When I was little and my family went on vacation, I would walk onto the plane and my eyes would be drawn to the cockpit. All of the lights, knobs, buttons, and switches were so cool! What I didn’t know was that the crew spent a lot of their time not playing with the cool lights but running checklists over and over. That’s why planes take off and land again with everyone in one piece.

Like everyone else, doctors make mistakes, sometimes big ones. As in aviation, checklists play a part in hospital safety, and that didn’t happen by accident. In the early 2000s a doctor at Johns Hopkins named Peter Pronovost decided to ask some big questions about hospital safety. Specifically, he wondered if a checklist-type system could help prevent infections in the intensive care unit. The study was done right here in Michigan, and it was deceptively simple, for example making sure doctors washed their hands before procedures.

And you know what? Creating a systematic, science-based approach that was simple and inexpensive nearly eliminated these sorts of infections. This is one of the things I love about science and medicine, and this is what distinguishes real medicine from everything else—the use of good science to inform our practices and save lives. More important, we change our practices based on real science rather than doing the same thing over and over again. We are always looking for the ways in which we’re wrong and trying to correct them.

And it’s incredibly complicated. Take intravenous catheters (IVs)—in the Pronovost study they looked specifically at catheters that go into the largest blood vessels. But many, many more people have regular IVs all the time, and while it may seem routine, it’s anything but. For example, there is a ton of medical literature looking into when an IV is actually needed. There are studies on exactly which fluids are best in which situations. And there is the safety of the fluids themselves—not just their sterility, but their “pyrogenicity”—if an injectable fluid isn’t tested correctly for bacterial endotoxin, it can be very dangerous. Sterilization can’t fix this—endotoxin is detected using, of all things, blood from horseshoe crabs. Everything we do in medicine has potential dangers, some obvious, some not.

This is one of the many reasons medical spas scare me. When you get an IV at a medispa, you aren’t dealing with professionals running safety checklists. You aren’t usually getting IV solutions from the major medical manufacturers, with all the layers of safety. There is no reason to believe they are sterile or non-pyrogenic. And you have no idea what kind of training or experience the spa workers have.

If something as “simple” as an IV can be dangerous, what about more complex procedures? Today I grabbed a bite of lunch at a little Mexican place down the road. On the way I passed a “hyperbaric treatment” facility. This scares me and it should scare you too. Hyperbaric chambers—where you are sealed into a high-concentration, high-pressure oxygen environment—are used to treat the bends, an illness SCUBA divers get if they surface too quickly. They are also used to treat certain complicated infections. But they are also used by quacks to treat just about any condition you can think of, such as autism or ADHD. The results can be deadly, as in last year’s accident here in Michigan in which a young boy was incinerated inside one of these devices.

I shouldn’t have to say this but there is absolutely no reason to use hyperbaric treatments for autism or ADHD—ever. This case is headed to trial but in my opinion it’s clearly homicide. Yet we continue to allow these centers to operate.

Medicine is very complex, and potentially dangerous. The amount of research, effort, and moment-to-moment attention that goes into keeping it as safe as possible is difficult to comprehend. Running a spa that offers IVs or a clinic that gives hyperbaric treatments for unproven reasons is like handing controls of your plane over to some guy who watched a lot of YouTube videos.

So, no, you shouldn’t get medical treatments from sketchy places. If they have warnings that the treatment isn’t approved for the purpose, disclaimers, waivers, and want cash, they probably aren’t a place you should go for care.