the risks and benefits of using them.