Jul 02 2008
Savvy consumers are familiar with the classic scam of the “bait and switch” – in practice if not the term itself. My wife and I ran across it when we were shopping for our first car. We needed a bargain and so we were attracted to the ads that promised a new Colt for only $9,000 (that’s the bait). Of course when we got to the dealership they were all out of Colts with the configuration advertised, but they had plenty of others that had different options that cost several thousand dollars more (that’s the switch).
It’s a basic and very successful form of deception, and so even though there are laws against such practices it is impossible to eliminate in all its various and more subtle forms. It even permeates scientific, political, and other intellectual endeavors – anytime a more palatable idea or claim is put forward to represent the less acceptable truth.
Science, however, requires transparent honesty to function properly, and therefore scientific practitioners must vigilantly guard against the cognitive bait and switch. Generic intellectual virtues incorporate this vigilance – they include the need to unambiguously define terms, to make claims as specific and operational as possible, and the use of valid logic. Beware of any claims that subtly violate these rules because they are probably setting you up for a bait and switch.
The purveyors of unscientific medical claims have become as expert at this classic deception as the slickest used-car salesman – in fact they have left the hawkers of dubious transportation in the dust.
Practitioners of health fraud, unscientific and sectarian medical practices have learned how to apply the bait and switch at multiple levels – with respect to specific modalities and at higher categorical levels. First I will address some of the more common sectarian practices and show how they apply this deception, whether consciously or out of intellectual sloppiness.
Chiropractic is perhaps the most common and egregious example of the bait and switch in medicine. The deception begins with the name itself – “chiropractic” fails the basic test of transparency because it is not unambiguously defined. There are in fact numerous professions doing very different things and employing mutually exclusive philosophies under the banner of “chiropractic.”
Therefore someone may go to see a chiropractor and think they will be seeing a medical professional who will treat their musculoskeletal symptoms, but in reality they will see the practitioner of a cult philosophy of energy healing. So-called “straight” chiropractors (who make up an estimated 30% of all chiropractors) still adhere to the original philosophy of chiropractic invented by “magnetic healer” D.D. Palmer, which is based upon the claim that an undetected life energy called “innate intelligence” flows through the spinal cord and nerves and is responsible for health. Such chiropractors will treat any disease or ailment with spinal manipulation.
Most other so called “mixer” chiropractors reject the notion of innate intelligence either partially or entirely, but still incorporate other pseudosciences into their practice. Chiropractors are the primary practitioners of homeopathy, applied kinesiology, and iridology in the US. The bait – claims that chiropractors are medical practitioners with expertise in the musculoskeletal system. The switch – practitioners of discredited pseudosciences that have nothing to do with the musculoskeletal system.
A more subtle form of the bait and switch among chiropractors is the treatment of musculoskeletal symptoms with standard physical therapy or sports medicine practices under the name of chiropractic manipulation. Ironically, the more honest and scientific practitioners among chiropractors are most likely to commit this subtle deception. The problem comes not from the treatment itself but the claim that such treatments are “chiropractic.”
Using techniques like massage, range of motion exercises, strength-building exercises, and mobilization of joints are all legitimate science-based techniques used by physical therapists and physicians with specialties in physiatry, orthopedics, and sports medicine. Some chiropractors also use similar techniques -and with good results. But by doing so and calling it “chiropractic” it legitimizes the pseudoscientific practices that are very common within the profession – like treating non-existent “subluxations” in order to free up the flow of innate intelligence.
Many studies of acupuncture employ this latter form of bait and switch – studying something that is not really acupuncture but calling it acupuncture and thereby legitimizing pure pseudoscience. Acupuncture refers to a Traditional Chinese Medicine (TCM) pre-scientific philosophy of health and illness that is based (very similarly to straight chiropractic) on the flow of life energy called “chi”. Fine needles are inserted into special locations on the body called meridians for the purpose of improving, freeing, and balancing the flow chi.
No study has demonstrated that chi exists, or that acupuncture of the meridians has any specific effect. A look at the entirety of the acupuncture literature, in fact, clearly demonstrates that it does not matter where the needles are placed (or how deeply, or if they are manipulated in ways that are designed to manipulate chi). This means that any effects of sticking acupuncture needles into a patient are non-specific – they are not related to the flow of chi. There may be some small non-specific physiological effects – such as counter-irritation reducing pain or inhibiting nausea – but even these claims remain elusive and controversial.
