Cult medicine vs. professional medicine

So-called alternative medicine beliefs are an interesting and perhaps inevitable phenomenon. They make use of uniquely human qualities such as our intelligence, our pattern-recognition abilities, and our tendency to over-estimate how well we understand things. Most “science”, including medicine, relies on similar human qualities, but modern science has made some improvements. Medicine used to be based on observation mixed with superstition and other non-evidence based ways of understanding the world. Many of these systems were internally consistent, but ultimately failed to accurately describe the real world.

The gradual transition of medical science (the use of evidence to evaluate medical practice) has revolutionized medicine. We no longer rely on the glorified shamanism that existed before the mid-20th century.

This also means that medicine has become a true “profession”; it isn’t something you can just “pick up”, hang out a shingle, and practice from your front room. I’ve taken to calling practices that aren’t evidence-based “cult medicine“.

This is because many of the practices have charismatic advocates who encourage followers to dedicate their beliefs and their money to non-mainstream (and ineffective) health practices. Cult medicine is full of folks who have simply decided what they think medicine should be.

Medical cults and their leaders make extensive use of denialism. They indulge in logical fallacies and “should-ism”. AIDS, the WTC attacks, the moon landings are events they have difficulty explaining, so rather than getting educated or asking an expert, they ask themselves. They develop (often) internally consistent explanations of phenomena based on their own interpretations of facts, and their own preconceptions of what “should” be true. Partly because no one believes them, they close ranks, and feel conspired against (although to be fair, that thought pattern may begin before the conspiracy theory).

The patterns seen with denialism and cult medicine are very similar. Whether it’s the CIA-Zionist conspiracy to blow up the WTC towers as causus belli, or the Big Pharma/AMA/FDA conspiracy to suppress the “truth” about vaccines, denialists “deny” reality in favor of their own paranoid, Byzantine ideas.

Cult medicine can be humorous (who doesn’t think coffee enemas are funny?) but it is dangerous. It turns people away from real medicine, and enriches all manner of cracks and cranks. And, because it is attractive, it requires constant debunking.

A recent post by Steve Novella at NeuroLogica discusses some of the logical fallacies used by cult medicine, especially the tu quoque of “not everything modern medicine does is evidence-based.” This is usually followed by the non sequitur of “therefore homeopathy (or other woo) is just as good.” It only takes a few seconds of thought to see through this argument. Modern medicine is imperfect. So is cult medicine. This doesn’t mean that they are equally imperfect. Take the following example…

Followers of cult medicine often ask us to believe in the unseen and untestable. But there reasoning is often internally consistent, that is, it follows its own sort of logic, just not one that is closely associated with the, um, facts.

Take, for instance, a Chinese acupuncture chart:


Compare it to something like, say, this:


One of these pictures, and the science it represents, is based on actual dissection, functional observation, electromyography, and, well, science.

The other has centuries of people talking to each other about meridians, and sticking needles into people with the hope of having something good happen.

One allows someone to make a prediction based on functional anatomy, perform surgery, and achieve an easily documented outcome.

One lets you stick needles into people with the hope of having something good happen.

I’m sure there will be argument about this—how acupuncture is really more complex than this, etc. But it really distills down to one being science, and one being hope. It’s just that simple.

Let’s say I have a patient with some type of neuropathy. I ask a surgeon to get me a sural nerve biopsy. Which chart represents a physical reality? Which one imagination? Which one do you want the surgeon to be familiar with? (Please, no smart-ass remarks about the sural nerve being absent from this particular drawing.)

Cult medicine is just that—an irrational belief system based on misfiring of human pattern recognition systems identifying cause and effect where none exists.

Real medicine is science.

Take the real test—who do you call when you have chest pain, the cultist or 911?


