Confirmation bias is the most potent of all the cognitive misconceptions. Often referred to as a critical thinking shortcut, you start out with a rational thought and then warp it into a poorly conceived notion where real evidence is supplanted by personal experience. We are all guilty of it. Each time you say “I think bottled water tastes better than tap water” or “I can tell the difference between organic fruits and conventially grown fruits” you are lying to yourself. 

Consider that Aquafina is merely bottled tap water. Why does it seem to taste better? The explanation is much simpler than the idea that you have a superhuman ability to taste properties of water that are unknown to science. It could be as simple as when you purchase a bottle of Aquafina, it comes perfectly chilled in a cool looking bottle. Isn’t that more appealing than drinking a lukewarm cup of water straight from the tap in a boring ceramic mug?

The great irony in this is that confirmation bias is demonstrably wrong.  Penn and Teller did an episode with blind taste testing. They took people who were absolutely convinced that organic foods taste better or bottle water tastes better and what they found is that people could not tell the difference. In fact, people often picked the opposite. This is hardly scientific evidence that organic does not taste better, but it interesting and entertaining nonetheless. However, here is an actual blinded and controlled study from the journal Nutrition and Food Science. They concluded “that the global claim that “organic food tastes better” is not valid.” They found that some organic products tasted better and some conventional products tasted better. Exactly what you would expect from a random sampling.

So why do we select data to confirm what we already “know?” It is simple, we value or own experiences over that of what science has to say. Anecdotes are valued over data. People often fall back on “well I don’t care what the studies say, in my experience…” Human experience is limited. Our logic is flawed. This is why science exists and this is why scientists collect data. They are seeking to overturn our misconceptions. So the next time you find yourself selecting experiences to agree with your preconceived thoughts, ask yourself if it is scientifically plausible. And the next time you eat a juicy and delicious organic grape don’t try to justify your purchase by saying it tastes better. It doesn’t. Your just forgetting all the good conventional grapes you’ve had, while simultaneously remembering only the best of the organics.

Airborne

March 2, 2010

When I first heard of this supplement years ago, I had hoped that it would fade away after a brief period in the limelight. After the FTC successfully sued Airborne for false advertising in 2008 (winning a total of $30 million for customers), I thought the matter was settled. Unfortunately, the company has returned stronger than ever. I saw a commerical on TV the other day and even more to my dismay, when I got a cold recently, a coworker suggested that I take Airborne. I tried explaining to her that it was unproven and probably useless, but she insisted that it “worked” for her. So here we are, but first, some background.

Background:

Airborne was invented by an elementary school teacher. Indeed, the website using this as a selling point. Why, I can’t imagine. It goes on to say that it is a drug-free formula. Fantastic, I can pretty much stop the post right here. If there are no active ingredients, then it doesn’t have any pharmacological effect. They are just short of admitting this product does nothing. Aiborne manages to salvage possible utility from the jaws of uselessness with the questionable claim that it “boosts” your immune system.

What’s in it?:

The website claims that its special blends of vitamins and minerals has been shown to support the immune system in scientific studies. Yet, they supply no references for these studies. This makes my job a little more difficult. The website lists Zinc, Ginger, Echinacea, Vitamins A, C, and E, Selenium, Manganese, Magnesium, some sketchy magical “herbal blend”, Riboflavin, and Amino Acids as the ingredients. That is a long list of what is essentially a multivitamin. Let’s look a big deeper…The National Center for Complementary and Alternative Medicine (part of the National Institutes of Health) conducted a study of 437 adults and found no effect of Echinacea more than placebo. One down, 12 to go!

Vitamins A, C, E, Zinc, Manganese, Magnesium, and Riboflavin all play important biochemical roles in the body and should be part of a healthy, balanced diet. If for some reason you are not getting enough vitamins and minerals in your diet, then you should take a far cheaper multivitamin. So yes, these products boost your immune system, but only in the sense that a deficiency in them leads to a depressed immune system. Once your body uses all the Vitamin C it can handle (approximately the amount you should already have in your diet or from a multivitamin), then you just excrete the rest in your urine. In fact, the myth that vitamin C will help you fight off a cold has been pretty well debunked. Furthermore, Airborne uses the faulty logic that a lot of a good thing must be a great thing. Megadosing of Vitamin C has side effects such as diarrhea. Adding diarrhea to my list of cold symptoms without any resolution of my cold symptoms does not sound very fun.

A quick search showed no evidence either way for Ginger. And the amino acids? I think they just added those to sound smart. Amino acid is one of those terms that people love to toss around. A normal person gets their amino acids from eating protein (any protein: milk, meat, beans, wheat, etc.). I fail to see how Airborne can boost your immune system by adding amino acids. Of course, I fail to see how Airborne can boost your immune system period.

Dubious Practices:

Finally, I come to my favorite part. This is where Airborne gets very dodgy. Apparently, a press release for the company once claimed that the product would get rid of a cold within an hour. Advertisements encouraged people to take Airborne at the first sign of a cold. The company later retracted this cold-cure claim and switched to the weasely “immune booster” claim–supported by a double blind, placebo controlled study, no less!

ABC News’ excellent expose revealed that the company hired to do the clinical trial was a 2-man business started up purely to do the Airborne study. No doctors, scientists or actual research. All mention of this study is now removed from the Airborne website. “We found that it confused consumers,” Donahue said. “Consumers are really not scientifically minded enough to be able to understand a clinical study.” I died laughing at that. Way to insult your customers Airborne. They’re too stupid to understand possible fraud? I do not think so.

