The Bent Spoon Award this year created more controversy than usual when it was awarded to Consumer magazine. Why did we feel it necessary to bite our consumer watchdog?
I was pleased when my copy of Consumer magazine arrived with a lead story on the natural way to health. I had had a survey a couple of months previously asking what I’d like to see in the magazine, and had replied that it was about time that an objective, hard-headed look at alternative medicine was done.
I was shocked and disappointed, therefore, when I found that the article did not meet Consumer‘s usual high standards, but was a startling blend of unsupported claims and sketchy, superficial statements. I really didn’t expect Consumer, of all publications, to produce something that so obviously deserved a Bent Spoon Award.
I wasn’t alone in this. Many Skeptics, it seems, are subscribers to Consumer — I put that down to the institute offering consumer protection for one’s physical environment, and the Skeptics providing such protection for one’s mental environment. And it soon became obvious from the phonecalls and faxes that a large number of you (and plenty of interested observers) were as disappointed as I. What to do?
We embarked on what has been perhaps one of the saddest Bent Spoon awards — sad in its implications for Consumers’ Institute and sad in that Consumer‘s apparent endorsement of what has been described as “controversial, even bogus, treatments” will make it so much harder in the future to debate these issues factually.
So what was in the article that virtually forced us to challenge Consumer and take on ourselves a great deal of misinformed abuse from the Institute?
The article, in the July 1992 issue, was titled “The Natural Way to Health — your guide to acupuncture, osteopathy, homeopathy and other natural therapies.”
“Natural therapies are popular and often effective,” it opened, with the caveat that going to an “untrained” therapist can be a waste of money and may be dangerous.
However, after that brief warning, the article continued:
When it comes to health, even Mother Teresa, Tina Turner and Queen Elizabeth have something in common. They all get help from non-conventional medicine, and homeopathy in particular. The Royal Family has consulted a homeopath for several generations.
Apparently an elderly nun, a former rock star and a clan of inbred blue-bloods are sufficient to validate some very questionable practices.
It noted that some practices, such as osteopathy and acupuncture, have their own professional bodies and are used by conventional doctors. It recommended looking for a trained, registered practitioner. After all, it added, “the best non-conventional therapists can offer highly effective treatment.”
This suggests that natural therapies are effective and the only caution necessary is to avoid untrained practitioners who may have got their fancy certificates through mail-order.
The article did say that radical treatment — such as having all your teeth pulled out — should lead you to seek a second opinion with your own GP or dentist.
It also ended with a case study of one therapist, pointing out problems such as the rejection of conventional medicine, promising cures and charging high prices. There was additional discussion of the Medicines Act, where it was stated, somewhat naively, that the Act limits what an alternative therapist can advertise or claim in the form of cures or treatment of certain illnesses. At least it did point out that the Institute was aware of cases where this law has been broken, but that it was not aware of any prosecutions.
Consumer recommended tightening up the Act and enforcing it more rigorously to “protect the public from untrained or improperly trained practitioners,” again suggesting that one need have no concern if one’s practitioner is trained in alternative therapies.
David Russell, chief executive of Consumers’ Institute, vigorously defended the article by pointing to these disclaimers. Dr Gordon Hewitt, head of the health professions school at the Central Institute of Technology and a Skeptic, in debating with Mr Russell on National Radio, compared this to two slices of thin bread, surrounding some very dubious meat.
It is obvious which part will be remembered, particularly by alternative therapists keen to cash in on the very supportive statements within the body of the text.
So what smelled rotten?
Acupuncture and Osteopathy
The acupuncture section talked about the flow of “life energy force” throughout the body, and that illness follows when the flow is blocked. It mentioned acupuncture’s successful use to treat a variety of complaints including headaches, sports injuries and muscular inflammation.
It supported this with the statement that stimulation of the acupuncture points releases endorphins, and that the World Health Organisation lists 71 disorders successfully treated by acupuncture.
In the Bent Spoon press release, our own Dr John Welch — himself trained in acupuncture — said that the section paid no regard to the large and growing scientific literature showing that it is clinically ineffective for diseases the magazine lists. There is now a Skeptic Truth Kit on acupuncture available for those interested in reading further about this.
The osteopathy section talked about the large body of scientific research behind the therapy, implying that its efficacy has been established but avoiding stating this definitively.
