All posts by Inferno

Medicine, Research, Science

Evidence-based medicine: Introduction Part 1

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In my last post, “What’s the harm?”, I talked about the problems of taking medicine (or treatments!) that’s neither good nor bad for you. I also talked about “evidence-based medicine”, but didn’t really delve into that topic. I won’t do that in this post, either!

So what, you may well ask, do I want to talk about now? I want to give you a look into what a few doctors do and why their approach is deeply flawed. I’ll give one specific and not-well-known example of alternative medicine as well as some obstacles I found when investigating its efficacy.

In short, I’ll talk about why medicine needs evidence and why practitioners of alternative medicine might be reluctant to look for evidence. I apologise if the post is fairly long, but I need to flesh out my example to make sure you understand the practices behind it.

 

First, let me try to explain PsychoSomatic Energetics (PSE).

Watch this video. Read this page. (If you speak German, read this book. Or don’t, it costs money… Twenty pages are also available here.)

Done? Now what do you know about PSE? Not very much, I’d think. You know it has something to do with “energy blocks” and with measuring the “subtle energy field”. But how does it work?

Here’s where I come in. I’ve read the book and I’ve talked not only to people who’ve taken a seminar in PSE, meaning they’re qualified to test with it, but I’ve also E-Mailed one of the inventors of PSE, the ex-Wife of the guy in the video. What I will now lay out will sound confusing, mad even. If you don’t trust me, read the book and cross-check what I’ve said. If anything I’ve said sounds exaggerated or false, feel free to criticize me in the comments.

PSE is based on Freud’s psychoanalysis, basically issues from the past are said to influence your current health. In Freud’s case, that meant mental health, in PSE language mental health influences physical health. Up until now, the theory’s sound. Of course depressions and other mental problems can affect the body, but the effects can be hard to spot and even harder to treat.  That’s why psychotherapy is such a difficult field, why so many therapists have to take long vacations and why they are given the harshest, yet most self-preserving advice.*

Here, then, is PSE’s amazing promise: Not only can we find out what is wrong, and how much is wrong, but we’ll even be able to cure them in a relatively short time using homeopathic remedies. Now we haven’t yet looked into homeopathy, so we’ll assume for now that the remedies are 100% effective. That’s how generous I have to be just to take PSE seriously. So what should strike us about the above is this: It claims to cure all energy-related problems. Any remedy that claims to cure everything of anything can be almost immediately dismissed.

Now I’ve failed to tell you two things:
1) What does PSE supposedly treat? “Energy problems” is not very specific a term in this context. I’d refer you to Dr. Banis’ book, but that’s not very helpful: “Most illnesses are caused by blockades of the soul, which can’t be tested nor treated early enough. That’s what we try to counter with PSE.” If you found that illuminating: Congratulations, you’re smarter than I am.
I have talked to some people though, and their answer is the same: “Almost everything can be treated with PSE, if it’s found early enough”. I’ll be generous and say “Non-serious mental problems (slight depressions, slumps, feeling worn-out, etc.) and small boo-boos (coughs, “feeling unwell”, etc.) can be treated”.

2) What is energy and how does it relate to PSE?
Remember that PSE is bound to eastern traditional medicine. In that tradition, the body has “energy” and that energy is located in one of the seven “chakra-points”. That energy is generally an astral “energy”, a sort of “I’m full of energy”-thing, but recent attempts (Deepak Chopra et al.) have tried to make this “energy” a real energy, a physical force.
If you read the PSE-book I’ve referenced above, you can find at least three definitions of energy:
a) The above described astral energy
b) Magnetism, in this case the slight magnetic field around the body.
c) The energy we know from physics known as “force” and the energy we know from electricity known as “electric charge”.

According to PSE, we can measure the energy at every chakra-point on a scale from 1-100, with every one of those points further being divided into four “energies” known as “vital”, “emotional”, “mental” and “causal”. We don’t  need to understand them, we just need to know that according to PSE, if any one of those energies suffers (note: that’s 28 different measurements!) then we won’t have enough energy, which can either result in us feeling depleted (think of it as forgetting to turn off a light at home, it drains your money) or in us becoming sick (a light bulb pops due to it being overused). I won’t go to tell you that it’s then compared to the four “juices” of the body, also known as the “four temperaments“. That would just be mean and discredit the whole thing immediately.

