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Ngrams and CAM

Ngram is a Google analytic tool/way to waste lots of time on the internet, a byproduct of Google’s scanning millions of books into its database. In a matter of seconds, Ngram scans words from about 7.5 million books, an estimated 6 percent of all books ever published. Type a word or phrase in the Ngram Viewer search box and in seconds a chart of its yearly frequency will appear. You can also search for a series of words or phrases and the Viewer will provide a color-coded chart comparing frequency of use. More sophisticated searches (e.g., making the search case sensitive, or not) are also possible.

As explained in the New York Times, researchers “have used this system to analyze centuries of word use, examining the spread of scientific concepts, technological innovations, political repression, and even celebrity fame.” Erez Aiden, a computer scientist who helped create the word frequency tool, says he and his co-researcher, Jean-Baptiste Michel, wanted “to create a scientific measuring instrument, something like a telescope, but instead of pointing it at a star, you point it at human culture.” In fact, the title of their new book is Uncharted: Big Data as a Lens on Human Culture. Still, they caution that, like other scientific tools, Ngram’s results can be misinterpreted. An example: the fax machine. If you query that term, it looks as if the fax appears almost instantaneously in the 1980s. In reality, the machine was invented in the 1840s but was then called the “telefax.”

If Ngram can search for scientific concepts, how about unscientific concepts? What might a search of unscientific concepts tell us about our human culture? Let’s find out.

Searching for alternative medicine

Let’s start with the search “alternative medicine, complementary medicine, complementary and alternative medicine, integrative medicine,” with no case sensitivity. But first, some technicalities applicable to all of the Ngram searches in this post. I searched only English-language books and applied a smoothing factor of 3. (Smoothing and other features are explained here.) I chose 3 for the sole reason that 3 is used by Google in its sample Ngram search for “Albert Einstein, Sherlock Holmes, Frankenstein.” (Not sure what conclusion, if any, about human culture is suggested by that search.)

In searching, I wasn’t particularly interested in the absolute frequency with which a word or phrase appeared (as represented on the y axis), but rather how it compared in frequency to other words and phrases, what year each appeared (as represented on the x axis) and its trajectory over time. The database only goes through 2008, so searches have to end there. Also, the searches have to assume that the word or phrase has only one definition, or perhaps one definition that dominates all others. We also have to remember that only books were scanned, not, for example, academic journals or popular magazines. Or blog posts, for that matter. For those of you used to scientific precision and charts offering meticulous measurements, you’ll have to forgive my rough calculations and interpretations. Finally, sorry for the fuzziness of these charts. (If you’d like a clearer picture you can follow along on your computer by performing the same Ngram search.)

SBM post ngram alt med

You’ll see that alternative medicine is far more prevalent than the others. It’s barely on the radar in 1970, climbs gradually to 1990, and then shoots off beginning in around 1993, peaking in about 2003 and then declining. Complementary medicine starts to show up in 1980, with a more gradual ascent, peaking earlier, around 1999, then flattening and declining. Complementary and alternative medicine doesn’t take off until full 15 years later, in 1995, peaking in 2004 and flattening, then declining a bit. Integrative medicine appears at about the same time and follows roughly the same trajectory as, but with less frequency than, complementary and alternative medicine. What was going on that might explain, at least in part, these trajectories?

There are some interesting parallels. The predecessor to NCCAM, the Office of Alternative Medicine (OAM), was funded with taxpayer money in 1991, established in 1992, and made part of the National Institutes of Health in 1993, all around the time the term alternative medicine started its steep ascent. The first national survey of alternative medicine use, then referred to as “unconventional medicine,” was published in 1993 as well. The article discussing the survey contained the misleading, but often quoted, claim that one-third of adult Americans used at least one unconventional therapy, a percentage puffed up by rebranding conventional treatments as unconventional.

