An Erosion of Trust

IN recent years, many people have been motivated to seek nontraditional “cures” or treatments because they lost faith in traditional medicine. “Since Covid, many people lost trust in the medical establishment and agencies like the CDC,” Dr. Lightman says. “Government officials admitted that there was no scientific basis for some of the restrictions they imposed, like the six-foot social distancing. They knew nothing at the time, and they should have said as such.”

Even more galling than the health authorities who knew nothing (but pretended they did) were the elected officials who forced their constituents to observe stringent protocols and isolate but then broke those very same rules. Another rupture of trust occurred when medical authority figures turned a blind eye for pet causes — like when social distancing rules were ignored for Black Lives Matter rioters.

During those first tumultuous months of Covid, the medical establishment was scrambling to cope with a hugely dangerous pandemic amid constantly changing information. “It has been described as trying to build an airplane while flying it midair,” says Dr. Martin Bluth, director of Translational Research for the Department of Pathology, Chief of Transfusion Medicine and Blood Donor Services, and assistant director of Clinical Laboratories at Maimonides Health. “Different clinical groups appeared to contradict each other. People were suspicious of the big pharmaceutical companies trying to make billions of dollars from the crisis. They had already seenbeen told, by various individuals, of how Big Pharma make huge profits pushing medications that weren’t always best for the patient. These truths, real or perceived, created distorted perceptions among the population regarding trust in the clinical machine at the time.”

Prior to Covid, for example, the complicity of Sackler Pharmaceuticals in creating the opioid crisis was an egregious example of pharmaceutical companies placing profits before patient well-being. Similarly, cigarette companies such as Philip Morris once sponsored “research” into the link between smoking and lung cancer that distorted the truth.

Even when research is conducted with integrity, medical wisdom changes over time. Mothers were once told to lay babies on their sides, while current wisdom says to lay them on their backs. For years, doctors used leeches to treat disease, and while this type of “bleeding” was proved ineffective, today leeches   have occasionally been used again for specific conditions like blood clots and venous congestion.

The continual shifting of medical beliefs and practices leave many people skeptical, and even doctors acknowledge the limits of their knowledge. “Ninety percent of headaches and thirty percent of stomach complaints have no identifiable basis,” admits Dr. Arnold Berlin, assistant clinical professor of medicine at NYU and a family practitioner at the ODA Health Center in Williamsburg, New York. The medical field strives mightily to progress, but in many areas, their knowledge is still but the tip of the iceberg.

Years later, people are still feeling lingering resentment toward the medical establishment. Not just the anti-vaxxers, but also those who complied with vaccination recommendations. That’s because there’s been a downplaying (and sometimes outright denial) of the side effects of the Covid vaccine, coupled with a highly condescending attitude of some healthcare providers toward people who question the vaccine’s safety.

Jews can also be less trusting of official “authorities” of any kind. It’s in our blood — almost every country we’ve ever lived in has eventually turned on us. Even more fundamentally, as much as we believe in science, we know it can be flawed, and that we cannot accept scientific theories as dogma. And since we don’t see science as a sacred, all-knowing discipline, that affects our medical skepticism to a degree as well.

Another factor contributing to the erosion of trust is the endangered doctor-patient relationship. “I don’t envy you,” an elderly medical school professor told Dr. Bluth’s class, over 30 years ago. “In my day, a doctor knew the names of his patients’ children and their dog. They had time to spend with each patient. You guys will be clocked. You are entering a new world where insurance companies and hospital policies won’t allow you to do that.”

The professor’s prediction was spot-on. “Physicians today are very pressed for time,” says Dr. Bluth. “I myself recently went to an appointment where the doctor walked in and immediately said, ‘I only have ten minutes for you.’ It’s not that doctors don’t want to spend time. The economics of the system can make it difficult.”

Today’s harried physicians haven’t been trained to deal with complaints that are not pathological. And the strain on the healthcare system doesn’t always allow for the time required to investigate all of the various biological, psychological, and spiritual dimensions of a patient’s problem set. These factors can cause physicians to miss important details and the big picture of a patient’s health.

The “concierge medicine” market is, in part, a reaction to the lack of a doctor-patient relationship in many practices. “I know of doctors who don’t take insurance and charge hefty fees, but they give their patients the time they need,” says Dr. Bluth. If patients don’t find relief from traditional doctors, however, or they can’t afford “concierge” services, it may prompt them to seek alternative healers. As Dr. Berlin says, “There’s a relief in having someone tell you a diagnosis and suggest a treatment, whether or not it’s on target.”

