An alternative way of thinking
I have had many responses to my previous columns on alternative medicine, where people have argued I am wrong, and that thanks to their experience, they know that remedy X is effective,
writes Skeptic Simon Perry.
So, if I and the scientific community are saying the majority of alternative treatments do not work, how can we explain why so many people believe in their efficacy?
Very easily.
I find the psychology behind what makes people believe in nonsense fascinating, and by getting to know the mistakes of reasoning that people typically make, you can protect yourself from being drawn into mumbo-jumbo healthcare.
I will be detailing the most common errors that lead people to believe in quackery below, but first let's first cover the placebo effect.
The placebo effect is fascinating. It doesn't work for everything, but the drama involved in a medical intervention can often be more powerful than the medicine itself.
One idea is the placebo effect evolved in animals as a way of knowing where the body should direct its resources.
When under stress, the body ensures all its resources are available for basic survival.
However, when you feel you are being cared for and helped, the body realises it does not require all of its resources for basic survival and directs more towards healing a particular ailment.
The placebo effect has been shown to help with pain, stress, mild depression, bruising and even stomach ulcers.
I do not believe the placebo effect is a significant factor in why people falsely believe in alternative treatments and there are two reasons for this.
Firstly, belief in the efficacy of these treatments for disease for which a placebo effect has not be demonstrated is widespread.
Secondly, people have been shown to believe in efficacy of treatments that make the patient worse.
One reason behind false beliefs of efficacy is the human mind's tendency to be convinced by anecdotes.
When someone tells how they took X remedy and then got better, there is no way of you knowing if the improvement was caused by the remedy, by a conventional treatment they were also taking, or if they just happened to get better.
In addition, anecdotes are subject to massive reporting bias.
Take 100 people with an illness with a 10% chance of clearing up by itself and give them a sugar pill. You can bet the 10 or so who got better after taking the sugar pill will be telling everyone, while the other 90 will have nothing interesting to report.
The biggest victims of reporting bias are alternative health practitioners. Those who don't get better after visiting a quack for the first time don't return.
Those who happen to get better anyway go back with stories praising the quack's ability.
By the nature of the way quackery operates, the quack ensures they are fed a constant stream of heavily-biased anecdotes. It's no wonder they'll tell you they "know" it works.
A slight improvement on the anecdote is to run a series of case studies. By deciding to track a number of patients at the start of the process rather than just selecting those who get better, you remove some of the bias.
As an extreme example, if you were to show me five people with missing limbs who, after going through a therapy, had their limbs grow back, you'd convince me it worked.
I am not persuaded by an example cited by the British Chiropractic Association as evidence about the efficacy of chiropractic treatment in the treatment of infant colic.
My understanding is that infant colic generally clears up by within a few weeks. If you take 316 children with colic then assess them a few weeks later, you are likely to find most would have got better.
So a case study showing that 94% got better a few weeks after receiving spinal manipulation does not persuade me chiropractic is effective.
Another error of reasoning can come from what is called "regression to the mean". The symptoms of most diseases vary over time, sometimes feeling better and sometimes getting worse.
We are drawn to seek help from a doctor or quack when these symptoms are at their worst.
And when symptoms are at their worst, guess what happens next? They get better.
Homeopaths have a prepared excuse for when their patients don't visit them when it is exactly at its worst point. According to many homeopaths, after treatment your symptoms may get worse before they get better.
Is there any scenario, other than the patient's death, that could not be taken to confirm the homeopath's hypothesis?
Once belief in an alternative remedy has been established, it will take significant evidence to shake this belief.
Psychologists tell us our brains suffer from a problem called "confirmation bias". We place more importance, and are more likely to remember, evidence that confirms what we already believe.
Someone I knew used an alternative therapy in place of conventional medicine to treat his bronchitis.
It took months before it cleared up. When it got better, he credited the therapy. He ignored the fact it took significantly longer than normal to get better.
Present a reflexologist with anecdotes about a reflexology miracle cure and a couple about where a patient got significantly worse after an identical treatment, and you can bet which two anecdotes they'll remember two months later.
If someone gets better after receiving an alternative treatment, they are likely to believe the treatment was the cause of their recovery. I've met people who believe the alternative treatment was the cause of their improvement, even though they were going through conventional treatment at the same time.
