The alternative industry: it doesn’t work and why it does
My last major project before leaving Oslo for openDemocracy was a six-part edutainment/documentary series on the ‘alternative industry’, its science and irrationality. It was produced by Teddy TV and broadcast on NRK1 (Norway’s equivalent of BBC1, ie the country’s main television channel). We cheekily named ourselves Folkeopplysningen, “The Public Enlightenment”.
The various branches of the alternative industry make a lot of claims, and a lot of money off these claims. We looked into homeopathy, healing, detox, acupuncture and strange panacea machines supposedly utilizing bio-resonance or quantum mechanics. (Astrologists, psychics and mediums got a showing too, but let’s leave them alone to lick their wounds for now.)
We decided it was time for some critical scrutiny of this business, and based on reception and ratings, we are not alone in thinking this.
Public Enlightenment. (c) NRK/Teddy TV
With a physicist, a psychologist and researchers, we asked three main questions: Are the claims made by the various alternative offerings possible from a scientific point of view? What does the available research say? Why is it so popular?
And yes, we found it is pretty much all hokum. Anyone spending a good amount of time honestly and objectively surveying the available scientific material will agree. The UK Parliament Science and Technology Committee did so on homeopathy.
Dear Jeremy Hunt, Beckhams, Orlando Bloom, Thorbjørn Jagland, Jennifer Aniston, Prince Charles and King Harald of Norway: there’s nothing in those pills besides the sugar and the faith.
Only acupuncture has some credible documentation to show for itself. But it’s rather thinner than its standing suggests. Here too the placebo effect is due most of the credit, most of the time likely all of it.
Yet, it works - raking in money, but more importantly: producing many genuinely satisfied patients.
While some of the popularity can be explained by our brain’s tendency to look for patterns where they don’t exist, ignore regression toward the mean, emphasise anecdote over data, justify its own choices and confirm the beliefs we already hold, many patients do feel better in a very real way.
This has been proven to stem from the bouquet of psychological and biochemical mechanisms that we lump together as the placebo effect. The placebo effect has clear limitations (rather than cure, it mostly alters our experience of symptoms), but we should all be happy that it exists. It means that visiting a homeopath can make people feel better. This does not mean that homeopathy works. But it does mean they feel better - and that is a good thing.
For many, what is needed to improve their well-being and outlook is attention and care. For someone to see them, touch them, discuss their life situation, unhurried and with empathy, to tell them that it’s all going to improve from now on, and that they’ve got a plan – this is what makes the difference. Some get this experience from their doctor, but many do not. Many people get nothing like this assurance from anywhere in their societies. In this regard, alternative therapists can perform an important service for people.
But the alternative industry is more than this, and much of it is problematic. So, as well as to educate and entertain, we set out in the hope of sparking debate on questions such as the following:
- - Why is alternative medicine so popular?
- - Is it right that a large and diverse sector dealing with health is almost completely unregulated?
- - Can society harness the placebo effect as a harmless way of improving well-being in the population, taking some pressure off the health system?
- - Can medical doctors learn from the way alternative therapists interact with their patients?
- - Should we demand proof from those who sell a service or product claiming it cures disease or improves health, or let the market offer the widest possible array of choice?
- - If we let the market decide – should the public health service pay for any such services without evidence of effect other than placebo?
- - Should we accept that some, based on mythological expertise or conspiracy theories, discourage the use of proven, life-saving methods such as vaccination and chemotherapy?
- - What can be done with those few who contact people on their death bed with expensive miracle cures, making the dying spend their last time on earth, and often money they don’t have, chasing false hopes, instead of spending it in the mutual comfort with their loved ones?
Reasoned debates on these issues with those in the alternative industry was perhaps too much to hope for. But at the very least we expected the more responsible parts of the industry to demand a clean-up of the murkiest.
In one of the programmes we sent a perfectly healthy, young woman to three different alternative practitioners. They gave her a variety of different, very serious diagnoses for which they offered expensive treatments.
Physicist and host Andreas Wahl with Grete Strøm, healthy undercover reporter with a long list of serious diagnosis. (c) NRK/Teddy TV
One identified fungi growing in her blood due to excessive consumption of carbohydrates, another found a throat problem and several allergies (but OK’d smoking), while the third claimed she was poisoned by the vaccines she was given as a child, had narrow veins and that despite feeling fine now, could expect to succomb to powerful headaches imminently.
And while most practitioners are nice people with some ethical standards, we found that implying that one could cure anything from cancer to dyslexia wasn’t all that uncommon.
Into the trenches!
The alternative minded did not like what they saw in our series. They took to their keyboards. It is clear who the enemy is. Not those preying on the dying. Not obvious charlatans who give random diagnoses, or those who cause preventable deaths by convincing their patients to forego vaccines or chemo. No, the enemy is those who dare to question their faith on TV. Oh, and Big Pharma. But in all likelihood, these were one and the same.
