March 30th, 2009
So, since we were talking about promoting a naturalistic worldview, here is a problem I had recently and am seeking your advice on.
I know someone who is seriously ill, and it is a virtual certainty that the result will be death much before his time. This is a terrible situation (obviously) and things are very hard for him and his wife these days. So recently I had dinner with this friend, and it came out that in addition to the usual medical treatments, he is having a lot of naturopathic and other sorts of woo treatments. And my friend is quite convinced that it is those latter treatments that are responsible for his recent rallying.
And this is the question: what would you have done there? I was really uncomfortable and spent a lot of time twisting my napkin around and trying to think of whether it makes me an enormous asshole if I say something about how absurd it is to credit an upswing to acupuncture. In the end I didn’t say anything like that at all, merely expressed my gladness that he is feeling better and that I hope the trend continues. But this felt very unsatisfying and also disingenuous, because I really think the woo treatments are a waste of time and money and not responsible for his improvements in any meaningful way.
Here are the factors I was considering:
1. He is getting proper medical treatment, so it’s not like the woo is replacing anything. Merely adding (so to speak).
2. I wasn’t overtly asked for my opinion, though sort of I was in that my friend spoke at length of the woo treatments he was getting and explaining how this helped him, so I was in a conversational sense expected to render a judgment (expecting agreement and encouragement, of course). Any time you are invited, overtly or covertly, to agree with someone, it is implied that disagreement is also possible. Though maybe not welcome. Am I making sense here? In other words he started it.
3. Is it wrong to take hope away? Or to challenge the basis of that hope and then maybe alienate your friend, who really doesn’t need to be fighting or losing friends at the moment?
4. How to be politely supportive without endorsing the woo? I tried to do this by focusing on his outcome rather than the process that landed him there but I don’t know if it really worked.
5. Every person has the right to do what they want with their body and spend their money on whatever they want. It’s not my job to police other people’s choices. But… do they know what the research on that stuff says? How do you inquire about this under such circumstances?
I just don’t know what to do here. I guess one factor for me is being uncomfortable with his illness – I don’t know what to say about it or how to help, and I’m nervous about voicing my opinion when it is so opposed to theirs – and amounts to a “you’re wrong.” And the placebo effect is real – who knows, maybe the woo really made some difference, at least in the short term.
As someone with strong feelings about the validity of complementary and alternative “medicine” it didn’t sit right with me to stay silent. As someone who cares about her friend and tries to understand the desperation that might lead someone to that stuff, I have a lot of compassion for them and their search for something to help. I want to be a good friend.
What would you have done?
I would have gone with the option you went with – “I’m glad that you’re doing well”. Especially given the fact that it doesn’t sound like he was planning on chucking the modern medicine in favour of the “Woo”. Or, one could always bend things a bit with a comment along the lines of “I’m glad the *enter current Woo topic here* is blending well with the medicine to leave you feeling so well.”
The tricky thing about the Placebo effect is that if you bring it up with someone, you’ve just destroyed it’s efficacy.
Being a good friend is being supportive, not trying to debunk his chosen treatments. How does he *feel*? If he’s feeling better, then why would you want to point out that any treatment he’s having (woo or otherwise) is crap? Unless you are a health care professional and have reason to believe that what he’s doing is actually *harmful*, just smile and nod, give a hug and words of encouragement. If you absolutely must, you could express your skepticism in a positive light, e.g. “really? I’ve always wondered how effective acupuncture is.”
and hoo boy, western medicine…. talk about chemical-y. ; )
I’m with you 100%, including on being unsure of what to do. I don’t think there is a right answer or a wrong answer here.
I think all I can say is to make sure to say “Just be sure not to let the ‘hopeful’ stuff keep you away from the scientific stuff, ok?” and leave it at that.
Puck — not to be argumentative (we know how BV doesn’t like that), but that sounds to me like “oh, and don’t forget, you’re gonna die”. This is *their life* — who are we to trample on their hope of recovery? When it comes time for you to be making your own medical decisions, and you sincerely believed you were making the right ones, would you want your friends to be second guessing you?
