Dec 20 2012
If there were an icon of Science-Based Medicine, I think it should be Sisyphus: pushing a boulder uphill, only to watch it roll down again. Forever. Blogging about pseudoscience in medicine can feel that way at times. There is no end to the variations of nonsense, most health professionals are indifferent at best, and sometimes I wonder if blogging is just preaching to the converted. Compared to the media presence and web traffic of those that promote pseudoscence, I do wonder what to make of SBM. Does it have a bigger impact. Occasionally something comes along to give you some hope that the key concepts of SBM are having some resonance.
To effect meaningful change, we need to teach the concepts of SBM - the process is the product, not the topics we blog about. This all came to mind as I was reading an open letter from TED organizers. TED talks are now iconic, but if you’re unfamiliar with them, the conferences started as a means of colliding speakers in the technology, entertainment and design fields to talk about big ideas. With a slogan of “ideas worth spreading,” perhaps it’s not surprising that TED talks can be provocative: that’s the point. TED talks are posted online and their success is remarkable: some talks get hundreds of thousands of views. The TED template has become so popular that it spawned TEDx, independent but licensed events that bring TED-like talks to smaller cities and venues. I’ve seen several TED talks and while many are compelling speakers, it’s clear the content is not always grounded in evidence. For all the talks by science advocates like Ben Goldacre, or James Randi, there’s the consciousnessbabble from Deepak Chopra. I’ve never seen TEDx presentations, but recently there’s been some very public criticism of its speaker standards. Anyone, it seems, can be a TEDx speaker including anti-GMO crusaders and naturopaths. Stung by recent criticism that the TED brand is losing credibility with its questionable presenters, TED HQ recently advised TEDx organizers to stop featuring pseudosicence:
It is your job, before any speaker is booked, to check them out, and to reject bad science, pseudoscience and health hoaxes.
Vetting your speakers is hard work, and can lead to uncomfortable moments. But as TEDx organizers, your audience’s trust is your top priority, over and above any other personal or business relationship that may have brought this speaker to your attention. It is not your audience’s job to figure out if a speaker is offering legitimate science or not. It is your job.
The consequence of bad science and health hoaxes are not trivial. As an example, Andrew Wakefield’s attempt to link autism and vaccines was exposed as a hoax last year. But while his work was being investigated, millions of children went without vaccines, and many contracted deadly illnesses as a result.
We take this seriously. Presenting bad science on the TEDx stage is grounds for revoking your license.
So what does TED consider bad science? They provide some tips:
Marks of good science:
- It makes claims that can be tested and verified
- It has been published in a peer reviewed journal (but beware… there are some dodgy journals out there that seem credible, but aren’t.)
- It is based on theories that are discussed and argued for by many experts in the field
- It is backed up by experiments that have generated enough data to convince other experts of its legitimacy
- Its proponents are secure enough to accept areas of doubt and need for further investigation
- It does not fly in the face of the broad existing body of scientific knowledge
- The proposed speaker works for a university and/or has a phD or other bona fide high level scientific qualification
Marks of bad science:
- Has failed to convince many mainstream scientists of its truth
- Is not based on experiments that can be reproduced by others
- Contains experimental flaws or is based on data that does not convincingly corroborate the experimenter’s theoretical claims
- Comes from overconfident fringe experts
- Uses over-simplified interpretations of legitimate studies and may combine with imprecise, spiritual or new age vocabulary, to form new, completely untested theories.
- Speaks dismissively of mainstream science
- Includes some of the red flags listed in the two sections below
This is a good starting point to distinguish real science from pseudoscience. TED also identifies certain “red flag” topics that require close scrutiny, including food as medicine, alternative medicine, free energy, time travel (!), and what looks like a Chopra clause, “the fusion of science and spirituality.” Nicely, TED points to an SBM post on Dr. Oz and green coffee beans as an example of how to to check out a possible health hoax.
TED also points to Emily Willingham’s checklist as another filter that can be applied when evaluating claims.
- What is the source? Does the person or group making the claim have any relevant expertise?
- What is the agenda? What does the person or group making the claim have to gain?
- What kind of language does it use? Watch for an emphasis on emotional terms, or jargony sciencey-sounding terminology
- Does it involve testimonials? When it comes to scientific claims, testimonials are weak sources of credible information.
- Are there claims of exclusivity? Was it invented out of thin air, by a single person? New treatments typically build on existing science.
- Is there mention of a conspiracy of any kind? Anything THEY don’t want you to know about is a huge red flag
- Does the claim involve multiple dissociated disorders? i.e., is it the “one cause/cure for all disease”?
- Is there a money trail or passionate belief involved? i.e., Follow the money
- Were real scientific processes involved? What credible evaluations have been performed?
- Is there expertise? Are they specialists in their field, with credible education from legitimate organizations?
No list is 100% sensitive or specific, and not every questionable practice will set off every red flag. But if you know the signs, you’ll develop an impressive ability to detect it. Reading this blog regularly helps. In time you’ll annoy your friends and family with the ability to spot medical hocus-pocus with a quick glance.
Given the multitude of health claims and alternative practices that exist, It helps that some some themes are recurrent, making them easier to identify. Once you understand the key concepts of an alternative practice, you’ll be able to spot its variations easily. One of the more recurrent is applied kinesiology. It’s been covered before, but merits a repeated look, if only because of its tenacity and its chameleon-like nature to manifest as what appears to be different treatments.