  1. Well, having had the “privilege” working on a marketing video for an alternative medicine insurance plan at least one of the acupuncturists in the video tried to use the fact that most people intuitively know better than to call an acupuncturist in an emergency to her advantage. She tried to say that “Western” medicine was **only** good for emergency medicine and that traditional Chinese medicine was for everything else, never mind that historically the average Chinese during those thousands of years of traditional medicine only lived to age 40 (or so I heard in one of the excellent Quackcast podcasts (highly recommended)).

    As to the charts, a relative’s acupuncturist/Chi Gong master told her that modern medical charts are very similar to TCM meridian charts, thus proving their validity. The concept of Chi is broad and vague, so for those who believe in Chi only the slightest resemblance between TCM charts and modern anatomical charts is seen as definitive proof.

    I think there is still hope to subtly reason with my relative with bits of information, especially bits that people can intuitively grasp, that clearly contradict the quack claims. But, she is a patient at multiple quacks–acupuncture and naturopathy and has a cognitive and emotional investment in them being true as to do otherwise would be to have to admit to being duped for years. However, trying to determine what any one naturopath believes so as to be able to falsify it is like trying to nail Jello to a wall.

    Cult Medicine is an apt term. As with all metaphors, it is not completely analogous. For instance, cults are usually provincial, whereas alternative medicine is loosely supportive of each other, the way Christians support even christians of other denominations. And while cult medicine may be a convenient term for the choir, it may be too loaded a term to use in some contexts–though perhaps its confrontational nature could be useful in and of itself.

  2. I agree that most alternative medicine is worthless and can be dangerous — but some is based on the same experimental principles that mainstream medicine has followed. Therapeutic substances derived from plants and animals are an obvious example: they were the source of most pharmacopeia before synthetic drugs.

    Today’s mainstream medicine is not as exact as it would like to appear. If a problem cannot be exactly identified, many doctors do a “statistical” diagnosis (what is most likely wrong, in order of probability). Hence such problems as antibiotics becoming ineffective due to over-prescription.

    As for PR, in this era where overspecialization makes it hard to find a good general diagnostician, alternative medicine wins adherents by appearing holistic. Tumors and viruses cannot be prayed away, but people still want to be comforted.

    Speaking as a basic research bioscientist, I concur that nothing beats observation and experimentation — and awareness that there is always more to learn.

  3. but some is based on the same experimental principles that mainstream medicine has followed.

    Speaking of science, citation for that claim, please.

    And as to your equivocation:

    A 1998 editorial in the Journal of the American Medical Association made the same point in another way:

    There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is “Eastern” or “Western,” is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. We recognize that there are vastly different types of practitioners and proponents of the various forms of alternative medicine and conventional medicine, and that there are vast differences in the skills, capabilities, and beliefs of individuals within them and the nature of their actual practices. Moreover, the economic and political forces in these fields are large and increasingly complex and have the capability for being highly contentious. Nonetheless, as believers in science and evidence, we must focus on fundamental issues — namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy [1].

    via Quackwatch

  4. Even though you wouldn’t know it from my previous comments, I think we agree on far more than we disagree on, but where is the fun in pointing out that?

    As for the disagreement, I don’t think that the concept or the understanding of medicine has changed that much over the centuries. There is more information added to our database of knowledge daily, but the same thing a doctor did 200 (or 2000) years ago is the same thing you do now. That is, you take the knowledge available to you and do the best you can with what you have. We have a better understanding of the various processes and systems of the human body, but it is far from complete. The concept of observation, experimentation and interpretation has changed little and that process of learning is what science is all about. It is now, and has always been, limited to our current understanding of the topic being studied. You can only progress so far beyond your current understanding of the topic and that assumes you didn’t take a wrong turn somewhere along the way. When doctors and scientists from 100 years from now look back on our time, I’m sure they will have the same mixture of disdain and amusement that we do looking back. We need to keep that in mind to maintain a certain amount of humility when we get to thinking we have everything figured out.

