Quick and Easy Guide to Spotting Altmed Bunk

Immersed in the world of breastfeeding and attachment parenting as I am, I am unfortunately bombarded with loads of alternative medicine hogwash. As I dutifully (and usually futilely) research and dissect the latest advice from someone's naturopath, or the information they got from their chiropractor, I have noticed certain signs that will cause my bullshit meter to bury the needle. What follows isn't a detailed discussion of why altmed practices are unscientific, or how to decide if a research study is reliable, or a treatise on the philosophy of science. It's just a quick and dirty list of features that anti-scientific quackery tends to share.

1. Most of the hits on Google are sites that promote or sell the product in question. Typical site names are phlebotinum.com, phlebotinum-advisory-group.net, drlaceyunderall.net, yournaturalhealth.com, and so on. Many strive to look like health information sites, but if they have only good things to say, and an easy link to purchase the product, you can bet it's just a commercial site shilling. If you get a high proportion of hits like Webmd, Mayo Clinic, National Institutes of Health, and maybe stuff like CNN or ABC stories, it has a much greater chance of being a real thing.

2. The remedy is promoted as a solution for vague and ubiquitous maladies. Usual suspects are fatigue, insomnia, body aches, headache, mood problems, low sex drive, weight gain, nausea, and constipation. Now these can be real symptoms of real problems. But when you see a product promoted as solving a long laundry list of these issues, it's time to raise an eyebrow. These symptoms are typically experienced by most people at least some of the time, especially in a culture plagued by poor diet, low rates of exercise, too little sleep, social isolation, and chronic stress.

Most of these symptoms are self-limiting, or can be alleviated by lifestyle change. But most people don't relish a prescription of "eat plenty of fruits and vegetables, exercise regularly, and get 8 hours of sleep a night." Lifestyle changes are difficult to initiate, harder to maintain, and are frankly a total drag. But give us a pill, a cream, or someone waving their hands over us once a week, and we perk right up - seems easy!

3. Self-diagnosis is encouraged. Whether it's checking off the laundry list of vague symptoms, or buying a test kit you can do at home, do-it-yourself is the name of the game for quacks. And if you did get tests at the doctor's office, they encourage re-interpretation. Doctor says your thyroid levels are fine? Well check your number against this web site's "more accurate" scale. Doctor says your hormone levels are healthy? Take a saliva test to find out more!

4. Remedy is promoted by an actress of fading fame. E.g., Jenny McCarthy and Suzanne Somers.

5. Proponents laud how natural the remedy is, and decry the toxins in the environment and/or conventional medicines. Arsenic is as natural as it gets - it's an element! Hemlock is a plant (make sure you get organically grown). Meanwhile insulin for diabetics is synthetic. Using "natural" as a synonym for "good" doesn't make sense. (Also look for the keyword "allopathic" to describe conventional medicine.)

6. Relies on testimonials, anecdotal evidence, appeals to authority. Approaches that work don't need this type of weak support, because they have strong scientific evidence - the kind that attempts to sweep away all the human foibles that can prevent us from seeing what's really happening, and determine if an intervention has a real effect.

7. Provides citations as though they refer to peer-reviewed scientific journals, but the cited material is actually a book, presentation, or web site of an individual proponent of the remedy. It doesn't matter how many letters are after your name - just because you say it doesn't make it reliable. Publication in a respected journal indicates your claims have been examined and probed for mistakes and found robust. Publication on a website means you successfully Googled GoDaddy.

8. Users respond to skeptical inquiry and questioning of the evidence by saying, "I KNOW this works - it worked for me." When the people trying to sell you on something have no clue about placebo effect, confirmation bias, coincidence, self-limiting conditions, and general methods for removing human perceptual bias, you can dismiss pretty much everything they say.

9. Praises or demonizes according to fad. Acai berries are magically delicious, but VDTs, power lines, electrical transformers, cell phones, Wifi is evil.

10. Invokes the Pentaverate. Promoters wave away criticism as the result of wide-reaching conspiracies involving doctors, pharmaceutical companies, the CDC, and other entities.

11. The remedy is said to have no possible side effects or risks. Generally if something can have an effect, it can have a side effect. If it can change your body in some way, that change might turn out badly for you. Even such benign and universally prescribed practices as exercise and high fiber diets have risks and side effects.

12. Oprah.

Package-deal Skepticism

In the crunchy mothering world, I run into this odd phenomenon. Women get involved in some aspect of mothering that is counter-cultural: extended breastfeeding or natural childbirth for instance - practices that are actually supported by evidence or are merely matters of personal preference. By engaging in this "weird" behavior, they find themselves battling against social norms and doctors' expectations. They find support in a group of like-minded people, and get used to filtering, altering, or outright rejecting advice from uninitiated people, from mothers in law to pediatricians.

Now, it can be perfectly rational to take uninformed advice with a grain of salt. And sadly even experts can be terribly uninformed about, say, breastfeeding. Doctors don't get a lot of training in this area, and often even well-read laypeople will be more up to date on the research than medical professionals.

The problem is, many people seem built not to question everything, but to act more like they're choosing between competing clubs. So many women just seem to see it as a choice between boilerplate belief systems, rather than an investigation into the truth. Either you eat processed factory farmed foods, have an intervention-heavy birth in a hospital, feed your baby formula, vaccinate them, and keep them in a car seat or crib 24/7, OR you eat organic whole foods, have a homebirth, nurse your child until they decide to stop, skip vaccinations in favor of homeopathic remedies, and wear them and cosleep with them.

