Understanding CAM believers

Buried 21 pages into the Wellcome Monitor, which I have alluded to in other posts, is a breakdown of what CAM modalities people use.  It raises a lot of questions, but it is well worth a look to get an insight into the popularity unreality medicine:

It's not clear to me just how this survery was conducted.  I'm guessing that people were asked what CAM they used, without prompting from a list.

The popularity of herbal medicine is startling, and it raises the first question: how many people surveyed knew the difference between herbal therapy (something that could possibly work) and homeopathy (utter nonsense)?

There's also something conspicuous by its absence: chiropractic.  There are three chiropractors in my high street, so it is not an unpopular CAM modality.  These data possibly suggest that most people don't consider the spine wizards to be a CAM at all. 

The really scary data concern the types of people who adopt CAM, and they might shock the average skeptic.  People who use CAM are likely to be:

• Women (51% compared to 39% of men)
• 50-65 years old (55% compared with 35% in the 65+ bracket)
• Educated (48% compared with 39% having no higher education qualifications)

There are a lot of unanswered questions there. 

Finally, the survey dug a little deeper into the public perception of homeopathy.  In one section, people who did not use homeopathy were asked why this was the case:

• 33% Haven't had an illness where this sort of treatment needed
• 32% Nobody had ever advised it
• 17% No scientific proof of effectiveness
• 5% Conventional drugs more effective
• 3% Too expensive
• 25% Never heard of homeopathy

[NB: respondents could give more than one answer.]

These data suggest that for many people, homeopathy simply isn't on the radar. Less than 2 in 10 people are bothered by its questionable effectiveness; indeed more people have never heard of it at all.  No wonder homeopaths are so vocal.

What is a significant reduction in CAM usage?

In science, we generally decide in advance that an experimental observation is significant when it is unlikely to occur by mere chance less than one time in twenty observations.  Thus, the P<0.05 rule that frustrates us when P=0.051, and the next repeat of an experiment shifts it to P=0.1.  The next experiment will probably push P to 0.2, because the first couple of repetitions were total flukes.

In clinical trials, the same rule applies, but we also have to consider if a finding is clinically significant. A different approach might be significantly better than another, but how many patients would actually benefit, and how much of a difference would it make to their lives? A statistically significant increase in life expectancy of 1 hour is hardly worth taking a drug worth £5 per dose, three times a day for thirty years.  Some drugs cost tens of thousands of pounds per year, and can extend lives by as little as a month on average.  Poor old NICE has to make these decisions about cost:benefit ratios.

So, what kind of change in public perceptions of quackery is significant? I'd guess that if 75% of people agreed that something as stupid as homeopathy is in fact stupid, you'd be onto a win.  Recent experiences with my supposedly clever students (via @DrAust_PhD) suggest that this is about the best that can be achieved, even with fairly intensive, didactic instruction.

So, if 45% of people have resorted to CAM, and of them only 18% of people have used homeopathy, hasn't the battle on that front pretty much been won?

Or, should we be aiming for a reduction of total CAM usage down to 25% or less? 

Feel free to argue the toss.


See the Wellcome Monitor, again, for the numbers.

Who are the effective mouthpieces?

Effective communication is the business of getting people who are listened to, to say things.

So, if we are going to change people's perception of say, CAM, we need to find out who they listen to when it comes to medical matters.

Now, the Wellcome Monitor survey I referred to earlier didn't specifically ask who people turn to for medical advice, but they did ask about medical research.  The breakdown of preferred sources of information on medical research looks something like this:

Two things mean that blogging away here would actually be constructive, providing I had a significant audience:

(1) I'm a scientist, a preferred source of information (especially for younger people).
(2) People get 33-81% of their medical information from the internet (depending on their level of education).


Now, I don't have the energy to try and build a significant web audience to communicate medical matters to, so we'll cross that out from the start.  Most people would probably feel the same way.

