We are seeing anti-medical, anti-science narratives everywhere – how can GPs like me respond?
On Wednesday, a jury found that fourteen members of the religious group 'The Saints' were guilty of the manslaughter of eight-year-old Elizabeth Struhs. Two were acquitted of murder.
As a doctor and a mother I read the news and felt deep grief.
Under the guidance of religious leaders, the family had withheld life-sustaining modern medicine. As little Elizabeth lay dying from diabetic ketoacidosis, the adults – her parents among them – were alleged to have prayed and sang, instead of giving her insulin and vital medical care. This was not the first time they had stopped her from receiving medical care: her mother had previously been jailed over Elizabeth's near-death medical neglect. This was an entirely preventable illness and death. As a parent, I feel sick that a little girl could be abused in this way, under the guise of God's 'healing' powers.
I am seeing the rise of anti-medical, anti-science narratives everywhere. A patient in my clinic tells us that she has stopped her HIV antiviral tablets, because her pastor told her she has been healed by prayer. A parent rejects mental health treatment for his impulsive, suicidal teenager, telling me that ADHD and major depression are made-up, modern conditions. A pregnant mother asks me to sign her Advanced Care Directive, saying she declines blood products in the event of a life-threatening bleed during birth, worried that she could receive 'vaccine-contaminated' blood. Another tells me she will 'free-birth' without midwifery or medical care.
During the Covid pandemic, conspiracy theorists distributed junk maps of Covid-19 cases connecting them to 5G mobile phone towers. As a result, I spent countless hours doing community outreach, health promotion work and endless individual consultations trying to debunk pseudoscience and explaining (often unsuccessfully) the risk-benefit ratios of vaccines. In the last year, we have seen outbreaks of pertussis, measles, chickenpox, hepatitis and influenza, often linked to pockets of vaccine refusal.
Medical doctors and scientists now face a barrage of anti-science, anti-medicine narratives, and it feels like we are losing the battle. We are no longer trusted instinctively. So how do we engage with people who mistrust us? How do we engage with the narratives that paint modern medicine as evil? The parents of Elizabeth Struhs appear to have truly believed that their God would save her. That they were acting in her best interests. They seem to have believed that science and faith were incompatible.
On the one hand, there are many good reasons to challenge medical practice. Medicine, and medical culture, is always evolving. Western medicine is emerging from a patriarchal, hierarchical way of operating. We all need to get better at listening, especially to those who have faced historical discrimination. Medicine holds the same biases as broader society, and these biases need unpicking.
We need better medical research, more social diversity among healthcare providers, affordable care, more inclusive clinical guidelines, better clinical communication, better teaching. We need to be able to better support those who are stressed, fearful, and not coping with the demands of chronic illness. We need systems that support health workers to take time, listen and thoughtfully acknowledge patients' concerns, especially for vulnerable families and children.
On the other hand, the amount of medical misinformation is overwhelming. For many, the promise of an 'all natural' cure is intoxicating: a simpler, purer way of life. As clinicians, how do we walk the tightrope of patient-centred care: how do we respect patient perspectives and preferences, acknowledge our limitations, while clearly signalling the often dangerous nonsense being peddled?
On a scale larger than ever, we see misinformation, false promises, faith-healing and fraudulent 'science' propagated by TikTok influencers, 'wellbeing' whackos, religious leaders, faith healers and some alternative medicine practitioners.
Also of concern, US president Donald Trump has signed an executive order to withdraw from, and defund, the World Health Organization, the global body for evidence-based public health. In recent days, he announced that he would attempt to halt PEPFAR's global HIV medicine distribution. If it had succeeded, it would have meant as many as 600,000 HIV-related deaths over the next decade in South Africa alone. Untreated, unchecked HIV could also mean worsening spread and drug-resistance across the globe.
These anti-medical narratives have consequences for individual patients, and for communities across the world. My patients are being denied, and in some cases are denying themselves, modern medicine that prevents disease and suffering. I don't know how to combat this, except to say that many of us are thinking about it. Worrying about it. Working on it.
Our worst sorrow is when vulnerable children who rely on parents and caregivers, are brought into care late, or not at all. In the news articles, little Elizabeth Struhs looks as vital and joyful as my own little girls. She had a well-understood medical condition, type 1 diabetes. It could have been managed. Instead of turning to the medical profession for support, her father turned to a religious group for psychological and logistical support. I am so angry. And I am so sorry that we have failed this little sweetheart: not just doctors, but all of us.
Dr Mariam Tokhi is a general practitioner, and teaches narrative medicine at The University of Medicine.
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