Mainstream medicine needs to play offense

Last summer, I published a post called “Alternative Medicine is Kicking Our Ass.” In it, I focused on one particularly slick alt-thyroid site that has done a masterful job of sowing doubt regarding the advice mainstream physicians give to our patients about the thyroid. Not only that, but the site has called into question our competency as doctors, citing “evidence” that supposedly proves (it doesn’t) we are all practicing medicine that’s 20 years out-of-date.

My mind wandered back to this post recently when I had the following interaction with a new patient: a 60-ish-year-old woman came to see me for a consultation about her thyroid treatment. She immediately handed over a piece of paper with pretty much every thyroid lab test that can be ordered — and of course, she wanted me to order all of them. She then launched into a lengthy soliloquy, quite matter-of-factly explaining how she knows that mainstream doctors don’t really understand the thyroid … and so on.

Although I have many interactions of this nature in my practice, I was particularly struck by this woman’s tone and posture. Upon reflection, she wasn’t accusatory, nor was she antagonistic. She also wasn’t curious about my opinion; she wasn’t asking, “What do you think about what I’ve read?” She was presenting her “research” to me in a way that said, “Listen, I’ve done my homework, so I just need someone with ordering authority to whom I can hand off the baton for the next leg of this relay.”

The way that she spoke to me was almost – but not quite – conspiratorial. I’m straining to capture this interaction accurately…it was like she was saying, “Hey, I know mainstream doctors don’t know about treating thyroid problems. You know mainstream doctors don’t know about treating thyroid problems. Let’s work on this thyroid thing together, since we both know there’s a better way.”

It took a mighty effort to conceal my incredulity, as I wanted to blurt out, “You do know that I’m a ‘mainstream doctor,’ right?!”

It is interactions like this one that have convinced me that mainstream medicine (MM) can no longer ignore alternative medicine (AM), nor can it be content with simply playing defense when a patient comes in sporting dubious research that she wants incorporated into her treatment plan. Patients are reading AM websites with information that is so plausible – and so ubiquitous on the internet – that the problem is no longer that they’re accepting this information at face value. It’s worse than that. They are also assuming that their research is so authoritative and unassailable that those of us who practice evidence-based medicine have come to the same conclusions. Or, if we haven’t come to the same conclusions, our patients believe that they can educate us about the “right” way to approach endocrine care. Folks, mainstream medicine needs to start playing offense.

In MM’s defense, it has published some fantastic works that address AM’s misguided approaches to treating patients. For example, the American Thyroid Association did a deep dive into why some patients struggle on their levothyroxine replacement therapy despite “optimal” blood levels, culminating in a well-researched, meticulously-cited 2014 guideline paper. The authors did a great job explaining where we are with the research, where the gaps exist, and what questions remain to be answered.

There is a wealth of information in that paper that can be drawn upon to refute common assertions by AM about how to diagnose, treat, and monitor hypothyroidism. So what’s the problem? Most laypeople will never read it. Granted, guideline papers are generally geared toward professionals in that space, which is appropriate. What’s no longer appropriate is to bestow sole responsibility for educating patients onto physicians. At this point in the techno-age, the physician is becoming a middleman. Sure, the doctor is an important middleman, but patients know how to do a Google search. Given that the average user won’t go past the first five results on the first page, if AM sites rank higher than MM sites, then none of MM’s great information will be seen.

Though I am not an expert on search engine optimization, I suspect that one reason why AM sites rank highly is because they are written for laypeople. They typically use language, keywords, and tags that match terms people type into search engines. These posts also address why people don’t feel well when their doctor tells them “everything’s normal,” which is unsurprisingly compelling to someone looking for answers.

Unfortunately, MM sites written for laypeople give accurate information,  but they do not usually address myths and misconceptions. This leaves a tremendous void that AM is happy to fill with nonsense galore, to the point where – for example – there is tons of information out there about why one should take pig thyroid (one shouldn’t), but there isn’t nearly as much information debunking these assertions.

I contend that MM’s professional societies – which are incredible resources for both patients and medical professionals – need to focus more on refuting AM’s claims. How could this be accomplished in a meaningful way? They should put out information in formats that laypeople actually read, listen to, and watch. This means that they need to prioritize direct-to-patient education and invest in the human capital necessary to create and disseminate this content.

Not that I’m auditioning for a job here, but if the Endocrine Society or American Association of Clinical Endocrinologists decided to pair up a physician and a savvy tech/marketing person, I’m pretty sure they could come up with ideas for blog posts, podcasts, and videos that would be both compelling and educational.

If our professional societies believe that our mission as physicians is to lead people toward better health, then they need to step up and steer people away from alternative medicine. It simply isn’t fair or practical to shift the entire burden to physicians, who spend more time in the exam room telling patients what they don’t have, with little time left to focus on what might actually be causing their problems.

HD” is an endocrinologist who blogs at Hormones Demystified.

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