Aug 14 2009
The Worried and Wonky Well
A skeptical theme that crops up very frequently is the fact that there is a huge disconnect between popular beliefs and the findings of science. There is a tendency for people to overestimate their own knowledge even when they have no basis for their confidence (even skeptics – we all do this). Often this amounts to just making up answers because they feel right and then assuming they are correct. We all do this – believers and skeptics alike. This is the default mode of human thinking. It takes discipline to insert the critical thinking filter – “is this really true? what does the evidence actually say?”
The specific topic at hand is attitudes toward so-called complementary and alternative medicine (CAM) – how popular is it, and what is the basis for its popularity? I have dealt before with the former question. Here’s the summary: most surveys that site huge numbers of people using CAM are grossly inflating the numbers by including things such as exercise, prayer, or taking a multivitamin. I exercise, so by some measures I am a CAM user. This, of course, reflects the confusion caused by the dubious category of CAM itself – it is a pseudo-category, containing a wide variety of modalities, some mutually exclusive, with very fuzzy boundaries.
It is more meaningful to consider individual claims and practices, and to use somewhat tighter categories (such as energy-medicine). If we consider the “hard-core” CAM practices – like homeopathy, acupuncture, and energy medicine – we find that their use is still in the tiny minority – single digits. And these numbers are not significantly changing over time. The popularity of CAM is overblown.
The other question (actually two questions) is also interesting – who is using CAM and why? As evidenced by my many discussions on the topic and comments left on my blogs (and others), the most common answer is some variation of “I guess people must be dissatisfied with mainstream medicine.” In a blog post for SBM this week, in fact, a commenter noted:
I suspect that the reason many people turn to CAM is because they feel that the medical practice they have experienced isn’t that good.
This is not an unreasonable assumption, but like many reasonable assumptions it turns out to be wrong. There have been many surveys and a common theme among them is that most people who use CAM do so because it was in line with their philosophy. The classic study is this one, a 1998 survey published in JAMA. It concludes:
Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.
People who use CAM have disposable income (which makes sense as most CAM is paid for out of pocket), which itself correlates with older age and more education. CAM use also correlates with having some chronic medical complaints, which also makes sense and happens to be true. Surveys also show that the most common CAM modalities (if you don’t include prayer and exercise) are for musculoskeletal complaints – massage, manipulation, yoga, and relaxation.
So if we put this all together the profile of the average CAM user is a middle-aged or older adult with cash on hand who is having the typical aches and pains of that stage of life and is looking for a touchy-feely therapy that fits their overall world view. Of course, this is just the typical user, and the numbers also include other profiles, but they seem to be in the minority. The profile we worry about the most are those with a serious life-threatening illness who are drawn to a hard-core CAM modality by desperation or the alure of false hope.
There is now a new survery, this one Flemish, adding another wrinkle to the data on who is using CAM and why. This survey of Flemish adults was about belief, and not necessarily use. They asked the typical questions, but also surveyed belief in the paranormal. The study concludes:
Support of CAM was very prevalent in this Flemish adult population. CAM beliefs were strongly associated with paranormal beliefs.
They also confirmed an associated with older age, which again is likely explained by disposable income. Belief in the paranormal and age were the only factors that predicted positive attitudes toward CAM. There was a positive relationship also with level of education and the social desirability of CAM, but these factors were not strongly enough correlated to be predictive.
I admit that this result is highly satisfying, and fits well with not only previous data but my personal biases. A world-view that includes belief in magic and the supernatural accords well with many of the claims made within the broad CAM umbrella. This may also reflect a poor understanding of or respect for science.
While paranormal belief was the strongest correlate of belief in CAM in this survey, this and other data also reflect that attitudes toward CAM is a complex and multifarious cultural and social phenomenon. It may be dominated by the worried and wonky well, but there are many other types mixed in as well.
21 Responses to “The Worried and Wonky Well”
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Ethnic CAM:
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=103622823.html
Anecdotally, both my wife and I have noticed doctors here (in New Zealand) spend 5 minutes with you, barely paying attention and dismissing all of your suggestions or observations about your condition. My wife has visited a homeopath, and they sit with you for a long time, discussing various issues, your lifestyle, any changes in your life etc.. etc…
That in itself would make people at least like the homeopath more than the doctor. Who wouldn’t? They are far more likable in general.
I’m a little surprised at the numbers for alternative medicine participation are inflated – again, anecdotally, I find a lot of people at my work visit osteopaths and homeopaths, as well as quite a few of our friends. That’s at a technical/software company. There is even one person at work who is taking a raiki training course.
artfulD- Maybe it’s just me, but I had a hard time figuring out whether the NIH was pro,con, or neutral on CAM. It read like “we just want to know”. Any thoughts?
I can’t tell from the abstract that this was any more than an informational publication. You could see it as pointing out the larger scope of the problem that CAM represented, or pointing out the areas open to further medical research, or none of the above.
