"If it Sounds Like a Quack"-new book by journalist Matt Holgotz-Hetling

Many thanks to Matt Holgotz-Hetling for joining me on this episode of The Art of Medicine with Dr. Andrew Wilner! Matt is a journalist and author of "If it Sounds Like a Quack…" His prior book, "A Libertarian Walks into a Bear," received 4.5 stars on Amazon and more than 1,000 reviews.

During COVID, Matt took an interest in two conflicting forces he observed in American society. On the one hand, public health officials were trying to protect the public by recommending masks and closing schools. On the other hand, many independent-minded Americans insisted on making their own decisions, often eschewing masks and social distancing. 

Matt was intrigued by fringe practitioners offering cures for COVID, which included baking soda, bleach, lasers, and leeches. Many alternative medicine practitioners had faith in their "One True Cure." Of course, it was difficult to eliminate greed and exploitation as supporting motivations.

Matt and I had an in-depth conversation for nearly an hour! It was a treat to speak with such an informed and thoughtful author.

Matt's newest book, "The Ghost Lab," should be available shortly. You can find all of Matt's books on Amazon.

To learn more, please check out Matt's website:

https://www.matt-hongoltzhetling.com

#concussion #CTE #traumatic brain injury #TBI

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Transcript

[Andrew Wilner, MD] (0:08 - 1:41)

Welcome to the Art of Medicine, the program that explores the arts, business, and clinical aspects of the practice of medicine. I'm your host, Dr. Andrew Wilner. Today, I'm pleased to welcome Matt Hongoltz-Hetling.

Matt is a journalist and the author of the new book, If It Sounds Like a Quack. In this book, Matt highlights the lucrative field of pseudoscience and pseudo-cures that is perplexingly pervasive in American culture. I learned about Matt from a recent op-ed piece he wrote in the New York Times.

He discusses the ironically named medical freedom movement, and that really caught my eye. I've read Matt's book, and I'm eager to chat with him. If you're interested in U.S. health policy, please listen in. You won't be disappointed. But first, a word from our sponsor, locumstory.com. Locumstory.com is a free, unbiased educational resource about locum tenens. It's not an agency. Locumstory answers your questions on their website, podcast, webinars, videos, and they even have a Locums 101 crash course. Learn about locums and get insights from real-life physicians, PAs, and NPs at locumstory.com.

Now to my guest. Welcome, Matt Hongoltz-Hetling.

[Matt Holgotz-Hetling] (1:41 - 1:44)

Thank you very much for having me on, Dr. Wilner.

[Andrew Wilner, MD] (1:44 - 2:57)

It's an absolute pleasure and honor to speak with you. Yeah, Matt, I'm thrilled. I found out about you in the New York Times.

I read the article. I said, boy, this guy, he's thoughtful, and he wrote something interesting, and I'd love to talk to him. So I tracked you down, and you responded.

So there you are. It's amazing. So I got you now.

For those of you watching YouTube, you'll see that Matt is in his usual office there. It looks like maybe a two-door, a four-door sedan, but not moving. So it will be safe to carry out the interview.

So first, Matt, journalism. I worked 10 years as a full-time medical journalist. I went primarily to medical conferences to see what was new, breaking news, new discoveries, and interviewed the authors, often colleagues of mine, and made a full-time job out of it.

And then I went back into clinical practice. So I'm very partial to journalists. Tell me a little bit about your typical day.

[Matt Holgotz-Hetling] (2:59 - 5:04)

Yeah, absolutely. And first, let me just say about your history in medical journalism, which I did not know about, the fact that you had sort of like the degree and the journalistic credentials going for you at the same time must have given you just sort of like a really unique and superior window into that work. And one of the problems that I sort of highlighted in this book and elsewhere is sort of the inability of those who make the science in medical fields and in other fields to control the interpretation of that science.

So often, we see sort of like sensationalized news or news that is presented with sort of like an agenda, whether that's medical bias within a news agency or from just an out-and-out agenda-driven organization trying to report on the science of what is really underlying our medical evidence-based treatment system. And so hats off to you for doing that. My typical day is actually, you know, to answer your question, my typical day is spent parenting.

My wife and I, we tried for about 10 years to have children unsuccessfully. Finally, thanks to the miracle of medical science, we were able to conceive through IVF, not once but twice. And now I have two young children at home.

I have a fantastic three-year-old boy named Karen, like the bird, and a nine-month-old daughter named Idrit, like the other bird. And the three of us spend a lot of time together. And so there are days when I'm able to actually devote my time to my writing career, and this is one of them.

So I was really sort of overjoyed that we could connect and I could get out of that, you know, screen-feeding headspace for a little while and come talk with an adult.

