Dec 04 2007

“Trust Me, I’m Not a Doctor”

Mark, who writes the denialism blog, sent me this story that he blogged about the other day. It is the tale of an HIV+ mother who has bought into the HIV denial community’s paranoid rantings. In turn the HIV deniers have taken it upon themselves to give her some medical advice, including not treating her HIV, not testing her infant, and breastfeeding her infant. Mark correctly points out that the available data shows that breastfeeding carries a 12-15% risk of passing HIV from the mother to the child. Their advice, therefore, if taken, is likely to result in the untimely death of both the mother and her child.

As an aside, the story itself has not been verified and is based upon the anonymous postings of the alleged mother on an HIV denial forum. Whether or not the mother turns out to be real (perhaps it is someone baiting the HIV deniers, for example) is actually irrelevant, the advice given by the HIV deniers is real – meaning that it is the sincere advice they give to HIV+ mothers.

The story brings up many very interesting and important legal and social issues. What, if anything, are the liabilities and responsibilities of free citizens giving medical advice? In the US this is generally covered under the principle of freedom of speech, which of course I heartily endorse. But free speech has always been limited by another ethical principle – that of not causing harm to others (such as the cliche example of yelling fire in a crowded movie theater). The courts have held individuals liable for speech that directly incited others to violence. Speech that preaches hatred is protected, but you still can’t tell your audience to grab a weapon and go out and kill the targets of your hatred.

Should the same ethical principles should apply to medical advice? The free exchange of ideas is vital and worth protecting, which means that unpopular and minority opinions must be tolerated. But it is possible to balance the unfettered expression of medical opinions while protecting the public from dangerous medical advice. Most venues that discuss medicine often include the disclaimer, “None of the opinions expressed here are meant to diagnosis or treat any disease or illness. If you have any medical problems you should consult your physician.” That is a fairly standard and painless disclaimer. It may not be very effective, but at the very least it expresses to the reader that a lay person discussing biology and medicine should not be substituted for professional medical advice.

But it seems that society increasingly tolerates non-professionals practicing medicine – something that used to be a crime (technically it still is, but is watered down to insignificance). Today it is not uncommon for coaches, psychics, and that guy behind the counter at the supplement store to give medical advice. Now any crank with computer access can start a website or just join a forum and start dispensing their nonsensical ravings as if they were sound medical decision-making.

I don’t think society has adequately wrestled with many of the questions raised by our new found ubiquitous access to information. For example, should Kevin Trudeau be held ethically and legally responsible for the horrific medical advice he dispenses in order to fleece the public? Should a faith healer be responsible for the health of the faithful they convince to throw away their medication because they have been healed? And should HIV deniers be held responsible when they tell an HIV+ mother to breastfeed their child? Should off-the-cuff personal advice be treated differently than an organized campaign of disinformation or fraud?

I admit that I am raising questions more than advocating a strong position. I am concerned about the chilling effect on free speech that any such liability could have.

Right now the line seems to be drawn at conscious fraud. Even then, however, the penalties are little more than the cost of doing business and the loopholes are wide open. Trudeau had no problem selling books filled with nonsense under the protection of free speech, even after the Federal Trade Commission found him guilty of deception and banned him from selling products on infomercials.

Maybe we just need more effective enforcement against fraud. This would not include those who dispense their advice because they are ideologues, or who do not collect fees for their advice, however. Here the line is much more fuzzy (is a faith healer accepting donations the same as taking a fee?). Also, we don’t want to hold granny liable for offering you chicken soup for your cold. Can we draw another line, however, between casual advice from friends and family and medical advice given in a public forum?

A legal remedy could either be criminal or civil. The bar for criminal liability should definitely be fairly high, but I think it is perfectly reasonable to hold people liable to civil action if they take it upon themselves to give medical advice to others. The weakness of a civil remedy is that those people who take such advice are not likely to admit their decision was a bad one and to seek civil recourse. Con artists routinely count on this fact.

In the end, although I think we do need to thoughtfully tighten up our regulation of the giving of medical advice, any legal remedy is extremely problematic. The far better solution is to educate the public so that they can recognize nonsense when they see it. This, however, is also a very imperfect solution as it is far easier to spread misinformation than it is to correct it.

Until we can find better solutions, at least we can blog about it.

3 responses so far

3 Responses to ““Trust Me, I’m Not a Doctor””

  1. Scepticonon 04 Dec 2007 at 3:39 pm

    Should we also treat the same advice given in different mediums differently?
    A point of view expressed in a chat room or other sort of informal online forum may carry less weight that the same opinion published in a print magazine or newspaper.

  2. DLCon 04 Dec 2007 at 9:16 pm

    I’ve been around online since the 90s. In that time, in message boards, chats and email lists. Sometimes one of the participants would bring out a medical issue, and ask advice. Being someone with some medical knowledge I would sometimes reply with my opinion, but always with a disclaimer — “I’m not a medical professional” . I always heavily stress seeking professional medical help for a medical problem. Sometimes I’d be busy and just say “See your doctor” .

  3. haguson 05 Dec 2007 at 12:29 am

    You will never put a stop to the morons out there on the Internet with the pseudo-science shaped hole in their hearts. They are just looking for a forum that reaffirms their crackpot beliefs, be they HIV+ denialists, creationists, etc.

    However, anyone offering medial advice as a service (either pro bono or otherwise) should be required to be a licensed medical practitioner. In the same way that you require a licensed electrician complying with council regulations to work on your house, anyone performing “work” on your body needs to subject to regulation.

    Faith healers publicly advocating the abandonment of medication are recklessly endangering human lives and should be prosecuted to the full extent of the law. And if the law doesn’t extend that far, it needs fixing.

    And for that matter, let’s bring the law to bear against the Jehovah’s Witnesses who refuse their ill family members life saving blood transfusions. Remove these people from society.

    Surely one of the highest and noblest acts a human being is capable of is the preservation of another human life. Nobody could argue with this, be they a religious crackpot or a hardline atheist. Ergo, placing lives at risk is one of the most despicable things a human can do; perpetrators of harm must be remove from society at large until their attitudes or beliefs can be modified.

    When I see these mendacious degenerates telling others to avoid blood transfusions, or treatment for HIV, or proper medical attention, I’m tempted to violate my own precept of not harming other humans.

    Modern medicine is the apex of thousands of years of ceaseless toil by human beings to better the lives of their fellows. To ignore it – or worse, claim that it is somehow malevolent – is an insult not just to practitioners, but to the entire human species.

Trackback URI | Comments RSS

Leave a Reply

You must be logged in to post a comment.