How the ‘alt’ is polarizing, and harming, medicine

Looking back, 2016 could be called the year of reactionary politics. Donald Trump was propelled to the presidency through widespread populism, helped by the fringe, conspiracy-theory laden alt-right community. A reactionary, antiestablishment sentiment prevails. The equally dissatisfied alt-med movement aims to have a similar disruptive effect. It certainly has some high-profile proponents: President-Elect Donald Trump has courted the community by tweeting about vaccines and autism while Jill Stein, the third-party presidential candidate and a physician, has explicitly attempted to merge alternative medicine culture with populist politics.

Alternative medicine is an innocuous, even attractive, term, framed as a healthy, natural option other than conventional medicine. What could possibly be bad about alternatives and nature?

The truth is, there’s little unconventional or natural about the factory production lines and multibillion-dollar industry behind most of the so-called alternative products used by millions of Americans.

Instead, much of alt-med is based on a deep distrust of for-profit medicine and science. Just as the alt-right community reacts broadly against the political establishment, the alt-med community seems more interested in reacting against the corporatization of medicine and nutrition and less about proposing its own reasonable, evidence-based alternatives.

Medicine is as vulnerable to populist and antiestablishment attacks as any other industry. Once defined by personal, one-on-one interactions between physicians and their patients, modern medicine is now undeniably a big-business endeavor. Mega-corporations have a growing influence in the field, providing the drugs and devices we use and conducting more and more of the clinical research that forms the foundation of modern medicine. The public is angered by the selfish way that some pharmaceutical companies behave.

But so are doctors. This shared ethical outlook should be strengthening the alliance between doctor and patient. Instead, we’re drifting apart. We need a new political movement to counteract this trend.

Alt-med attacks on doctors look similar to alt-right attacks on politicians. As a young physician, I admit that I’m idealistic about advocating publicly for patients regarding issues important to their health. I have no compunction about discouraging doctors and the media from promoting unproven alternative products.

Yet individuals like me who criticize unproven alternative health interventions are often accused of being shills for big corporations. Alt-med attacks on physicians recapitulate the tribalist left-right divide in politics by implying that doctors are either on the side of patients or they are on the side of pharmaceutical and medical device companies.

Some alt-med criticism is based in reality. Some pharmaceutical companies have skewed clinical trial results for their benefit and to the detriment of patients. Some companies have priced drugs to maximize profit rather than maximize the number of people they can help. There are bona fide cases of physician kickbacks from pharmaceutical companies. And new diseases have been invented just to sell pills rather than to address a real need. When the alt-med community discusses these problems, it isn’t wrong, though the facts are often exaggerated beyond recognition.

I and other doctors are connected to big business, whether we like it or not. You may see the pharmaceutical industry as bad, but should agree that it can make wonderful products that ease suffering and lengthen lives. I’m grateful I live in a world with antibiotics and Gleevec. Doctors are trained to put the needs of their patients first. Sometimes that means prescribing helpful drugs and, in the process, enriching large corporations. This puts doctors in a complicated position, because through our prescriptions we direct patients and insurers to flood pharmaceutical companies with billions of dollars. Yet we cannot control how that money is subsequently spent, whether on innovative research or protectionist lobbying.

You won’t see this nuance when reading popular alt-med publications. The narrative there is that pharmaceutical corporations are thoroughly evil and that physicians or scientists who endorse their products are morally equivalent to these “evil” organizations.

That’s the big lie getting between doctors and their patients. This is the conspiracy that unites alt-med with alt-right. When framed through a reactionary lens, politicians who interact with corporate leaders are automatically shills and doctors who prescribe drugs from Big Pharma are automatically corrupt. But politicians can’t ignore the importance of big business on American life and doctors won’t ever entirely divorce themselves from corporate medicine.

Doctors do, however, need to align themselves with patients and against amoral corporations as best they can. The medical profession must be vocal in criticizing the flaws of the industrial-medical complex and finding innovative ways to address the fact that we are inadvertently enriching corporations when we appropriately prescribe helpful medications to our patients. But we also need to address the unfair conflations and outright conspiracy theories that the alt-med community generates. It is harming the doctor-patient relationship and decreasing patient trust of physicians.

The distrust bred by conspiracy theories can also injure patients just as much as any disease. Vaccine-related conspiracy theories, for example, have caused a deadly polio outbreak in Pakistan.

Unfortunately, profits drive much of alt-med “fake news,” just as profitable advertising schemes back most fake news targeting the alt-right audience. When natural health publications peddle unproved therapies, that content is used to sell ads — and often their own treatments — for massive profits. Passionate advocates of alternative medicine who aren’t in it for money need to recognize that their work is also inadvertently enriching unethical corporations.

Doctors and patients need to make a new alliance beyond the usual one that takes place in medical offices and hospitals. Widespread distrust and cynicism of important public institutions such as the health care system are counter-productive. Pessimism erodes, rather than strengthens, our institutions. Doctors can’t counteract this reactionary trend by merely doing their jobs. It will require a larger social and political campaign where we listen to patient concerns about corruption and ineffectiveness then act together. Doctors and patients can and should address the unethical behavior of the medical establishment, whether it is peddling traditional remedies or alternative ones.

Benjamin Mazer, MD is a resident physician in pathology at Yale New Haven Hospital. His views are his own and do not represent those of his employer.