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David X. Swenson PhD LP 2004

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Title: David X. Swenson PhD LP 2004


1
Scrutinizing the Quick Fix A critical
examination of Pop Therapies
Herbs
BSFF
EMDR
Energy
TFT
Therapeutic Touch
Acupuncture
Faith Healing
2
Objectives
  • to overview the popular growth of CAM
  • to explore reasons for its proliferation
  • to identify assumptions problems with its
    claims
  • to explore ethical and scientific implications
    for this trend

"The trouble with the world is not what people
don't know it's what they know that ain't so."
-- Will Rogers
3
What is considered conventional treatment
changes over time
I have an earache 2000 B.C.B Here, eat this
root. 1000 A.D.B That root is heathen. Here, say
this prayer 1850 A.D.B That prayer is
superstition. Here, drink this potion. 1940 A.D.B
That potion is snake oil. Here, swallow this
pill. 1985 A.D.B That pill is ineffective. Here,
take this antibiotic. 2000 A.D.B That antibiotic
is artificial. Here, eat this root

--anon
4
What are CAM? (NIH categories)
  • Alternative medical systems acupuncture,
    chI gong,
    tai chi, massage, indigenous systems,
    homeopathy, radionics, naturopathy
  • Bioelectromagnetics use of magnets
    electromagnetic fields
  • Biofield use of subtle energy fields,
    Therapeutic
    Touch, Reiki, chi gong
  • Biologically-based herbalism, special diets,
    macrobiotics,
    orthomolecular therapy, dietary
    supplements
  • Lifestyle disease prevention electro-dermal
    diagnostics, intuitive healing, stress
    management, self regulation
  • Manipulative body-based chiropractic,
    bodywork, reflexology, rolfing, polarity,
    colonics
  • Mind-body yoga, meditation, biofeedback, prayer,
    remote healing

Be very, very careful what you put into that
head, because you will never, ever get it out
--Thomas Cardinal Wolsey
http//nccam.nih.gov/
5
The Proliferation of CAM
  • In 1990 30 visited CAM practitioners, 46 by
    1997
  • Twice as many CAM visits than to primary provider
  • 27 billion business (mostly out of pocket)
  • 30-40 use CAM in industrialized countries
    70-90 in non-industrialized
  • 58 used for health promotion disease
    prevention
  • 64-70 not disclose CAM use to providers

6
Who uses CAM--
  • Age 30-50
  • Women (49), Men (38)
  • Baby Boomers
  • College educated
  • Income 50,000
  • Worried well or desperately ill
  • Used for anxiety, depression, headaches, back
    pain
  • Positive attitudes toward holism,
    environmentalism, feminism, spiritualism,
    self-determination, naturalism, and personal
    growth psychology

Eisenberg, D. M., et al. (1998). Trends in
alternative medicine use in the United States,
1990-1997 Results of a follow-up national
survey. JAMA, 280(18), 1569-1575.
7
Proliferation in the Professions
  • 31 medical schools require CAM courses, 64
    elective
  • Columbia University College of Physicians
    Surgeons, Johns Hopkins,
    School of Medicine,
    Mt. Sinai School of Medicine, Harvard
    Medical School.
  • 13 of US hospitals, 25 inner city hospitals,
    30 large facilities provide CAM treatments
  • Therapeutic Touch (TT) has taught 50,000
    professionals in 75 countries, 100 university
    programs, 95 health facilities
  • Several thousand professionals practice
    Thought-Field Therapy (TFT) voice technology
    costs 100,000
  • There are more than 32 energy therapy spinoffs
    of TFT

8
Scientific Illiteracy The Full Moon Effect, or
why do you think they call it
homicide rate traffic accidents crisis calls to
police or fire stationsdomestic violence births
of babies suicide major disasterscasino payout
rates assassinations kidnappings aggression by
professional athletes violence in prisons
psychiatric admissions agitated behavior by
nursing home residents assaults, gunshot wounds,
stabbings emergency room admissions alcoholism
sleep walking epilepsy
  • 43 of University students
  • 80 ER nurses
  • 64 physicians believe in the
  • Full Moon Effect

