We can all understand why someone with a chronic illness who hasn't found a successful treatment will turn to alternative medicine. Just the hope of finding a treatment can produce a placebo effect which will make them feel better. If they hear positive recommendations from friends, that will increase the placebo effect, and they'll tend to feel better still. So there's a good explanation for the attraction of customers to alt-med offerings. Couple that with a longer consultation, personal attention, questioning about all aspects of their lives, and the use of pseudo-science or mystical phrases and it's all too easy to see the attraction.
But what about the psychology of those who are selling these therapies? Somewhere along the line, they crossed over the counter, from consumer to seller, from looking for treatments for themselves to running a business selling them to others.
There's one sceptic school of thought that regards them all as charlatans, frauds, venal types who don't care what they say as long as they make money. But this is hopelessly wide of the mark. The truth is that the overwhelming majority of those who sell alt-med therapies are well-meaning, caring individuals who genuinely believe that what they are doing helps their customers. Based on their own experience, and the reports from other people, they have chosen to devote their time and money to working in the alt-med industry for honourable reasons.
Their willingness to help, their keenness to offer relief to people who are suffering, their belief that what they do is valuable, are all very laudable characteristics. And if their practises were evidence-based, there would be good reason to support their efforts. But there is a palpable lack of evidence, an abundance of trials which demonstrate no effect beyond placebo, a desperate shortage of any explanation of the alt-med claims, severe conflicts with known human physiology and biochemistry, and in many cases, a contradiction of known fundamental physical laws. Faced with so much evidence against these therapies, why are people still attracted to them? How do they become convinced that it is acceptable to sell them?
A major factor in the psychology of the Woo practitioner is the belief in the value of anecdote. When someone tells you they are better after an illness, what more evidence could you want? What could possibly be more accurate than a first-person report from a person affected? How can anyone doubt the reports of patients who have received the therapy? If you believe such anecdotal reports, you will not feel that there is any need for further evidence.
Unfortunately, the anecdote is the most unreliable type of evidence available. It is necessarily influenced by the values, beliefs, impressions, perceptions, hopes and expectations of the reporter. Often it is simply mistaken or confused, sometimes it is deliberately biased, always it is untrustworthy. Even if the reporter believes they themselves are being honest, they may well be unaware that they are reporting inaccurately. All of these forms of bias can be very easily confirmed by experiment, and have been; the bias inherent in anecdotal evidence has been known for centuries. Before anecdotal evidence can be accepted, it has to be free from bias. Those who are committed to alternative medicine nevertheless place enormous importance on anecdotal accounts – they simply believe them and see no reason to doubt them.
This misunderstanding of what constitutes reliable evidence is widespread amongst alt-med practitioners and is reflected even in those quasi-academic papers published in alt-med journals. The scientific community typically uses double-blind, controlled trials to eliminate the otherwise inevitable bias in trials, but this practice is often not followed in papers published in alt-med journals. They often simply publish case studies reporting anecdotal accounts from patients. Double-blind simply means that neither patient nor practitioner knows whether or not the patient in the trial is receiving real or fake treatment. This ensures that the results of the trial are not biased, and enables a comparison to be made. Without the double-blind aspect of the trial, no genuine comparison can be made.
So alt-med practitioners have a very different view of what constitutes sufficient evidence, placing undue weight, and even total reliance, on anecdotal accounts. But is that it? If so, a simple presentation of the facts would convince them otherwise. But that hasn't happened. Alt-med practitioners resist the appeal of evidence and controlled trials. No matter how many truckloads of evidence land at their door, they still won't take it seriously. What is the source of this resistance?
A second thread is the belief that there is some alternative world of medicine which has been systematically neglected, that somehow the scientific view has underestimated a number of other powerful mechanisms for curing people of illnesses. Often it is seen as conspiracy involving the pharmaceutical industry. This alternative medical world is variously claimed to include energy sources like Qi, remedies such as herbal potions, and mystical entities such as chakras, doshas, channels, and so on. The belief is so strong in these entities that despite acknowledging that there is no evidence even of their existence, the practitioners are still willing to offer treatment and take money from patients on that basis.