[Andrew Wilner, MD] (5:05 - 5:17)

Well, it's my pleasure. So I guess your day varies. Now, are you out and about most of the time, or are you like researching things on the internet, or are you going out to interview people?

[Matt Holgotz-Hetling] (5:18 - 6:34)

When I'm doing my journalism work, they're really sort of almost like seasons that are associated with the production of a book. So early in the process, I am sort of doing a lot of online research, but more importantly, I'm out there talking to those first-person, collecting those interviews that are sort of like the blood and bones of any good book, right? So I'm out calling, in this case, a lot of fringe practitioners who have come into some sort of a conflict with the medical establishment, and I'm talking to experts in the medical establishment.

I'm really just sort of trying to fumble my way through what is at first a very sort of strange terrain, and then as I get more familiar and comfortable with it, I'm able to sort of hone my focus and zero in on those topics. And once I get to that stage, then I'm really spending much more time writing and doing sort of like online research or making phone calls to the sort of plug holes that I've identified in my worldview and knowledge. And then at the end, it's just all writing, which is sort of when it's quietest and in some ways the nicest, because then I'm really able to sort of hone my own writing into something that I can be proud of.

[Andrew Wilner, MD] (6:36 - 7:09)

Yeah, so I think that's something people don't realize about writing. They say, well, we're going to write. You just sit down and write.

But actually, a lot of the writing is done before the writing begins. And I find that very hard because I'm anxious to start writing, but you can't write really until you know what you're going to at least have a clue, what you're going to say, and that requires collecting a lot of information, which is not an efficient process usually. Yeah, my process is actually less efficient than most, I think.

[Matt Holgotz-Hetling] (7:10 - 7:28)

I tend to collect far more information than will actually appear in the book and go down a lot of sort of false rabbit holes before I start to find my footing. And that's got some upsides, but the downside is that it's very time costly.

[Andrew Wilner, MD] (7:29 - 10:42)

Yes. You know, I want to go back to what you were talking about way, way at the beginning, is that I noticed that what you said is exactly true. When I worked as a medical journalist, and I was often in those days, this was pre-Zoom and sort of everybody was on site.

I would go to the press room, excuse me, and I would go to the press room and there'd be, you know, 50 or another hundred journalists in the press room. And I would ask questions, you know, and journalists are trained to ask, well, what did you do? And why did you do it?

And how did you do it? And when did, you know, the sort of four or five W questions. But I found that I could read between the lines.

And so I could ask kind of, you know, deeper, more insightful questions like, well, why didn't you do, you know, X? And that an untrained, a non-medical journalist might not be able to ask. And I think it really is, and this is sort of leading into your book, that it really is important for the communication of information to kind of everybody be on the same page, if you will, you know, for the doctor who may or may not be a great communicator to be talking to a journalist who actually understands what he's talking about, who can then translate it into a way without another agenda.

You know, and I'll give you a great example, a recent example that has nothing to do with medicine. I, from my other channel, Underwater with Dr. Andrew, I do a lot of scuba diving, and most of that diving is in the Philippines. And one of the unusual aspects of diving in the Philippines is that dangerous shark encounters are extremely rare.

I don't know if the sharks in the Philippines are just very well behaved, but it just doesn't happen. You just never see a shark incident, you know, unlike Florida or Australia, some other places. And there was a recent report of two divers who went missing, and then they found one that had been bitten by a shark, and he was dead.

But the headline was shark attack in the Philippines, or something like that. But that wasn't the story at all. What had probably happened, and this was what I explained to my wife just from what I read, and sure enough, there was a news article that followed up a few days later with the same sort of theory, is that this diver, both divers had died and were out of air, and had gotten swept up in some currents, and really weren't familiar with the terrain.

And the shark probably had sort of chomped on this guy after he was dead, is the most likely scenario. But the headline was shark attack, and it's sort of not untrue, right? The shark did attack, but the guy was already dead.

So I just thought that was like a glaring example of how the facts can be true, but distorted. And, you know, as a journalist, I'm sure you appreciate that.

[Matt Holgotz-Hetling] (10:43 - 13:44)

Yeah, I mean, science, and medical science in particular, is in a sort of really unusual place in history, where, you know, the first scientists, you know, we're talking like right around the age of reason, they were doing their work for patrons, right? And so they were sort of beholden to the interests of the folks who had the first strains. And only after, you know, more than hundreds of years later, did they really sort of like achieve that place inside institutions, where they could practice their craft of science objectively, right?