The alternative practitioners appeared to loathe breaking rank and criticizing each other, except in the most careful and general terms. Wouldn’t the mainstream ones benefit from distancing themselves from the wingnuts? Maybe there is too much overlap? Could this explain their unwillingness to offend the “most alternative” ones in their ranks?
There also seems to be a siege mentality. Us against the world. Combined with a culture for “my truth is as valid as your truth”, where extreme relativism functions to make questioning even the weirdest of beliefs taboo. The outcome: little willingness to question even the strangest of bedfellows.
Our programmes were quite assertive, more so than unconfrontational Scandinavians are used to. Unlike many previous ‘balanced’ looks at alternative medicine, we researched in depth and actually concluded where there was enough evidence available to conclude.
This, to our minds, is what journalists do. Approaching an issue with an open mind does not mean refusing to draw conclusions when there is every basis to do so. (Clare Sambrook calls it “Investigative Comment”.)
But to the practitioners, used to being interviewed as “alternative experts” alongside actual doctors, with their perspectives presented as equally valid, our conclusions came as a shock.
Instead of a fruitful debate, trenches were soon filled with unrepentant and offended alternativists raging on one side, and pretty smug skeptics snidely sniping from the other.
We’ve sometimes wondered if our critics have seen the same programmes as the ones we have made. We have never questioned the motives of the therapists, called for a ban, uttered a rude word, derided the placebo effect or claimed they were all of the same cloth. Nor did we edit anyone for the purpose of ridicule. Viewers were indeed afforded a few laughs, but some of these theories and practices can easily have that effect when explained in all seriousness.
Soon enough we were dismissed as hateful, propagandistic, dishonest, falsifiers, ignorant, closed-minded, fanatics, arrogant, satirical, populists, speculative, unethical, lying, proselytizing, pathetic, angry atheists, ridiculing and factually wrong. That’s what politely pointing to the prevailing scientific consensus gets you from the “open minded”.
The allegations of wrongdoing weren’t specified concretely of course. They remain as general and un-sourced as the assertion that “the good science says it works.”
Thankfully we’re a thick-skinned bunch and appreciate the extra publicity. Last Monday 621,000 people, more than a third of the Norwegian TV audience, watched the program, and its hashtag, #Folkeopplysningen, crowds the nation’s twitter streams.
The party line
While we expected a bucket of bile from believers, we had imagined that the official organisations would voice their disagreement in reasoned ways, and with some adherence to reality.
This hope was dashed. NHL, Norway’s largest organisation for homeopaths, attempted to sabotage the programme even before the first day of shooting. Early on in the project we contacted them and openly described our intentions. Perhaps naïvely, we believe in playing fair. It was all smiles at the meeting, but soon thereafter all homeopaths, as well as the other organisations for alternative therapies, received a letter from them – a “Warning”, no less – imploring everyone not to talk to us, as we might “be detrimental to all of the alternative industry”, and encouraging them to report back to them should they hear from us.
NHL also asserted that the series was instigated by the small organisation Norwegian Skeptics (which they amusingly branded “unscientific”), an untrue allegation they have refused to retract. Other alternative organisations have since actively propagated this idea in the social media, spinning a conspiracy theory involving the inevitable payments from Big Pharma. This fits perfectly into the underdog narrative so popular in the alternative sphere. The reality was and is a smallish, independent production company looking into a large industry. And I’m still waiting for my Big Pharma check.
The Norwegian Acupuncture Association’s broadside against the programme came last week, signed by their leader. In it she repeatedly misquoted the programme, scornfully dismissed the “science” (sic) presented, unashamedly citing as proof of effect a study that in fact concluded the opposite, giving misleading statistics on the popularity of acupuncture, and presenting as her trump card the fact that doctors and nurses are legally permitted to use acupuncture: therefore it must work.
She contended, “the most important thing is freedom of choice and the ability to individually find out what works best.”
Bloodletting was a successful and widely used medical treatment for centuries. Its effectiveness was a given. When statistics entered the scene, it was discovered to have been mass murderer all along. Many of those killed by the practice certainly believed it the right thing for them; after all that’s what their trusted doctor said, and their neighbour did eventually rally after one such treatment. Today’s alternative medicine isn’t nearly as dangerous of course; most of it is just ineffective, plus placebo, which is why it’s still around.
The author of the critique is a nice person. But to paraphrase Upton Sinclair: it is difficult to get someone to understand something, when their salary depends upon their not understanding it.
Those who call themselves a healer or psychic are in essence saying, “I have magical abilities”. Fair enough. If they charge money for these magical services, we might suggest testing it on TV, but hey, what’s the world without some wizardry?
It’s different for those who clad themselves in the garbs of science. If you want to give your treatment an air of authority by using scientific terminology and insisting on being backed up by evidence and trials, you have to play by the rules of science, and accept criticism if you disregard those rules.
