Friday, May 27, 2005

Nice resource on the scientific evaluation of alternative medicine

Professor Thomas J. Wheeler, of the Department of Biochemistry and Molecular Biology at the University of Louisville School of Medicine, has made the classroom handouts and reading lists for his course, A Scientific Look at Alternative Medicine, available online. It's a nice resource for anyone interested in a critical look at alt-med claims, and I can only give Paul at Confessions of a Quackbuster his well-deserved props for having found it.

I wish more medical schools and universities would offer courses like this, and hopefully Professor Wheeler will expand on this resource in the future.

The introduction to his course gives a nice summary of the characteristics of alt-med claims (some of which I've annotated with my own comments in parentheses):

SOME CHARACTERISTICS OF PSEUDOSCIENTIFIC HEALTH CLAIMS
  • Nonfalsifiable or irrefutable hypotheses. (This is almost essential to not just quackery but pseudoscience in general, like "intelligent design" creationism.)
  • Attribute failure to reproduce results to: (1) Failure to perform procedures properly; (2) bias; (3) incorrect attitude. (This is one that I hear again and again in misc.health.alternative. Alties will claim that scientists are biased, that they approach the idea with a "skeptical" attitude--which in my book is entirely appropriate. Scientists should approach such claims with a skeptical attitude.)
  • Unwilling to examine the phenomena closely with carefully controlled experiments. (This one is common in all pseudoscience as well. It's particularly common for paranormal phenomenon, but devotees of several altie techniques, like "psychic surgery" or many of the traditional Chinese medicine techniques that rely on Qi, which is basically an vaguely defined "life force" also fall under this rubric, as do quacks like Hulda Clark. How on earth does one measure quantitatively Qi, by the way?)
  • Reliance on anecdotal evidence, or on data from flawed studies (poor controls, insufficient sample size, etc.). (This is a big one. Alties will use testimonials to sell their product or berry pick very small studies that seem to show an effect and ignore all the others that do not, as chelationists frequently do.)
  • Anecdotal evidence can be very persuasive - especially if it concerns yourself. (True, although in most cases, even the anecdotes are questionable, based on insufficient diagnostic testing, insufficient followup, and neglecting the contribution of previous conventional medical treatments. Often the reason the anecdotes seem convincing because most people do not understand the disease for which the testimonial is being given.)
  • Argument from authority rather than evidence - endorsements by doctors, panels, etc. (There's not necessarily anything inherently wrong with arguing from authority if the authority is truly an authority and if the evidence supports it. However, the "authorities" these guys argue from are usually highly questionable at best.)
  • Selection of only supportive data, or deletion or changing of unfavorable data. (A favorite. However, in fairness, I will point out that, unfortunately, scientists aren't always above selection of only supportive data to make their case. Other scientists will usually call them on it, though. However, unlike the case with alties, scientists who are caught deleting or changing unfavorable data will suffer severe consequences in their career, their ability to be published, and their ability to obtain funding to support their research. Not so with alties.)
  • Confuses correlation with causality. (Chapters of books have been written on this. Repeat after me, everyone, "Correlation does not necessarily mean causality. The antivaccination zealots who claim mercury in vaccines causes autism are prime examples of this pseudoscientific fallacy.)
  • "Special pleading" - less stringent rules of evidence should be applied to its claims. (I've seen this one before. Typical is the claim by some alties that there are "different ways of understanding" or "different ways of knowing" other than science. Of course, these "different ways" are almost always less stringent and biased in favor of the "alternative" treatment being discussed. It makes me want to barf when I hear this one.)
  • Claim to be too busy healing patients to pursue verification through research. (A great excuse if you can get away with it. I wish I could use this one four years from now, the next time I have to renew my grant. Oh, I'm sorry, Dr. Study Section Director, I was too busy taking care of patients to pursue the research. Somehow I doubt they'd be very sympathetic. This excuse is a cop-out used by alties who are clearly not interested in proving or disproving their claims using empiric evidence.)
  • Lack of acceptable confirmation of diagnosis before treatment and/or proper followup to confirm healing. (Another big one. When you see "hair analysis" or "live blood cell analysis" used to diagnose cancer or other medical conditions and then to "monitor" response to treatment and "prove" that it's been cured by altie treatments, you're definitely dealing with a quack." Another example is Hulda Clark's "Syncrometer," which purports to diagnose the presence of toxic compounds by changes in skin resistance.)
  • Subjective evaluations or measurements. (See above.)
  • Use of pseudomedical jargon: "detoxify," "rejuvenate," "energy," etc. - entities which cannot be measured. (Another favorite pseudomedical piece of jargon among alties is "strengthens the immune system." How many times have you heard the claim that some altie therapy or other "strengthens the immune system"? More times than you can count? Me too. Too bad it's a meaningless claim, as they never get specific. For example, does the therapy improve T-cell function? What is the evidence that it does? Does it improve antibody response? You'll never get a specific answer with evidence to back it up.)
  • Proposes a single underlying cause for diverse diseases or conditions. (Hulda Clark is guilty of this in her Cure for All Diseases claims, in which she attributes all cancer to an intestinal fluke. Another example is the Gerson therapy, which attributes all cancer to a deficiency in pancreatic enzymes.)
  • Supported through myth and legend: if idea has been around so long, must contain some truth. (Traditional Chinese medicine is a prime example of this. Yes, a few of the herbs they use have medicinal value, but that does not mean the whole package is correct. As for the claim that the fact that an idea has been around a long time must mean it contains some truth, consider this: For thousands of years, people thought that the earth was flat and then, after scientists realized that it wasn't, for hundreds of years after that people believed that the sun revolved around the earth. Just because an idea has been accepted a long time does not necessarily mean it is true.)
  • Charge opponents with being close-minded. (See The Galileo Gambit, by yours truly.)
  • Charge persecution of unorthodox and revolutionary ideas: "They laughed at..." (See The Galileo Gambit again, by yours truly.)
  • Appeals to vanity of patients: "think for yourself." (Indeed. What's the matter with you? Are you going to let doctors and so-called "experts" tell you how to think? Well, are you?... That's sarcasm, by the way.)
  • Exaggerated or false advertising claims. (Just listen to infomercials and many radio commercials to see this one.)
  • Bogus credentials of practitioners (e.g., degrees from unaccredited institutions). (There are too many examples of this to list.)
  • Use of secret formulas. (If they won't tell you what's in it, be very suspicious about putting it into your body.)
The above are a very good primer on the warning signs of pseudoscientific quackery. I'm going to download all his course notes and check them over. I recommend that you do too.

