Evidence-based medicine: Introduction Part 1

Inferno
Inferno
Tue Mar 05, 2013 4:59 pm by Inferno

In my last post, “What’s the harm?”, I talked about the problems of taking medicine (or treatments!) that’s neither good nor bad for you. I also talked about “evidence-based medicine”, but didn’t really delve into that topic. I won’t do that in this post, either!

So what, you may well ask, do I want to talk about now? I want to give you a look into what a few doctors do and why their approach is deeply flawed. I’ll give one specific and not-well-known example of alternative medicine as well as some obstacles I found when investigating its efficacy.

In short, I’ll talk about why medicine needs evidence and why practitioners of alternative medicine might be reluctant to look for evidence. I apologise if the post is fairly long, but I need to flesh out my example to make sure you understand the practices behind it.

 

First, let me try to explain PsychoSomatic Energetics (PSE).

Watch this video. Read this page. (If you speak German, read this book. Or don’t, it costs money… Twenty pages are also available here.)

Done? Now what do you know about PSE? Not very much, I’d think. You know it has something to do with “energy blocks” and with measuring the “subtle energy field”. But how does it work?

Here’s where I come in. I’ve read the book and I’ve talked not only to people who’ve taken a seminar in PSE, meaning they’re qualified to test with it, but I’ve also E-Mailed one of the inventors of PSE, the ex-Wife of the guy in the video. What I will now lay out will sound confusing, mad even. If you don’t trust me, read the book and cross-check what I’ve said. If anything I’ve said sounds exaggerated or false, feel free to criticize me in the comments.

PSE is based on Freud’s psychoanalysis, basically issues from the past are said to influence your current health. In Freud’s case, that meant mental health, in PSE language mental health influences physical health. Up until now, the theory’s sound. Of course depressions and other mental problems can affect the body, but the effects can be hard to spot and even harder to treat.  That’s why psychotherapy is such a difficult field, why so many therapists have to take long vacations and why they are given the harshest, yet most self-preserving advice.*

Here, then, is PSE’s amazing promise: Not only can we find out what is wrong, and how much is wrong, but we’ll even be able to cure them in a relatively short time using homeopathic remedies. Now we haven’t yet looked into homeopathy, so we’ll assume for now that the remedies are 100% effective. That’s how generous I have to be just to take PSE seriously. So what should strike us about the above is this: It claims to cure all energy-related problems. Any remedy that claims to cure everything of anything can be almost immediately dismissed.

Now I’ve failed to tell you two things:
1) What does PSE supposedly treat? “Energy problems” is not very specific a term in this context. I’d refer you to Dr. Banis’ book, but that’s not very helpful: “Most illnesses are caused by blockades of the soul, which can’t be tested nor treated early enough. That’s what we try to counter with PSE.” If you found that illuminating: Congratulations, you’re smarter than I am.
I have talked to some people though, and their answer is the same: “Almost everything can be treated with PSE, if it’s found early enough”. I’ll be generous and say “Non-serious mental problems (slight depressions, slumps, feeling worn-out, etc.) and small boo-boos (coughs, “feeling unwell”, etc.) can be treated”.

2) What is energy and how does it relate to PSE?
Remember that PSE is bound to eastern traditional medicine. In that tradition, the body has “energy” and that energy is located in one of the seven “chakra-points”. That energy is generally an astral “energy”, a sort of “I’m full of energy”-thing, but recent attempts (Deepak Chopra et al.) have tried to make this “energy” a real energy, a physical force.
If you read the PSE-book I’ve referenced above, you can find at least three definitions of energy:
a) The above described astral energy
b) Magnetism, in this case the slight magnetic field around the body.
c) The energy we know from physics known as “force” and the energy we know from electricity known as “electric charge”.

According to PSE, we can measure the energy at every chakra-point on a scale from 1-100, with every one of those points further being divided into four “energies” known as “vital”, “emotional”, “mental” and “causal”. We don’t  need to understand them, we just need to know that according to PSE, if any one of those energies suffers (note: that’s 28 different measurements!) then we won’t have enough energy, which can either result in us feeling depleted (think of it as forgetting to turn off a light at home, it drains your money) or in us becoming sick (a light bulb pops due to it being overused). I won’t go to tell you that it’s then compared to the four “juices” of the body, also known as the “four temperaments“. That would just be mean and discredit the whole thing immediately.

In any case, back to PSE. Now that we’ve understood what is to be tested, we can see how it is tested. The process is relatively simple:

Take a machine, in this case the Reba® special test device and hook the patient up to it. You do that by placing the machine on a flat surface, lying the patient down next to them and attach a wristband to one of their wrists.
Next, you take an vial of the homeopathic remedy you want to test (one vial corresponds to one of the 28 levels I described above) and place it into the receptor of the machine. Note that at no point does the actual remedy get into contact with the device.
Having done that, you switch on the machine and test for the first of five levels. (100/5=20, so you test at 20, then 40, then 60, etc.) To do that, you (being the doctor) take the arms of your patients and lightly pull on them. (Arms outstretched behind/above your head) If one arm is longer than the other one (supposedly called “kinesiological arm-length reflex”), you know that energy is lacking.

Practical example: If you test vial one and your patients arms are the same length at 20, but one is shorter at 40, then you write down “20”, because that’s the “available energy level”. If they’re the same length at 20 and 40, but different at 60, you write down 40. And so on.

