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Google Trends and the Interest in Alternative Medicine

USA Today has come out with a new survey – apparently, three out of every four people make up 75% of the population.

–David Letterman

How popular is alternative medicine? One way is to survey people and ask them. Like all surveys, the nature of the question determines the answer. The first, and probably most referenced, and misquoted, article on ‘alternative’ medicine to address the question was “Unconventional Medicine in the United States — Prevalence, Costs, and Patterns of Use” from the NEJM .

‘Alternative’ proponents quote this article, often as the opening sentence of the paper. “One in three respondents (34 percent) reported using at least one unconventional therapy in the past year.” No one, it appears, ever reads past the abstract. As is so often the case, the substance of the article may not reflect the spin found in the abstract.

There are many issues with this paper (see http://www.quackwatch.org/11Ind/eisenberg.html for a detailed critique) , not the least of which is the definition of unconventional therapy. To get to this huge percentage of users they had to include exercise (26%), prayer (25%) and relaxation techniques (13%) as unconventional therapies. Little did I know that I participate in unconventional therapies every day.

When you look at use of the more irrational modalities, it appears the Americans are not as gullible as the abstract would suggest. The lead irrational therapy used was chiropractic with 10%, homeopathy was 1% and acupuncture was <1%. Other modalities that garnered single digit use included massage 7%, imagery (4%), commercial weight loss (4%), lifestyle diets (4%), megavitamin (2%), self-help groups (2%), energy healing (1%), biofeedback (1%), and hypnosis at (1%). Many of these therapies are unlikely to be used to treat a diagnosed medical condition. Not an impressive list of “unconventional’ therapy use by US citizens to treat disease. Diet and exercise may or may not be unconventional, depending on the exercise and the diet and the intent of its use.

The reality of the article never stops ‘alternative’ proponents from touting this study as to the popularity of these therapies to justify their use. Argumentum ad populum is always a favorite. Like Eskimos having 30 words for snow (4) or we only use 10% of our brain (insert your own snide comment here), the fiction that 34% of Americans use alternative medicine is perceived as true.

Subsequent surveys have demonstrated that ‘alternative’ modalities are used at rates less than 1 in 3. The 2007 National Health Interview Survey had the following rates for whether people ever used the following ‘alternative’ therapies: acupuncture 6.55 %, ayurveda 0.56%, biofeedback 1.23%, chelation 0.34%, chiropractic manipulation 21.91%, energy healing 1.72%, hypnosis 2.34%, massage 16.02%, naturopathy 1.51%, homeopathy 3.65%, tai chi 0.9%, qi gong 0.6%, yoga 9.53%.

The numbers from the National Health Interview Survey are different from the Eisenberg data, and are probably more representative as the therapies on the National Health list are likely to be used in an attempt to treat illness, and are what I would consider ‘alternative medicine’.

Polling populations to ascertain their use of ‘alternative’ therapies is a cottage industry. Pubmed has numerous references of the type “Use of alternative therapies in X patient population”, where X is, for example, cancer patients or AIDS patients. It must be a quick way to get a publication. Often with small in sample size, using these studies to judge extent of alternative medicine use is difficult. It depends on the nature of the questions asked and the honesty of the answers given.

I ask every patient if they partake of ‘alternative’ providers, and my experience (as I fallibly remember it) is that it is the rare patient who is involved in these modalities outside of chiropractic and OTC supplements. Not that popularity is a determinant of efficacy. When one of your hobbies is evaluating ‘alternative’ medicines, confirmation bias makes it seem like quackery is everywhere. The internet also makes it seem like ‘alternative’ medicines are rampant, but it may be that the louder voices are the ones being heard. Is there or is there not a lot of interest and use of medical woo?

Google to the rescue.

Google trends is an interesting feature. It allows you to see what search terms have been entered over time and get a general idea of a topic’s popularity.

Google trends came to my attention with flu trends (3), where google search terms for influenza predicted influenza in the US two weeks before the traditional reporting mechanisms. The data is graphed over time. The explanation of the scale is in the references. People were searching for influenza before the culture data made it back to the CDC.

You can enter any search term into Google trends and see the search activity over time. It is a rough idea of the popularity of a topic in the subset of people who use Google. You can search by time and by region and I thought it would be interesting to use Google trends for the US and the World as a surrogate for interest in various unconventional therapies.