By having a rationale for turning away from clinical evidence (after all, science has hidden from us this alternative medical reality), they feel justified in seeking non-evidenced confirmation of their beliefs. The belief therefore takes the place of evidence, and they see as a source of evidence other people repeating their same beliefs. Hearing their own beliefs repeated fulfills for them the role of evidence.
This is as much true of the belief in subluxations in chiropractic, as it is in the belief in meridians in acupuncture, or healing energy in the case of Reiki. None of them are supported by any evidence, but the practitioners see no reason to require it. They sometimes even claim that scientific techniques are incapable of detecting their chosen mystical entity or of investigating their techniques.
This psychology makes alternative medicine almost impervious to reason, relying as it does on self-justifying belief and anecdote. However, this causes something of a dilemma for the alt-med practitioner. If they are going to get official recognition, they have to be able to demonstrate efficacy. If they are going to get insurance companies to fund these treatments, they need to accumulate some evidence to show success. And since the only evidence they have is the anecdote, they have to persuade medical authorities to accept it as evidence. And that's the core of the conflict between medicine and alternative medicine. As far as the clinical practitioners are concerned, if it works it's medicine plain and simple, not in any way alternative. But the alt-med community can't provide the evidence. Instead they have to rely on believers swaying the regulatory framework, as for example in the case of homeopathy in the UK.
Where does all this leave the practitioner of alt-med? In a rather difficult position. Because if they acknowledge the need for evidence, they end up accepting that their business is based on very shaky foundations. But if they reject the need for evidence, they have little basis on which to make their claims. That's precisely why the reaction against chiropractors in the UK was so severe when they made claims to be able to treat childhood colic. In that case, they claimed there was evidence and submitted it to the BMJ, who rejected it totally on the grounds that it categorically did not demonstrate efficacy – they didn't have the evidence. But had they not presented something it would have been obvious that they were making unjustified claims.
The same applies to Reiki practitioners who claim to be passing invisible, undetectable energy to their patients, sometimes even at a distance. With absolutely no evidence even of the existence of this energy, the consumer is justified in demanding how even the practitioner can claim to know what is going on.
And that leads us to the closing of the loop. In order for Woo therapies to be sold, the customer has to be changed from a buyer into a believer. If they are believers, they won't ask for any evidence beyond a shared belief. A customer buying a TV that works on a new kind of energy will want to see a demonstration, they'll want tangible evidence that it works. But a Reiki patient only has to be converted into a believer, then they won't ask about evidence or proof. They'll open their mind and their wallet at the same time.
So the transformation of the consumer of Woo into a seller of Woo is very much a process of instilling belief. The stronger the belief, the stronger the acceptance of anecdote as sufficient evidence, and the stronger the conviction that there is an alternative world of medicine hidden by conventional science, the more impervious they become to real evidence, clinical trials, and measures of efficacy.
Unfortunately, for those well-meaning people who want to help others, it's a delusional path. Some people wise up and realise what has happened, as in the case of Karla McLaren, a new-age practitioner. Her article explains in some detail the difference between the cultures of the real world and new age. It should be required reading for all those interested in alt-med. Karla McLaren is reorienting her business activities away from the Woo nonsense, trying instead to understand the psychology of how it can be so successful in the face of so much contrary evidence.
Along with debunking pseudoscience and false claims from the alt-med community, we also need constructive ways of drawing these practitioners back into the evidence-based world of clinical science. It is important to question their belief in this other world of alternative medicine and bring them closer to an understanding that if it works, it's medicine itself and not some alternative. But first they have to demonstrate their therapies working, and that demonstration has to meet the exacting standards of clinical evidence.
Belief in a product is no basis for making clinical claims. If alt-med wants to be accepted in the mainstream, it has to come up with the evidence, and until such evidence is available, its practitioners should stop making outlandish claims of efficacy. The sheer lack of evidence together with the outlandish claims made by many Woo practitioners is inviting a quacklash, and we may well see many Reiki sellers and others starting to think seriously about other lines of work.