Claims of Post-Truth Medical Therapy

Miracle health claims are a common phenomenon that dates back to historical times.

Not only are such claims made by doctors, hospitals, and anyone with an interest in therapeutic regimens, they may also be made by patients. This phenomenon continues to grow in today's digital era. A doctor can freely spread their views about the efficacy of a therapy or even promote it. Patients may even be more vocal about their experience with a certain treatment, whether good or bad, sharing it enthusiastically with others and drawing conclusions about the treatment’s efficacy.

Such claims, of course, can influence public opinion. If a claim is proven to be fake or false, the effect can be very detrimental. Lured by false hope, people may lose time and suffer financial losses and serious risks to their health.

Patient claims

The rapid development of information technology has brought about disruption in society, the so-called post-truth phenomenon. Public opinion is more influenced by feelings, emotions, and personal beliefs than objective facts. In the health sector, the patient as the object of therapy is prone to experiencing post-truth effects because of their poor medical knowledge or limited health literacy.

As a result, their views on various medical aspects tend to be subjective. They measure the success of a therapy based on their feelings. It is common to hear patients testifying that they are satisfied with a therapeutic treatment because they “feel better and healthier” after receiving the therapy. “Feeling better and healthier," they claim and promote the therapy as effective to other people. Without hesitating, will they compliment the doctor who provided the therapy.

Patient testimonials used to be an important parameter of therapeutic success. Until the 14th century, the efficacy of a therapy was weighed on only two indicators: patient testimonials and clinical changes in the patient. After administering a therapy, a doctor evaluated it by asking how the patient felt and addressing any complaints. If the patient said that their condition was improving and gave no complaints about their illness, this was enough to conclude that the therapy was a success.

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Patient testimonials were even used in court to determine whether a medical treatment was proper or improper. A doctor was liable to be jailed on a patient testimonial. At that time, the medical world was still immature and conventional. Not many testing tools or objective parameters were available.

The world of medicine has since evolved. Various testing tools and methods have been discovered that allow for objectively assessing the structure and function of the human body. The microscope was developed in 1590-1665. Blood pressure measuring devices started being used in 1881. At the beginning of the 20th century, discoveries in medical technology became widespread, including the invention of the X-ray, ultrasound, and nuclear magnetic resonance.

The discovery of new and sophisticated tools has been growing over the last few centuries. With these various tools, almost all functions and structures of the human body can be quantified objectively, even at the molecular level. The new global paradigm necessitates medical assessments to be more precise and objective, and the role of patient testimonials has started being marginalized.

Today, patient testimonials are considered nothing more than anecdotes, or unverifiable, subjective narratives or arguments. In terms of legal aspects and scientific evidence, they are not seen as strong and relevant as they were before, unless they are objectively quantifiable.

The narratives of patients who “feel healthier” need to be quantified objectively as to what, specifically, has produced this feeling. Is it the blood pressure, sugar level, fat level, blood flow to the brain, blood flow to the heart, number of blood cells, hemoglobin level, the ability to perform activities, lung and kidney capacity or other elements?

All these elements can be measured quantifiably today. Quantification is important to prevent fake or false testimonials that can cause potential harm to the public. Ironically, many people still rely on subjective testimonials, especially when they are given by public figures. On the other hand, many institutions persist in using patient testimonials by involving public figures to promote their products.

Physicians’ claims

A doctor needs to be extra prudent in promoting the healing effects of a therapy. There are rules and codes of ethics. The world of medicine is currently in an era of evidence-based medication. Medical therapies and advice to patients must be based on adequate clinical evidence gleaned from valid studies, instead of simply the doctor's logic and personal experience.

Logic and personal experience are limited and subjective. What may be considered good is not necessarily good when it is tested on a wider patient population. A doctor’s experience in treating a number of patients cannot necessarily be extrapolated as justification for treating thousands or millions of other patients.

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The positive effect of a therapy for a number of patients can differ when the therapy is administered to more patients. A study has revealed more than 400 common logic-based therapies used by doctors appear to contradict the results of clinical studies. One of these is estrogen therapy, also known as hormone replacement therapy.

During menopause, women have an increased risk of heart disease due to reduced levels of the hormone estrogen. Logically though to reduce the risk of heart disease, estrogen therapy for postmenopausal women has become widespread. Unfortunately, some studies have reached the paradoxical conclusion that estrogen therapy can actually increase the risk of heart disease in postmenopausal women. The therapy that appeared to be logical has turned out to deviate from the results of clinical studies.

The need to use comprehensive clinical evidence complies with the code of ethics for taking medical action, which must fulfill the principles of non-maleficence (giving no harm) and beneficence (being beneficial). This principle cannot be violated. By reviewing and analyzing various sources, doctors endeavor to examine clinical evidence of the dangers and benefits of the planned medical action.

If the clinical evidence shows that a medical action could harm the patient, it should not be carried out. Doctors cannot be justified in providing therapies that do not have clinical evidence or have only weak clinical evidence, even if the therapy is believed to be useful. Breaking this principle is not only a betrayal of the oath of medical ethics, but is also a violation of the standards of the medical profession.

Era of clinical evidence

Medical claims by either doctors or patients can be valid or invalid, depending on the basis of the argument. If it is based on adequate clinical evidence, the claim could be valid and true. The subjective claims of patient alone cannot be used as a measure of a therapy’s efficacy, even if the patient is a public figure.

The “I feel healthier” narrative is irrelevant to a therapy’s efficacy. For a patient's claim to be relevant, it must pass various objective tests. A doctor's claims are also unacceptable if their argument is based only on their individual thoughts or experiences. A valid claim must be based on adequate clinical evidence.

Medical actions that are claimed to be useful but have not been clinically tested should be temporarily suspended pending valid and adequate clinical trials. In the current era of information technology, there must be no medical claims that do not come with clinical evidence. The world of medicine is very advanced today, with many tools available for using in clinical studies. They should be used to test therapies that do not have a scientific basis. Scientific studies are also booming.

That our world today has not only been hit by the Covid-19 pandemic, but also a pandemic of practices triggered by the post-truth spirit.

Around 2,000 clinical studies were registered with the World Health Organization (WHO) in 2000. This figure has increased to nearly 700,000 studies in 2022. With this mass of studies, the medical world has adequate references. Medical issues can be analyzed using the available scientific references. Medicine is developing into a field of increasingly accurate and precise medical examinations with shrinking space for speculation or subjective arguments. This means that subjective claims should have no place in medicine.

However, subjective claims are continuing to circulate until now. Subjective testimonials continue to pepper the media. There are also doctors who insist on carrying out therapies they think are proper, even though they have not been adequately studied on a clinical basis. There are even doctors who continue to administer a therapy against the clinical results, with reasons varying from the patient's request to financial benefits, or to it being a popular procedure.

In the wake of increasing access to sources of information, such practices should be eliminated. What some experts say is true; that our world today has not only been hit by the Covid-19 pandemic, but also a pandemic of practices triggered by the post-truth spirit.

ARSIP PRIBADI

Iqbal Mochtar

Iqbal Mochtar, Physician and doctorate in medicine and health; chair of the Middle East Indonesian Doctors’ Association; member of the Indonesia Public Health Experts Association (IAKMI) and the Indonesian Occupational Medicine Association (Perdoki)

This articles was translated by Musthofid.