This is just a comment on the belief that your post perpetuates, that all CAM is used by middle aged, wealthy ( money is disposable), and paranormal believers. I would limit the paranormal commentary to the Belgian population that was studied, until an equivalent study is done in the U.S. In the U.S., the common complaint for CAM users is back problems. Generally, physicians don’t refer their patients to back surgeons until late into the degenerative process. What does a patient get from the friendly physicians before the ultimate sacrifice to surgery? A few nods of the head and agreement that the patient has a definite mechanical back problem? Do you know that the average back surgeon makes $600,000 per year? Guess who has more disposable income, the patient with chronic pain or the practicing doctors who thinks his client is a pain? I have seen all age groups and socio-economic levels use CAM in the U.S. Most of the users had some belief in a supernatural being, usually Jesus because Christianity has been a dominant faith in the U.S.
People like to have 100% of their hole filled.
If you total up your beliefs, and you need 30% more filling for your hole, the next best thing to reality is going in there, like foam peanuts, and bubble wrap.
Per Dr. N.’s “a world-view that includes belief in magic and the supernatural accords well with many of the claims made within the broad CAM umbrella”:
a) I like this survey as well, “Vitalism, Purpose and Superstition”
http://www.ingentaconnect.com/content/bpsoc/bjp/2007/00000098/00000001/art00003
“the results from 116 superstitious and 123 sceptical individuals showed that more than sceptics, superstitious individuals attributed purpose to objects, and explained biological processes in terms of organ intentionality and energy transmission. In addition, they thought of energy as a vital force, attributing life and mental properties to it. These conceptual confusions were positively associated to all types of superstitions as well as belief in alternative medicine. The results support the argument that category mistakes and ontological confusions underlie superstitious and vitalistic thinking.”
Oh my, where’s the “k” in skeptic?
b) also, here’s someone’s very well-written essay regarding their skepticism of supernaturalism / spiritualism / vitalism, kind of along the same line of correlates
“Do We Need Soul to Understand Ourselves?”
http://www.examiner.com/x-11708-Philadelphia-Reason–Religion-Examiner~y2009m8d14-Do-we-need-a-soul-to-understand-ourselves?#comments
Perhaps the issue is one of parsimony: if we don’t need it and we think we do [CAM beliefs, beliefs!, explanations that don't work, rituals thought to be beneficial but actually are inert], there-be dead wood that could be pruned.
-r.c.
HHC wrote:”This is just a comment on the belief that your post perpetuates, that all CAM is used by middle aged, wealthy ( money is disposable), and paranormal believers.”
Meanwhile, I wrote:”While paranormal belief was the strongest correlate of belief in CAM in this survey, this and other data also reflect that attitudes toward CAM is a complex and multifarious cultural and social phenomenon. It may be dominated by the worried and wonky well, but there are many other types mixed in as well.”
Was I not clear?
Also – you seem to countering the data I presented with anecdotes.
Steven Novella, Is “wonky” an East Coast phenomenon? Please define the term. What “types are mixed in as well”. Personality types,e.g. narcissistic personality disorder? I gave anecdotes because that’s a simple naturalistic observation. You want clinical studies? OK, I use CAM. I admit I am middle aged. But wealthy with disposable income? No, I use it because its more affordable than Western medicine. I don’t believe in the paranormal, but I admit there’s a lot of synchronicity in the world.
HHC-”I don’t believe in the paranormal, but I admit there’s a lot of synchronicity in the world.”
I also don’t believe in the paranormal, but there ‘s a lot of apophenia in the world.
Apophenia may take one to a search for the sacred amidst the profane.
Synchronicity may take one down the path to the paranormal.
That is Jung’s synchronicity.
Reminds me of the story about the patient who went to Dr Jung and said doctor, I’m terribly constipated and it’s so bad I’ve gotten to the point that I just can’t see what to do. Please, you must advise me, what, if any, are my options?
Whereupon Jung reportedly replied, “Well synchronistically, it appears that you must either defecate or go blind.”
BA-dump-bump.
[not to pun, punningly].
-r.c.
And, of course, regarding Jung:
“there’s a little black spot on the Sun today.”
Does ANYONE know what I’m talking about?
-r.c.
I’d guess it has to do with what Jungians call the Shadow. Supposedly the dark and rejected aspects of our unconscious.
It doesn’t hurt of course that anyone can take a reiki course, and that healing energy is an easy thing to explain to a layman.
@daijiyobu
The Police, of course
daijiyobu-”“there’s a little black spot on the Sun today.”
Does ANYONE know what I’m talking about?”
I didn’t, but a little Google solved it for me. What did we do before the intertubes? Nice arcane aside. In ‘sync’ now.
Some claim darkness at noon is planned but I root for coincidence.