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

Advertisements

Dr Caroline Leaf: All scare and no science?

Screen Shot 2014-12-24 at 11.02.44 am

On her social media feed today, Dr Leaf posted a meme implying that conventionally farmed food was toxic.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist. Anyone who’s been following Dr Leaf will know from her frequent food selfies that she is an organic convert.

Dr Leaf is welcome to eat whatever she chooses, though not content to simply push her personal belief in organic foods, Dr Leaf is now actively criticising conventional food, publishing memes on her social media posts which imply that conventional produce is poisonous.

As I’ve written before, despite Dr Leaf’s blinding passion and quasi-religious zeal for organic foods, there is no evidence that organic food is any more beneficial than conventional food (Dangour et al, 2009; Bradbury et al, 2014). Indeed, there’s no magic to a healthy food lifestyle. Eat more vegetables. Drink more water. Conventional veggies and conventional water do just fine. Sage advice, even if it doesn’t lend itself to food selfies.

While organic zealots believe they have the high ground on the topic of food safety, the published science cuts through the hype. As noted by Smith-Spangler et al (2012), there is some evidence that there may be less pesticide residue on organically grown foods, but there is no significant difference in the risk of each group exceeding the overcautious Maximum Residue Limit.

Two points on the Maximum Residue Limit that are particularly important:

  1. The Maximum Residue Limit is extremely cautious, and most food tested is well below this already overcautious limit. The Maximum Residue Limit is set to about 1% of the amount of the pesticide that has no effect on test animals.   According to a recent survey of grapes done by Choice Australia, the amount of residue was well below the Maximum Residue Limit (about 1% of the Maximum Residue Limit on average) (Choice Australia, 2014). So on the average bunch of grapes in Australia, the pesticide residue is about one ten thousandth of the level that is safe in animals, and this pattern is the same across all conventional produce. Thinking in more practical terms, “a 68 kg man would have to eat 3,000 heads of lettuce every day of his life to exceed the level of a residue that has been proven to have no effect on laboratory animals … an 18 kg boy would have to eat 534 apples every day of his life to exceed a residue level that is not dangerous to laboratory animals. And an 18 kg girl would have to eat 13,636 kg of carrots every day of her life to exceed such a level.” (ecpa.eu, 2014)

    2. Organic foods have pesticides too. Granted, this is at lower levels than their conventional counterparts, but it’s there all the same (Smith-Spangler et al, 2012). I once had a lively discussion with an organic food zealot about the pesticides in organic farming. Her argument was that organic pesticides are safe because they’re “natural” poisons. So are arsenic, cyanide, belladonna and digitalis (foxglove), but why let the truth get in the way of ones opinion. Poisons are poisons whether they’re “natural” or not. The Maximum Residue Limit applies to organic foods just the same as conventionally farmed produce for that reason.

Another interesting thing … in the Choice survey, the organic grapes had no detectable pesticides, but so did conventionally farmed grapes bought at a local green grocer. So organic food zealots can’t claim that they have a monopoly on low pesticides in their foods.

Not that having lower pesticide residues means that organic foods are necessarily safer. Organically farmed produce has a higher risk of contamination from E. coli and other potentially toxic bacteria, depending on the farming method used (Mukherjee et al, 2007; Sample, 2011).

So to bring it all together, conventional produce has levels of pesticide residues so low that it would take an extra-ordinary feat of vegetarian gluttony to exceed a level that was still found to be non-toxic in animals. The risk to human health from conventional farming with pesticides is nanoscopic. Organic foods may have less pesticide, but they have a higher risk from enterotoxigenic bacteria.

Since there is nothing to fear from conventional foods, it seems irresponsible for Dr Leaf to promote the unscientific idea that conventional foods are poisonous. One wonders why Dr Leaf would engage in a campaign of fear against healthy, nutritious foods? Personal bias perhaps, although that doesn’t bode well for her credibility as an objective scientist. Another plausible reason could be marketing. Fear sells things, that’s Marketing 101. Gardner (2008) wrote, “Fear sells. Fear makes money. The countless companies and consultants in the business of protecting the fearful from whatever they may fear know it only too well. The more fear, the better the sales.”

Posts like today’s make Dr Leaf seem like all scare and no science. Publishing images with the skull and cross bones and the word “POISON” is certainly not attempting to allay anyone’s anxiety, and that fact that it‘s directly tied to a reminder of her upcoming book on food only makes shameless promotion all the more likely. I’m sure that a Godly woman of Dr Leaf’s standing wouldn’t stoop so low as to use fear and mistruth just to make better sales, but posts like today’s open her up to legitimate questions from others regarding her credibility and her motivation.

For her sake, I hope that she tightens up her future posts, and reconsiders her stance on the science of organic and conventional foods.

