Archives for posts with tag: alternative medicine

QED is the UK’s largest conference on science and scepticism. It’s a get together for people who are passionate about science and evidence in contemporary culture and current affairs. It takes place yearly in Manchester and it’s now in its sixth year. This is my fifth year attending. As ever, it was a wonderful conference. We were really spoiled for choice this year with many tracks taking place simultaneously, so until I am able to master bilocation or out-of-body travelling, this is my account of just a small sliver of events happening over the weekend.

YouTube Debunkery!

The intro video this year was really superb, with production values in the stratosphere. It became clear how this was done when the speaker for the conference, Alan Melikdjanian aka Captain Disillusion, gave us an insight into how he makes debunking videos for YouTube. It was an incredible presentation, complete with audience polls, interpretive dance, hater comments, bad 90’s Powerpoint, arguing with himself on video, all done flawlessly with maximum comedic effect. The slides looked beautiful too.

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In terms of technical presentation skills and using the different types of media to communicate a message, this was one of the best I have ever seen. Really, truly excellent.

Here’s one of his videos.

Good Advice, Bad Advice!

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The next speaker was Petra Boynton, an advice columnist with the Telegraph. She showed how advice columns are a very old and venerable part of print media for over 300 years, and in many ways, they have not changed that much. It was interesting to hear how careful columnists needed to be, as context is everything. She very much sees this as a kind of public service, particularly when access to professional help has been cut back in recent years.

Naturoquackery

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The next speaker was Britt Hermes. Britt had a very unusual story to tell. She thought she was a doctor, then found out she wasn’t. Britt studied naturopathy in Bastyr University in California, where she was indoctrinated in alternative medicine. Even though there was a small amount of medicine taught, everything was solidly encased in new age woo.

I’m taking down these notes and I’m thinking “Wow. These doctors are so stupid.”

During her studies, Britt went to Ghana. She learned to give intravenous injections of ineffective medicines to people who were very sick. She then went to Nicaragua where she dispensed homeopathic products to treat cardiovascular disease.

When she graduated, she started teaching in Bastyr. She moved to Arizona under Michael Uzick, which was where the wool was pulled from her eyes. Uzick appeared to be involved in a dangerous, so-called cancer drug called ukrain. She reported him to the authorities, with predictable consequences. She ended up leaving naturopathy, a profession which, by this time, she had spent hundreds of thousands of dollars in fees.

I realised I was a fraud.

Britt found help and support from within the global skeptic community. She has since set up a blog to expose the practices of naturopathy to the rest of the world. It’s hard not to see naturopathy as a kind of twenty-first century cult, despite it’s veneer of medicine.

Naturopaths can basically say and do what they want. There is no standard of care.

Britt is adamant that naturopaths should under no circumstances be given the title of doctor. They should not be treating children as they get only 10% the training of paediatricians.

There is no doubt that many naturopaths have good hearts. But without a medical degree, they are nothing more than good hearted charlatans.

Britt has stared a petition “Naturopaths are not doctors” to raise awareness of the inadequacy of naturopathic care, and to stop naturopaths being licensed as doctors in America.

You have to fool patients and you have to fool yourself. So I am glad to say, I am one of the most unsuccessful naturopaths on the planet.

Britt has shown incredible bravery in admitting her mistake and then challenging the fundamental basis of naturopathy to a world audience. Britt got a well deserved standing ovation from the audience for her talk.

We’re not done (not by a long shot)…

There is a broadcaster in Cork, Neil Prendeville, who has no problem promoting pseudoscience and instilling fear into people during his radio programme. He regularly invites a guest, Michael O’Doherty, whom he calls a healthcare professional, onto his show to expound on vaccines and antibiotics. O’Doherty has no medical qualifications. He is a quack healer whose shtick seems to be that natural is good, that the body is capable of healing itself without the need for modern medicine. 

This stuff is dangerous. It is simply not true to say that our bodies are able to deal with every illness that comes along. The flu, a common disease, kills millions of people every year. Before modern medicine, deaths from smallpox, measles and TB were common. They are much less so now because of vaccines, antibiotics and antivirals. Where is the evidence for the great natural panaceas they keep talking about? In the face of an invader, eating berries and taking exercise won’t always cut it. That’s not how human physiology works. 

Another pernicious lie that’s promoted is that when you get sick, it’s your fault. If only you had been thinking properly, or meditating the right way, or drinking the correct drinks, or eating the right foods, you wouldn’t have fallen ill. Sure, some lifestyles are decidedly unhealthy, but healthy people still get sick, all the time, through no fault of their own. Telling people that they are responsible creates unnecessary guilt while scaring them away from treatment options that might save their lives. It’s awful.

Prendeville says he is not anti-vaccinatipn, yet he regularly promotes anti-vaccination views. He promotes a culture of suspicion around medicine and medical practitioners. On a regular basis, he lays into the medical profession while promoting some of the worst pseudoscience imaginable. Not to put too fine a point on it, but he’s endangering people’s health. 