    The average person of today doesn’t understand what a doctor does to make them feel better any more than the typical native American did 500 years ago when their medicine man rubbed gook on them and made them sit in a smoke filled tent (or whatever the hell they did…). The average person groups everything they don’t understand into one big category of stuff they don’t want to look at just the same then as now. They know that there are smart people out there that know more about these subjects than they do, but they also know it is far above their capabilities of understanding.

    As for the cult quacks, I have no use for those practitioners, but as for the followers, there always has been and always will be people that are not capable of discerning truth from fiction. They are totally lost when it comes to understanding medicine, science, astronomy, where the water goes when they push that little handle down on the back of the toilet, etc. These people need religion. They need faith. Without understanding, that’s all that’s left. A doctor that is purely about science and has no religion (philosophy)is lost trying to communicate with these patients and, I would bet that subset makes up the largest demographic in your practice.

    Did Hippocrates use wine and vinegar on wound dressings because of faith or science? Did he have any understanding of the antiseptic properties? (Was he eating a salad and spill it on a cut?)

    Where am I going with all this rambling? I am a very analytical person, a scientist at heart. I like facts. My wife on the other hand runs on emotion. Facts only confuse her. That drives me insane. I would bet that, when you deal with a patient that thinks like my wife does, you see that same glazed look that I see when I try to explain why I can sit here on my couch with my laptop and post on this blog without any wires attached to the computer.

    The point is, the average person is incapable of distinguishing the gobbledygook that you are telling them from the gobbledygook that Mercola et al posts on his website. Actually, the simple (but erroneous) logic that he uses is easier to understand, so they accept it more readily. To a nonlogical thinker, facts come across as cold and uncaring, where fluff comes across as warm and fuzzy. Since they don’t understand either one, they go for the warm and fuzzy.

    Somewhere in medical school, there should be a class teaching a doctor how to communicate with patients. You have to read your audience and adjust your presentation accordingly. (If I come to see you for a serious problem and you start with the “warm and fuzzy” approach, there may be a fight. Show me the damn lab work and the xray, thank you very much…)I’m sure I’m not the first to make that observation, but the answer to the problem of “woo” and “cult medicine” is a better understanding on the side of the “good guys” of how to communicate more effectively. THAT is where the snake oil salesmen are beating you. It’s not the patient. You can’t expect someone to do something that is outside their ability to do. They are mostly incapable of understanding the concepts being presented. It is up to the doctor to give a better sales pitch.

  5. @ Bill

    I actually wasn’t sure if we disagreed much or not. Saying that “some [alternative medicine] is based on the same experimental principles that mainstream medicine has followed” is pretty open, and without a specific example it’s hard to know if I agree or disagree with you, or how much. But generally, I don’t agree with that premise, because most forms of alternative medicine actively reject “reductionism” and proper placebo controlled randomized clinical trials, saying such reductionism doesn’t apply to their “holistic” approach. And, unlike scientific medicine, alternative partitioners don’t change their therapies with new evidence–and they don’t close shop just because study after study says their treatment is no more efficacious than placebo. Scientific medicine changes with the facts, albeit slowly and imperfectly.

    Where am I going with all this rambling? I am a very analytical person, a scientist at heart. I like facts. My wife on the other hand runs on emotion. Facts only confuse her. That drives me insane.

    I am all to familiar with this dynamic :-p

    An emotion, or, perhaps, “intuitive,” person is, I think, very attracted to the emotionally and intuitively satisfying appeal of alt medicine–an appeal that is hard to counter since facts and science are not necessarily as appealing in those ways.

    Nonsense is often easier to grasp than science. Nonsense can be simple. Why do children die? “God works in mysterious ways.” How do you cure illness? “Like cures like” etc. And easily digestible nonsense is especially appealing to people with a strong intuitive sense as the simple maxims are easy to internalize, whereas science is a never ending process and nothing is ever completely certain. People like certainty, and nonsense can provide it.

    For those intuitive and emotional people, I’m not sure the term “cult medicine” will be a useful “deprograming” tool. I wish I knew what is.

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