Are you an easy mark for a quack?

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Ever wonder how people fall for get rich quick scams?

I’m talking about the scams like emails that announce you have won a contest that you never entered, ads that claim you can earn $50,000 a month working from home, or expensive seminars that promise to make you a real estate magnate.

Who falls for those things?

It is understood that greedy people fall for these scams, but not most people who are greedy are also wary. The people who fall for these scams aren’t merely greedy; they want something for nothing. The rest of us understand that short of inheriting massive wealth, the only way to make large sums of money is to work for it. We are sadly aware that there is no such thing as “something for nothing.”

The perpetrators of get rich quick scams know that greedy people who want something for nothing are easy marks and tailor their approaches to appeal to people with that specific vulnerability.

Those who fall for science quackery are very similar. They too are greedy and want something for nothing. In their case, though, they aren’t looking for money. Victims of quackery are looking to boost fragile self esteem by claiming expert knowledge without doing the hard work of taking the courses, putting in the training time, and getting the degree. Professional quacks know that those who want to claim expert knowledge without education or training are easy marks and tailor their approaches to appeal to people with that specific vulnerability.

Those who would fight quackery would do well to understand this basic fact. A recent, apparently paradoxical study on anti-vaccination suggests that they don’t understand. The study, Effective Messages in Vaccine Promotion: A Randomized Trial, was published in the journal Pediatrics. The authors of the study started with the assumption that it is ignorance that leads to opposition to vaccines. Based on that assumption, they designed educational interventions:

A Web-based nationally representative 2-wave survey experiment was conducted with 1759 parents age 18 years and older residing in the United States who have children in their household age 17 years or younger (conducted June–July 2011). Parents were randomly assigned to receive 1 of 4 interventions: (1) information explaining the lack of evidence that MMR causes autism from the Centers for Disease Control and Prevention; (2) textual information about the dangers of the diseases prevented by MMR from the Vaccine Information Statement; (3) images of children who have diseases prevented by the MMR vaccine; (4) a dramatic narrative about an infant who almost died of measles from a Centers for Disease Control and Prevention fact sheet; or to a control group.

Much to the surprise of the authors, the attempts at education were completely ineffective at changing parental attitudes.

… Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes. In addition, images of sick children increased expressed belief in a vaccine/autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects.

The authors were surprised because they assumed that being uninformed is what rendered parents vulnerable to anti-vax quackery. But most people lack the requisite education in immunology, virology and public health and they vaccinate their children anyway. Those most vulnerable to anti-vax quackery are a subset of the uneducated who are greedy to assert expert knowledge without education.

In other words, those most vulnerable to quackery aren’t the uneducated; they are the uneducated who wish to view themselves as educated without doing the work required.

That’s why educational messages are startlingly ineffective in combating vaccine quackery. Anti-vax is not about children and not about vaccines; it is about parents and how they wish to veiw themselves.

So how can you tell if you are an easy mark for a quack?

  • If you are anxious to view yourself as more educated than others without actually getting the requisite education, you are vulnerable.
  • Do you believe that you can “educate” yourself about medical topics without going to medical school, you are vulnerable.
  • If you believe that “researching” a topic means using Google, you are vulnerable.
  • If you believe that lay people can know more about medical topics than medical experts, you are vulnerable.

But the flip side is that if you understand you are vulnerable, you can take precautions to avoid being scammed. The first step is recognizing that flattery as an inappropriate component of medical information.

Doctors, scientists and public health officials do not sit around flattering each other about their knowledge. When someone tries to flatter you, you know you are in the presence of a quack, not a legitimate medical professional. Run in the opposite direction.

  • expat
  • Irène Delse

    Talking about quacks and easy marks, have you seen this?
    http://m.today.com/health/breast-milk-health-food-men-experts-caution-against-bizarre-trend-2D79745134
    I know that breastmilk is supposed to have near magic properties, but the idea of adults using it as a health food is disturbing, if only because it means less donor milk available for preemies, for whom it can really be a big help.

    • Amy M

      I saw some other article about using breast milk to make ricotta cheese. 3qts of breast milk were required in the recipe…how long does it take the average woman to produce 3qts?

      • FormerPhysicist

        I don’t know, but it took me less than a week. I had SUCH an oversupply.

        • Amy M

          Still—several days. One cow can do that in one milking, which is why we usually use cow milk.

        • Amy M

          I did some quick math…I had a pretty low supply (based on exclusive pumping), and it would have taken me probably 8 days to get 3qts, at an average rate of 12oz/day. I”m going to guess that at peak production, the average woman might produce close to 1qt/day, so still 3 days necessary to set this up. Or you could just go to the store and buy some ricotta cheese. :)

  • Susan
    • Karen in SC

      So sad. “Doctors at Valley View and Dixie Regional said both twins were in
      critical need of neonatal intensive care, but A.S. would have had “a 100
      percent chance of survival” had he been born in a hospital.”

      • The Bofa, Being of the Sofa

        Seriously, Karen? That’s the part you quote?

        How about this one: “When the medics began asking for the baby’s medical history, Sorensen claimed she did not know when the baby was born, his gestational age, or how long CPR had been underway; instead she said she was not present during the boy’s birth and claimed the mother “had just walked in off the street for help with the delivery.””

        • lawyer jane

          Holy … I just can’t even … this whole story! The only bright side is that she has been criminally charged with a felony, although the charge is laughably light. Should have been murder.

        • AmyP

          Yep.

          And officer, that’s not my pot. This guy just handed the baggie to me and walked away. He said it was oregano.

    • The Bofa, Being of the Sofa

      Whoa.

    • Mel

      Dear God. I think I’m going to be sick.

    • Susan

      I just googled the midwife name and found her site. Gee… there was a time in my life this birth center would have looked very tempting. And there looks like there is money invested in this place… which somehow makes me angrier.

      http://birthandhealth.com/index.php

      • Young CC Prof

        And NOTHING about her being a murderer is in the top Google hits. Nothing at all. How to fix that? Ideas?

        • The Bofa, Being of the Sofa

          A Dr Amy post…

          • Young CC Prof

            That would work. Dr. Amy, if you post about this, please use her name a lot!

        • Ash

          Google algorithms are highly dependent upon links. The more people who link to the news article, the more it’ll be moved to the top. If you have a blog, blog about it.

      • Irène Delse

        “When the mother went to the birth center later that day, a naturopathic doctor there tried to administer an I.V. of magnesium to stop labor, police wrote.
        “The mother stated that [the doctor] was unaware of how to administer the substance and had to call the hospital to ask how, and to ask the amount,” police wrote.”

        Everything in that story is a horrible train wreck. Sorensen and Wilcox reckless amateurism, their eagerness to handle a difficult case in the face of several warnings, then their attempts to wriggle out of responsibility… The clueless naturopath playing doctor at the so-called birth center… The fact that licensure is voluntary anyway in that state…

        • Susan

          I was like… huh? Mag IV at home? really? This is a clusterf*** of crazy….

          • Anj Fabian

            Mag IV at a birth center – not great, but with a CNM or someone who knows how to do it, okay. Stabilize patient, transport.

            To stop labor? And then what? If the Mag IV is keeping labor at bay, then what happens when you stop it?

          • Amy M

            Well it was obvious these crazies didn’t know wtf they were doing and I am so sorry for that poor baby and that family. I imagine they were sucked in and made to feel like they had competent care providers, and instead, they got a total train wreck of criminal negligence leading to a death. Though the fault lies 100% with the midwife and her accomplices, I bet that mother will never forgive herself. And hopefully, she’ll be less likely to be taken in by a quack in the future.

          • Susan

            I frankly think even though I have taken care of more patients on Mag than I can count I would never be a part of using it outside a hospital. I doubt they have the tools to rescue if something went wrong with the Mag. But true, it was a birth center not home, but that’s really an illusion of safety I think, especially in this case.

          • Amazed

            Giving birth in someone else’s home, as Magnus’ mom learned a bit too late.

          • Trixie

            If you called up a hospital and were like, “hi, this is Naturopathic Doctor X, I have a woman in premature labor with twins, can you walk me through this mag sulfate thing?” would any hospital give any response other than, go to the hospital now? I can’t imagine they’d actually walk him through it.

          • Young CC Prof

            Possibly it was more like, “Hey, Frank, remember that Mag sulfate thing? How do you use it? How do you know when you’ve given enough? No, no, I was just wondering!”

          • Susan

            Yeah, I thought that was especially weird too.

