Brennen McKenzie, MA, VMD is a 2001 graduate of the University of Pennsylvania School of Veterinary Medicine, and he works as a small animal veterinarian in private practice in California. He has a special interest in promoting science-based veterinary medicine and is currently President-Elect of the Evidence-Based Veterinary Medical Association. He has published articles on evidence-based medicine in veterinary science journals, and he also writes about both science-based and “alternative” veterinary medicine as the SkeptVet.
Prior to becoming a veterinarian, Dr. McKenzie completed a Master’s Degree in animal behavior, studying captive chimpanzees and working as a specialist in environmental enrichment for captive primates.
Also, Dr. Clay Jones is introduced as the new co-host of the Prism!
Having such research in a frequently read (and cited) journal like the JADA is problematic in many ways. Time and my attention span will not permit me to go into great depth into those issues, but I do want to present an outline of the article, how (while no doubt well-intentioned) bad science was constructed atop a foundation of worse science, why the JADA had no business publishing such nonsense, how our body of scientific knowledge was not advanced one iota by this piece, and why the American Dental Association sullies the concept of science based inquiry when it associates with pseudo- and pre-scientific woo.
This research, supported by the National Center for Complementary and Alternative Medicine (NCCAM), was authored by four Chiropractors, a PhD (all but one of whom are associated with the Palmer College of Chiropractic), two dentists, and an RN (the latter three associated with the University of Iowa College of Dentistry). Their stated goal was to “assess the feasibility of conducting a full-scale RCT to evaluate the effectiveness of AMCT (Activator Method Chiropractic Technique) for the treatment of patients with chronic myofascial TMD (Temporomandibular Disorder).” (Note: RCT = Randomized Controlled Trial) Their rationale was that since many TMDs “can become a chronic problem lasting several years, and patients receive little help from traditional forms of treatment”, perhaps complementary and alternative medicine (CAM) therapies should be considered.
Believe it or not, there are podcasts out there that are even better than the one Jason and I did a couple of weeks ago (#sarcasm). Among the many fine choices out there, RadioLab is consistently excellent and intriguing; it is invariably at the top of my listening queue. Recently, RadioLab did a show on a patient who survived rabies, which until recently was 100% fatal- a death sentence with no chance of commutation or reprieve from the Governor. The story itself is amazing, and you should stop reading here, take a brief intermission and go listen to it. I’ll be here when you get back.
OK, back? Pretty good, huh? Though I was transfixed during the entire episode, do you know what little tidbit of information stuck with me more than anything else? The off the cuff factoid that back in medieval times, one of the treatments for rabies was to pluck the feathers from around a rooster’s anus, then apply said anus to the animal bite, ostensibly to “suck out” the infection. Makes sense, eh? I mean, I’m no rooster anus aficionado, but I can imagine that it might resemble a suction cup sort of thing. These are some pretty weird dots to connect to be sure, but I guess that when faced with a potentially fatal disease, physicians back then tried anything and everything hoping to find that magical cure, even if by luck or trial and error. Without the scientific method, that’s pretty much all they had.
Why, I can hear you ask, whywould tincture of tush even continue as a recommended treatment after the first attempt or two? OK, I’ll give the doctor/barber/blacksmith the benefit of the doubt when thinking of it for the first time and giving it a go, but then after that? How could the doctor of yesteryear think this was a good idea? Did his success rate in treatment skyrocket after sphinctotherapy? How does one rationalize this?
Well, here’s how it went down, and the reason I’m bringing this up isn’t just because it’s a fun, quirky subject or that I have a thing about poultry and/or anuses. There are modern day applications of this same dysfunctional thought process, and the public must be made aware of these modern day purveyors of rooster anus therapies and their likes.
Suppose you’re this guy, the village doctor:
A frantic mother comes running into your office/stables with her 12 year old daughter in tow. The young girl has just been bitten by a mad dog and everyone knows what that means. Thinking quickly, you grab a rooster, pluck the feathers from around its anus (I’m sure there’s an insurance code for that), and apply buttsuction pressure to the wound stat. You then write a prescription to the mother like so:
After a week, you go and check up on the family; lo and behold! the girl is fine. No signs of rabies and the wound is healing well. When you get back to your office/stables, you look back over your notes and determine that your avian treatment protocol has roughly a 25% success rate. “That’s pretty good” you say. “If it weren’t for my quick thinking and medical acumen, they all would have died. This modern treatment of rabies is proof that we have truly made great advances in medical science. In my experience, rooster anus is the treatment of choice for rabies.”
So what is the reality here? Do sphincters possess medicative qualities? Was Yorick the doctor/barber/blacksmith on the right track?
No and no.
The reality is that while rabies is a horrible disease, it is only 100% (well, until recently at least) fatal once it has established a foothold in the host. Often, a person who is bitten by a wild animal doesn’t contract rabies at all. There are several possible explanations for this: 1. the animal didn’t have rabies to start with, 2. the bite didn’t break the skin, 3. the virus didn’t enter the bloodstream or other area where it could take up residence in the nerve tissue, or 4. the victim’s antibodies dispatched the viruses before they could cause harm.
There could be other explanations and scenarios, but you get the picture. While all rabies infections were 100% fatal, not all animal bites were. Dr. Yorick, of course, wasn’t aware of all the times a person was bit who subsequently remained healthy. His experimental group, as it were, consisted only of those who either had been bitten but not yet showed the signs of rabies or people with full-fledged rabies. The former group would naturally respond reasonably well to Rooster Anus Therapy®, not because of the rooster, but because that person stood a decent chance of remaining healthy anyway. Yorick naturally would take credit for the health of this subgroup. This fallacy in reasoning is called Post Hoc, Ergo Propter Hoc, which is similar to Affirming the Consequent. The logical structure goes something like this: P occured before Q. Q resulted, therefore P caused Q. Translated, this reads “If I put a rooster’s anus onto an animal bite, the patient will not contract rabies. The patient did not contract rabies. Therefore, rooster anus is effective and prevented the rabies.” This is where Yorick went wrong and relied only upon his experience, but you can’t blame the chap.
