How We Know What Isn't So (22 page)

This tendency to blame the patient for a treatment’s deficiencies is often adopted, not only by practitioners, but, sadly, by the patients themselves. Most individuals who seek out Kathryn Kuhlman for a miraculous cure for their afflictions do not blame her when improvement is not forthcoming. Many conclude that it was their own fault—they had not lived a sufficiently holy life. Others assume that their getting well was just not a part of God’s plan.
¹²
Likewise, many of those who do not benefit from various holistic health regimens engage in similar self-blame to protect their belief in the treatment’s general effectiveness. Carl and Stephanie Simonton, pioneering advocates of the use of mental imagery as a tool for treating cancer, provide a telling example of how far this can go:

Explaining away obvious failures is really just part of a broader tendency to evaluate treatment outcomes in a biased manner. Evidence indicating that a favored practice might be effective is considered decisive; information to the contrary is critically scrutinized and explained away. While even unambiguous failures can sometimes be discounted (as in the examples above), it is obviously easier to maintain belief in an ineffective intervention when the outcomes are less clear-cut. Thus it is easier to believe that a treatment is effective in bringing about vague improvements in symptomatology than in effecting a genuine cure. Consider the results of a recent survey of cancer patients receiving unorthodox treatment for their illness (e.g., metabolic therapy, diet therapy, faith healing, etc.) either in concert with or instead of more conventional treatments like chemotherapy, radiation, or surgery. In line with the results presented thus far in this chapter, the patients were generally pleased with their decision to undergo an unconventional treatment However, they were more likely to believe that the treatment had some vague positive effect on their general health than to believe that it had an actual impact on their cancer. Less than half of the respondents felt that the treatment had affected their cancer, whereas two-thirds thought that it had brought about an improvement in their general health.
¹⁴
The more ambiguous the criterion, the easier it is to detect evidence of success.

It is for precisely this reason that many alternative health practices do not offer precise remedies for specific disabilities. They promise instead to bring about “wellness,” “higher functioning,” or “better integration”—ambiguous benefits that may be hard to refute. Faith healers take full advantage of ambiguous criteria and studiously avoid pinning themselves down to verifiable predictions. When Kathryn Kuhlman announces that “I see someone up there [in the audience] being cured of their arthritis; I rebuke that disease,” the risk of being disproven is slight indeed. In the enthusiasm of the moment it is almost certain that at least one person will experience some alleviation of symptoms and will stand up to “claim a cure.” Who can tell whether the cure is genuine? Note that Ms. Kuhlman does not proclaim that “someone with skin disease has just been cured; I rebuke that disease.” Such a claim would be manifestly false to those assembled. Instead, she sticks mainly to cures for relatively invisible or ambiguous maladies like bursitis, migraines, cancer, or hearing loss.
¹⁵
In a similar vein, an insightful Frenchman once remarked after visiting Lourdes, where there is an abundant supply of discarded eyeglasses, hearing aids, canes, etc., “What? No artificial limbs?”

I do not mean to imply that Kathryn Kuhlman deliberately hides behind ambiguous criteria to dupe individuals with terrible illnesses. Although some faith healers cynically play upon the public’s hopes in search of profit, others sincerely and fervently believe in what they offer. I do not wish to speculate as to which camp any particular healer belongs. The important point is that although ambiguous criteria can be deliberately exploited by someone wishing to pass off a bogus therapy as effective, they can also impede our genuine efforts to understand whether or not a given treatment works. Without a precise specification of what constitutes success and failure, our hopes and expectations can lead us to detect more support for a given treatment than is actually warranted. A brief anecdote illustrates, perhaps, that even two-time Nobel Prize winners can be misled by the juggling of ambiguous criteria. Linus Pauling, a long-time proponent of vitamin C as an antidote to the common cold and other physical ailments, was once asked whether it was true that he and his wife (who, of course, make sure they consume the requisite amount of the vitamin) no longer suffer from colds. “It is true,” he said, “We don’t get colds at all.” Then he added, “Just sniffles.”
¹⁶

We believe certain things because they ought to be true. We believe that handwriting analysis or various projective tests yield deep insights into a person’s personality because the underlying logic seems plausible. People
ought
to leave traces of themselves in their overt responses, especially their responses to ambiguous stimuli (such as an inkblot or a blank sheet of paper). Similarly, most people are convinced that eating beef contributes to heart disease, in part because the fat on the side of a steak or on the bottom of a skillet looks ideally (and diabolically) suited to clog coronary arteries. What is gummy and coagulated outside the body, the thinking goes, ought to be gummy and coagulated on the inside as well. Of course, things that ought to be true often are. But many times our sense of what ought to be true obscures our vision of what is actually the case, particularly when the underlying theories that generate this sense of plausibility are rather superficial.

This tendency to rely heavily on what seems plausible has contributed to a number of questionable beliefs about health. Misguided general theories about nature or about the way the body works have made certain notions seem plausible, and this in turn has led to the adoption of various ill-advised practices. One such general theory (so general, in fact, it is perhaps best considered a metatheory) is the representativeness heuristic discussed in Chapter 2. According to this overarching belief, effects should resemble their causes, instances should resemble the categories of which they are members, and, more generally, like belongs with like. In the realm of health, this results in the belief that the symptoms of a disease ought to resemble or in some way suggest its cause. Similarly, the symptoms of a disease ought to resemble or in some way suggest its
cure.