Only when there were, you know, public universities and research institutions that had capital, but they had results that were largely divorced from the capital, or from where those funding sources came from, like say the taxpayer, which allowed them to be very, very objective. But that also puts them in a position of, um, that same separation allows for the public to start to mistrust the results of that science. I don't know, the average person in the public probably doesn't even know a scientist.

And when they try to read the science directly, the field has become so jargon laden, that they can find it impenetrable. And there is sort of like a real cultural difference between the scientist and the lay member of the public. And all of those factors sort of make it a field that's ripe for misinformation of the type that you just described, which is probably more or less innocuous, you know, shark attack, I want to get some clicks.

But also, you know, to these sort of special interest groups that go after that messaging. In the 1900s, when a scientific report came out, it was largely interpreted, actually, it was more like the 1800s, largely interpreted by special interest groups. So you know, creationists would go out and they would parse all the scientific literature, looking for stuff that supported their worldview.

And then, you know, atheists would be doing the exact opposite, right? Sort of putting out a more secular interpretation of the science. And those folks were largely the standard bearers for how the public perceived that information.

And so in the early 1900s, gave rise to some of these fair broker journalist organizations like National Geographic and Popular Science, that first sort of brought that messaging in any sort of respectable way to the public. And now, you know, the dawn of the internet, and all these other things in our culture that have changed, have sort of ground out those voices. And now we're back in these special interest bubbles.

[Andrew Wilner, MD] (13:45 - 15:09)

Right. So that's one of the justifications for this podcast, The Art of Medicine with Dr. Andrew Wilner, is I like to talk to people who are informed, and are going to give us a straight story, and you're one of them. Now, why this book you wrote, really, is about snake oil salesmen, right?

I mean, there's always been people who have been willing to promote, for their own benefit, really untested and unproven treatments and cures. The classic one being, you know, snake oil, it'll make you feel better. I mean, everybody has ailments, might be depressed, or have an ache, or a pain, or dying of cancer, there's a whole range.

But we're all looking for something that's going to make us better. And as much as there's been enormous scientific advances, you know, not least of which is antibiotics and vaccinations, there are still many things we can't fix, which leaves a wide opening, right, for people who are going to offer something that is a cure-all. So it's a pretty big topic.

How did you decide that you're going to spend a few years of your life trying to sort this out?

[Matt Holgotz-Hetling] (15:10 - 17:44)

I started during the pandemic, where I thought, there's sort of like two treasured American values that are in conflict with one another. One is the desire to keep the public safe through public health campaigns, like vaccination and social distancing, and school closures, and those sorts of things. And the other is sort of this long-cherished American right to individual choice, and the right of the individual to not get vaccinated, or to go out without wearing a mask, or all these other things.

So a lot of people felt very affronted by the public health recommendations, and a lot of the public health folks were very affronted by these yahoos who were running around opposing their recommendations. And so I thought, there's a really interesting nuance to be had here. And I wonder, if I were to talk to some of these people who are at the extreme fringe of the alternative health movement, who are promising that they have cures to COVID, that medical science is not recognizing, and that, frankly, seemed very implausible, what would those folks tell me about how to create a system that they could sort of buy into?

What reforms would they recommend be made to the FDA or to the CDC? And when I started to ask them, they started telling me, burn down the CDC, abolish the FDA. Their answers had no nuance whatsoever.

And so then I sort of changed tack a little bit and gifted into exploring how these people, many of whom seem to have started off with more or less good intentions about what they thought legitimately was a cure-all, into these sort of cultural warriors who were taking up this medical freedom mantle and vowing to burn down the CDC. So I identified some really compelling trends that applied to all sorts of these wacky practitioners that I spoke to for the book. There's the guy who thinks he can cure cancer with baking soda injections.

There is a woman who can cure everything with leeches. There's a guy who, a retired dentist from South Dakota, who thinks he can cure everything with lasers. And the folks who sold a bleach-based solution to their followers, and on and on.

[Andrew Wilner, MD] (17:45 - 18:40)

Right. The one true cure is what you call it. The one true cure.

In the book. So I had a few questions about that. And I don't know if they're even answerable.

I mean, it is not a coincidence that they were trying to get rich. Okay. One guy was, you know, he had a cure for cancer and you came and stayed at his estate in California for $2,000 a night and you got very expensive treatments.

That's the one you reference in your Times article where the woman later died. Right. And I want to talk about that also.

But do you think in their hearts that they truly, truly believed in this stuff, or do you think they knew they were scam artists?

[Matt Holgotz-Hetling] (18:42 - 21:24)

I think, yeah, it's a great question. And it's one that can never be answered with a hundred percent satisfaction because these folks don't tend to leave that confessions. But I do think that for the most part, I think that they either, I think that they fooled themselves.