Doctor Google

IF the ticking clock didn’t kill the relationship between doctors and patients, the Internet did. In earlier generations, doctors were venerated; patients saw them as near-infallible experts. Today’s patients, however, are likely to go home and consult Dr. Google and conceive their own ideas about their illness. The Internet makes even the average consumer feel like an expert.

But as Dr. Bluth points out, “There’s an avalanche of information available online,” and with so much information flooding into our phones and brains, we often give up trying to sort it all. Instead, we rely on the opinions of others, or trust that what little data we’ve gathered is sufficient to make a sound decision.

Unfortunately, a little knowledge is often a dangerous thing. The Dunning-Kruger Effect (identified by psychologists David Dunning and Justin Kruger in 1999), posits that people with low competence in an area nevertheless tend to overestimate their knowledge or skill. At the other end of the spectrum, those with greater competence tend to underestimate their knowledge, proof of the principle that the more you know, the more you realize how much you don’t know. But those with little knowledge are often sure they know all the facts, overestimating their own powers of deduction. “It’s just like the way every balabos is a rabbi these days,” Dr. Berlin says, chuckling.

Because of Dr. Google, patients believe they are better informed, and now see themselves as clients in the health care system rather than passive patients. Many people do not take well to doctors who seem arrogant or dismissive of their complaints. A person who shows up convinced he has Lyme disease doesn’t want to hear a doctor say, “Nonsense, your test results are fine!” dismissing his proposal of alternative treatments as blarney. He wants to be taken seriously and offered a solution even if there is no medical justification for treatment.

People today are impatient for cures. “They’re often looking for the shortcut, the quick fix,” Dr. Lightman says. In other words, if you’re experienceing infertility, magnetic realignment or crystals may appear less challenging than going through fertility treatments. “There are people with a debilitated child or a malignancy who will go to any length to improve the situation. Whatever you try, just make sure it isn’t detrimental to their short-term or long-term health,” he warns.

Dr. Berlin suggests that many people gravitate toward natural cures because they have an easier time understanding how they work (or feel that folk cures somehow require less explanation). “People want to maximize their hishtadlus,” he says. “When someone is seriously ill, they will grasp at any idea for a cure. And on the Internet, you can find support for just about any position.”

The Psychology of Gullibility

WE can all be a little gullible sometimes, a little too believing when we hear of a “miracle cure,” and there’s a real reason for that. Human beings are social animals. Within our own circles, we share views about the world and believe we can trust each other. But that trust can be exploited, because we tend not to question the opinions and directives of people we’re close to.

In fact, most people have a “positivity bias,” which causes us to assume other people are honest and genuine. Unfortunately, sometimes they aren’t. There have always been snake oil salesmen who just want to make a fast buck. In other cases, the purveyors of dubious cures may truly believe in their efficacy, even though no real proof exists.

Professor Eryn Newman, at the University of Southern California, is among the authors of The Psychology of Fake News: Accepting, Sharing, and Correcting Misinformation. She believes that our gut reactions to new information cluster around five questions: 1) Do the facts come from a credible source? 2) Do other people believe it? 3) Is there evidence to support it? 4) Is it compatible with what I already believe? And 5) Does it tell a good story?

We trust people who are familiar to us and don’t necessarily keep track of how many other people support or discount a belief. “If something feels smooth and easy to process, then our default is to expect things to be true,” Newman told a BBC reporter.

Newman has found that the medium affects the message. A slick, professional presentation of a treatment or product (think a video posted online) makes the message more believable. Even employing an easy-to-read font and speaking with good enunciation can sway people’s opinions. The more a story is repeated, increasing its familiarity, the more people are willing to believe it and resist information to the contrary.

“Confirmation bias” is the term used to indicate that we are more likely to believe less-valid information that confirms our previous opinions and reject solid information that challenges our beliefs. That might explain why it’s so easy to make fake news go viral — just think of the successful pro-Palestinian propaganda that’s spread everywhere since the war began. “You have to decide which sources you can trust as a gatekeeper. of information,” Dr. Bluth says.

We are likewise swayed by an “authority bias.” If someone we respect — a mentor (spiritual or otherwise), rav, speaker, or celebrity — says that something is effective or worked for them, we are more likely to try it. Even a single testimonial from a trusted friend or relative is enough evidence for many people. A claim could be nonsensical, but if it comes from someone you trust, “it becomes Torah miSinai,” says Dr. Bluth. “Even though you will be relying on a case study with a population of one.”

