[bpsdb] You won't hear practitioners say it - it would spoil their underdog, anti-establishment vibe - but alternative medicine is big business, pulling in over US$60billion a year. In many countries, alt med is primary healthcare. Unsurprisingly, those tend not to be the healthiest countries. The thing is, as Tim Minchin astutely observes in his poem 'Storm': "By definition, alternative medicine has either not been proved to work, or been proved not to work. Do you know what they call alternative medicine that's been proved to work? ... Medicine" So why do such lousy treatments remain so popular? The authors of a recent PLoS paper, "From Traditional Medicine to Witchcraft: Why Medical Treatments Are Not Always Efficacious," have one intriguing idea [1].
The crux of it is this. Suppose I have a cold, and it gets worse and worse and worse until in desperation I try a cure I've found on the internet - drinking cow urine (and I wish that wasn't a real example). So I drive to the nearest farm, get somebody with agricultural experience to, er, milk the special teat, and spend the next few days merrily guzzling the amber nectar that is produced.
Miraculously, I get better.
Well of course I do. In this hypothetical situation I had a cold, and colds generally get better in a few days anyway. Another point is that I waited until the illness was very bad until I sought this special treatment, meaning that the cold hadn't peaked it was probably pretty close. Thus, we would expect to see regression toward the mean. I've used the example of a cold here, but the same is true for many mild to moderate illnesses - however you treat it, you're likely to get better soon. If you treat it properly of course, you'll get better sooner. Of course this doesn't mean that the treatment works, but humans have a powerful urge to link cause and effect, and so people will tend to link the treatment to getting better.
Hence we see anecdotes like: "I tried this cow urine therapy for my warts, and for the first day or so it kept getting worse, but I stuck with it and by the end of the week my cold had really improved." This is one of the many, many reasons why anecdotal evidence absolutely sucks.
This is one of the reasons why alternative medicine remains popular, but it doesn't explain why these 'treatments' are able to compete in a market against evidence-based treatments that are generally more effective. With all things being equal, why would you choose a less effective remedy?
What Tanaka and his colleagues have done is to construct mathematical model that demonstrates that far from being a hindrance, the lower efficacy of these treatments may in fact help them to spread and become more popular.
Their model is populated by people who are either sick or healthy, with new treatments spreading among sick people. "A new behavioural trait arises in (or is invented by) an ill individual who may then demonstrate this practice; others who are ill may adopt the practice upon being exposed to it, and then become demonstrators themselves. In other words, demonstrators convert observers. [...] Observers adopt the trait at a constant rate per demonstrator per unit time. This rate is when the demonstrator is ill and when the demonstrator is healthy."
Tanaka and his colleagues that made an interesting and perhaps controversial assumption - or rather they didn't make one. "We do not assume that observers adopt self-medicative practices according to their efficacy in treating others." In other words, sick people keep spreading the treatment for as long as they are using it, and while lack of efficacy may cause them to abandon the treatment sooner, it doesn't directly influence the ability of the treatment to be passed on. Observers are assume to be completely unbiased.
The results of this are counter-intuitive, but profound. Ineffective treatments will tend to have a higher rate of abandonment, however they will also prolong the illness. Because the duration of the illness is increased, the period in which the sick person is "demonstrating" the treatment to observers is also longer, which not only cancels out the increased rate of abandoment, but actually means that ineffective treatments can spread faster than effective ones. "Maladaptive and superstitious treatments can become prevalent because their ineffectiveness prolongs illness."
Of course, this can lead to some extremely bizarre situations, as the authors relate:
"Our finding that superstitious treatments can easily spread is supported by reports of extraordinary treatments for conditions such as leprosy (treated with a drink made of rotting snakes) and syphilis (treated by eating a vulture), and by similar myths for poisonous snake bites (apply ‘guaco’ leaves, poisonous lizard skin or snake's bile), dog bites (drink tea made from the dog's tail) and scorpion stings (tie a scorpion against the stung finger). The analysis also helps explain the persistence of medical treatments of animals, such as ‘firing’ (cautery) of working horses, employed for millennia as treatment for lameness, where recovery is rare, and still widely practiced in many countries in spite of trials establishing its ineffectiveness."
