Doctor Google

The late Steve Jobs was a visionary in many ways, and his ideas about how things should work made life more enjoyable for countless people. It is hard for his contemporaries to imagine what it would be like without Apple computers, phones, and other electronic devices. Nevertheless, the man was not perfect. His confidence that he saw things that others could not led him to be skeptical about the value of orthodox medicine. It seems to be a widespread skepticism.

But he was wrong, and after months of unsuccessfully treating his pancreatic tumor with acupuncture, herbal remedies, fruit diets, and expressing his negative feelings, he finally ac­cept­ed the need for surgery. It is quite possible that his overall prognosis worsened and his life expectancy was shortened because of this voluntary delay in surgical intervention.

Such confidence in one’s own med­ical knowledge, and belief in un­substantiated theory, is far from un­common. Just about all of us will at one time or another have encountered Steve Jobs–type skepticism about what we say and believe. It can be demoralizing to have our opinions rated on the same level as those of self-appointed Internet “experts” who have no apparent grounds for credibility, but it is a new era. Credibility is gained by having a flashy website and multiple testimonials, and even more so by an appearance on a major television talk show. Orthodox medical credentials are a peripheral consideration; it’s much more important for a medical “expert” to sound glib and confident. And glibness and confidence abound when it comes to three specific areas in medicine: chronic pain, infertility, and cancer. So it isn’t surprising that Mr Jobs, having spent so long in the company of alternative thinkers, would tend to believe (or at least give credence to) the glib and confident instead of the dull and orthodox. Lots of our patients do. And because our treatments have the capacity to be eith­er painful or unpleasant, who wouldn’t favor a confident message that changing their diet or lifestyle would cure their condition?

So should we all take lessons in sounding glib and confident to get our patients to pay attention? Not so fast. Dull and orthodox, in the long run, is the best approach. Richard Smith, former editor of the British Medical Journal, cited a number of requirements for the future of the medical profession, and prominent among these were having clear ethical values, basing what we do on evidence, and constantly trying to improve. Having clear ethical values allows patients and potential patients to decide whether they feel they can trust what we say. Making our ethical values clear is, I hope, what we do in all of our clinical activities—and if we don’t, we should. Basing what we do on evidence came slowly to my generation of practitioners. Our education was based on medical dogma, our practices were steeped in medical tradition, and it took cour­age to accept that much of what we were doing before the era of evidence-based medicine was wrong or misguided. But accept it we did, and our credibility has grown as a result.

Constantly trying to improve is a hallmark of modern orthodox medicine, and it is what distinguishes medical practitioners from the glib and confident Internet soothsayers. Barry Marshall, in trying to prove that micro­organisms, not stress, were the underlying cause of most peptic ulcers, didn’t rely on websites and celebrity endorsements. Instead, he undertook a brave experiment on himself to satisfy Koch’s postulates. That also took courage, but the postulates were satisfied, our treatments changed, and Marshall was rewarded with the No­bel Prize.

When we become sick, we all have the option of trying to be our own physician. But I think that just about all of us would choose to have faith in our dull and orthodox colleagues—because we can count on them to base what they do on evidence, and to be constantly seeking to improve. Steve Jobs was clever, but he was not the only visionary. 
—TCR