The choice to reject medical authorities on one subject (which may make sense) tends to lead to rejection of all scientific authority and adoption of crunchy-culture alternatives, even in cases like homeopathy, when it is completely stupid.

Woo creeps in everywhere

Sometimes it's so frustrating being a skeptic among a sea of the credulous. People don't understand why you have a problem with irrational garbage, because they don't examine it themselves.

We decided to hook Kitty up with a therapist to help her deal with some anxiety. No big problem, it just seems like her worries are making it hard for her to enjoy life fully, and I'd rather help her change her thinking now, than let her negative thought patterns get entrenched. So I asked my therapist (see above, re: entrenched negativity) for a recommendation. She only knew of one person who was good and took our insurance.

So I perused this lady's website. Cognitive Behavioral Therapy . . . good, good. Integrated approach . . . OK. EFT, which uses meridian tapping to relieve depression and anxiety - WHOA NELLY!

I'd never heard of EFT, but that description set off all my pseudoscience alarm bells. I looked it up, and sure enough, it's a load of codswallop about manipulating your "energy fields." It is, of course, untestable and unfalsifiable.

So now my anxiety levels were up. How to proceed? It's possible this person is relatively competent and would teach my kid CBT techniques, and all would be well. Also, no one claims that EFT fails to alleviate anxiety - it's just that it appears to be a combination of placebo effect and distraction. Would it be acceptable for her to teach my child this technique, if it helped her?

I finally decided no, it would not be acceptable. I'm not having someone indoctrinate my impressionable 7yo with magical thinking, even if it might confer some benefit. I decided to call my therapist back and use someone in her practice, paying the out-of-network price. It's worth it.

The scary thing is, you don't necessarily know if your health care provider is infected with woo-think. Not all of them will be kind enough to advertise it on page 1. Naturally, I'll be chatting with this new therapist to suss things out.

But sadly, I think sometimes you have to put up with creduloids. Actually, that name is a bit unfair. Most people are largely rational, with odd pockets of irrational beliefs. Probably that first therapist could have helped my daughter with proven, reasonable methods. And I could have discussed that I didn't want EFT used, I suppose. But that's a hard conversation, isn't it? "I'd like to hire you for your expertise . . . except this one thing you believe is total garbage, so don't use it." Ironically, she's probably used to and totally unoffended by people saying, "Don't use EFT, because we're Christians and it's against our beliefs."

A little example of faith versus science - in an unexpected place

This is not a post about religion at all. It is about warring approaches within the field of medicine. Specifically, how we in the U.S. deal with birth.

There are two layers of faith involved. First, and more obviously, is the faith people have in doctors. Sure, one should "have faith" in one's doctor in the sense of feeling trust and believing that the doctor knows what they're doing - the sense of "having faith" that refers to trust or dependability based on prior observation and evidence. However, (and yes, it was the homeopathy discussion that prompted this) many people seem to "have faith" in a more religious sense, i.e., they believe doctors are infallible authority figures, and promptly turn their critical thinking and confidence off when in one's presence.

The second layer is even more disturbing, especially combined with the first. In the field of obstetrics at least, doctors practice medicine by faith. And I mean "faith" in the full-on "believing things contrary to evidence, and stopping your ears and singing 'lalalaIcan'thearyou' when presented with such evidence" way. It all starts out very reasonably - giving birth is an uncomfortable, sometimes painful experience. It would be nice to alleviate the discomfort. Also, sometimes moms and/or babies are injured or even die during the process. It would be terrific if we could prevent that.

To this situation, add new technology. For instance, electronic fetal monitoring. It makes perfect, rational sense that EFM, which allows doctors to constantly monitor fetal heart rate during labor, would improve outcomes for babies. Babies that might have suffered hypoxia and brain damage or even death during labor could be identified and quickly rescued via c-section. All of this is perfectly reasonable, and I agree with the reasons EFM came into use. Of course at that time, there was no research available on actual outcomes with EFM - doctors went on logical deduction that it would be helpful.

Except, once research was done, it became clear that EFM is associated with poorer outcomes for mother and baby. The main reasons seem to be twofold - first, having constant information on heart rate means a very high "false positive" incidence for fetal distress. Scientific study indicates that intermittent readings with a hand-held doppler device actually result in more healthy moms and babies, perhaps because troubling trends that can be identified with this method are much more likely to be indicative of real trouble, versus isolated decelerations that are picked up by the always-vigilant EFM.

The other big factor is that EFM requires the mother to be lying in bed, stationary, so she can be strapped to the machine. As far as I know, every single study of labor and delivery has found better outcomes when mothers can stand, squat, walk, and otherwise remain upright and move around. Looking at the mechanics of birth, this makes perfect sense.

The story is similar for many other technological interventions - from epidurals to inductions to ultrasound estimates of size, it would seem that the innovation would improve birth outcomes, but they actually result in lots of pain, fear, and unnecessary surgery, injury and side effects to mothers and babies, and often disruption of breastfeeding, which has ill effects for both as well.

So it makes me cringe when I hear mothers blithely say, "Oh, my doctor said this is a big baby, so I have to be induced next week," or "Why wouldn't I get an epidural - the doctor says it's perfectly safe!" These people are handing over their intellect to a person who is a product of a system that rejects evidence-based practice in favor of authoritarian received wisdom and perceived infallibility.

Gee, that reminds me of something.