How We Know What Isn't So (21 page)

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Adults
are generally reluctant to do so, that is. Children tend to be more brutally honest with one another, and, as a result, it is in childhood that we receive some of the most informative feedback about how we affect others. If we believe that we have funny ears, cannot sing, or look awkward when we run, chances are that we were apprised of this fact by a childhood acquaintance. A telling comparison: It is not an uncommon experience for an adult to return from a social gathering and learn that his fly is open, she has broccoli in her teeth, or that one’s nasal hairs have grown too long—and no one said a word! On the playground, however, children point out such offenses with great enthusiasm.

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o area has been more plagued by questionable, erroneous, and often harmful beliefs than the field of medicine and health. As recently as the nineteenth century, the acclaimed physician and signer of the Declaration of Independence Benjamin Rush treated victims of yellow fever, himself included, with vigorous bloodletting. Today, people afflicted with cancer flock in great numbers to worthless Laetrile clinics in Mexico, fraudulent psychic “surgeons” in the Philippines, and profiteering faith healers in the United States. Desperate AIDS patients seek help in all manner of worthless rituals and costly potions, including pounding themselves on the chest to stimulate the thymus gland, exposing their genitals to sunlight, rectally administering ozone gas, and injecting themselves with hydrogen peroxide.
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It is not just the uneducated or dull witted who are vulnerable to these beliefs. Francis Bacon believed that warts could be cured by rubbing them with pork rinds. George Washington thought that various bodily ills could be cured by passing two three-inch metal rods over the afflicted area. The British statesman William Gladstone thought that we would all be healthier if we chewed each bite of food precisely 32 times: Why else, he argued, did nature endow us with exactly 32 teeth?
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If the bloodletting of Benjamin Rush did not make this clear, it is also important to note that such beliefs are not just harmless sources of idle talk and speculation. They often exact a fierce price, a price paid in dollars, in physical health and emotional trauma, and in lives lost. It has been estimated that Americans spend ten billion dollars per year on quack remedies, including three billion on bogus cancer “cures” and one billion on worthless AIDS treatments.
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In the more important currency of lives lost, John Miner of the Los Angeles County District Attorney’s office goes so far as to claim that “quackery kills more people than those who die from all crimes of violence put together.”
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Why do so many people subject themselves to such expensive and, in many cases, injurious treatment? Something must make these treatments seem effective, or potentially effective, even when they are not. What is it? What is there about such treatments, about the nature of disease and dysfunction, and about the way people think that makes so many people believe in the therapeutic value of demonstrably ineffective health practices?

Part of the reason that erroneous beliefs about health are so rampant is that what they offer is so tempting. Having an untreatable disease—or the possibility of contracting one—is so threatening that people desperately grasp at claims that the threat is not so severe or so completely beyond their control. Alternative medical practices offer hope when the limits of conventional medicine are exceeded. It is no accident that bogus remedies are most prevalent for those problems, such as arthritis, cancer, or aging, that orthodox medicine can do little or nothing about. The temptation to believe in such cases is so strong that we do not exercise our critical faculties to their fullest; sometimes we suspend them altogether.

The contrast between the cold truth of conventional medicine and the warm comfort of “fringe” practices can affect our thoughts and actions in several ways. Many individuals faced with a terminal illness that conventional medicine cannot cure will turn to various fringe practices out of desperation. “I have to try something,” “I have nowhere else to turn,” or simply “Why not?” are some of the sentiments expressed in such cases. Then, if a little positive thinking is considered necessary for the treatment to be effective, the person will no doubt do everything possible to muster the necessary optimism. The individual then acts as if he or she believed fully in the treatment’s effectiveness. Upon doing so, it is not always easy to distinguish desperate actions from genuine belief—even to the person doing the acting. Just as our actions can convince others about what we believe, they can also convince us.
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Under such dire circumstances, a person can hardly be faulted for trying anything that has even the most remote chance of success. (Provided, of course, that the “remedy” in question does not do any actual harm, or does not do more harm than a more conventional treatment.) Desperate times call for desperate measures. And besides, why not?

But it is not these practices that serve as the subject of this chapter because in such cases, at least initially, there is no strong belief. Instead, the focus here is on those instances in which people genuinely believe in the practice’s effectiveness—instances in which people insist their beliefs are warranted in light of experience, or in light of some underlying theory of the practice’s soundness. Here too the will to believe has an impact. The comfort provided by believing that there are remedies for many of life’s afflictions can affect how we evaluate information pertaining to a remedy’s effectiveness. We may become kinder to information that supports our hopes and rather critical of information that is antagonistic to them (see Chapter 5).

Note, however, that this does not mean that people will simply believe whatever they want to believe. Usually there must be some evidence that a particular fringe practice may be effective. Granted, the evidence may seem compelling only when evaluated rather uncritically, but to the person holding the belief, it is evidence nonetheless. People rarely defend their beliefs in certain health practices by simply asserting,“ I just prefer to believe it is true” (as they do when defending certain religious beliefs, in contrast). But what evidence is there? How can a demonstrably ineffective health practice nonetheless appear to be effective? To answer this question we must consider certain aspects of the nature of disease and dysfunction.