Social media also allows every new craze to spread in viral fashion. “I’m told about a lot of ‘interesting ideas’ from  mommy chats,” says Dr. Lightman’s wife, Leah, who works closely with her husband in thehis medical practice. “These young mothers rely on anecdotal ideas they get from their peers, but too often these have no substantiation.”

In his book Thinking, Fast and Slow, psychologist Daniel Kahneman explains that the brain uses two systems to process new information. “Thinking fast” means arriving at quick, intuitive, uncritical decisions, often based on others’ stories and anecdotes. This is best suited to life in a time when humans lived in small groups. “Thinking slow” requires a slow, analytical, more effortful approach that carefully evaluates incoming information. It’s a scientific approach that is critical and skeptical and is more often used by people with greater education. It’s easier to think fast, but when it comes to new or unorthodox medical treatments, we would do well to spend time thinking slow and doing the necessary research.

“First Do No Harm”  

There’s another fundamental reason that people are increasingly pursuing alternative treatments: because they sometimes work.

“Today, alternative or complementary medicine is officially recognized as a field of treatment by the medical establishment. There’s even a section on Medical Board exams about it,” Dr. Berlin says. He cites some of the more popular and accepted forms of alternative medicine: homeopathy, which fights disease by administering a miniscule concentration of a natural element; chiropractic medicine, which helps many people with musculoskeletal pain; and natural remedies and “nutraceuticals,” such as vitamins and other supplements. “These help many people,” he says. “I myself take vitamin D and fish oil.” He also mentions physical methods such as acupuncture, reflexology, and massage.

“All these forms of treatment are fine to try as long as they do no damage,” Dr. Berlin says. “A massage is very unlikely to cause harm. I’m more concerned about treatments like MDMA [“ecstasy,” effectively used in psychological trauma or PTSD therapy], which causes people to hallucinate and can potentially have long-lasting psychological effects. Then you have people who are convinced they have Lyme disease and are put on three-month intravenous antibiotic treatments when the test results do not indicate it, and that carries certain risks. There are also situations when nonproven methods inhibit the delivery of evidence-based medical care that has been proven to help.”

Historically, the movement toward seeking more “natural” treatments outside traditional (“allopathic”) medicine can be viewed as part of a more general cultural shift away from artificial substances in favor of organic, plant-based food and medicines. In the 1950s and 1960s, Americans welcomed new, “scientifically improved” products like baby formula, TV dinners, and white bread. Today most people acknowledge that Mother Nature really does know best, and have become suspicious of industrially produced food and medicines.

But it behooves patients to take a balanced approach to nontraditional medical treatments. “Some people believe all medications are not good because they’re not ‘natural,’ ” Dr. Berlin says. Yet many medications are derived from natural sources.

There are also limitations to natural treatments. For example, some people swear by diet to cure chronic diseases like Parkinson’s, MS, and diabetes. “You can enhance the immune system this way,” Dr. Lightman acknowledges. “But generally nothing is a panacea — not diet, not vitamins, not even antibiotics.”

When it comes to childbirth, many women have sought to return to natural approaches such as home births or water birthing. Dr. Lightman does not oppose these categorically. But he urges women who choose these options to give birth in a setting that provides proper backup and follow-up care for mother and baby. “There are places for water birthing that are licensed. They have ultrasound machines, use nurse-midwives, and physician backup,” he says. “Home births also must have backup and coordinated care. There are certain hospital protocols we follow, such as giving vitamin K drops to babies after birth, that should be done as well; they can be lifesaving.” (Vitamin K prevents internal bleeding that can result from the baby’s still-immature gut bacteria)

Dr. Berlin’s general approach to alternative medicine is that if something helps, then by all means do it, as long as the doctor and patient respect the foundational medical principle of, “First, do no harm.”

Risky Business

Since the days of old, people have tried to get rich on the vulnerability of patients, touting bogus products as “miracle cures.” The Internet is replete with examples of pills and products that have outrageous, unsubstantiated claims of healing. But there are some less transparent ways that manufacturers can lull people into a false sense of security.

Reena has seen many women fall into this trap. “Many patients come to our clinic after losing trust in the mainstream medical system where they felt they did not have anyone to turn to,” she says. Yet Reena has found that many of the “antiestablishment” patients she sees are more than willing to try remedies that have not been properly tested. “Many herbal remedies are billed as dietary supplements in order to avoid the need for regulation or clinical trials. As practicing Jews, we would never put something into our mouths if we didn’t know what hechsher it had and where it came from,” Reena says. “Yet we’ll blindly take an herbal remedy that someone recommended without understanding its mechanism of action, let alone want to know exactly what’s in the drug. People just check to see if it has a hechsher and that’s good enough for them to confirm it’s safe.”

