As a medical oncologist, science denialism from my patients is all too familiar to me. Cancer misinformation is, unfortunately, endemic in our society. After 18 years as a cancer doctor, it sadly doesn’t come as a surprise anymore when a patient declines treatment recommendations and instead opts for “alternative” treatment.
When it happens, I explain the reasons for my recommendations (science), the risks of not taking standard treatment (death), and that I’ll be there for them when they want to reconsider (hopefully before it’s too late).
So when it comes to the anti-vaccine movement and COVID-19 science denialism, a similar sense of frustration and helplessness comes over me. I want to better understand it so as to better intervene.
Even before the pandemic, I started asking those of my patients who decided not to pursue standard cancer treatments for their rationale. My goal was never to judge them but to try to come to a better understanding so that, if possible, I could tailor my approach to addressing their doubts and concerns.
Two of the most common answers I have received are:
- They don’t trust that the medications have been developed in their best interest and are instead only to make money for the pharmaceutical companies. Sadly, many also tell me they believe that doctors only prescribe these medications to profit themselves. (“But not you, doc,” they always say.)
- They don’t trust that the standard treatment recommendations represent the best of what we have to offer. Instead, “the government” (or some other secret entity) has the “real” cure and is keeping it away from the general public for their own nefarious gain.
I am not on the front lines of COVID-19. But I have been at the ICU bedside of my patient who begged me to give her chemotherapy, as she lay dying of the breast cancer she chose to treat with vitamins and essential oils. I will never forget the despair and rage I felt at whatever influenced her to refuse the treatments that could have helped her before it was too late. I can only imagine what my colleagues are experiencing now as the unvaccinated are dying of COVID-19.
But where the analogy between cancer and COVID-19 breaks down is where it comes to individual risk vs public health risk. My patient dying of cancer after refusing standard treatment is not risking the lives of anyone else around them.
I can’t help but reflect on where we, as a medical and science profession, may have gone wrong in our public health messaging.
I think that, analogous to cancer misinformation, its roots are much deeper than we’re perhaps willing to admit. I believe, as per the answers my patients have given me, that it goes back to 150 years of medical paternalism and perceived elitism, and, yes, profit-motivated healthcare.
I’m not claiming to have the answers. I only write to share my experiences, knowing they are universal. And what I’ve learned from my patients is that trust isn’t necessarily granted by name, or rank, or title, but by putting in the work to connect, human to human.
I try to stay present, open, and mindful. It’s hard work.
Unfortunately, for our patients, some paths seem “easier.” Google, Facebook, their best friend’s aunt’s cousin’s homeopathic business — those are all easily accessible for them, and what’s more, provide the rose-tinted answers they would rather hear.
I’m the parent of a child under the age of 12 who cannot yet have access to the vaccine. I’m also a physician to immunocompromised patients who either cannot yet safely get the vaccine or may be at risk of the vaccine being less effective. I disagree strongly with the CDC’s shift in public health messaging to what can essentially be boiled down to, “It’s up to you, the individual, to protect yourself.”
Because it’s up to the public to do their part to protect my child — and all children under 12. And immunocompromised people. As well as those who globally do not yet have access to the vaccine.
And we, as physicians, have a more immense responsibility that includes making up for our predecessors’ historical lack of transparency. Yet still, I don’t see short-sighted individualism as the solution for the long track record of medical paternalism.
Behind the scenes, out of the public eye, many of us in our longitudinal clinics — primary care physicians and subspecialists — are having these conversations with our patients daily. There’s no reimbursement for it — and no public recognition. But if we’re going to turn the tide on pandemic misinformation, we shouldn’t discount the importance of first earning the trust of our patients.
If patients don’t first trust us, they will go elsewhere for their information and treatment decisions. And that affects all of us.
Originally published on Medscape Blogs July 27, 2021