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The Empowering of Alternative Medicine in Portugal

João Madruga Dias

February 14, 2017

I am a young medical doctor, a rheumatologist, from Portugal. I have been interested in science since I can remember. Entering medical school in Portugal is hard; you have to be one of the top students in the country. Then you have six years of medical school, one year of general practice, and four to six years of specialty training. I am now working as a rheumatologist in public and private practice, and I belong to the Board of Rheumatology of the Portuguese Medical Association. I also represent Portugal (Rheumatology Division) at the European Union of Medical Specialists (UEMS), and I am a co-opted member of the Standing Committee on Education and Training of the European League Against Rheumatism (EULAR).

In Portugal, as is probably the case on the rest of the planet, there is a serious lack of scientific knowledge by the general public and many politicians. The public is bombarded with a specter that goes from fraud to infotainment and a confusing mixture of quasi-scientific studies whose purpose is no different from click-bait ads. Real scientific breakthroughs are levelled in traditional and social media as being as important as these click-baits, while increasing importance is given to the personas and not the ideas. If scientists had the money to buy super sports cars and started dating celebrities as routine, maybe in the swampy gossip some science would be delivered Trojan Horse–like to the unwary public. On a more serious note, at the decision-making level I would dare say some mistake economic interests for science, while others deliberately use confusing scientific jargon to create pseudoscience to suit a political need. Like Carl Sagan, I also consider living in a science-driven technological world filled with scientific illiteracy is dangerous and the best path toward disaster.

Returning to my small (yet quite illustrious) country: in recent years, there has been a fairly strong movement promoting the so-called “alternative medicine.” This is not something associated with one specific social or political party or the current or past governments but a trend that has been growing in strength and influence across society, motivated by alternative practice interests. These interests include endorsing alternative medicine practitioners and recognizing them as valid health practitioners, approval of alternative “treatments” to be used on patients (without scientific testing), and the perennially present economic backstage. Lobbying and political contacts not only allowed alternative medicine practitioners recognition by the Portuguese Health Ministry and other health authorities, but even tax exemptions similar to doctors. Yes, an appointment by a specialist doctor will have the same tax exemption as a “fully qualified” homoeopath. Patients can deduct both appointments in their own taxes as if no differences exist in principle, training, requirements, and outcomes. I will be blunt: most, if not all, of these “alternative” treatments are nothing more than quackery. Most have no scientific evidence. The results of the few serious randomized controlled trials prove them identical to placebo, and yet this magical thinking is damaging real medicine, real doctors, and especially real patients

My area of expertise is especially prone to these magical thoughts. Until fifty years ago, the word rheumatism defined what are now over 150 different rheumatic diseases. Although we have state-of-the-art treatments with immunotherapy and expensive biotechnological drugs, the truth is the etiopathology of most conditions still eludes us. We are proven wrong, we change ideas about diseases and treatments, and we make mistakes. We don't know everything, nor we claim to, but what we do know is due to science. And we have learned a lot in recent years, with more accurate diagnosis, better follow-up, and being able to offer live-changing treatments to patients.

It's very hard to debate with most of these “alternative medicine” practitioners, as many fail to understand that science is not a belief or faith (like theirs), it's a system of proof. If science proves me wrong, I am compelled to change my thoughts. I would love if new ideas, refreshing new concepts, and treatments would arise from alternative medicine. The fantasy of a common substance, mysterious unknown energy source, or even some exotic unheard-of plant being the cure to some of the most unfortunate diseases that affect humankind is shared by doctors and alternative practitioners alike. Unfortunately, I am also aware that you have to prove, and for that you have to use science. I keep wondering if in the midst of hundreds of sham treatments and diagnostic methods and procedures used by alternative practitioners, something real and useful is lying dormant because no one looked at it through skeptical lenses or tested it through the scientific method.

Sometimes I think all this is like trying to explain what an immunoglobulin is to someone who refuses to believe bacteria exist and considers microscopes an illusion. Where do you start? Of course, some people in the “alternative medicine” community try to learn science, and some use it. I even know some alternative medicine practitioners who are highly critical of their own community, devoted to learn medicine in a scientific way. But what do you do when the principia behind your practice are simply wrong, while you are being validated by a health authority? Shouldn’t health authorities be entirely science-driven?

The so called post-truth politics, as coined by David Roberts in his blog, is the trendy Orwellian speak of the decade. In this environment that censors truth to favor political bias, science is welcomed with a yellow smile. It looks good to be “scientific” on the photo, but only if it helps your agenda. From black holes to viruses, the universe is “shockingly” indifferent to this. Our future as a species, however, is dependent on how we face the truth using the proper tools (science) and how we apply them to the best of our knowledge toward the common good. If we, based on social pressure and obscure interests, demolish the barriers (and how thin they are sometimes) between science and quackery, truth loses meaning, and progress is seriously impaired. Even worse, we will harm those in need with a grim conviction validated by our own deluded peers.

I have to say most of the medical community is worried about this issue, and most of my colleagues are appalled by what is happening. We’re in the twenty-first century watching health authorities approving what was already quackery in the nineteenth century! Unlike the “alternative medicine” proponents, who thrive on lobbying action and protest, bannering deceptive slogans of free choice and practitioner recognition, doctors tend to educate. And health education is a hard, laborious, and often frustrating task. Quoting Russel: “The whole problem with the world is that fools and fanatics are always so certain of themselves and wiser people so full of doubts.” I don't pretend to be wise; I don't wish to call others fools; and I don’t think this is the whole problem with the planet, but Russel has a point. It’s time for doctors to openly expose and fight the usage of pseudoscience in healthcare.