So, what to do?  Well, getting clinicians with a significant audience to speak out more against CAM (our example in this case) would be one way.  Preferably, clinicians with a significant online following.  Dr Goldacre comes to mind, of course, but his audience is a pretty narrow field.  Furthermore, he's widely (if erroneously) seen as a journalist, and they rate at the bottom of the pile when it comes to public trust. Note: he's doing a fabulous job all the same.


If I was really interested in changing public perceptions of CAM, I'd be writing to every clinician who writes for a newspaper, asking them to be a little more critical and reminding them that they are very influential.  So that's what I'll be doing from now on.  And encouraging others to do the same.


What else could we little folk be doing, do you think?

Assessing the damage

To understand the depths to which we have sunk, we need some data.  Now, as a senior lecturer at a London medical school, my interests lie in medical endarkenment.  The best data set I've come across in this area is the Wellcome Trust's Wellcome Monitor.  It is a high quality survey of over 1000 UK residents views on science, and medicine in particular.  The Trust aims to repeat the survey in the future, which will be an invaluable resource.

If you know of a similar data set in another area, let me know and I'll add it

Most of the questions in the Wellcome Monitor are fairly medically-oriented, but there are some simple observations on common myths that are quite informative.  Take astrology:

 

There's some good news there.  A surprising number of people claim to never read their horoscope.  As I occasionally read my horoscope in the paper for a laugh, I'm in the rarely category. So, an impressive 79% of people read their horoscope either rarely or never at all.  Fortunately, a similar number of people (69%) consider astrology to be "not scientific at all", and only 1% of people suffer from the delusion that this witchcraft is "very scientific".  

There's some scope there for improvement, but on the whole, the UK public seem to be pretty well informed when it comes to astrology.


On the other hand, the news for people interested in the scam that is complementary and alternative medicine (CAM) is less encouraging:

Yes, you are reading that data correctly, 45% of people surveyed by the Trust have used CAM.


So, while 69% of people are aware that astrology is nonsense, only 55% of people hold the same view of CAM.  There's some work to be done there.


EDIT: Thanks to @xtaldave for pointing out that 1% of the UK population is roughly the population of Glasgow.  That's how many people think that astrology is "very scientific".


*headdesk* indeed.



[Next: Who are the effective mouthpieces?]

"I don't believe in molecules"

This opening post takes its title from a comment left on a science journalist's (@TomChivers) blog. You can read it, and the predictably lengthy exchange of apparently insane and rational comments that followed it in equal measure, here.

Molecules exist. Unfortunately, we now live in a world where many feel they would have to apologise for saying as much.

Is there really any point in engaging with people who wander about a world so beautifully made of molecules, all the while denying that molecules exist?

These people are so untouchable, that they will happily argue - at length - with a simple computer algorithm, without realising it. Watching thoughtless people argue with a database of counter-arguments could well become a new sport.

If you spend some time looking at blogs and the associated comments, you could easily fall into the trap of thinking that there are only two types of people in the world: the forthright, stoic and completely rational, and their naturally enemy, the borderline insane. But, it is a trap, because so many people don't leave a comment at all. Blog traffic statistics confirm this time and time again.

This majority of voiceless readers are the people who may be lost in the mire of the endarkenment. Hundreds of equally vitriolic blog comments possibly do nothing to help many of them back towards truth and reason

Comments threads often appear to be little more than a battleground for two diametrically opposed groups, with equally immutable views; a place to enjoy the ritual of repeating the same old tired counter-arguments. Nomadic trolls and counter trolls appear move from blog to blog fighting their endless battles. Is it really worth all that effort to persuade just one, of possibly thousands of voiceless readers, who can be bothered to follow it all?

So, point 1: Let's leave the untouchable trolls to algorithms. No one will notice the difference. Is that dishonest?

Point 2: We need to think about how to communicate with the voiceless. One way conversations are trying. Any lecturer will tell you that.

Who would be best placed to do the talking, and what should they be saying?

[Next: Assessing the damage]