Where Do F ads Come From?

1. Where Do Fads Come From? A Presentation by: Jessica Jaruczyk For ABA 553 Assessing Autism Interventions

2. Fad • Defined by: Merriam-Webster • A practice or interest followed for a time with exaggerated zeal :craze • The authors Jacobson, Foxx & Mulick (2005) define Fad as: • A procedure, method or therapy, that is adopted rapidly in the presence of little validating research, gains or wide use or recognition, and then fades from use –usually in the face of disconcerning research, but often due to the adoption of a new fad.

3. What is a Fad Therapy? • Authors refer to treatments (therapy’s) they address using adjectives such as: • FAD • Alternative • Controversial • Pseudoscientific • Unsubstantiated

4. Labels • By using these labels to distinguish various treatments and therapies for Developmental Disabilities, categories are established on the basis of the presence or absence of scientific support • Pseudoscientific: an adjective used to described disapproval for the treatment in question as appearing to be, but not scientific • Unsubstantiated • Non-evidence based treatments

5. Controversial or Not Controversial • A therapy is “controversial” in relation to some issue of controversy brought by those who are critical of its use • Being free of controversy does not bring value to the label of a therapy

6. Controversial Therapies • To be controversial a therapy must have something about it that attracts supporters. • Some Factors: • The Guru factor • No unexplained failures: • The parent misunderstanding the goal of the therapy • The therapy providing the groundwork for future (not immediate) growth • The parent not believing or following through sufficiently for the program to be successful, or • The child being lazy and unmotivated. In other words, failure is attributed to influences external to the therapy itself. • All forward progress is related to the therapy. • The lack of research-based support is due to professional jealousy.

7. Where Do Fads Come From & Why Are There So Many? • Market Demands • What is the prevalent demand at the moment? • Parents looking for the “Silver Bullet” • Why they choose them over scientifically validated options • In order to better understand we must look at the history of medicine in America

8. American Medicine • Medical research that we value today became widespread only at the beginning of the 20th century • Prior to, there is a history of alternative, unsubstantiated, treatments in developmental disabilities treatment. • American Medicine before the Revolution • American Medicine from the Revolution to 1900

9. American Medicine Before the Revolution • Medical services were provided by a variety of practitioners that had no former academic training • Barbers in England were authorized to perform surgery and training was passed down through apprenticeship • 1745- Surgeons separated from the Barbers to form their own guild • Surgeons were not authorized to practice medicine but served the lower class

10. American Medicine Before the Revolution • Apothecaries served the poor • Minister Physicians: while studying theology also studied medicine as an alternative means of employment such as Cotton Mather • Treated ailments of the wealthy • Top of the medical hierarchy • Studied at the great hospitals and universities in England

12. From the Revolution to 1900 • Many of the forces that led to modern medicine of the 20th century were present in the period following the revolution. • The methods of the physicians were highly criticized • The most important and influential doctor of the late 18th and early 19th century was Benjamin Rush • He was a signer of the Declaration of Independence • Physicians who used traditional methods taught in medical schools were known as “regulars” • Those using non-standard treatments were known as “irregulars”

13. A Bad Rap! • The problem with American Medicine before the end of the 19th century: • Not based on what we know think of as scientific evidence • Harmful techniques were employed and not recognized as harmful (Heroic Medicine) • Did more harm than good • Led to Oliver Wendell Holmes to deliver his famous assessment in a lecture at Harvard Medical School: “I firmly believe that if the whole materiamedicacould be sunk to the bottom of the sea it would be better for mankind and all the worse for the fishes”

14. Heroic Medicine • Heroic medicine-Based on the on the theory first articulated by the Greek physicians, Hippocrates and Galen asserting that illness was cause by an imbalance of four basic bodily humors: yellow bile, black bile, phlegm, and blood • The Four Humors are responsible for the nutrition, growth and metabolism of the organism.  They originate in the digestive process. • Autumn: blackbileSpring: bloodWinter: phlegm Summer: yellow bile. • According to Gary Lindquester's "History of Human Disease," if it was a fever -- a hot, dry disease -- the culprit was yellow bile. So, the doctor would try to increase its opposite, phlegm, by prescribing cold baths. If the opposite situation prevailed (as in a cold), where there were obvious symptoms of excess phlegm production, the regimen would be to bundle up in bed and drink wine.

