A lot of “alternatives” to standard ideas have been gaining popularity lately.
Alternative history tells us that we’d all be speaking French right now if Hitler hadn’t saved us from the evil forces of Gallic imperialism.
Alternative chemistry teaches that Aristotle was nearly right with his conception of four classical elements, but that the world is in fact made up of Earth, Fire, Air, and Coleslaw.
Alternative zoology suggests that ducks are actually a species of moss.
And alternative medicine works on the revolutionary principle that your cure doesn’t need to cure anything to be worth billions and billions of dollars.
The thing to which ideas like homeopathy and acupuncture offer an “alternative” is that of evidence-based or science-based medicine, otherwise known as “medicine”. I shouldn’t need to drag Tim Minchin over to explain the obvious again – he’s a busy man and I imagine he’s getting pretty sick of it by now – but it bears repeating that if these alternative practices had any significant evidence backing them up, they’d just be medicine. Why would you even want an alternative to “all the stuff that works”?
I’m not going to look too much at specific alternative therapies here. But it’s worth looking at the field as a whole, to see if we can find what’s common to all or most of them. Why do people turn away from reality-based ideas in favour of fanciful nonsense?
Well, there’s various reasons. But what I think suckers most people in is some variant on:
It worked for me!
Sounds persuasive. Here’s my response:
No it didn’t.
Okay, let me explain how I’m allowed to say that (aside from that I’m obviously being a tad flippant).
Personal testimony, and the telling of heartwarming anecdotes of past success, is probably the most common cause for buying into any kind of hokey nonsense. But there’s a real problem with using some individual story as evidence, and drawing grand sweeping generalisations about what works.
When people blather about how wonderful they felt after mainlining some homeopathic rosewater, they might say: “It worked for me.”
But what they really mean by this is: “I took it; later I felt better.”
If you don’t appreciate why this difference is important, consider this. You are, at this moment, reading words that I have typed. Additionally, there’s a high probability that sometime later today you will go to the toilet to expel urine from your bladder.
I am hereby claiming that my blog has powerful diuretic properties. So, when you do indeed go to relieve yourself – probably within the next few hours – you can confidently claim that it really did work for you, just as predicted. You now have valuable anecdotal evidence of this phenomenon. You’ve just proved – as conclusively as anything has ever been proven about homeopathy – that my blog can make you piss yourself.
I imagine you may have some objections to this line of reasoning.
If you’ve noticed that, actually, you have every reason to suppose that these events are entirely unconnected, and the “effect” would have occurred anyway with no prompting from the “cause”, then congratulations! You’ve just exercised some basic critical thinking skills. You’ve realised that correlation does not imply causation, and as a further exercise, you might like to try coming up with some other explanations for why you started feeling a bit better after being stuffed full of natural soothing herbs. Maybe you just regressed to the mean. Maybe you’re only remembering instances when it seemed to work, and unconsciously glossing over the many failures as being irrelevant.
Or maybe you’re just a basically good and trusting soul, who assumes that the rest of the world is just like you, and you’re sure you couldn’t possibly be misled by so many comforting, trustworthy authority figures.
Gosh darn it, my aromatherapist’s just such a jolly good chap. We always have a nice chat in his office, someone makes me a cup of tea, it’s all very cosy, and he’s so reassuring to talk to about my problems. Honestly, sometimes I’m having such a nice time, and feeling so well taken care of, I completely forget about the devastating cancer that’s tearing my body apart.
Many alt-med practitioners may indeed be very nice people, and having someone listen caringly to your problems and tell you that it’s all going to be okay can be a real pick-me-up. They’re generally good at being charming and approachable, and can give their clients much more one-on-one time than your average overworked GP. All of which can leave you with a much more favourable impression of them than would be merited by the quality of their treatments alone. They’re so nice, and they seem to know what they’re talking about, and they’re saying all these positive things that you really want to hear – it can be hard to disbelieve such good news from such a compassionate, friendly source.
But you shouldn’t be tempted to give Hitler a break on his politics just because you visited his fluffy bunny petting zoo. (No, I didn’t just compare alternative medicine to Nazism. You’re imagining things. That was actually just a complete non-sequitur cunningly disguised as a bizarre and inappropriate Nazi analogy.) It may be lovely to spend time with these people, and you’re welcome to make the case that mainstream medicine could pick up a few hints about patient care in this regard.