Yeah. So I think that for the most part, a lot of these people started off, yes, they wanted to make money, but they thought that the product they were selling was legit. I think most of them did have good intentions at one point where they had what they thought was a medical advance.

They got the dollar signs in their eyes. They bought into this idea, this really wonderful idea that they had come up with something that was going to better humanity. Right.

And once they started talking about that, boy, yeah, we all have egos, don't we, Dr. Wilner? And when your ego is telling you that you can eradicate cancer with herbs or some other implausible method, you want to believe that very, very badly. Your brain will help you to cherry pick the information that reinforces that belief.

It will screen out the information that does not reinforce that belief. And you're not only going to have your personal identity wrapped up in this idea, but your finances also get wrapped up in this idea. If Robert Young can't cure cancer with baking soda injections, then he has to stop having people at his miracle ranch and getting $2,000 a month from them.

And that was sort of a dynamic that described pretty much all of the healers that I spoke to. So they were so deeply attached to their beliefs that they clung to them even when things started to go bad for them. And they collided with the establishment and began to get sort of legal heat.

There's one guy that I spoke to, he's the founder of the so-called Church of Grief, who I spoke to him in prison. And he's in a Colombian prison for fraudulently selling his miracle mineral supplement, where it was the name of his cure. And what's he doing in prison?

He's treating fellow inmates with junk, right? And he's not stopping. There's no stopping them once they get beyond a certain threshold.

[Andrew Wilner, MD] (21:25 - 22:37)

Yeah, I was going to say, I think it's a strange phenomenon that they believe in themselves. And normally, that helps make you successful when you believe in yourself. But it gets to the point where you alluded to confirmation bias, right?

That whatever is working supports your theory, and then whatever doesn't support your theory, you don't pay attention to. But they become totally deluded that, in fact, this really does work to the point which also makes them much more effective salespeople. When you have some guy knocking on your door, and you can tell he believes down to his core of the second coming is going to be on Wednesday, you start to give him the benefit of the doubt.

Because you see, he has no doubt whatsoever. And that's what happened to these people. But what I wanted to emphasize, though, was the other side of this, which are the followers.

It's like, why is anybody paying any attention to these people when what they're selling is clearly fraudulent?

[Matt Holgotz-Hetling] (22:45 - 25:23)

Yeah, and on sort of like the flaws in the medical profession. We have a system that is not easily accessed to some people. We have a system that is sort of, it's a little demeaning.

It's a little dehumanizing to go to a hospital and wear a paper gown and answer the same questions about what your birth date is over and over again. And I know that our medical professionals recognize this and try to mitigate it. But there's also sort of like this cultural gap between a lot of the practitioners who, through the active and successful campaign of the AMA, have formed sort of like the most successful salary-wise profession that somebody can hope to frame themselves into in the country.

And so the American system is creating a space through its flaws. And we talked about the Byzantine system and all of that as well, and some bad actors, and lack of transparency, and everything else. And so what all those things do is they drive people into a space where they can fall prey to these hucksters.

If we had a perfect healthcare system, then nobody would need the hucksters because nobody would be interested in something that doesn't work. But what they're selling is they're selling a promise that they cannot keep. They're selling a friendship that is based on money.

They can afford to spend more personal time with their patient and give them a more human connection than the average MD can, because they're not bound by all of the rules and demands that force an MD to limit his patient face time to something like an average of whatever it is, minutes per second, 17, 18 minutes. And so all of those things, combined with a general lack of understanding of science, and a lack of scientific literacy, and all of that, combine to create an environment that is very fertile for these hucksters. And it seems like every advance we make in terms of the internet, or partnership, just seems to make this even worse.

[Andrew Wilner, MD] (25:24 - 28:37)

Yeah, very discouraging, because these people are frankly unethical. They're taking advantage, and the young woman that you describe in your article was diagnosed with breast cancer stage one. She did have it removed.

Her chances of survival were 90% and plus if she followed up with radiation and chemotherapy as needed. She didn't follow up. She wanted some holistic cure, spent a fortune on it.

And then when it wasn't working, the answers from the purveyors of it is like, well, you're not doing it right, or you're not taking a big enough dose. The blame was on the patient with no thought that, well, gee, maybe there's something wrong with the treatment. And finally, she realized when this cancer had metastasized to the rest of her body that this other treatment, the alternative therapy, was not working.

But now it was really too late, and so she spent quite a bit of time getting the treatment she should have had years previously that now failed, and you couldn't find her because she was dead. So, you know, it reminded me of the story. I think Dr. Offit is a pediatric pediatrician who has written a lot about vaccination, and he starts out one of his books with this mother who is holding her child who is deathly ill dying of measles. This was quite a few years ago, and he was just sort of tempted to, you know, oh, what can you do? And it's like, unfortunately, there's no treatment for measles. You know, other than supportive care, and the child died, and it was a tragedy, and he sort of, you know, held his tongue and didn't say, well, you know, if his parents had been a little more, a little attentive to the realities of life, you would have vaccinated your child, and you wouldn't have died.