        • Ash

          Who wants to bet that the ND won’t be reprimanded by the licensing board for NDs in Utah?

        • Trixie

          I hope Siri2 from the other day is reading…she was confused about an ND’s qualifications to attend a birth.

    • Deena Chamlee

      As I said yesterday there is no telling how many poor sweet babies we have lost.

      • The Bofa, Being of the Sofa

        Apparently, there are 5 buried in the yard of their birth center…

        • Susan

          I once thought it just crazy to think that they would bury babies in the backyard but now I came to believe it was believable that some of these birth junkies are just that evil. Now it looks as if it’s true. How soon will they be supported by the sisters in chains?

          edit–already on sisters in chains!

          • The Bofa, Being of the Sofa

            I really want to hear a MW try to defend this.

            Bofa’s Law tells us that we are going to hear that “not all midwives are this bad”, to which I’d say I sure as hell hope not. However, how unusual is it?

            Twins are normal? Check.
            Can’t do resuscitation? Check.
            Deny involvement? Check.

            The only one that seems to stand out is her claim that she won’t deliver before 36 weeks, but then does it at 32/33 anyway.

            But their behavior is, in fact, all too familiar. That they get away with it on other occasions just makes it less notable.

          • Trixie

            It sounds like the grandmother being there was the only reason this ever got reported.

          • Young CC Prof

            I imagine her witness was a key reason the police were able to actually do anything.

          • anion

            Did you catch the bit about the “backup midwife” they tried to get, who refused because she thought they needed to go to the hospital?

            It’s a little unclear when they called her or how extensive the discussion was–it seems she was called months before and refused, but then they called her during the labor anyway?–but it’s an interesting little sidenote. Not just because another midwife actually offered sound advice and followed some guidelines re good practice, but because had that other midwife been an OB, she’d be vilified for hating on midwives and being arrogant and whatever other nonsense.

          • Anj Fabian

            It meant Sorensen was aware that she needed help – and also given advice that she refused to heed.

            The more witnesses, the better.
            #notburiedtwice

          • Anj Fabian

            I can understand family cemeteries but a birth center’s property?

          • MLE

            Right???? Talk about a one-stop shop.

          • Amazed

            Katie McCall even made an appearance in the comments to defend her,

        • Young CC Prof

          These people need to be in jail. It’s obvious that they can’t be stopped any other way.

          • Susan

            Seems like some sort of crazy southern Utah convergence of New Age meets polygamous compound….

        • Anj Fabian

          It was kinda sorta not really investigated.

          I don’t know if the authorities will be any more motivated. The one thing I found intriguing was that she apparently catered to polygamist families. (/cults?)

          One such group of families was so closely related that a rare autosomal recessive gene appeared. As diseases go, it’s a nasty met/endo one with poor prognosis – fumarase deficiency.

          Oh. The midwife is from southern Utah. This disorder is found in in….southern Utah. Coincidence?
          http://www.reuters.com/article/2007/06/14/us-usa-mormons-genes-idUSN0727298120070614?sp=true

        • Ash

          Isn’t it crazy that just the other day Deena Chamlee mentioned the possibility of some infants being buried in Portland without the authorities knowing they died during a HB attempt?

        • The Computer Ate My Nym

          How does this even work? Are the mother’s ok with having their infants buried in the yard? Too intimidated or brainwashed to object? Or are there some full sized graves yet to be discovered?

          • Irène Delse

            I would think some mothers may be past caring from grief and depression, some may be afraid to have charges brought against them too because of the fetal personhood laws… And it’s possible that in case of stillbirth, if parents don’t understand that it may have been avoidable (‘it could have happened in a hospital too’) and see the baby as never have been alive, they take up the midwife on an offer of ‘taking care’ of the body.

        • MaineJen

          ???????????????

    • The Bofa, Being of the Sofa

      “The mother learned she was having twins, which Sorensen described as a “routine situation,” saying she delivered twins on a regular basis, police wrote.”

      “The mother began laboring in December 2012, at 32 to 33 weeks of pregnancy. The mother and the twins’ father “became greatly concerned” that the twins would be born premature outside of a hospital — Sorensen allegedly told them she would not try to deliver the babies before 36 weeks — but Sorensen allegedly told the parents not to worry because they could go to a hospital if problems were to arise, police wrote.”

      Then again…

      “Wilcox said she and Sorensen wanted to take the mother to Dixie Regional Medical Center in St. George — 45 minutes away in good driving conditions — but the roads were too bad for safe travel. When urged to take the mother to the local Valley View Medical Center, Wilcox said she and Sorensen “did not like” that hospital”

      Yeah, I’m guessing that hospital doesn’t like her, either.

      • Deena Chamlee

        ” I dont think about much, but I am all I think about…..”

      • The Computer Ate My Nym

        This is the bit that gets me: “‘Once the mother was in the ambulance, … [Sorensen] came out yelling,
        requesting the mother come back into the wellness center to deliver the
        second baby,’ police wrote.”

        Sorensen claimed that the mother had just wandered in off the streets asking for help, had clearly demonstrated that she didn’t know what she was doing with a baby that gestational age, and the mother was bleeding profusely–a fact she also seems to have ignored, and she was demanding that the mother return to deliver the baby? How does that make any sense?

        • Anj Fabian

          I was aware of the home births that were claimed to be “accidental” but I hadn’t heard about strange women walking into birth centers in active labor before.

          Good one.

      • anion

        She says so in the next paragraph, that they “don’t love us” there and “really treat [her] clients really horrible” there.

        Because screw saving babies, it’s all about them licking her unlicensed butt and being nice to her.

        This woman makes me sick to my stomach.

    • Deena Chamlee

      You all now know our medieaval history.

    • Ash

      Does Vicki Dawn Sorensen feel no shame about her actions? All her lies, all the harm she’s done? It is insanity.

  • OldTimeRN

    I’m usually amazed when I hear woman retell their birth stories. Sometimes I wonder “HUH?”, because of where I work. There have been times at work where a parents are complaining to a supervisor or another co -worker about what happened in L&D with the labor and or delivery or a previous shift. Reality vs perception is very interesting thing. Sometimes it’s downright scary.

  • An Actual Attorney

    OT, but not totally, right not loving the Daily Show & Sam Bee interviewing Dr. Offit and mocking Sarah Pope and anti-vaxxers right this minute! Oooh, and now mocking Jenny McCarthy.

    • Karen in SC

      It was hilarious! Do they add the mocking replies in editing? That’s my first encounter with Sam Bee but I think I love her!

  • Elaine

    One contributing factor to starting down the alt-med rabbit hole, too, is dealing with medical providers who aren’t properly educated. Everybody knows somebody who (for instance) had a fairly minor breastfeeding problem and had a doc tell them to switch to formula. Two or three encounters like that convince a mom to not trust anything that provider says about breastfeeding, and from there it’s a quick hop to not trusting anything they say about anything, and instead looking for information online, and getting sucked into the alt-med whirlwind.

    This post brought to you by an anecdote that surfaced on one of my crunchy-mom groups, featuring a pediatric urologist who forcibly retracted a 9-month-old baby. If a PEDIATRIC UROLOGIST doesn’t know better than to do that, how on earth can a parent trust him on anything else?

    • Young CC Prof

      Yes, I definitely agree that part of my own flirting with woo was due to errors on the part of the conventional medical establishment. (Plus dealing with some problems that didn’t actually have an effective treatment.)

      I had a weird sort of dual thought process. I believed in vaccines and other measures for controlling contagious disease 100%. I knew that the medical profession was great, modern medicine saved all kinds of lives, including my brother and grandmother. But at the same time, I didn’t think it would ever help ME.

      Yes, that’s illogical and contradictory. Guess what, human brains do things like that.

    • Sue

      As a medical provider myself, it’s interesting to hear this point of view. Do we expect professionals in other areas to know every aspect of their area. I didn’t learn parent-craft skills medically, I learned them personally, and through the help of lactation consultants. If I was trying to help a person with breast-feeding difficulties, I would refer them to a lactation consultant, the same as I would refer to a dietitian, physiotherapist or psychologist for a range of other issues.

      I wouldn’t accept the label of ”not properly educated” because I make use of the skills of others.

      If not knowing the details of lactation advice makes a person doubt a doctor’s medical skills, and fall into the arms of woo, we all have some serious thinking to do.