In any case, back to PSE. Now that we’ve understood what is to be tested, we can see how it is tested. The process is relatively simple:

Take a machine, in this case the Reba® special test device and hook the patient up to it. You do that by placing the machine on a flat surface, lying the patient down next to them and attach a wristband to one of their wrists.
Next, you take an vial of the homeopathic remedy you want to test (one vial corresponds to one of the 28 levels I described above) and place it into the receptor of the machine. Note that at no point does the actual remedy get into contact with the device.
Having done that, you switch on the machine and test for the first of five levels. (100/5=20, so you test at 20, then 40, then 60, etc.) To do that, you (being the doctor) take the arms of your patients and lightly pull on them. (Arms outstretched behind/above your head) If one arm is longer than the other one (supposedly called “kinesiological arm-length reflex”), you know that energy is lacking.

Practical example: If you test vial one and your patients arms are the same length at 20, but one is shorter at 40, then you write down “20”, because that’s the “available energy level”. If they’re the same length at 20 and 40, but different at 60, you write down 40. And so on.

And that’s it, basically. You repeat that 28 times and write down the results. If they’ve got energy level 100 everywhere save for vial 28 (associated with “wrong thinking”), you give them remedy 28 to “boost their energy level” at that point. After six to twelve months, the patients come back and if they tell you that they feel better, then everything’s fine. If they don’t, you re-test them and give them more remedies.

Now obviously, there’s so much wrong with that, I won’t be able to go into all. A quick overview:

  • What is energy and why do they use so many different, conflicting definitions?
  • How can PSE supposedly treat “everything”?
  • How can we test if “chakra-points” really exist?
  • Why are they using outdated concepts like the “four-temperament” theory?
  • How does the test device work?
  • Is the arm-reflex reliable? (Hint: NO!)
  • Isn’t the whole thing a bit subjective?

But most importantly of all, I want you to focus on one very specific problem: Where’s the evidence that it works? Anybody can say that it works (more on that much later), but how can I prove that it does?

Here’s where PSE encounters some very serious problems. There are four!!! relevant studies to this, with a total sample size of about 2000-2500. That’s not a bad sample size, it should be enough to see if PSE works or not. Below are the four studies:

Schmetterlingsstudie – Butterflystudy

Banis R, Banis U: Psychosomatische Energetik – Ergebnisse einer Praxisstudie. Schweiz Zschr Ganzheitsmed 2004;16:173–178.
Holschuh-Lorang B: Psychosomatische Energetik in der Allgemeinmedizin – Ergebnisse einer Praxisstudie. Schweiz. Zschr. GanzheitsMedizin 2004;18,368–371.
Banis R: Multizentrische Praxisstudie zur Psychosomatischen Energetik. Schweiz Z Ganzheitsmed 2010;22:269–272.

If you look at them, they all document a large percentage of “good” and “very good” results. But didn’t I just tell you PSE had serious problems when it comes to evidence?

Yes, because the above is not evidence of anything. It’s worthless trash, not worth the bits it’s written in.
That may sound harsh, but I’ll explain myself and I hope you’ll share my view.
Take note, because this is what the whole post has been building up to!

Eye-witness testimony is the lowest form of evidence in science, especially so in medicine. You can get better without the medicine or treatment doing anything (placebo effect), you can think you’re getting better even though the evidence shows no benefit and you can think the drug as a whole is beneficial (just not in you) even when it’s actually actively killing people. In his excellent book Bad Pharma, Ben Goldacre documents (pages 140-143) the effects of a drug called Iressa on the general population. Basically, Iressa showed no real-world improvements for patients, yet they gave positive testimonies nonetheless.
So at the very least, we can expect PSE to look slightly beneficial just due to this misinformation or misunderstanding or whatever you would like to call it. We will also expect it to look more beneficial because of the placebo effect and, because often people go to get treated with nothing more than “feeling bad” or “anxiety”, even better because people care for them and talk to them.

None of that would matter if PSE were ever tested fairly, that is to say using real, measurable effects. Since none exist (bar the subjective “I feel well” from patients), we would at the very least expect PSE to be tested against a placebo. After all, we know how potent the placebo effect can be. No, none of that. After over 15 years of PSE having been practised, NOT A SINGLE study has been conducted comparing PSE to a placebo. I even went as far as suggesting a cooperative effort between Dr. Banis and myself, but that failed due to a number of factors. (She was interested and would even cooperate with me, but no suitable venue nor funding was found.)