Anecdote time. When I was working at Goodyear, I developed terrible back pain. Some days, I could barely walk. I went to see a physiotherapist for treatment, and she suggested acupuncture.
I was dubious about it, but I was at the point where if you’d told me you could cure it by setting my hair on fire, I would seriously consider it.
It helped. Whether it was the placebo effect, or it actually does stimulate the release of endorphins like she told me it did, I pretty much didn’t care. And it sounds like it’s helping your friend, too. So, what’s the harm? And what would be the point of trying to convince him that it’s crap?
yes, exactly. In this case I wondered how he could possibly know that it was the CAM treatments making the difference when he was doing them at the same time as the medical treatments though.
I guess it all depends on the timeline. When did the traditional medical treatments start, when did the alternative treatments start, and when did the rallying occur?
Here’s a somewhat related Skeptoid episode:
http://skeptoid.com/episodes/4089
Here’s an article that does a good job of pointed out problems with alt-med in a way that even a believer might recognize:
http://www.quackometer.net/blog/2009/03/top-ten-tips-for-creating-your-own-new.html
That doesn’t directly help with your question about what YOU should do in this case. It’s not easy to know what’s best. I might have done what you did in that situation, but I think I might say something about how I care a lot about my friend and think unproven treatments do more harm than good.
Dr. Steven Novella has written a few posts about acupuncture:
http://www.opposingviews.com/arguments/acupuncture-lacks-a-plausible-mechanism
http://www.theness.com/neurologicablog/?p=14
http://www.theness.com/neurologicablog/?p=362
and Dr. Harriet Hall wrote a great article about this not-actually-so-ancient practice:
http://www.sciencebasedmedicine.org/?p=252
Hope some of this helps.
I caught a show on Skeptiod a while back and it may be good for you to have a listen.
http://skeptoid.com/episode_guide.php
Episode
2/26/08 Despicable Vulture Scumbags
Take care
What’s wrong with endorsing the woo?
I mean, presumably the woo isn’t going to kill them any faster. So if they are all “hopey”, I’d just nod along. I mean, I’m usually brutally honest with my closest friends, because that’s how we are. “Hey, you are getting fat!” or “Man, your girlfriend is a crazy bitch” and so on. With less close friends, I’m much more diplomatic, and willing to let a lot of things slide by. Why, because what does it matter? I mean, operating out of your particular world view, what harm does self delusion do, even if you are 100% certain that there is no merit in woo?
As a follow-up question, would you have to wrestle with a similar internal conflict if your friend said they were dealing well with their feelings of sadness because they knew they’d get to be healed and live in Heaven after they died?
So again, what’s the harm in the self-delusion of a dying man?
~I.
What’s wrong with endorsing the woo? Well, one, it doesn’t work – other than placebo, so let’s say it doesn’t work as advertised. Woo salesmen take money from desperate people without giving them anything. Except false hope, and possibly placebo… so let’s say again they don’t give what they advertise (a cure, an effective treatment). That… that is just so fucking wrong. Taking advantage of the dying is as bad as taking money from the grieving to speak to their dead loved one. It’s a lie. It’s shameless profiteering. Those people are assholes, full stop.
But! I think you were asking, what’s wrong with it from the point of view of the person – a totally different matter. And this the the crux of my problem. Is it worse to have false hope than none at all? Opinions will differ. Personally, I would rather know the facts, not waste time and money on bogus treatments, and spend that time and money with loved ones and on causes I believe in (which might just be me, but could be a charity such as a medical foundation researching the disease I have).
Sometimes woo does kill people faster (thought not in this case I don’t think) – many people forgo proper medical treatment while trying “natural” cures first, and only make it to the doctor when it’s far too late. This is another reason I think the peddlers of CAM are complete assholes. They really do hurt people. But when it is indulged in concurrent with proper medical treatment? Probably not a big deal in terms of actual harm. I guess that would depend on the nature of the treatment and how it interacted with medicine (ie, mega dose vitamin regimes might conflict with certain medications or something like that).