Homeopathy

The World

United States

Looks encouraging. A slow decline in searches about homeopathy. Apparently there is less interest in homeopathy over the last 4 years. Is this valid information? Google receives several hundred million searches a day. Over time variations should smooth out making trends, rather than absolute numbers, valid. Compare this graph, just for fun, for diet in the United States.

I think it is interesting that there is a spike right at the start of the year and the end of the feasting season. As one would expect. There is also a dip just before Thanksgiving; people, I suppose, being less interested in starting a diet just before the holiday season.

How about searches for skin cancer in the US?

Searches peak in the spring/summer when there is the most sun and the most inadvertent sunburns. As expected.

Hypertension/High blood pressure?

No big variations. Stable searches for a disease with no seasonal variation or change in incidence.

And look at the most popular search term of 2008, Britney Spears

But back to the topic at hand.

Chiropractic

World

US

Stable to slight increase in the US, while the world at large may be becoming less interested in chiropractic.

Acupuncture

World

US

Interest is declining worldwide but stable in the US over the last four years.

Naturopathy

World

US

Stable to declining interest in naturopathy. Perhaps evidence is are having some effect on the acceptance of alternative medicine?

As a topic of google search interest, alternative medicine seems to be in decline.

Same declines with complementary medicine, the decline starting after Prince Charles came out in favor of their use. Cause and effect? I’d like to think so. When it comes to health care advice, Prince Charles should be considered to be on opposite world.

Reiki: in decline.

Herbal medications: in decline.

Ayurveda: in decline.

Hypnosis: in decline.

Male enhancement, fraught with puns too bad even for me, has the following trends demonstrating that not all medical woo is decreasing in popularity.

World

US

Vaccinations and autism searches appear to be driven by news events, but what occurred in September 2007 I am uncertain. The recent ‘greening’ of the vaccines, a new organization with celebrity support, may have some traction in Google over the last several years.

These, of course, are not a scientifically validated polls and drawing conclusions is probably suspect. It may all be ‘Dewey defeats Truman’, but it was fun to do.

Many of the declining interests seems to parallel an increase in the volume of news stories about ‘alternative’ modalities.  Increased knowledge, pro or con,  seems to lead to decreased interest in many unconventional therapies.  Which, it you think science and evidience will sway opinion, is what you would hope for.

I would conclude, however, that rational thought, against all odds, may be making way against quackery of all kinds. Despite the incorporation of woo into some medical schools, most people are harder to fool than Deans. Lincoln was right.

Maybe, just maybe, science based medicine, which seems to be a small voice in the loud world of woo, is being heard. Maybe, just maybe, ‘alternative’ medicine is becoming all sound and fury, signifying nothing.

A more amusing way to look at search metrics is http://statestats.appspot.com/, which compares search results by state and relates the search to other metrics. For example, Mississippi most often searches for male enhancement and there is a strong correlation with having voted Bush. Oregon, my home state, leads the list for searches for acupuncture and it is most correlated with high income. Draw what conclusions you wish from this site.

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References

How is the data displayed? From the google site.

The data is scaled based on the average search traffic of the term you’ve entered.

There are two modes of scaling – relative and fixed – and the only difference between them is the time frame that’s used to calculate the average.

In relative mode, the data is scaled to the average search traffic for your term (represented as 1.0) during the time period you’ve selected. For example, if you entered the term dogs, the graph you’d see would be scaled to the average of all search traffic for dogs from January 2004 to present. But if you chose a specific time frame – say 2006 – the data would then appear relative to the average of all search traffic for dogs in 2006. Then, let’s suppose that you notice a spike in the graph to 3.5; this spike means that traffic is 3.5 times the average for 2006.

In fixed mode, the data is scaled to the average traffic for your term during a fixed point in time (usually January 2004). In our example, 1.0 would be the average traffic of dogs in January 2004. If you chose 2006 as your time frame, you would be comparing data for dogs in 2006 to its data in January 2004. Since the scale basis (1.0) doesn’t change with time, you can look at different time periods, and relate them to each other. (Note: For keywords without a historical record, it may not be possible to establish a fixed scale).

2) Unconventional Medicine in the United States — Prevalence, Costs, and Patterns of Use. http://content.nejm.org/cgi/content/abstract/328/4/246

3) http://www.google.org/flutrends/

4) Numbers vary and I bet this one throw away sentence gets the most comments. BTW, Eskimo’s DO have 27 words for circumcision, all favorable.

Posted in: Science and Medicine

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