      • Elaine

        I think that is the responsible approach. It’s good to know the limits of your own knowledge. There’s a difference between being approached by a patient whose baby is (say) having difficulty latching, and saying “Just use a nipple shield” or “Just switch to formula”, versus saying “I can think of one or two things you could try, but breastfeeding is not my area of expertise, so I am also going to refer you to an IBCLC to get the best assistance with this problem”. And there’s a big difference between the mindset of the providers who would take these two different approaches. The problem isn’t not knowing everything; it’s acting like you do when you don’t.

        • fiftyfifty1

          ” It’s good to know the limits of your own knowledge. ”

          …and yet YOU are certain that you know better than pediatric urologists. And that if a pediatric urologist (who has 4 years of university, followed by 4 years of medical school, followed by 5 years of urology residency, followed by a 2 year pediatric urology fellowship) retracts a foreskin to look for problems of the distal urethral course, that there could be NO possible reason on earth to do that, and it MUST have been done out of ignorance because YOU heard that an infant foreskin shouldn’t be retracted. Ha ha ha ha!

          • Lion

            Looks to me like she was saying that she thinks that is the way some people think or justify to themselves why they don’t trust doctors, not that she was saying she thinks that.

          • fiftyfifty1

            No, read her comment about the pediatric urologist upthread. She complains about a pediatric urologist not being “properly educated” because he examines under the foreskin when in her (completely uneducated) opinion, there is no reason to check under the foreskin. Elaine is a perfect example of what Dr. Amy addresses in this post, although ironically she doesn’t see it. She apparently can’t be bothered to get a real medical education but she loves to show off her “medical knowledge” here at the Skeptical OB. Too bad she has chosen a site populated by many people including statisticians, scientists, doctors, nurses and CNMs who have actually taken the time to get a real education and can see right through her attempts to impress with the pseudo-knowledge she has acquired.

          • Lion

            Here is the portion I was referring to, where she appears to be explaining the lack of logic on a crunchy mothers page, which it seems to me you have assumed is showing that this is what she believes:

            “This post brought to you by an anecdote that surfaced on one of my crunchy-mom groups, featuring a pediatric urologist who forcibly retracted a 9-month-old baby. If a PEDIATRIC UROLOGIST doesn’t know better than to do that, how on earth can a parent trust him on anything else?”
            The way I read that is that a mother did not understand that the paediatric urologist might have a greater understanding and genuine need to do something that might usually, in other circumstances not be done. That mother then says, flouncing, “if the paediatric neurologist doesn’t know that, then what else don’t they know” or words to that effect.
            Elaine was pointing that out.
            Having had you attack me because youhave misunderstood what is being said, I’m naturally concerned you’re doing this to others who post here in good faith to ask questions or just make a comment.

          • fiftyfifty1

            Disagreement is not sign of misunderstanding, but rather a sign of not agreeing. And expressing that disagreement in writing is not an attack.

            It is possible that Elaine believes the pediatric urologist was in the right, but it doesn’t seem at all likely from what she has written. If she has been misunderstood, as you assert, she can come back and correct me as well as correcting all the other commenters who interpreted what she said in the same way I did.

          • Elaine

            Where to start… I only have a few minutes. I worked yesterday and came home to discover my Internet was down, which it proceeded to be for the entire rest of the day, so I did not see this thread until now.

            I am far from an expert on infant urinary issues and I never pretended to be. The sum total of my knowledge is that 1. I shouldn’t ever retract my intact son, I should wait until he can retract himself and that 2. there are many issues that crop up that have been said in the past to be an indication for circumcision, but don’t actually have to be in MOST cases–and therefore, if I landed in a situation with urinary issues with my son, I would make sure to see a urologist who in general was biased towards keeping boys intact, rather than one who was really pro-circumcision. I can certainly understand that a medical professional might have a good reason for retracting a baby, but I think that if s/he does so, that should be articulated to the parents–in advance of doing it. That did not take place in this story, and then afterwards the urologist told the parents they needed to retract and clean under the foreskin. The mom posting did not indicate that the urologist said he knew this was unusual or indeed provided any indication that he knew that the typical rule was to not retract. And there ARE still doctors and nurses out there who genuinely think that ALL intact babies need to be retracted and cleaned every day. This is not the kind of advice that inspires parents to be confident in these providers.

            My “know the limits of your knowledge” post was in response to Sue, who talked about referring patients out from primary care when she encountered issues that were more in-depth than her training.

            And by the way, I do have a real medical education, though not in this field. I’m a pharmacist. I have great respect for the depth of education and knowledge of other providers, but it doesn’t mean I’m not wary when I see blanket recommendations that even I, who know I’m not educated in that field, know are wrong. I have personally met and talked to two nurses who did think that the foreskin needed to be retracted on all intact babies; this means that if another nurse is working on my son for some reason, I would make sure to warn her, in case she had the same gap in her education. I know some crunchy parents look at stuff like this and leap from there to distrusting the entire medical establishment, which was the point of my original post. I do not do this, but I know that medical providers aren’t perfect either.

          • Lion

            I think everyone else understood your post just fine, but thanks for clarifying. Some people have a bit of a chip on their shoulder.

          • The Bofa, Being of the Sofa

            In this sort of setting, all we have to go by is your words.

            And when someone says, ” If a PEDIATRIC UROLOGIST doesn’t know better than to do that”, which clearly implies that the pediatric urologist is unaware of the general recommendations, then that is what people will conclude.

            It’s NOT about “assumptions,” it’s a conclusion based on what is said.

          • Elaine

            Yeah, I realized my post was unclear and reading these posts prompted me to clarify my own thinking on the subject too, so I appreciated all of it. Please see my clarification of my own point as well.

          • Lion

            The line above that said it was from a crunchy mom group clarified enough.

          • fiftyfifty1

            “a medical professional might have a good reason for retracting a baby, but I think that if s/he does so, that should be articulated to the parents–in advance of doing it”
            Possibly so. Intactivism is such a hot button issue in certain social circles, that it probably is prudent for pediatric urologists to realize that strong opinions have spilled over to the point that it is considered problematic to even retract the foreskin and that to check under the foreskin might morph into a complaint on a natural parenting forum that you “forcibly retracted” their child. It is akin to what OBs have to do when they bring up the topic of inducing. They have to do a little apologetic dance to make sure they don’t offend the woman.
            What I find interesting is the bluster that NCB parents display to each other ( “My OB said WHAT!!!??” or “If a PEDIATRIC UROLOGIST doesn’t know better than to do that, how on earth can a parent trust him on anything else” ) contrasted with their apparent meakness (cowardice?) at the time of the actual visit. If they thought the doctor was so wrong, why not ask something along the lines of “Gee Doc, can you help me understand why you want us to clean under the foreskin, because both my pediatrician and baby care book recommended that I not do that.” I think the reason they don’t is that in NCB circles there are certain litmus tests. If a provider fails the test (for instance by recommending supplementation), they are deemed idiots and become characters in a “I know better than the doctor” tall tale.

          • Elaine

            I think that reaction makes sense; they’re in shock at the time. I like to think I’d respond better than splutter if someone retracted my son without so much as a by-your-leave, but I think it can be hard to muster a good response on the fly. Particularly if you’re not even entirely sure what they did was wrong–this poster’s attitude was more along the lines of “Wait, he retracted my son really hard, twice, that’s not right, is it?”

            How do you “check under the foreskin” for a young baby where the foreskin is fused to the glans and does not retract normally, unless it is by tearing those adhesions aka “forcibly retracting”? I’m genuinely curious as to why you chose the words you chose.

          • fiftyfifty1

            “that reaction makes sense; they’re in shock at the time”

            The reason that the parents are shocked is that intactivist dogma spreads the myth that foreskin must never be touched and to try to retract it will cause danger and damage. If you believe propaganda like that, of course you will be shocked. Intactivists use loaded terms like “forcibly retract” on purpose because they have a larger agenda.

            The truth is that the majority of 9 month old babies have foreskins that can be retracted without much difficulty. Cultural practices regarding foreskin care vary widely. I care for the infants of many different immigrant cultural groups. Some of them wash just the outside of the penis, while others routinely retract and clean their sons. Both methods seem to work just fine most of the time. Because it fit my style better, I mainly chose the first approach for my own offspring, but did occasionally clean underneath (after a super-poop front blowout where the foreskin had obviously trapped poop etc, or the time there was a stinky yeasty infection under the foreskin). But “NCB/Intactivist dogma will have you believe that the glans is “fused” to the foreskin until puberty and to retract must cause “tearing” of flesh. Luckily, Urologists know accurate medical information about foreskins and penises, and don’t get their education from natural parenting message boards.