Journal of Emergency Medicine, 1987
9
Scientific Illiteracy
  • Overall scientific illiteracy rate is estimated
    at 95 (Sagan, 1996)
  • 91 do not know what a molecule is
  • 60 believe UFOs have visited earth 49 that
    the government conceals visitors
  • 50 believe in ESP, telepathy, precognition
  • 50 of Americans do not know the earth orbits the
    sun annually
  • 48 believe that humans and dinosaurs coexisted
  • 45 believe in faith healing
  • 33 believe in astrology it is scientific
  • 20-50 believe in ghosts and haunted houses
  • 25 believe in reincarnation
  • 14 (est. 25 million people) could not locate the
    United States on an unmarked global map
  • 14 believe in fortune telling
  • 12 of most popular school science texts have 500
    pages of errors

National Science Board National Science
Foundation, 1996
10
Follow the money
  • The annual budget for the National Center for
    Complementary
    Alternative Medicine (NIH) was 40
    million in 1999, 113 in 2003
  • NCCAM granted 4.5 million in the study of

    St. Johns wort
  • The estimated annual market for integrated
    health centers in
    the US is 20 billion
  • The Maharishi International University received
    2.2 million for research of medication on
    hypertension from the Natl Heart, Lung, and Blood
    Institute
  • The White House Commission on Complementary
    Alternative Medicine Policy (WHCCAMP) recommends
    integration of CAM into health care agencies,
    medical education, research, and insurance
    systems
  • The Targ research group received 2 million for
    research on remote healing with HIV and
    glioblastoma patients

11
Cultural factors in CAM proliferation
  • Stress awareness Recognition of stress
    potentially
    lasting effects of trauma
  • Entitlement Belief that everyone deserves
    the good life
  • Immediacy Belief in and need for quick
    fixes, everything has
    a solution
  • Crisis orientation Preoccupation with trauma,
    crises, emergency,
    violence, excitement
  • Postmodernism Widespread uncritical acceptance
    of Magical thinking, paranormal, personal
    realities
  • Globalization diversity curiosity and
    unquestioning acceptance of cross-cultural
    practices
  • Scientific illiteracy ignorance or
    misinformation about scientific inquiry,
    reasoning, evidence
  • McDonaldization faster, better, cheaper!

12
Managed Care factors in the proliferation of CAM
  • Competition Extremely competitive service
    environment
  • Financing Generate revenues with high client
    loads and rapid turnover
  • Cost containment Cost-effective treatment,
    efficiency
  • Public demand Reimbursement for some
    non-traditional methods
  • Prevention Early treatment may cut costs
  • Control unconventional treatments need to be
    under conventional control

13
Client factors in proliferation of CAM
  • Desperation Pain, despair, suffering, need to
    find solution when traditional methods dont work
  • Dissatisfaction with limits of traditional care,
    less invasive, misperception CAM is safer less
    expensive
  • Media promotion web testimonials, infomercials,
    news, requests for advertised/popular
    approaches
  • Cost Limited financial resources for traditional
    services, do not see long term hidden costs and
    risk in CAM
  • Uncritical thinking many people are not willing
    or able to think through complex information
    peripheral processing
  • Superstition is alive well

I dont want reality, I want magic.
--Blanche DuBois A Streetcar Named Desire
14
Therapist/Provider factors in proliferation of
CAM
  • Good intentions to be effective practitioner,
    desire to help
  • Anyone can be a Founder or Discoverer
  • Frustration discouragement with treatment
    resistance and unresponsive conditions
  • Power control need for influence
  • Reputation need for status, recognition
    as a specialist
    become the Ultimate
    Therapist
  • Faith in utility Belief that so long as it
    works so what?
  • Extreme belief in constructed reality If you
    can think of it, its real, its our personal
    realities that are real
  • Snake oil create dependency, scams, take
    advantage of vulnerable people

15
Conditions Treated by Energy Therapies-- One size
fits all?
  • Abuse trauma
  • Addictions (food, cigarettes,
  • alcohol, drugs)
  • Allergies
  • Anxiety and Panic Attacks
  • Anger
  • Attraction to the wrong people
  • Cancer
  • Compulsions obsessions
  • Depression and sadness
  • Dyslexia
  • Eating disorders
  • Fears and phobias
  • Fibromyalgia
  • Frustration
  • Gambling
  • Grief and loss
  • Guilt
  • Immune deficiency problems
  • Learning blocks dyslexia
  • Low self esteem
  • Migraine headache
  • Negative memories
  • Nightmares
  • Obsessive-compulsive disorders
  • Pain management
  • Peak performance
  • Phobias
  • PTSD
  • Procrastination
  • Rejection
  • Self image
  • Sexual abuse issues
  • Sexual problems

