Last night, I was trying to explain (yet again!) why I am not much impressed by the long lists of testimonials that accompany most (if not all) "alt-med" therapies. As I was mentally beating my head against a wall, I was suddenly struck by the following:
I periodically get letters (and, more frequently, e-mail) with "incredible stock tips", offering to sell me a newsletter, bulletin or system to make money in the stock market. Some of the best send a series of "amazingly accurate" predictions of how
a certain stock will rise or fall in price. After getting four or five accurate prediction in a row, some people might be tempted to ignore their skepticism and send their money.
Here is how this particular scam works:
The scam artist gets a list of potential victims and sends half of them a letter (or e-mail) telling them a particular stock will rise in price over the next week - the other half get a letter saying the stock's price will fall. After a week, he checks the stock price and discards the names that got the "wrong" advice. Next week, he sends half of the remaining "potential victims" a letter saying that another stock will go up - the other half gets the opposite prediction. And so on.
After four predictions, he is now down to a list that is 1/16th the size of the one he started with, but those people have seen four "amazingly accurate" predictions. They are much more likely to pay to continue to get stock tips now that they have seen this incredible demonstration.
So, what does this have to do with health fraud? Plenty.
"Alt-med" practitioners generally do not admit (or even record) their failures - instead, they provide us with a parade of successful "cures" in the form of testimonials. So, what happens to the people who DON'T get better? Not surprisingly, they don't provide testimonials. Let's run the numbers:
[1] "Dr." Scam sees four new patients a day (a modest number) - this gives 800 new patients a year (allowing for 12 weeks of vacation, holidays, conferences, speaking engagements, book signing tours, etc.).
[2] Assume a low "cure rate" of 5%. It is usually much, much higher than this - placebos in pain and fatigue studies generally show 30% efficacy - but let's use an artificially low number to avoid claims of being "unfair".
[3] "Dr." Scam thus has 40 patients a year who believe that he "cured" them of some grave and chronic illness. After five years of practice, this gives a pool of 200 patients to write gowing testimonials.
[4] However, this means that 760 patients a year (3800 over five years) are NOT cured - they usually end up in someone else's office (occasionally a lawyer's office). They are not asked to provide testimonials, but they are also generally not interested in exposing "Dr." Scam (unless they were actually harmed) because it would take too much time and effort.
Since the 3800 "silent" treatment failures are not heard from, the 200 "cures" sound very impressive. The practitioner ("Dr." Scam) may not even be aware of the high number of failures - since those people may simply stop coming to the office - and think that all are "cures."
"Mainstream" medicine never sounds as good as "alt-med" because "mainstream" medicine publishes its treatment failures and the efficacy of its treatments. "Alt-med" keeps its failures a deep secret - ignores them when it can, denies them when it can't. "Alt-med", in essence, "buries" its failures - something they constantly accuse "mainstream" medicine of.
Another common ploy among "alt-med" apologists is to point out (correctly) that even "mainstream" medicine makes occasional use of "testimonials" - in this case, the word-of-mouth reports of a particular drug or treatment that have not (yet) been subject to formal study. An example of this is the initial "off label" use of a drug to treat a condition different from the ones it was tested for.
[Note: Most "off label" uses for drugs have been thoroughly tested by clinical studies - some drugs have had more studies done for "off label" uses than for the original indication. "Off label" use is not an indicator of "alt-med" practices, even though some "alt-med" practitioners use drugs "off label" in very unconventional and dangerous ways.]
This sort of "testimonial" evidence, although it may seem superficially similar to the "alt-med" testimonials, is in fact very different. The major difference is the intended "target" of the testimonials.
In the "alt-med" testimonials, the target is the patient - to get the patient to try a particular therapy or see a particular practitioner. They are a kind of "come-on" or advertisement designed to allay fears, break down resistance and encourage acceptance by use of the "everybody else is doing it" fallacy (Argument by Consensus or Appeal to Authority; see: http://www.fallacyfiles.org/bandwagn.html ).
In the "word-of-mouth reports" kind of "testimonials", the target is the practitioner - to inform them about a potential new therapy that has not yet been formally tested. The practitioner may then advise a particular patient that this therapy might be of use to them. This is a very different situation because:
[1] The practitioner makes the decision to offer the therapy (or not), based on their knowledge of the potential risks and benefits and the patient's condition. It is only offered when standard therapies have failed, are not adequate or are not appropriate.
[2] The patient is made aware that the therapy is untested and non-standard AND that the information supporting it is entirely anecdotal.
[3] The patient is informed that the treatment may not work and may cause unforeseen problems.
[4] The patient is informed of the treatment alternative (if any) to the untested therapy.
With enough positive case reports (and early clinical studies), this therapy may become an "alternate standard" therapy. If further studies warrant, it may eventually become a standard or even first-line treatment. This is how it is done in
"mainstream" medicine.
n the "alt-med" world, the process stops after the first report of a potential treatment. No real clinical studies are done (or read) and the practitioner's enthusiasm is the only limit to how "effective" this "cure" can become. Most importantly, the "alt-med" practitioner, since they have no doubts (or acknowledge none), does not bother to inform the patient that the therapy recommended (or promoted) has not been tested or, worse yet, has been tested and found wanting |
