EDITORIAL: An Antidote to Anecdote

Any discussion of alternative medicine requires an understanding of the difference between an anecdote and a scientifically proven fact.

But to begin, we need a definition of alternative medicine. Loosely, the term refers to any alternative to accepted medical treatments or methods. Labeling treatments as “alternative” is tough, however, because modern medicine is always moving, and accepted treatments are always changing as new discoveries are made and tested. Was hand-washing an “alternative medicine” prior to acceptance of germ theory? Plenty of surgeons thought Dr. Semmelweis was crazy when he first put forth the idea that hospital staff were transmitting the microbes responsible for puerperal fever between patients.

It’s important to understand that treatments considered “alternative” might not be wrong--they just might be poorly studied. That’s how treatments cross from alternative medicine to evidence-based medicine: by rigorous studies involving large numbers of people, with minimal variables between the study group and the control group.

Alternative medicine often includes treatments supported solely by anecdotal evidence, which means evidence based on stories, observations or word-of-mouth. The patient who told me that she “read a blog about a woman with melanoma and after her surgery she started using an herbal supplement from South America and she is still alive five years later” was telling me an anecdote. For a thousand dollars a month, she could get the same herbal concoction shipped to her.

Likewise, the patient who told me that he didn’t want to quit smoking because “My dad smoked two packs a day his entire life, and he lived to 86 and never got cancer” was also telling me an anecdote.

Distinguishing between an anecdote and scientific proof comes down to elucidating causality. Simply, if A then B. You check into a hotel room and see a row of light switches. In a few seconds, you understand that the first switch turns on the light near the door, the second switch turns on a light near the bed, and the third turns on the ceiling fan. Easy, right?

But sometimes it’s “if A + B, then C.” Or it’s “if no A and no B, then 10% chance of C; but if A + B, then 85% chance of C.” The more complex the relationship, the lousier we are at understanding and determining causality. Scientists determine causality by studying the same event in large numbers and looking at the outcomes. Studying one smoker does nothing to say how bad smoking is because lung cancer is not simply “if A, then B.” But by studying hundreds of thousands of people, we know that my patient’s anecdote is not a reliable prediction of how everyone who smokes will fare.

No current health issue better highlights the difficulty of determining causality than autism. Ever since the former surgeon Andrew Wakefield (he has since lost his license) published findings in 1998 of 12 children with intestinal inflammation and “behavioral symptoms,” scientists have been trying to set the record straight. Wakefield claimed that the onset of autism occurred shortly after MMR vaccination in 8 of the 12 children. His study in no way determined causality, nor was it large enough to determine a relationship between MMR and autism. Even Wakefield wrote, “We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described.” Too bad the media jumped on the suggestions he put forth.

Anecdotes are highly susceptible to false association, also known as “true, true and unrelated.” In a false association, two events might happen simultaneously, but that doesn’t mean they are related. The talk-show host Jenny McCarthy attempted to relate vaccines with autism when she said, “In 1983 the shot schedule was 10. That’s when autism was one in 10,000. Now there’s 36 [shots], and autism is one in 150.” But she could have said, “In 1980, there were 6,000 McDonald’s restaurants, but now there are over 34,000 … ” Yes, many health-related factors have increased in the past 30 years, but it takes research on tens of thousands of patients to figure out what is really related.

Autism is not “if A, then B.” A Danish study of 537,300 children, for example, found no difference in autism rates between MMR vaccinated and unvaccinated children.[1] Instead, autism is likely “A + B + C + D = increased chance of autism,” with none of the variables being immunization.

Anecdotes are seductively simple; medical science rarely is. A recent study of 625,000 children found that boys born to mothers who had induced labor had a 35% increased chance of developing autism.[2] But even this finding is complex and incomplete. Does the increased chance of autism come from the labor itself, from the drugs given, or from something related to autism? Although the researchers found a relationship, they have yet to determine a specific cause.

These studies are all very complex, and they’re written in language that is neither exciting nor easily decipherable. Humanity has always tried to find the simplest explanation for any event. Having the Earth be the center of the solar system was very easy: you can see the sun arc across the sky every day. Copernicus needed a lot of observation and math to determine otherwise. And once he proved that the Earth wasn’t the center of the solar system, plenty of people argued his findings.

All of which leads us to why people support anecdotal medicine. Their reasons aren’t solely because they don’t understand causality, or aren’t good at math, or didn’t do a study using a half-million patients. It is more about what they want to buy.

Everyone who offers treatment for any disease is actually selling you healthcare, whether you are paying for it or not. They are selling you an idea, an exercise, an herb, a carefully inserted needle, a quiet place, a vitamin, a surgery, a prescription drug, an injection, or even radiation therapy. If you can’t distinguish the difference between treatments based on scientific merit, you just might go with the nicest salesman. I am sad to admit that there are studies suggesting one reason people seek alternative treatments is not because they don’t believe in evidence-based medicine, but because they have had a bad experience with their doctor.

Doctor-haters aside, the reasons for pursuing alternative medicine boil down to Obama’s first campaign: Hope and Change. We are willing to spend big money on Hope and Change.

We all want Hope. But when the doctor says there is nothing more that can be done for your cancer, recurring sinus congestion, backaches, migraines or stress, you still hope for a treatment. After all, you are still suffering. So you look online, and the search engine pulls up scientific studies right next to alternative options, in no particular order and often indistinguishable by look. For $29.95, you can order your bottle of hope. For the most part, it’s safe or else they wouldn’t be selling it, right? Wrong. Recent studies of Vitamin E supplementation, for example, showed that supplementation was associated with a higher incidence of prostate cancer. Likewise, some herbal combinations contain heavy metals that decrease the efficacy of blood pressure medicines.

Nonetheless, we hope something “natural” works without the side effects of the doctor’s medicines. We desire something less expensive than a prescription drug. We seek out something simpler than the plan outlined by our physician. It’s easier to eat more berries to theoretically prevent cancer than it is to lose weight, eat more veggies, avoid sugary drinks and exercise regularly (and yes, a healthy lifestyle has been proven to decrease cancer risk).

We also want to Change our situation, and we want to be an active part of the change. People want control of their lives and their future. Ailments take away control: your body is doing something you didn’t plan. By taking alternative meds or going to alternative healers, you are taking an active part in getting better.

Modern medicine tends to be prescriptive. The patient doesn’t get much choice, particularly in well-studied diseases with defined treatment algorithms. In contrast, alternative medicine offers meditation, tai chi, yoga and guided imagery--which are all about taking control of your mind and body. Alone, these techniques may not cure many problems, but they are part of the treatment, and they feel a lot better than chemotherapy.

So where does that leave us? On the one hand, anything that provides false hope while wasting time and money is a sin. On the other hand, any non-pharmaceutical treatment that can reduce stress and pain while potentially increasing strength and coordination is an integral part of not only recovery, but healthy living. Let’s continue to separate the facts from fiction.

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Dr. Iaquinta, an otolaryngologist at Kaiser Permanente San Rafael, is the author of The Year THEY Tried To Kill Me and serves on the MMS Editorial Board.

Email: salvatore.iaquinta@kp.org

References

1. Madsen KM, et al, “Population-based study of measles, mumps, and rubella vaccination and autism,” NEJM, 347:1477-82 (2002).
2. Gregory SG, et al, “Association of autism with induced or augmented childbirth in North Carolina birth record and education research databases,” JAMA Pediatrics, 167:959-966 (2013).