Monday, March 2, 2015

Why Bogus Therapies Seem to Work.

Most treatment in mental health but specifically in Substance Use is totally created from hunches, "educational intuition"<whatever that means, and outright pure guessing.  That is bad enough, except as I state in the introduction to this blog, only about 28% of all mental health practitioners ever read any science. That means that the substantial majority of mental health practitioners are SCIENCE ILLITERATE, they might have well be totally illiterate because most of them probably can not read the  eight grade level, and sure they can not do make any Critical Evaluation of Scientific Journals of their profession. To me that is shameful and not in the best interest of their patients. If you know anyone in mental health get an idea of what they know about science, for the most part they will not answer your questions or give you some horse rubbish that is not consistent with the truth. 

Mental health practitioners like most persons in our society enjoy the benefits of science, but are ignorant of the science they enjoy. They can be bamboozle easily by their professors at the University that are just as likely to be science illiterate.  Here is an article about what makes good science  treatment.

There are numerous reasons why we get bamboozled into believing some mental health treatment and assessment are real and are valid and reliable.  I will try to provide some educational information with references in the next few blog article. For thirty year the profession have been talking about "Evidence Based Treatment" (meaning based on scientific research).  I have reason to believe that most practitioners haven't the faintest idea what Evidence Based means.

Why Bogus Therapies Often Seem to Work

                                                      Barry L. Beyerstein, Ph.D.

Subtle forces can lead intelligent people (both patients and therapists) to think that a treatment has helped someone when it has not. This is true for new treatments in scientific medicine, as well as for nostrums in folk medicine, fringe practices in "alternative medicine," and the ministrations of faith healers.
Many dubious methods remain on the market primarily because satisfied customers offer testimonials to their worth. Essentially, these people say: "I tried it, and I got better, so it must be effective." The electronic and print media typically portray testimonials as valid evidence. But without proper testing, it is difficult or impossible to determine whether this is so.
There are at least seven reasons why people may erroneously conclude that an ineffective therapy works:
1. The disease may have run its natural course. Many diseases are self-limiting. If the condition is not chronic or fatal, the body's own recuperative processes usually restore the sufferer to health. Thus, to demonstrate that a therapy is effective, its proponents must show that the number of patients listed as improved exceeds the number expected to recover without any treatment at all (or that they recover reliably faster than if left untreated). Without detailed records of successes and failures for a large enough number of patients with the same complaint, someone cannot legitimately claim to have exceeded the published norms for unaided recovery.
2. Many diseases are cyclical. Such conditions as arthritis, multiple sclerosis, allergies, and gastrointestinal problems normally have "ups and downs." Naturally, sufferers tend to seek therapy during the downturn of any given cycle. In this way, a bogus treatment will have repeated opportunities to coincide with upturns that would have happened anyway.
3. The placebo effect may be responsible. Through suggestion, belief, expectancy, cognitive reinterpretation, and diversion of attention, patients given biologically useless treatments often experience measurable relief. Some placebo responses produce actual changes in the physical condition; others are subjective changes that make patients feel better even though there has been no objective change in the underlying pathology.
4. People who hedge their bets credit the wrong thing. If improvement occurs after someone has had both "alternative" and science-based treatment, the fringe practice often gets a disproportionate share of the credit.
5. The original diagnosis or prognosis may have been incorrect. Scientifically trained physicians are not infallible. A mistaken diagnosis, followed by a trip to a shrine or an "alternative" healer, can lead to a glowing testimonial for curing a condition that would have resolved by itself. In other cases, the diagnosis may be correct but the time frame, which is inherently difficult to predict, might prove inaccurate.
6. Temporary mood improvement can be confused with cure. Alternative healers often have forceful, charismatic personalities. To the extent that patients are swept up by the messianic aspects of "alternative medicine," psychological uplift may ensue.
7. Psychological needs can distort what people perceive and do. Even when no objective improvement occurs, people with a strong psychological investment in "alternative medicine" can convince themselves they have been helped. According to cognitive dissonance theory, when experiences contradict existing attitudes, feelings, or knowledge, mental distress is produced. People tend to alleviate this discord by reinterpreting (distorting) the offending information. If no relief occurs after committing time, money, and "face" to an alternate course of treatment (and perhaps to the worldview of which it is a part), internal disharmony can result. Rather than admit to themselves or to others that their efforts have been a waste, many people find some redeeming value in the treatment. Core beliefs tend to be vigorously defended by warping perception and memory. Fringe practitioners and their clients are prone to misinterpret cues and remember things as they wish they had happened. They may be selective in what they recall, overestimating their apparent successes while ignoring, downplaying, or explaining away their failures. The scientific method evolved in large part to reduce the impact of this human penchant for jumping to congenial conclusions. In addition, people normally feel obligated to reciprocate when someone does them a good turn. Since most "alternative" therapists sincerely believe they are helping, it is only natural that patients would want to please them in return. Without patients necessarily realizing it, such obligations are sufficient to inflate their perception of how much benefit they have received.

