Dr Crankenstein

Medicine as a Vehicle for Insanity, Evangelical Medicine and MDs & Social Media

My feeling has long been that a lot of doctors really do want to help more people and expand their medicine as they can. I’ve worked with doctors like this who are concerned about obesity and its downstream effects for example, and want to offer more help outside of standard care.

Meanwhile, the internet has provided MDs with an obvious means of disseminating health information and new developments in medicine.

In this dynamic I tended to think most doctors mean well, but that doesn’t mean nothing can ever go wrong in this process.

For example, there’s an MD on here who has had some quite reasonable health content, and some interesting takes on medicine, but also exhibits some quite concerning behaviour.

This started for me, with the way he presented things initially. There was a certain amount of muddle, of repurposing of words people associate with other things to now describe familiar drugs.

His intention seemed to be get people to take these drugs. And I’m not even saying that’s wrong, where it’s appropriate. I’m just saying his language was obviously intended to muddle, to confuse, one might even say to misrepresent, with the intent to persuade. There was a striking lack of context for who these drugs were even for. They seemed to be for “everybody”. I’m not anti- any particular drug class on principle, but I don’t expect a doctor to be using the language of vitamins to describe certain drugs for example.

Then when he would start out on a new topic with,

“everything I’m saying is backed by the latest science”,

I suppose it could be perfectly innocent, after all doctors frequently invoke science to make recommendations. And I’m not the ultimate decider of how people should communicate, but it’s not something I would normally expect a doctor to start with.

Science is a backdrop that’s evolving all the time, it’s not static, and there are real limitations in what we call evidence based medicine, partly down to those interpreting it, especially if they do so without thought, treating it as a religious text. The pyramid of evidence based medicine is not sufficient on its own. Context and individual patient care matter a lot. To start out with science in that way, it’s the language of conversion, of convincing, of evangelism.

Now, he has no doctor-patient relationship with his readers (or the majority of them I imagine), but it wasn’t formal language based around informed consent. It was something else.

He seemed to be very interested—almost obsessed—in a cluster of drugs and getting people to take them. It’s quite possible some of his audience would benefit from some of these drugs, but when we’re talking about medical topics, clear communication is important. If you were a casual reader, you wouldn’t understand where he’s coming from at all, and who these drugs are indicated for. And he never explained it directly. You had to piece it together. You had to read between the lines to find out his focus is almost entirely in obesity related medicine, and that he himself has had significant weight issues, which he’s never really overcome by the sounds of it. So he sees the world fully through that lens.

I suppose I just felt some of his language and treatment of topics, even if one thought them well-intentioned were “un-medical”, some of it wrong, but that he was probably trying to get people to be a bit healthier who might have fallen through the net in some way.

Okay… My question is how much do we bend reality, how far do we go to get people not to fall through the net ?

But then the even stranger stuff would creep in.

His responses to comments were not always fully in touch with what the original comment was. His own replies were strange, evasive, sometimes barely related, sometimes nonsensical, almost like a bot had written them.

Then at some point I became aware I was getting “woke” American left political narratives rammed down my throat in his newsletter.

It’s “politics” that have done this to you.

A discriminatory “society” has done this to you and given you high blood pressure and made you obese and stopped you getting healthcare and destroyed your kidneys.

Genes don’t matter, they don’t determine anything.

That kind of thing.

In one case he was taking really bad unscientific activism, that through the policies of plurality and inclusion had wrongly found their way into publications, now as the basis of scientific and medical truth to pass on to his readers, probably taking advantage of certain sensitivities around some of these topics, that he could construe as “agreement”. That was an obvious problem. This was not science, and remember he had presented himself from the first moment as The Science Guy.

At this point, I just want to call this whole thing Evangelical Medicine™, where reality is a set of “feelings”, and then we use any kind of rhetoric, it may happen to be basically true or false, based on real information or fiction, to get someone you don’t know to take a pill, or adopt some lifestyle change.

Even if there is some good intention there, there’s an extremely questionable ethical basis in pursuing this, and I believe the truth, and open discussion matter more.

Despite all this stuff, I’d tried to be very nice to him over time, because very occasionally he has some really interestingly little bits and pieces, some of which I’ve reposted very selectively, once or twice.

But what got even more unsettling is when I realised he was deleting comments that might offer a different view to his own, or point out he’s got something wrong.

With me, I let it go the first time, although I could see it was happening to others too, sometimes people’s comments would vanish in real time from his page. If you ask him why he’s deleted a comment, he just deletes that comment too, so he doesn’t want people to know he’s deleting comments like mad.

It’s a bad sign this person is deliberately curating an audience of people who are not able to process or debate anything they are actually writing. Only people who agree or who hit “like” are allowed into this precious space. It’s an ill path anywhere, but especially around medicine, which requires open discussion and scrutiny.

