Blind faith

“Oh, just give him barley, it really works for dengue,” said the midwife.

It was early morning and I was in a rush because I had just received a text from one of my student-scholars, who was confined at the university clinic for what seemed like dengue. I was telling my mother’s caregiver about the student when the midwife, who was trying out as a possible substitute, gave her unsolicited advice on barley.

She got her bag, fished out a brochure plugging a brand of “organic pure barley,” and gave it to me. Her name and phone number were written on the brochure, which I will describe shortly. What caught my eye right away was a claim that barley was helpful for healing (“nakakatulong upang mabigyang lunas”) a long list of ailments. No dengue in the list, but maybe it was supposed to be covered by “at iba pa” (etc.), which appeared at the end of the 62 medical problems.

That incident was a rude reminder of the growing challenges with healthcare in the Philippines. Until about 10 years ago, the problem was mainly one of an expensive but more effective Western healthcare system pitted against a folk healthcare system (e.g., the hilot, albolaryo and faith healer) that was affordable if not free, but marked by ineffective or even dangerous remedies. I will emphasize here that the Western healthcare system was and is not free of quackery, and that the folk health system did have some strengths with very caring healers and some effective healing techniques.

Today, the situation has become more complicated with the rise of all kinds of other healthcare systems as well as products. Ironically, much of this came about because of the rise in the West of complementary and alternative medicine, part of a “return to nature” movement riding on people’s growing fears of synthetic chemicals, including Western medicines.

Over the years we’ve seen an explosion in the local market of these “natural” products, together with all kinds of alternative health systems such as iridology, pranic healing, homeopathy, chiropractic, traditional Chinese medicine (acupuncture in particular), Ayurvedic medicine. People’s concepts of health are now a mix-and-match of Western medicine, traditional Filipino folk systems and these imported ones, plus a few homegrown hybrids.

What have grown in leaps and bounds are the supplements, many of which are unregistered or, if they do go through the Food and Drug Administration, are approved only as food, not as medicines, and are not supposed to make any therapeutic claims.

Because many of these products claim to work through daily intake over a long period of time, like food, clients end up paying thousands of pesos a month. As one of my physician-students pointed out in dismay, “Patients will complain about buying prescribed medicines that cost P50 a day, but don’t mind paying P3,000 a month for some ‘herbal’ remedy, which comes out to P100 a day.”

Wired

There’s a new field of neuroeconomics (sometimes overlapping with behavioral economics), which looks at how people make economic decisions (what to buy, what not to buy, as well as cost-benefit calculations). An important overarching finding is that our brain does wire us to sometimes make mistakes, and our sense of realities can become distorted because of preexisting biases and variations on what “costs” and “benefits” mean. We are, in a sense, wired to be fooled.

Marketing of supplements often rides on that defective wiring. The brochure on barley provided by the midwife impresses people with pseudoscientific language such as a list of nutrients (for example, boron, cesium and nickel, plus more well-known vitamins and minerals).

Then there were so-called testimonials, which were really brief case histories with no proof that barley itself cured the cases of neonatal pneumonia, meningocele, diabetes and “three vessel disease,” kidney stones. April Boy Regino’s photograph was there with a caption “Diagnosis: Prostate cancer” and a claim that he was saved by the barley. But the actual quote from April Boy is: “I started feeling better after taking it only for a few months.” A photo of “Kuya Kim” (Atienza) also appears but the caption has him just welcoming people.

We’re wired to believe people. It doesn’t have to be April Boy; it can be a neighbor or an officemate who claims to have felt better after taking a supposed natural remedy. But we must remember that feeling better is different from having an illness treated, or cured. In cases like dengue, there is no actual specific treatment, so when the patient does get better, which will happen anyway with proper medical monitoring and good nutrition, people will attribute the “cure” to whatever was taken: barley, mangosteen, maybe even a swig of whiskey.

Then there’s the midwife-endorser. A midwife is a college graduate, with a government license and, for the poor, often a trusted frontline healthcare provider in both the public and private sectors. It’s that kind of endorsement that I really worry about. In a new twist, I’m getting reports now from my students in medical anthropology of physicians and nurses pushing some of these ineffective and often very expensive remedies, sometimes in the name of modern medicine (for example, stem cell therapy as rejuvenation). As if that’s not bad enough, I also have stories of health professionals who actually push patients with critical illnesses to rely only on religious healing. The saddest case was one where a nurse actually told the patient, who had breast cancer, not to go for the chemo and to just rely on a faith healer.

Snake oil

Perhaps our growing gullibility shows how insecure we are today. Snake-oil remedies feed off our many fears: of getting sick, of an illness (or what seems like illness—for example, aging), of doctors, of medicine, or of hospitalization (which overlaps with the fear of losing income, if not a job). Yet we end up paying more for ineffective products, as well as complications from the untreated illness.

Fear needs the converse: a convincing alternative that one can trust, or believe in. I have to say that barley brochure had all the bases covered when it came to marketing: Besides the testimonial-endorsements and pseudoscientific language, it begins by saying its product is from New Zealand (clean and healthy air?).  Even more importantly, the brochure says barley is mentioned in the BIBLE (quotes in the original) 37 times for food and medical purposes.

How can you lose with boron, cesium, vitamin C, New Zealand, and God, plus the midwife?

The advertising and promotions for these products have been relentless on TV and radio and in print, including our own Inquirer. Almost daily I get unsolicited texts promoting some “herbal” product. Even Mercury Drug stores push many of these products on their video players, which is dangerous because Mercury is seen as being backed by scientific medicine. I’ve practically memorized the video promoting a mangosteen drink by showing commandos machine-gunning all kinds of illnesses. Meanwhile, there’s a a tiny “No Therapeutic Claims Approved” at the bottom of the screen, which, thanks to our brain wiring, no one seems to notice.

We have to learn to be more critical of these promotions. Blind faith not just blinds but also maims, even kills.