MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The use of so-called alternative medicine (SCAM) are claimed to be associated with preventive health behaviors. However, the role of SCAM use in patients’ health behaviors remains unclear.

This survey aimed to determine the extent to which patients report that SCAM use motivates them to make changes to their health behaviours. For this purpose, a secondary analysis of the 2012 National Health Interview Survey data was undertaken. It involved 10,201 SCAM users living in the US who identified up to three SCAM therapies most important to their health. Analyses assessed the extent to which participants reported that their SCAM use motivated positive health behaviour changes, specifically: eating healthier, eating more organic foods, cutting back/stopping drinking alcohol, cutting back/quitting smoking cigarettes, and/or exercising more regularly.

Overall, 45.4% of SCAM users reported being motivated by SCAM to make positive health behaviour changes, including exercising more regularly (34.9%), eating healthier (31.4%), eating more organic foods (17.2%), reducing/stopping smoking (16.6% of smokers), or reducing/stopping drinking alcohol (8.7% of drinkers). Individual SCAM therapies motivated positive health behaviour changes in 22% (massage) to 81% (special diets) of users. People were more likely to report being motivated to change health behaviours if they were:

  • aged 18-64 compared to those aged over 65 years;
  • of female gender;
  • not in a relationship;
  • of Hispanic or Black ethnicity, compared to White;
  • reporting at least college education, compared to people with less than high school education;
  • without health insurance.

The authors concluded that a sizeable proportion of respondents were motivated by their SCAM use to undertake health behavior changes. CAM practices and practitioners could help improve patients’ health behavior and have potentially significant implications for public health and preventive medicine initiatives; this warrants further research attention.

This seems like an interesting finding! SCAM might be ineffective, but it motivates people to lead a healthier life. Thus SCAM has something to show for itself after all.

Great!

Except, there is another explanation of the results, one that might be much more plausible.

What if some consumers, particularly females who are well-educated and have no health insurance, one day decide that it’s time to do something for their health. Thus they initiate several things:

  • they start using SCAM;
  • they exercise more regularly;
  • they eat more healthily;
  • they consume organic food;
  • they stop smoking;
  • they stop boozing.

The motivation common to all these changes is their determination to do something about their health. Contrary to the authors’ wishful thinking, SCAM has little or even nothing to do with it. The notion was induced by SCAM practitioners who like to think that they play a role in disease prevention, by the leading questions of the interviewer, by recall bias, or by other factors..

What did the wise man say once upon a time?

CORRELATION IS NOT CAUSATION!

 

 

16 Responses to So-called alternative medicine (SCAM) helps improve patients’ health behaviour. True or false?

  • People have very strange ideas when it comes to healthy eating, which isn’t helped by the difficulty of collecting good evidence on the effects of different diets. The evidence these days seems to point to added salt and sugar being very bad, that it is better for the food to be processed as little as possible (e.g. fruit is better than juice which is better than smoothies which are better than fruit-flavoured drinks), that we should eat more vegetables and a greater variety of them, that whole grains and nuts are probably a good idea, that we should eat oily fish once or twice a week, and that red meat, particularly beef, should be limited. And of course that we shouldn’t overeat. Superfoods are a marketing nonsense. Organic food is OK in theory but it isn’t actually healthier, nor is it good for the environment because it requires much more land than modern farming methods, so it is really a luxury for the wealthy who like to fool themselves that they are being virtuous.

  • There is of course no evidence that organic food overall is more healthy.

    • @ Les Rose & Dr. Julian M-K

      It can easily be argued that organic food is overall more healthy by virtue of the fact that it contains less toxins.
      https://www.nbcnews.com/better/health/produce-side-pesticides-what-nutritionist-wants-you-know-about-ewg-ncna864156

      Dr Julian

      I live near one of the biggest food producing regions in the world, the San Joaquin Valley of California.

      My son lives in the SJV, and I visit him there much. I can tell you that modern mass farming is anything but clean, in fact the SJV is a toxic waste site…. the ground and the air.
      https://newrepublic.com/article/75946/how-gross-my-valley

      As to the subject of this SCAM article, I find it interesting that the writer prefers to focus on a “what if” scenario, rather than the results of a study, of the analysis of the 2012 National Health Interview Survey data involving more than 10,000 patients participants.

      All the behavior modifications sited “including exercising more regularly (34.9%), eating healthier (31.4%), eating more organic foods (17.2%), reducing/stopping smoking (16.6% of smokers), or reducing/stopping drinking alcohol (8.7% of drinkers” are legitimate verified health benefits.

      If MD’s were to recommend the same lifestyle changes (and I’m pretty sure they do, with the exception of eating organic), would they not be patting themselves on the back ? And would this writer be questioning the remedy, or the results ?

      Why is it that the author disregards the positive results because he wants to assume a predetermined outcome ? … which he referrers to as SCAM ? What gives him the confidence to make such an assumption ? His conclusion is a best a double standard.
      I could easily pose a similar assumption, do MD’s exhibit success just because patients decided to go and pay them a visit ? … and then to follow the advise of the MD.

      C’mon you high thinkers, you who pride yourselves on critical thinking. This is critical thinking at it’s worst.

