Sometimes, if I have the chance, I like to review the list of referral letters before I see any patients for the day. It tells me what to expect; how to allocate the time for the consultations; whether any of them might be particularly interesting. Surprises happen. The other day, one letter about a patient caught my attention. It was short and to the point: Chronic yeast infection. Tried everything. Nothing worked!
Great. I noticed she was booked for the end of the day so there was always the chance that she wouldn’t show up. The thought sustained me all that morning.
But of course, she did.
Quite an confident looking young woman in her early thirties walked into the office accompanied by her partner. Tight jeans and a bulky grey tee shirt announced her presence on the chair, a too-loud voice from an un-makeupped face made it echo around the room.
“I’ve just done a cleanse, but I thought I’d keep the appointment anyway,” she shouted defiantly. I suppose it wasn’t technically a shout, but it made my ears vibrate nonetheless. She glanced at her partner to underline the proof of the assertion, and then they both glared at me, in case I dared to disagree.
I’d never actually knowingly talked with anybody who’d confessed to a cleanse, and to tell the truth, I was a little vague on what it entailed. I thought I’d ignore the gap, and ran my eyes over the referral paper to make sure I had the correct patient. “So…” I said, noisily unfolding the referral letter on my desk -I often start this way, to demonstrate beyond a doubt that I am in possession of their doctor’s opinion- “Your doctor tells me you’ve had a yeast inf…”
Both their eyebrows shot up in unified derision of whatever it was that the letter contained. “Oh, don’t listen to her!” the partner interrupted in a softer, angrier voice. “She had no idea what was going on with Marcie…”
“Was..?” There was hope in my tone.
“I told you I did a cleanse!” Marcie said, almost reverently. And slowly, as if she were spelling the word out in her head.
I must have looked puzzled, because she produced an overly-tolerant look on her face, and smiled at me, the only slow one in the room.
“Cleanse!” She said it so slowly she seemed to caress the sound on the way through her lips. “It’s a way of ridding your body of its built-up toxins.” When my expression didn’t change, she continued after a maudlin sigh that her partner obediantly repeated. “The colon contains all sorts of toxins that build up over the years and stop the body from fighting off things like yeasts…” She rolled her eyes at the need to explain it to a specialist like me.
“So it worked?” I had meant it as a tentative acceptance of her information at first, but by the time the sound made it out of my mouth it had turned upwards into a question.
Her partner, Grace, seemed offended. “Of course it worked!” she said indignantly. “We both tried it,” she added proudly and smiled broadly at Marcie.
“The theory makes sense, when you think about it,” Marcie bellowed at the picture on the wall behind me. I could almost feel it rattle.
“Oh? Why’s that?” I was trying to be polite –there’s absolutely no evidence for its benefit in the standard medical literature. In fact the fecal microbiome is important for proper immune functioning- but I’m afraid that, once again, my words came out suggesting I was doubtful at best.
Her eyes narrowed and her face tightened –both faces tightened, actually- and she straightened her tee shirt as shocked as if I had sworn in church.
“There’s evidence,” she said and crossed her arms defiantly, satisfied that she had bested me.
I tried to look neutral –neither judging, nor rejecting her statement. “I…” It was all I could get out before she launched into a tirade.
“You doctors,” she roared, somehow managing to make ‘doctors’ sound like a disease. “You restrict your information to narrow little unreadable journals. You never read anything that disagrees with what you already think you know… Or, if you happen on it, you never read the whole thing…” I used the opportunity between her breaths to think about that one. Maybe she had something there… Confirmation bias is something we all struggle with.
She quickly turned to Grace who nodded in support. “There was a website I saw just last week that proves it…” She hesitated momentarily when I picked up a pen to write it down. In fact, she lowered her voice to encourage me. It’s http://www.tylervigen.com/
And then she laboriously spelled out each letter, including the forward slashes -in case I got them backwards, I suppose. “I just looked at a couple of them, but they were stuff you’d never find in your medical journals –and all statistically proven.”
I must have raised my eyebrows, because she quoted an example. “Did you know, for example, that the per capita consumption of chicken in the USA is correlated with the total USA crude oil imports? Don’t you find that strange? I mean stuff like that is proven, but they don’t want us to know about it.” She crossed her arms again.
I just concentrated on keeping my expression neutral, all the while trying to figure out how oil imports had anything to do with cleansing.
“And what about the margarine one, Marcie?” Grace added to overwhelm me with evidence.
Marcie nodded, somewhat annoyed she had chosen the chicken example, I thought. “Anyway, I’m betting it’s the same with colon toxins!”
And with that, they both rose in unison and thanked me for listening, all the while glancing furtively at each other. “We’ll come back if it doesn’t work out, though,” Marcie added as a sop to my dignity as she left the room.
As for my part, I felt disappointment at my inability to defend myself. Sometimes naivete is attractive, but usually it is just annoying. Incapacitating…
Out of curiosity, I looked up the website that night. Marcie must have skipped over the title, though -it was called Spurious Correlations. Or maybe she read it as ‘Curious’ Correlations… Anyway, I managed to find an article on it in the BBC News Magazine http://www.bbc.co.uk/news/magazine-27537142
Somehow, I think they both missed the point of the website -written by a student at Harvard- that correlation does not equal causation. But maybe it wouldn’t have mattered: I didn’t read the whole thing…