CAM pseudoexperts

I have to admit, I occasionally get irritated by some of the so-called CAM ‘experts’ that so vociferously dominate our field, but more often these people amuse me. Virtually all fields of medicine are driven by healthcare professionals and scientists, but CAM is different – it is an area that is driven by consumers. It also is an area where, relative to mainstream medicine, scientific knowledge is still in its early infancy. These important differences have many far-reaching implications, and one of them is that almost everyone seems to be an ‘expert’ in CAM.

My dictionary defines an expert as someone who has acquired special skill or knowledge of a particular subject. A more cynical but also quite apt definition of an expert is that of a person who has committed all the errors in a particular area that one can possibly commit. Even this definition implies what common sense tells us: in order to qualify as an expert, one has to have a reasonably long history of dealing with the subject. In CAM, such common sense is often suspended. Here people seem to become ‘experts’ virtually overnight.

A more appropriate name for this phenomenon is probably ‘pseudoexperts’. CAM pseudoexperts abound and, after observing them for many years, I think I have identified a set of characteristics that enables us to identify them quite easily.

As already mentioned, with pseudoexperts there is no real history of having studied CAM in any depth. They have therefore little or nothing to show for themselves by way of publications. Search for their name in Medline, for instance, and you will find no more than two or three citations (in all likelihood, however, you will find none). As they lack factual knowledge of CAM, pseudeoexperts normally don’t bother with the all-important fine detail; they often pretend to be visionaries capable of ‘seeing the bigger picture’. As soon as you put them on the spot, however, you find that their ‘vision’ fades into shallow speculation.

In order to be convincing (and unfortunately some are amazingly convincing to a lot of people), the pseudoexpert has to observe certain rules. The choice of language is often vague and nonsensical, a fact which is cleverly disguised by excellent rhetorical skills. As this would hardly be persuasive to rational thinkers, the pseudoexpert avoids scientific audiences like the plague. His or her strength is to convince lay people – and sadly this often includes politicians and other decision makers.

The personality of the pseudoexpert merits detailed psychological analysis. It helps, I think, not to be too intelligent. This makes it easier for the pseudoexpert to fall victim to his or her own powers of persuasion. The result is often an almost religious belief of the pseudoexpert in the correctness of his or her assertions. One cannot readily disprove a religion and those pseudoexperts who mistake CAM for a religion cannot even conceive the possibility of being wrong. Not all pseudoexperts, however, are true believers nor are all of them stupid. Some are highly motivated by strong self-interest. These are the ones who tend to be addicted to the limelight of public interest. If you read the Sunday papers and follow how some health writers promote certain treatments, you probably understand what I mean. One does not need to do an awful lot of research to find that some of these pseudoexperts are motivated by financial rewards. For others the attraction lies in the prospect of fame or power. Attractive positions and distinctions wait for those who loudly and unscientifically promote what the government of the day or other VIPs want to hear.

The proliferation of CAM pseudoexperts is perhaps not surprising and in many instances it is a highly entertaining phenomenon. Yet it is also regrettable for several reasons. Pseudoexperts misdirect decision makers. They can also produce more tangible harm, e.g. by misleading patients into using the wrong type of CAM or the right type wrongly. Finally they jeopardise the potential that CAM has in certain areas. And this is a lasting disservice to our field.