By William M. London
Sometimes journalists focus their efforts on distinguishing fact from fiction: they carry out well-planned, well-executed, objective investigations that yield illuminating findings about important issues. But when it comes to building and keeping an audience, telling an appealing story is often more important than proceeding properly with skeptical, truth-seeking investigation. The late Don Hewitt, creator and, for more than 35 years, executive producer of the extraordinarily successful CBS Television newsmagazine program “60 Minutes,” frequently suggested that the priority for journalists is summed up by four words: tell me a story. Health-related program segments during the Don Hewitt-era of “60 Minutes” were consistently models of engaging storytelling, but many of the programs misinformed rather than enlightened viewers.
Local television news producers and reporters attempt to follow Don Hewitt’s advice when putting together reports on health topics. They try to tell stories that will get viewers to pay attention and feel good about watching the news. If the stories are heartwarming, hopeful, or awe-inspiring, viewers are likely to stay tuned, but heartwarming, hopeful, and awe-inspiring stories can be as misleading as “60 Minutes” at its worst.
On July 12, 2013, I came upon a video recording and transcript of a typical feel-good local news feature: Local doctor battles cancer through natural healing. It appeared on KGET, the NBC affiliate station in Kern County, California. Here’s the transcript (indented and italicized) with my comments interlaced:
BAKERSFIELD, CA – A local doctor is fighting a deadly cancer diagnosis through natural remedies and spiritual healing. He says he has never felt better. Dr. Boyce Dulan practiced medicine for 33 years. Twenty-two of those years he spent with the Kern County Public Health Department. Now he’s throwing his medical background out the door, focusing on natural healing to fight the battle of his life. The 72-year-old is full of life.
At this point in the video, Dr. Dulan says, “I’m feeling fantastic.” Many viewers are likely to have formed an impression at this point that “natural remedies and spiritual healing” are working effectively against Dr. Dulan’s cancer. They may not realize that a patient’s subjective appraisal of how they are feeling may not correspond with what the cancer is doing to the body. It is possible that Dr. Dulan really is feeling well at this point. It is also possible that part of his commitment to his approach to healing involves accentuating the positive aspects of his situation and disregarding the negatives. If that’s the case, it just means the negatives are not being fully presented to the viewers—perhaps because doing so would detract from the storytelling. Viewers may not realize that others who have received a diagnosis like Dr. Dulan’s, but who use no “natural remedies and spiritual healing” have been known to report at various stages feeling fantastic. Receiving a diagnosis of a deadly disease can lead some people to live more fully in the present and value the remaining time they have alive. Social support received while facing deadly disease can be enormously uplifting and produce a fantastic feeling, at least for a while.
Many viewers by this point in the story might conclude that it’s important to think of “natural remedies and spiritual healing” as advantageous alternatives when facing a dreaded diagnosis. They might even get the impression that it makes sense or that it is somehow heroic for physicians to discard their medical backgrounds. But most viewers aren’t skeptical inquirers inclined to consider questions such as:
- Is this personal story a good reason to conclude that the “remedies” actually remediate anything?
- What’s natural about them—and what isn’t?
- What does Dr. Dulan mean by healing and what makes a healing spiritual?
- Might a medical background offer insights that should not be discarded when offers of natural healing are received during a time of personal crisis?
Six weeks ago, Friday, a doctor told him he only had six weeks to live. “He said this looks bad. So I said, what are you seeing? He said well we see a mass in the tail of your pancreas with extensions into your liver and into your lungs. So you have stage 4 disseminated cancer,” said Dulan.
I have heard this kind of story many times before. And here’s what’s most striking to me: In most of these stories, it isn’t one week to live, two weeks to live, three, four, five, seven, eight, or nine weeks to live. It’s six weeks to live. And when it’s not six weeks to live, it’s usually six months to live. Perhaps there is something about the number six that gives these stories optimal narrative impact. Perhaps six is a Goldilocks number: not too little, not too big, but juuuuussssst right.
I’m tempted to jump to the conclusion that satisfied customers of promoters of pseudomedicine operate according to some kind of “law of woo” that leads them to report that a “conventional” physician gave them six weeks (or months) to live. But I’ll resist the temptation. I first noticed “six” mentioned in a supposed declaration by a physician of a patient’s remaining lifespan in 1997 when I wrote about Kathy Keeton whose efforts to find a publisher for her book Six Weeks to Live: How I Defied the Odds With a $3-a-Week Cancer Treatment ended when she died during surgery to treat complications of her metastatic disease. I hope I live long enough to write about other examples I’ve noticed since Keeton died.