Sure, if you are fool enough to believe him, the argument could be made that it’s your fault. But what of your children or elderly and incapacitated adults that might depend on you? What of innocent bystanders whose kids you might be putting at risk because you won’t vaccinate your children?

But what to do about it? 

Write a strongly worded letter to Red FM? Send a complaint to the Broadcasting Authority of Ireland? What will that do, exactly?

Complain to my local TDs? What will that achieve, exactly?

Blog away like I am doing, to the 20 or so people who read this blog?

Write to the Irish Medical council and other healthcare agencies to let them know what he’s up to?

Is it a free speech issue, so better off being left alone? Do I keep quiet and suck it up?

I don’t know. All I do know is that a radio personality is abusing his power and influence to scare people away from practical healthcare, and it feels like nobody cares about it, except for me and my army of one.

Update: here is a link to the show in question. The Gardasil / vaccine discussion starts about 50 minutes into the show.

Update 2: I have amended a statement that Prendeville tells people not to vaccinate their kids, which is not correct. I have also had feedback that he introduces O’Doherty as a healthcare professional. I have corrected this also.

Homeopathy Overdose by Richard Craig (CC Licenced)

Homeopathy Overdose by Richard Craig (CC Licenced)

“What’s the Harm”? It’s another question that often comes up from supporters of Complementary and Alternative Medicine (CAM). Is it not the case that most people attending alternative practitioners can expect to happily live long, chaotic and unexpected lives just as much as the next person?

Yes, but. There’s always a “but”. In fact, there are quite a few “buts”.

Let’s tackle the extreme cases first. There are many cases of people foregoing proper medical care in favour of CAM, thus prolonging pain and suffering for longer than is strictly necessary. In the worst situations, this can be life-threatening. There are many examples of people foregoing medical care for ineffective practices, much to their detriment. So, if you are really sick, go to a doctor. That also applies to your kids.

Other cases exist where semi-medical interventions are being performed, using acupuncture needles without gloves, performing chiropractic manipulation near the neck region, using actual medicines in homeopathic treatments, adding heavy metals to Ayurvedic treatments, triggering asthma attacks during salt therapy. While rare, such treatments have lead to medical complications because, by their nature, they border on real medical intervention, with all its attendant risks.

And then there’s just stupid, avoidable stuff that could have huge negative consequences if the practitioner gets it wrong. Ear Candling, I’m looking at you.

These are the easy ones. But, let’s say it’s not acute or life threatening, and the intervention appears totally safe. There’s no harm then, right?

I looked at the phenomenon of “It Worked For Me” in a previous entry, where I examined what might be going on for people who reported marked improvements in their condition after having CAM treatment. What this implies is, while people often report improvement, there is no actual improvement taking place. They may temporarily report improvement, but only until the condition reappears again sometime later.

If it doesn’t work, it might require another visit. Then another visit. Then another. Or multiple visits to different therapists in search of a cure. The problem may eventually get better, but that may have nothing much to do with the treatment. It’s just your body getting better naturally, as it would have done anyway, without any CAM intervention whatsoever. That’s a lot of money spent on nothing.

Many people take regular visits to alternative therapists, any time they feel poorly, or tired, or in pain. Given that most alternative treatments have been shown to work no better than placebo, it’s all a very effective way of spending a big portion of your income on something that could have been better spent on a holiday, or a new car, or saving for college, or whatever.

It’s also a great way of spreading nonsense. Some CAM practitioners feel themselves to be in competition with proper doctors, and so are not unfamiliar with spreading negative propaganda about the so-called “allopathic” medical profession. It’s not to say that the health service is perfect, but neither is it the bogeyman they often make it out to be. At the worst, the propaganda engenders a disproportionate sense of distrust in science-based medicine. Completely preventable diseases have been making a comeback because anti-vaccine nonsense continues to be perpetuated by some CAM practitioners and consequently, their clients. Children are referred to dangerous quacks because of a conviction by some that doctors are part of a conspiracy to hide cures from the general public.  So, while there appears to be no harm to you, you may be putting others at risk, simply by passing on bad advice.

Another way harm is spread is simply by perpetuating false hope. Sadly, there are some conditions and diseases where cures still evade us. People can be driven to their wits’ end, trying to find a cure or a treatment that will work. While doctors are expected to be honest with their patients in such cases, the CAM profession has far less qualms, and so clients are sent on distressing wild goose chases when perhaps they should be moving on towards more palliative measures. These are difficult, heartbreaking situations, but one thing is clear: nobody should be capitalising from such tribulations.

A question you might be asking is this: don’t medical treatments sometimes cause harm? Yes, but medicine usually looks beyond placebo into actual interventions, the bulk of whom have a great deal of evidence to back them up. These interventions can be harmful, but this is balanced against an improved outcome for the patient. Most alternative therapies are placebo at the best of times, so if little improvement can be expected, then neither should there be much harm in the intervention.

So, while active harm is rare, there are more indirect kinds of harm. Harm can be caused through inaction, or through spreading misleading information to others, or through the perpetuation of false hope. We shouldn’t look at alternative medicine as having no downsides. In the end, it’s never the best when people are forced to seek out solutions that don’t exist.

