Alternative Medicine – Testimonials, Natural History and Secondary Gain

In my blog posting, entitled, Alternative Medicine – Important Questions,  I commented on the fact that many therapies, alternative to those of traditional Western medicine, are becoming common place and that many of these therapies are based on belief systems quite different from that of Christianity. I raised the question, when seeking out advice about these therapies, “Is the advice good?” and “How do we decide?”

One way to consider various alternative therapies is to consider whether the therapy really does what it claims to do. Many, appropriately, want some evidence that a therapy may help before embracing it.

Often the first exposure to the possible usefulness of alternative therapies comes from families and friends, who have had experiences leading them to believe these therapies really work. When medical problems and illness arise and we are in need of help, it is natural and even right to seek out counsel from trusted family and friends. If these friends share your biblical Christian values, it is reasonable to give serious consideration to the advice that they give. But how do we know that their advice is good? Does it matter how they go about evaluating these therapies? How strong is their evidence if it is limited to that fact that they or a loved one improved while using a therapy? Although the topic is different, consider the people of Berea in Acts 17. They are said to be of more noble character because they examined the Scriptures daily to see if what the apostle Paul said was true. What?! Check up on the apostle Paul? Is he not the apostle of apostles? Yes, but he is human and fallible, just as each of us are. We do need to check out even what trusted friends say. What tools do we have to test out the truth of the claims people make, even about alternative therapies?

An internet search of most alternative therapies will come up with many sites that appear to have evidence of the effectiveness of the therapy in question.  A careful review of the evidence often shows only testimonials of individuals who have used the therapy and who claim it helped them.  Does evidence like this prove a therapy works?

Testimonials alone do not provide proof.  Consider a therapy given to 500 people where only 10 improved 490 did not .  If all 10 who improved while using the therapy are included in the testimonials, while the 490 are not reported, then it will appear as though the therapy was responsible for improvement when, in truth, it is not.  Although a therapy with testimonial evidence of success may be beneficial, the use of testimonial evidence alone can be a deception rather than show the truth.  In the proposed case the testimonials suggest success while, the truth is that most who used the therapy do not improve. Also, this does not consider those who, while using the therapy, got worse.

Another important consideration when looking at whether an alternative therapy really does anything good, is the natural history of the problem one is trying to treat. It is possible for most who use a therapy to improve and for it still to be false to say that the therapy is responsible for the improvement.  The natural history of many illnesses and injuries, in healthy adults, is to improve over time.  Natural history refers to what happens with a problem if no therapy is applied.  For example, most people who get pharyngitis, (an inflamed, sore throat,) get better within a week to ten days, no matter what therapy is applied.  When I started working as a family physician, it was common for people to call in the middle of the night to get antibiotics for a sore throat.  For a number of years, many people had been given antibiotics in association with getting better, even though they would have improved anyway.  As a result, people in the community developed the belief that the antibiotics were responsible for making them better.  The natural history of the disease allows people to believe that the therapy worked when most would have improved even without the therapy.  Examples of problems where the naturally history for most people is to improve over time, include many sprains and strains, including those of the joints and muscles of the back and neck. Another example is infant colic, which generally improves over time. One study I recollect involves infants with colic having their formula changed to a different formula. It turned out that all improved and it did not depend on which the formula was switched to.

It is also important to consider the possibility of secondary gain. Even when, in truth, a therapy does not reliably lead to improvement, the use of positive testimonials, along with the advantage of a positive naturally history, may be innocently used by those promoting a therapy. Through these things some may be led to believe that a therapy is responsible for improvement, when it really is not. When someone has something to gain through the promotion of a therapy, they are more likely to get caught up in using testimonials and natural history. When there is something to gain, it can be hard to accept evidence that a therapy does not really help. The promoter of a therapy themselves may be deceived, but it is also possible that they are aware of evidence that questions the usefulness of a therapy, but do not share this because of what they hope to gain by selling it.  As I hope to show in future posts, if a therapy has a real likelihood of leading to improvement, over and above chance, it should be possible to present evidence that demonstrates the therapy’s effectiveness.

In future blog postings, I hope to help you to understand what kind of evidence is needed to prove that a  therapy actually helps..

-this blog posting is part of a series – the next in the series, Alternative Medicine – Placebo Effect

-the first posting in this series – Alternative Medicine – Important Questions

-For all postings on  Alternative Medicine – Alternative Medicine Postings Page



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