The OAM became the National Center for Complementary and Alternative Medicine in 1998, about three years after the phrase “complementary and alternative medicine” began its appearance. The first Consortium on Integrative Medicine met in 1999, and the Consortium of Academic Health Centers for Integrative Medicine was formed in 2000. “Trends in Alternative Medicine Use in the United States, 1990-1997,” was published in JAMA in 1998. It used the same questionable methodolgy to reach a conclusion that alternative medicine was increasingly popular. This was followed, in 2002, by “Complementary and Alternative Medicine Use Among Adults: United States, 2002.” Once again, conventional modalities such as diet (including a vegetarian diet) and exercise were counted as CAM. (Note the ever-changing nomenclature, perhaps an indication of confusion over just what it is we are measuring.)

As has been pointed out before, the creation of NCCAM (and its predecessor, the OAM) and the first two articles about CAM use, were the products of Wayne Jonas, David Eisenberg, Tom Harkin and others who want to promote widespread adoption of CAM into American healthcare, evidence be damned. This brings us to a “chicken and egg” question. Which came first? The increasing cultural significance of CAM, as evidenced by Ngram, or its ardent promotion by aficionados? Was increasing cultural significance the result of this PR campaign? (We know, of course, it’s not the evidence of safety or effectiveness that encourages CAM use.)

But what about the term “CAM” itself? Here we run into some search issues. In addition to being an acronym for complementary and alternative medicine, it can stand for computer-aided manufacturing, the Construction Association of Michigan, and the Contemporary Art Museum in Raleigh, NC. It is also the NYSE symbol for a company, a person’s name and a machine part. And our search is complicated by the fact that we have to drop the case-insensitivity filter as that would likely pick up more irrelevant uses. Still, here’s what the search looks like, for what it’s worth.

SBM post Ngrams and CAM CAM

You’ll see that the word “CAM” is already around in 1970, peaks in about 1987, falls and then rises again a bit, only to level off at about the same time as the other terms. Yet it falls as the others are taking off. It is also far more common than the others, although we don’t know how much any of this can be attributed to its different meanings.

CAM practitioners and practices

Let’s move on to specific CAM practitioners. First, we compare chiropractor, naturopath and acupuncturist. Since Traditional Chinese Medicine and Oriental Medicine can be both modifiers describing a type of practitioner and nouns designating the practice itself, I excluded them, although we will get to them in the next chart. (Note that we are on an entirely different frequency scale here.)

SBM post Ngram and CAM chiropractor

As would be expected, chiropractor comes in first, followed by acupuncturist, then naturopath. I was surprised that acupuncturist was not used more frequently but perhaps this can be explained by the fact that acupuncturists go by more names than the other two: Traditional Chinese Medicine practitioner, Oriental Medicine practitioner, Doctor of Oriental Medicine, and so forth. What is more intriguing is that chiropractor and acupuncturist both hit a peak about 2000 and then decline. Recall that this was true of some terms on the first chart.

Next, we switch to the practices themselves (again, note the change in frequency scale.) Here’s how chiropractic, acupuncture, naturopathic, Traditional Chinese Medicine, and Oriental Medicine compare.

Ngrams and CAM acupunture etc

Note how acupuncture is far ahead of the other terms. Naturopathic, Traditional Chinese Medicine and Oriental Medicine hardly appear before 1990, rise a bit, and then flatten. And notice the upticks starting around 1990, again like the first chart. As with the practitioners, the words “acupuncture” and “chiropractic” have seen a decline in frequency from their peaks.

Homeopathy rules?

I’ve saved the most surprising for last. Here we compare homeopathic (because the products are often called homeopathic remedies), homeopathy, herbal medicine, and dietary supplement.

Ngrams and CAM homeopathic

I was surprised to see how far homeopathic/homeopathy surpassed dietary supplement, even though far more of the latter is sold each year. Some of this might be explained by the use of “homeopathic” to describe a practitioner as well, although they are generally called homeopaths. Even herbal medicine is more frequent than dietary supplement. Interestingly, all four share a similar trajectory, with the first three falling since 2000-2005, and dietary supplement remaining flat since around 2003. Note that dietary supplement begins to climb around 1994, the same year dietary supplements were deregulated by the Dietary Supplement Health and Education Act (DSHEA).