People don’t think of vitamins as dangerous, but they can be more harmful than people realize. Dr. Bluth urges people who use supplements or nutraceuticals to take a close look at their composition and dosage. “Check the active ingredients and how much you’ll be consuming,” he says. “Check the type of active ingredient. Poppy seeds from Madagascar may contain a greater concentration of opioids than poppy seeds from elsewhere. Ceylon cinnamon is effective to help with glucose control, but cinnamon from other places may not be as effective. Some ingredients are labile — for example, vitamin C will denature if it’s heated.” He notes that certain vitamin and supplement chains, like GNC and Better Health, do some legwork for their clients by carrying products with better ingredients and refusing products that contain ingredients that are useless or harmful; an unlabeled “cure” received from a friend may contain toxic or damaging ingredients.

It’s not widely known that overdosing on supplements is possible. Dr. Lightman cautions that vitamins A, D, E, and K are fat-soluble, so overdoses can increase pressure in the brain. A study published this year in JAMA Network Open (Likhitsup et al., August 2024) reports that the use of some herbal and dietary supplements resulted in a substantial increase in liver toxicity cases (which can be fatal if untreated). Among the culprits were green tea extracts and curcumin (the main ingredient in turmeric, which is apparently not dangerous if used in normal quantities for cooking). The study did not capture the dosages and frequency of the botanicals assessed; it emphasized that since these supplements are not regulated by the FDA, safe dosages have not been established. Furthermore, chemical testing revealed discrepancies between what was advertised on the bottle and what was actually present in the tablet.

Let’s say that you start taking a supplement and it does help. You notice immediate results. Surely you can trust its efficacy then, right?

Not necessarily. Since there’s little to no data on some alternative medicines, it’s hard to evaluate the efficacy of them. Confusing matters more is the power of the mind to boost healing; it’s a poorly understood yet undisputably real phenomenon, and it can obfuscate our ability to identify what really helps heal us.

In medical research, the gold standard is the double-blind trial, in which some patients receive a treatment, others in the control group receive no treatment, and yet others may receive a fake treatment. The doctors administering the treatment do not know which patients belong to which group. Yet there will often be a substantial percentage of patients who improve when given the dummy treatment (otherwise known as the placebo effect). “For example, you can get results like 44 percent efficacy for the medication, and 22 percent efficacy for the placebo,” Dr. Bluth says.

The power of the placebo effect means that patients trying “quack” or nontraditional treatments may show improvement regardless of the efficacy of the treatment. They may even develop “side effects.” Dr. Berlin has seen doctors administer sugar pills for sleep disorders, telling patients to try them for a week. “They come back cured,” he says. In fact, the same dummy pill can be used to make people feel more alert or sleepy, depending on what was suggested to them. As with hypnosis, the power of suggestion can cause people to “heal” in ways they might not have been able to achieve through conscious effort.

But Dr. Berlin says that treatments that work only because of a placebo effect and/or don’t get to the root of a real physical problem have limited efficacy. “Mind over matter treatments don’t work forever when there’s a real underlying issue,” he says.

As believing Jews, we know that Hashem can do anything, and that there is more to reality than meets the eye. Dr. Lightman himself once tried a cure sourced in the Gemara for curing liver disease with pigeons, and to his surprise, it worked. But he reminds us that we are not allowed to rely on miracles, and while emunah and bitachon are important, we are also required to put in our best hishtadlus.

“You should pray, but you also have to follow the best evidence available,” Dr. Lightman says. “For example, we don’t understand SIDS [sudden infant death syndrome]. But we see that statistically it occurs less frequently to infants who are laid on their backs. Hence, we follow the evidence. And while, yes, there is a nuach from the Gemara to read if someone is choking, it’s a lot faster to do the Heimlich maneuver.”

So what ultimately makes us, as a community, vulnerable to risky alternative medicine?

Ignorance, naivete, and lack of education certainly play a role, as does the legitimate and growing distrust of the medical system. But there’s also something else that’s unique to our community: “Our hardwired desire to always do, help, and weigh in when someone needs help,” says Reena. “But sometimes stepping in or weighing in isn’t really a chesed.”

A woman once berated Reena for not racing over to help a woman who was hemorrhaging after an unattended home birth; the woman had refused Reena’s urgent directive that she be transported via ambulance to the hospital, where she could receive the care she needed. “Why won’t you do this chesed?!” the woman asked.

“Because helping out here isn’t doing a chesed,” Reena replied. “It’s irresponsible, negligent, and potentially being an accomplice.”

(Originally featured in Family First, Issue 915)