    • Durango

      With medical anecdotes with partcularly shocking outcomes, I do always wonder about the accuracy of the story. Not that the teller is lying necessarily, but perhaps their recall is missing some crucial information. Maybe the pediatric urologist is a moron, or maybe in this child’s particular case retraction was a not unreasonable thing to try, I have no idea. How many birth stories have we read where the laboring mom says that the doctor yelled at her? Maybe ob’s are by nature or training people who yell a lot or maybe the patient’s recall is inaccurate or they’re exaggerating a little for effect.

      TL;DR: I don’t give a lot of weight to message board horror stories, personally.

      • Fuzzy

        I’ve “yelled”. i.e. Spoken strongly to people in an emergency. I’ve been yelled at to push because I needed to help out the forceps yanking out my otherwise dying baby. Hey guess what? People are unfocused in an emergency. You do what you have to.

        • OldTimeRN

          Right, someone needs to be the calm one and in control of the situation. I’ve seen woman screaming like crazy to get the baby out yet they aren’t helping my pushing. One they are “yelled at”, i.e. spoken to strongly with clear directions, they usually calm down enough to focus and do the job they need to do.

      • http://www.antigonos.blogspot.com/ Antigonos CNM

        Patients, and the families of patients, often–in fact, I’d say most of the time–have selective hearing. Add to that the unfortunate fact that most doctors are poor communicators [not a topic covered in med school, alas], and you get a high level of disconnect. My last job, an outpatient Women’s Clinic with a very high percentage of women with high risk pregnancies, consisted a great deal of explaining to the patients just what the doctor had just told them, or what he/she had omitted to tell them.

        Of course, it can be very difficult to give patients a well-rounded picture when the patient is either anxious, in pain, stupid, or has a 30 second attention span, which was why, when I taught “preparation for childbirth” classes back in the days when I was a Lamaze instructor, one of the sessions was devoted to “what goes wrong” as well as “what to expect in labor”. I would always stress that I’d repeat and repeat the really important stuff, but I would also mention the stuff that it was good to know but not essential to remember: “If Antigonos only mentioned it once, it’s not that vital”. It is MUCH easier to discuss why cEFM might be required BEFORE a woman is in labor, for example.

        I also used to use one session as a semi-comic “run through” of an average labor, beginning with the bad-tempered nurse [because she's just had a fight with her husband or supervisor] at the door to the labor suite, who demands “And what makes you think you’re in labor?” instead of a welcoming “Come in, we’ve been expecting you?” I have plenty of anecdotes of the sort which are pretty innocuous but often wind up, in the patient’s view, as being evidence of “bad” or “unpleasant” treatment. [like the wife who tried to hit her husband with a bedpan when he suggested that transition was "no big deal"]

        Over time — and a lot of things have changed since my early days, when shaves and enemas were still the rule, etc. –I’ve found that, when patients are given clear, basic explanations, MOST of the time they are cooperative with what I suggest. Of course, there are always some who are determined to be as hostile as possible…

        • Young CC Prof

          My allergist’s nurse puts instructions in writing after every appointment. I’ve often wondered why this isn’t standard practice. Several times I’ve had to order my medical notes, say, when switching providers, and come across clear evidence of miscommunication, something that the doctor thought he told me and I did not remember hearing.

          Telling someone something once and expecting him or her to remember every part of it just doesn’t make sense, and if the actual words are unfamiliar, expecting the patient to take notes isn’t going to work, either.

          (I remember one technical term that I wrote down and tried to look up later. I got nowhere, eventually figured out that not only had I misspelled it, MOST of the letters were wrong, including the first one!)

          • Life Tip

            I really appreciated when my son’s specialist’s nurse wrote everything down for me. When I got home after one appt, I looked at the paper and realized I had totally misunderstood a specific direction he had given me and it would have caused serious problems for my son. I’m an intelligent person and I was listening, but I was also a very stressed mother watching her son hurt. I felt awful that I had misunderstood in the first place, but was very grateful for that nurse!

          • fiftyfifty1

            ” I’ve often wondered why this isn’t standard practice.”

            Because of 2 issues: cost and complexity of the instructions.

            Allergists make more than primary care physicians, and so have more income to pay more nursing positions/hours to do things like write down instructions.

            Allergy is a very repetitious specialty. The majority of the patients all have the same problem and get the same recommendations. 90% of the patients are getting the same standard factory advice.

            Primary care is totally different. My nurse does not have the time to do even one more thing than she is doing already, and we don’t have the funds to hire any more nurses. I often end up writing it all down myself, but I can’t always write it all down. I will often address 4 very different problems at a given visit. I agree written instructions help and wish there was a viable way to ensure that for all my patients at every visit.

    • fiftyfifty1

      “Everybody knows somebody who (for instance) had a fairly minor breastfeeding problem and had a doc tell them to switch to formula”

      No actually everybody doesn’t.

      • lawyer jane

        Agreed – I hear FAR more stories about quack lactation consultants telling moms to do crazy things that ultimately end up sabotaging breastfeeding or making life much more difficult than it needs to be, like pumping around the clock or purposefully keeping your infant hungry in daycare so they will nurse more.

        • Young CC Prof

          Some LCs are indeed nuts. I don’t know how many, but it certainly seems like the nut ratio is too high for a well-controlled profession.

          As I’ve said before, though, a big part of the problem is that there just isn’t enough really solid information about breastfeeding. There’s very little genuinely scientific evidence about how to solve breastfeeding problems, but, as with every other parenting decision, there are mountains of conventional wisdom, personal anecdote, opinion, etc.

      • anion

        I always wonder how many of those “the doctor told me to just supplement! Fascist breast-hater!” was actually the doc saying, “You can give formula if you want,” or “Baby is getting pretty seriously dehydrated, so maybe we should try supplementing, and you can keep pumping/trying to nurse until your supply is up or you and Baby get the hang of it.”

        When my second was born I was in Recovery for like seven hours, and a nurse came down to ask me, very apologetically, if they could give my baby some formula because she was hungry. I said of course, but I’ve wondered since then how many mothers would see that as the hospital trying to sabotage breastfeeding or something. (We ended up nursing for seventeen months with no problems at all, despite that Evil Bottle Feeding which any NCBer will tell you would result in dangerous nipple confusion and the total failure of a baby to ever successfully breastfeed. And of course the destruction of the “virgin gut.”)

    • fiftyfifty1

      “pediatric urologist who forcibly retracted a 9-month-old baby.”

      When a baby is in the office of a pediatric urologist it is because the baby is having problems with the urinary system significant enough to require specialty care. A full exam at that point is warranted. The rule of “don’t retract” on a baby applies where everything is going along normally. But when there is a problem going on, you have to get to the bottom of it.

      These sort of anecdotes always have another side of the story. It will be like the moms on NCB boards claiming “My OB induced me at 38 weeks and kept me tied down with wires to the bed. Any idiot knows you shouldn’t induce until 39 weeks and that cEFM is not better than intermittent.” And then in some other story she admits that her baby was growth restricted and that she had hypertension.

    • theadequatemother

      I think you have to distinguish between the standard advice given to parents (don’t retract the foreskin, you don’t need to clean under it etc etc) with the special skill set of a pediatric urologist. If parents retract foreskins they have no idea how much force to use or whatever and are likely to cause inury/ inflammation…esp with repeated retractions.

      But a retraction by a pedi urologist during an exam for a problem? Totally appropriate.

      You were probably told not to scrape your teeth with sharp objects too but no objections when the dental hygienist does it right?

      What else…don’t stick anything smaller than your elbow in your ear. And yet when the family doc has a look-see with the otoscope or uses a tool to grap a piece of wax no one says they are “uneducated.”

      • An Actual Attorney

        I believe I’ve also been told not to shine a laser in my eye, but then there’s lasik surgery. Or to stick a knife in my belly, but then there’s conventional surgery. This could be fun.

        • Young CC Prof

          I’ve been told not to give my baby sweets, but the nurse gave him a live oral vaccine which was predominantly sugar.

          There are plenty of things medical professionals do in particular situations that are normally not advised.

          • Mishimoo

            Hope you read the MSDS for the dangerous sucrose component! (/sarcasm)

          • Young CC Prof

            Indeed. It causes tooth decay! (In people who have teeth, which most rotavirus vaccine candidates do not.)