16
Magical Thinking Assumptions of Energy
Therapies
  • all living things have an energy field
  • this field reflects life energy and health
  • energy flows through channels and is
  • expressed through aura
  • energy can be blocked by physical, emotional,
  • psychological, or toxic causes
  • blocked energy produces symptoms of illness
  • energy treatments seek to unblock energy and
    reestablish balance

17
Qigong Tai Chi
  • Chinese movement discipline for relaxation,
    meditation, low impact exercise, self defense
  • Claims to circulate and balance chi (vital
    energy)
  • Claims to cure an immense variety of acute and
    chronic disorders
  • Chinese research is terribly flawed for claims
  • Current research shows improvement of balance,
    blood pressure, bone density, relaxation,
    cardio-vascular exercise

18
McTherapy Claims
  • Works rapidly, often within minutes,
    instant relief
  • Money back guarantees
  • Non-invasive, painless process with little
    or no
    discussion of painful memories
  • Long lasting or permanent results
  • Results where others fail 85 - 99 success rate
  • Eliminates problems even when you dont know what
    the problems are
  • Dramatic testimonials
  • Based on centuries old traditional techniques of
    healing, new discoveries in neurology or physics
  • One size fits all regardless of type of disorder
  • Simple, easy, painless, anyone can do it
  • Training available to anyone who wants to be a
    healer certification available

19
(No Transcript)
20
Then theres the QUANTUM connection
  • quantum are packets of subatomic particles that
    show
  • unusual properties, such as being in two
    places at once
  • events are reducible to both matter and wave form
  • energy and matter are interchangeable
  • SO
  • thinking is energy
  • thinking makes it so creates reality
  • thinking can block and unblock energy
  • since thoughts can be in two places at once, one
    can
  • heal from a distance (also ESP, remote reading,
    etc.)
  • Except
  • even physicists cant agree on how quantum
    physics works
  • there is no evidence whatsoever that quantum
    events influence macro events
  • the idea that the observer makes the difference
    is a misinterpretation
  • experimental results in CAM dont even come close
    to the rigor of physics
  • it is not appropriate to transfer concepts from
    one discipline into another
  • nice metaphor but no cigar!

21
The problem with energy therapies
  • energy is poorly defined (magnetic,
    electro-chemical, heat)
  • scientific instruments measure physiological
    processes not energy per se
  • pseudo scientific instruments misrepresent
    measurements
  • Chinese journals have notoriously poor designs
    statistics (78-53 flawed)
  • American CAM journals presume

    energy test differences
  • very low inter-rater reliability
  • conflicting opinions in diagnosis
  • inconsistent conceptualizations

Emily Rosa testing therapist sensitivity to
energy
22
Eye Movement Desensitization Reprogramming
(EMDR) (more recently Reprocessing Therapy)
  • 1987 wandering eyes walk Shapiro received PhD
    from unaccredited now defunct school original
    study 22 Ss
  • 30,000 professionals trained over 1m patients
    90 cure within 3 sessions
  • Alleges to unblock the information processing
    systems between brain hemispheres that somehow
    restructures memory or balances energy
  • Visual movements unnecessary got similar results
    with blind patients
  • No neurophysiological mechanism to explain theory
  • Often combined (contaminated) with other methods
    such as relaxation
  • Most evidence anecdotal or poorly designed
    well-designed
    studies show effects similar to other
    exposure methods
  • Promoted as widely validated treatment for PTSD

    including rape, highway carnage, industrial
    accidents,
    war, crime, terrorism, sexual
    abuse, domestic violence,
    natural disaster