Many people do not appreciate how much healing is done, not by doctors, drugs, or surgery, but by our bodies themselves. Roughly 50% of all illnesses for which people seek medical help are “self limited”—i.e., they are cured by the body’s own healing processes without assistance from medical science.
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The body is a truly amazing machine with remarkable powers to set itself right. If this were not the case, it is entirely possible that the practice of medicine would not have survived the long formative period of its history when it offered a host of destructive interventions like bloodletting and trephining (i.e., drilling holes in the skull to allow evil agents to escape). Civilization might well have given up on the quest to treat disease and injury before the development of antisepsis, vaccination, antibiotics, and improved surgical procedures in the nineteenth and twentieth centuries. (Or at least it might have limited itself to interventions like rituals and prayers in which there is no bodily intrusion.)

With the body so effective in healing itself, many who seek medical assistance will experience a positive outcome even if the doctor does nothing beneficial. Thus, even a worthless treatment can appear effective when the base-rate of success is so high. When an intervention is followed by improvement, the intervention’s effectiveness stands out as an irresistible product of the person’s experience. As Sir Peter Medawar describes it: “If a person a) is poorly, b) receives treatment intended to make him better, and c) gets better, then no power of reasoning known to medical science can convince him that it may not have been the treatment that restored his health.”
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This, then, is a particularly noteworthy example of the general problem of learning from experience discussed in Chapter 3. By trying one treatment, the person cannot learn what would have happened if another treatment (or no treatment at all) had been attempted. The current success dominates the person’s experience, making it difficult to consider likely outcomes under other, hypothetical conditions.
Post hoc ergo propter hoc.

Another source of misplaced faith in ineffective treatments stems from the precise course of ailments that are
not
self-limited. Even when the body cannot heal itself of certain afflictions, the ailments generally do not result in a steady, uniform deterioration. Rather, the problems unfold in fits and starts, with periods of deterioration mixed with episodes of improvement. It is these temporary periods of relief that give rise to erroneous perceptions of a treatment’s effectiveness. When, after all, will a treatment most likely be applied? Generally, it will be administered when there is a marked deterioration in the person’s condition. And, as with all trends characterized by considerable fluctuation in improvement and deterioration, such low points will tend to be followed by periods of improvement even if the treatment is completely ineffective. Statistical regression guarantees it. Thus, without a general appreciation of the phenomenon of regression, or without an awareness of the common fluctuations in the course of most diseases, any temporary improvement is likely to be attributed to the treatment.
Post hoc ergo propter hoc
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In fact, when a “treatment” is introduced immediately after a flare-up in a person’s symptomatology, almost any outcome can appear to support its effectiveness. If the treatment is followed by improvement, it will be deemed a success as just described. The treatment might also be considered successful if the person merely stays the same: After all, the treatment was able to arrest the person’s slide and successfully stabilize his or her condition. Furthermore, if one’s initial confidence in the treatment is sufficiently strong, all may not be lost even if the person deteriorates or dies. Even such dramatic failures can sometimes be accounted for in ways that leave one’s faith in the treatment intact. Perhaps the dosage was insufficient. Maybe the patient waited too long before seeking help. Because such rationalizations do so much to sustain people’s beliefs in ineffective health practices, it is important to examine them in some detail.

Although a high rate of spontaneous remission can provide apparent support for the effectiveness of even a completely worthless treatment, it still leaves a number of unambiguous failures that need to be accounted for in some way. Often the failures are simply discounted, as in the examples above. Faith healers employ a particularly convenient form of this defense by attributing any setbacks to the sufferer’s lack of spiritual purity or the vagaries of God’s will. The faith healer J. J. Rogers, a.k.a. Prophet Johnson, is remarkably clear on this matter: “If I can’t heal them, there’s something wrong with their souls.”
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The more widely-known Kathryn Kuhlman employs the same tactic when she professes that “I don’t heal; the Holy Spirit heals through me.”
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The field of holistic health, with its emphasis on mental control over physical states and the importance of mind/body/spirit integration, has spawned similar explanations for its failures. Consider one of the holistic health movement’s most popular credos: “It is much more important to know what sort of patient has the disease than what sort of disease the patient has.”
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Apparently, those whose physical symptoms do not abate are simply not the right “sort of patient.” Perhaps they have not meditated sufficiently, have not achieved the proper integration of mind, body, and spirit, or have not abstracted the proper “meaning” from their illness. Failures are not the fault of the underlying theory, but stem from the patient’s inability to apply it effectively.

Belief in the effectiveness of an intervention or an overarching philosophy of health can also be bolstered by attributing failure to the inadequacies of the
practitioner
as well as the patient. The treatment is still thought to be generally effective, it just was not administered correctly. One holistic health advocate goes so far as to state that most of the failures of holistic interventions stem from the practitioner’s failure to adequately understand or administer the proper holistic techniques.
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To be fair, it is important to note that such rationalizations plague conventional medicine as well—witness the old standby of the surgical profession that “the operation was successful but the patient died.” Such justifications, however, are more common and are taken more seriously in the field of fringe medicine because it is a field that relies so heavily on anecdotal evidence. In fact, many advocates of alternative health practices completely reject controlled experimentation as a valid means for arriving at the truth. “Real life” experience is considered the only informative guide to whether a treatment is beneficial. But everyday experience, as we have just seen, can sometimes make even worthless remedies seem effective. Conventional practitioners might initially defend their pet treatments by explaining away their failures, but most at least acknowledge the supremacy of scientific investigation. Under such scrutiny, a treatment’s weaknesses will eventually come to light, as it has with bloodletting, laetrile, and the porta-caval shunt (see Chapter 10).