You know, that science has a role, and, you know, it became very trendy recently to attack the FDA, the CDC. You know, these are government agencies that are imperfect, but have a purpose, and the purpose is to protect the public. And, you know, when you get a prescription medication with, there's a little package insert, and it shows exactly what the testing was for this medication, and it had to, the clinical trials, and what its side effects are, what percentages.

A lot of time and effort went into preparing these and getting them approved, and when you buy a supplement, for example, that is not regulated by the FDA, you don't get any of that. There might be a label that says what's in it, and when people have tested those, you know, vitamins, for example, they often find that that's not at all what's in them. You know, there's just no quality control whatsoever, that there's an important role for the, for agencies like the FDA, and it does not extend to supplements, which I think you agree that that is a gigantic loophole.

[Matt Holgotz-Hetling] (28:38 - 29:11)

Oh, absolutely, absolutely. Yeah, the changes to the law in the 1990s that allowed for almost total deregulation of the supplement industry have been the biggest thing for blacks, and the worst thing for the public health that I can imagine. We, just to springboard off what you were saying, one guy that I spoke to was a vegan activist, and his name was Herb of War.

Yeah, his name legally changed. Yeah, I loved it. That was great.

[Andrew Wilner, MD] (29:11 - 29:11)

Herb of War.

[Matt Holgotz-Hetling] (29:11 - 31:25)

He sort of like embarked on this quest, this really like a springing from his like high principle of belief, the same ones that led him to sort of like pursue natural living, and avoid the eating of animal products, and all that, got him obsessed with this idea that one could find an all-natural alternative to Viagra, right? And so, Herb of War travels the world, chasing down sort of like traditional folklore and traditional beliefs, looking for that herb, and he's taken a lot of herbs in a lot of places that will create in him the same effects that Viagra has. Looking for herbs in all the wrong places, okay.

Looking for herbs in all the wrong places, right. And then he's, one day he's running a call, he's also like a big email spammer type guy, and like a call center manager, entrepreneur. So, he's at a call center in India, and he gets an herb from an acquaintance who says they found the perfect plant extract, and he gives it to his staff, and then 20 minutes later, they're all giggling behind their desks, and they won't stand up.

So, he thinks he's found it, this plant extract works, and he paid for it himself, and sure enough, it's just like Viagra, and it's from a plant that is grown only in China. And so, a Chinese supplier is sending it to him, and then he's thrilled, and he markets it under the term Stiff Knights, and sells out across the nation. He sells millions of these things, until somebody took it and died, and the FDA looked into it and found out that that mystery ingredient from China was actually the same chemical that's the basis of some of Viagra's competitors.

So, it was a drug in other words, and it was a drug that was in this supposedly product in an amount that was not safe, that there was an excess of the legal allowable limit.

[Andrew Wilner, MD] (31:25 - 31:31)

So, it was contaminated, it wasn't the natural herb, it was a contamination of the product.

[Matt Holgotz-Hetling] (31:32 - 32:25)

Yeah, the supplier told Herb what he wanted to hear, so that he could get him, yeah, so he could sell this stuff, which was, yeah, it was contaminated, it was a drug. And Herb bought it and marketed it, and then, yeah, things didn't go very well. And so, those regulations protect not only the public, but also the seller, right?

Because here's a guy who actually thought that he was doing something. And so, I think the industry needs to do more to sort of, or rather the government, our public policy needs to do more to sort of reward the supplement makers who are actually trying to do it the right way, who have injected a fair amount of effort into what they do, and are selling vitamins without fraudulent blown up claims, and to penalize those who do not.

[Andrew Wilner, MD] (32:26 - 33:12)

Yeah, and people don't realize that counterfeit medications are a huge problem in other countries. I mentioned Philippines earlier, people do not want a, many people do not want a generic medication in the Philippines, because it may well be counterfeit. It's not that it's an issue with the generics, it's that this may not be the medication at all, because their system of, you know, inspecting medications is not as rigorous as ours.

So, protecting the public, as much as it sounds paternalistic, can be, and goes against a little bit the medical freedom ethos, is very, very important. Absolutely.

[Matt Holgotz-Hetling] (33:13 - 33:52)

Yeah, when you buy a supplement in an unregulated industry or environment, you're not only trusting the guy who sold it to you, but you're trusting the supplier who gave it to him, and you're trusting everyone along his supply chain. And you really have no basis or reason to do so, other than that, you know, maybe somebody you know took it and didn't get sick. But those supplements have had all sorts of horrific things in there.

