“It Isn’t Always Fun.” – Medical Charismatics
Essay
“. . . the dark side of charisma is narcissism.” Sherron Watkins. Enron whistle blower.
I picture medical charismatics as bright stars spinning away on the fringes of the medical galaxy. Finally, accruing critical mass from cumulative adulation and power, they fly off into their own orbits — as Astrae Charismae — when “charismatic” may become “catastrophic.”
Historically, medical charismatics have concerned themselves with “cures,” but even in the saner world of prevention there are those who promote a message based more on a “cult of personality” and their own desire for fame and fortune than on scientifically tested advice. Here I recount my experience with such prevention “superstars” and my wonder about their motivation.
Primary traits of the charismatic seem to be, in my admittedly amateur analysis, an over-weaning egocentricity, intellectual brilliance however self deceived, and ideas of grandeur warding off self-doubt and insecurity. These may be manifest by “show-off” behavior, by manipulation, by autocratic outbursts, and by all-consuming ambition. I have found our charismatic colleagues at the same time bright and intellectually curious, shrewd and scheming, and eloquent and persuasive. Waves of warmth and energy, of pathos and seeming caring, radiate from the charismatics I have known.
It appears to me that the charismatic requires, nay, commands absolute devotion and commitment, a loyalty that may eventually envelop and smother his colleagues and novitiates. The charismatic suffers no peers. No one is ever his equal.
Self-delusion, perhaps a primary characteristic of the charismatic, is preferable, no doubt, to premeditated fraud, but it is much more difficult for colleagues and society to deal with. Deluded sincerity probably creates greater havoc in the world than simple chicanery. Or, as Nietzche put it: “Convictions are more dangerous foes of truth than lies.”
The Number One issue for the charismatic and his sycophantic entourage is “The Hypothesis,” “The Baby,” “The Way,” “The Diet,” the “Widget,” or the “Gizmo” — to be nurtured and pampered, protected and apologized for, explained ad nauseam, and, if necessary, lied for, jailed for, or died for, whatever is required to hide its inadequacies and exaggerate its gifts to humankind.
The charismatic’s frequent wail is that his genius is unappreciated by the scientific establishment. Meanwhile, the charismatic often, willy-nilly, breaks the rules of scientific method, ethics, and decorum. He seems desperately to desire acceptance by the scientific community and may assume the trappings of academia, all the while acting like a naughty child to provoke the negative parental behavior it anticipates. An establishment Goliath appears a requisite for the brave and innocent David to take on — even to the level of mortal combat.
Some modern examples of medical charismatics portray the American Heart Association as the great non-believer, the powerful establishment Goliath to be outdone by the righteous, small-yet-perfect David. Never mind that perfect be the enemy of the good. To the self-righteous charismatic, the merely good is intolerable. The charismatic may use specious arguments, for example, not acknowledging that the American Heart Association addresses primarily a national goal of lowered average diet fat and blood cholesterol levels, while he, the charismatic practitioner, seeks maximal interventions and optimal behavior change for his high-risk, motivated (and usually affluent) patient. Both views are correct and desirable, of course; one for the population’s needs, the other for the high risk patient’s. The confusion of these separate needs is a story as old as medicine.
Eventually, the charismatic’s carelessness with facts, his stretching of hypotheses beyond the evidence, and his attacks on even those reasonable minds willing to listen, render him isolated. Finally, he is a spent star, no longer hot and no more credible.
Two prototypes of our time are, I suggest, Nathan Pritikin, who died a few years back, and Dean Ornish, who is very much on the scene today. Their talents and behaviors make them remarkably effective and widely influential but also put them beyond the pale — as charismatics.
Ornish speaks for himself. He and “his” diet (“Dr. Ornish’s Diet”) were well known in the halls of the Clinton White House. Today he nobly carries the battle against the recurrent fad for Dr. Atkin’s “high-protein, low carb” diet. Here I recount an illustrative personal story with Nathan Pritikin.
Pritikin
In the mid-1970s in Minnesota we were in the midst of the Multiple Risk Factor Intervention Trial (MRFIT). Steve Zifferblat was social science consultant to the National Heart, Lung, and Blood Institute and at the same time to MRFIT, in the behavioral aspects of risk factor change. Suddenly and surprisingly he left his elevated academic administrative position to join the great health charismatic of the day, Nathan Pritikin. Not long after arriving at Pritikin’s Longevity Institute-by-the-Sea in Santa Monica, Zifferblat sent me a note informing me that “Dr.” Pritikin (who was not a physician but rather possessed a doctorate in the humanities) would be appearing in the Twin Cities on a book promotional tour and could be available for a seminar if we wished to receive him at the Laboratory of Physiological Hygiene.