    • PrimaryCareDoc

      I don’t know a single person IRL who had trouble breastfeeding who had a doc tell them to just switch to formula. And as a primary care doctor, I see A LOT of new moms. If anything, freakin’ breast is best has been so pounded into their heads by pediatricians that I have to convince them that it really is OK to supplement with formula and they are not ruining their baby for life.

    • yentavegan

      Where to begin…so much to choose from. Medical providers ,( we used to call them doctors and nurses) are by definition properly educated. If a pediatric urologist is seeing an “intact” 9 month old and retracts his foreskin that isn’t indicative of the doctors lack of knowledge
      The baby was being seen by the specialist for a reason, most likely related to the foreskin so duh…
      When mothers bring their breastfeeding issues to a pediatrician, who is after all the baby’s doctor, it makes sense that the pediatrician’s first concern is that the baby is being fed and being kept hydrated. If the doctor determines that this mother is in danger of not meeting her infants needs due to breastfeeding problems, well what would you expect the doctor to do? Ignore the nutritional needs of the patient?

      • Stacy48918

        I thought that as well – just why exactly was a 9 month old seeing a pediatric urologist???

        • Lion

          Sadly there are some commenters here who make assumptions, misread things and attack anyone who asks a question, sure that everyone is a parachuting nut job and then can’t back down when corrected.

          • Lion

            Hmmm, seems the post I wrote this in response to was deleted.

      • Elaine

        Of the responses to a breastfeeding problem that is potentially threatening the infant’s nutritional status:
        1. do nothing
        2. tell the mom to use formula
        I don’t think either is an adequate response. I would hope for something more thorough.

        If someone just gets 2. then that’s not exactly going to inspire their confidence that the provider is a good person to consult as regards breastfeeding. They may respond by trying to find other advice instead… and may end up in quack/woo territory.

        Since the original post was about what puts people at risk for quacks, my contribution is that receiving incomplete or inaccurate or *seemingly* inaccurate advice from proper medical providers is also a factor that puts people at risk for quacks. And since many of us on this board are medical providers, myself included, I think this behooves us to consider rather than dismiss. It appears I could have made my point more clearly since only some people got what I was trying to say.

        By the by, I understand why I got some of the responses I did to this, but I’m not, in fact, a parachuting nutjob steeped in woo. I didn’t return to this thread yesterday because our Internet was down when I got home from work. I’ve been reading this blog for some time (I’m pretty sure I was reading back before I was pregnant with my son, and he’s now 4 months old) and usually agree with most of it. I read some of the comments, but I don’t usually comment because I don’t usually have much to add. I don’t expect anyone to recognize my name or know me as a regular reader. But there it is.

        • Young CC Prof

          Yes, those two options are not a complete picture of good breastfeeding solutions for pediatricians.

          It also depends on how urgent the problem is. If a baby is actually dehydrated, he should be fed immediately right there in the office, with formula if necessary. Then you can talk long-term solutions. If the issue is more subtle, like sluggish weight gain, then there’s time to figure things out.

  • Sue

    The way I see it, the most vulnerable to quacks are those who want reassurance and simple answers.

    As we discussed under Amy’s previous post, we are in an era when we want doctors to be honest and act as partners in our health care decisions. At some level, though, we still seem to crave a parental, caring style that offers validation and a simple answer. But it’s not fashionable to trust The Establishment, so we want that style from (what I like to call) the New Paternalists – those who reassure us that what we feel is real, identifiable with a label and, most importantly, can be easily fixed.

    We keep forgetting that the placebo effect occurs with effective medicine too – so it is additive to real therapeutic effect. It is no longer considered ethical, though, to provide just the placebo effect, deceptively.

    Of course, therapies with effect beyond placebo also have side-effects. Don’t we all wish for a confident diagnosis and something that will fix us safely, without side-effects. See? It wasn’t just in your head!

    The skill for effective AND ethical health care providers is to recognise that all symptoms are ”real” to those who experience them, whether we can identify patho-physiological changes or not. Rather than “all in your head”, we need to communicate the fact that one’s state of mind can indeed influence physical symptoms – they are interchangeable in both directions. The best approach is to acknowledge all the mechanisms related to a person’s health and wellbeing without offering false hope or sCAM remedies.

    • Adelaide GP

      Well said Sue! This very much rings true with my experience of some patients that consult both me and the neighbouring naturopath/Chiros. I try hard to validate symptoms, especially ones that are hard to manage eg some forms of chronic pain , chronic fatigue, somatisation disorders etc. however, I feel my naturopathic “colleagues” sometimes have the edge on their trust as they give them simplistic but untrue explanations that appeal to them. (. And some of the placebos given are not harmless eg I recently had a post menopausal patient with endometrial hyperplasia due to the “bio identical” hormones ( probably a degree of unopposed oestrogen) given. ). Seeing these issues play out for the past 10 years has inspired my interest in the skeptic community ( am so glad I found this blog to read, it’s great :) )

      • Sue

        Glad you found your way here, Adelaide GP. I first found Amy’s blog when Meryl Dorey of the anti-vax AV-SN was complaining about her, which turned out to be a recommendation!

        As Amy often points out, there are many things (and people) in common between the radical anti-obstetrics HB movement, the anti-vax movement and the wackier sides of chiropractic and, of course, homeopathy. There is a certain style of ”irrational” that gets us all going!

      • araikwao

        Yup, heard of a case of that in my state too..

  • Gene
    • Young CC Prof

      I would say the comment thread on the companion article is precious:

      http://bbs.boingboing.net/t/how-to-have-an-evidence-based-pregnancy/33224/16

      Complete with the obligatory my wife almost died at HB thank god we weren’t in the hospital the doctors would have made everything worse story.

    • An Actual Attorney

      That I’m shocked (shocked!!) that a site named “boingboing” is full of copy written by hacks designed to be nothing but click-bait..

  • Guesteleh

    This.

    • Guesteleh

      Argh, I meant THIS.

      • Guesteleh

        Okay, so before no pictures posted and now they are here two times. Sigh.

        • Young CC Prof

          It’s there. Reload the page and you’ll see it.

          It does illustrate the point quite well.

  • Renee

    There are anti vaxxers that simply do not accept any proof because they think that all evidence we show them is a lie. Science is either all wrong, or just part of the evil system, or its all a big conspiracy, etc, etc, etc. They just don’t accept the same reality as we do, so its impossible to reach them.

    I have a friend like this, she even told me we were lied to and measles isn’t even bad and never kills! But vaccines are evil. To be fair, she is a schizophrenic, severe enough to be on disability, and has always heard voices and thought really out there stuff related to her disease. It just sucks because she has a 1yr old now, and she won’t get any vaccines, no EBM, and no school.

  • Renee

    A lot of the “get rich quick” scams, like the ones advertised on TV, are marketed to desperate people. I don’t think it’s so much an issue of greed, and a desire to get something for nothing, as it is hope for a better day, and the ability to change your situation.

    I know people that fell for these scams, and none are greedy. I am sure some are greedy, but IMO, the majority are just naive, and desperate. They know that riches aren’t realistic, but most hope that a meager living/stability can be made with these schemes. They really do not understand it when I tell them why it’s a scam. And wow, are they ever bummed when they find out.

    So who falls for this stuff?

    People that are socially disenfranchised, those that have never had any opportunity to earn even with hard work, and those that have no idea how others make money. They simply have no clue how those rich developers (for example) do it, so when someone says “you can too” they honestly think “maybe I can”. While short cuts are the American dream, most of these people just want a way to better their lot in life, and since the mainstream is not offering much as far as financial/class mobility goes, its easy to lure them in. Its really nasty to do this to others, IMO.

    • Kerlyssa

      Doing inhome care and seeing a woman trying to do her mother’s finances- she herself had lived a cash only existence before mom’s illness, and had no idea how to read a bill or even to differentiate between a bill, a contract, an invoice, and an advertisement. She seemed reasonably intelligent, just completely lacking in knowledge of financial matters beyond ‘pay the store money, get product’. It takes a certain amount of savvy just to be able to sort mail safely, much less spot an actual scam.

      • The Bofa, Being of the Sofa

        It takes a certain amount of savvy just to be able to sort mail safely

        No, it doesn’t. It’s really not hard. Which is why 99.9% of the population does it without problem. The problem is that in our country, 0.1% of the population constitutes a lot of people,

        But even your example, the reason it is remarkable is because it is so unusual.

