Psychology, Science, and Pseudoscience: Class #12 (CAM cont.)


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In short: Like homeopathy complementary/alternative therapies such as acupuncture and chiropractic lack plausibility and efficacy, despite claims to the contrary. Placebo and other psychological effects of treatments may explain their popularity.

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Psychology, Science, and Pseudoscience: Class #12 (CAM cont.)

  1. 1. PS409 Psychology, Science, & Pseudoscience Dr Brian Hughes School of @b_m_hughes
  2. 2. Case Studies:Examples of Psychology-related Pseudoscience
  3. 3. Case Studies from Outside Mainstream Psychology:1. Complementary and alternative medicine/therapies
  4. 4. CAM efficacy: AcupuncturePlausibility issues: Qi, yin, yang, meridians Poor inter-rater agreementEmpirical issues: Cochrane Library: 16 reviews 3 reviews for pain: 63 trials; 4,096 participants No effect 1 review for smoking cessation: 24 trials No effect
  5. 5. CAM efficacy: AcupunctureAdverse effects(Noeheim & Fonnebo, 1995; Yamashita et al., 1998)Exaggerations? Anaesthesia Chinese authenticity vs. Western romanticism Impact on health in ChinaEndorsement by health insurers Actuarial logic rather than concern for efficacyEndorsement by medical authorities Populism or evidence?
  6. 6. CAM efficacy: Acupuncture Ireland China India CubaAnnual health $2,496 $278 $82 $251spend percapita*Life expectancy 75/81 70/74 61/63 75/80(M/F), yrsChild mortality 7/5 27/36 81/89 8/7(M/F), per 1000Adult mortality 105/60 158/99 275/202 131/85(M/F), per 1000TB cases, per 11 101 168 10100,000Last polio case 1965 1999 2006 1962reported*“International Dollars” = US dollars, corrected for purchasing power parity(i.e., figure shown refers to amount purchased in terms of US market values) Source: WHO
  7. 7. CAM efficacy: Acupuncture “Approved” by the BMA Reasons given: Popularity among physicians Popularity among public Reported efficacy for, e.g., back pain (citing Ernst & White, 1998) 2000
  8. 8. CAM efficacy: ChiropracticPlausibility issues: Form-function relationship, subluxations, bodily intelligence, homuncularityEmpirical issues: Cochrane Library: 1 review Dysmenorrhoea 5 trials, 236 participants No effect Other frequently cited review: Shekelle et al. (1992) No chiropractic among successful trials
  9. 9. CAM efficacy: Chiropractic
  10. 10. CAM efficacy: ChiropracticOther reviews Pain: Ernst (2003); Gay et al. (2005); Lisi et al. (2005) 50 trials No effect Asthma: Ernst & Harkness (2001) 2 separate studies No effect
  11. 11. CAM efficacy: ChiropracticCost-benefit analysis? Adverse effects of chiropractic 1 per 2 million manipulations (Powell et al., 1993) 1 per 400,000 manipulations (Dvorak, 1985)
  12. 12. Placebos Inert substances that cause symptom relief “My headache went away after having a sugar pill” Substances/procedures that cause changes in a symptom not directly attributable to specific or real pharmacological/curative action “My headache went away after I had my hip operation” Any therapy that is deliberately used for its non- specific psychological or physiological effects “My headache went away after I had my bath”After Ogden (2004)
  13. 13. Placebos Patient characteristics Treatment characteristics Convincingness e.g., ultrasound for pain (Hashish et al., 1988) Seriousness e.g., placebo heart surgery (Cobb et al., 1959; Diamond et al., 1960) Patient-treatment interaction characteristics Expectancy effects e.g., Beta-blocker Trial (Horwitz et al., 1990)
  14. 14. Acupuncture placebos: Sham needles
  15. 15. From:Kienle & Kiene(1997)
  16. 16. Complementary and alternativemedicine/therapies
  17. 17. PS409 Psychology, Science, & Pseudoscience Dr Brian Hughes School of @b_m_hughes