Evaluating the Claims of Alternative Medicine

1. Evaluating the Claims of Alternative Medicine Professor Matt McCormick Department of Philosophy California State University, Sacramento mccormick@csus.edu

2. Conventional Standards of Evidence • Where do we get our justifications? • Trusted authority figures: educators, news reporters, professionals, scientists, printed sources, etc. • Friends and family • People whose judgment we trust • Our own experience • Common sense

3. What Sort of General Evidence Policy is this? How do we reason most of the time? When I am considering whether or not X is true, I should believe X when most or all of these conditions are met: • a) trusted authority figures, b) friends and family, and/or c) trustworthy people all claim that it is true. • My own experience indicates that X is true. • Common sense indicates that X is true. Important: Do we actively seek out disconfirming evidence, try to disprove it, or reflect on the adequacy of our information with regard to ~p?

4. How Good of an Epistemic Policy is This? Seems pretty good. In lots of ordinary cases, something like this seems to work well—we can recall many times it led to good results or true beliefs. • Brit Hume on CBS asserts that 13 American soldiers died in Iraq today. • My mother tells me that I was born on July 9th. • I see sunny skies and infer that I don’t need to take an umbrella. • My 5 year son is running in the house with scissors and I predict a visit to the emergency room if I don’t stop him.

5. Does This Strategy Work in Less Obvious Matters of Science and Medicine? When you get a cold, or a backache, or have allergies, it is quite common to hear someone say, “You should try echinacea—I used it and it cleared my cold up right away.” “That new supplement, Airborne, really works if you want to get over the flu.” “I have an herbal tea that cured my back pain.” “If you are going to be on a plane, you need to take some Germbuster—that label says it boosts your immune system.”

6. Alternative and Complementary Medicine are Enormously Popular • Some 60 million Americans use these therapies in the effort to combat serious diseases like cancer and AIDS, as well as the normal physiology of aging. In the United States, office visits to providers of complementary and alternative medicine now outnumber visits to primary care physicians. The costs of such care approach $40 billion dollars a year. Books, talk shows and Web sites present riveting testimonials of clinical benefits from Eastern breathing techniques, dietary supplements, positive thinking and prayer. Groopman, Jerome. “Faith and Healing,” New York Times Book Review, Jan. 27, 2008. 14-15.

7. Positive Thinking, Stress Reduction, and Disease • Talk therapy, optimism, and stress reduction improve health/diminish disease, don’t they? • A widely reported study: Stanford psychologist David Spiegel studied the effects of support groups (weekly discussions about fears and hopes) and self-hypnosis on 86 advanced breast cancer patients. • Spiegel concluded that the group therapy patients lived 36.6 months, the others lived 18.9 months.

8. The Evidence Isn’t There • But neither he nor anyone else has been able to reproduce the results. • Groopman: “Recent studies show that belief, even in inert treatments, can have a profound benefits in relieving pain, likely via release of endorphins and other mediators in the brain. But despite several decades of concerted research in the field of psychoneuroimmunology, to my scrutiny no robust effects of meditation or other relaxation techniques that could combat illness like cancer or AIDS have been identified.”

9. Is there a better way to gather evidence than our conventional way? Science gives us a method that proves to be much more reliable and accurate.

10. The Scientific Method • Observe phenomena for what appear to be patterns of events These observations require that events that repeat, that can be measured, and that can be observed by multiple observers. Example: It has been alleged that echinacea shortens the length and reduces the severity of colds.

11. The Scientific Method • Develop questions to investigate the phenomena further, refine our observations of the patterns. Example: researchers developed a set of questions to determine how the effects of echinacea on colds could be determined.

12. The Scientific Method • If there is a repeating, significant, real phenomena, then we develop hypotheses or testable explanations that answer the questions from our observations. Example: If echinacea reduces the length and severity of the common cold, then we would expect users in a test group to have significantly fewer colds and colds of significantly shorter length than subjects who do not take it.

13. The Scientific Method • We systematically collect and analyze data to test the hypothesis. This step must employ double-blind testing procedures: Neither the researchers nor the test subjects are in possession of information that could skew the results of the test, especially by the placebo effect. The sample populations must be large, there must be control groups-- as many causal factors as possible must be controlled for.

14. The Placebo Effect • The placebo effect is a positive (or even negative!) reaction that humans have to medical treatment that arises from their expectation that they are being treated or affected. The effect is independent of any real effect that drugs or other treatments may have. The effect is measurable and well-documented—test subjects who get fake medication such as sugar pills will show more improvement than subject who get no treatment at all.

15. Placebo Effect: Complementary and Alternative Medicine • The placebo effect is certainly contributing to the passionate testimonials from so many people that the treatments work. • People also credit the treatment for improvements that might have happened anyway if they had taken nothing.

16. The Scientific Method • We analyze the results of the data collection and come to conclusions about whether or not the hypotheses are correct. This step will often generate more questions and hypotheses to be explored.

17. The Scientific Method 6. The whole process is carefully peer-reviewed—other experts in relevant field scrutinize the experiments and data gathering for mistakes, alternative explanations, problems, and so on.

18. The Scientific Method 7. When the research passes peer review analysis, and when the results of the investigation have been repeated and corroborated in many more clinical trials, the scientific community reaches a consensus. But even that consensus is defeasible.

19. So What About Alternative and Complementary Medicine? • People taking them do not inform their doctors. • The effects, side-effects, dangers, dosages, and quality of them typically have not been regulated or studied. • People are giving these treatments to children where we know even less about effects.

20. Other Problems with Alternative Medicines • People forego proven treatments. • Pregnant women are taking them when we have no data about the possibly disastrous effects on the fetus. • And people are spending—wasting—billions of dollars on treatments that have been demonstrated to not work.

21. Conclusion: Two Models, Science works better Conventional Standards: word of mouth, common sense, people we know, personal experience suggest p is true, therefore I believe p. Science: Gather relevant data, form a hypothesis, investigate thoroughly, actively seek out disconfirming evidence, critically scrutinize the investigation and inferences, draw provisional conclusions, repeat, keep investigating. Discovering science as a means for finding truth is the single most important development in human history.