Everything from, you know, rat poison to rat birds, and to printer ink. And there's just no reason to have any faith in the brand or the market of some of these smaller operations, in particular.

[Andrew Wilner, MD] (33:54 - 34:24)

So, you know, as I, you know, your book is very thoroughly researched, and you go into these guys' lives, like this guy went in the Colombian prison, and he's, you know, he's still administering his miracle cure to vulnerable and susceptible inmates. A lot of interesting details, and it's a great read. But, you know, at all the end of it, it was like, well, now what?

What are we going to do about this? I mean, this is really a huge problem.

[Matt Holgotz-Hetling] (34:26 - 40:06)

Yeah, no, that's a great question. And I actually, I have a forthcoming book that will have just been published, I think, by the time this podcast drops, called The Ghost Lab. And in that, I get sort of get into the solution a little bit more to this idea of sort of folks who are not trusting institutions, and instead are trusting these individual experiences.

And part of it is that, you know, institutions need to address those sort of flaws that I referred to earlier. They need to, you know, improve transparency even more, improve accountability even more, and they need to serve people at a higher rate, and in a more accessible way than they're currently doing. But we clearly don't seem to be on the track to achieve that with our current political environment.

But also, you know, I sort of very reluctantly come to adopt the position that we need to do more to meet patients where they live. And I think we need to do more to accommodate belief systems that you and I, who are, you know, evidence-driven, you know, believers in science and skeptics of the supernatural—I assume, Dr. Wilner—we need to do more to accommodate folks who do not believe in that, who do not believe in science. You know, we are humans, right?

And the idea of believing in sort of narrative over fact is a very human thing. And right now, science has sort of rested on its laurels by being correct and by actually producing practical effects, but it hasn't done enough to sort of pickle the brain in the way that a huckster can. And I think that in order to do that, they can be more welcoming of people with these sorts of anti-institutional beliefs by sort of getting off the high horse and stopping the sort of aggressive debunking.

You know, we think that if we are not going to confront, say, a patient who says that he's been abducted by aliens, right? Let me give you an example, although this comes up in my more recent book. In the Muslim world, a lot of people believe that they've been possessed by jinn, you know, what we hear in the U.S. sometimes called genies. And they will go into a clinical setting reporting symptoms that they attribute to jinn possession. And this is like a very common belief. Something like 40 to 60 percent of university students who are presumably getting a decent education will believe this.

And when they go into a clinic in the Muslim world, the clinicians have all the tools that we have here in the West, but they also have access to a treatment program for jinn possession that sort of trojan horses some traditional accepted methods of conventional treatment into a window dressing that is accepting the basic premise that a jinn has possessed this patient. So a rakhi, a holy man, will come into the clinic and take some powerful words out of the Quran and write them on paper that will then be dissolved in water. The afflicted person drinks it, and there's a whole set of sort of like protocols that spring out of that ritual, some of which involved sort of like, you know, providing follow up and peer support and some of these other things that we recognize are good for one's mental health in the United States.

But there's hope in this, you know, on the face ridiculous premise that there is a demon inside this person. And what they find is that that is an effective treatment for many of the symptoms that we would treat otherwise in the West, you know, that it's comparable, whether it's a combination of sort of like that social support and follow ups and checking in process, or whether it is the placebo effect or some of a whole host of other similar related effects. We don't know, but in a practical sense, it worked.

And so I think in addition to providing a better health care menu for their patients, I think practitioners have to do a little bit less debunking, because I think that if they embrace the idea that a patient's been abducted by an alien or possessed by a djinn, that there will be sort of like sanctioning and building up those beliefs and making them more relevant. But what I fear happening is that if they don't do that, those beliefs aren't going to get any less relevant, the scientists and the medical practitioners are going to get less relevant. So I think in a practical sense, that sort of like the same viewpoints that drive, you know, a half-embrace of complementary techniques, the complementary medicine can be used to sort of mitigate the harm that these practitioners would otherwise cause and give them an incentive that allows them to operate within the system in a way that makes them trust in it and have a stake in holding the system up.

[Andrew Wilner, MD] (40:08 - 40:37)

Yes. But I'm going to call you out on that because in your book, it seemed to me you were critical of the Cleveland clinics and Mayo clinics who were incorporating alternative medicine, that they were somehow corrupting their science by allowing these proven therapies in their doors, presumably for profit. You want to enlighten me a little bit?