        • kerlyssa

          I’d say 99.9% is stretching things- way more than .1% of the population lives without the type of fixed address/credit history that generates this type of crap. More than .1% even lack this history for exactly the same reason as the daughter did. If nothing else, young people have to learn it as they move out of their parent’s financial shadow. In any case, I was not saying that sorting mail is too hard to learn, I’m saying that the type of life experience that allows people to easily spot scams is not universal or inborn.

        • Guesteleh

          I once participated in a study of workplace literacy and at my very large corporation there were a significant number of people with a fifth grade literacy levels. So yeah, those of us who are have a high level of literacy need to understand how lucky fortunate we are.

          • Guesteleh

            Holy damn, just writing about this subject caused my literacy to drop. Sorry for the typos.

        • Trixie

          No. I used to work in banking. You’d be amazed. Our literacy rate, even for native English speakers, isn’t approaching 99.9%.
          Then you factor in old people with early stage dementia, for exa!mole.

        • An Actual Attorney

          Considering not even 80% of the US population reads at a 5th grade level, not that unusual at all, Bofa.

    • The Bofa, Being of the Sofa

      So who falls for this stuff?

      My favorite (infamous) example of a scam is the guys in Canada who were bilking money from the elderly, telling them it was some kind of retirement fund.

      They had them a) send cash b) to Canada, and (this is my favorite) c) hide the cash in the pages of magazines “so customs won’t find it.” (seriously, that is what they told their “clients.”)

      Gee, what could go wrong with that?

      I don’t like to blame the victims for this, because they really were trusting old people who thought they were getting a good deal, but the lesson to me is that it is a good illustration of the type of people who would fall for that stuff.

    • Mishimoo

      There’s also the “someone is going to make loads of money, so it may as well be me” aspect, except it never works out like that and they end up worse off than before.

      • The Bofa, Being of the Sofa

        Ha. I also think there is a lot of “that person can do it, why can’t I? I’m just as good as them. What do they have that I don’t? ”

        A complete lack of ethics, of course, but hey…

        • Mishimoo

          It makes me think of the child modelling scams too – “My child is so beautiful, and someone has to wear the clothes for advertisements. Why not my child?” and then you’re out money for the signing fee, the portfolio shots, the petrol and time to get to the casting calls, make-up, hair styling, etc

  • Therese

    Most anti-vax people seem to focus on the lack of studies with a control group that receives no vaccines. If this is what someone feels like they need to see before they can support vaxxing, then it’s not surprising to me that showing them some other information from the CDC doesn’t change their minds.

    • Medwife

      Also the parents and grandparents can not have had vaccines because “epigenetics”.

    • Who?

      I agree with this, and with Medwife’s remark. My response is that there is a load of data about people who aren’t vaxxed-let’s go to the local graveyard, or check parish or state records of who died when and of what back in the day-say before the 50′s. Compare that with who dies now, at what age and from what.

      Around here anyway there was reticulated water in the 50s, and while the cars burned leaded petrol there were many fewer of them. Whatever credibility the hygiene argument might have doesn’t stack up comparing now and the 50′s.

      Challenge is if they ‘know’ vaccines are bad, that the recent UK measles outbreak wasn’t measles at all but a similar virus, and that their appaliing child’s behaviour problems are caused by heavy metal (or whatever) then no amount of calm and reason will help.

  • Zornorph

    I always laugh at those ads that say things like ‘Language professors HATE him!’ and then show the picture of some person whose ‘secret’ trick to doing something would frustrate the ordinary teachers who would want to teach in a conventional way. Especially funny in the case I cited because the person actually was a language professor and had been honored by his peers. Which they wouldn’t have done if they had HATED him!

    • Young CC Prof

      Yeah, those crack me up. Do you have any idea how much time the average teacher spends going out and learning about new ideas and trying to make them work? Now, I do hate people who promise the impossible, demand payment in advance, and don’t deliver, but that’s another matter.

      • AmyP

        The ads on the radio for language learning programs that require no books and no memorization just kill me. Also, when they promise, “Learn a foreign language the way you learned English!” Yeah–say almost nothing for one year and then say single words for the next year and then take a third year before you can talk well enough for non-family members to be able to understand you.

        But nobody stops to ask themselves, how long does it take a baby to learn another language?

        • Young CC Prof

          Learn a foreign language by allowing a group of people to carry you around, control your every decision, and talk over your head about you in a language you don’t understand! And when you need something, your only recourse is to scream and hope that the stupid carrying people figure it out. Awesome!

          Or, you could study.

        • S

          Not quite understanding your last question? I know plenty of kids who came here at age three or four, fluent native speakers in a year or two.

          But your first paragraph cracks me up, and i totally agree, those claims make no sense. An adult brain simply isn’t wired for effortless language acquisition like a small child’s.

    • MLE

      There was one on this page yesterday that said “Librarians hate this one trick” or something to that effect. Really, librarians?

      • Young CC Prof

        Yeah, I was thinking the same thing. Why not “bookstore owners?” Or Amazon?

      • Zornorph

        Librarians hate everybody.

  • lawyer jane

    I think this gets at part of the story, but I am not convinced that self-education has no place for the lay patient and that it always indicates some kind of delusion.

    For example, my midwives wanted to delay induction for high blood pressure, and through searching PubMed I found out about the HYPITAT trial and learned that induction could have more favorable results than waiting. Medical error is also an unfortunate reality, and self-education and self-advocacy seem important there.

    And with all the problems with the pharmaceutical industry, it seems totally appropriate for patients to do their own research before taking a prescription. Eg, my doctor offered Tamiflu but I did some research and decided that the side effects were not worth shortening my symptoms for a day. At the same time, I totally trust my doctor, so if she had told me “you NEED to take Tamiful,” i would have.

    • Amy Tuteur, MD

      I’m not suggesting that you can’t aquire knowledge on the internet. My point is that you are never going to attain anything approaching expertise on whatever topic you choose to investigate. You haven’t done “research” and you are not “educated” regardless of how much you learn on the internet.

      • Trixie

        You can obtain expertise on everyday topics on the internet. I taught myself how to replace my garage door sensors just recently. You can teach yourself things about gardening, and cooking, and a myriad of household topics this way. The difference is, the stakes are much lower. If you screw up a meal or your bok choy bolts because you planted it at the wrong time, it’s mildly inconvenient, but doesn’t hurt anybody.

        This is why I think Jan Tritten should give up midwifery and stick to crowd sourcing gardening disasters.

        • Sue

          The net is ideal for those simple procedural things that don’t require a university degree to master the background knowledge.

          I recently used YouTube to revise two things I had forgotten how to do: long-division and casting-on knitting.

          • MaineJen

            I just used the internet to find out how to get Sharpie off of a tile floor (Windex! and the rough side of a sponge!)…yes, I have a 2 year old.

          • The Bofa, Being of the Sofa

            Tile floor? Try rubbing alcohol. Should work for a sharpie, without effort. Depending on the tile, finger nail polish remover would be an even better choice (be careful, though, because that can do a lot more than remove marker ink).

          • MaineJen

            We ended up not having rubbing alcohol, but I’ll bet that would have been easier :) Windex took a lot of effort (me scrubbing the floor and swearing under my breath).

      • Ainsley Nicholson

        When I look up a medical topic on the internet, my goal is to learn enough about the topic to understand what the doctor is telling me, and to be able to ask good questions.

        • Young CC Prof

          Like when the doctor says, “I’m testing you for ABC disease, come back in a couple weeks when the blood tests are done” and then has to run. I’d like to have a basic understanding of what ABC disease is BEFORE the next appointment, so we can have a more productive discussion and I’m not stuck in an emotional place during the whole (very short) appointment.

          If you’re thinking you’ll find a complete diagnosis and treatment plan on the Internet, however, you’d better think again.

        • Jessica S.

          This!!

      • Mishimoo

        I use the internet to keep up on current research from reputable sources for my joint disorder, so that I can give my GP easily accessible accurate information if/when needed because it makes my appointments more efficient and means that if I need to see a specialist, I will be able to access a referral easily.

      • Sue

        One can learn a huge amount with the insight of knowing what you don’t know. I can easily judge what medical references are reasonable because I have a background in the clinical sciences.

