The Merchants of Magical Thinking

I don’t know what it's like to get a stage four cancer diagnosis. I wouldn’t want to pretend to speak with authority about what an emotional punch in solar plexus that must be. Still, I get angry when I read stories on the internet of people having cured themselves of metastatic cancer by doing nothing more than drinking carrot juice. The same goes for people claiming that our thoughts can cause and cure cancer. Just as I have no patience for the Christian Scientist teaching that the sick should be cared for exclusively through prayer. I have no truck with consuming carrots, positive thinking, or prayer. My objection is to the medical claims, the causal efficacy, if you will, of these activities for curing illness.

I do know a little about having a life threatening illness; and I know something about the anxiety a rotten diagnosis produces. And I can imagine why some people would prefer almost anything to chemotherapy, especially if they have already experienced how crappy it makes them feel. I can conceive of why someone might seek alternatives to conventional medical care, especially if their prognosis is poor. Still, I think that the pursuit of these alternatives is a big mistake and that to encourage people to engage in them is irresponsible.

The thought that reliance on alternatives to conventional medicine, such as drinking carrot juice, thinking positively, or praying, can cure terrible illness is an example of what I call “magical thinking.” The fundamental feature of magical thinking is the rejection of the scientific picture of how the world works. This is a picture that includes the idea that biological conditions, such as wellness and illness in organisms, are caused by other biological processes and other physical influences, such as trauma.

The scientific picture of the world bases confidence in any claim about a causal relationship between a biological condition, such as illness, and some possible influence on the existence of repeated experimentation. Biology and biochemistry are exceeding complex and much is not very well understood, so it’s possible that what looks like a relation of causation is instead some sort of statistical fluke. We can’t be certain without being able to repeat the sequence of apparent cause and effect, preferably on a large scale. Evidence-based medicine is supported through such processes of repetition and large scale study.

Magical thinking involves affirming and disseminating views that are not supported by the evidence in that way and that generally do not seem to fit very well with our current evidence of the way the world works. This makes the claims of magical thinking highly suspect.

There are two problems with encouraging magical thinking in medical care. First, it encourages false hope. It encourages someone to put their aspirations and emotional resources in the service of an effort that is so unlikely to succeed that relying on conventional medicine, even when it offers much less than one wants, would be better. And second, as I have stressed in other posts, it often involves claims about the control that individuals have over their wellness that are implicitly victim blaming.

Our world is through and through full of the results of scientific enquiry and experiment applied to the development of infrastructure, technology, medicines, and medical procedures. Most of us don’t think much about the physics involved in the engineering of bridges as we drive over them. We simply trust that the bridge will hold us. The contrary happens so rarely that is perfectly sensible not to worry about it. We trust fundamentally in the sciences and engineering to live the way we do. Just think of how different our lives would have been without the discovery of Penicillin and the subsequent development of antibiotics.

The trust we have in science and engineering should give us reason to pause when we are encouraged to forgo it by the offer of a cure that is at odds with the conventional scientific understanding of how causes work in the physical world. And magical thinking is precisely that.

Our basic trust in science is one reason to believe that magical thinking offers false hope. Another is based on economics. Think about how much cheaper it would be to treat cancer by means of carrots than chemotherapy. Prayer would be cheaper still. If these worked reliably, insurers—whether private or public—would have a very strong incentive to nudge, even shove, us all in that direction. It would be a terrible waste of their money for us to receive chemotherapy. Insurers make it their business to figure out ways to cut the costs of the services they cover. Unless you think insurers are not particularly costs conscious, the fact they do not push us to consume carrots or to pray rather than take chemotherapy should give you a compelling reason to doubt the power of carrot juice and prayer to cure cancer.

It is much more likely that someone will find a cure, manage their symptoms, or gain palliative relief if in the first instance they trust in the accumulate understanding of medical science. Such understanding is imperfect to be sure, and it will not always be able to deliver what patients want most dearly, but there is no more reliable way towards better health.

If magical thinking only encouraged false hope it would be bad enough. But it is sometimes even worse still. At least some forms of magical thinking claim that a more positive or prayerful outlook on the world can reliably prevent serious disease and cure it when it occurs. If that were the case, then everyone who happened to be seriously ill could cure themselves by developing the outlook. Those who have a grave illness would have it within their control to cure themselves. By implication, if they remain sick, then they have failed to act (think or pray) appropriately on their own behalf. That conclusion is victim blaming pure and simple. To suggest this to a terribly ill person is deeply offensive.

It’s not that I can’t understand the desperation that might lead one to explore alternatives to evidence-based medicine. I don’t fault someone their life-shaking anxiety. But anxiety makes us vulnerable to those who peddle in hope. And not all hope is well-placed. If patients are to act in their best medical interests, they should stay clear of the merchants of magical thinking. They are the problem. Sometimes magical thinking is based on ignorance; other times a cure is being sold and the profit motive corrupts. And, as for those who urge the adequacy of positive thinking or prayer to the task of curing, please just spare us the sermons according to which, by implication, we are responsible for our suffering.

Hope Kept Me Eating

Punctures and Threads