But some studies of “acupuncture” show a larger and more reliable effect, usually on pain. What these studies have in common is that they employ “electrical acupuncture” (for example). Electrical acupuncture, however, is not acupuncture – it’s transdermal electrical stimulation, which is a scientific practice that has proven efficacy in the treatment of pain. Giving transdermal electrical stimulation through acupuncture needles, calling that “electrical acupuncture” and then using positive results to conclude that acupuncture works – is an elaborate bait and switch.
Homeopathy and Herbal Medicine
Homeopathy is another dubious practice based upon pre-scientific notions long discredited. A truly homeopathic remedy is diluted to the point that no active ingredients remain – so a homeopathic remedy is pure solvent, either water or alcohol, sometimes placed on a sugar pill (making a homeopathic pill a literal placebo). But much of the public believes that “homeopathic” simply means “natural” or “herbal”. Few realize that it means that the so-called medicine contains nothing.
But some homeopathic products are not even truly homeopathic – meaning they are not based upon homeopathic principles but rather contain measurable amounts of real drugs. This is now not uncommon for over-the-counters lotions and cold remedies. For example, this pimple cream contains many active ingredients at a “1x” dilution – that’s only 1:10, meaning there is still actual molecules of drugs in the cream. That’s not homeopathic.
A similar and more subtle deception is used in the marketing of herbs. They are sold and regulated as “natural supplements” when in fact they are drugs. Herbs contain chemicals that have pharmacological activity and they are usually taken in doses that are insignificant in terms of their nutritional content, but are significant in terms of their pharmacological activity. The bait is that they are nutritional supplements, the switch is that they are unpurified drugs.
CAM – the Biggest Bait and Switch
All of these modalities fall under an artificial category – so called “complementary and alternative” medicine (CAM) or “integrative” medicine that was created as the ultimate bait and switch.
The deception is largely two-fold. The first is to include modalities within this false category that are legitimate, like nutrition, exercise, physical therapy, relaxation, etc., – and then claim that these legitimize the entire category of CAM, even the far-out stuff like homeopathy. This is just a higher-order version of including physical therapy modalities within the umbrella of chiropractic, for example.
Essentially, at every level terms are used that are vague and poorly defined, and in practice are designed to be all-inclusive so that the purely pseudoscientific can ride on the coattails of the barely plausible or even the legitimate.
This is the opposite of what happens within scientific disciplines – where terminology evolves over time to become more discriminating, unambiguous, and specific. To take an example from my specialty, multiple sclerosis (MS) has been divided into sub-diagnoses: relapsing remitting and chronic progressive. Divisions multiplied and now there are seven subtypes – for example, primary progressive, and progressive remitting.
This increased “splitting” as it is called is not just a pedantic dedication to precision, but a recognition that such divisions may reflect differences in underlying mechanism of the disease. Also, different subtypes of MS respond differently to different treatments. Some drugs work in relapsing remitting but not in primary progressive. Part of the motivation for finer categories is to more accurately predict which MS patients are likely to respond to which treatments.
Contrast this to the maximally broad and imprecise but common marketing slogan “chiropractic works.”
The second kind of deception created by the category of CAM is in the language used itself – “complementary” and “integrative.” What, exactly, are CAM modalities integrating? On close examination it is quite clear – the movement is an effort to mix unscientific, disproved, and dubious modalities into scientific medicine. The bait is that CAM offers legitimate alternatives, the switch is that it primarily promotes treatments that don’t work or are at best untested and highly implausible.
If there were truth in marketing then we would have the Office of Implausible Medicine, the Journal of Bad Medical Science, the Center for Rejected Therapies, and the Institute of Dubious Medical Claims – all under the umbrella of unscientific medicine. It used to be called, even more simply, “health fraud.”
The public would be best served if they were given a reasonable expectation of honesty and clarity in the health marketplace. Instead, increasingly they are being given the old bait and switch, and increasingly the governments and institutions of medicine that should know better are instruments of this deception.
Science and intellectual honesty require that terms mean something specific and definable. Unscientific health modalities have become very savvy at using terminology to confuse rather than inform, to deceive rather than to illuminate.
It is the simplest form of the bait and switch – just call a product or service something that it isn’t.
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