MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Research is essential for progress, and research in alternative medicine is important for advancing alternative medicine, one would assume. But why then do I often feel that research in this area hinders progress? One of the reasons is, in my view, the continuous drip, drip, drip of misleading conclusions usually drawn from weak studies. I could provide thousands of examples; here is one recently published article chosen at random which seems as good as any other to make the point.

Researchers from the Department of Internal and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen, Germany set out to investigate associations of regular yoga practice with quality of life and mental health in patients with chronic diseases. Using a case-control study design, 186 patients with chronic diseases who had elected to regularly practice yoga were selected and compared to controls who had chosen to not regularly practice yoga. Patients were matched individually on gender, main diagnosis, education, and age. Patients’ quality of life, mental health, life satisfaction, and health satisfaction were also assessed. The analyses show that patients who regularly practiced yoga had a significantly better general health status, a higher physical functioning, and physical component score  on the SF-36 than those who did not.

The authors concluded that practicing yoga under naturalistic conditions seems to be associated with increased physical health but not mental health in chronically diseased patients.

Why do I find these conclusions misleading?

In alternative medicine, we have an irritating abundance of such correlative research. By definition, it does not allow us to make inferences about causation. Most (but by no means all) authors are therefore laudably careful when choosing their terminology. Certainly, the present article does not claim that regular yoga practice has caused increased physical health; it rightly speaks of “associations“. And surely, there is nothing wrong with that – or is there?

Perhaps, I will be accused of nit-picking, but I think the results are presented in a slightly misleading way, and the conclusions are not much better.

Why do the authors claim that patients who regularly practiced yoga had a significantly better general health status, a higher physical functioning, and physical component score  on the SF-36 than those who did not than those who did not? I know that the statement is strictly speaking correct, but why do they not write that “patients who had a significantly better general health status, a higher physical functioning, and physical component score  on the SF-36 were more likely to practice yoga regularly”? After all, this too is correct! And why does the conclusion not state that better physical health seems to be associated with a greater likelihood of practicing yoga?

The possibility that the association is the other way round deserves serious consideration, in my view. Is it not logical to assume that, if someone is  relatively fit and healthy, he/she is more likely to take up yoga (or table-tennis, sky-diving, pole dancing, etc.)?

It’s perhaps not a hugely important point, so I will not dwell on it – but, as the alternative medicine literature is full with such subtly  misleading statements, I don’t find it entirely irrelevant either.

7 Responses to Alt med = a continuous flow of misleading conclusions

  • Couldn’t agree more. Why wouldn’t turning on its head be equally true!
    On another point I have recently been diagnosed with cancer, and. Have been amazed at the number of folk beating a path to my door to advice me( I’m a doctor too) that I must be on cannabis oil as it definitely cures cancer( huge conspiracy of course) and that I must be on Vitamin D high dose, and various other cures. Because of that, for interest as you do I have been reading through the ‘literature’, and for ‘lay people’ it’s immense and incredibly confusing.
    So no wonder folk think there are ‘cures’ out there worth delving into.

  • I like to challenge believers with the Telly Test. Yesterday a natural medicine monger told me an anecdote about his grandmother who after twenty five years of anti-depressive meds has developed Parkinson’s. I asked does she have a television. Why yes he answered. Then how do you know that the television didnt cause her Parkinson’s rather than the medication.

    Causation is tricky. But necessary.

  • Today my hairdresser who was sorting the locks said.. Do you have a dog, and I said yes, and he said there that’s the reason, it’s because a virus in the slobber causes breast cancer… All dogs should be outside..
    What next??

  • I see your point, a correlation can indeed be looked at from both directions. The question would then be, how would one test the direction?

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