15. Heroic Medicine • The Standard Treatment • Physicians sought to alter the balance of humors by • Bleeding • Cupping • Purging

16. Cupping • Accomplished by heating a glass cup or jar and placing it on the patients skin. • As the air in the cup cooled, it created a vacuum that was thought to draw materials out of the body • Wet cupping-cutting the skin under the cup so that blood was drawn out of the wound http://www.youtube.com/watch?v=lv0cp6RfO-0

17. Purging • The administration of strong herbal formulas that created violent vomiting and diarrhea

18. Bloodletting • The most popular of all heroic treatments, involving the draining of large amounts of blood from the patients body • Benjamin Rush believed that the body contained 25 lbs of blood and recommended bleeding until four fifths of it had been removed from the body. • Yellow Fever Epidemic of 1793 • George Washington died as a result of bloodletting

19. Rival Therapies • The brutality of the heroic methods fueled the development of other medical theories and techniques • Rival therapies challenged the “regulars” • Thomsonianism-Samuel Thompson favored botanicals • In 1822 published a book describing his methods • He grew in popularity because his methods were more humane and the social reform of the time

20. Rival Therapies • Homeopathy – Developed by the German physician Samuel Christian Hahnemann • Based on 2 principales • Like cures like- to cure a disease, one must find an herb or substance that produces the same symptoms as the disease in a healthy person • That the medicines are most effective when they were highly diluted • Homeopathy made its way in and by 1935 the first homeopathic college in America was established in Allentown, Pa.

21. On the Defense • The growth of the competitors led to the defensive move of the orthodox physicians to create the “consultation clause” • The American Medical Association was formed in 1847 and adopted its first code of Ethics which included a clause regarding consultation • The effect of the consultation clause was to forbid any regular physician from taking on a patient who was also being seen by a homeopath, and no physician could consult with a homeopath, even if the patient requested it

22. A Loss of Science? • The irony is that science was lost in the battle for dominance • By the late 19th century the war between them began to fade • The late 19th and early 20th centuries were the era of social Darwinism

23. The Origins of Fad Therapies • Some conditions that lead to the popularity of alternative, nonscientific therapies: • Incomplete Effectiveness of Available Therapies- if there are conditions for which science has yet to produce a successful treatment people are going to look for the magic bullet

24. The Origins of Fad Therapies • Best Available treatment is burdensome or difficult for the parent or client- heroic medicine was difficult • In the field of Developmental Disabilities-the best therapies are expensive, demanding to administer, and take years to complete or are never fully completed. • Alternative Treatment Supported by Ideology- Belief based on an ideological application of a therapy, is sufficient to sustain the use of a treatment in the absence of any evidence that is effective

25. The Origins of Fad Therapies • Treatment Promoted by Proprietary Professional Group- a therapy originates with a professional group and goes on to be promoted by the members of that group. • Authority-Beliefs are acquired by the method of authority if we accept the word of another. Ex. Andrew Wakefield • Tenacity- Beliefs are often held onto because of loyalty, defending our beliefs against strong contradictory evidence

26. The Origins of Fad Therapies • A Priori- a conclusion or judgment based on deduction if they make sense or feel right. Example: Thomsonianism aligning his approach with political and social themes of the day • The Scientific Method- the answer to fixation of belief. When empirical methods are used with adequate controls they should lead to beliefs that have “external permanency”(Pierce)

27. In Search of Bartholow’s Future • Robert Bartholow an early advocate for the scientific approach to medicine wrote: • “Homeopathy and allopathy are dream of a by-gone time. Modern science is indifferent to Hippocrates and Hahnemann. The therapeutics of today rejects dogmas, and the therapeutics of the future that will accept nothing that can not be demonstrated by the tests of science.

28. Any Questions? http://www.youtube.com/watch?v=FPUqsZx5ARg