“There is nothing new under the sun but there are lots of old things we don't know.”
― Ambrose Bierce
Science and discovery - expanding the limits of our concepts of reality - takes real imagination. Pseudoscience (or the cheap imitation, as Sagan called it), not so much. Perhaps that is why old ideas are recycled over and over again as if they were new with the world of pseudoscience. Alternatively, new ideas are stolen from real science and then twisted into the latest scam.
In my previous post for Swift I covered the common features of the "quack clinic" - clinics or practitioners making dubious claims that are not based upon science and evidence. In this article I will cover the different categories of unscientific medical claims.
While there is an endless parade of new unscientific health products and services, they are largely a repackaging of the same basic themes. Understanding these themes is helpful in dealing with the flood of nonsense. Being able to say, "Oh, that's just another version of X," is a huge time saver. Here are some of the most common "flavors" of medical pseudoscience you are likely to encounter.
I have to start with the notion of vitalism - the idea that life is different from non-life because a living force animates it. This was, perhaps, a reasonable idea in pre-scientific times, and every culture seems to have come up with their own version of the life force (chi, prana, spiritus, etc.).
The early scientific community took vitalism seriously, but it was always little more than a placeholder. Whatever could not be currently explained by biology and chemistry was left to the vital force. Eventually, however, all basic biological processes gave way to purely physical explanations, and there was simply nothing left for the vital force to do. It therefore simply faded away from scientific thinking.
No old and discredited idea is ever wasted, however, and so modern charlatans have repackaged the notion of a vital force many times. Straight chiropractic is based upon vitalism. D. D. Palmer's original concept of chiropractic, one still held by some modern chiropractors, is that the life force (called Innate Intelligence) descends from above, through the brain, and then to the rest of the body through the nerves. Subtle subluxations or displacements in the bones can block the flow of innate, causing disease and symptoms. The purpose of chiropractic adjustments is to fix these subluxations and restore the flow of innate.
Therapeutic Touch and Reiki are also vitalistic practices. TT practitioners claim to be able to feel the "human energy field" and manipulate it with their hands, or energize it with their own energy.
Homeopathy is also a vitalistic belief. Hahnemann believed that homeopathic potions contained the essence of what had previously been diluted in them, and this essence is then transferred to the person taking the "remedy".
Acupuncture is also a vitalistic practice. Interestingly, there is good evidence that historically acupuncture was closely tied to bloodletting. In fact it was believed that chi, the life energy, flowed through the blood - that they were functionally one and the same. Modern manifestations of acupuncture, however, downplay the blood angle and speak of just pure chi energy.
The idea of a template or pattern is a very old one in human thinking. This explanatory model was applied in many areas, even ones that now seem quaint. For example, it was once hypothesized that each sperm had a tiny but complete animal inside, a little homonculus, which would grow into the adult creature. The concept of a list of genetic instructions had not yet entered human thinking.
Many pseudoscientific diagnostic and therapeutic schemes are based upon the quaint idea of the homonculus. I should note that in neuroanatomy there are real homonculi - where the body is mapped inside the brain for sensation for motor control, for example. This, however, is quite separate from the imaginary homonculi claimed by certain dubious practitioners.
Irididology is the practice of diagnosing illness by examining the iris of the eyes. The claim is that the little flecks of color in the iris map to the various parts and organs of the body. Of course there is no anatomical or clinical evidence of such a connection or mapping, but that doesn't stop adherents.
Reflexology also relies on a similar mapping of the body on the soul of the foot. Auricular acupuncture places the homonculus along the outer ear. Korean hand therapy places the homonculus on the hand.
These various schemes are just a convenient way of claiming that one simple method (like foot massage) can affect the whole body. In every case, however, there is a complete absence of any underlying anatomy or physiology.
Ever since the ancient discovery of magnetic stones magnetism has had a certain mystique that has been exploited by charlatans. It is tempting to believe in the healing power of magnetic fields or electrical stimulation. It feels like magical energy, and it also feels sciencey.
Scientists had to debunk quack magnetic devices two centuries ago, and today the same claims are being endlessly recycled with just some updating of the jargon. The products are little more than magic amulets - wear the necklace, bracelet, ring, or whatever and you will magically feel better, have more energy, lose weight, have a better sex life, more flexibility, and greater athletic performance.
When magnetism was new, that was all that was necessary. Interestingly, when radiation was new and exciting that was the focus of quack remedies for a few decades, but eventually the deadly effects of radiation had a negative impact on the market - although still it took FDA action to close down the selling of radioactive health products.
Today the sellers of magic medical amulets use words like "vibrations," "frequencies," "ions,” and of course the near ubiquitous, "quantum." Sciencey jargon is just scrambled up into an incoherent technobabble meant to dazzle the scientifically illiterate. (As an aside, I am sometimes criticized for pointing out such scientific illiteracy, as if it's impolite. I am sorry to be the bearer of impolite news, but I stand by the position that if you purchase a small piece of plastic and rubber to wear around your wrist because you think it will improve your balance and flexibility, you are scientifically illiterate and/or lack significant critical thinking skills.)
Nutrition is a very legitimate part of science-based medicine. The basic knowledge of nutrients, vitamins, metabolism, etc. were all discovered by mainstream scientists, and continue to be researched as any other medical discipline. There are many evidence-based recommendations for specific supplements in specific situations - like folic acid for women trying to get pregnant.
The pseudoscience comes from making grossly exaggerated claims about the potential for nutritional therapy. The dubious concept that is often exploited is the notion that if a little is good then more must be better. This leads to recommendations for megadoses of vitamins or highly restricted diets to consume only "good" foods.
There is no compelling evidence for any of this, and in fact there is growing evidence for risks from any extreme diets or supplementation.
Often claims are made that many if not all diseases are really symptoms of malnutrition, even when we know that there are other mechanisms of those diseases. There are many nutritional risk factors for certain diseases, but that is not the same thing as those diseases being caused by poor nutrition, which is often claimed. Further, evidence that a specific supplement may reduce the risk of a disease does not mean the same supplement will treat the disease when it occurs.
There are some of the common ways in which the nutritional literature is distorted in order to sell billions of dollars worth of unnecessary, and perhaps even harmful, supplements to the public.
Another significant conceptual problem is missing the concept of homeostasis. Living organisms have evolved elaborate mechanisms for maintaining their own biochemical and physiological balance. Trying to alter this system by taking large amounts of one substance makes little sense.
Antioxidants are a good example. They do play an important role in the body, but so do the free radicals they eliminate. Free radicals, for example, are used by the immune system as weapons against invading organisms. Taking large amounts of exogenous anti-oxidants may not be a good thing, as it will disrupt the homeostasis that ordinarily exists in the body.
Of course the body's mechanisms often break down resulting in disease, and then it may make sense to compensate by blocking or enhancing some biological factor. But this should always be done with caution and humility for the complexity of the body as a system - and of course with clinical evidence to see what the net health effect is.
The bottom line here is to be highly skeptical of simplistic notions that the functioning of the body can be significantly improved just by taking a supplement. Any such claims need to be clinically evidence based, not just based upon a speculative extrapolation from some basic science.
These are just the few most common themes you are likely to encounter in the world of dubious medicine. You will see these themes repeated in countless variations. There are a few others worth discussing, but that will wait for a later article.
Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s Science-Based Medicine project.
Dr. Novella is an academic clinical neurologist at Yale University School of Medicine. He is the president and co-founder of the New England Skeptical Society and the host and producer of the popular weekly science show, The Skeptics’ Guide to the Universe. He also authors the NeuroLogica Blog.