Conclusion (if there is any)

What have we learned? Well, nothing maybe, but Ngram is an interesting analytic tool. It would take someone with far more expertise than me to cipher this data but here are two tentative conclusions. First, vigorous advocacy by CAM proponents over a short period of time was followed by an increased use of some CAM terms, indicating an increased cultural awareness of CAM. A popular rationale for research funding, inclusion in medical curricula, selective use in integrative medicine, licensing of practitioners and the like is a supposed public demand for CAM. But was demand, at least in part, ginned up by the increased cultural awareness following these advocacy efforts? Did more people try CAM not because of a perceived benefit, but because it was on the cultural radar? Is demand leading or is it following? Second, the frequency of CAM-related terms is decreasing. Perhaps this is temporary, or is an illusion created by the short time span covering the decrease. We can only hope this means a real decrease in the cultural impact of CAM, despite its advocates’ best efforts. Time will tell.

Posted in: Acupuncture, Chiropractic, Computers & Internet, Herbs & Supplements, History, Homeopathy, Naturopathy, Traditional Chinese Medicine

Leave a Comment (26) ↓

26 thoughts on “Ngrams and CAM

  1. Birdy says:

    I think ‘homeopathic’ being so much more frequent than the terms you compared it to may have to do with the fact that many people confuse it with herbal medicine and other potentially rational interventions (like dietary changes and relaxation) and then use the words interchangeably. It wouldn’t surprise me if that is why it occurs more frequently than ‘herbal medicine.’

    I’ve even seen people refer to certain diets as ‘homeopathic.’ Would that mean eating fewer calories would mean you get fat because they are ‘potentized’ calories?

  2. windriven says:

    Thanks for the link to Dr. Atwood’s post about the descent of Hah-vahd into the madness of sCAM. Atwood’s disbelief and sadness are palpable as he relates the story. That was in 2009. Depressingly, things haven’t gotten better.

  3. Björn Geir says:

    Ngram is fun and interesting to play with.
    I tried searching for “acupuncture” in Chinese (simplified) language.
    Simplified Chinese was introduced in the late fifties so it is not strange that there are no records of the word before 1961. But the interesting finding is how the word seems to reach a zenith in 1979 and then sharply drop after 1980 to become virtually nonexistent at the turn of the century.
    Of course there can be simple alternative explanations but one cannot but wonder whether the Chinese themselves are loosing interest in their own big invention while the rest of the world are still crazy about it? ;-)

  4. Eugenie Mielczarek says:

    Jann: Thanks for a great post on the history of the CAM quagmire. I would add two crucial reports which influenced members of Congress: the Clinton Commission Report “The White House Commission on Complementary And Alternative Medicine Policy March 2002” and the Institute of Medicine Report from the National Academy of Sciences ; “Complementary and Alternative Medicine in the United States 2005”. The fact that the Executive Office was persuaded to give a thumbs up to installation of alternative medicine with federal funding is not surprising but the Institute of Medicine Report was equally disappointing.

  5. graph science-based medicine, alternative medicine,evidence based medicine
    sigh

  6. irenegoodnight says:

    I wonder what would have happened to your “dietary supplements” line if you had just used the term “vitamins”?

    I didn’t know this Ngram thingy existed, but I can’t wait to waste some time with it! Maybe it will stop me reading blogs all morning.:-)

    1. windriven says:

      Here is another take that you might find interesting. Adding god to the mix buries the various confessionals so I left it out.

    2. windriven says:

      And to end on a happy note, here is a graph comparing creationism, intelligent design and evolution!

  7. windriven says:

    Dummass. Try again. Here is the graph intended to appear above.

