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ooking 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.

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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.

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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.

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  • Classic us versus them arguments – “My Dad is stronger than your Dad”!

    As with most arguments/debates, the truth lies not on one side or the other, but in the middle. Take “Big Pharma” for example. First it’s an incredibly simplistic, and somewhat flawed, term. To paint an entire industry with a such a simplistic broad stroke accomplishes tow things. One, in the eyes of a skeptical patient (and we should all hold healthy degrees of scepticism) it automatically discredits, partially, the physician who prescribes the drug. If you are so anti-pharma, then put the Rx pad away. Physicians want to have their cake and eat it. Pharma is evil, but we’re happy to use some, any, or all of these proven medications, because for your situation, it will help, but when push comes to shove, we’ll always say that pharma is bad. Intentionally, or unintentionally you have contributed greatly to the alt medicine beliefs by discrediting your own practices. Physicians need to step up and work with pharma companies to improve research, marketing and post marketing surveillance. If all physicians do is hurl criticism at industry, then you’re not part of the solution.

    As for herbal, natural, supplemental medicine, nothing is more preposterous than their claim that “these pills” are safe, because there are no reported side effects. I love how homeopathy and alternative medicine claims to be about patient health through exercise and lifestyle- along with OUR medicines. What a load of BS. As if a medical doctor never counselled anyone on lifestyle.

    Everything you put in your body has both an effect, and/or side effect. Can you imagine if we started labelling food with all it’s side effect. Oatmeal: may cause bloating (otherwise known as feeling full in some cases), GI distress, lack of appetite and so on. In fact, if you take nothing – there are still “side-effects”. Why are herbals and supplements seems safe? Because there is no clinical trial, or post marketing surveillance required. It’s just cause we say so. If the logical fallacy of this argument isn’t smacking you in the face, I don’t know what would.

    At the end of the day, there are benefits to MANY pharmaceuticals and there are some that have “proven” to be awful – in the long run. Why? Because science wins out. Warfarin and Aspirin would be highly unlikely to be approved by today’s standards, which shows science gets it right. Any product that is gojng to be promoted for human health need to be proven in evidence. 2, 10, 15 trials before authorization? I don’t know. Depends on how much you want that treatment to cost. After all, I don’t see the scientists working for free, and nether should they, so make up your mind. And yes,herbals and supplements need to beheld to the same standards.

    It isn’t an either or debate. There is value in prescription pharamceuticals. For every story about a horrible effect of an option, statin or anti-psychotic, I can produce an equal story of how the antipsychotic pi CD’s a person back together, how the statin reversed plaque (yes, seen through PCI I imaging) and how the person with massive pain (perceived maybe) went back to work. On an option, and did not become addicted. Equally there are stories to be told of people with the same issues, who achievedthe same result without pharmaceuticals. Wait!!! You mean they BOTH work?

    You know, we are all taught, in school, to pick a hypothesis and defend it, which is what contributes greatly to these polarized arguments. We should always consider the value of a counter point and be prepared to admit we might not knwo it all. Supplements have value to some, not all. The same for prescription pharmaceuticals. Sometimes evidenced based medicine is the right measurement tool (and should probably be the starting point for any “product”). However, evidenced based medicine is nothing without “eminence” based medicine. We will know more next year than we did this year.

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