It’s also a strong attribute of internet marketers. They don’t want critics, they don’t want people questioning the claims of the product, they just want a steady trickle of buyers, and they feel very entitled to rig reality in whatever way they please to get there.

Your Deleted Comments on YouTube

Perhaps in this case, this doctor justifies this to himself, as “medicine”, that he assumes his posts are so important and medically potentially assistive—that they might save one person from disease— that nothing should divert from their purpose. And that his, is a special grandiose mission as the saviour of obese and diabetic people. Under this doctrine, you can say or do anything you want, because you’ve told yourself this is as mission to “help” people.

But I wouldn’t accept that belief if that’s what he thought. I don’t think that’s a healthy or appropriate one for an MD to wallow in.

I think it’s more a case the guy has some issues and he’s using this platform, and his platform as a doctor, to spread his kind of evangelical medicine, along with wonky or certain crank political ideas too. He’s disseminating these ideas, mixed in among some more reasonable sounding health topics in his own private bubble.

We could say it’s his right to do that.

But it’s not his right to determine how people find his work. It’s not a right everyone has to agree with you. It’s not a right to not have anyone notice a mistake or and draw your attention to it, or your own inadequate behaviour.

Doctors are imbued with a considerable amount of responsibility and public trust. But it’s not a given anymore in this day and age. This trust actually has to be maintained, and science and medicine can also provide a lot of leverage and cover for personal bad habits and tendencies.

If others recognise something as incorrect in some glaring way, that’s what they have experienced. If others feel medicine may be being misused in some way, then that’s what they feel. Or if they notice some other major problem with tone or facts or intentions, you can’t stop them noticing it. They have noticed. It’s like a major fracture on an X-ray. We can’t unsee it or just pretend it’s not there.

And then, on top, if people notice you’re deleting comments all the time—one assumes to stop others noticing—then as I’ve said before, it’s not something we can unsee, the deletions are taken into account.

Maybe this is an example of someone a bit quirky, who isn’t fully calibrated to internet life; blogs and stuff like that. Such a person should be confined to their office, writing prescriptions for overweight and diabetic patients and not trying to opine on life, medicine or politics.

But when you come across this stuff you do wonder what they are like as a doctor and how they are making clinical decisions. Personally, it wouldn’t be my first choice to be treated by a doctor who’s behaving in this way online.

There is now a wider recognised problem with the way some doctors are conducting themselves on the internet.

However, sharing on social media also comes with significant risks, particularly when oversharing, being overly emotional, or getting too political. Physicians must strike a delicate balance between connecting online and safeguarding their professional integrity, patient confidentiality, and personal boundaries.

And the problems can be subtle or more overt. If your job as a GP for example doesn’t involve you wearing scrubs, don’t dress up in scrubs for YouTube. You look like an idiot and a con man. If you’re posing with your shirt off on YouTube as a doctor giving medical advice, you wouldn’t be my doctor for very long.

Or take another example. You’re a doctor on YouTube, and you’re using YouTube to promote your services, which include a pill mill you run, where you sell the controversial hair loss drug finasteride through your “three clicks” form service. If you lie in your video and say, “most people buy finasteride from my service” when your pill mill company only appeared a few months ago, and it’s obviously total bullshit, and then delete comments that object to the lie, the next question is, “What else are you lying about ?” and “What other lies are you trying to protect?”. That’s not a small deal for a doctor.

And that particular doctor climbed the YouTube ladder very rapidly via a stream of celebrity hair loss and celebrity plastic surgery videos, and an ironic sob story about himself.

But it gets far worse and more personal. Some doctors use of social media has resulted in catastrophic violations of ethics and the well-being of their own patients.

A lot of people feel there’s a thread of arrogance that runs through the profession of medicine. But being a doctor isn’t a licence to lie. Being a doctor doesn’t mean you’re immune from making bad decisions, mistakes or receiving criticism. It doesn’t make you are a perfect human being. It doesn’t mean different rules of discourse apply to you when you interact with non-MDs. It doesn’t mean you have the right to manipulate stuff unnoticed. It doesn’t mean your understanding outside of your area of medicine is competent or is exempt from challenge.

All of this is a shame, because as I’ve said, I tend(ed) to think a lot of doctors do mean well and seek to help more people. I get the idea.

But how you do it matters. If the mistakes and out-of-step behaviours stack up enough overtime and start to impinge on the better output, then people will inevitably make a judgement about you, and the ratio of harm to help you’re providing.

You can delete as many comments as you want to create a world were it seems no one notices, but that’s not an honest world, it’s your private hole of made up madness.

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