This is what this post has been about: More than fifteen years of practising PSE have passed and we don’t even know the most basic thing about it: Does it work? (I’d say no, but then you shouldn’t take my word for it.)

So I asked a practitioner (or at least advocate) of PSE about the lack of evidence for PSE, not to mention the various pieces of evidence against PSE. What does she make of that?
Her response: “I don’t care about evidence, I have seen it work with my own eyes. And I probably wouldn’t change my mind if I saw studies to the contrary.”

This staggering lack of curiosity about the evidence is baffling. Why don’t you want to know if it works? Isn’t evidence something to actively seek out? And even if you don’t want to conduct the studies yourself, wouldn’t you at least like to know?
Interestingly, I was then chastised by nearly everybody at the table for daring to challenge a doctor and for being a “damn skeptic”.

So as of today, the evidence is still not in on PSE, but it most definitely is in on homeopathy and since that doesn’t work we can safely assume that PSE doesn’t work either. If new evidence comes along, I’ll review my view and make a second post on this issue.

For now though, I hope you’ve taken one thing away from this: Medicine needs evidence, otherwise we don’t know if something works or not. I’ll give specific examples for that in the next post, this one here was mainly to give one example of practitioners or advocates of alternative medicine being reluctant to seek out evidence against which to measure their medicine or treatment.

Beware of alternative medicine.
*In a lecture, future therapists were told the following: “Some day in the future, a person will walk through your door. This person will be extremely friendly and will immediately open up to you. They’ll tell you that you’re the only person who’s ever understood them and that all previous doctors just couldn’t find the answer but that they just know that you’ll be better. If that ever happens, THROW THEM OUT! They’re lunatics and you can’t help them”. -unsourced

Edited by Dean, 06/03/2013
Reason for edit: Spelling correction [1].

Science

What’s the harm?

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This will be my first post on alternative medicine. In it, I will try to cover the prominent excuse people give when taking things like homeopathy: “If it doesn’t help me, at least it won’t hurt me”, otherwise known as “what’s the harm?”.

Edzard Ernst, the first Professor of Complementary Medicine (University of Exter) to ever exist, defined complementary and alternative medicine (CAM) as “health care which lies for the most part outside the mainstream of conventional medicine”. Alternative medicine, as defined by nsf.gov, refers to “all treatments that have not been proven effective using scientific methods”.

The opposite of the above two is “evidence-based medicine”, defined as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”. (I’ll take a look at THAT much, much later.)

With the definitions out of the way, let’s look at what proponents of alternative medicine propose, using homeopathy as an example: Proponents of homeopathy are often heard to say that homeopathy has no side effects.*

So, the reasoning goes, if it can’t harm you, you can just take it anyway. (I’ll assume, for the sake of this post, that alternative medicine has no beneficial effects what so ever. I’ll explore this in later posts.)

There are two rebuttals to this:

1) Spending money on alternative treatments can result in you not having money for proper medication. Approximately $34 billion are spent on CAM in the US alone. A direct comparison of a homeopathic fever remedy and ibuprofen showed that the homeopathic remedy cost $7.05, while ibuprofen cost $6.98. That’s not a huge difference and it also doesn’t address whether the homeopathic remedy will actually help against the fever. The difference, $0.07, is negligible, but in favour of the evidence-based treatment.

I might make a later post detailing the cost of the alternative treatment vs the evidence-based treatment, but for now even a cursory look at common treatments shows that “alternative medicine is less expensive than evidence-based medicine” is, at best, misleading.

2) Spending time on alternative treatments can delay access to real treatment.

Bob Marley didn’t allow the amputation of his cancerous toe due to religious reasons and sought out alternative treatments. He died. Former President Warren G. Harding died after his homeopathic practitioner did some weird stuff on him.

In total, What’s the harm? documents around 370,000 deaths, 305,000 injured and nearly $3 billion in economic damages due to pseudo-science, of which surely more than half can be traced back to CAM.

So the next time someone tells you to go to a practitioner of CAM, politely decline, show them the above website and go to a real, licensed doctor. They’re far from perfect, but at least they can do some things right.

 

*It must be noted at this point that any and every remedy, be it a placebo or a real remedy, can have side effects due to the nocebo effect. What is meant is “no side effect due to the active ingredient”.

Future projects on the topic:

In my next post, I’ll look at why studies in medicine are important.
My third post will deal with a few alternative treatments and look at their benefits.
A series of posts sometime in the future will look at evidence-based medicine, what it is and how much evidence there really is.

