In the mostly excellent Netflix series, Apple Cider Vinegar, we follow the stories of two young women, one who fabricates a diagnosis of cancer as a path to creating a successful nutrition podcast, and another true cancer victim who eschews traditional medical therapy in favor of alternative nutritional treatment. Of course, the first woman is exposed for the fraud she is, and the second succumbs to her foolishness by diving into a sham alternative medical cult.
The lessons are clear. Those who buck traditional doctors and medicine are doomed to fall prey to their own lethal misconceptions. And those who are preaching nutrition and alternative treatments are likely to be charlatans and frauds. All the doctors in the show are the very beacons of scientific and humanistic integrity, offering salvation through the lens of scientific certainly. When one of the doctor heroes, an oncologist, is asked how she knows that nutritional and alternative treatments are not effective, she simply says: Because I went to medical school.
That’s funny, because medical school doesn’t teach anything about nutrition or alternative treatments. Doctors are taught to treat with drugs, they are taught that there is only one right answer, they are taught that alternative treatments and “food as medicine” are unsubstantiated and don’t work. Doctors may say: eat well, but they don’t know what that means, nor is that a large part of the program they offer to their patients. At best, it’s just going through the motions. A recent article in one of the drug-company written medical blogs that come to me suggested that while Kennedy is pushing nutrition, doctors don’t have to be told that because they already know enough about nutrition. Really? Because they are not taught anything about nutrition, they are taught to push drugs and other aggressive treatments, and they definitely know nothing about alternative treatments. They basically push all that “nonsense” to the side.
Which is tragic because in areas of the world in which people largely neglect traditional medical treatments and rely on alternative treatments, good diets, and ample exercise, they live far longer than we do, have fewer chronic diseases and less cancer than we do, and are healthier for most of their lives. Reality puts a dagger into the arrogant and fallacious claims of our white-coated saints who show up on TV and invariably save the day. Sure, a few bad egg doctors are often exposed on TV networks, but it’s only because they too veer from the medical norm and go off on their own. Why are we so quick to extoll our horrific and over-priced medical system and demonize any who dare offer an alternative, or even complementary, philosophy of care?
Well, we can look at the money. This show is all about how oncologists, or cancer doctors, are heroes and saints and whose treatments are the only path to wellness. But facts don’t bear this out. We spend a lot of money and effort convincing patients that they must look for and eradicate all cancers, that there is only one way to do it, that any and all cancers must be eliminated by the doctor's dogmatic (and well-reimbursed) singular approach. Take prostate cancer, a multi-billion-dollar industry predicated on finding even harmless cancers and then slamming people with drugs and treatments that do not extend life at all but provide an illusion of cure while also providing life-altering side effects. Take most skin cancers, that are usually dormant if left alone but whose removal has vaulted dermatologists into among the highest paid doctors by scaring and fooling people. Take treating late-age breast cancers, and so many others, that have been definitely proven to be better off left alone. The oncology community has a long history of deception, creating a feasible narrative that finding and fixing all cancers through draconian interventions is helping us become survivors. Facts speak a different language.
Most oncologists I know and work with are genuine, caring souls, some even are willing to talk to patients about diet and exercise—all proven to lower inflammation and prevent and ameliorate diseases like cancers—but their gaze is clearly on drugs and interventions. And they get paid very well when they convince their patients to go down the drug route; that alone, not their care or their brains, has vaulted to them to the top echelons of doctor incomes. An academic oncologist I know well, and someone at the top of his field, has bemoaned that most of his students and colleagues will find any study out there—most published by drug companies and clearly flawed—to justify the use of chemotherapies that put the most money in their pockets. This is not a unique view. Many conscientious doctors and journalists have pointed out that doctors often convince patients to follow a path that is most financially beneficial to the doctor.
Thus, when media and fictional dramas depict wise, caring cancer doctors as offering the only hope for a bleak disease, they are perpetrating a dangerous myth: that there is an oppositional binary pitting compliance to the medical dogma preached by doctor-saints against that of eating well and trying alternative treatments. Why can’t they both be true? Why can’t some of the medical interventions offer succor (and some not so much) and also the use of diets and alternative treatments help as well? Because, if that were the case, oncologists would not be in the top ten of doctor incomes; their salaries are contingent on convincing patients that drugs are the only way out of the mess they are in, and those drugs are typically the ones that provide them with the most reimbursement. And of course, the entire pharmaceutical industry would suffer if patients used data and common sense to treat a disease that can often be ameliorated in a multifaceted way that includes diet.
In our politically charged world, this binary has played out in the battle between scientifically motivated politicians like Joe Biden and quack medical misinformers like Kennedy. But few know, or care to know, that Biden is one of the most heavily subsidized politicians by the drug companies, and that his “moonshot to cancer” was a complete sell-out to drug companies so they can market their wares long before the drugs have been sufficiently scrutinized to prove benefit and prove no harm. Kennedy, on the other hand, wants to emphasize diet and exercise, not as a binary opposite of traditional treatments, but as something complementary. He also wants to lower reimbursement to doctors who are paid by testing, drugging, and doing procedures, removing what is a pernicious conflict of interest that pushes even well-meaning oncologists to consistently eschew anything other than strong drugs. But by creating this binary, by highlighting stories of successful cancer survivors who received traditional care vs cancer victims who strayed from the medical liturgy and died, we are erasing the common-sense middle ground and creating a fiction that only with draconian treatments can anyone survive.
