Missing Serious Symptoms

Ominous signs and symptoms of serious disease are often overlooked, misinterpreted, and minimized by many overconfident and under-trained “professionals” in complementary and alternative medicine (CAM). Most naturopaths, chiropractors, acupuncturists and massage therapists are blinkered by bad ideas and pet theories to some degree, but some are openly contemptuous of medical knowledge and expertise and will actually challenge the correct diagnosis.1

Meanwhile, the patient’s disease develops while it might be treated — or at least not mis-treated. Missing a serious diagnosis has an extremely high “opportunity cost”2 — distraction from appropriate medical diagnosis and treatment.

Alternative treatment gets the headlines, but alternative diagnosis is the deepeer problem

Controversies about appropriate treatment are conspicuous. There’s a lot of human drama involved in treating deadly diseases, which often involve impossible dilemmas and ethical puzzles with no right answer. The film Dallas Buyers Club explores an excellent example. And it’s always big news when celebrities make tough treatment choices: Steve Jobs initially treating his cancer with diet, or Angelina removing her breasts to prevent cancer.

But their eyes were wide open.

There is much less drama involved in diagnostic quackery and failure. Failed CAM diagnosis — wrong or missing — is almost never a story. It’s less newsworthy, because no one’s really all that surprised when CAM blows a diagnosis. And so the problem is constantly overlooked and underestimated. And the only thing worse than ineffective treatment for dire health problems is to be deprived of good diagnosis in the first place. Patients may make poor choices even when they know exactly what they’re dealing with, but they’re doomed to it when the diagnosis is wrong or completely missing. The consequences are the most tragic when minor problems are missed until they become serious.

When all you have is a (plastic) hammer: ignorance and incompetence in CAM

Diagnostic failure in CAM is mostly caused by ignorance and incompetence. But ignorance is never just an absence of knowledge: it usually involves bad ideas drowning out better ones. The biggest major factor in missing diagnoses is the preoccupation with pet theories and pseudoscientific ideas, which run the gamut from weak pet theories to militant ideology and zealotry. If someone actually believes that people can have an “allergy” to electromagnetic radiation,3 then it’s all too easy to favour that diagnosis over legitimate ones. Even mainstream physical therapy is cluttered with amazingly dubious ideas.4

But it gets worse! Haughty disdain for “mainstream” medicine is common in CAM. Many practitioners are much more alternative than they are complementary: not just dismissive but contemptuous of medical knowledge and opinion, extremely uncomplimentary complementary medicine. As a result, many militantly dismiss important precepts of scientific medicine — anti-vaxxers and germ theory denialist are excellent examples of the extremes. Germ theory denialists are as nuts as flat earthers, and just as bizarrely common. But it takes much less to seriously warp clinical reasoning skills and sabotage diagnosis.

But doctors misdiagnose all the time!

Sometimes CAM gets it right when doctors don’t, especially in musculoskeletal medicine, an area where medical incompetence is a bit glaring.5 One of the best diagnosis stories in my files is about a chiropractor who caught a spinal cord tumour that had been missed by physicians for years.

Good diagnosis is hard. The TV show House, M.D. was unrealistic in many ways, but it effectively dramatized just how difficult it can be to figure out what’s wrong with people.

Of course, physicians don’t know everything either and also have bad ideas and make mistakes — nobody’s perfect (see Medical Errors in Perspective). However, the chances of a doctor missing a scary diagnosis are much lower, especially because they have much more experience with much sicker people (see Chiropractor, Naturopath Training Way Less Than Doctors). When they do, that is a story.6

In any event, the failures of CAM are never excused by the failings of medicine: see the tu quoque fallacy.

