Dr Caroline Leaf on Drugs

We all have a drug problem.

Well, we do according to communication pathologist and self-titled cognitive neuroscientist-come-health guru, Dr Caroline Leaf.  She’s pretty chirpy for a woman with essentially no health credentials.  She did a PhD two decades ago on a specialized area of educational psychology, but she has no medical training or experience.  Essentially she is the Christian equivalent of the health and relationships section of a tabloid newspaper.  Her information lurches between unfounded and the bleeding obvious.

Today’s e-mail newsletter, “Mental Health News March 2017” is a mixture of both. It’s more moderate than usual in its tone, but it’s still inspired by her open rejection of pharmaceuticals, especially medications for mental health which she has railed against many times.

Her second paragraph is a specific case in point.  “Although many medications have saved lives and can help us, we cannot have a quick-fix-pop-a-pill mentality for everything in life, and we should not denigrate alternative methods of health and healing, such as diet, exercise, human relationship, love, compassion and therapy, particularly when it comes to mental health.”

She’s right – we shouldn’t have a quick-fix-pop-a-pill mentality, but she overstates her case.  Most people don’t want pills for everything – people want good care and good treatment.  Sometimes that involves a pill, sometimes it just involves reassurance.  This is bread and butter for any good GP, and I’d love to show Dr Leaf what the front-line of medicine looks like if she ever wanted to see (seriously, the offer’s open).

And who’s denigrating diet and exercise?  Diet and exercise aren’t “alternative” health, they’re mainstream.  Is Dr Leaf so out of touch that she can’t see this?

Her bias against pharmaceuticals is more obvious in their third paragraph.  Pharmaceutical medications are not a major cause of death. According to the Centre of Disease Control, the top ten causes of death in the US are:

* Heart disease
* Cancer (malignant neoplasms)
* Chronic lower respiratory disease
* Accidents (unintentional injuries)
* Stroke (cerebrovascular diseases)
* Alzheimer’s disease
* Diabetes
* Influenza and pneumonia
* Kidney disease (nephritis, nephrotic syndrome, and nephrosis)
* Suicide

Notice how medications do not feature on that list.  Dr Leaf is so biased against medications that she is willing to ignore official government data in favour of her own bias.

But the truth is, pharmaceutical grade medications have revolutionised our lives.  When used in the right way, for the right people, they improve our quality and quantity of life. They give people independence.  They give people choice.   They help people work, spend time with their family and care for others where that may not have been possible otherwise.

Do medications have side effects? Can people feel worse sometimes while taking them? Of course! We need to be realistic. Pharmaceutical medications are powerful agents and we have to use them respectfully.  Prescription drugs are like power tools.  In the right hands they can do wonders, but they can also be very dangerous when used incorrectly.  But while medications can be used incorrectly, using that as a reason why we should use less drugs is like arguing that we should use less knives because sometimes they cut people, or that we should drive less cars because there are car accidents.

Oh, and what was that about the widespread manipulation of data and results in the world of science?  Dr Leaf would never misrepresent the results of her studies, or misrepresent the results of other people’s research, in order to make her products look better than they are?

Lifestyle is important, and in some cases, lifestyle is more important than medication, but there is much more nuance involved.  You need different tools for different jobs.  Imagine a surgeon going into surgery and the scrub nurse passed over a nerf scalpel.  It wouldn’t be particularly helpful would it.  Or what if the scrub nurse passed over a butter knife?  The surgeon might get the job done but with great difficulty, without the precision needed.

What a surgeon needs to perform surgery is an extremely sharp stainless steel scalpel blade.  It is more effective and more precise.  It might occasionally do some unintentional harm, but it will be a lot more effective than a butter knife (and a nerf scalpel!)

There are three different levels of treatment in health – “alternative” medicines, lifestyle treatments, and pharmaceuticals.  “Alternative” medicines are, by definition, useless.  As comedian Tim Minchin says, “Do you know what they call alternative medicine that’s been proven to work? Medicine.”  Alternative medicines are probably not going to cause a lot of harm other than making their user poorer for wasting their time, but they’re highly unlikely to do any good.

Lifestyle treatments are the equivalent of the butter knife.  They work, but their effect is non-specific and cumulative.  Hear me right, “non-specific and cumulative” is not code for “ineffective”.  Exercise is one of the most effective non-pharmacological health strategies with clearly proven benefits, but like all lifestyle changes, the effect is fairly general, and the benefit accumulates.

And sometimes, despite doing everything right, people still get sick, and this is where pharmaceuticals have their place.  They are like the scalpel – they might have some unwanted effects, but in the right hands, when used correctly, they make a specific and tangible difference to a person’s life and health.

Dr Leaf then goes on to assert that “Changing your lifestyle and, significantly, the way you THINK can have dramatic effects on your health”.  That’s a furphy.  Thoughts make no difference to our health (I’ve shown how little difference thought makes to our health in my review of Dr Leaf’s book “Think and Eat Yourself Smart”).  Some scientists may have recommended produce over Prozac, but that doesn’t mean to say they’re right.

