Among other factors, gaps in doctor–patient communication and the public's poor health literacy create fertile ground for the spread of quack medicine.

Family physician Marta Velgan said the problem often lies in the fact that the healthcare system has simply become too complex. "People don't understand how it works or have lost trust because of a past negative experience," she said speaking for the Estonian Family Doctors' Association on the radio program "Reporteritund." Patients don't always know where to turn with their concerns and sometimes forget about their family doctor altogether, opting instead for paid private consultations.

Estonian Medical Association President Neeme Tõnisson agreed, noting that people's turn to alternatives may be driven by issues of accessibility. "If it's difficult for someone to reach their doctor or nurse, they might start looking for other sources and end up in the realm of alternative medicine," said the professor of medical genetics.

Health Board Director General Birgit Lao, however, said family medicine is not necessarily hard to access. She saw the bigger issue in people's lack of awareness about their options and their fear of being judged. "The fear of disapproval probably pushes some to anonymously search the depths of the internet for interesting solutions," Lao suggested.

Crisis of trust and communication

This makes communication between doctor and patient especially important. According to Marta Velgan, a doctor's response to a patient's doubts is crucial. When a patient feels heard and understood rather than dismissed, they are more likely to turn to their doctor with questions and concerns. "If a doctor gets angry or irritated and says, 'If you don't like it, then leave,' that's one thing. But another option is to truly listen, understand and at least leave the door open," Velgan said, describing common situations.

Neeme Tõnisson also emphasized the importance of communication, noting that people's approach to health is often more emotional than rational — and that applies to all sides. "I sincerely hope every doctor knows how to listen to their patient and thinks before proclaiming the truth in anger or from a patronizing stance," the professor added.

The medical community's lack of unity also points to a systemic weakness. According to Tõnisson, the Estonian Medical Association is concerned about colleagues who "sit on two chairs" — meaning they use their professional position to promote non-scientific methods. "You cannot be both a doctor and a healer at the same time; you must choose one or the other," he said firmly. Such behavior, he argued, undermines the credibility of the entire medical profession and confuses patients.

At the heart of the issue lies medical ethics. Tõnisson pointed out that the medical code of ethics obliges doctors to always apply the highest standards of care in the patient's best interest. If a doctor recommends methods without scientifically proven effects — such as homeopathy — this directly violates professional ethics.

Concerns about doctors' actions are not limited to professional associations. The Health Board has both the right and the duty to intervene if there is reason to doubt the competence of a licensed healthcare worker's advice. Director General Birgit Lao explained that such concerns may stem from patient or colleague complaints or from a doctor's own social media activity.

"In those cases, it's possible to speak with the healthcare professional, draw their attention to the issue and consult the Family Doctors' Association, specialist societies or a university to verify whether the advice is evidence-based," Lao said, describing the process. She added that Estonia plans to follow the Nordic model of stricter oversight, which would give the board the authority to temporarily suspend a doctor's license in cases of serious violations.

According to Tõnisson, the Medical Association itself has had to take tough action in particularly serious cases. When a doctor's actions have fundamentally contradicted the core values of the profession, the association has expelled them from its ranks.

Regulatory gaps

Gaps in legislation also contribute to the spread of quack medicine. The Health Board often lacks the authority to act against those who spread misinformation but do not directly sell dangerous products. Birgit Lao explained that the agency can only intervene when the person in question is a registered healthcare professional or when they are selling substances hazardous to health, such as chlorine dioxide (known as MMS) or "fly agaric chocolate."

Since last fall, the Health Board has been granted the right to conduct misdemeanor proceedings in such cases. "We've gained a little more power," Lao admitted. "But the question remains: it seems to us that the media is full of people who just talk but don't act. So what should we, as a society, do about that?"

Further confusion stems from the classification of dietary supplements and health products. Under current rules, they fall under the jurisdiction of the Agriculture and Food Board, not the Health Board. This fragmentation makes oversight more difficult and allows products to be marketed with claims that have no scientific basis.

Family physician Marta Velgan said she is troubled by the fact that pharmacies sell products marketed as health remedies, even when their effects are unproven. "All sorts of things are being labeled as health products. There's no regulation for what I can and can't call a health product," she said.

The Ministry of Social Affairs has discussed banning the sale of clearly dangerous substances — such as frog poison and MMS — in the same way narcotics are prohibited. According to Lao, the current Public Health Act is already clear enough to ban the distribution of substances that are demonstrably harmful and have a proven laboratory effect. However, this does not extend to, for example, homeopathic preparations. "That little sugar pellet that supposedly performs miracles probably doesn't fall under this category," she noted.

Solution in cooperation and education

All the experts agreed that tightening legislation alone will not solve the problem. According to Estonian Medical Association President Neeme Tõnisson, the long-term solution lies in raising public awareness. "We need to improve both health and scientific literacy so that people know how to look for sources that are based on actual research," he emphasized.

Cooperation among government agencies, doctors and patient organizations is key. Both Marta Velgan and Birgit Lao said it is crucial to involve the Patients' Union to better understand why people turn to alternative medicine in the first place and how to reach them more effectively.

Family physician Marta Velgan expressed skepticism about the impact of traditional awareness campaigns. "In public health, especially when it comes to changing people's behavior, we know that awareness campaigns are the least effective — they just don't work," she noted. Even when doctors share good information, social media and the internet drown it out with ten times as much noise.

In addition to prevention and education, Lao said more attention should be given to the consequences of pseudotreatments — what happens when people abandon evidence-based care. "It's important to share real stories," she said. "The issue isn't what I choose, but what the outcome is. And we need to talk about those outcomes." She stressed that everyone's right to choose comes with responsibility — especially when that choice affects children or other family members.

Ultimately, the best defense against quack medicine is critical thinking. Lao recommends doing a bit of detective work with any piece of advice: "Make sure the person giving it is qualified. You wouldn't ask a hairdresser about chimney sweeping. Do a little homework — if you've made it to the internet, you can also check their credentials."

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