Posts Tagged Questionable Techniques

Facilitated Communication Case Fails to Deliver Darcy Cowan Feb 16

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The indefatigable Dr. Novella has been keeping track of the Facilitated Communication case of Rom Houben and via his blog I have learned that further investigation into the case has failed to deliver the goods.

As a refresher, late in November last year the news broke of a man who had been misdiagnosed as being in a Persistent Vegetative State (PVS, an essentially hopeless prognosis) being given a new lease on life thanks to modern diagnostic techniques and a practice known as Facilitated Communication (FC). While the mainstream media initially reported this news without a hint of scepticism (despite FC’s chequered past) it didn’t take long for doubts to be made known (for previous posts by myself and fellow Sciblogger Alison see here and here).

Dr. Steven Laureys, the neurologist whose work had thrust Rom into the limelight, only performed a few simple tests to convince himself of the communication method’s legitimacy. To his credit once the full force of the criticism was evident Dr. Laureys determined to return the question of FC’s validity with regard to Rom and conducted tests with the appropriate controls and protocols. These test subsequently showed that Rom was not the one communicating after all.

As detailed in an article by Spiegel Online:

Laureys has now carried out those tests, and his results hold that it wasn’t Houben doing the writing after all. The tests determined that he doesn’t have enough strength and muscle control in his right arm to operate the keyboard. In her effort to help the patient express himself, it would seem that the speech therapist had unwittingly assumed control. This kind of self-deception happens all the time when this method — known as “facilitated communication” — is used. (As a result, the things that Houben was attributed as saying to SPIEGEL for an article printed in November 2009 were also not authentic.)

In the more recent test, Houben was shown or told a series of 15 objects and words, without a speech therapist being present. Afterward, he was supposed to type the correct word — but he didn’t succeed a single time.

Those of us that were aware of FC’s history may not have been be surprised at this result but that does not mean we are not also saddened. I for one would have been happy to lose my cynical opinion of FC in order to keep the eloquent man who spoke movingly of having “Dreamed [him]self away” and his relief at being recognised as conscious; “I will never forget the day they discovered me, the day of my second birth.“. Speaking of which, what pray tell, has happened to the alleged speech therapist Linda Wouters who, it is now evident, was the true originator of the words gushingly attributed to Mr Houben by his family and the media? (And would have been behind the planned book ostensibly written by Rom.) Even if such deception was inadvertent (ie she truly believed that the words came from Rom) this surely casts deep doubt on her professional abilities, and possibly, integrity.

It must be a crushing blow to Mr Houben’s familiy to realise that they must start all over again in their attempts to communicate with Rom, remember that the speech therapist had been working with him for three years. Three years wasted. I hope his family can find the strength to carry on and the fortitude to be cautious about further improvements in the face of this disappointment.

[UPDATE: 19-02-10. Dr. Novella participated in a radio story about the case yesterday, the audio of which can be found Here. Interestingly Dr. Laureys was also interviewed and admitted that the facilitator may have been in the room during the first tests thus completely invalidating the results and subsequent tests were thwarted by "Rom" responding with answers like "you don't trust me" and "I don't want to do the test". A second facilitator had to be brought in in order for the final testing to be done. To my mind this makes the likelihood of Linda Wouters being an innocent participant here much less and that of conscious fraud much more.]

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Filed under: Hoaxes, Psychological, Questionable Techniques, Sciblogs, Science, skepticism, Warped Science Tagged: Add new tag, Facilitated communication, FC, Health and Medicine, persistent vegetative state, Rom Houben, Science, Steven Laureys

What is the Harm of Alternative Medicine? Darcy Cowan Jan 26

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Yesterday fellow Sciblogger Grant posted about homeopathic medications in pharmacies and questioned the legitimacy of reputable organisations selling such patent snake oil. The comments to this entry reveal one of the most frustrating aspects of speaking out against unscientific medicine and can be summarised thusly: “I’m far too sophisticated to be taken in by this stuff myself but other people seem to like it and if it doesn’t work then what’s the harm?”.

This attitude is ever present and comes from a reasonable starting point i.e. everyone is entitled to their own opinion and it’s not my job to save them from themselves. I can totally get behind that, usually. When it comes to ineffective medications of the alternative variety however this impulse though understandable is misguided and I’d like to put down a few reasons why I think so, some are speculative but I think the possibility of harm is great enough that they deserve to be considered.