23
Left brain, right brain no brain?
24
Brain-Based Education Therapy
  • The brain is a completely integrated and
    complementary system, not isolated, exclusive
    units
  • Using only 10 of our brain is a myth
  • Sperrys split-brain research in the 1960s gave
    rise to the topic there is no separation unless
    by surgery or injury
  • Most neurologists and neuropsychologists view the
    brain as a whole, not left-right
  • Brain-based instruction is too simplistic and
    goes way beyond the evidence
  • Many studies referred to by BBE involve rats and
    monkeys, not humans extending to humans is
    unwarranted
  • brain-based references are not necessary to
    applying established learning theories and
    techniques
  • Developmental windows are not critical people
    can learn throughout life
  • The Mozart Effect has not been replicated for
    claims on IQ, physical or mental illness

25
Popular Treatments for Autism that have not been
proven
  • Auditory integration training
  • Facilitated communication
  • Hyperbaric oxygen
  • Secretin
  • Vitamin B6 and magnesium
  • Dimethylglycine (DMG)
  • Intravenous immunoglobulin (IVIG)
  • AZT (zidovudine, Retrovir)
  • Steroids
  • Antifungal medications
  • Detoxication chelation
  • Dietary manipulations (elimination of gluten,
    casein, etc.)
  • Hippotherapy dolphin therapy
  • Sensory integration therapy
  • Craniosacral therapy
  • Behavioral optometry

26
Problems with CAM Approaches
  • Demand characteristics of stage performance
  • Few or no articles in peer reviewed, refereed,
    conventional,
    professional journals
  • Insufficient design controls
  • Unclear and insufficiently established diagnoses
  • Faulty logic pseudoscientific comparisons
  • Reliance on self report rather than more
    objective measures
  • Unfounded transfer of concepts from physics to
    psychological physical processes
  • Sale and use of quasi-scientific instruments at
    high prices
  • Diagnosis through unestablished procedures
  • Poorly defined and untestable concepts
  • Denial and rejection of established explanations
  • Nonfalsifiability of approach
  • Defiance and claimed irrelevance of established
    science

27
Proliferation of McTherapies
  • Therapeutic Touch (TT) Delores Kriegers nursing
    technique for healing by brushing balancing
    your bodys energy fields (no touch)
  • Brief Strobic phototherapy (BSP) use of colored
    light on subtle energies of emotion
  • Thought Field Therapy (TFT) Roger Callahans
    algorithmic tapping to balance body energies
  • Emotional Freedom Techniques (EFT) Gary Craigs
    modification of TFT
  • Tapas Acupressure Technique (TAT) modification
    of TFT by Tapas Fleming
  • Miracle Acupressure Tapping Technique (MATT)
    more of the same
  • Energy Psychology (EP) still more by Fred Gallo
  • Touch and Breathe (TAB). Diepolds combination of
    tapping and breathing
  • Attractor Field Therapy (AFT) Acupressure for
    universal energy fields
  • Acupressure Chakra Technique (ACT) acupressure
    yogic energy centers
  • Creating, Allowing, Receiving Technique (CART)
    Tapping 1-2 meridians for the future
  • Be-Set-Free Fast (BSFF) Nims four-step tapping
    to resolve unconscious energies

28
So long as it works, I dont care except
that
  • it may delay effective treatment,
    cause
    injury, or complicate
    further
    treatment
  • it is misleading (false hope)
  • it defies informed consent
  • some assumptions imply external locus of control
    or self blame
  • it neglects what we know about placebo effect
  • professionals are obligated to identify what
    works and how
  • it contributes to the popular belief that such
    treatment has been validated
  • it predisposes some people to more vulnerability
    to exceptional beliefs and claims

29
The Growing Herbal Trend
  • 1994 FDA relaxed guidelines
  • 33 of US adults use herbals at a cost of over
    3 billion
  • From 1982-95 physician use of herbals was 16,
    referrals 9, and interest 23
  • 38 million Americans use fraudulent health
    products annually
  • 49 use herbal remedies, 24 regularly (44.6
    million people)
  • 31 use herbs with Rx meds 48 with OTC meds
  • 70 do not tell their physicians or pharmacists
    they are using herbal remedies
  • Media effects 2800 St. Johns Wort, 1007 Green
    Tea, 500 Kava after news reports

30
"Poisons and medicines are oftentimes the same
substances given with different intents."