The us vs them binary, as we explore in our book A Return to Healing, began in 1911, when our system was pushed on a course of testing and drugging rather than using common sense and patient-centered science. When the AMA, the drug industry, the Rockefeller Foundation, and academic medical bemouths created the Flexner Report, they decimated all but drugging from their medical armamentarium. They misused science to shove it in the direction of maximum profit, relying on German notions of lab testing and Eugenic principles of absolutism to enshrine the doctor-as-God ethos we live with today. To do this, they pitted their scientific approach against the barbaric brutality of charlatan patent medicine salesmen, no less a binary than is presented in shows like Apple Cider Vinegar. For the last 100+ years, that philosophy of care—test, test, test, fix, fix, fix—has been normalized, relegating nutrition to the basement of deception and assuring that the medical budget flows toward doctors, drugs, and tests and none moves toward nutrition and prevention. That is the very fuel that has pushed our healthcare budget over $4 trillion even as the burden of chronic disease increases and longevity decreases.
A recent Atlantic article by David Frum entitled “Why the COVID Deniers Won” demonstrates the power of that binary. I recorded a podcast about this that dissects how dangerous this article is. What is COVID denial? Frum defines this as anyone who questioned the liturgy of Fauci and the CDC, anyone who dared dispute the efficacy or brought up problems with the vaccine, or anyone who suggested alternative ways of confronting the virus or daring to suggest that in most people it was very much like the flu. He actually blames our poor outcomes from COVID on those who refused the vaccine, using absolutely bogus manufactured data that are so misleading as to make anyone conscientious tremble. He refuses to point to things we did wrong, the problems with the vaccine, or any other nuance. It was us vs them. And the fact we had the worst outcomes in the world, that kids suffered and continue to suffer, that all the “science” spit out of Fauci’s mouth has been completely debunked, all of that is the fault of the “others,” the “COVID deniers,” not the fault of a self-serving, deceptive, and dysfunctional medical system.
But as we know, despite the us vs them narrative of Apple Cider Vinegar and the Frum article, there is always a third road, one that is patient-centric and scientifically valid, one that does not sit on the edges of us vs them but rather is right in the center. This was Osler’s path. Throughout his career, Osler was skeptical of corporations and drugs (yes, he was one of those “others”), he derided the self-serving top-down dogmatism of groups like the AMA, and advocated a science that matched patient-centered common sense and critical thinking with robust data. Osler believed in some medicines, but not many. As he said: “The young doctor prescribes 20 drugs for every disease, while the older doctor prescribes one drug for 20 diseases,” noting that, “One of the first duties of the physician is to educate the masses not to take medicines.” He understood the value of nutrition, the danger of too much testing and drugging, and he believed that doctors must listen to patients rather than dictate to them. “If you want to know what’s wrong, ask the patient,” he said.
All of which is absent from today’s binary medical system that posits only two paths: that of tests/drugs/treatments provided by wise, white-coated doctors, or that of sham treatments that are being pushed to enrich swindlers at the expense of your own health. Thus, to be a compliant soul in America’s medical industrial complex, we must cringe at the villains of Apple Cider Vinegar as we applaud the brave and thoughtful doctors. That is the goal of binary demonization. By pitting something obviously crazy against what that which you seek to extol, all the sudden your guys look normal. By erasing the sensible, common-sense, and nuanced “center,” the medical establishment can rest on its dysfunctional but self-serving norms. Frum did this brilliantly in his article (often by twisting facts and engineering data), and so does the script of Apple Cider Vinegar. The poor girl who leaped upon the deceptive train of alternative medicine dies. Had she listened to her doctors, she would have lived. That’s the binary. That’s the lesson. There is no middle ground. Because American medicine is built with one-right-answer bricks, the middle must disappear, and otherness must be degraded for the one-right-answer to be unassailable.
How would a good Oslerian doctor approach the situation in Apple Cider Vinegar? By using a patient-centered gaze that acknowledges the benefits and limitations of all interventions, she would look beyond the binary and land squarely in the middle. If Osler had his way, doctors would not be paid more if they give you drugs, tests, or procedures. If he had his way, doctors would be up to date with their knowledge of nutrition and alternative treatments, not putting those in some drawer beneath that of traditional medicine. If he had his way, doctors would truly care about what the patient wants, what she is afraid of, and find the most effective path forward that uses the breadth of our scientific knowledge juxtaposed with a patient-centric roadmap.
“I understand your concerns,” she may say. “You don’t want your arm chopped off, you don’t want to fill your body with poisonous chemicals. And I agree with everything you’re saying about eating well, using food to fight cancer cells, that all will help tremendously. But I looked up that place you want to go to in Mexico, and it scares me. Their outcomes are not good. We can design a similar plan that is more common sense and less dangerous. And we can start that way. But with these cancers, even if we agree that chemotherapy may not be the best approach, the amputation likely is the best way to assure we keep you healthy, and I’ll explain why. I will also put you in touch with people who had similar amputations so you can see how their lives moved forward. Just think about it, and I’ll give you all the data and information I have, and let’s meet again in a week or two and we can come up with a plan together. But for now, let’s talk about a good diet.”
No, that may not make for good TV drama, and David Frum would cower at the depiction of a doctor who is willing to listen to the patient and work with her rather than slamming her with dogmatic proclamations that she must obey or else, but isn’t this what we all want in a doctor? And Osler had it figured out 100 years ago, before the self-serving doctor lobbies and corporations pushed us down the us vs them path of profit over patients. Let’s find that middle road again. That’s what we try to lay out in A Return to Healing, and what most patients truly crave. Doctors in white coats who are arrogant and bombastic thrive by scaring you and then selling you their wares. But they are no better than the sham alternative medicine providers depicted in the show. Both are equally dangerous. Both are equally polarizing. The middle ground is where we all want to be.
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