Applied kinesiology is just as implausible as homeopathy, so the more people understand the absurdity of the practice, the better. (Note that AK is unrelated to kinesiology, the legitimate study of body motion.) AK involves some form of muscle “testing” that purports to identify illness or if you prefer, “dis-ease”. It can manifest as magical “energy” bracelets (think Power Balance) touted to improve sports performances. AK is even claimed to identify food intolerances, simply by holding the food in your hand. Not surprisingly, this form of testing is no more effective than random guessing. But you don’t even need to hold a product when you’re tested. Even just thinking about a substance can cause muscle weakness, according to AK advocates. There are no biologic or scientific principles that suggest AK might be effective. So not surprisingly, AK fails every test for every type of illness, condition, or intolerance. All of them. Despite this, AK is frequently offered by chiropractors, naturopaths and other alternative practitioners. It is a disproved treatment that cannot be killed with evidence or reason, like the other alternative medicine zombies. Why doesn’t it get dropped? Because to admit AK is nonsense would be tacit agreement that vitalism is bunk.
Applied kinesiology itself has only been around since the 1960s, but it’s a extension of vitalistic thoughts about the body and the interconnectedness of cells and systems. AK is believed to be effective because of the interconnectedness of cells based on some form of mysterious, undefined energy. This energy is vitalism: the pre-scientific belief that living objects differ from non-living objects because of some sort of “vital force” or energy field. Vitalism was a scientific placeholder, which was dropped from our understanding of the world when it was shown to be unnecessary. Alternative medicine practices that are not based on science, such as homeopathy, naturopathy, chiropractic and acupuncture remain permeated with vitalistic thinking.
Understanding the premise of applied kinesiology, with its roots in vitalism, make it easy to spot its hundreds of variants. I was recently asked a manual therapy called ”The BodyTalk System“. I’d never heard of it, but the idea of body “talk” sounded a bit like vitalism (and also of Olivia Newton John). According to the advertising:
BodyTalk is an revolutionary form of alternative healthcare. It encompasses:
- Western Medical Expertise
- The Energy Dynamics of Acupuncture
- Osteopathic and Chiropractic Philosophy
- The Insights of Modern Physics and Mathematics
BodyTalk is an astonishingly simple and effective form of therapy that allows the body’s energy systems to be resynchronized so they can operate as nature intended. When a body is operating at its optima level, each system, cell and atom is in constant communication with each other at all times. Through exposure to the stresses of day-to-day life, these lines of communication can become compromised, which can lead to a decline in physican, emotional and or mental/health.
Wow. Sciencey jargon, disproved practices like acupuncture, chiropractic philosophy (i.e., subluxations) and explicit references to “energy systems”. Sounds a lot like vitalism. The treatment description suggests this is just a variation of applied kinesiology:
During a BodyTalk session, the practitioner facilitates communication with the innate wisdom of the body by using neuromuscular feedback. After asking Innate (sic) a series of yes or no questions, the client’s own body wisdom leads the practitioner to locate the imbalances within the body that are a priority, or are not communicating correctly and are out of balance with the rest of the body.
Next the practitioner hold the areas that have been highlighted by the testing procedure and taps gently on the head and sternum. By tapping on the head the brain becomes aware of and repairs the communication link. Tapping on the sternum, or heart, ensure that the new information is stored throughout the whole body.
When you look past the ritual, it’s clear that this is applied kinesiology. Innate wisdom is code for vitalism, and the references to “balance” are a fixture of homeopathy, acupuncture and most other alternative practices. Perhaps not surprisingly, Bodytalk was invented by an Australian chiropractor and acupuncturist, John Veltheim. Veltheim dismisses the materialistic, “Cartesian” view of health and instead proposes an approach he calls (pg 45) “quantum health care”:
The quantum scientific principles have been understood for over a hundred years. The ethical and philosophical principles, such the (sic) Indian Advaitic/Vedantic teachings, which underpin quantum scienc,e have been around for many centuries. Just a little careful observation reveals that our solar systems (sic) and mother earth are not two. Instead they comprise a dynamic matrix of interlacing morphogenic fields. In quantum physics this matrix is referred to as variations of Quantum entanglement. Int is critical that we recognize and acknowledge that everything we do has extensive, short and long-term, dynamic ramifications throughout the universe.
Here’s another screening question to add to the list above: Any reference to “quantum” in the context of health care is a red flag that almost always identifies pseudoscience.
One of the common practices of BodyTalk is called “tapping the cortices” which is claimed to be effective for stress, poor attention span, and even shock and coma. It’s better seen, than described:
His video bring up another useful screening tool for pseudoscience: Any reference to magnetism in health care (unless you’re discussing MRI) is another red flag to watch out for.
Does Bodytalk work? Not surprisingly, there’s no credible published evidence to substantiate the concepts of BodyTalk or any of its claims. Credible science has references. Pseudoscience offers testimonials. When all you have is testimonials, you put them front and center: If the health product or service you’re investigating has a dedicated testimonials page, you’re pretty much guaranteed unproven or disproven treatments.
Bodytalk has all the characteristics of pseudoscience. It’s one example of a family of “energy healing” practices with roots in applied kinesiology which still reflects its origins in vitalistic thinking. Like other forms of applied kinesiology, BodyTalk is health theater, appearing to do something but accomplishing nothing substantive. Not surprisingly, there is no credible evidence to suggest that BodyTalk treatments have any meaningful therapeutic effects. There are endless variations of these kinds of alternative healing treatments. Sorting pseudoscience from science can look challenging, but its easier when you can spot the themes. Conveniently, pseudoscientific health practices share many key principles. Look for the red flags, and you’ll be a stronger science-based thinker.
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