More thoughts on this issue from Science Based Medicine.

WhatsTheHarm.net – a database of alternative therapies going wrong.

Acupuncture Needle, CC Licenced via Acid Pix

Acupuncture Needle, CC Licenced via Acid Pix

“It Worked For Me” : these are the four words I always expect to hear when I get into a discussion on Alternative Medicine. In many ways, it’s very difficult to argue against. If you are not particularly careful in replying, you can come across as highly insensitive. How dare you assume that you know their circumstances better than themselves! Are you accusing them of lying? Furthermore, there is almost always a readymade refutation should you challenge any aspects of the assertion. It happened, you were not there, I was.

“It Worked For Me” is a minefield, and yet it needs to be tackled.

In the case of most alternative therapies, it’s implausible in the extreme for the putative cure to have been the cause of the recovery. Scientific studies have established, far beyond reasonable doubt, that homeopathic pills contain no active ingredient. These pills, by themselves, are utterly useless. Further studies have established that Chiropractic back manipulation is of no use beyond providing temporary relief to lower back pain in some cases. Other studies have demonstrated that Acupuncture, the insertion of needles in the skin, does little from a medical perspective. The list goes on and on. Whatever they say is working, it’s obviously not the particular treatments themselves.

And yet, many people swear by them. They had back pain, they went to an aromatherapist, and the pain disappeared. They felt very unwell, they went to a naturopath, and felt much better. Some people have reported the end of chronic pain and illness from going to alternative practitioners. They have reported the clearing up of allergies, the ending of depression, fatigue, lots of things.

So what is happening? Clearly, it’s difficult, without full information, to comment on any individual case, but here are some of the things that may be happening:

1) The Placebo Effect. The Placebo Effect relates to the tendency of people to report improvement after all manner of interventions, medical or none. Significant study has been done on this, and, while measurable improvement (beyond what would happen without intervention) is almost never seen, the effect refers to a strong tendency to make people feel better in themselves. It’s triggered by lots of things: the dosage, the nature of the dosage, the ambiance of the consulting room, the attitude and friendliness of the therapist, and much else. We all feel better from having spoken to someone who listens and helps us talk more easily. The Placebo Effect is particularly strong when it comes to non-specific symptoms, such as pain, fatigue, low mood and general feelings of un-wellness. It has less of an effect for specific, clear symptoms, such as cuts and infections.

2) Regression to the Mean. This refers to the natural tendency of the body to get better. Given enough time, back pain tends to get better by itself, sleep cycles are re-established, and allergies clear up, at least for a while. Just because a therapy was invoked before the recovery happened, doesn’t mean it caused or accelerated the recovery. It may have happened quite naturally, and there is no way of knowing this without careful analysis.

3) False Memory. Our memory of an event is actively re-created every time we recall it, so by necessity, many details of what actually happened tend to get lost, particularly the aspects that do not resonate with the main story. So it might be forgotten that the person was on antibiotics at the same time as visiting a homeopath, or that the recovery didn’t happen quite as fast as they remember. Even worse, the memory tends to become even more fixed with the telling as the weeks and years go by.

4) Belief contamination. We tend to view the world based on our inherent beliefs. Ghost hunters see and hear ghosts everywhere. Right-wingers tend to see left-wing conspiracies everywhere, and vice-versa. So too with people with an invested belief in their chosen form of alternative therapy. They will reach for signs of it working, even when the evidence is very slim.

5) Cognitive Dissonance. Once we have established a story about ourselves, we hate admitting we might be wrong about it. So when challenged on any aspects, our brains tend to go into overdrive to defend our position. This can have the effect of further changing our memory of it, bolstering the false memories even further.

6) Subjectivity. People don’t normally establish criteria for success beforehand, then judge the outcome based on these pre-existing criteria. Instead, there is a tendency to retro-fit a meaning after the event, which gives them much greater latitude to define what success means. The bar can be set as low as the person wishes.

7) Maslow’s Hammer, or “if the only tool you have is a hammer, it is tempting to treat everything as if it were a nail”. This is where people do not understand the limitations of their thinking. If we know of only one major way that a problem can be solved, we are unlikely to conceive of other alternatives to solving the problem. So, lack of knowledge of alternative modalities limits us to conceiving just one answer to the problems we have.

 

None of this, by the way, imputes deliberate action or foul play on the person making the claim. It’s just the way our minds work. When it comes to how our brain interprets the information we get from our environment, we are truly a funny lot.

If confronted with a personal anecdote and asked to explain it, it is far better to avoid engaging in a particular diagnosis, as you are unlikely to win that battle. It is possible, however, to engage in a hypothetical situation, on why we should be sceptical of personal testimonies. You could also imagine yourself experiencing a magic cure, then testing yourself on how you might have interpreted it incorrectly.

In the end, we are all too easy to fool. Convincing ourselves that a discredited modality works is the easy bit. Trying to establish that we might actually have got it wrong is much more difficult. “It Worked For Me”, as a reason for believing in a treatment, is simply not good enough.

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