    1. That may be partly because intelligent design and creationism have not been used very long to describe those types of arguments.

      https://books.google.com/ngrams/graph?content=creationism%2Cintelligent+design&case_insensitive=on&year_start=1600&year_end=2008&corpus=15&smoothing=3&share=&direct_url=t4%3B%2Ccreationism%3B%2Cc0%3B%2Cs0%3B%3Bcreationism%3B%2Cc0%3B%3BCreationism%3B%2Cc0%3B%3BCREATIONISM%3B%2Cc0%3B.t4%3B%2Cintelligent%20design%3B%2Cc0%3B%2Cs0%3B%3Bintelligent%20design%3B%2Cc0%3B%3BIntelligent%20Design%3B%2Cc0%3B%3BIntelligent%20design%3B%2Cc0

      You can see the two arose around 1800 with a huge spike by creationism in the later 1900′s and of intelligent design right at the turn of the 2000′s. That is to be expected. After loosing at creationism as a science, intelligent design arose as an alternative.

      1. windriven says:

        But happily, these pale in comparison to evolution and natural selection.

  8. rork says:

    upregulate
    synergy
    define
    exponentially

    I’m getting real tired of (science) people who say define 4 times per hour, without ever meaning define. Fashion – it can make you look bad. The last one is not the abuse of science types, but rather the abuse of those who want to sound like they are. It is nearly meaningless for some people.

  9. far out says:

    I was speaking with a social worker and psychotherapist today who left her hospital-based practice, together with a psychiatrist, many years ago in downtown Toronto. They started an integrated wellness clinic with provision of many allied services including homeopathy, relaxation techniques, reiki and the whole nine yards. She reported that the improvement in her patients was nothing short of magical.

    I believe that SBM does not have all the answers. Remain open. Be sure to question. Inquire. If you get relief from something like homeopathy or acupuncture, I am all for it. Because of the tools and techniques it is limited to, science cannot even ask let alone answer many of the most important questions in life, such as what is the best way to open the heart and mind to healing. Medication, surgery, other conventional modalities will always have their place, but there are other healing arts, and they have been practiced for thousands of years in many cultures, places and times. The approach of science is to take something like meditation and put monks into an fMRI scanner to try to figure out why they are so happy and liberated from suffering. This is a$$-backwards in my view. By reducing something in this way, you will never be able to replicate it, and probably never be able to explain it. Science is only one route among many. Hence the term “complementary and alternative medicines”. When we shed our blinders, our blinkers and our biases, we come to realize there is much more to this world that can be scientifically dissected and reduced (even at a macroscopic level, even in controlled human clinical trials). I feel very sorry for those who are deeply blinkered by Western scientific reductionism.

    1. WilliamLawrenceUtridge says:

      Of course SBM doesn’t have all the answers. If it did, it could stop.

      Of course, science not knowing everything doesn’t mean your speculation about what might be happening is right. That’s kinda the problem – quacks point to the lack of treatment and changing recommendations for low back pain (or anything) and say “here is a flaw in science”, and offer instead iron-clad certainty that their completely untested, improbable nonsense is the answer (and doesn’t need to be tested, and if it fails testing then the problem is with science, not the nonsense they are willing to sell you at a premium).

      The “ancient healing wisdom” of cultures you allude to was notably inefficient at healing things like trauma and disease, and did nothing to prevent massive numbers of babies from dying – something real medicine has managed with considerable success. If ancient wisdom is so great, why did it take vaccines to drive smallpox to extinction, or cause iron lung manufacturers to go bankrupt? The fact that people are now concerned about “being tired all the time” rather than “I’m bleeding out of these fist-sized pustules” rather puts the effectiveness of real medicine into context, doesn’t it?

      Monks are happy because they are well-fed, protected from suffering, and don’t have to worry about a lot of the things that make many of us miserable – work, having enough to eat, the health of their families and children. And some of those monks have turned that into greedy assholes.

      And you know what they call “complementary and alternative medicine” that passes rigorous scientific testing? They call it medicine. The entire category is defined by being unproven, by being based on assertions that it works, rather than evidence. It’s not real medicine’s fault that CAM practitioners have to make their living by unethically selling unproven nonsense.

      I feel very sorry for those who rely on gurus rather than their own intelligence to tell them how to be happy.

    2. windriven says:

      “Remain open. Be sure to question. Inquire.”

      All hallmarks of a scientific mind. But an open mind differs from an open sewer and inquiry must be done in a logical and structured way.

