Scrutinizing the Quick Fix: A critical examination of Pop Therapies

1. Intercessory Prayer Scrutinizing the Quick Fix: A critical examination of Pop Therapies Herbs BSFF EMDR Energy TFT Therapeutic Touch Acupuncture Faith Healing David X. Swenson PhD LP 2004

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 David X. Swenson PhD LP 2004

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 David X. Swenson PhD LP 2004

4. What are CAM? (NIH categories) • Alternative medical systems– acupuncture, ch’I gong, t’ai chi, massage, indigenous systems, homeopathy, radionics, naturopathy • Bioelectromagnetics– use of magnets & electromagnetic fields • Biofield– use of subtle energy fields, Therapeutic Touch, Reiki, ch’i 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/ David X. Swenson PhD LP 2004

5. Holistic Alternative Complementary Pluralistic Integrative 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 David X. Swenson PhD LP 2004

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. David X. Swenson PhD LP 2004

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 David X. Swenson PhD LP 2004

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 David X. Swenson PhD LP 2004

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. John’s 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 David X. Swenson PhD LP 2004

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! David X. Swenson PhD LP 2004

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 David X. Swenson PhD LP 2004

13. Client factors in proliferation of CAM • Desperation: Pain, despair, suffering, need to find solution when traditional methods don’t 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 don’t want reality, I want magic.” --Blanche DuBois A Streetcar Named Desire David X. Swenson PhD LP 2004

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, it’s real,” it’s our personal realities that are real • Snake oil: create dependency, scams, take advantage of vulnerable people David X. Swenson PhD LP 2004

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 • Insomnia • 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 David X. Swenson PhD LP 2004

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 David X. Swenson PhD LP 2004

17. Qigong & T’ai Chi • Chinese movement discipline for relaxation, meditation, low impact exercise, & self defense • Claims to circulate and balance “ch’i” (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 David X. Swenson PhD LP 2004

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 don’t 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 David X. Swenson PhD LP 2004

19. David X. Swenson PhD LP 2004

20. Then there’s 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 can’t 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 don’t 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! David X. Swenson PhD LP 2004

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” David X. Swenson PhD LP 2004

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… David X. Swenson PhD LP 2004

23. Left brain, right brain– no brain? David X. Swenson PhD LP 2004

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 • Sperry’s 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 David X. Swenson PhD LP 2004

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 David X. Swenson PhD LP 2004

27. Proliferation of “McTherapies” • Therapeutic Touch (TT): Delores Krieger’s nursing technique for healing by brushing & balancing your body’s energy fields (no touch) • Brief Strobic phototherapy (BSP): use of colored light on subtle energies of emotion • Thought Field Therapy (TFT): Roger Callahan’s algorithmic tapping to balance body energies • Emotional Freedom Techniques (EFT): Gary Craig’s 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). Diepold’s 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 David X. Swenson PhD LP 2004

28. “So long as it works, I don’t 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 David X. Swenson PhD LP 2004

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. John’s 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. John’s Wort & Kava have MAO inhibitory effect • St. John’s 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 David X. Swenson PhD LP 2004

31. Herbal Treatments: If it’s natural, it’s 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 David X. Swenson PhD LP 2004

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 S&H David X. Swenson PhD LP 2004

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 5:14 “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 David X. Swenson PhD LP 2004

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 David X. Swenson PhD LP 2004

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 • Placebo 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. David X. Swenson PhD LP 2004

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 client’s beliefs, practitioner beliefs, beliefs resulting from interaction (Benson, 2000) David X. Swenson PhD LP 2004

37. The Conditioned Placebo Response Unconditioned Response Conditioned Response Conditioning Adrenalin Acetylcholine Adrenalin High Low Blood Pressure David X. Swenson PhD LP 2004

38. Social care & support Reduction of anxiety & tension Expectation of improvement Decreased pain perception; higher pain tolerance Distraction & redirection of attention Production of brain opiates Improvement in Subjective well-being, optimism & hope, symptom decrease, resolution of disease Conditioned response to treatment Rebound or enhancement of immune response Treatment Component Possible Mechanism Response How Placebo Possibly Works David X. Swenson PhD LP 2004

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 David X. Swenson PhD LP 2004

40. The C.R.A.P. Detector (Crackpot, Ripoff and Pretension Detector) You should be cautious & questioning when: • it can’t 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 • it’s too good to be true (“miracle cure”) • reliance on “famous” authority or “founder” • claims it can’t be tested by conventional means • it’s 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 David X. Swenson PhD LP 2004

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? David X. Swenson PhD LP 2004

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 David X. Swenson PhD LP 2004

43. Evidence- based Treatment Levels of Credibility in Research Peer Reviewed Randomized Double-blinded Placebo-controlled 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 David X. Swenson PhD LP 2004

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 isn’t 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 • approaches without sound evidence Science is what we have learned about how to keep from fooling ourselves --Richard Feynman David X. Swenson PhD LP 2004

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 isn’t, it ain’t. -- Tweedledee in Through the Looking Glass David X. Swenson PhD LP 2004

46. http://www.css.edu/users/dswenson/web/sitemap.html David X. Swenson PhD LP 2004