I was a horrible football player in high school. Terrified of losing my expensive non-disposable contact lenses, I made the unwise decision to remove them before walking onto the field. As you might expect, I was often crushed to the ground without even seeing who hit me. Friends and family in the stands witnessed brutal breaks in my shoulder and torn ligaments in my neck. When my pain tolerance wore thin and I relented to surgery, the next several months were spent with an arm wed to my torso under plaster. When the cast was removed, besides physical therapy, I saw a chiropractor. And it seemed to work. The pain disappeared, my shoulder and neck felt supple, and so I continued going to chiropractors for years.
Impatient to become bigger, stronger, and faster, I never let my body heal on its own terms. When I finally did, I realized that I felt better without my trusty chiropractor.
Why do I share this story? Because when someone is in chronic pain, unable to function, they are susceptible to charismatic people who claim to have the answers. Skepticism disappears. Consumers aren't to blame. This is an age of unprecedented information overload. Who has the time to read the science on whether chiropractic care works? Chiropractic care must be effective. After all, why would health insurance companies pay for visits? I mean, if someone suffers from crippling depression, their insurance only pays for 10-15 visits to a therapist (even though most treatments require at least 3 months to be effective!).
Despite my narrow focus on chiropractic care, I could just as easily be talking about other alternative approaches such as reflexology (the unproven idea that there are connections between the foot and nearly every organ in the body and applying pressure to the right spots on the foot can alleviate ailments and even diseases).
As a clinical psychologist and scientist, I wanted to share three red flags that an intervention is likely to be a scam or sham on the horizon:
1. Jargon. If a practitioner knows that they are doing, they should be able to explain why their services are needed and how they work so that an 11-year old can understand them. Don't ever blame yourself if you are confused by wacky terms, practitioners should be able to describe your problem and their plan in everyday language. If your chiropractor tells you that subluxations of the bones and joints (misalignments) are responsible for an illness or disease, don't be content with this gobbledygook. I kid you not, this is the exact same thing that Daniel D. Palmer, the founder of chiropractic care, wrote about in 1895! Palmer thought that subluxations were the cause of nearly every problem suffered by humankind. Haven't we learned a few things about the human body in the past 115 years? After all, in 1895, scientists had just learned that little microbes called germs can cause disease and perhaps its a good idea if surgeons wash their hands before reaching inside your body cavity.
Moving beyond chiropractors, there are proponents of magnetic therapy who claim that wearing their brand of necklace or bracelet will change the body's magnetic field, aligning or changing electrons, which in turn stimulates healing. Sounds really interesting until you ask how this magnetic field works. How do little trinkets know exactly which electrons and body parts need to be changed and which to leave alone? And how did this magnetic field get out of whack in the first place to lead to health conditions such as headaches, sinus problems, arthritis, insomnia, and cancer and heart disease? All of which are supposedly healed by magnetic therapies (a multi-billion dollar industry)!
2. Evidence. Following the mantra of Carl Sagan, "extraordinary claims require extraordinary evidence." But let's be generous, how about evidence showing that a group of people receiving alternative medicine fare better than people who exercise regularly, sleep well, and eat healthy over a 6-month period?
Gushy testimonials are not enough. What do you think happens after a reflexologist gives you an intense foot massage or a chiropractor stretches the joints and tissues that join vertebrae to one another? You're going to feel real good, much better than when you came in. And you are going to attribute this relief, this feeling of hope, to chiropratic care or reflexology. And in a few days when you return to how poorly you felt before, you are going to schedule another appointment.
On top of this, we often attempt to justify the time, effort, and money devoted to therapy by saying that it's helpful. These reactions are often automatic. That is, we don't deceive ourselves on purpose, it happens outside of conscious awareness. Psychologists call this "cognitive dissonance". Before your first ever visit to a chiropractor, you might be 60% confident that it's going to help. Asked again after spending hundreds of dollars on dozens of visits, you are likely to be 70, 80, even 100% certain that the treatment is working. There are hundreds of studies to document this process. Our knowledge about ourselves is more flawed than we think. This is just one of many reasons why anecdotes do not quality as acceptable evidence that medicine works.
Ask your practitioner for stronger evidence. Ask about published research. Ask for details about the research such as what other possible explanations could exist for why people ended up better after treatment. You want to know if their treatment is better than waiting and letting the body heal on its own. You want to know if their treatment better than exercise. You want to know if their treatment is better than taking pain relievers. You want to know what exactly is going to be changed that is relevant to the problem being treated. And while you're asking questions, carefully observe your therapist. Look for signs of resistance, look for signs that they're comfortable (vs. being pissed off) with your curiosity, and look for signs that they are more interested in your health instead of selling their wares. Any good therapist should welcome an engaged, skeptical consumer walking through their doors...unless they have something to hide or something to be afraid of.
3. Change should be observable and measurable. There should be some clear, objective way to know that the treatment is doing what is supposed to do. I'm not talking about feeling good after being touched in a gentle way on the feet or back. Feeling good doesn't mean a treatment works. Our feelings are affected by the weather, hormones, music, colors, and a thousand other features that have nothing to do with being treated for an ailment.
If a chiropractor says that a subluxation is the cause of your problem, then you should be able to gauge the steady, systematic decline of a subluxation. If you are taking part in magnetic therapy, you should be able to observe changes in your magnetic field and the alignment of electrons and ions. Ask your practitioner how they are going to measure what your magnetic field looks like before treatment and how they are going to notice whether there is improvement. If there is no way to tell that you improved except by what you feel then there is no evidence that their work is responsible for any gains. Can you see it on an X-ray? in a blood test? in a brain scanner? a test of flexibility, stamina, or physical strength? Do other people notice a difference (who don't know you are being treated)? You can never rely solely on anyone's so-called words of expertise. They have plenty of economic incentives to tell you that you are getting better or that you need to be patient and continue what you are doing with them to get better.
Yes, I'm concerned when people offer treatments that lack evidence. I'm concerned when people in pain or who are sick, weak, or desperate for help are preyed upon. When someone invests their limited time and money in a treatment that doesn't work, there is an opportunity cost. That is, they are being pulled away from treatments that can really help them. When this happens, everyone loses.
Here's a simple idea for health care reform, only support treatments that work. When it comes to the spinal manipulations of chiropractors, magnetic therapies, and reflexology, there is little evidence that they are effective in the treatment of any medical condition. And as for lower back pain, headaches, or neck pain, these procedures have yet to be shown to be any better or worse than any other standard intervention that consumers are confident in. This includes massages and exercise. So if you want to get rid of some pork and help prevent problems in the first place, remove chiropractic care from health care plans and support people to exercise regularly....
Dr. Todd B. Kashdan is a clinical psychologist and professor of psychology at George Mason University. He is the author of Curious? Discover the Missing Ingredient to a Fulfilling Life. For more about his books and research, go to www.toddkashdan.com