And Dr Leaf has trotted out the same worn, tired old factoid about loving and serving others that I’ve shown to be inaccurate as well.

If you want to improve your health without medications, then start walking.  Eat vegetables.  Drink water.  Don’t waste your time and money buying into Dr Leaf’s inaccurate teaching.

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On sperm and common sense

I’ve been thinking the last few days about critical thinking, or more specifically, the lack of it.

I’ve written about critical thinking before.  I realise that critical thinking can be difficult, and it doesn’t always come naturally to us humans.  And in discussing it here, I don’t want to give the false impression that I expect everyone to suddenly become Aristotle or Francis Bacon, but I’d like to think we can all have enough critical thinking skills to have some basic common sense.

A case in point came across my Facebook feed tonight.  A Facebook friend had laryngitis and was about to embark on a speaking engagement and was asking the hive mind for some advice.

Now I know that this was a question posed to lay people, and I wasn’t expecting anyone to be giving specific medical advice … but it was interesting that the answers, by and large, didn’t even pass the common sense test.  Most of the answers recommended either gargling or drinking various home-made potions.  Except, when you gargle something or drink something, it doesn’t go anywhere near the voice box – we know that because we know what happens when you get liquid into your voice box, you cough or choke.  So clearly, no matter what you’re gargling or drinking, it isn’t going to affect your vocal cords one bit.  You don’t need a medical degree to know that, you just have to use a little bit of common sense.

The same deficiency in entry-level critical thinking is seen in the church all the time.  It afflicts everyone from pew-warmer to pastor.  Common sense so often escapes us when it comes to understanding scripture.  Christian celebrities skew the text of the Bible to suit their own agendas all the time, and most Christians are too gullible and just accept the incorrect interpretation.  Sometimes a scriptural misinterpretation can be passed down from generation to generation because people don’t question the orthodoxy for fear of appearing divisive or ignorant.

A funny example of how the scripture can be taught with all sincerity but without much understanding is in relation to sperm.  When I was in my final year of high school at a prominent Christian school, one of the male teachers took it on himself to get all the boys together from our year level for a chat about important man things.

One of the things that was mentioned was that we shouldn’t masturbate, because of the story of Onan.  In Genesis 38, Onan ejaculated on the ground rather than in his sister-in-law and God smote him.  Somehow, that was taken to mean that semen is precious, therefore it shouldn’t be wasted.  This lead to a historical view, expressed by Clement of Alexandria who wrote, “Because of its divine institution for the propagation of man, the seed is not to be vainly ejaculated, nor is it to be damaged, nor is it to be wasted. To have coitus other than to procreate children is to do injury to nature.”  This lead to the concept that masturbation is evil because it is seminal genocide, which eventually lead to the Monty Python parody “Every sperm is sacred” (https://youtu.be/fUspLVStPbk?list=RDfUspLVStPbk).

Anyway, back to my high school – the teacher wasted our entire morning tea time talking about Onan, and about how we should be chaste and not masturbate because every sperm is sacred.  But he clearly didn’t read the actual scripture, nor did he or anyone else ever consider why, if God was so stressed about wasting semen, He would create men to have wet dreams.  I really wanted to make this point, but didn’t because it was morning tea time and everyone wanted to get out of there, and I also didn’t want to be mercilessly harassed about being pro-masturbation by every guy in my grade.

My high school teacher and the story of Onan is an example of how people can be well meaning and still misguided, and why we need to apply common sense to scripture.  It doesn’t take a great deal of biological knowledge to know that men have nocturnal emissions of semen, yet for centuries, the story of Onan was about how he was smitten because of his treatment of his sperm, not about how he was disobedient.

Another example of how well-meaning but misguided teaching can be perpetuated comes from the Christian course, “Valiant Man” by Australian pastor, Dr Allen Meyer.  The “Valiant Man” program was a ten-week series of small group sessions designed with the intention of helping men develop their Christian character in the area of sex.  In week three, Dr Meyer (not a medical doctor) tried to show that men should respect women more because we all started off in the womb as females, and the Y-chromosome eventually turned us from a girl into a boy.

This little factoid wasn’t the only significant defect in the Valiant Man program, but it was one of the most memorable.   “We all start off female” was one of the things that the other participants in the program all remembered, and it even made it to Sunday morning church as part of a testimonial one of the men gave about the program.  And yet, it was one of the most clearly inaccurate parts of the program – all embryos have the structures to be either male or female.  We didn’t all start off as women.  Men aren’t an aberration of the female default setting*.

In week one of the program, all participants were required to agree to some ground-rules in order to keep going on the program.  Point 2 of this ‘contract’ said, “intellectual opinions play no part in our discussion, except where they are relevant to our growth.”  In other words, don’t challenge the material gentlemen, and don’t think for yourselves.  While this might be conducive to running a smooth program, it meant that gross errors and distortions were left unchallenged.

