Pooping is free! Why do people pay for it?
Drove past a van on my way home today; the van advertised "Cleanse Your Colon," with a phone number under the ad. What can this tell us about our modern age?
1) Creepy people love vans.
Everyone knows that a windowless van is a crucial tool for anyone with a creepy agenda. We learned this from The Silence of the Lambs.
2) Some Americans have wacky health beliefs.
This website showed us this. All you have to do is mention one of the least controversial statements in the history of scientific research: "fluoride administration reduces cavities," and these
wing nuts appear on your blog's comments page.
3) Many people enjoy telling others what to do.
These people often find themselves in careers in health. The power in these jobs comes with a noble justification, a veneer or selflessness: Do what I say because it's good for you. You will feel better if you follow my expert advice-Ignore me at your own peril!
Back when this relationship started, the advice was terrible. People donned costumes, stoked their reputations as experts, then told people what to do. Many patients embraced this system, eager to have experts tell them what to do. Mostly they did things with dramatic although probably mostly harmful effects, such as applying leeches to skin or administering mercury in high enough doses to cause mercury poisoning. All you needed was a theory and some gravitas.
4) Some people will pay you to give them diarrhea.
Okay, I admit: The people who do colon cleansing know more about this than I do. I don't know the risks and benefits of taking mega-doses of laxatives, or about getting enemas. Help me learn! Hey, colon cleansing practitioners out there, a favor: When you comment, could you please let me know how you address the following questions:
How do you know that it provides benefit?
How do you know that it's safe?
These questions: They are among the most important topics in health care. Rephrased: Which treatments are likely to help, and which are not?
I feel sad when people with unsophisticated answers to these questions make health recommendations. Not that I should care. I can whine all day about how I spent years learning sophisticated methods of evaluating the responses to the questions above. Some of my colleagues have gone to extravagant lengths to design clinical trials designed to give the best possible information that can help people know which treatments are likely to help.
Other people seem to take a different approach, advertising van-side: "I know what's good for you! Ignore all those doctors with their fancy science and their fetish for evidence. Instead, give me cash and I'll give you diarrhea!"
This is not to say that all doctors give sound, evidence-based advice all the time. Some people who have earned medical degrees also practice without much regard for clinical evidence. Others spew misleading corporate propaganda for profit. Well-meaning, honest doctors sometimes don't know evidence that's relevant to their patients, and sometimes fail to provide optimal therapy because of this. (It's impossible to know everything, but many of us try our best.) Available evidence has flaws, too, but it has transformed hundreds of previously lethal or permanently disabling diseases into oddities; factoids that only rarely affect us. (People used to die of Lockjaw!) The majority of us, though, are trying our best to give sophisticated, evidence-based therapy, and are doing a reasonably good job most of the time.
In fact, I'm trying so hard to learn about clinical evidence that I have a favor to ask any colon-cleansing practitioners reading this: Please educate me. Show me why I'm wrong when I search the literature and conclude that you don't really know if colon cleansing treatment is better for you than avoiding colon treatments. Tell me what you know. The link to the comments section is below.