Buyer Beware!

The job of distinguishing real from spurious causal relationships requires well designed studies and logical abstractions from large bodies of data. Many sources of error can mislead people who rely on intuition or informal reasoning to analyze complex events. Before agreeing to any kind of treatment, you should feel confident that it makes sense and has been scientifically validated through studies that control for placebo responses, compliance effects, and judgmental errors. You should be very wary if the "evidence" consists merely of testimonials, self-published pamphlets or books, or items from the popular media.

Related Topics


Dr. Beyerstein, a member of the executive council of the Committee for Scientific Investigation of Claims of the Paranormal (CSICOP), is a biopsychologist at Simon Fraser University in Burnaby, British Columbia, Canada. A more detailed discussion of this topic is one of six superb articles on "alternative medicine" in the Sept/Oct 1997 issue of CSICOP's Skeptical Inquirer magazine, which costs $7.50. An introductory (six-issue) subscription at the special Internet price of $16.95 can be obtained by calling (800) 634-1610.
This article was posted on July 24, 2003.

New York in Crisis and Policy Makers Ignore the Science

When I say Substance Use Treatment is the Worst Treatment I Ever Had, is not because the treatment itself when done scientifically with appropriate medical protocol is bad. My complain is that most methadone clinic continuo to ignore the Federal Guidelines and rarely if ever read science and follow science evidence of effectiveness and best practice, but rather because of the clinics and the policy makers IGNORE THEM and the patients are the ones that suffer.  I happen to believe that this is medical malpractice, but can never find an attorney willing to take this clinics and policy makers on. After all we are the most HATED patients in the system.

Here is an example, please do not ignore the since and stop acting capriciously.

New York Plunging into a Disaster
New York like many other states across the country is in the middle of a heroin epidemic.  Last Fall Governor Cuomo launched a Combat Heroin Campaign and this week Senator Schumer called on more Federal funding to combat the growing heroin epidemic. So what does the NYS Office of Alcoholism and Substance Abuse Services (OASAS) do; the agency in charge of treatment in the state?  They are closing 5 methadone programs in the Bronx!  Methadone treatment has been demonstrated to be the most effective treatment for opiate addiction.
The owners of Narco Freedom have been indicted on criminal charges of insurance fraud, money laundering, bribery and grand larceny.  The state has removed them from managing the program and that leaves us with the patients. These 3200 patients at NARCO FREEDOM are in comprehensive treatment consisting of medication in conjunction with counseling and other appropriate services. Many have gotten their lives back together and are engaged in productive activity. What is the state’s best solution for the health and well-being of these patients? Close the 5 programs down, take away any privileges the patients have earned over the course of their treatment, assign them to Interim Treatment. 
Interim Treatment requires patients to come daily for medication without the required comprehensive services. Interim Treatment was developed over 20 years ago during the HIV epidemic because many OTPs had waiting lists and to get drug users at least the minimum of treatment until a place was open on a comprehensive program. It was never intended to move patients from a comprehensive program into minimum treatment.
Whenever a program closes typically 10-15% of the patients do not make it to their new program. They relapse to active drug use.  Even those patients that manage to make the transition will have to rearrange work and school hours to come to Interim treatment every day. In addition the state which currently has no Sunday treatment is planning on sending these patients to our already overcrowded emergency rooms to get their Sunday medication.  This is not a solution to the problem.
The National Alliance for Medication Assisted Recovery (NAMA-R) urges that the Governor Cuomo step in and order OASAS to find new ownership to take over these programs.
This is by far the best solution for the patients and will cost the state nothing!