This pattern of unquestioning acceptance of misguided teaching continues throughout the church.  This is something that Dr Leaf does all the time.  It doesn’t take theological training to see that her use of scripture is inaccurate (like her interpretation of Proverbs 23:7, for example), but the vast majority of Christians simply accept her misguided interpretation and theologically trained church leaders also accept it, or don’t correct it (both of which are just as heinous).

I know that critical thinking is sometimes tricky, but I’m not advocating for anything more than common sense.  Entry level critical thinking doesn’t take much effort but it can be particularly life changing.  Like with “Valiant Man”, a little bit of critical thinking can stop bad teaching from being accepted as truth.  Like the story of Onan, a little bit of critical thinking can stop centuries of incorrect teaching being perpetuated.  Like with my friends Facebook status, a little bit of critical thinking can help a person make the best choice for their own personal health.

As Christians, we need to have some self-respect and stop being so gullible, just accepting something as the truth because some Christian celebrity says it from the pulpit.

Ultimately it’s the truth that sets us free, not some gilded assumption.

* In fairness, I did the program in 2010 and it may have been updated since then … here’s hoping.

Dr Caroline Leaf and Testimonials – Good marketing, poor evidence

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist. She is a pseudoscientist of the highest order. She once wrote a PhD. Now she has episodes of her TV show titled “Surviving cancer by using the Mind”.

This weeks edition of her newsletter started off with some subtle boasting:

“We have received many E-mails over the past years asking for Testimonies with regards to Dr Leaf’s research and teachings. We have summarized eight pages of testimonies received at TESTIMONIES. Be encouraged and feel free to refer them to friends, family, acquaintances, and work colleagues struggling with Mind issues.”

Testimonials are an empty box wrapped in shiny paper and trimmed with a bow. They look really good but offer nothing of substance. They’re simply an old advertising trick.

According to the Market Science Institute, “Testimonial solicitations – in which firms solicit consumers’ personal endorsements of a product or service – represent a popular marketing practice. Testimonials are thought to offer several benefits to firms, among them that participating consumers may strengthen their positive attitudes toward a brand, through the act of writing testimonials.” [1]

Who can argue with a person who says that Dr Leaf helped turn their life around? Saying anything negative just makes you sound like a cynical old boot.

And that’s the real problem, because while publishing a whole bunch of positive stories is good for marketing, it makes it very hard for those who had a genuinely bad experience to say anything. No one wants to listen to those people whom Dr Leaf has confused or mislead – it makes for terrible PR. Those people feel devalued, and sometimes worse, because it seems like everyone else had a good result from Dr Leaf’s teaching, except them.

Testimonials also make for very poor scientific evidence. Indeed, testimonials are considered the lowest form of scientific evidence [2]. It’s all very well and good for a bunch of people to share their positive experiences, but as life changing as the experience may have been, they are not evidence of the effectiveness of Dr Leaf’s teaching. Without specific, well-designed research, no one can say if the testimonials Dr Leaf is publishing are the norm. Recent research demonstrates that self-help literature for depression may not have any benefit over a placebo treatment [3]. So it may be that any improvement attributed to Dr Leaf’s teaching was actually the placebo effect. Dr Leaf can list testimonials until she’s blue in the face, but that doesn’t prove that her work is scientific or therapeutic.

Indeed, selectively publishing testimonials is duplicitous, telling half-truths, positively spinning her own story. How many e-mails has Dr Leaf gotten from people who have found her teaching inaccurate, ineffective, unbiblical or harmful? Dr Leaf’s social media minions deliberately delete any negative comments and block anyone from her sites that disagree with her. And over the years, many people have shared with me how arrogant and dismissive her team has been to polite, genuine concern or criticism. I can personally attest to the same treatment. If Dr Leaf was honest with her followers, she would be openly publishing the brickbats as well as the bouquets.

For her readers and followers, the testimonials need to be seen for what they are: just individual stories. Sure, we should rejoice with those who are rejoicing (Romans 12:15), and so good for those who feel Dr Leaf has helped them. But they do not constitute evidence for the therapeutic efficacy or scientific integrity of the work of Dr Leaf.

For people genuinely struggling with “mind issues”, the last thing they need is testimonials collated by Dr Leaf’s marketing team.  They don’t need to be referred to Dr Leaf’s work, they need to be referred to psychologists and doctors.

And if Dr Leaf really wanted to prove her legitimacy, she would rely on independent peer-reviewed published research, not on the list of vacuous, self-serving cherry-picked testimonials that she is currently offering.

References

[1] Marketing Science Institute. Consumer Testimonials as Self-Generated Advertisements: Evaluative Reconstruction Following Product Usage. [cited 2014, Aug 3]; Available from: http://www.msi.org/reports/consumer-testimonials-as-self-generated-advertisements-evaluative-reconstru/.
[2] Fowler, G., Evidence-based practice: Tools and techniques. Systems, settings, people: Workforce development challenges for the alcohol and other drugs field, 2001: 93-107
[3] Moldovan, R., et al., Cognitive bibliotherapy for mild depressive symptomatology: randomized clinical trial of efficacy and mechanisms of change. Clinical psychology & psychotherapy, 2013. 20(6): 482-93