When it comes to our health, doing nothing is often better than doing something wrong


Natália Pasternakhttps://www.iqc.org.br/
Natalia Pasternak is a microbiologist with a PhD in bacterial genetics and a research fellow at the University of Sao Paulo. She’s founder and current president of Instituto Questão de Ciência (Question of Science Institute).

Carlos Orsihttps://www.iqc.org.br/
Carlos Orsi is a journalist and science writer who also writes mystery and science fiction. He’s currently chief editor of Revista Questão de Ciência (Question of Science magazine).

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In his now-classic 2016 book on the use of science denial as a political weapon, ‘Lies, Incorporated’, American journalist Ari Rabin-Havt stresses the role of denialism as a cue for inaction: as long as there is uncertainty, and as long as “the science is not really settled”, there is “no reason” to act against, say, climate change, second-hand smoking or – bringing the issue closer to our present day – COVID-19. After all, what do we really know about those dastardly lockdowns anyway? Wouldn’t it be wiser to let people carry on as usual until we have more information, so we don’t cripple the economy for nothing?

The answer, of course, is no – as soon as it became clear that the virus is transmitted via saliva and mucus droplets, things like masks and social distancing become no-brainers. However, as Rabin-Havt aptly shows, the main goal of the denial-monger is not to be right: what they actually want is to stop us from acting, or, more to the point, to stop the government from taking action to regulate anything. Keeping the controversy alive preserves the status-quo. Nobody wants to be unduly harsh under uncertainty. Let’s just stop and wait.

About the role of scientific denialism and even outright lying about science in the United States during the last decade, Rabin-Havt wrote in his book that “our democracy has been hacked, manipulated by political practitioners who recognise that as long as there is no truth, there can be no progress”. This equation between denial and public policy paralysis seems to hold quite well in several fields (here in Brazil, for instance, denial of rampant deforestation in the Amazon keeps the destruction going unpunished), but the current pandemic has highlighted at least one field in which denial seems to equate with calls for action: health. More precisely, the use of unproven or useless treatments for a variety of health conditions.

In Brazil, the same Federal Government that says that the data on deforestation is iffy and therefore fighting illegal logging ought not to be a priority also peddles unproven treatments like hydroxychloroquine, ivermectin against COVID-19. Further, they do so with the support of doctors who argue that these treatments are not yet completely “disproven” by research, so using them is reasonable and desirable.

In this instance, then, the denial of scientific results – the dissemination of doubt about the present scientific consensus that these drugs are not recommended for COVID-19 – is used not to paralyze the creation of public policy, but to justify the implementation of a foolhardy one.

The Brazilian government’s love affair with hydroxychloroquine has been noted all over the world, but the association between denial of evidence and action in healthcare goes beyond the present crisis. The “what’s the harm” argument so often used by proponents of alternative therapies can be construed as a form of proactive denialism.

Doctors expect – and are expected – to treat people. That means caring for them, giving advice, and of course, prescribing treatments. With time, prescribing took on more and more prominence, and so some patients came to feel cheated if they left the doctor´s office without a prescription for a pill or treatment. This over medicalisation is not exclusive to mainstream medicine, of course: it is a main component of alternative medicine, in the form of sugar pills or healing energy. But the important take-home for the patient is that the doctor / healthcare provider / psychic healer is actually ‘doing’ something.

If the doctor just sends us home, and tells us to get some rest and drink plenty of fluids, we feel frustrated… and so does the doctor. They also want to ‘do’ something. They feel powerless if they don’t. Unfortunately, this can lead us to widespread use of all sorts of useless health interventions and pills. This became clear throughout the pandemic with the hydroxychloroquine hype – doctors felt better prescribing it, just in case. They didn’t want to be held responsible for omission in case the treatment proved to work.

Surprisingly, the notion that it could harm the patient didn’t seem to cross their minds. The same happens with alternative medicine. And even when skeptics try to explain that these practices do not work, there are plenty of people to point out that even if it’s just a placebo, what’s the harm? The worst that could happen is nothing.

Sadly, that´s not true. The worst that could happen is death, and it happens more often than most people think. Several studies show that use of alternative medicines increase risks of complication and death. Edzard Ernst, in his book ‘More Harm Than Good’, states some examples: alternative medicine has the potential to actually kill diabetic patients, advice given to asthma patients by chiropractors has the potential to do serious harm, and anthroposophic doctors often advise patients not to get vaccinated, and can cause serious public health crises, such as measles outbreaks. As we are seeing right now especially, anti-vaccine advice can have serious consequences.

An assortment of blister packets containing different shaped and coloured tablets.

Studies published in JAMA Oncology also show increased risk of death for cancer patients who use alternative medicine, usually because they abandon, totally or even partially, regular treatment.

Unproven and disproven medical treatments for COVID-19 such as hydroxychloroquine, ivermectin, nitazoxanide have been widely prescribed in Brazil during the pandemic, because doctors want to prescribe something, and end up prescribing anything. And they probably truly believe that if it does not help, at least it will do no harm.

Just as in the general case of alternative medicine, it’s not true. These drugs have the potential to harm the patient directly, because of side effects, and indirectly, for creating an illusion of safety. The person is medicated, and feels safe to meet with family, forgets about masking and other preventive measures.

All in all, being proactive can be a good thing. But doing nothing is better than doing something stupid. It’s even an old trope in medical wisdom: first of all, do no harm. That’s the real “traditional knowledge” we need right now.

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