Testing the placebo effect with ice water. (c) NRK/Teddy TV
As well as investigating the validity of certain commercial offerings, we wanted to highlight our inherent irrationality. Not theirs – ours. Perhaps our first mission sabotaged the second somewhat, because some have asked why we label the users of these treatments stupid. That was far from our intention.
Those who believe in alternative medicine aren’t stupid. They’re human. We are human.
Every bias and fallacy we discussed can apply across the board. People with no belief in alternative medicine can make utterly irrational choices in other areas. The placebo effect exists in evidence-based medicine too. All of us experience cognitive dissonance and illusory correlations on a regular basis. Much advertising and rhetoric is geared towards exploiting these quirks of the mind.
Our programme’s psychologist, who is extremely well read on (ir)rationality, recently caught himself googling the brand name of a car he was inclined to buy, plus the phrase “best in test”. He found exactly what he wanted to find; a prime example of confirmation bias.
With lack of quality-controlled information, inherent trust in our fellow beings and a brain prone to biases and logical fallacies, the popularity of alternative medicine isn’t very surprising. We’ve tried to assist the information part, while highlighting the fact that our brains play tricks on us all.
Science = tools
Scientists are fallible humans too, which is why they use the scientific method, developed in large part to cancel out the effects of the mechanisms that make us so prone to drawing wrong conclusions.
Modern, evidence-based medicine is a young discipline, but its impact have been massive. Most of us would not exist without it. In developed countries, we now expect to live into our eighties, a century ago you would have been lucky to reach fifty.
It is imperfect of course, and so is the pharmaceutical industry, with extremely serious flaws that urgently needs to be addressed. But its underlying principles are sound. A casual stroll in a cemetery, noting the lifespan improvement in recent times, confirms that.
“There is so much we don't understand yet”, we’ve been told repeatedly. And while that’s quite correct, unfortunately it’s often paired with an unwillingness to learn about what we in fact do know, and why it seems to be incompatible with their pet theory.
“Science can't be used for everything,” they say. And indeed, science is a terrible method for creating works of art, lovemaking, comforting the grieving, comedy or finding out the meaning of life.
But it’s a fantastic one for going to the moon, creating the technology you read this on – and concluding which medical treatments work and which not. Ancient Chinese wisdom, spirituality, good intentions and even empathy are all rubbish at those.
And make no mistake: despite loud claims, had healing or homeopathy had real effects other than placebo, these would be easy to measure. The trials have been done. They don’t.
Using the imperfections of evidence-based medicine, or the fact that treatments with effects may also have side effects, as a fig leaf to cover up the truth about alternative treatments is a cheap trick.
In fact, randomized controlled trials are so good at finding answers to certain types of questions (if something quantifiable works and how well, but not how), they should be applied more often to areas other than medicine. In a recent UK Cabinet Office white paper, Ben Goldacre and David Torgerson make a good case for using RCTs to test the effectiveness of certain kinds of policies, making for better results and less waste.
Science - bad a jokes, good at space travel and medicine. (c) NRK/Teddy TV
Cake, and the eating
Saying “we should do more research into alternative medicine” is at best a crowd pleaser, after all who can be against more research? But this ignores the fact that resources are limited. When there is reason to believe an alternative treatment has real and useful effects, trials are naturally warranted. Unfortunately, there is much to suggest most or all of the good bits of alternative medicine have already been adopted and enhanced by actual medicine by now. Willow bark was an effective alternative treatment, which is why it is no more – today we know it as aspirin.
We must spend our efforts on what is most likely to benefit humanity. Instead of trying to prove or disprove faith-based theories, we should focus on reasonable goals, such as cancer research, combating the diseases that ravage the developing world, or investigating the promising potential of drugs that have been off-limits to scientists for far too long, due to the taboo of the irrational “war on drugs”.
Hearts and minds
We’re emotional beings, but when we are to make decisions on our health and safety, we need facts. When we’re trying to solve the climate crisis, counter xenophobes wielding pseudo-demographics, or decide whether we should get vaccinated - we need solid data, not wishful thinking.
We must dismiss gut feeling and taboos and embrace honest, open, fact-based debate, so that we can use our resources for research in ways that give the most benefit to the most people.
Each of us possesses an exquisite brain. But it is capable of deeply irrational judgements. Despite it being fantastically adaptable, evolution prepared it for a very different life than the one we’re living; anecdote used to be key to survival on the savannah, data is a new concept.
The vast majority of alternative practitioners aren’t frauds, they’re believers, motivated by the desire to help others. There is no nobler motive. But without the tools developed to circumvent the biases and fallacies that are hardcoded into our brain, helping is a lot harder than it seems.
Isn’t acknowledging our human shortcomings and taking steps to reveal them the most open of all approaches?
We must set our goals with our hearts, but use our minds to figure out how to reach them.