[Matt Holgotz-Hetling] (40:37 - 44:34)

Yeah, yeah, yeah, absolutely. Yeah, no. And there is certainly a school of thought that I have recently espoused that this is sort of like an unalloyed public bad.

When you have a hospital that's offering aromatherapy or sound therapy or hypnosis treatments that are not supported by the evidence, that this is in fact a bad thing. My thinking on that has evolved. I basically buy into the idea of debunking on a visceral level because it drives me nuts to think that the science is correct, these fringe treatments are wrong, and why would we give the time of day to the fringe treatments?

Now I'm more of the mind of strategically, the debunking is not working. And in fact, it's driving worse patient outcomes. So I now sort of believe that if you can offer certification systems for some of the more commonly believed forms of hokum, that that might actually be a good thing.

So for example, homeopathy, right? Ridiculous idea. The idea is like at its core, it's got two bizarre beliefs that if you take something that mimics the symptoms of a disease, that that will be the cure for that disease.

So if measles makes you itchy and give you a fever, take this herb that makes you itchy and give you a fever, and then you won't get measles, right? Ridiculous idea. Second ridiculous idea is the more diluted a solution of that active ingredient is, the more powerful it is, which results in a process, a production process of diluting it so many thousands of times that often there's not a single molecule of the active ingredient in the bottle of fluid that you buy, right?

So also ridiculous idea. But in the state of Nevada, they have a board, a state board of homeopathy, where a bunch of homeopathic practitioners are sort of like issuing certifications to other homeopaths that operate in the state of Nevada. And on the one hand, that's ridiculous.

Well, why is the state holding up this ridiculous practice of homeopathy? Well, in fact, a lot of people buy that stuff, right? And so if you have a state board of homeopaths, what you can do is you can hold licensed practitioners up to a standard that mitigates their harm.

So if you're a state certified homeopath, and somebody comes in with cancer, if you want to keep your license, you have to refer them to a doctor, to an MD, and you can't sleep with your patients, right? You can't sleep with your followers, because that's an abuse of ethics. And you can't put poison in this alley.

You have to make sure that the stuff that you're selling them is not poisonous, right? And so, for all of these reasons, I've sort of come around to the idea that it's more efficacious, it's more efficient to try to create a space that doesn't instantly deride practices like homeopathy, and instead sort of like creates a path of homeopaths who will actually prop the system up instead of tearing it down. And then the fringe homeopaths who don't want to play by that rule, they get pushed further out to the margins.

And now you have homeopath versus homeopath, and that is for the good of evidence-based practitioners.

[Andrew Wilner, MD] (44:34 - 48:30)

You know, there's a phenomenon in medicine where patients may have a very strong belief that they're ill with a particular disease. I'm a specialist in epilepsy, and there are people who believe very strongly that they have epilepsy and will actually have what appear to be clinical seizures with jerky movements and foaming at the mouth and biting their tongue, collapsing. But in fact, they don't.

They have a psychiatric syndrome that has caused this really strange delusion. So we call those pseudo seizures, or we call it functional disease, in that it appears to be a disease, but it actually isn't. So in the old days, when a patient like that would present to a neurologist, we would do our various testing and conclude that, and just tell the patient, well, you don't have epilepsy, so you need to go somewhere else because I treat epilepsy and you don't have it.

Well, that didn't work very well because the patient would conclude, well, that doctor doesn't know anything. Obviously, I have epilepsy because that was their belief system. So we still try and refer these patients to psychiatry, but it's more successful to say, well, the type of epilepsy you have is a little different and it doesn't respond to our usual medications, as you know, because you've been taking them and they don't work.

So we're going to try some other treatments like physical therapy, and that approach, well, it's not 100%, but it does work better because I was trying to get back to the belief system, that if you have a strong belief system, like your patients who are possessed, and you simply tell them that they're wrong, then you don't get anywhere because you don't have enough credibility for them to go, oh, really, doctor? Okay.

I guess I'm not possessed, right? That's usually not going to be what happens. They're usually going to say, well, this guy, he doesn't know anything.

Of course I'm possessed because that's their culture. So it's a little bit on a slippery slope, like a placebo treatment where you give something that does not have active ingredients, and yet because it's presented in a certain way, it can, in fact, have activity. So, you know, the human brain and mind is complicated.

But it is so distressing to me when I see people who refuse to accept the scientific method and die because of it. There was a really heartbreaking case in your book of a family that was very religious, and their poor child was getting sicker and sicker by the day and turned out to have a new onset diabetes, and glucose was going sky high, and the patient became ketotic and listless, and they felt that prayer could fix anything. And they got everybody they knew to throw in some prayers, but the child continued to get sick until finally somebody called EMS, and the child died on the way to the hospital.

