Dec 26 2012
Any sociological question is likely going to have a complex answer with many variables that are not easy to tease apart. We should therefore resist the temptation to make simplistic statements about X being the cause of Y. We can still, however, identify correlations that will at least inform our thinking. Sometimes correlations can be triangulated to fairly reliable conclusions.
When the data is complex and difficult to interpret, however, evidence tends to be overwhelmed by narrative. The recent Sandy Hook tragedy is an excellent example. No one knows exactly why the shooter did what he did, so it is easy to insert your own preferred narrative as the explanation.
Another example is the phenomenon of so-called complementary and alternative medicine (CAM). Why has it been increasing in popularity (and is it, really?). Is it slick marketing, relaxed regulations, scientific illiteracy, a gullible media, or the failures of mainstream medicine? You can probably guess I think it’s all of these things to some degree. The most common narrative I hear by far, however, is the latter – if people are turning to CAM it must be because mainstream medicine has failed them. This version of reality is often promoted by CAM marketing.
The evidence that we have, however, simply does not support this narrative. Studies show that satisfaction with mainstream medicine is not an important factor in deciding to use CAM, that CAM users are generally satisfied with their mainstream care, and they use CAM because it aligns with their philosophy, and they simply want to expand their options.
None of this is to imply that mainstream medicine has no problems or failings – it does. We should, however, be working toward keeping and improving what works and fixing what doesn’t, not discarding science and reason to embrace fantasy as an alternative. This is often the false choice presented by CAM proponents, and is analogous to creationists pointing out alleged weaknesses in the theory of evolution as an argument for creationism as an alternative.
We have to acknowledge how deeply the narrative has penetrated and resonated with the public. Even among those who are generally skeptical, pro-science, and scientifically literate, this is the default narrative. Further, many people have personal experiences with illness and health care, and personal experience can have a powerful influence on our beliefs (even if we are generally science and evidence-based in our thinking). We are apparently hard-wired to find anecdotes compelling, and nothing is more compelling than our own personal anecdotes.
I recently received an e-mail from a person generally skeptical of alternative medicine. The e-mail begins:
I am a skeptic; have been an active Randi reader for over a decade. I don’t believe in acupuncture, homeopathy, chiropractic, energy healing or virtually any form of snake oil.
But I have had personal experience with ‘alternative medicine’.
That’s a powerful “but.” He then goes on to describe his 20 year experience with back pain. He was told that he needed surgery for a herniated disc, but was skeptical of this option. I should add this occurred 20 years ago, and much has changed since then. The e-mailer concludes that the recommendation was based on the surgeon’s greed, which certainly may be the case, but even well-meaning and honest surgeons doing their best to practice according to the evidence were probably performing too many back surgeries 20 years ago. In the last two decades published studies have narrowed the range of patients in whom such surgery is deemed appropriate. Like many such questions in medicine, when to do surgery is complicated and the subject of intense research.
The e-mailer decided to forgo surgery and opted instead for John Sarno’s book on Healing Back Pain:
I followed his treatment program, which involved completely foregoing standard treatment (throw away the meds, do serious back exercises etc; because those mainstream treatments reinforce to the mind that the problem is physical and not psychosomatic, and this perpetuates the process). Within a couple weeks, I was completely pain free and have been for the past 20 years. I do not accept some of Sarno’s hypothesis (that the pain acts as a “distraction from repressed tension) but I am 100% convinced in the underlying cause in my own case; there is simply no other explanation for the evolution of my pain and how it reacted to ‘treatment’ (the pain switching locations, and a number of sensory symptoms that would be impossible for me to verbally describe to you…).
It is clear from above how powerful the experience was for the e-mailer, who is “100% convinced” of his current narrative. There are other possible explanations, however. The e-mail admits to engaging in back exercises as part of the program. In my opinion, that alone is likely what resulted in his improvement. In fact that is perhaps the most effective long-term treatment of chronic back pain, and what I recommend to almost every patient with back pain. The surgeons I refer to when needed want patients to undergo an exercise regimen before they will consider surgery (this does not include those with certain neurological complications that require immediate treatment).
