Personal views: Internet therapy
Authors: Claudio Crisci
Journal: BMJ (2001)

Diagnosing an untreatable illness is a bad moment, and explaining it to a patient is even worse. This experience is unusual for Italian doctors, who usually prefer to tell the patient's partner or relatives. It is then up to them to decide whether or not to let the patient know about his or her fate.

This is not ethical practice, nor is it right to treat patients as children, but it is common in Italy, where we are not taught how to deal with patients or how to give bad news. Our Latin culture and famous sentimental attitude still reject the idea of an inevitable death. We prefer to ignore it and pretend there will be a happy ending.

So it was unusual for me to explain to my patient and her husband that she was suffering from a fatal degenerative disease of the nervous system and that the only useful drug would probably only delay her death and prolong the agony for her and her family. I was compassionate but precise and sincere and suggested how they could prepare themselves for the remaining few years. 

I saw the couple again two years later. The patient had seen several other neurologists, more authoritative but less direct than me. She was already connected to a ventilator, being fed with a tube, her body as well as her life almost destroyed. They told me that no one had clearly explained what was going on—or were they preferring to ignore the reality?

It was then that the patient's husband, browsing on the internet, found “The therapy” for her disease. In a well written and meticulous way, it stated that “The therapy” had already saved the life of its inventor, and for about $1000 (£625) every patient could be treated in the same way and be healed. The whole thing sounded very convincing to lay people, although it was clearly stated that “The therapy” was not yet recognised by the US Food and Drug Administration.

They asked me to try this last magic. At first I was quite angry. I had spent years studying neurology, and now an electronic swindler, with two well written lies, was con-sidered more reliable than me. Why not a pilgrimage to Lourdes? The odds were the same, but “The therapy” advertised on the internet and offering a kind of machine had a more scientific appeal.

I discussed with colleagues the unethical practice of making money out of patients' desperation. I thought that these miracle cures should not be available on the electronic highway—the symbol of progress and science—but someone reminded me that you can buy almost anything on the internet, good or bad. Why not the hope of escaping from a certain death?

I wasted a lot of time trying to convince the family that the therapy was really an expensive placebo and that to rely on it would lead to useless and stressful suffering. The couple insisted, and I agreed to play the part of apprentice wizard using “The therapy.” I set up the whole procedure and trained the nurses and the therapists, instructing them to act as if it was a real treatment.

I feel very uncomfortable in this role, cheating on the woman with daily visits in which I prepare “The therapy” for her. But the tired smile on her lips and her insistence on feeling better (a good placebo effect, I admit) win me over and I keep on with the play acting, inviting her to think positively and let the force of nature enter her as is suggested in the rigorous instructions. She is dying happy and hopeful, and that is what her family wants. But I think that she knows the true situation, and that she, like me, is playing a part, trying to cheat on herself to make her family more comfortable.

After all, it is not always necessary to tell the truth, nor is it useful if the patient does not want to listen and when the internet offers a last unreasonable hope to die with.