And that’s it, basically. You repeat that 28 times and write down the results. If they’ve got energy level 100 everywhere save for vial 28 (associated with “wrong thinking”), you give them remedy 28 to “boost their energy level” at that point. After six to twelve months, the patients come back and if they tell you that they feel better, then everything’s fine. If they don’t, you re-test them and give them more remedies.

Now obviously, there’s so much wrong with that, I won’t be able to go into all. A quick overview:

  • What is energy and why do they use so many different, conflicting definitions?
  • How can PSE supposedly treat “everything”?
  • How can we test if “chakra-points” really exist?
  • Why are they using outdated concepts like the “four-temperament” theory?
  • How does the test device work?
  • Is the arm-reflex reliable? (Hint: NO!)
  • Isn’t the whole thing a bit subjective?

But most importantly of all, I want you to focus on one very specific problem: Where’s the evidence that it works? Anybody can say that it works (more on that much later), but how can I prove that it does?

Here’s where PSE encounters some very serious problems. There are four!!! relevant studies to this, with a total sample size of about 2000-2500. That’s not a bad sample size, it should be enough to see if PSE works or not. Below are the four studies:

Schmetterlingsstudie – Butterflystudy

Banis R, Banis U: Psychosomatische Energetik – Ergebnisse einer Praxisstudie. Schweiz Zschr Ganzheitsmed 2004;16:173–178.
Holschuh-Lorang B: Psychosomatische Energetik in der Allgemeinmedizin – Ergebnisse einer Praxisstudie. Schweiz. Zschr. GanzheitsMedizin 2004;18,368–371.
Banis R: Multizentrische Praxisstudie zur Psychosomatischen Energetik. Schweiz Z Ganzheitsmed 2010;22:269–272.

If you look at them, they all document a large percentage of “good” and “very good” results. But didn’t I just tell you PSE had serious problems when it comes to evidence?

Yes, because the above is not evidence of anything. It’s worthless trash, not worth the bits it’s written in.
That may sound harsh, but I’ll explain myself and I hope you’ll share my view.
Take note, because this is what the whole post has been building up to!

Eye-witness testimony is the lowest form of evidence in science, especially so in medicine. You can get better without the medicine or treatment doing anything (placebo effect), you can think you’re getting better even though the evidence shows no benefit and you can think the drug as a whole is beneficial (just not in you) even when it’s actually actively killing people. In his excellent book Bad Pharma, Ben Goldacre documents (pages 140-143) the effects of a drug called Iressa on the general population. Basically, Iressa showed no real-world improvements for patients, yet they gave positive testimonies nonetheless.
So at the very least, we can expect PSE to look slightly beneficial just due to this misinformation or misunderstanding or whatever you would like to call it. We will also expect it to look more beneficial because of the placebo effect and, because often people go to get treated with nothing more than “feeling bad” or “anxiety”, even better because people care for them and talk to them.

None of that would matter if PSE were ever tested fairly, that is to say using real, measurable effects. Since none exist (bar the subjective “I feel well” from patients), we would at the very least expect PSE to be tested against a placebo. After all, we know how potent the placebo effect can be. No, none of that. After over 15 years of PSE having been practised, NOT A SINGLE study has been conducted comparing PSE to a placebo. I even went as far as suggesting a cooperative effort between Dr. Banis and myself, but that failed due to a number of factors. (She was interested and would even cooperate with me, but no suitable venue nor funding was found.)

This is what this post has been about: More than fifteen years of practising PSE have passed and we don’t even know the most basic thing about it: Does it work? (I’d say no, but then you shouldn’t take my word for it.)

So I asked a practitioner (or at least advocate) of PSE about the lack of evidence for PSE, not to mention the various pieces of evidence against PSE. What does she make of that?
Her response: “I don’t care about evidence, I have seen it work with my own eyes. And I probably wouldn’t change my mind if I saw studies to the contrary.”

This staggering lack of curiosity about the evidence is baffling. Why don’t you want to know if it works? Isn’t evidence something to actively seek out? And even if you don’t want to conduct the studies yourself, wouldn’t you at least like to know?
Interestingly, I was then chastised by nearly everybody at the table for daring to challenge a doctor and for being a “damn skeptic”.

So as of today, the evidence is still not in on PSE, but it most definitely is in on homeopathy and since that doesn’t work we can safely assume that PSE doesn’t work either. If new evidence comes along, I’ll review my view and make a second post on this issue.

For now though, I hope you’ve taken one thing away from this: Medicine needs evidence, otherwise we don’t know if something works or not. I’ll give specific examples for that in the next post, this one here was mainly to give one example of practitioners or advocates of alternative medicine being reluctant to seek out evidence against which to measure their medicine or treatment.

Beware of alternative medicine.
*In a lecture, future therapists were told the following: “Some day in the future, a person will walk through your door. This person will be extremely friendly and will immediately open up to you. They’ll tell you that you’re the only person who’s ever understood them and that all previous doctors just couldn’t find the answer but that they just know that you’ll be better. If that ever happens, THROW THEM OUT! They’re lunatics and you can’t help them”. -unsourced

Edited by Dean, 06/03/2013
Reason for edit: Spelling correction [1].

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