      • American farming practices are appalling for many reasons. To a non-American it seems completely insane that you have destroyed the environment to the extent that there are no natural pollinators left and you can’t produce your crops without transporting huge numbers of bees around the country. Or chicken raised in such unhygienic conditions that the meat has to be washed with chlorine in order to kill the Campylobacter and E. coli before it can be sold. Or the use of antibiotics in animal feed which has contributed to their increasing lack of efficacy in treating human infections. Or giving hormones to cattle. Or even the difficulty in getting a proper omelette because it has to be overcooked due to the risk of infection from raw eggs.

        This is all illegal in Europe. However, organic farming is not the only alternative.

  • Organic food is a con trick, designed to appeal to those who, as Julian so neatly puts it “like to fool themselves that they are being virtuous” and can afford to pay the higher prices involved.

    Show me how the present and projected world populations can be fed (sustainably) with organic food and I’ll perhaps buy into the idea. We farmed organically for millennia and had to struggle constantly against one or another form of crop failure or disease. Until the 19th century famines were an everyday experience for lots of people.

    Science lent us a great hand with improved farming methods, but these are under-appreciated right to the present-day (European) fear of GM crops.

    • Frank,

      What exactly is the point of the “con trick”? The only arguments I’ve heard for organic food is safety for farm workers, the water supply, pollinators & other wildlife…things like that. I’ve never heard anyone say it was for the health of the person eating the food.

      • @jm

        I call it a con trick because it was originally promoted on a raft of premises designed to appeal to folk with good intentions and therefore to make money from them. If you’ve never heard claims that organic food is healthier you must live in a very different part of the world from the rest of us.

        The rationale for organic food (in the UK) is a mélange of muddled reasoning, ranging from “it prevents cruelty to animals” to “it tastes better”. Somewhere high up in this muddle comes “its healthier”; this is based mainly on the notion that organic fruit and vegetables are free of pesticides (with a flavouring of “the content is healthier”).

        “Many champions of organic food, such as Prince Charles, have claimed that food grown organically is healthier and more nutritious.” That comes from a page full of good sense opposing the view that organic = ‘healthier’.

        For your educational starter, you might try this survey from 2016. You’ll see that ‘health-related reasons’ tops the poll for ‘why do you choose organic?’. And the UK is by no means the leader in nominating health as a major reason.

        So I repeat: If you’ve “never heard anyone say it was for the health of the person eating the food.” you’re living somewhere different from the rest of us.

        • Frank,

          I do live somewhere different from you – read Julian’s comment about US farming practices. So I’d choose ‘health-related reasons’ on a survey as well – the health of the farm workers, and the water.

          Perhaps with European farming practices you can’t taste the difference. But here you can. Not the top reason to eat organic…but a wonderful fringe benefit.

          Another possible US/EU difference: “appeal to folk with good intentions and therefore to make money from them”. The organic farmers in our area would tell you they’d make more money flipping burgers at McDonalds.

          • Oh come on, jm! That survey I linked to asked 3000 people “What is the primary reason you would buy organic products?” We don’t know how many answers came from the USA, but 33% of Americans answered “For Health related reasons”. Only 3% answered “Concern for farm workers”.

            “Perhaps with European farming practices you can’t taste the difference. But here you can. Not the top reason to eat organic…but a wonderful fringe benefit.” Taste differences have been tested in so many poorly designed trials, the field almost resembles that of SCAM. You can so easily find accounts on line that support better taste of organic and worse taste, it’s hardly worth debating.

            “Another possible US/EU difference: “appeal to folk with good intentions and therefore to make money from them”. The organic farmers in our area would tell you they’d make more money flipping burgers at McDonalds.” I bet the organic farmers in New York and San Francisco wouldn’t say that. Why don’t the organic farmers in your area revert to conventional farming (or go flip burgers in MacDonald’s)?

            According to the Organic Consumers Association, “58% of U.S. Consumers Prefer Organic Food, Survey Says.” The full article is hidden behind a pay- or pest-wall, but this was the middle result from the numbers I raised by googling “do americans prefer organic food” (the lowest percentage was 45, the highest was 80.

            When I’m wrong I freely admit it. It takes an exceptionally perverse mind to argue in the face of a tsunami of contrary evidence.

          • Frank,

            You’re a hoot. “That survey I linked to asked 3000 people…” I’m sure it did. When I say “I’ve heard…”, I mean that literally. Talking to people.

            One thing that Julian didn’t mention about US farming practices is the use of immigrant labor – people who, for many reasons, do work that no one else will touch. Because (as Julian points out) – American farming practices are appalling. There’s a lot of that in the region I live in, and a lot of people who buy organic from small farms because the appalling practices leave a bad taste in their mouths.

            But surveys are nice, too.

            Speaking of taste, I hope you’re kidding about tests on taste differences. If money changed hands on that one…I think you found your actual “con trick”. Good grief.

      • I’ve never heard anyone say it was for the health of the person eating the food.

        I think RG would disagree with you here.

        • He’d probably be right. At some point, I’ve probably heard somebody somewhere say that. I wouldn’t be able to give you an example, though. They’d be the extreme outlier – for the vast majority it’s about water quality and the farm workers.

        • I would agree yes, this would be the main motivation for many succumbing to the theory.

          There is no argument that chemical fertilizers, herbicides and pesticides will increase yield. That said, there is also a downside to the soil, and effectively the food. Since also with modern farming they won’t allow the soil to rest a year.
          Different people have different motivations. Some people have jumped on the eat less meat bandwagon. Not because of animal conditions, not because of food quality… but because of global warming.

          Pros vs cons… different strokes… pick your poison.

          Again, for me it’s about less toxins and non-GMO… I can verify my motivation.

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