For a start there may well be direct harm caused by using alternative remedies. As there is little to no regulation of these medications then no proof of safety or efficacy is required for sale. Witness the Zicam debacle last year regarding a “homeopathic” cold medication.

Further more the possibility for indirect harm (as multiply alluded to by Grant) may be significant. In case your imagination is not up to the task I will outline a few ways this may be the case. For instance the underlying principles of something like homeopathy are no only unscientific they are in direct contradiction of the last 200 years of scientific understanding. If they are used as the basis of reasoning about health then the results can be more dire than someone getting a bad nights sleep (in the case of the homeopathic sleep aid Grant used as an example).

Use of these therapies for minor ailments by the “worried and wonky well” may increase the possibility they they will be used for more serious health issues where the results could be deadly.

Look no further than the position statement of the WHO regarding the use of homeopathy in the treatment of Malaria and AIDs (among other things). The consequences of such thinking could be incalculable in terms of human suffering and spread of disease. But what’s the harm, right?

Additionally it is one thing for adults to make an informed choice for themselves based on available evidence filter through their particular world view but what about when this choice id forced on their children? The recent case of parents being found guilty of manslaughter over giving homeopathic remedies to their sick daughter is a terrible reminder that sometimes it is innocent children that pay the price for people’s gullibility. But, you know, what’s the harm?

When ostensibly professional medical providers such as pharmacists sell demonstrably irrational treatments they lend credibility to them that the average person uses to base decisions on. I mean the wouldn’t sell it if it didn’t work, right?

So while I understand the commitment to individual autonomy and freedom of choice that leads to the “What’s the Harm?” question, I fail to see how this means that fraudulent therapies must be let off the hook simply because there is a demand for them.

This has been a more vitriolic post than I normally write but what’s the point of a blog if you can’t vent once in a while?

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Posted in Alternative medicine, Medicine, Questionable Techniques, Sciblogs, Science, skepticism Tagged: alternative, health, Health and Medicine, Homeopathy, Medicine, Practitioners and Clinics, Science and Society, Scientific method

Can Torture Ever Be Justified? Darcy Cowan Oct 26

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I don’t think I would be going out on too much of a limb if I observed that most of us find the idea of torture to be repellent. As social creatures it is natural for us to shy away from inflicting harm on our fellows, empathy stays our hand when ruthlessness might otherwise help us achieve our personal goals. This holds true both in normal social interactions and in the extreme situations of conflict. It requires a significant expenditure of effort for us to overcome our inbuilt aversion to causing pain.

Even so torture can be rationalised as being for the “greater good” such as in the hypothetical situation which illustrates when torture might be a reasonable recourse known as the “ticking time bomb” scenario. In this case it is supposed that a terrorist has planted a bomb in a populated area, the terrorist is captured but the authorities have not been able to ascertain the location of the bomb which might go off at any time killing hundreds or possibly thousands of innocent people. If the terrorist refuses to co-operate, so the logic goes, it is then not only permissible to resort to torture to extract the information it might even be obligatory in order to prevent greater harm.

This situation however contains a hidden assumption that if untrue leaves the entire argument moot, namely, torture leads to accurate information. If this assumption is false then the justification falls apart. Last week in the journal Trends in Cognitive Sciences Shane O’Mara argued exactly this point. The main thrust of O’Mara’s argument asserts that prolonged stress causes changes in the brain that make it difficult for the subject to accurately recall memories and make the implantation of false memories and confabulation more likely.

False memories can be laid down when a subject incorporates what they are told into their own memory as if it actually happened when it did not. Simple repetition of information can induce false memories in normal subjects, assuming that it does not also happen in stressful situations is not  particularly reasonable.

Confabulation is the involuntary creation of false memories in response to questioning when the frontal lobe of the brain is impaired. The subject believes what they are saying and so is not lying but the information may not be accurate in any meaningful way. Events from the subject’s past and imagination can be jumbled together without the ability to tell the difference between them, when or if they happened. As prolonged stress can have negative effects on the frontal lobe confabulation could be a real danger in torture situations.