But, maybe self delusion is okay. The thing I worry about is that the person is sincerely hoping for improvement due to the CAM, which is definately the case in this case. It won’t happen. They are flushing their money away on a lie. If they knew it didn’t work and wanted to try anyway, I guess that’s their business, but I worry the person really believes in the good outcome. They have fallen victim to false advertising. It really pisses me off to see decent, desperate people being lied to by money grubbing assholes. If we could ensure informed consent (“There is no proof this stuff works but give us your money anyway”) then fine. Dying people don’t delude themselves – or at least not entirely. They get a big helping hand from the people taking their money.
Also there is a community aspect to this. We are all responsible to one another (or should be, if we have hearts and even a modicum of compassion). Allowing the CAM vultures to continue taking advantage of the desperate by silently standing by while it happens is perhaps a deriliction of an ethical duty, and allows it to become more entrenched, therefore better able to prey on future vulnerables.
Shouldn’t people know the truth? Shouldn’t they be free to make choices based on reality?
I wouldn’t have nearly so much internal conflict about the heaven bit. Unlike CAM, heaven is free and doesn’t get in the way of proper treatment, so I am much less bothered by it. We know that the more religious a person is, the more likely they are to go to great lengths to prevent death (requesting all the life saving measures available however invasive), so generally speaking it doesn’t mean that the sufferer will give up and die just to get to heaven. (That would be the one place I would definitely speak up.) In this case, I would likely be much more relaxed and open to stating my views if asked or “conversationally invited”. A dying person’s being religious imposes no obligation on me to lie about my atheism. As before, my concerns would be around whether the person is being taken advantage of in some way – less time alive, less money, less connection to the people they love, less autonomy.
I like this point. I think you’re saying people have the right to make their own choices, and it’s very nice to have the support of friends and family when you do it. And I think you are so right! The one area where I could see a potential problem is if the person is making poor choices and doesn’t know it. In that case I would feel a responsibility to speak up. But, if they know the all the relevant facts and want to go ahead, then as a friend in most cases the right thing to do is be a support, I would think.
Exaggerated to make the point: If someone said they wanted to try a new treatment for their disease that involves jumping off the top of a skyscraper and crashing to the ground, I would really seriously want to have a talk with them about whether they knew the relative risks and rewards of that before offering my thumbs-up. To do anything else would be irresponsible and uncaring.
But real life is seldom so clear cut, alas!
First, you’re saying that a dying person (and in this case, one who is dying well before his time) is rational and will accept logic over anything. I would counter that this is usually not the case among the dying. Consider how many people “find religion” as the end draws nearer — not logical, but they do it anyway, as a means of hope.
Secondly, I don’t think that just because your friend brought it up means that he has subtly asked you for your opinion. Maybe he was sublty asking for your support. Maybe he just likes to hear himself talk. If you can’t bring yourself to offer support, then don’t, but telling your friend that he’s done it all wrong, that there’s no way what he’s doing is going to help, and everyone knows that woo is crap is uncalled for.
Thirdly, I think it’s reasonable to expect that he has done some (and probably LOTS) of research on his disease, the various treatments, potential outcomes, what he could expect as a result of the treatments, and possibly even survival, and that he has talked to his health care provider(s) about them all at length. You ought to respect the path he’s chosen, since he probably didn’t flip a coin to make that decision.
All of this brings me to…. the issue of why you even asked this question in the first place. Your original post said you “want to be a good friend”. And as I said before, being a good friend is being supportive in this sort of situation, when death is all-but-certain, no matter which treatment he’s chosen. If this is a *very* close friend, you could sensitively broach the topic of your feelings on the woo, but if they insist that it’s helping, then you ought to back off. In my opinion, you’ve turned the idea of being a good friend into being an advocate of science and your world view. Those two things are not the same. This course of treatment is the one he has chosen, whether you like it or not, and to be a good friend is to be there for him and support him (and his partner). From what you’ve told us, no one is asking you to administer treatments you find flawed, pray for him, or whatever.