Here’s the key point to remember about supposed pronouncements by physicians that particular patients have something like six weeks to live: Physicians don’t have precognitive abilities to predict absolute maximum survival limits weeks in advance and they aren’t inclined to pretend that they have such abilities. Survival times vary—sometimes greatly—for people with the same diagnosis. It’s possible that some patients who have been told estimated median survival times mistake them for maximum survival times, and then miscommunicate the statistic to others.
I find it fascinating that in many “six weeks to live” stories, patients seem to suggest that the prognostic capabilities of “conventional” physicians are infallible, yet they consider such physicians to be too conventional to be trusted for providing the best available treatment. Instead, regarding treatment recommendations, they place more trust into practitioners offering non-standard—i.e., non-validated or invalidated—treatments.
It’s important to recognize that top-notch physicians sometimes make large prognostic errors even when their estimates are usually correct. The best prognosticators providing the best interventions are fallible, but that’s not a reason to expect better or useful complementary treatment offered by medical renegades.
I doubt that Kathy Keeton was told that she had only six weeks to live when she was diagnosed with metastatic breast cancer: more than 12% of patients with metastatic breast cancer at the time of her diagnosis were expected to survive at least five years. But Six Weeks to Live is a provocative book title and “six weeks to live” is an attention-getting phrase for television. Keeton didn’t survive even three years following her diagnosis. There was nothing extraordinary about her survival time.
I also doubt that a physician told Dr. Dulan he had a maximum of only six weeks to live at the time of diagnosis. According to a 2005 clinical guidelines report on pancreatic cancer from the British Society of Gastroenterology: “Patients with metastatic disease have limited survival of 3-6 months….” (p. v10) Three to six months survival is a grim prognosis, but it does exceed Dr. Dulan’s six weeks of post-diagnosis survival at the time the news feature was taped. And one should not assume that the statement rules out the possibility of survival beyond six months.
Doctors suggested chemo, but Dulan declined after seeing his son go through it just a few years earlier.
The British Society of Gastroenterology report suggests that potential benefits of chemotherapy for patients with metastatic pancreatic cancer are improved management of symptoms and modestly prolonged survival. I can appreciate that a reasonable patient in Dr. Dulan’s shoes might not think the uncertain, though probably enhanced, potential for benefit from pancreatic cancer chemotherapy would be worth the drawbacks of treatment.
Dulan said, “I never had any question in my mind about anxiety about what would happen as a result of cancer. I’ve seen many people die from cancer, our son and so forth and so on. But it was never a question of am I going to die or not. My issue became is it death or is it healing in life?”
I’m not sure how to interpret Dr. Dulan’s statement here and I’m not sure how viewers interpreted it. The statement could have meant that since Dr. Dulan’s disease was deadly and beyond curing, he decided to focus not on dying, but on living as fully as possible until he dies. That’s a reasonable approach for a patient.
But I imagine that some viewers may have interpreted “healing in life” as something akin to reversing or slowing the course of his cancer, especially given Dr. Dulan had already mentioned that he’s feeling fantastic. Dr. Dulan may or may not have meant this. When some people refer to experiences of healing, they may not mean that they’ve experienced an objective improvement in some health condition. Instead, their idea of healing is a subjective experience of transcendence or connectedness with the cosmos—and beyond. I call this the Buzz Lightyear approach to healing.
Instead, he sought the help of a Christian medical therapist and began a daily 15 hour[sic] routine of natural treatments, spirituality and exercise.
“Fruits, grains, nuts and vegetables, that’s it. Herbal teas, just a regime and I started feeling better immediately,” said Dulan.
Dulan credits this to natural healing and his faith.
Dulan said, “If God says jump, that’s it. Other people would say you’re crazy. I’m saying no because I read my scriptures, I study the word of God, I pray, but most importantly I hear his voice within me speaking to me.”
When people truly believe in their self-care regimens—especially regimens that take up 15 hours in a day—they may find themselves concluding that their regimens promote fantastic feelings. Perhaps this is an example of what social psychologists call effort justification. I imagine that a 15-hour regimen could be an ordeal for many patients just as chemotherapy could be. It seems to me that to really justify a daily 15-hour regimen, it would need to do at least as well chemotherapy in extending survival, improving symptom control, and/or giving patients opportunities for substantive “healing in life.” Connectedness to the beyond sounds good, but it doesn’t seem an adequate substitute for minimizing pain and suffering.
I acknowledge that people who have a strong religious faith can find valuable consolation in their faith when faced with serious illness. But that doesn’t mean that others will find similar consolation from faith or that a faith-based approach to coping is likely to alter the progression of disease.