It was a completely preventable death. That's heartbreaking. So, you know, I think we don't have to say that the scientific method is the only way to look at things, but it's a good place to start.

[Matt Holgotz-Hetling] (48:31 - 51:22)

Yeah, yeah, absolutely. Yeah, an example of that from my own life is, when my wife and I got pregnant, we were, you know, hearing messaging that sort of, like, was not that favorable towards sort of like the idea of a medical industrial complex that administers C-sections without just cause or sort of frivolously and all that. But my local hospital has a team of medical doctors who work alongside a team of midwives.

And the midwife, so you can, when you go to the hospital, you check a box, you want the doctor route or do you want the midwife route? And we checked the midwife route. And all of our care happened in a hospital setting.

The midwives had a very good understanding of what they could and could not do. Yeah, they're recommending positioning or they're doing all sorts of, just their whole worldview was embracing a sort of more naturalistic form of birth when possible. And yet they could do the science when a medical intervention was necessary and helped guide us because they, we sort of understood that they were following what we wanted, you know, that they came from sort of fundamentally the same place as us.

And when a medical intervention did become necessary for us, we didn't like to hear it, but we trusted the source, right? And we trusted these midwives who we had built a relationship with. And then, you know, we got a wonderful surgeon who instilled us with all the confidence in the world and he delivered our beautiful boy, you know?

And so, you know, there are ways for medical institutions to create pathways that sort of read into the correct medical decision for the patient without, you know, buying into some of the other stuff. Now, I don't know what would have brought that religious family into the fold. They were very framed, right?

They prayed over their dying, comatose child. But I do think that in many cases, it's sort of nipping those things in the bud. You're always going to get some hard for anti-institutionalist warriors.

But before somebody becomes that, there's someone who's persuadable. And I just think we've got to work a little bit harder to get them when they're at that point of persuadability.

[Andrew Wilner, MD] (51:23 - 51:35)

All right. Before we wrap up, tell me again the title of the book that we're discussing and then the new book and where we can find them.

[Matt Holgotz-Hetling] (51:36 - 52:38)

Actually, thank you so much for asking. So, If It Sounds Like a Quack, A Journey to the Fringe of Alternative Medicine. That is the book that you and I have spent most of the last little bit talking about.

It tracks some very extreme, very bizarre medical practitioners. It's available at Amazon and indiebooks.com and anywhere books are sold. My forthcoming book, which again will have been recently published by the time this drops, is called The Ghost Lab.

And that is sort of analyzing the connection between institutional distrust and paranormal belief systems. And focuses on a group of colorful New Hampshire paranormal enthusiasts who embark on this sort of noble quest to inject science into things like witchcraft and ghost hunting. I'm mostly coming up short.

But they are, I think they're both not worth reading.

[Andrew Wilner, MD] (52:39 - 52:56)

And I thank you so much for giving me a chance to talk about both of them in this context. Matt, thanks so much for this freewheeling conversation. Matt Hongoltetling, thanks for joining me on The Art of Medicine.

[Matt Holgotz-Hetling] (52:57 - 53:14)

Dr. Wilner, it's been a joy. And can I just also say that what you're doing with this podcast is so important and provides such a benefit to the public. Thank you for the good work that you do, not only in the clinic, but out here in the world.

It's really appreciated and it's really vital.

[Andrew Wilner, MD] (53:15 - 55:36)

I appreciate that. And now a final thanks to our sponsor, locumstory.com. Locumstory.com is a free, unbiased educational resource about locum tenens. It's not an agency. Locumstory exists to answer your questions about the how-tos of locums on their website, podcast, webinars, and videos. They even have a locums 101 crash course.

At locumstory.com, you can discover if locum tenens make sense for you and your career goals. What makes locumstory.com unique is that it's a peer-to-peer platform with real physicians sharing their experiences and stories, both the good and bad about working locum tenens, hence the name locumstory. Locumstory.com is a self-service tool that you can explore at your own pace with no pressure or obligation. It's completely free. Thanks again to locumstory.com for sponsoring this episode of the Art of Medicine. I'm Dr. Andrew Wilner. See you next time. at the University of Tennessee Health Science Center, Memphis, Tennessee. Views, thoughts, and opinions expressed on this program belong solely to Dr. Wilner and his guests, and not necessarily to their employers, organizations, or other group or individual. While this program intends to be informative, it is meant for entertainment purposes only. The Art of Medicine does not offer professional financial, legal, or medical advice. Dr. Wilner and his guests assume no responsibility or liability for any damages, financial or otherwise, that arise in connection with consuming this program's content. Thanks for watching. For more episodes of the Art of Medicine, please subscribe. www.andrewwilner.com