In other words, the e-mailer undertook what is now standard therapy for chronic back pain and it worked. Everything else is likely incidental and not important. It is the equivalent of telling someone who wants to lose weight, eat less, exercise, and say my magic phrase once a day, and you will lose weight because of the magic phrase. This is why we do studies that properly control for variables. Regarding Sarno’s book, my impression is that it takes one possible factor in the etiology of chronic back pain (psychological stress) and raises that to “the” cause of back pain.
The e-mailer goes beyond just interpreting his one personal anecdotal experience to make some broad conclusions about medicine and illness:
Psychological stress. Stress that did not exist 50, 100 or 200 years ago because our society has become so altered in recent years due to the internet, increased communications and technology. We as a species see not only the very worst actions of our species on a daily basis, we also are presented with the very best or most lucky individuals (we see the lottery winner on tv; we don’t see the 100,000,000 individuals who lost…) as if it is expected of us. Hence the rise of ‘fame obsession’ seen in social media and ‘mainstream media’. Be extremely wealthy/famous, or be a loser… There has been no time for our human psyche to evolve to adapt to this stress.
It is very difficult to measure, especially historically, something as vague as “stress.” What the psychological literature shows is that stress is relative. We tend to adapt and normalize to our situation, and find happiness and stress relative to our norm. I think it’s naive, however, to argue that people living one or two centuries ago were under less stress that today. They had to deal with problems that are much greater than our own – the death of many of their children, many more untreatable and common illnesses, harder and longer working conditions, etc. We have it comparatively easy today, but obviously many people do not realize how relatively brutal life was in prior centuries (and likely future centuries will look back at how brutal our lives are).
Toxins. You heard me right! Sorry, but if you read the labels of most of the food this nation consumes (not to mention how it is produced, processed etc) you cannot tell me with a straight face that it is as healthy as the food of 100 or 200 years ago. Add the water we drink, the air we breathe that in most cases is worse than in generations past, and there is definitely a problem.
The “toxin” meme has penetrated far. In terms of industrial pollution, that peaked in the middle of the 20th century. We have much less pollution today (at least in many developed countries – developing countries are still reaching their peak). Yes, I can say with a straight face that there is no compelling evidence that the modern diet is less healthy than in previous centuries. In fact, the modern diet is better in many ways. We have access to fresh fruits and vegetable year round. We have refrigeration. We have a more varied and nutritious diet. Our problem is one of excess – mainly excess calories. Our food and water supplies are generally safe, safer than in the past. New York city water is famously pure and good tasting, for example. Water supplies are tested and treated – not so in the past.
I believe one if not the main reason snake oil is so popular with the masses is that there is a recognition that medical science has failed us. We have wondrous technology, especially the computerized devices that dazzle us all. Yet, we have no good explanation for the most common maladies, such as acne, back pain, allergies etc. We have no complete understanding of some of the most dangerous and common ailments such as cancer or the common cold. That is why, when you go to a mainstream doctor (and I’ve seen my share!) there are dubious diagnoses, and either more dubious treatments (the ever-so-common prescription for antibiotic comes to mind…) It is sad, but It explains why the public is so gullible when it comes to alternative treatments.
As I pointed out above – this is simply not true. The evidence shows that it does not explain gullibility to CAM treatments. Further, the e-mailer makes the mistake of listing the limitations of modern medical science and its application as if that implies that it has “failed.” We certainly lack a “complete understanding” of many diseases and symptoms, just as science in general lacks a “complete understanding” of just about everything. Our understanding is always partial and tentative, but can still be quite powerful and predictive. Some things in medicine are understood very well, and the application is so standardized and effective that people no longer even think about it. It is the complex and difficult problems that people focus on when discussing the “failures” of modern medicine.
This is partly a “glass half full or empty” issue. There is no question that modern medicine has many effective treatments that prolong and improve the quality of life. There is also no question that there remains much we do not know and cannot fix.
The way forward is with science-based medicine, not abandoning science for a fantasy (I know the e-mail is not suggesting this, only that others follow this logic). While some may commit this fallacy, most people still respect the role of evidence in medicine and want their treatments to be evidence-based. In my opinion the big problem with CAM is that its proponents are telling the public that their treatments are based on evidence, when they aren’t. They are distorting the process and findings of science to meet their ideological agenda, and supporting that further will propaganda meant to confuse the public about the nature of medicine itself. Unfortunately they have been somewhat successful in causing precisely the kind of confusion they need to sell implausible treatments that don’t work as if they were a viable alternative.
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