Thinking that it would be worthwhile to expose our faculty and staff to Pritikin’s ideas, and anticipating a free-ranging discussion, I accepted and asked Zifferblat what would be the requirements for the visit. Indicating that a slide projector would be needed, he added in jest, “and a bullet proof glass partition.” I replied that I could not promise Pritikin could be shielded from all barbs and sharp questions, but that our faculty was not malicious and would welcome his presence and that I would encourage an open and genial dialogue. In due time, all faculty and staff were invited to crowd into our small Stadium Gate 27 library to hear Pritikin’s message.
I met Pritikin in our parking lot as he arrived precisely on time. He seemed a fidgety, dour man, apparently so pressed for time that he came to the Stadium in a long, liveried black limousine. On descending, he instructed the driver to wait outside for him during the hour or so that he would take with us. In my experience of several decades, this was unique behavior for visiting dignitaries to Stadium Gate 27, including governors and congressmen. Nevertheless, we bade him a warm welcome. I made what I felt to be an appropriate introduction, after which he launched into a discursive, argumentative recounting of his views of the whole history and field of diet and cardiovascular disease risk.
Pritikin had effectively acquired all the relevant pieces of evidence and assimilated them into his personal revelation, forgetting entirely to assign any origins for his information. It was almost amusing to hear Pritikin describe the nutrient composition of the traditional Japanese diet, which he had incorporated into the Pritikin Diet Plan, with no acknowledgment that the exact composition he described was the one documented by the Seven Countries Study of Ancel Keys and colleagues, carried out from the very Minnesota center Pritikin was visiting this day. Remarkably, there was no word of acknowledgment of the origins of any of the evidence he exploited or any of the ideas he propounded. Such hubris, with the appropriation of others’ findings into a personal, “revealed” testament, is, I suspect, another characteristic of the charismatic — the opposite of a good scientist.
At the close of the discourse, Pritikin was questioned thoughtfully and respectfully, I thought, by our faculty and staff. When discussion moved at all toward confrontation, I tried to defuse the situation so that, I believed, we were responsive and hospitable hosts. We had not insulted him. We had not even challenged his lack of attribution or his misrepresentations and exaggerations, of which there were many. And we had been impressed if not awed by his conviction and intensity, and, yes, by his charisma.
A few days after Pritikin’s departure, I wrote a short editorial about his visit for our in-house MRFIT Clinic Newsletter that was sent to our Minnesota faculty and staff. I pointed out what I considered fact and what fiction in his message. And I opined about the characteristics of a presentation that failed to separate the two. Pritikin’s major conceptual error, I thought, was his failure to distinguish public health goals from individual goals for a healthy diet. I explained that I had invited him so that we could hear his point of view in the international debate about diet and heart disease and his apparent (then undocumented) contribution to the effective reduction of risk factors among selected well-to-do patients at high coronary risk. In my editorial I also punctured his “David” railings against the American Heart Association “Goliath.“ I pointed out the difference between an appropriate and feasible national policy goal for average diet change and a rigorous individual goal for high-risk persons, a point that he apparently never grasped. I discounted his petulant plaints that the AHA dietary goal is “a sell-out to industry,” and countered other terms of derogation that he seemed to use to bolster his exaggerations and perhaps aggrandize his importance.
At any rate, my commentary, directed solely to our laboratory staff was, I thought, a straightforward and unemotional if critical dissection of Pritikin’s presentation. I assumed that my colleague Zifferblat retained his scientific objectivity and so copied the newsletter to him. A few days later I received a special-delivery letter from Pritikin’s lawyers indicating that I should prepare for a libel suit.
I immediately phoned Zifferblat and followed up the call with an explanatory letter. I gave my view that Nathan Pritikin could not really have it both ways, as huckster and as scientist. I maintained my right and duty to criticize his presentation before our largely non-medical staff. And I pointed out that the newsletter Pritikin thought to be a nationwide MRFIT publication was our Minnesota in-house organ with a limited circulation. Pritikin’s libel suit never materialized.
Pritikin went on, of course, to greater fame and fortune. His successors have, I believe, appropriately documented his Institute’s considerable accomplishments in health promotion — among select, affluent individuals at high risk.
Wonderful people, these charismatics I have known. As a youth growing up in a parson’s family, I read extensively in the New Testament about the greatest of them all. My experience then and now leads me to admire the skills, effectiveness, and many good works of charismatics — but to trust or follow them — not at all.