In addition the subject will also be conditioned that while they are talking the extreme interrogation techniques are stopped, thus talking represents safety. There is no extra inducement to truthful speech. In this situation there is no immediate method of ascertaining the truth of the subject’s words and so as long as the subject continues to talk further interrogation is not necessary.

Given these objections and certainly in the absence of reliable data to refute these points the justification for the use of torture simply dissipates. I for one find this information very reassuring.

Posted in Psychological, Questionable Techniques, Sciblogs, Science Tagged: confabulation, false memories, Psychological, psychology, Science, Science and Society, torture

Natural Health Expo(sed)? Darcy Cowan Oct 15

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Driving around Hamilton the past few weeks I couldn’t help but notice the signs sprinkled around the city for the “Natural Health Expo” which is to take place here this week end. As I perused the website for this event yesterday I was disturbed by the large number of anti-scientific “treatments” that will be showcased. Like my co-blogger Grant who has already posted on this, I was troubled by the amount of misinformation that will be leveled directly at consumers.

As I was pondering how to answer the bewildering array of AltMed that will be promoted I checked my email and found a great little article just published in Chiropractic & Osteopathy (made available through the open access publisher BioMed Central).

The paper, “Why do ineffective treatments seem helpful? A brief review” written by Steve E Hartman, looks at how practitioners and patients can fool themselves into thinking that ineffective medical interventions actually work. An excellent example of Evidence Based Medicine 101, Steve covers the cognitive biases that hinder our ability to draw logical conclusions in the medical sphere such as the Post Hoc, Ergo Propter Hoc logical fallacy, confirmation bias and cognitive dissonance. Also covered are explanations of how it can seem that a treatment has been directly responsible for improvement in a patient’s condition when it may not  have been.

The paper touches on disease natural history, which simply refers to how a particular malady might be expected to progress without treatment. Self limiting diseases such as colds, headaches and fatigue can be expected to get better on their own . If a patient is taking a treatment at the time, the treatment (rather than their own immune system) might erroneously be given the credit.

This combined with the overlapping arenas of the placebo effect and regression to the mean can be a powerful confounding factor when treatments are not being considered in light of scientifically controlled settings. The placebo effect is referred to frequently in common culture but regression to the mean is a less well known entity for the layman. Steven does a good job of explaining the concept, essentially people experience a variety of different intensities in their symptoms. Also they will tend to seek medical help when the symptoms become severe, knowing that the severity of the symptoms will tend to cluster about a mean value it is likely that whether treatment is sought or not the patient’s condition will tend to get better.

Thus the patient will feel relief and attribute that relief to what ever modality they are using at the time. Practitioners are not immune to these effects either and will in their practice see time and again that patients are getting better after their pet therapy is applied. In which case they will feel justified in proclaiming it works in the absence of confirming studies (or even in the face of disconfirming evidence).

The one aspect that I felt was missing from the paper, although it may have been obliquely implied, is the role of prior plausibility in evaluating treatments. Many modalities that will be on offer at the Natural Health expo are not only unusual they fly in the face of currently understood science. Scientific plausibility is our compass, without it we can become lost in the wilderness of fanciful ideas without any method of discerning the way forward. This concept is what separates Science Based Medicine from simply Evidence Based Medicine. The former takes the plausibility of a treatment into account when deciding the threshold of evidence needed before it can be considered effective. The later only measures outcomes and so is less able to distinguish true effects from chance outcomes.

Consider the following scenario: I claim to be able to influence the outcomes of coin tosses by virtue of what I had for breakfast on a particular day. If I have eggs then tails with predominate, lettuce produces more heads. Now without considering the plausibility of the setup we could run a trial, perform statistical analysis and find that my predictions are correct. But given that there is no good reason to suspect that my diet can influence a coin toss the positive is more likely to be because of chance than because of a real effect. In this case then a higher standard of evidence would need to be achieved than if I had said I could alter the probabilities be sticking a piece of gum to one side.

All-in-all though this a very nice paper and my complaint is a small one, given the probable readership of the journal the inclusion of plausibility may even have alienated those that might otherwise have been receptive to the other points presented. I recommend reading it for yourself, it is a very easy and informative read.

Posted in Alternative medicine, Medicine, Questionable Techniques, Sciblogs, Science, skepticism Tagged: Alternative medicine, altmed, Expo, Hamilton, health, Health and Medicine, Medicine, Review, Science and Society