References

Bradbury, K.E., et al., Organic food consumption and the incidence of cancer in a large prospective study of women in the United Kingdom. Br J Cancer, 2014. 110(9): 2321-6 doi: 10.1038/bjc.2014.148

Choice Australia, 2014. <http://www.choice.com.au/reviews-and-tests/food-and-health/food-and-drink/groceries/pesticide-residues-in-fruit-and-vegetables.aspx&gt;

Dangour, A. D., Dodhia, S. K., Hayter, A., Allen, E., Lock, K., & Uauy, R. (2009). Nutritional quality of organic foods: a systematic review. Am J Clin Nutr, 90(3), 680-685. doi: 10.3945/ajcn.2009.28041

European Crop Protection Agency, 2014, <http://www.ecpa.eu/faq/what-maximum-residue-level-mrl-and-how-are-they-set>

Gardner, D., The science of fear: Why we fear the things we shouldn’t – and put ourselves in greater danger; 2008, Dutton / The Penguin Group, New York

Mukherjee, A., et al., Association of farm management practices with risk of Escherichia coli contamination in pre-harvest produce grown in Minnesota and Wisconsin. Int J Food Microbiol, 2007. 120(3): 296-302 doi: 10.1016/j.ijfoodmicro.2007.09.007

Sample, I., E coli outbreak: German organic farm officially identified. The Guardian, London, UK, 11 June 2011 <http://www.theguardian.com/world/2011/jun/10/e-coli-bean-sprouts-blamed>

Smith-Spangler, C., Brandeau, M. L., Hunter, G. E., Bavinger, J. C., Pearson, M., Eschbach, P. J., . . . Stave, C. (2012). Are organic foods safer or healthier than conventional alternatives? A systematic review. Ann Intern Med, 157(5), 348-366.

Dr Caroline Leaf, Testimonials, and Levels of Evidence

ScreenshotDrLeafTestimonial

It’s nice to be appreciated.

Gratitude is a wonderful thing. The Bible encourages it (1 Thessalonians 5:18), and psychology has detailed why. Gratitude increases happiness and life satisfaction, while tending to decrease depressive symptoms [1]. And it’s not just good for the giver, but also the receiver. I always appreciate it when my patients thank me for helping them. Genuine gratitude makes you feel good inside.

Dr Caroline Leaf, Communication Pathologist and self-titled Cognitive Neuroscientist, must be positively glowing right now. She has been getting a lot of positive feedback from her fan base of late, and she has decided to share it with the world via her social media feeds.

I’m sincerely happy for those people who feel they have been helped by Dr Leaf’s work. I remember my darkest days, feeling far from God and unable to find my way out of the emotional black hole of depression. It’s always so good to hear that others are finding their way out too.

While I’m happy for those who are sharing their stories to Dr Leaf, I can’t say I feel the same for Dr Leaf herself. It’s excellent that people are sharing their stories with her privately but publishing them is another matter. At best, it’s ethically delicate.

The testimonies are likely to be from people recovering from a psychological or emotional challenge, which carries an ongoing level of vulnerability. Even if Dr Leaf has their consent to publish their stories, sharing their problems with the world can still cause or contribute to psychological damage. Without knowing their whole story, Dr Leaf has no way of judging whom she may or may not harm.

It’s also a bit disingenuous. By publishing a series of testimonials, Dr Leaf is essentially self-promoting. It’s one thing for a supporter to spontaneously offer her praise in a Facebook or blog comment. But Dr Leaf specifically asked for her followers to send in their testimonies so she could publish them.

Screen Shot 2014-08-03 at 12.12.25 amScreen Shot 2014-08-03 at 3.05.21 am

Soliciting testimonials to republish is 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.” [2]

Testimonials are very good as a marketing tool. 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 [3]. 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 [4]. 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.

I’m sure would say that she’s asking for testimonies so that she can share the joy of others with her followers, or seek to give glory to God, or something like that. And perhaps she is. I’m not sure how she reconciles that with Jesus words, “Be careful not to practise your righteousness in front of others to be seen by them. If you do, you will have no reward from your Father in heaven.” (Matthew 6:1) But that’s for her own personal consideration.

Whatever her intentions, the soliciting and publishing of personal testimonials from potentially vulnerable people is ethically delicate. I think she’d be better to step away from publishing these testimonials.

And 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.

References

  1. Toepfer, S., et al., Letters of Gratitude: Further Evidence for Author Benefits. Journal of Happiness Studies, 2012. 13(1): 187-201 doi: 10.1007/s10902-011-9257-7
  2. 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/.
  3. Fowler, G., Evidence-based practice: Tools and techniques. Systems, settings, people: Workforce development challenges for the alcohol and other drugs field, 2001: 93-107
  4. 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