One Skeptic, in writing to Consumer independently before the award was announced, said that such a statement was exactly the type which Consumer has criticised advertisers for making.
“If there is any scientific basis for so contentious a therapy as osteopathy, then you owe it to your readers to explain it,” he added.
Consumer quoted a 1986 survey by its UK counterpart which showed that 82% of respondents who had visited osteopaths claimed to have been cured or improved by the treatment.
As one who is highly skeptical of survey techniques, I find the wording of this interesting. “Respondents” suggests that the responding to the survey was voluntary, which immediately skews results.
The other interesting point to note is that the material in the Skeptic Truth Kit on chiropractic explains that any form of back manipulation can produce apparently good results, but more from the nature of back pain itself than from actual efficacy. That is, pain is often a chimeric thing, disappearing of its own accord.
Once again, registered osteopaths are recommended as providing some form of protection, but the article does also mention that “improperly trained people advertising their services as osteopaths” can cause serious problems. There is no control over the use of the term “osteopath” — the implication is that someone with little or no training can use it legitimately — but this important point appeared not to be worthy of comment or criticism by our consumer watchdog.
Homeopathy
Consumer said that “many [homeopathic] remedies work only in specific cases” and that “a few remedies can be used widely.” There was no supporting information for these blanket claims. The institute was much more rigorous in recent tests of cough medicines, but did not subject homeopathic claims to the same criteria. Why not?
The magazine said that a homeopath will find the right treatment by conducting a detailed interview. Yes, but this is because homeopaths believe that certain extracts “match” certain personality types. Oyster shells, for example, are said to suit patients who are fearful and who feel better when constipated. This sort of dubious anthropomorphic alchemy was not mentioned.
While it may initially seem reasonable that such extracts could have some physiological effect, none of these substances actually come anywhere near the patient. This is because homeopaths believe that a preparation becomes much stronger when highly dilute — something akin to having sweeter coffee by putting less and less sugar in it.
Homeopathic preparations are diluted in 100-fold steps, commonly 30 times, but sometimes as much as 120 times. This is like stirring a teaspoonful of sugar into the Pacific Ocean — only that would give you a much higher concentration than that of most homeopathic solutions.
And how did Consumer report this? It said merely that the substances are “diluted in a particular way many times”. Hardly indicative of the true situation. If I tried selling a microwave that worked without being plugged in, I am sure that Consumer would be more than a little suspicious.
Even homeopaths admit that there is no substance in their solutions. They believe that shaking the solutions during dilution will “potentialise” them, causing physical changes in the water’s structure so that it remembers the substance long after it has disappeared. Presumably water at the base of any waterfall would be incredibly potentised through being violently shaken and thus highly dangerous in a homeopathic sense.
There is no physical mechanism for changing the basic molecular structure of water in this fashion. Consumer used the term “potentise” in its passing reference to the dilution process, but did not mention the idea that shaking water gives it these fantastic properties.
The magazine did note that the “scientific evidence is not conclusive,” but quoted only one positive study without any details, ignoring that a great many scientific trials, and basic science itself, are all against homeopathy.
In fact, the literature review which Consumer quotes is by no means as positive as suggested. The article says that the Dutch review of 107 (it was actually 105) homeopathic trials showed that 81 indicated that homeopathy worked and 21 did not. Consumer did not quote the review’s conclusions which said:
At the moment, the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias.
The doctors themselves noted that the most poorly performed trials produced the most positive results, and said that the inferences seemed to be over-optimistic at times. They also voiced concerns about the failure to submit negative results for publication. In addition, the most important positive trial in the review was reworked by the researchers involved and was found to show no firm evidence for the efficacy of homeopathic treatments.
You’d only know about this, however, if you had access to back issues of the British Medical Journal (Vol 302, 9 February 1991; 316-323; 2 March, 1991; 529; 23 March, 1992; 727).
Consumer also said that “homeopathy is taken seriously in many European countries”, as if this was enough to endorse it. Certainly homeopathy deserves to be taken seriously because serious problems can result from it, particularly with regard to the sometimes disastrous consequences of the anti-orthodox attitudes which are common to many alternative medicine followers.