To draw an analogy, what if a friend came to you to tell you that they were homosexual? Would you support them or lecture them about how that doesn’t make scientific sense?
Well… do note that in reality all I did was say I was pleased he was doing better and then shut up. Because I am well aware that this is a complicated situation and there are probably no right answers and I did decide to err on the side of being supportive. I didn’t push any agendas and really, all I did was listen. But it did bring up some issues for me, and I got to thinking about it, so I wrote about it. I’m always interested in the thoughtful and interesting things others have to say and it helps me to bounce ideas off people. So… that’s why I blogged about it. It’s a hard situation. I don’t feel I have all the answers, ya know?
But I disagree that being a good friend means being supportive of what he does end of story. Sometimes being a good friend involves pointing out a painful truth (“Your girlfriend is cheating and I don’t know if proposing marriage right now is a good idea.”). When health is on the line, I worry that my friend has been taken in by unscrupulous salesmen. I would love to assume he did all the research and talked it over with his doctor, but I can’t know that for sure. It’s the sort of thing I might want to gently ask about – respectfully, and with concern, not out of some impulse to be right or push an agenda. Maybe something like, “what got you interested in Treatment X?” or “What did your doctor say about it?” or “What kind of outcomes can you expect with this treatment?” Something like that.
It is true my friend may not give a whit about my opinion. And really, what he does is his own business. So, maybe the very first place to start if I wanted to talk about this stuff would be to say something like, “I want you to know I really care about you and want to be a good friend to you. Are you interested in hearing my thoughts on this issue, or would it be better if I just listened?” Actually now that I write that out that seems like a darn good way to go. Gives him the choice and takes guesswork out of it. (This is why I write these kinds of things out on the blog – you really help me refine my thinking and show me new angles on a problem.
)
I’m not sure homosexuality is a good parallel because it’s not a choice a person makes – you’re just born that way, and it doesn’t hurt anyone, and whether it makes “scientific sense” is sort of irrelevant – it’s just reality. Nothing to be done about it, and even if you could, why would or should you? The reason I worry about CAM stuff is it seems fundamentally dishonest, like taking advantage of very vulnerable people, and that hurts me to see. It’s not free, to say the least. The reason scientific evidence applies in the case of CAM is that they are selling it on the grounds that it does something – cures or treats an illness. If it doesn’t do that, well, that’s a lie and theft and it’s wrong. I don’t even know how you could measure whether being gay makes scientific sense – it impedes reproduction perhaps but people are about a lot more than making babies (and homosexuals can adopt or otherwise contribute to the loving upbringing of children).
Think of it this way – what if I sold you a special hair dye that utterly failed to change your hair colour? You’d be mad at me for taking your money and failing to deliver what I promised. And you’d be right. This is what CAM does – it sells false promises. People need hope, I get that – but selling them false hope seems wrong.
But that doesn’t mean every individual is interested in or wants to know my opinion on the matter. So, on a one to one basis, asking permission before commenting may be the best policy except in cases of real danger. And using other venues (political, etc) to advance my position.
I think these are really complex issues, lots of emotional entanglement, hard to know what to do.
I just had another thought. I wonder what would happen if my friend talked a lot about his CAM treatments and I, trying to be supportive, nodded and smiled along with it… then, two months later, he asked me what I thought of it. I would have to tell the truth and say I don’t put much stock in it. I imagine he would be very embarrassed and might think I had lead him on, pretending I thought it was okay by saying nothing, when secretly I was highly skeptical.
This has got me wondering, is it deceptive to stay quiet? Could this be construed as a sort of lie? Is going along with it as a form of being supportive actually patronizing?
It probably depends on how close a friend they are.
Very good links. My jaw dropped at the quackometer article – whoa. They just nailed it.
I just can’t say enough how bloody WRONG it is to take advantage of suffering people. Aargh, it makes me all clenchy.
Something you might find interesting, in this vein:
http://science.slashdot.org/article.pl?sid=09/04/04/042214&from=rss