These beliefs are revealed most clearly in certain primitive medical practices, according to which substances that cause or cure a particular condition tend to share various external features of the condition itself. In ancient Chinese medicine, for example, people with vision problems were fed ground bat in the mistaken belief that bats had particularly keen vision and that some of this ability would be transferred to the recipient. Similarly, primitive tribes have forcibly fed liver (thought to be the locus of mercy) to the mean-spirited, early Western physicians prescribed the meat of the fox (known for its endurance) for asthmatics, and even today a number of alternative medical practitioners recommend raw brain concentrate for people with psychological problems.
¹⁷

This belief that like goes with like finds one of its most interesting and consequential expressions in the field of homeopathic medicine developed by Samuel Hahneman in the late eighteenth century and still advocated today by many holistic health practitioners. Hahneman believed that every disease could be cured by administering to the sick individual whatever substance
produced
similar symptoms in a healthy person. Thus, the cure is suggested by the cause—like goes with like. He called this the “law of similia.” Hahneman carried out systematic “provings” in which he administered various herbs, minerals, and other substances to healthy individuals and noted any symptoms that developed. The results were compiled in reference books, his
materia medica,
that are still consulted by homeopaths today. Although this simple connection between cause and cure might give homeopathic medicine some intuitive appeal, research studies have shown it to be ineffective.

Perhaps the other founding principle of homeopathy will more clearly lay bare its lack of value. This is Hahneman’s “law of infinitesimals,” which also follows a crude sort of logic. Hahneman noticed that the less of a substance he administered to a healthy person, the less severe were the resulting symptoms. He then concluded that the less concentrated were the remedies administered to the sick, the
more
they would help alleviate the sick person’s symptomatology. As a consequence, books on homeopathic medicine describe in great length how to create extremely diluted concentrations of various medicines. In some cases, the recommended dilutions are as high as one part active ingredient per decillion parts water. At such concentrations, it is unlikely that what is given to the person actually contains any of the supposedly active ingredient. Nevertheless, homeopaths insist that their interventions are effective, and that they are more effective at lower concentrations. Once again, research shows otherwise.
¹⁸

The influence of representativeness is also present in people’s intuitive beliefs about nutrition, according to which whatever simple properties are present in certain foods will be directly transferred to the person who eats them. Like promotes like. Of course, this belief that “you are what you eat” is sometimes valid: We can gain weight by eating a lot of fat or develop an orange tint to our skin by ingesting a lot of carotene—a compound found in carrots and tomatoes. Many times, however, this belief is taken to almost magical extremes. Psychologist Paul Rozin asked groups of college students to speculate about the personalities and physical attributes of members of (hypothetical) primitive cultures. For example, one group was given a description of a tribe that ate wild boar and hunted sea turtles for their shells; another was told of a tribe that ate sea turtles and hunted boars for their tusks. The students’ responses indicated that the tribe members’ physical and personality traits were assumed to match the characteristics of the food they ate. Members of the turtle-eating tribe were considered to be better swimmers and more generous; the boar eaters were thought to be more aggressive and more likely to have beards. What we consume is believed to influence, in the most detailed ways, who we are.
¹⁹

Various dietary “remedies” for arthritis are similarly based on the assumption that the external properties of food will be maintained after digestion, and that these properties will have the same effect inside the body as they do outside. Dr. Dan Dale Alexander, author of
Arthritis and Common Sense,
argues that you can fight arthritis by essentially oiling your joints. He recommends that arthritis sufferers ingest liberal amounts of oil, and that they not drink water during meals that contain oil (they don’t mix, he argues, so water might destroy the lubricating properties of oil). Utilizing analogous logic, Dr. DeForest Jarvis, author of the phenomenally-popular
Folk Medicine: A Vermont Doctor’s Guide to Good Health,
states that in searching for an arthritis remedy he “… studied methods used by plumbers in freeing the inside of the furnace water compartment from deposited calcium.”
²⁰
Whatever breaks down calcium outside the body is supposed to do the same to recalcitrant compounds on the inside. Because plumbers use an acid compound to solve their problem, Dr. Jarvis recommends vinegar—a mild acid—to relieve the stiffness of arthritis.

These remedies ignore the fact that the body transforms most ingested substances, and therefore whatever properties they have outside the body can be radically altered or completely absent inside. Vinegar, for example, is transformed after metabolic breakdown from a mild acid to an alkaline residue. Without this understanding, unfortunately, people continue to try worthless treatments because they seem to make some intuitive sense. Many diet fads suffer from the same problem. Dr. Jarvis again: “Oil and vinegar don’t mix. Maybe vinegar and fat wouldn’t either, and vinegar might win out.”
²¹
His logic apparently has some surface appeal because his diet prescription was widely followed.

Simple theorizing has also contributed to the widespread belief that we should periodically “cleanse” the insides of our bodies. Just as we periodically clean our car engines or our videocassette recorders to make them function more effectively, so it is believed that our alimentary canals could benefit from an occasional housecleaning as well. Some people do so by fasting, others by administering enemas, drinking large quantities of water, or eating yogurt. Perhaps the most extreme manifestation of this belief was the surgical procedure known as “Lane’s kink.” The British physician Arbuthnot Lane was concerned, along with many of his colleagues, about the deleterious consequences of “auto-intoxication,” or the build-up of waste products in the body. Dr. Lane believed that he had spotted a location in the colon in which the flow of waste slowed down, and so he developed a surgical procedure to cut it out and speed up elimination, a procedure he performed on hundreds unfortunate enough to seek out his services.

Dr. Lane’s practice aside, many of these techniques seem to make some intuitive sense, but their appeal is more metaphoric than logical. People say that they “give the body a rest” by periodic fasting. They “wash away” toxins with an occasional enema. Although these metaphors of rest and rinse may seem compelling, our bodies do not necessarily work so simply. Although the buildup of toxins in the body is certainly something to be avoided, the body has evolved to handle this job extremely well. Our simplistic tinkerings can hinder this process as much as help it.