Now that we’ve defined medical bullshit, and know what we are looking for, we can ask, who are the agents and perpetrators of bullshit? — so that we know who we are watching out for. In understanding them on a deeper level, we can also start to see how they are also us, how the traits and desires that define their role are simply part of our shared human nature. This makes it even easier for us to see them clearly, and to catch our own behaviors that may perpetuate BS (e.g. spreading a wild internet claim because we like the attention). From here, we can move from anger and blame to compassion and healing, for both the agents of bullshit and ourselves.
The Quack (aka charlatan, conman, flimflammer) is the classic snake oil salesman who purposefully uses deception to sell you a product that they know is worthless. The modern quack is unlikely to be found going town to town with a wagon, or even to sell their wares in a store. The modern quack is online, is sophisticated (at least when it comes to selling sh*t), and increasingly works within large corporations.
The Guru (aka self-proclaimed medical expert, medical celebrity) can be found on television, on Youtube, in the media, and in the bookstores, often with a string of bestsellers under their belt. For the Guru, fame is the name of the game, and while they are not above deception, they really don’t care if what they are saying is true or false as long as it gets them attention and helps them to build their personal brand and following. While some Gurus may have done some legitimate work and study in the past (e.g. Dr. Oz, Dr. Bredesen), they found it too hard and too slow, so decided to take a short-cut to attaining the appearance of making real contributions to the world of health.
The True-Believer (aka the disciple, fanatic, proselyte) is so sincere it feels hard to accuse them of being an agent of bullshit. The True-believer, as the name suggests, wholeheartedly believes in the work they are doing, whether that be practicing homeopathy or selling supplements in a pyramid scheme. The problem is that no amount of sincerity or presence can make up for a lack of diligence and intellectual honesty. The unquestioning faith that makes them such a great disciple and caring healer is, ironically, the very blind spot that makes them prone to offering you dangerous and worthless products (with only the best of intentions).
The Sleepwalker (aka zombie, technician) is a healthcare provider who may be a competent technician but is not fully present or awake, is not engaged with the person in front of them. People may be disengaged due to sleep-deprivation (think long call shifts), burnout (from electronic medical records and other administrative drudgery), or as part of the intentional design of some “efficient” healthcare systems (see my friend Ray Dorsey’s wonderful article on the McDonaldization of medicine). This can also happen when providers get so focused on the technical conquest of disease that they lose sight of caring for people (i.e. the oncologist who hates cancer more than he likes patients).
While not yet as popular as bird-watching, I hope the BS-spotting catches on as a national pastime. If you think there are other categories I’m missing, please send them my way.