Last year, a Wellington nurse refused antibiotics for her baby’s earache, preferring to have it treated homeopathically. Two weeks later, after a number of unsuccessful treatments, the child was taken back to her regular doctor who had her hospitalised immediately. Both the doctor and the hospital’s paediatrician had great difficulty in persuading the woman to allow conventional medicine to be used. It was all too late anyway, as the baby died. (See Skeptic #22 for Coroner’s Court report.)
Presumably the way to avoid this is to find a good homeopath, and Consumer provides addresses for finding ones with the “best” qualifications. It is to be hoped that those qualifications include learning how to recognise when real treatment is needed.
Other Therapies
Consumer then goes on to briefly look at other popular therapies which one can learn in a weekend or through books. These therapies are “often very gentle,” Consumer says. So’s my ferret, but he can be very dangerous too…
Aromatherapy, using plant oils in massages and baths, is said to help insomnia, anxiety, boils, rashes, acne, colds and chest infections. The magazine suggests reading a book or attending a workshop before embarking on this form of treatment, but notes that it is one of the easiest natural therapies to use yourself.
British nurses use lavender oil to massage patients and help them to relax, Consumer tells us. One wonders if the natural therapeutic properties are really anything to do with the specific type of oil used — surely the massage itself has a part to play?
A form of massage, reflexology, is said to help in psychological as well as physical areas. This may well be so, but is it really because of direct links between the extremities and other body organs and tissues, as suggested? There is no anatomical basis for many of the claims of reflexologists, but this is not mentioned.
Consumer does mention that “the crystalline deposits that reflexologists say they can feel has not been scientifically proven.” This implies that there is some real, substantive basis for these claims, and final, conclusive proof is all that is lacking. In fact, the overwhelming evidence of anatomy, physiology, radiology and so forth suggests that such claims are entirely without foundation.
Again, Consumer uses a single positive example which it calls “intriguing” to suggest that reflexology may be an effective diagnostic aid. Surely Consumers Institute, of all organisations, recognises that one personal anecdote — printed in an alternative health magazine to boot — is not adequate. I very much doubt that they would let a manufacturer get away with extraordinary claims “backed up” by just one happy customer.
In the section on herbal remedies, the article stated that “few manufacturers can afford clinical trials of their product.” What amounts to a grave omission on the part of people selling untested “medicines” is passed by with no comment.
Does this mean that Consumers’ Institute would find it acceptable that clothing manufacturers save money by ceasing to test their products for fire resistance? Struggling toy manufacturers no longer checking to see whether their latest product can be swallowed by toddlers? Surely not. Yet herbalists are apparently permitted such gross irresponsibility towards the consumer.
The section goes on to say that traditional folklore rather than scientific evidence will often be the basis for selecting a herbal treatment. Consumer then says that a better option is to go to an experienced herbalist, implying that they won’t be working on traditional folklore lines.
Certainly, as the article says, some modern drugs are based on plant extracts, but these are compounds which have been rigorously tested through clinical trials, not a mish-mash of “natural” ingredients. Consumer suggests that herbal experts will protect you from dangerous overdoses or inappropriate uses.
I wonder whether people will take the trouble to check whether their local health shop owner is a member of the New Zealand Natural Health Practitioners Accreditation Board before stocking up on their comfrey tea. Given comments I have heard from nutritionists and other health professionals, as well as personal experience, I am not particularly sanguine about the education or expertise of many health shop owners.
Missing
Perhaps one of the most disappointing things about the article was that there was no discussion of one of the primary ways in which many of these alternative therapies work — the placebo effect.
It is generally recognised that a significant proportion of medical conditions will get better with time, regardless of whether alternative or orthodox remedies are prescribed. Combine this with the provision of some form of treatment and you have a very powerful, though not necessarily valid, conjunction of “treatment” and “cure”.
In addition, people will respond to someone taking an active interest in their condition, and healers take advantage of this, whether by design or accident. The intense personal focus of alternative therapies has a strong advantage over the generally perceived impersonality of much of conventional medicine these days.
Yet there was no discussion of this vital point in the Consumer review. Nor was there any discussion of what is meant by “natural”, bar the note in the herbal discussion that suggests it involves being untested.
I wonder what Consumer would say if I sold “natural” iodine, extracted lovingly from organic kelp, and charged a small fortune for it, claiming that it is somehow more “natural” and healthier for you than the synthesised version…
It will be quite some time before many of us will be able to see Consumer‘s advertising boast — “Get the facts you need from the source you can trust” — without feeling a little betrayed.