One last point that I enjoyed: the man who conducted the disappearing study claimed to have lots of clinical trial experience and an undergraduate degree from Indiana University. ABC News revealed that he had never graduated from Indiana.

Conclusion:

Airborne is more or less an expensive multivitamin. It is almost definitely useless for any sort of acute treatment of the common cold or flu-like symptoms. What’s the harm? You lose $6.99 on a worthless treatment. It is not so much the money that bothers me, but the very affront to science and common sense that this company respresents. They literally flaunt the pseudoscience in our faces and people keep buying this ridiculous product. The only shred of evidence that the CEO can provide is that it “works” for 40,000 people who wrote testimonials in to the company. Argumentum ad populum is a logical fallacy. Just because a lot of people like it does not make it legitimate. Furthermore, the concept that it worked for them means nothing more to me than the placebo effect. If you want to buy it, fine, but you’re a moron (according to the CEO who says you can’t interpret scientific literature). Challenge Ms. Donahue’s words and read the literature. I do not think you will ever buy Airborne again.

Prayer in Medicine

February 25, 2010

This topic is a touchy one. I am responding specifically to things that Dr. Mehmet Oz has claimed both on his show and in other public appearances. To begin with, Dr. Oz may be a doctor, but he is a poor scientist. He believes in Reiki (energy healing),  acupuncture and other forms of alternative medicine. None of these modalities have ever been proven effective. Dr. Oz claims that prayer has helped patients recover from cardiac procedures, but that is a highly questionable claim.

He introduces the topic by citing the Byrd study. This study, performed in 1988 was one of the first to investigate intercessory prayer (prayer by other people). The author summarized the findings as “these data suggest that intercessory prayer to the Judeo-Christian God has a beneficial therapeutic effect in patients admitted to the coronary care unit.” The study makes prayer sound pretty good. However, the actual data show very few statistically signficant findings. For example, the study shows that 2 patients in the prayer group and 7 patients in the control group went into cardiopulmonary arrest. This is a statistically significant difference, but the sample size is extraordinarily small.

Furthermore, the most important comparison point between groups would be the average number of days a patient spent in the intensive care unit. Unfortunately for prayer, there was no difference between groups. This paper also goes on to cite Biblical passages of healing as examples where prayer has been efficacious. The Bible is not a source of scientific literature and should be not cited as such. Dr. Oz completely mischaracterizes this study by saying “the people who got prayed for did better.”

He then goes on to cite even more nonsense. The semi-famous (Time did an article on in it) Korean “Miracle” Fertility study.  Basically, the study demonstrated that prayer increased the fertility of women who were trying to conceive. In reality, the study has been since retracted over allegations of fraud. It seems the authors falsified data. One of the main authors is currently serving prison time for fraud. All of this took place in 2004, yet Dr. Oz is still citing the study as evidence that prayer improves people’s health.

Finally, he brings up the MANTRA II trial. He is vague and simply says “we saw some intriguing findings.” Of course, he neglects to mention that those intriguing findings are summarized in the abstract as “neither masked prayer nor MIT (music, imagery or touch) therapy significantly improved clinical outcome after elective catheterisation or percutaneous coronary intervention (heart procedures).” Given the inconclusive data, this is a fair statement. However, the authors go on to say in the discussion “the MANTRA study project represents a continuing effort to collect systematic, scientifically structured information on widely practised, intangible therapeutic approaches for which we have essentially no mechanistic understanding.” If something is intangible, then why try to measure it? How can you measure it?

Of the above three studies, one was inadequate, one was fradulent, and one found no effect of prayer. The STEP study, on the other hand, showed a very interesting result. The study included 1802 patients compared to Byrd’s 393 patients. “Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.” The patients were split into 3 groups. One group received intercessory prayer after being informed that they may or may not receive prayer, one group did not receive intercessory prayer also after being informed that they may or may not receive prayer, and the third group received intercessory prayer after being informed they would receive prayer. This final group were significantly more likely to develop complications post-bypass surgery.

Thus, prayer did not have a positive effect on outcomes and furthermore, when patients were certain they were going to receive prayer, they were more likely to have complications. My suspicion is that patients who knew they were being prayed for may not have taken their drug therapy or cardiac rehab as seriously because of the false notion that they were being taken care of. This idea, of false assurance through prayer, needs to be investigated to see how it influences outcomes.

Conclusion:

I think Dr. Oz makes obviously false claims about the efficacy of prayer in medicine and I hope no one gets duped by his pseudoscience. After reviewing the current literature, I also question the use of research funds for such studies. The proponents will constantly claim that any inconclusive studies have “intriguing findings” and thus, we should fund more studies. We do not have a proposed mechanism for the benefit of intercessory prayer (no, God is not a mechanism). We are trying to extrapolate the healing power of prayer from historical anecdotes and Biblical stories to patients with serious medical problems that need science-based treatments. This is not science. And most assuredly, Dr. Oz is not a scientist.

First Post

February 23, 2010

I am writing this blog so other people will read it. I know very few people will, but I don’t really care. The main topics I will cover are medicine, history, pseudoscience, and pop culture myths. If you want me to investigate a claim, just comment and I will respond. I have a lot of time on my hands and I enjoy debunking unscientific nonsense.

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