-- Peter Mere Latham (1789-1875)
  • Wormwood potentiates phenobarbitol (seizures)
  • Evening primrose lowers seizure threshold
  • Yohimbe tricyclic antidepressants increase
    hypertension risk
  • Fiber products reduce lithium absorption
  • St. Johns Wort Kava have MAO inhibitory effect
  • St. Johns Wort SSRIs produces serotonin
    syndrome
  • Ephedra interacts with MAO produce hypertension
  • Gensing exacerbates extrapyramidal effects of
    neuroleptics and produces mania with
    antidepressants
  • Ayurvedic Shankapulshpi diminishes anti-seizure
    effect of dilantin
  • Ginkgo for mental alertness Feverfew for
    migraines potentiates other blood thinners
  • Kava benzodiazepines can produce lethargy
    disorientation

31
Herbal Treatments If its natural, its got to
be good!
  • Lack of standardization
  • Variable dosage
  • Variable potency (can vary 10,000 fold)
  • Fungal, pesticide, heavy metal contamination
  • Mistaken harvesting
  • Marketing under common rather than botanical
    names
  • Allergic reactions
  • Interactions with medications
  • Side effects with large dosages
  • Pregnancy/nursing risk

32
New! Improved! Placebo Plus! 50 more Inert
ingredients Than regular Placebo
Absolutely no chemicals. Some placebos are 30-70
more effective than regular medication or even
surgery. Nothing is more effective. Get
Placebo Plus Today! Money back guarantee if you
are not satisfied no questions asked 9.95 SH
33
Intercessory Prayer
  • 82 of Americans believe in the
  • power of prayer
  • Faith/support yields 12x higher
  • open-heart surgery survival
  • Mortality was 25 lower for church
  • attendees than non-attendees
  • Lower incidence of blood pressure for
  • churchgoers
  • Positive and negative prayer affects
  • seed germination, bacteria, and fungi

James 514 Is any among you sick? Let him call
for the elders of the church, and let them pray
over him
  • 64 want providers to pray with them
  • NIH funds 5-year study to determine effect of
    prayer
  • on cancer
  • Intercessory prayer in the workplace to improve
    task
  • performance
  • Federal funding for prayer in prisons as
    treatment

34
Research on Intercessory Prayer Possible
conclusions
  • Omniscient god operates according to human
  • experimental design (does not heal those not
    prayed for)
  • Some omniscient force knows how to match prayer
    with
  • unnamed patients thoughts affect the material
    world
  • We are subject to a veritable ocean of
    subliminal,
  • unconscious, ever-present, intentions,
    thoughts, emotions,
  • and environmental toxins that influence our
    behavior
  • Flawed design, bias, or chance

35
Alternate explanations of McTherapy cures
Likely but not fancy
  • Natural history and cyclicity of disease
  • Condition runs it course
  • Regression to the mean
  • Suggestion
  • Counter-irritation
  • Distraction
  • Hawthorne Effect
  • Audience demand characteristics
  • Confirmation bias
  • Stockholm Effect (please powerful figure)
  • Fatigue
  • Avoidance of painful memories
  • Misattribution to CAM when combined with
    conventional methods
  • Cognitive dissonance
  • Temporary mood improvement confused with cure
  • Habituation
  • Reinforcement
  • Desensitization
  • Lake Wobegon Effect

These are the alternate explanations that must be
controlled for with research design in order to
establish what is treatment effect and what is
not.
36
The Placebo Effect what you see is what you
think you get
  • Became prominent with Beecher using normal saline
    when
    morphine ran out during WWII (33 effectiveness)
  • Krebiozen case (Klopfer, 1950)
  • A study of antidepressants showed that 75 of
    effect was
    due to expectation (Kirsch Sapirstein, 1998)
  • Nocebo effect with 57 Japanese students allergic
    to lacquer tree real touch did not react, fake
    touch reacted (Ikemi Nakagawa, 1962)
  • Sham orthoscopic knee surgery showed 60 Ss with
    improved gait pain (Moseley, et al., 2002)
  • Placebo effect has been documented in cases
    involving pain conditions, headaches, cough,
    senile dementia, common cold, arthritis,
    seasickness, ulcer, hypertension, anxiety,
    depression, and schizophrenia
  • Placebo effect ranges from an average of 33 to
    as high as 75
  • Level of effect depends on clients beliefs,
    practitioner
    beliefs, beliefs resulting from interaction
    (Benson, 2000)