You can, however, blame the frauds, quacks, and ignorant practitioners of woo out there who peddle their own version of rooster anuses to a gullible and unsuspecting public. From homeopathy to acupuncture, to just about every kind of “complementary” or “integrative” therapies, they all work on the same Affirming the Consequent principle. You pressed, poked, stabbed, or shocked some alleged point on your body and your knee pain felt better? You swallowed a supplement and you slept better last night? You pressed a rooster anus to your squirrel bite and you didn’t get rabies? The delusional practitioner will think “In my experience, ________ has worked well.” This is very dangerous thinking.
Modern day alt-med thinking and medieval rooster thinking is pretty much the same thing.
Most health care practitioners worth their salt know this; however, a vast number of lay people, as well as many other health care providers either don’t know it or choose to ignore it because of some bias or agenda. Or perhaps they are outright charletans. However, it is the responsibility of every science minded individual to fight this type of thinking and challenge these dysfunctional practices wherever they occur.
Athletic mouthguards have been a staple of sports for decades; they provide a vital role in preventing injuries to the teeth and jaws as well as reducing the incidence and severity of concussions. In the past few years, however, the emergence of “performance mouthguards” has flooded the sports scene. These enhanced products claim to do more than merely protect the wearer; indeed, by positioning the mandible (lower jaw) into a specific position, the mouthguard is said to open the airway to increase oxygen intake, to relax jaw muscles ostensibly to prevent those contracting muscles from “robbing” other parts of one’s body’s energy (which allegedly decreases muscular efficiency elsewhere), and to trigger hormonal changes (chiefly by diminishing cortisol, the “stress hormone”, release). Big names such as Under Armour®, as well as smaller niche companies, dental labs, and others are invested in this concept, and millions are spent by athletes each year trying to get that extra edge that will allow them to rise above their competition.
Whether or not they do what they claim is not the purpose of this post (spoiler alert: probably not, but the jury is still out), but to alert our readers of a technique that dentists and other providers of these mouthguards employ to “demonstrate” the effectiveness of these expensive hunks of acrylic. Known as muscle testing or Applied Kinesiology, the practitioner will have the athlete clench his or her teeth, then perform tests such as pressing down on an extended arm, pushing the person to test for balance, and so on. Then the athlete will place something between his or her teeth- the mouthguard, a pencil, or a stick- and the tests are repeated. LO! The balance and strength is improved!
This is not a new trick. It was invented in the 1960s by a chiropractor, and is used for a myriad of uses, for example allergy testing whereby a patient holds a vial of a suspected allergen in his or her hand and the muscles are tested as described above; if there is weakness, then there must be an allergy or sensitivity for that particular substance. And no, I’m not making that up or pulling your leg. Recently, it has been showcased in “proving” the effectiveness of the Power Balance bracelet, debunked so beautifully by Richard Saunders. And now, it is been used to show that muscle strength and balance is improved with the use of these mouthguards. The sad thing is that I know many many dentists who believe in this “technology”, and I can attest to their honesty and sincere desire to help their patients. So in an overwhelming majority of cases, this is not an issue of fraud and deception (except for self-deception). It is merely ignorance of how the placebo effect, operator bias, and suggestibility works.
As with most fad gizmos, celebrity endorsements and patient testimonials are the cornerstone of the marketing approach undertaken by the producers of these products. After all , who needs a study when all you need is Shaq telling you that a mouthguard improved his free throw percentage (from 12% to 16%?)? And in a marketing coup, here is a photo from 2011 of Bill Gates being muscle tested for a mouthguard:
While there are a few small, poorly done studies (example here) that purport to show, if not outright effectiveness then a glimmer of biological and physiological plausibility, most of the perceived benefits can be attributed to biases on the part of the operator and recipient. A good overview of the process by Stephen Barrett can be found here, along with several references. Whether or not they eventually are shown to work, don’t rely on parlor tricks as evidence of effectiveness.
So, exercise caution when evaluating the claims of these so-called “performance mouthguards.” To be sure, the appliances themselves are of high quality and will do all the things a mouthguard is supposed to do, but they cost 1-2 orders of magnitude more, so buyer beware.
Here at the Prism, it is our thesis that one of the major issues with alternative medicine is their over-reliance on anecdotes (n = 1) as solid evidence for whatever treatment regimen or therapy they are promoting. To be sure, an anecdote in and of itself is not de facto invalid; for example, when a proven therapy works, we have a positive anecdote to attest to it. However, any self-respecting science based individual would not place any significant weight on a single anecdote, or even a small cluster of consistent anecdotes, without evaluating the context in which is it offered.
The philosophic heart of the anecdote-as-evidence issue is “The Problem of Induction,” elucidated most famously by David Hume in the 1700s. Called “the glory of science and the scandal of philosophy” by philosopher C.D. Broad, inductive reasoning is a useful method of acquiring knowledge; however, it is not without its issues.
(I’ll try to figure out how to embed one of these days…)
So you see that while it is useful (and often necessary) to apply to the general what is observed from the specific, the logic is not airtight. The premise “the future will resemble the past” is the cornerstone of the argument, and it can never be shown to be true (at least not without a time machine!).