      An open mind accepts even the revolutionary claim but only when that extraordinary claim is based on extraordinary proof. You may recall some years ago two academics – a phycist and a chemist as I recall – claimed to have demonstrated nuclear fusion in a bench top apparatus. Now these were serious people and the technology they proposed would have solved some serious world problems. Yet scientists were very skeptical because what they proposed fell far outside how we know atomic fusion to work. And indeed, their experiment was flawed and so-called cold fusion was a tempest in a teapot.

      Science examines claims very closely to determine if they are true and if they are, what are the underlying principles at work. This is why you have safe air flight at 600 mph and a reliable Internet that allows billions to communicate instantaneously to others around the world. It is also why you have magnetic resonance imaging that can explore structures deep inside the body and why physicians almost routinely save 800 gram premature babies and drugs that have turned AIDS from death sentence to manageable condition.

      Science doesn’t reject therapies because it doesn’t like them, it rejects them because they don’t work beyond placebo. A placebo that makes you believe that your athsmatic lungs are working better but that doesn’t improve your pulmonary function does you no service.

      Your acquaintance who operates the quackery emporium no doubt believes that what she does produces miraculous results just as some store front preachers may believe they actually can bring sight to the blind and hearing to the deaf with a prayer and a smack on the head. Sadly, both those beliefs are fantasies.

      Read the posts here. Follow the studies cited. Learn the basics of how science is conducted, how it applies to medicine, how it has changed the human condition in spectacular ways, and how it protects you from worthless nostrums.

      What you blithely dismiss as Western scientific reductionism is the intellectual discipline that allows you to live an 80 year life that is mostly free of disease and disability. That quality of life and freedom from disease gets a little better every day because of blinkered scientific reductionism – not because of magic water and dancing needles.

      But look, if you come up with coronary artery disease or breast cancer or s. aureus on a heart valve you’ll have a choice. You can see a doctor or a shaman. You’ll go to the doctor because you know they can cure you if you can be cured. So if you’d choose a medical doctor when your life depends on it why would you use a quack when it doesn’t? Charity?

    3. weing says:

      “I feel very sorry for those who are deeply blinkered by Western scientific reductionism.”

      There is an Eastern scientific reductionism? I feel very sorry for those who are deeply blinkered by woo.

  10. Kov says:

    I wonder if the dropoffs in the various terms starting around 2000 has anything to do with the books that Google has eaten? Maybe it’s because I live in Portland (hi, Dr. Crislip!), but at least anecdotally, all flavors of alt-med seem to increasing in popularity. Interesting use of the Goog, in any case.

    1. Eugenie Mielczarek says:

      Re: the switch from creationism to intelligent design: two important court cases. One from a mid western state–judge struck down the teaching of ‘creationism’ in biology texts. However the Publisher merely switched the phrase to , intelligent design. The second in Pennsylvania -the judge’s ruling essentially said ‘intelligent design’ has no scientific validation and could not be taught in the science class.

      1. irenegoodnight says:

        Many of us have recently been reading Monkey Girl about the case in Pennsylvania. A very good read.

        I have to confess, Prof. Mielczarek, I had you confused with the recently retired Eugenie Scott of NCSE, who has also done a great deal to defend the teaching of evolution. :-)

  11. Pete Attkins says:

    Jann, many thanks for your interesting article. You and the commentators led me to perform some analytics of terms related to my fields of engineering. Interestingly, all of the results showed a decline towards the end (2008).

    I’m wondering if this is caused by an increasing percentage of fiction being included in the database rather than an actual decline in technical usage of the terms.

  12. Uh Oh! Have the scientologists infiltrated google? Ngram/Engram! ;-)

    Fascinating stuff though. Seems at first glance that the problem is that once a pseudo meme takes off, it may decline but still leaves a residual baseline.

    What would be more interesting would be if we could distinguish between positive and negative coverage, and maybe tie those trends in to say market effects e.. sales of homeopathic products.

    1. WilliamLawrenceUtridge says:

      Heh, you’re effectively saying “it would be great if computers could read books for us”.

      That would be great! Right up until they rose up and destroyed us :)

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