37
(No Transcript)
38
How Placebo Possibly Works
39
Are you ready to ruuumble?
  • Sound research (randomized, double-blind,
  • controlled, large sample, representative,
    reputable
  • measurements, etc.)
  • Peer reviewed publications Scientific Review of
  • Alternative Medicine
  • Committee for Scientific Investigations of
    Claims of
  • the Paranormal (CSICOP)
  • National Council Against Health Fraud
  • American Council on Science Health
  • Quackwatch
  • Evidence-based health care

VS.
  • WHCCAMP (White House Commission on CAM Policy
    (Final
  • Report March 2002)
  • Weakening of regulatory agencies
  • Alternative Health News Online
  • Center for the Study of Complementary
    Alternative
  • Therapies (U. of Vir.)
  • Rosenthal Center for Complementary Alternative
    Medicine
  • (Columbia U.)
  • Certification programs
  • Association for Comprehensive Energy Psychology

40
The C.R.A.P. Detector (Crackpot, Ripoff and
Pretension Detector)
You should be cautious questioning when
  • it cant hurt to try
  • testimonials and anecdotes
  • unclear why or how it works
  • uses pseudo-scientific jargon
  • makes extraordinary assumptions
  • diagnoses or cures at a distance
  • secret cures proprietary knowledge
  • appeals to your vanity (you know best)
  • treats an variety of unrelated disorders
  • its too good to be true (miracle cure)
  • reliance on famous authority or founder
  • claims it cant be tested by conventional means
  • its touted as a revolutionary new breakthrough
  • uses energies or other vaguely defined
    mechanisms
  • unusually high effectiveness rate with difficult
    to treat conditions
  • paranoid accusations against the AMA,
    pharmaceuticals, government

41
Would you be willing to
  • Buy land in Florida sight unseen?
  • Purchase a hot stock with no performance
    information?
  • Buy a jar of food with a broken seal?
  • Take medicine out of an unmarked bottle?
  • Undergo a highly unconventional medical
    procedure?
  • Receive surgery from someone who had a weekend
    workshop on it?

so, where is critical thinking when it comes to
asking for evidence about sound
psychological treatment?
42
Characteristics of good science
Randomization all participants are assigned by
chance to experimental and control groups
controls for selection bias
Double-Blinding neither the participants nor
researchers know which participants receive the
treatment or placebo controls for confirmation
bias
Placebo control the group who receive an
inactive or sham treatment in contrast to the
real treatment controls for the effects of
expectation
Falsifiability an hypothesis must be testable in
a way that can show it is false and can be
rejected
Representativeness the participants in the study
match the key characteristics of the larger
population to which the results will be
generalized
Standardization the procedures used (tests,
steps, instructions, etc.) are all presented in
the same way to participants
Peer Review expert peers, wide dissemination,
and feedback
Independent replication multiple reproductions
of the study by others who have no personal stake
in it
43
Evidence- based Treatment
Levels of Credibility in Research
Peer Reviewed Randomized Double-blinded Placebo-co
ntrolled Multiple replications
Efficacy Whether controlled studies show
treatment effects
What is the specific mechanism that makes it
appear to work in practice?
This is the mechanism, will it hold up in applied
context?
Case series studies/ Meta-analyses
Effectiveness Whether treatment effect occurs in
clinical work
Naturalistic Controlled studies (not randomized0
Observational studies
Expert opinion
Testimonials anecdotes
44
Recommendations
  • Keep looking for innovations--better ways to
    serve clients
  • When a novel approach is presented, ask
  • How do you know it works?
  • What are the assumptions that underlie the
  • technique and how do you know they are
  • sound?
  • How do you know that some other
  • mechanism isnt operating?
  • If you use these methods
  • make sure the client knows they are
  • experimental
  • keep good records
  • keep partialing out what the mechanism is
  • (use good science)
  • publish/share your results seek criticism
  • Challenge proliferation of unconventional

Science is what we have learned about how to keep
from fooling ourselves --Richard
Feynman
45
The ideas of great minds ahead of their time are
often not accepted--Galileo, Copernicus, Harvey
Pasteur were all ridiculed for example However
they persisted in using the scientific method and
through evidence established their claims
If it was so, it might be and if it were so, it
would be but as it isnt, it aint. --
Tweedledee in Through the Looking Glass
46
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