4 example(s) of insolence returned:


At 5/27/2005 2:46 PM, Blogger HaloJonesFan said...

There's a cute irony there, in the "secret formulas" bit.

ALTIE: You know, those drug companies put all kinds of things in those drugs, things you don't know about!
RUBE: Gee, you're right. I'll take your drug instead. What's in it?
ALTIE: The healing power of goodness!

 

At 5/27/2005 3:18 PM, Blogger Orac said...

Of course, drug companies are heavily regulated by the government and have to report every component of their drugs. No such regulations exist for "alternative" or "herbal" medicines. They can put basically anything they want in their products and not tell anyone. Talk about your double standard!

 

At 7/08/2005 11:23 PM, Anonymous Anonymous said...

One problem I have with a lot of published research, is well its published. A lot is due to the publish or perish bit.

Having had access to data a lot of researchers wanted, I used to review requests to use the data. and pass them on to other bureaucrats I worked for. Some requests were better than others. Some were, well, there is the old toss it down the stairs test.

Not everything that is statistically significant is scientifically relevant. There is a lot of stuff that isn't evidence based. But it works.

A lot of statistics has been dumbed down with programming that any idiot, er, MD, can grab some data and get it published. Useful, sometimes. Helpful...well...

Consider. Lots of ER visits are costly and not needed. Well, one study determined that a not needed visit was one that you would have survived without. i.e. until 8 am or whenever your family doc showed up the next weekday. Forget its a fracture, you're in pain, or cardiologists want chest pains seen in ER, and neurologists want stroke symptoms seen ASAP, not a few days later when you're full blown paralyzed. Or you're a mom with a kid with a 105 deg temp.

Now some studies will keep on giving. Prayer helps patients heal. OK, love the controls on this one. Just how did we measure prayers? Or we need to drink 8 glasses of water a day (nobody said beer counted...).

 

At 10/29/2005 5:49 AM, Anonymous star said...

"No such regulations exist for "alternative" or "herbal" medicines."
yeah, it's so, and it's problem I guess

 

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