        If I were looking up architecture or law, however, I’d have to be much more cautious about sources and assumptions

  • The Computer Ate My Nym

    I think there’s another aspect, at least in some cases: desperation. People who have a chronic condition that is either undiagnosed or untreatable are particularly vulnerable. Think about the number of quacks who prey on cancer patients, for example. Or on people with depressive disorders with a lot of somatic features, which can be very difficult to diagnose and very difficult to accept as a diagnosis. People who feel (rightly or not) that standard medicine has failed them, who are suffering and unable to get an answer they find acceptable, are vulnerable to promises of miracle cures and secret knowledge.

    • KarenJJ

      This. It is a subset that are preyed upon and it is despicable. But it is understandable that people will try anything that appears to help or might help. Being faced with a child going deaf due to chronic inflammation I would probably be trying every woo-y anti-inflammation option available to try and help (and I see parents who don’t have a specific medication who do this – mostly diet and supplement based). We’re incredibly fortunate that in recent years a biologics medication works very effectively.

  • Busbus

    I think this is spot on. I also read that study and it left me feeling kind of deflated… But I think you really hit the nail on its head. I

    t would be great to design a study that tested your proposed solution further down in the comments – marking anti-vax as the stupid it is.

  • Young CC Prof

    This is true for a certain subset of quackery followers, the smug, arrogant graduates of Google U. There is another group, however, those who turn to it out of fear or desperation. Those who haven’t been helped by real medicine, either because their condition is truly incurable or because the doctor hasn’t found the right answer yet. People who are dying, or living with chronic pain.

    For them, it’s the promise of hope, of magic. It’s still unrealistic hope, something-for-nothing, but those people are coming from a different place and may actually benefit from a more delicate touch.

    • Guesteleh

      Thank you for saying this. My husband went through years of diarrhea and
      weight loss (was 6′ and weighed 135 pounds at one point) and none of
      the doctors he went to was able to figure out what was going on. His
      yoga instructor friend told him to go on an elimination diet. He started
      with dairy, which didn’t help. Next he went gluten-free and ta-da! His
      symptoms improved in a matter of weeks. He’s been GF for 15 years and
      gained 50 pounds. Recently, my husband met a researcher who studies
      celiac disease and told her his story. She said he had a classic
      presentation of CD but since he’s been GF for so long the only way to
      tell for sure would be for him to consumer gluten and then get a blood
      test. He declined because he doesn’t care enough about a formal
      diagnosis to put himself through a gluten challenge.

      Luckily my
      husband is a skeptic so he didn’t fall down a woo hole but I can easily
      imagine someone else in his situation becoming an alt convert. Given
      that we know celiac disease is underdiagnosed, I’m willing to bet that a
      lot of folks whose GP’s miss the diagnosis pursue alt med in
      desperation.

      • Dr Kitty

        I offer coeliac blood tests to anyone who might even remotely have coeliac.
        I hope that by doing so I prevent non coeliacs going on pointless GF diets, and the coeliacs going undiagnosed.

        What I often get is people who aren’t coeliac very disappointed that they don’t have an easy fix. Since they often have IBS, I suggest FODMAP, and that often helps, is “natural” and gets cool points for being even more complicated than GF.

        I’m hoping that by doing that the people with IBS and medically unexplained GI symptoms won’t go to the woo…

        • Mishimoo

          My woo-infected b-i-l has just been put onto the low FODMAP diet by his specialist for Crohn’s Disease. He only eats junkfood and is very frustrated to discover just how many things contain garlic and onion.

        • Jessica S.

          This is great!

        • KarenJJ

          We had a GP who, as a desperate last measure, recommended eating gluten-free foods. It made no difference to the anaemia but he suggested it might help and we should stay on it. Even doctors can feel that desperation and go for woo when trying to help the difficult to diagnose/treat patients.

          We actually got back in contact with this GP after the diagnosis (he’d since retired). He’d wondered about us and was surprised we had an answer and also astonished at what it was and how rare it was. He gave it a good shot at diagnosis and was happy to hear we were doing well. He was a good GP and one of the few that gave it a go.

        • S

          I don’t have celiac and my issues weren’t so severe, but when they got to the point where they were affecting my job, that was when i fell down the woo hole. First i went to my doctor, who did refer me to a gastroenterologist, but i felt he treated me like an attention-seeking young female (this attitude became more apparent in a later interaction). It was months before i could see the specialist, and i figured he’d think i was just crazy too. I already felt guilty for going in at all because i knew i wasn’t that sick, but i also didn’t know how i could continue working. I found an acupuncturist, who told me he could help me. He suggested i cut out wheat and dairy. I just knew he acted compassionate toward me and didn’t treat me like a pain in the ass, and that his advice helped me. (I didn’t have reliable Internet access at the time so i wasn’t doing a ton of googling.) I know now that acupuncture is fancy placebo, but it’s still hard for me to hold anything against this man for taking my money.

          • S

            Short version: I didn’t necessarily want an answer, just someone to tell me they’d try to help me. If i’d had a doctor like you, Dr. Kitty, i probably wouldn’t have gone searching.

    • Alcharisi

      Yeah, this is my suspicion as well. I agree that it’s important to differentiate between these groups–and also to remember that pain and desperation may clog the critical faculties of the most humble and thoughtful among us.
      To be honest, when I look at some of the reasoning going on in these cases (which I do for my academic work), I often find myself thinking “there but for the grace of God* go I.” I *have* fallen for quackery before, and I recognize with a deeply uncomfortable familiarity the cognitive errors anti-vaxxers, for example, make. I think this is one reason why a truly functional intellectual community is so important for everyone–it provides a mechanism to hold each of us accountable for our inevitable cognitive errors in one arena or another.
      *FTR, I mean this idiomatically and not as a theological statement.

      • Young CC Prof

        “They will believe a lie because they want to believe it’s true, or because they are afraid it might be true.” Terry Goodkind.

        The corollary is that knowing this doesn’t provide much protection.

      • Sue

        It’s also important to distinguish between the vulnerable and sometimes desperate people who are looking for help, and those who would take advantage of them and profit from that desperation.

    • Trixie

      I agree with this. I wrote elsewhere I watched someone turn to CAM because medicine had basically nothing to offer for this person’s condition. It wasn’t Dunning-Kruger, it was desperation.

    • the wingless one

      As someone who has lived with an incurable (currently anyway) chronic disease (lupus nephritis) for the past ten years I agree with this 100%. There is also the “it can’t hurt” factor with trying alternative treatments, something I’ve said to myself more than once!

      The “desperation factor” also extends to the loved ones of the person who is sick, my mother has gotten much more into “woo” and alternative medicine in general since my diagnosis because she is so desperate to find a way to make me better. I love her for it of course, but she’s often the reason I find myself saying, “Ah well, it can’t hurt,” as I try whatever new thing she’s heard about. Luckily they have all been free/cheap treatments that don’t suggest stopping conventional treatments. Except acupuncture which would have been quite expensive but somehow my insurance covered it. It also did hurt a bit but was oddly relaxing too!

  • Deena Chamlee

    People will always tell you who they are if you listen. Denial, projection , mirroring, lying, decieving abusive is the correct term to use. And harmful to others and eventually to themselves.

    This leads to manipulation of your reality through gas lighting.

    • Irène Delse

      Not really, but Australia did force Meryl Dorey’s organization to change its name so it can’t pretend to offer independent information on vaccines. They also lost their charity status, IIRC.

      • Sue

        They were directed to change their name to something that reflected their anti-vax stance, and they’ve changed to:
        “Australian Vaccination-skeptics Network” (hyphen and lower case ‘s’ so they can keep the acronym AVN). We all know, however, that they are really AV-SN and anti-vax, not just ”pro-choice”.

        Incidentally, the ex-President has recently been at a woo-fest, where she claimed (again) that the pathological changes that reflect the pattern of non-accidental injury called Shaken Baby SYndrome can be caused by vaccination. If this doesn’t make it clear how destructive these people can be, I don’t know what could be any plainer. Ugh.

  • no longer drinking the koolaid

    And when you edcuate yourself about a specific pregnancy complication you don’t trust birth and are allowing fear to influence your pregnancy and birth.

  • Deena Chamlee

    This may be true but if others self esteem is fragile and want to seem to express themselve as more knowledge than MDs, don’t you think this is mirroring or some other psych mechanism? Question is do they really care? Possibly not. So can kids be protected? Probably not but it should signal a red flag regarding the parents.