About Paul Ingraham

I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter., or subscribe:

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Related Reading

• Alternative Medicine’s Choice — What should alternative medicine be the alternative to? The alternative to cold and impersonal medicine? Or the alternative to science and reason?
• Reviews of Pain Professions — An opinionated guide to the most popular sources of professional help for injuries and chronic pain
• Quackery Red Flags — Beware the 3 D’s of quackery: Dubious, Dangerous and Distracting treatments for aches and pains (or anything else)
• Why “Science”-Based Instead of “Evidence”-Based? — The rationale for making medicine based more on science and not just evidence… which is kinda weird
• Pseudo-Quackery in Physical Therapy — The large, dangerous grey zone between evidence-based care and overt quackery in rehab and pain treatments

Notes

1. These are sweeping statements about alternative medicine, a complex opinion that needs support, but impossible to support with a few simple references. However, there are a great many independent, unrelated sources that converge on my conclusion. I have written dozens of relevant articles that zoom in on sub-topics, like the concept of “subluxation” which the chiropractic profession relies on so heavily. Another good example: there are about a dozen major myths about massage therapy, and collectively they indicate a profession that is “blinkered by bad ideas.” And there are rotten conceptual paradigms like structuralism that permeate all of medicine, mainstream and alternative alike, but which reach some of their most absurd extremes in CAM clinics. And so on and on.
2. “Opportunity cost.” Wikipedia.org. Accessed 2021-01-23. “In microeconomic theory, the opportunity cost, or alternative cost, of making a particular choice is the value of the most valuable choice out of those that were not taken. In other words, opportunity that will require sacrifices.” Opportunity cost is regarded by anti-quackery activists as the main non-obvious reason why alternative medicine is not “harmless.”
3. Electrosensitivity is an alleged allergy to electromagnetic fields and radiation. It is the basis for irrational paranoia about the health effects of Wi-Fi networks, power lines, and cell phones. There’s little doubt that the afflicted are suffering from something, but it’s either an unrelated medical condition and/or psychosomatic. Electrosensitivity has been thoroughly debunked. No one with an actual energy allergy would last a day anywhere in the modern world: they’d vanish in a poof of oversensitive smoke, moths flying into a bonfire. Fear of EMF causing cancer is related, but the epidemiological data shows that the risk is either nil or less than other risks we accept without drama. See Electromagnetic Sensitivity Absurdity: Chronic pain is sometimes blamed on electrosensitivity — an imaginary, debunked allergy to energy.
4. Pseudo-quackery is quackery that passes for good medicine despite strong evidence that it doesn’t work. Unfortunately, not all quackery is obvious — not even to skeptics. “Pseudo-quackery” appears to be mainstream, advanced, technological, “science-y,” or otherwise legit — quackery without any sign of being way out in left field. It has enough superficial plausibility to persist in the absence of evidence against it. This subtler type of snake oil is a more serious problem in musculoskeletal health care, because it hides right in the mainstream. For instance, it’s nearly synonymous with the early history of physical therapy, and remains alarmingly prevalent in that profession. So pseudo-quackery is extremely common, and generates more false hopes and wasted time, energy, money, and harm than more overt quackery, which is relatively marginalized. See Pseudo-Quackery in Physical Therapy: The large, dangerous grey zone between evidence-based care and overt quackery in rehab and pain treatments.
5. Most doctors lack the skills and knowledge needed to care for common aches, pains, and injury problems, especially the chronic cases, which they tend to underestimate the complexity of. This has been shown by many studies, like Stockard et al., who found that 82% of medical graduates “failed to demonstrate basic competency in musculoskeletal medicine.” It’s just not their thing, and people with puzzling or stubborn pain should take their family doctor’s advice with a large grain of salt, and even lower their expectations of specialists (who tend to be too specialized). See The Medical Blind Spot for Aches, Pains & Injuries: Most physicians are unqualified to care for many common pain and injury problems, especially the more stubborn and tricky ones.
6. For instance: back pain is rarely as dangerous as it feels, except when it is. The BBC on singer Talia Dean’s greatly delayed diagnosis of inflammatory back pain, a type of back pain that can cause severe disability: “Talia Dean: ‘My back pain was misdiagnosed for 15 years — now I can’t dance’.”

   “You just make all these excuses, you know the whole world has a back ache, so I didn’t really think anything of it.” ~@taliadean