Often people try alternative treatment after alternative treatment hoping for a cure. When they eventually get better, they credit whatever treatment they'd happened to be having at that particular time.
To be confident a therapy works, put it to the test with a randomised, controlled trial. Alternative therapists will tell you trials are expensive and there isn't the money to run trials on their particular interventions, but this is not true.
Homeopathy has been tested for different diseases in randomised controlled trials and collectively these trials show no effect.
The US Government has spent over $120m a year on training quack practitioners and testing everything from acupuncture for lower back pain (doesn't work) to Ginkgo Biloba for dementia (doesn't work) through funding body NCCAM (National Centre for Complementary and Alternative Medicine).
NCCAM has wasted this money to find hardly anything beneficial.
I say "wasted" because although it is of value to be aware that these treatments do not work, it's a huge waste if once you've discovered they don't work, the therapists keep selling the treatments anyway.
The quacks are not waiting for research to find out if their treatment works.
They're waiting for research to back up the opinion they've already formed.
Research showing anything else will be ignored.
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SIMON PERRY belongs to a group called Skeptics in the Pub which seeks to rigorously and openly apply the methods of science and reason to commonly held beliefs and claims.
Skeptics in the Pub is a monthly lecture series held in cities, including Leicester.
Speakers are usually scientists or a prominent sceptic and talks range from subjects such as alternative medicine to religious beliefs.
13 Comments
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by Steve, Leicester
Wednesday, February 03 2010, 10:30AM
“Good article.
Most people are only too happy to look for any kind of cure when they are ill, whether that be a synthetic cough syrup or naturally occurring honey in a herbal tea. In my opinion, if most people were more in tune with their bodies when they were healthy then they would prevent the vast majority of illnesses they have in the first place.
The human body has evolved over millions of years to preserve itself. If you only ingest natural things in the first place (ie fresh fruit, vegetables, lean meat, fish and dairy) and maintain an active lifestyle, with plenty of fresh air, then chances are that you will get ill far less frequently. As with all the recent TV ads too, washing your hands is a good way of keeping those winter sniffles at bay.
If you can accept that once a year you may well get a cold but that it will disappear within a week or so then you're on the right track. You aren't going to die from it so take a day off, keep hydrated and rested, then carry on as normal.
All old wives tales? Or just common sense?
Take a wander through a major frozen foods supermarket where people are doing their weekly shop and have a look around. Now try popping to a local farm shop and looking at their clientele. Now I'm not trying to be snobbish or judgmental here but which set of shoppers looks the happiest and healthiest?
If you get to know your own body then you will KNOW when something is wrong, and it's for occasions like this when our health professionals are needed.
I have not been to a GP in since I was 15 (I'm now 30) but 5 years ago I knew something was wrong and had to go into hospital. At this point the excellent staff at LRI (my sister included) took me in for the night, gave me some antibiotics and sent me home for some rest. A week later and I was A1 again.
My personal opinion is that if everyone took it upon themselves to look after their own body then this would free up a lot of doctors/nurses time and provide everyone with a more efficient health service for when people really do need it.
You could consider me an alternative health therapist if you like as I went back to college to study sports massage therapy. This has a whole range of uses but the crux of it is that it's a complimentary therapy, ie complimentary to a healthy lifestyle. No matter how much I effleurage Wayne Slobs legs it is not going to make him Usain Bolt!!!
With regard to homeopathy specifically, I generally agree with Simon here. The one thing I would say though, as evidenced by the recent Gallowtree gate experiment, is that if you want to go ahead and use a homeopathic remedy then fine, do so, it won't do you any harm (finances withstanding). Please, get the basic lifestyle right first though!”
by JB, Leicester
Wednesday, February 03 2010, 9:10AM
“@ Patrick, Germany. The question of natural products is a little misleading. "Alternative" and "complimentary" treatments are those for which there is no evidence to show they work. Those which are shown to work form part of mainstream medicine.
Simon, Good article.”
by Patrick, Germany
Tuesday, February 02 2010, 2:48PM
“Are we to understand that acupuncture does not work in general ? It is now used successfully for various NH treatments throughout Europe.