I wonder whether Dr. Dulan left out any “natural” treatments he included in his 15-hour daily regimen. Fifteen hours seems like a long time for eating, drinking, exercise, and whatever his spirituality entails. Did Dr. Dulan’s regimen include any “natural” methods that are appropriately described as unnaturalistic? It isn’t hard to find Christian medical practitioners who package quack treatments that worsen quality of life as “natural healing” techniques.
Did Dr. Dulan actually hear his god tell him to spend 15 hours per day on his regimen? Or did Dr. Dulan misinterpret what he sensed within himself? Strong faith makes it difficult to make such a distinction. But it’s a distinction that matters. Although an omnibenevolent god might not mislead people, one’s own thought processes could mislead people down all sorts of undesirable pathways. The faithful have not been shown to avert suffering with any more success than those who view faith—belief without regard to evidence and reason, or even in what is contradicted by evidence and reason—as a vice rather than as a virtue.
He says this has given him the strength to survive. “There’s a peace. That is, there’s no way to describe it. It’s like, ok great. Let’s go for it,” Dulan said.
He’s going for it, feeling better than ever.
“I’m feeling fantastic. I mean, I can’t even imagine that after such an illness and how sick I was, that God has provided an opportunity for me. I give all glory to His name,” said Dulan.
I appreciate that Dr. Dulan felt better, at least around the time of the taping, imagining God intervening on his behalf or just feeling closer to God. Many viewers of the news feature might also like to look at it that way. But it’s still important to recognize that feeling fantastic six weeks following a grim diagnosis is not sufficiently extraordinary to require divine intervention or the process of worshipping the divine as an explanation. Some terminally ill patients have periods of feeling fantastic even when they are not devoted to “natural healing” and faith.
Dulan has been doing this therapy since the beginning of the month. He hasn’t taken any prescription medications to deal with the cancer.
And thus the report ended on an optimistic note.
But perhaps viewers would have been interested in a follow-up story to see how long Dr. Dulan maintained his healing program and avoided use of prescription medication. The only follow-up story I can find from KGET is Dr. Dulan’s obituary including a photo and brief text, but no mention of the optimistic July 12th feature story. He died on September 18th at age 72. Based on the July 12th news story, we can conclude that he received his diagnosis in late May and he survived less than four months after receiving his diagnosis. That’s a less than extraordinary survival time. We can’t tell based on published information how long he felt fantastic or at peace; how much he suffered compared to most patients with his diagnosis; how long he maintained his 15-hour daily regimen, various components of it, or whether it included components not mentioned in the July 12th report; and the extent to which he wound up taking prescription medications to deal with his disease.
In other words, on July 12th, KGET gave us an engaging feel-good story suggesting a special outcome, but never gave the follow-up needed to determine whether anything medically extraordinary actually occurred. KGET offered a story of hope and comfort in the face of devastating illness; a story supportive of popular views of natural healing and faith combined with the popular, misleading narrative of a courageous maverick doctor bucking the establishment. Nevertheless, the progression of Dr. Dulan’s cancer turned out not to be unique.
Skeptical inquirers like good stories about real people just as most people do. And many of us appreciate stories of hope. But we differ in an important way from most people: Skeptical inquirers strive to avoid confusing good storytelling with accurate, non-misleading, useful reporting that helps us to distinguish important fact from insidious fiction.
So What’s the Harm?
I just spent a couple of thousand words commenting on a brief, mid-summer, soft news feature. Many people see such features as harmless fluffy exercises in inspirational infotainment. I expect that some readers will consider this long post to be overkill; they may wonder why I’m not writing instead about something more important. So let’s consider the story in terms of five categories of actual or potential harmful consequences for either Dr. Dulan or to viewers of the story. These categories are similar to categories described by William T. Jarvis:
Category 1: Direct Harm
By direct harm, I mean harm caused by toxic or traumatic effects of a health product, service, or practice that hasn’t been shown to have countervailing therapeutic value. It isn’t clear whether Dr. Dulan received any “natural” treatment with toxic effects during his 15-hour daily regimen. It isn’t clear what was left out of the description provided of the regimen. Herbal tea is included in the description, but we weren’t told what kind of herbal tea. Some herbal teas are benign, but others promoted to cancer patients, such as pau d’arco tea and Kombucha tea have caused dangerous toxic reactions. KGET News provided viewers of the July 12th story with no warning about how so-called natural treatments can be toxic. By neglecting to point out that natural doesn’t mean safe, the report served viewers poorly.
