Why Bogus Therapies Often Seem to Work
Barry L. Beyerstein, Ph.D.
Subtle forces can lead intelligent people (both patients and therapists) to think that a treatment has helped someone when it has not. This is true for new treatments in scientific medicine, as well as for nostrums in folk medicine, fringe practices in "alternative medicine," and the ministrations of faith healers.
Many dubious methods remain on the market primarily because satisfied customers offer testimonials to their worth. Essentially, these people say: "I tried it, and I got better, so it must be effective." The electronic and print media typically portray testimonials as valid evidence. But without proper testing, it is difficult or impossible to determine whether this is so.
There are at least seven reasons why people may erroneously conclude that an ineffective therapy works:
1. The disease may have run its natural course. Many diseases are self-limiting. If the condition is not chronic or fatal, the body's own recuperative processes usually restore the sufferer to health. Thus, to demonstrate that a therapy is effective, its proponents must show that the number of patients listed as improved exceeds the number expected to recover without any treatment at all (or that they recover reliably faster than if left untreated). Without detailed records of successes and failures for a large enough number of patients with the same complaint, someone cannot legitimately claim to have exceeded the published norms for unaided recovery.
2. Many diseases are cyclical. Such conditions as arthritis, multiple sclerosis, allergies, and gastrointestinal problems normally have "ups and downs." Naturally, sufferers tend to seek therapy during the downturn of any given cycle. In this way, a bogus treatment will have repeated opportunities to coincide with upturns that would have happened anyway.
3. The placebo effect may be responsible. Through suggestion, belief, expectancy, cognitive reinterpretation, and diversion of attention, patients given biologically useless treatments often experience measurable relief. Some placebo responses produce actual changes in the physical condition; others are subjective changes that make patients feel better even though there has been no objective change in the underlying pathology.
4. People who hedge their bets credit the wrong thing. If improvement occurs after someone has had both "alternative" and science-based treatment, the fringe practice often gets a disproportionate share of the credit.
5. The original diagnosis or prognosis may have been incorrect. Scientifically trained physicians are not infallible. A mistaken diagnosis, followed by a trip to a shrine or an "alternative" healer, can lead to a glowing testimonial for curing a condition that would have resolved by itself. In other cases, the diagnosis may be correct but the time frame, which is inherently difficult to predict, might prove inaccurate.
6. Temporary mood improvement can be confused with cure. Alternative healers often have forceful, charismatic personalities. To the extent that patients are swept up by the messianic aspects of "alternative medicine," psychological uplift may ensue.
7. Psychological needs can distort what people perceive and do. Even when no objective improvement occurs, people with a strong psychological investment in "alternative medicine" can convince themselves they have been helped. According to cognitive dissonance theory, when experiences contradict existing attitudes, feelings, or knowledge, mental distress is produced. People tend to alleviate this discord by reinterpreting (distorting) the offending information. If no relief occurs after committing time, money, and "face" to an alternate course of treatment (and perhaps to the worldview of which it is a part), internal disharmony can result. Rather than admit to themselves or to others that their efforts have been a waste, many people find some redeeming value in the treatment. Core beliefs tend to be vigorously defended by warping perception and memory. Fringe practitioners and their clients are prone to misinterpret cues and remember things as they wish they had happened. They may be selective in what they recall, overestimating their apparent successes while ignoring, downplaying, or explaining away their failures. The scientific method evolved in large part to reduce the impact of this human penchant for jumping to congenial conclusions. In addition, people normally feel obligated to reciprocate when someone does them a good turn. Since most "alternative" therapists sincerely believe they are helping, it is only natural that patients would want to please them in return. Without patients necessarily realizing it, such obligations are sufficient to inflate their perception of how much benefit they have received.
The job of distinguishing real from spurious causal relationships requires well designed studies and logical abstractions from large bodies of data. Many sources of error can mislead people who rely on intuition or informal reasoning to analyze complex events. Before agreeing to any kind of treatment, you should feel confident that it makes sense and has been scientifically validated through studies that control for placebo responses, compliance effects, and judgmental errors. You should be very wary if the "evidence" consists merely of testimonials, self-published pamphlets or books, or items from the popular media.
- Spontaneous Remission and the Placebo Effect
- Common Questions about Science and "Alternative" Health Methods
- Why Extraordinary Claims Demand Extraordinary Proof
- How Quackery Sells
- Response to an Alt-Muddled Friend
Dr. Beyerstein, a member of the executive council of the Committee for Scientific Investigation of Claims of the Paranormal (CSICOP), is a biopsychologist at Simon Fraser University in Burnaby, British Columbia, Canada. A more detailed discussion of this topic is one of six superb articles on "alternative medicine" in the Sept/Oct 1997 issue of CSICOP's Skeptical Inquirer magazine, which costs $7.50. An introductory (six-issue) subscription at the special Internet price of $16.95 can be obtained by calling (800) 634-1610.