Of course this only works when observers are unbiased, and this isn't always the case, but it is apparently true a lot of the time, and the authors are able to cite a body of evidence accumulated in recent years showing this "unbiased copying" in various aspects of human culture.
It's also the case that acquiring an effective remedy is not as easy as we might think. For a start, in many impoverished nations proper medicine may simply not be available. And decision-making about the alternatives is often far from evidence-based, as the authors note: "For most ailments and practices, the decision to adopt a treatment is based on weak circumstantial evidence, cultural preconceptions and perceived efficacy, which may not reflect actual efficacy. Cultural mileux that frame natural phenomena in terms of supernatural causes would further weaken the connection between efficacy and the rate of adoption." Couple that with the general unreliability of anecdotal evidence that I described above, and basically you have a sort of information black hole, devoid of light and reason.
The comforting thing from this study is that if the results are correct, it means that education and information can combat the spread of these remedies in the West. I mentioned Cow Urine Therapy above, and no doubt many of you almost instinctively dismissed it as ludicrous. If more people were aware of just how daft the mechanics of e.g. homeopathy were, then we would expect a similar response. As with so many other aspects of life, good education is the key to empowering people to make good choices.
[1] Tanaka, M., Kendal, J., & Laland, K. (2009). From Traditional Medicine to Witchcraft: Why Medical Treatments Are Not Always Efficacious PLoS ONE, 4 (4) DOI: 10.1371/journal.pone.0005192
[2]Bentley, R., Hahn, M., & Shennan, S. (2004). Random drift and culture change Proceedings of the Royal Society B: Biological Sciences, 271 (1547), 1443-1450 DOI: 10.1098/rspb.2004.2746
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You're absolutely correct! Nature can't create cures naturally, it has to come from a lab. I mean drinking tea from valerian root or feverfew didn't treat anything until an ingredient was extracted, synthesized and patented. Then it's medicine and only then were any of the treatments real.
Companies aren't searching through Amazon jungles for potential cures from plants, that only happens in movies.
So, therefore, only medicine can cure things and natural cures are completely bogus.
It's good that such objectivity in medicine is the standard.
Wow, a comment that addresses absolutely none of the points in the article.
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This is really interesting, I've thought for a long time that not enough attention is paid to how people convince their friends to try these treatments in comparison to the amount of attention the companies peddling them get. The tragedy is that while I'm sure the majority of companies profitting from quack remedies are doing purely for profit, a lot of people convincing their friends to try them are doing it out of the best possible motives.
A friend of mine recently had breast cancer, and after the tumour was removed she refused radiotherapy and bankrupted herself to spend a month at some natural healing institute in the States. She then came back and tried to follow a ludicrously extreme detox diet - basically eating nothing but celery, cucumber and sprouted sunflower seeds - which all her friends could see was doing terrible things for her health. The cancer hasn't returned and we have now talked her into eating a bit more sensibly, although her health isn't great and is made worse by the long hours she has to work to pay off the trip to America, but the sad thing is that she has now become a bit of an evangelist for what to me seems like a frankly evil programme to exploit the vulnerable. But she genuinely believes in what she's doing. I think we do urgently need more research like this about people spreading these memes for the best possible motives, rather than just concentrating on the manufacturers
Not so sure.
This works fine for a word-of-mouth propagation of a particular treatment but that will always have existed. I've been doing some research into the media coverage of homeopathy in the UK and there are points in time when it completely drops off the radar. However, we are now at a point where the media assumes so much familiarity with homeopathy that it doesn't bother with the little panel explaining what homeopathy is. What has happened? To be frank, I'm not sure yet, but...
Another factor I have always wondered about is the decline in church going. Is it the case that there are links between the decline in adherence to traditional religion and the rise in Alt Med ideas? I don't know, but it would not surprise me.