Category 2: Indirect Harm
Ineffective products, services, and practices cause indirect harm when they lead people to delay or avoid seeking science-based treatments. KGET News presented Dr. Dulan’s avoidance of prescription drugs as a viable alternative. But for how long after the broadcast was Dr. Dulan able to continue avoiding use of prescription drugs for symptom control? While there are no science-based treatments that have been shown to greatly extend survival in cases of advanced pancreatic cancer, it is a disservice to divert patients away from palliative care involving the use of prescription drugs. I’m not aware of evidence that natural therapies enhance quality of life when patients have poor prognoses. The best evidence suggests that standard treatment leads to higher quality of life scores than a popular protocol of natural treatment when patients with cancer have a projected median survival time of less than a year. Maintaining a strong commitment to avoid use of prescription drugs can be self-defeating.
Category 3: Economic Harm
Economic harm involves counterproductive uses of limited resources such as money and time. Although nothing in the regimen described by Dr. Dulan appeared to significantly drain monetary resources, it was clearly a regimen that required a large time commitment. Devoting significant amounts of time to life-enhancing and relationship-enhancing activities is a productive use of limited time resources. There was no evidence of economic harm to Dr. Dulan presented in the broadcast, but we really don’t know what his days were like. Devoting 15 hours of day to natural healing (whatever that includes) and faith could be burdensome to many people and could interfere with accomplishing other personal and family-related goals. A feel-good news feature promoting natural healing for terminal illness irresponsibly ignores the common problem of quacks convincing desperate terminally ill patients to drain their finances and raise funds to pursue natural healing. (This will be the topic of one of my upcoming blog posts.)
Category 4: Psychological Harm
I’m not sure that psychological harm is of concern for this story. Psychological harm includes the distress people experience from burdensome regimens of treatment or from discovering that they have misplaced trust in people making inflated claims for benefits of non-validated or invalidated treatments. Dr. Dulan’s regimen might not have been a burden for him, but it might be an unnecessary burden for others misled to believe that it is the best way to proceed. In recent years, some researchers have expressed doubts about the notion that providing false hope is psychologically damaging. Readers of poignant stories of people misled by faith healers told in an important book by James Randi might tend to disagree.
Category 5: Societal Harm
The issue of societal harm is especially relevant to this story because Dr. Dulan was a public health official for 22 years. Public health has been described as “the science and art of preventing disease, prolonging life and promoting health through the organized efforts of society.”
Contemporary public health practice is evidence-based rather than faith-based. It’s important for public health professionals to explain to people why testimonials tend to be misleading as evidence for the effectiveness of health products, services, and practices. However, Dr. Dulan allowed KGET to feature him as a role model for rejecting medicine and embracing wishful thinking and to cope with advanced cancer.
Society is harmed whenever faith and wishful thinking are encouraged rather than healthy, science-informed skepticism. Unfortunately, many public health professionals are oblivious to the need for organized efforts of society to mitigate the problem of promotion of non-validated and invalidated methods of health enhancement in the health marketplace. In other words, quackery is a largely neglected public health scandal. Sadly, it has become politically incorrect to even use the term quackery.
It is not unusual for public health professionals to ignore evidence-based decision-making and biological plausibility when making judgments about products, services, and practices labeled with euphemistic buzzwords such as natural, faith-based, spiritual, alternative, complementary, integrative, and holistic. I plan to present some egregious examples in future blog posts. ____________________________________________________________________________________________
William M. London is a specialist in the study of health-related superstition, pseudoscience, sensationalism, schemes, scams, frauds, deception, and misperception, who likes to use the politically incorrect word: quackery. He is a professor in the Department of Public Health at California State University, Los Angeles; a co-author of the college textbook Consumer Health: A Guide to Intelligent Decisions (ninth edition copyright 2013); the associate editor (since 2002) of Consumer Health Digest, the free weekly e-newsletter of Quackwatch; one of two North American editors of the journal Focus on Alternative and Complementary Therapies; co-host of the Quackwatch network’s Credential Watch website; a consultant to the Committee for Skeptical Inquiry. He earned his doctorate & master’s in health education, master’s in educational psychology, baccalaureate in biological science, and baccalaureate in geography at the University at Buffalo (SUNY), and his master of public health degree from Loma Linda University. He successfully completed all required coursework toward a Master of Science in Clinical Research from Charles R. Drew University of Medicine and Science, but he has taken way too much time writing up his thesis project: an investigation of therapeutic claims and modalities promoted by chiropractors in the City of Los Angeles.