Now what about your "real " medicine treatments? Wasn't penicillin a natural product ? Fleming saw the possibilities and the rest is history. Given the the three most important groups of medical products in the last 60 years are antibiotics, steroids and prostaglandins and that all are naturally occuring items why should not other natural products function.
Declare you interest Simon !”
by Ricardohere, Gloucester
Tuesday, February 02 2010, 2:46PM
“Another great post Simon...
Thoroughly recommended further reading for all matters regarding the mind's seemingly infinite power to fool itself:
Stuart Sutherland's 'Irrationality'”
by Rob, Belfast
Tuesday, February 02 2010, 2:33PM
“The point is that these folks make claims like double-blind testing stops my particular treatment from working testing has no value because I know it works.
I hate to break it to some people but claiming that by testing a claim about a treatment it prevents the treatment from working utter nonsense (and I'm being charitable in my phrasing)
@Jane, Errr so you are saying that all studies are worthless?
Hmmm that bodes well for alternative therapys then, maybe that makes them even better because they don't work in "controlled studies"
As for the effectiveness of antidepressants not being effective, I suggest that you are being somewhat selective (if not dishonest) in your statement.
Not every form of depression is suitable for treatment with antidepressants, lets see how do they find that out and which study will the woo supporters latch onto (and misrepresent)?
I suggest the diversion regarding the gold standard shows you are attempting to be pedantic and have nothing particularly worthwhile to say.
@LS not always 'psychologically deluded' ignorant (using the proper meaning of the word) or misinformed are also possible.”
by Sam Cook, London
Tuesday, February 02 2010, 2:27PM
“Jane what's your first point about? "Gold standard" is just a phrase.
As to emerging evidence I can't comment on prozac etc but if a treatment is shown to not be effective then it shouldn't be administered: doctors are just as susceptible to confirmation bias as the rest of us, they just tend to base their treatments on a grounding of evidence that has been shown to work these treatments (should) then evolve with new evidence.
When it comes to trial design "gold standard" has a specific meaning for medicine: double-blind randomised trial with suitably large population. The trial is carried out without the people conducting knowing who gets a placebo and who gets the treatment. The results are then processed according to the plan set out at the start. The results are then the results. The analysis that they do on results is used to account for difference in age etc these are valid statistical manipulations that do not change the results: all they do is adjust them based on other factors. eg in a cancer study if it is known that as age increases the chance of a particular cancer increases by 0.01% every year after age 20 then the found chance of a particular cancer in a 21 year only will have 0.01% removed from it so that the 21 year old's chance can be compared to that of a 20 year old, NB this is not how its actually done but a very crude example.”
by fed up, leics
Tuesday, February 02 2010, 2:22PM
“LOL good job your best mate (Zeno) is there to back you up Simon. As per usual the only positive comments you get are from your mates on twitter, who you have just directed to this site. Keep up the good work of patting each other on the backs.”
by HJ, London
Tuesday, February 02 2010, 2:09PM
“LS,
I've searched, and that 'psychologically deluded' quote of yours is not in this article.”
by Neil, Leicester
Tuesday, February 02 2010, 2:03PM
“LS, if thinking and behaving in a manner that's not rational can't be described as 'psychologically deluded' then what can?”
by Jane, USA
Tuesday, February 02 2010, 1:16PM
“The basic problem with the anti "quackery" movement is that it holds a faith based reverence for the "gold standard" controlled study. The very name "gold standard" shows an obliviousness to the real world. The term gold standard comes from economics, when up to around post WWI, all currency was backed by gold bullion. Then, it was found there wasn't enough gold to cover the currency and I think they went on the silver standard (Pounds Sterling) and then to the current floating rates where money is worth what it is believed to be worth, mitigated by countries arbitrarily devaluing and upvaluing their currency value relative to the other countryies' currencies. So if you want to be gold standard, you are way behind the times.
More concretely, researchers have become so sophisticately about designing controlled studies, they can get most any resutl they want, but by controlling dose, subjects and even placebo content. Conversely, one can criticize most any study for the same reasons. For example, prozac and other antidepressants are now shown after thousands and thousands of studies showing their "efficacy" to probably not be effective at all. Yet doctors keep prescribing them! Way to go, quacks!”