Something Funny For Money?
By Keir Liddle
If someone sells us faulty goods, be they electronic gadgets that just don’t work or clothing that’s missing a few crucial stitches, we would rightly expect our statutory consumer rights to be met and would likely complain vociferously.
Yet when it comes to alternative and complementary medicines where is this vehement and noisy outcry from those who imbibe homeopathic remedies, stick Hopi candles in their ears and poke themselves with acupuncture needles?
Why is it left to those who decry these treatments to criticise them and inform the consumer that using alternative and complimentary medicine is often equivelant to being sold a car without an engine?
Well the main reason that people who use CAM therapies might not complain is probably because they earnestly believe that they have been treated and that their conditions have improved. The power of the placebo effect can be very convincing – but why?
One reason is perhaps that most people using complimentary and alternative therapies are doing so for self limiting conditions: a condition that will run its course within a specific period and is little modified by treatment. So folks who use alternative therapies get better anyway and mistake the correlation between using their favoured alternative therapy with a causative and curative effect.
The suppossed effects of alternative therapies can also be explained, when applied to self-limiting conditions, by the concept of regression to the mean. Take the example of back pain – people may suffer from pain on and off but only seek treatment when the pain is particularly bad.
However if they seek treatment around the time that the pain is at its most extreme then you would expect (on average) that the pain would lessen and their condition improve regardless of any treatments sought. Thus people using complimentary or alternative therapies for back pain will think that their choosen remedy has “cured” them or alleviated their suffering without considering that the condition would likely have cleared up on it’s own anyway.
That people believe that CAM has an effect, despite scientific evidence to the contrary, probably explains the use of pseudoscience and anecdote to support their claims and beliefs and leads me towards one conclusion: nobody has ever sat them down and explained the logic behind evidence based medicine.
Anecdotes are unreliable because people are unreliable. There are all sorts of reasons why people are unreliable judges of their own health. They don’t want to appear a burden, don’t want to admit to themselves that there is a problem – they could be afraid that a visit to the doctor will uncover something serious for instance?
When it comes to testing drugs people can be equally as bad at assessing their effects. This is down to a myriad of psychological effects – the expectation effect for one. Essentially people expect an effect from some sort of remedy and then overinterpret or attribute any improvement experienced to the treatment given.
Clearly there needs to be a way of controlling for the unreliable nature of human beings…
…and there is: the blind trial. To determine if a drug has a real effect patients are randomly assigned to one of two groups placebo (or control) and treatment (or experimental). The treatment group unknowingly received the remedy being tested and the placebo group are given a suitable alternative that it is known has no active ingredients or effect. If there is a greater effect size in the treatment group compared to the placebo group then you can be more sure that the remedy is effective.
Except, well, there can be issues where, either conciously or unconciously, the experimenters can bias the results of the study. By reinterpreting results that seem odd or don’t fit with what they would expect; rechecking results that seem odd but taking on face value those that fit their hypothesis. They could also not properly randomly assign people to treatment groups – assigning “stronger” or “healthier” folks to the treatment group and “weaker” folks to the control group in order to bias the results in favour of the treatment group.
To avoid this scenario studies can be double blinded.
This is where not only do the patients not know if they are getting a remedy or a placebo but those administering the treatment don’t know either. So there is no way they can bias the results! Now this tells you if a remedy is better then placebo or more technically it tells you whether there is a significant difference between the two groups. To measure how much of a difference one should really employ an effect size measure of some sort. There is no point lauding a remedy based on statistical significance alone as the effect size it has over placebo could be tiny.
By going through this process you can determine whether or not a remedy is actually effective and whether it is likely to help your condition.
Unfortunately, in the case of many, many complementary and alternative therapies the above method is not followed in research and you see a lot of low quality (not properly blinded/problems with randomization and the like) trials that show CAM therapies and remedies have an effect. For people unaware of the quality issues encountering the “high quality” trials and the fact they contradict the findings of “low quality trials” can make it appear that there is still some debate of the efficacy of such trials – but there really isn’t.
There is the adoption of scientific language and appropriation of approximations of the methods of evidence based medicine that all add up to create the illusion that there is scientific evidence when in reality it’s just pseudoscience.
In an ideal world people wouldn’t be fooled by such things and would not spend their money on engineless cars – but until then I suppose it will only ever be the skeptics who expose those who peddle placebos as paneceas for all your ills in the interests of consumer rights and in the interests of good public health.