Introductions

This is me!

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He_Who_Is_Nobody will hopefully have started a trend: He talked about himself. And his goals on this blog. And he gave us some insight into his future blog plans.

I’ll follow suit.

This is me.

Just so you can put a face to the name.

Right, so where do I come from? Well, I’m a 22 year old student at the Pedagogical Highschool of Vienna, studying “English as a foreign language” and “Geography and Economics” (G&E). I studied “History and Political Sciences” and G&E for 2.5 years at the University of Vienna. I’m training to become a teacher and should be finished next year. Hopefully.
I also take some courses (both online and IRL) on biology.

Currently, I have five post series in mind:
1) Making education a priority. I’ll talk about why schools/Unis/kindergarten/etc. are the way they are and what we should do to improve them.
2) Politics. I already started on that here. Basically, I know a lot of politicians, especially in the EU, so I have a bit of insight. I’ll counter Euro-sceptics and lash out at idiot politicians.
3) Medicine. My flatmate studies medicine and I like to read about it, so between us we’ve got quite a bit covered. I also have a few doctors in the family: My Aunt and Uncle, plus their son who’s about to start studying it, my other Aunt and Uncle, her Father, plus her mother’s a pharmacist. The intent here is to look at some alternative medicine, at some good medicine and at the business and politics of medicine.
4) Science in the news. I’m not sure if I’ll get to that, but it’s one of my pet peeves. Idiot journalists who butcher real science. Gah, hate.
5) Biology. I’ll say upfront that I have no degree in biology, but I’ve got some people who will look through these particular posts. Here, I mainly want to talk about some obscure creationist claims and I may post monthly paper reviews, depending on the time I have.

I’ll also be in the show, I hope, so see you there!

I hope you’ll enjoy my posts. If there’s anything else you want me to post about, any questions you might have: PM me and I’ll (probably) be happy to comply.

Culture, Politics

The politics of misinformation

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Having just written my 1337th post on the LoR forum, I thought I’d write up my first blog post.

A very short background on me: I studied “History and Political science” as well as “Geography and Economics” for 2.5 years at the University of Vienna, without obtaining a degree. I am now almost finished with my “Geography and Economics” and “English as a foreign language” degree, BSc.

So much for that. Now with the U.S. elections just behind us and many upcoming European elections, I wanted to look at one question that’s always baffled me: Why is there so much misinformation in trivial politics? Is there a huge conspiracy, do politicians want to keep us dumb? And why do politicians implement so many bad and unnecessary laws? Why don’t they listen to good advice?

I’ll start with an example from the U.S., as seen in PZ Myers talk “A despairing perspective on American education“. At 14:29 in that video, he talks about the I35W Mississippi River bridge in Minneapolis collapsing in 2007. The bridge was constantly classified as “structurally deficient”, but apart from a plan to retrofit the bridge, nothing was done. In 2007, it collapsed and a new bridge was built in 2008. This could have been avoided if the bridge had been replaced 17 years prior to the incident, in the year of my birth, 1990.

There’s one obvious question: Why didn’t politicians react to the Minnesota Department of Transportation (MnDoT)? In the end, the replacement bridge cost them 234$ million, plus the cost from people not being able to commute (400,000$-1$ million per day), plus the rescue operations and finally the lawsuits. Bad decisions, based on sufficient information, cost the state at least twice as much as a completely new bridge would have cost.

Now I can’t give an answer as to why the politicians in charge did nothing, but this is, after all, just an example to highlight my point: Politicians make bad decisions even though there is enough data to come to the (obviously?) correct conclusion.
Closer to home, politicians have just tried to revamp the education system in Austria. The idea was a good one: Competency-based learning. It’s basically learning how to think instead of learning only facts. With that came a centralized baccalaureate, similar to the SAT’s in the U.S. That’s not a bad idea, because people want (and sometimes need) to be compared more or less objectively. (I’ll go into that in a later blog post.) That sounds excellent!

So why am I ranting? Well, obviously something didn’t go as planned. Do you want to venture a guess as to what went wrong? Yep, that’s right! Politicians (centre left party) made the wrong call, even though the answer should have been obvious. The whole scheme was set in motion in 2004, but back in 2008, when I was still at the other Uni, my Geography Professor always had one day where she would go to schools all around the country and teach teachers about… competency-based learning. Basically, the teachers didn’t even know what or how they were supposed to be teaching! That’s a shocker, to say the least. How can you expect a school child, even an 18-year-old, to pass a standardized test when they’ve been taught something completely different during their years at school?

