Sunday, January 07, 2007

Homebirth and common errors of reasoning.

In Alternative Medicine and Common Errors of Reasoning, Beyerstein asks the question: "Why do so many otherwise intelligent patients and therapists pay considerable sums for products and therapies of alternative medicine, even though most of these either are known to be useless or dangerous or have not been subjected to rigorous scientific testing? Many of his findings appear to apply to homebirth advocacy, the spurious claims about "natural" treatments, and the use of herbs in midwifery.

Beyerstein describes user of complementary and alternative medicine as someone who:
... chooses alternative treatments out of a philosophical commitment to the ... cosmology of CAM, which rejects the mechanistic-empiricist under-pinnings of scientific biomedicine. CAM embraces subjective, emotive truth criteria, whereas its detractors demand objective evidence. Because one's concept of health is entwined with one's fundamental assumptions about reality, an attack on someone's belief in unorthodox healing becomes a threat to his or her entire metaphysical outlook. Understandably, this will be resisted fervently.
Among the factors that contribute to the popularity of alternative practices like homebirth:
Poor scientific literacy. Surveys consistently find that ... the average citizen of the industrialized world is shockingly ignorant of even the rudiments of science ...

Dislike of the delivery of scientific biomedicine. CAM has played on a widespread but exaggerated fear that modern medicine has become excessively technocratic, bureaucratic, and impersonal ... [which has] led some patients to long nostalgically for the simpler days of the kindly country doctor [or midwife] with ample time and a soothing bedside manner. They tend to forget, however, that this was often all a doctor of that era could offer.

Safety and side effects. A quaint bit of romanticism that promotes holistic health care is the belief that natural remedies are necessarily safer, gentler, and more efficacious than scientific ones.
According to Beyerstein, there are psychological reasons why people cling to alternative practices like homebirth and herbalism:
Psychologists have long been aware that people generally strive to make their attitudes, beliefs, and behaviors conform to a harmonious whole. When disquieting information cannot easily be ignored, individuals have a great ability to distort or sequester it to reduce the inevitable friction...

The will to believe. We all exhibit a willingness to endorse comforting beliefs and to accept, uncritically, information that reinforces our core attitudes and self-esteem... Once adopted, such beliefs will be defended strongly, by misconstruing contrary input if need be.

Logical errors, shortcomings of judgment, and missing control groups. One of the most prevalent pitfalls ... is the mistaking of correlation for causation. We are all prone to assume that if two things occur together one must cause the other, although, obviously, this need not be the case... It cannot be known that any vaunted treatment is effective without blinded comparisons with placebo-treated controls...

Those who impugn fringe treatments are frequently dismissed ... with the rejoinder, I don't care what your research says. I have seen [the] treatments work hundreds of times. Unfortunately, this kind of intuitive judgment is also conducive to false conclusions...
Beyerstein goes a long way toward explaining why advocates will fervently believe claims for which there are no proof (such as most claims about homebirth), and why they will spend large sums of money on products like herbs, which do not work.

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