And often you’re probably right: I’m certain that a lot of these people aren’t trying to con you, or lying to you, or intending to do anything other than help their patients who they see with genuine compassion. But for reasons like those I’m outlining here, they are wrong. How much you feel at ease when someone smiles at you is not a good indicator of whether the water they’re prescribing you is of any medicinal use.
And this is just one of many factors that plays a part in…
The Placebo Effect
The placebo effect is
a Robert Ludlum novel the very weird process by which your brain can decide just how much better or worse it wants you to feel, independent of what it’s being told by the chemicals you’re taking to shove it around. A treatment that doesn’t actually do anything can still work, simply because of the effects induced by your expectations of it.
Ben Goldacre covers this effect and its implications in his Bad Science book more thoroughly than I’m going to here, but it’s important to be aware of. Taking a medicine-free sugar pill might well be better than nothing, but it also sets the bar for how good any other treatments need to be, if they’re going to be taken seriously as medicine. Your magic water or magic needles or magic whatever-the-hell’s-popular-these-days might also be better than nothing, and people might be persuaded of its life-saving powers on this basis. But if it’s not also better than a sugar pill (or an equally inactive saline injection, or something else which provides the same conscious experience as the treatment but without the actual medicine), then they’re falling for an illusion.
The most ridiculous example within easy reach of the placebo effect fooling people is a clip from Penn & Teller: Bullshit!, in which people marvel at how much better they feel after doing silly things with magnets, and how rejuvenated their skin looks after having snails crawl across their faces. Something that seems technical and medical is being done to them by a trustworthy-looking guy in a lab coat; clearly they’re meant to feel better afterwards; so, they come to believe that they do.
It might seem wacky, but you can’t just dismiss these people as idiots being stupid. It’s really easy for anyone to think this way. They’re trusting, and hopeful, and unaware of the many problems with this way of evaluating evidence. And no individual has the capacity to usefully evaluate the validity of anything based on a sample size of one.
Alternative therapies are littered with the kinds of pseudoscientific buzzwords that make it seem like there must be something to them. These cures are “natural” and “holistic”, not like those big scary monolithic drug companies and white-coated scientists. But no single person’s experiences can be enough to demonstrate whether waving magnets over you really does make your chakras more aligned. Because who knows what else was going on that might have caused it? Was it definitely the magnets that cured you, or was it that new shampoo you started using around the same time? You really can’t gather enough data on your own to be sure about anything.
We can be a lot more certain, though, if we take a broader view at what happens to thousands of people under this treatment regime. If you look at enough people who got better, then they can’t all have simultaneously started using a new and surprisingly therapeutic shampoo, or inadvertently done a kindness to an old gypsy woman who returned the favour, or been cured by some other random factor. If you compare them to a few thousand other people, under similar conditions but not being treated, then you can start to see what actually works.
In most areas of life, it’s obvious that extremely small samples of the population tend to be meaningless if you want to draw wider conclusions. Taking a sample of the CDs I own, Hungarian Jewish folk music is about as popular a genre as hip-hop. Based on the house I shared at uni, it seems clear that 50% of this country writes Lord of the Rings fanfiction. Clearly we need to cast the net wider to prevent small, anomalous examples from swamping the data. But it’s apparently harder to recognise this when it comes to personal experiences with things like alternative medicine.
Doing some science is the best chance we have of arriving at a useful understanding of what’s really helpful, and what we’re just tempted to think is helpful because of the above factors. A lot of alternative practitioners try to discourage you from worrying about the usual standards of scientific evidence when it comes to their treatments, or claim that these are somehow inappropriate for testing what they’re doing. But if a treatment has any noticeable therapeutic effect, then a double-blind controlled study is exactly where such an effect will most clearly show up, since we’ll have stripped away all the clutter of human biases and other random variables that might interfere.
This isn’t to say that nothing “alternative” is ever going to work. Of course some unconventional ideas might turn out to be reality-based. There’s some weak evidence to suggest that acupuncture is effective in treating some kinds of pain and nausea; for all I know, future research might back this up further. Some herbal remedies really can do stuff, like St John’s Wort for mild depression. If having a few scented candles around you feels nice and isn’t going to break the bank, then what the hey. And homeopathy… well, no, that’s just unequivocal bullshit. But good science is the only way we can know what’s worth recommending, to whom, under what conditions.
Damn. All that skeptical bitching’s given me a headache. Where’s my echinacea?