I’ll offer a possible solution for this example, and then move back to the U.S. Being the centre left party, the SPÖ (Social Democratic Party of Austria) is in favour of giving the same education to all children, if possible for free. However, their political goals, admirable as they might be, conflicted with reality and with science. (One of their aims was a comprehensive school, which is no better than elite schools. That’s what people though, for various reasons, but it’s not true.) Anyway…

Now let’s get back to the U.S. There are similar problems in education, with not enough money being spent on Schools and so on. There are many avenues I could explore, but I’ll take the most obvious one: Why do Republicans push educational laws that are demonstrably stupid and impeding the education of the next generation?

We already know that women mostly voted for Obama (55% to 45%), that young people mostly voted for Obama (60% to 36%), that higher-income people tend to vote for Romney and so on. We also know that of the top 10 states in education (percentage with a degree), 10/10 voted for Obama. Of the ten worst educated states, nine voted for Romney. Now I dare you to tell me that’s a coincidence.

Top 10 best vs Top 10 worst educated states, and how they voted

This goes back to what PZ said in his talk: Republicans tend to favour bad education policies because they would be voted out of office if not for the uneducated.

Avid readers might now howl in protest and say something like: “That’s a generalization! I’m educated/uneducated and I voted for Romney/Obama!”

Yes, of course. I have to make some generalizations, otherwise this post isn’t going anywhere. To analyse this phenomenon in depth and to do it proper justice, I’d have to write at least a book about it. I’m still confident that the overall message would remain the same. The next few paragraphs contain generalizations so sweeping that even I cringe, but like I said… text length and time and all…

So the (very short) answer to the questions I posed is this: Extremist (both left and right wing) parties as well as moderately right wing/conservative parties tend to have bad education policies because their ideas are not compatible with reality, their voters would stop voting for them if they were educated.

Now some might think of me as a left-wing hippy, so let me take the wind out of your sails right away: Left wing parties have an equally bad reason to favour bad politics. In my Austrian example, bad policies were implemented because of ideological reasons, even though they were contrary to what science said and even though they could not be implemented in the time span allotted. I think that’s true for most parties: Decisions are made to get re-elected, which includes staying true to your ideology, however wrong it may be.

Even more avid readers than the above might now raise their hands and say: “But that doesn’t answer your question at all. Why don’t they simply drop their idiotic policies in exchange for some good ones? Why don’t people change their votes after a party has done them a disservice?”

And this, dear reader, is where my (partially rational) mind can’t quite follow any more. Why don’t they? It should be so simple. Is it possible that it’s got something to do with what I alluded in the topic “How to debate/argue – tips and tricks” as well as what is stated outright in the “Psychology of Belief” series, namely that people are so set in their ways that we can’t change them? At least, we can’t change them without a lot of effort involved.

There’s a positive and a negative message to all this.
The negative: If we don’t turn this around, our grandchildren might end up in a world run down by the likes of our current-day Republicans.
The positive: Change is on the way. The number of Skeptics (people who need evidence to be swayed, who possibly even think scientifically), not pseudo-skeptics like the Euro-Skeptic movement, is growing. Maybe if the next few Presidents all over the world could be Skeptics… Ah, I can dream, can’t I?

So what’s the conclusion to this post? Be skeptical, in all areas of life. Be it politics, science, medicine, the supernatural… Skepticism is a good thing and there’s too little of it in the world today. I’ll end with a quote and something to think about:

“Trying to figure out how something works on that deep level, the first ninety-nine explanations you come up with are wrong. The hundredth is right. So you have to learn how to admit you’re wrong, over and over and over again. It doesn’t sound like much, but it’s so hard that most people can’t do science. Always questioning yourself, always taking another look at things you’ve always taken for granted, […] and every time you change your mind, you change yourself.” –Sauce

My guess is, that’s why politicians don’t change their views: Because they’d have to admit that they’re wrong. And that’s one thing they can’t admit, under pain of expulsion. If a politician ever admits (s)he’s wrong, they’ll soon be kicked from the party. So the next time you vote, look out for two things:
1) If a politician says that they know the answer, vote for the other party.
2) If a politician can admit they’re wrong, vote for that one.

Or don’t, that’s up to you.