  • Amy

    This absolutely makes sense. I have an ex-friend who created for her blog the tag “doctors are morons” and spent a lot of time on social media talking about how smart she was based on her grades in non-AP high school classes. She did let the facade slip, though. I remember one time when she betrayed herself by expressing her admiration for the number of students in my AP calculus class who’d earned perfect scores on their AP exams; her high school, she said, didn’t even have that many students total, in any class, who’d done that well, never mind all in one class. It’s the same thinking behind the site “My OB said WHAT?!?” and women who spent lots of time talking about how their children’s pediatricians know less than they do about breastfeeding. (And honestly, it’s the same thinking that leads software executives to think they care more about children’s education than teachers.)

  • Amy M

    So what would be a better way to reach these people and get them to vaccinate their children? Is there a way? I mean, most of THEM are vaccinated, clearly with no ill effects, yet they are convinced their children will be harmed by the same vaccines they received.

    Also, I think there is another factor here, which is lack of trust/paranoia/fear. Of course it goes hand-in-hand with the ignorance—people fear what they don’t understand. The way they see it, there is an elite group who claim to understand this medical mumbo-jumbo and that group makes money based on their understanding. How do they know that the doctors aren’t making it all up? You can’t prove a negative, so how do they KNOW that the MMR is responsible for almost eradicating measles? To them, there’s no tangible evidence, because they can’t understand the science. So the quacks play on that fear, and explain things in simple terms that make the ignorant feel educated, and that they have the secret knowledge and we all see where that leads.

    • Amy Tuteur, MD

      I suspect that the most effective way to discourage anti-vax is to imply that it is a mark of being uneducated. That’s already happening. Mainstream media outlets like Salon, which promoted anti-vax, now insist that it is stupid not to vax.

      • Alcharisi

        Do you think that’s especially the case given the fact that a significant proportion of anti-vaxxers seem to be middle class, educated (in the sense of “having a bachelor’s degree or higher”, rather than in the sense of “actually having relevant expertise”) people for whom the implication that they ARE, in fact, uneducated in a critical arena would be a particular stigma?

        • Trixie

          Last time I was talking to an upper middle class delayed vaxxer about her 2 year old not having MMR, I reacted with shock and revulsion while backing away quickly and telling her we wouldn’t be able to have a play date after all. I’m tired of acting like this is a valid choice without social consequences. I hope she felt a glimmer of shame.

          • Amy M

            I called out an acquaintance once, about her son not having gotten the MMR. There was a mumps outbreak in her area. She was afraid that MMR vaccine would give her child a seizure disorder because someone she knows has a child who has a seizure disorder, and that child had his first seizure right after receiving the MMR vaccine. So, she wanted to get her son done with each component separately and couldn’t find a doctor to accommodate her—last I knew boy still wasn’t vaccinated.

          • Trixie

            I’m pretty sure they don’t even manufacture the MMR components separately.

          • Amy M

            Yeah, that’s probably why she couldn’t get it done, I guess. :) Of course, trying to explain that vaccines don’t cause epilepsy was a waste of time as well.

          • Alcharisi

            Didn’t a big part of Wakefield’s fraud hinge on the fact that he was trying to market a formulation where the components were separated?

          • Trixie

            Yes, it did.

          • Young CC Prof

            I think he was also paid a pile of money by some lawyers who wanted to sue vaccine makers?

          • Mishimoo

            I know they don’t, at least not here. I was immune to Rubella until some point between our two eldest kids, and discovered while pregnant with the second that I’d lost my immunity. I’ve had 3 MMR booster shots for the Rubella component, which has failed to seroconvert each time. I’m so glad that it’s rare thanks to people vaccinating, and wish more people would so that it doesn’t come back in a big way.

          • Elaine

            Unfortunately, they are more likely to just get mad at you for harshing their buzz and judging them, and go look for “moral support” online to “stay strong” in their decision not to vax.

      • Amy M

        Why did they promote anti-vax? Ugh.

        • Deena Chamlee

          Exactly probaby disordered, so is it child abuse?

          • Amy M

            What?

          • Deena Chamlee

            If their parents repond totally different than the reachers expected, suggesting it is not about education it is about comprehension due to the subjects wiring, you can not change that subset into thinking differently. AAP needs to get large and in charge and go after anti vax quacks or exploitations of vunerable adults.

      • Amy M

        So the mainstream media has to be active in this, they have to call the uneducated “stupid.” Obviously the anti-vax crew don’t listen to the doctors who say not vaccinating is stupid.

        • Medwife

          Except doctors generally do t say that. They THINK it. But they (NPs and PAs and RNs too) are limited in things that can be said. I draw the line somewhere before “stupid” and before “totally up to you, man”.

      • The Bofa, Being of the Sofa

        Recall that much of the anti-anti-vax sentiment in the media woke up after the Wakefield retraction. Basically, it took the medical community standing up and saying, “This is crap” in an official manner to get the media’s attention.

        And it really took an official move for that to happen. It’s not just good enough to say, “Doctors recommend…”

        You need to get a strong statement opposing these activities.

        I’ve often taken groups like the AAP to task for their soft response to anti-vaxxers. When uneducated folks make high profile public statements opposing things like vaccine, and especially those that suggest that doctors are somehow foolish or, worse, complicit in a conspiracy, the AAP needs to make a high profile statement going after them, and especially calling out the implicit message that underlies their statements.

        The Wakefield affair made it clear. You get far more traction by publically shunning those leaders with the bad messages, making it very obvious that the medical community does NOT accept them as just having a different view of the matter. It’s a WRONG view.

        • http://www.antigonos.blogspot.com/ Antigonos CNM

          Unfortunately, even after Wakefield was exposed, there is a considerable community who feels he was martyred because he told “the truth” and still support him.

          “Obviously” all the criticism directed against him was orchestrated by the Evil Establishment.

          • The Bofa, Being of the Sofa

            Yes, there are always crazies, but the tide absolutely turned after the Wakefield retraction. Anti-vax is far more marginalized than it used to be.

      • Jacob Wrestled (Danielle G.)

        I suspect this would help.

        The other tactic is to make it vaccinating seem as cool as possible. Do you believe in science? Can you really sort through competing claims? Well, here’s how you can make sure all your friends know how clever you are!

        Or perhaps this is friendlier: Other mothers who believe in “evidence-based medicine” and home birth / baby wear / eat organic / cloth diaper / breastfeed are vaccinating! It’s because they are so educated and caring, just like you!

        A friend posted this on FB, which embodies that approach:

        http://therivardreport.com/vaccines/

        I wonder if it will work?

    • Therese

      Usually they argue that the vaccine schedule is drastically different than the ones they received as children. Most vaccines that are currently on the schedule aren’t ones that the parents received as children.

      • Amy M

        True there are new ones, but the big bad MMR has been around for a while now.

        • Jessica S.

          I was just reading yesterday, I can’t recall where, about one of the more vocal anti-vax moms who chose not to vaccinate one of her younger kids b/c her older kid(s?) have autism. Then that unvaccinated child is diagnosed with autism. Can’t be the vaccines, so what does she say? Maybe it’s the vaccines SHE received as a child. :/

          • Amy M

            Oh good lord. No vaccine for stupid, unfortunately.

          • The Bofa, Being of the Sofa

            That’s Kim Stagliano, and you read it here.

            Her oldest two were vaccinated and autistic, so with the third, they didn’t do any. Still autistic.

            So then, yes, she switched to it being the vaccines that SHE got.

            Once you start with the premise that vaccines are bad, nothing can change that.

            I’ve said this before, in the early days, the MMR/autism connection wasn’t the craziest thing. There was a concordance between the onset of detectable symptoms and the MMR shot. Not a perfect one, but at least one worth testing.

            The problem is, it has been tested. It came up empty. Fine, on to the next hypothesis.

            But for the anti-vaxxers, the next hypothesis was, “It’s some other vaccine” or “mercury in vaccines,” etc. Which makes absolutely no sense, because, unlike MMR, there is not even a appearance of a relationship between other vaccines and autism. But with an anti-vaxxer, if MMR doesn’t cause autism, then it must be some other vaccine. And they cause everything else bad, too.

          • Jessica S.

            I thought it was something you wrote, but I second guessed myself. I should trust my brain more often. :)

            It’s sad how much energy and many resources they’ve poured into nailing vaccines as the cause. I assume there’s plenty of valid research and support services for autism that need that sort of energy and resources.

  • fiftyfifty1

    This post brought to mind Gina Crosley-Corcoran and her self-described status as a Public Health Scholar.

  • The Bofa, Being of the Sofa

    Yeah, so much for the “you would do better if you would just politely provide the information” tone-trolls.