It is a really neat model.
Is it natural to not be able to read? Apparantly so.
It's a fairly good paper although their model makes an awful lot of assumptions. In fact, I don't really think the model itself is very useful. The interesting (because counter-intuitive) point is that bad treatments can end up getting used more than good ones, precisely because they are bad. (Good example - vaccinations. Vaccinations work brilliantly - you only need to have them once.)
Incidentally, this is why I'm fairly sure that most (maybe almost all) complementary & alternative medicine doesn't work very well. There's just so much of it. I don't mean that I don't think it works better than placebo - everyone around here believes that right? I mean that I don't think it's a very good placebo. If homeopathy, say, were really a brilliant placebo that makes people feel great for ages, there would be little need for other forms of CAM. The sheer amount of CAM makes me think that it can't work very well.
I tend to agree, although I didn't have time to take a detailed look at the model itself. It's useful to illustrate the power of a process, but as a descriptive model I think it's just too simple - there are too many other factors involved, and it's pretty trivial to pick out examples that buck the trend.
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I gather the point that Anonymous is addressing is Tim Minchin's "astute" observation that By definition, alternative medicine has either not been proved to work, or been proved not to work. Do you know what they call alternative medicine that's been proved to work? ... Medicine
Mainstream doctors who would never dream of recommending a herbal remedy routinely prescribe patented extractions from these very herbs, or syntheses thereof, in pill form. Surely if the pills have been shown to work, then at some point the herbal extracts, and thus the herbs themselves, must have been shown to work, too, but there's no money for the drug companies in marketing herbs, so they are shunned.
Anonymous, by correctly implying that economics is a powerful disincentive against mainstream medicine's use of herbs, undermines Minchin's glib premise. That some herbs can be effective remedies, analgesics, etc., is something that the drug companies are well aware of. It is simply wrong to imply, as Minchin does in his statement, that because no herbs are recommended by mainstream practitioners, no herbs have been proven to work.
Sorry, I thought I was attaching this below Anonymous' comment below.
Here's a brief article from The Canadian Medical Association Journal which discusses the difficulties that non-patentable (hence alternative)drugs have in seeing the light of day in mainstream medicine, which relies exclusively on drug companies to develop new treatments:
http://www.cmaj.ca/cgi/content/full/174/4/483
Here's the key quote:
Pharmaceutical companies play a pivotal role in drug discovery; yet they develop and test only those drugs for which they can get a patent. Instead of relying exclusively on pharmaceutical companies to determine the effectiveness of drugs and to develop new treatments, nonprofit agencies should take up the relay for nonpatentable, off-patent and orphan drugs.
Thanks for the link.
You'll find a lot of us are very sympathetic to this problem. I'm an equal opportunity attacker. I think one of the things that frustrates scientists and doctors in the field is that a lot of alt med supporters don't seem to realise that there are three sides to this - pharmaceutical firms who can behave badly, alt med companies who behave equally badly, and those of us in the middle championing evidence based medicine. That's why we have things like the Cochrane reviews - independent studies produced by scientists donating their time.
But there's one point I must make in terms of the economics. Alt Med is, as cited, a US$60bn a year industry. Why should Big Pharm have a responsibility to trial meds, but not Big CAM? If they're earning so much money, why can't they organise similar clinical trials for their products?
Ultimately, the responsibility for both Big Pharm and Big CAM is to demonstrate scientifically that their products work. If they can do this, fine you'll see me and other science bloggers running about going "Omfg, homeopathy works!", if not, then they have no right to make what amount to marketing claims that can't be proven. That's what's so unacceptable to me - the fact that these firms can make millions or even billions of dollars, without doing the basic trial work necessary.
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I couldn't agree more. IMO, your argument here is much more to the point and tightly reasoned than your original post, with its strong but unwarranted implication that all alternative medicine is a waste of time by its very definition.
Definitely. All babies are born naturally unable to read.