NPR: Embracing Anecdote

The awful NPR report on the use of pseudo-medicines to treat pain in Oregon was nicely discussed over at Science-Based Medicine by Dr. Novella.

The NPR article was reproduced without comment on the Lund Report, which calls itself "Oregon's most vital source of health news."

In the comment section of SBM Windriven used the term embracing anecdote, a description of NPR report and much of the basis of pseudo-medicine. I have said before that one anecdote is more powerful than a dozen randomized placebo controlled double blind studies.

The NPR starts with the story of Doris Keene who had chronic pain. Exactly want the pain was and how long she had it is not clear. Sciatica is mentioned, a disease that more often than not improves with time. So it would be nice to know if that were indeed the diagnosis and how long she the process, but as is so often the case with anecdotes, the important specifics are never mentioned.

She was given Vicodin and muscle relaxants and they did not help. That does not surprise me. Having had a ruptured disc and 9 months of pain I can tell you: nothing helps the pain.

Ms Keene increased her medication with little effect on the pain but she did get addicted. One nice thing about being on call 24-7 is I could only take a Vicodin on the Friday and Saturday nights when I was not working so addiction from self-medication was never an option.

When she is cut off from the medications she went to Quest Center for Integrative Health, which NPR describes as

a pain management center in Portland

but  the services on the website would suggest that, with 4 acupuncturists, two naturopaths and a reiki practitioner, they are, in my opinion, a general purpose pseudo-medical clinic not grounded in medical reality.

"There should be an array of things for people to choose from," Eisen says, "whether it be chiropractic care, or naturopathic care, or acupuncture, nutrition, massage.

Ms Keenen had a response to her first session that would a faith healer proud and suggests a similar reason for her improvement:

"I come in here wearing back braces, and knee braces and a crutch, and Dr. Dave told me, 'Get rid of them! They're just weakening your muscles,' " Keene says. "And when I could walk out of here after the first acupuncture [treatment], I wanted to grab him and kiss him."

And that description makes me wonder about several issues.

Just what was the cause of pain? Why all the braces? Seems overkill for sciatica

There is a tendency for some patients to minimize their illness. Others dramatize them. This seems on the dramatic end of the scale to me. And some patients become medicalized, their illness and treatments becoming a key part of their identity. I get that sense as well. Patients do get into care that is dysfunctional, where the interventions serves to worsen the patient and make them dependent on their provider. It is how much of the chronic Lyme industry works.

They note

acupuncture treatments ease her pain at least as effectively as the Vicodin and muscle relaxants she once depended on.

Which, they noted early on, was not much. So it sounds like she exchanged a placebo opiate and a poor relationship with her MD for a placebo pseudo-medicine and a caring, but deeply pseudo-scientific, environment. 

But the story is not not spun that way. It embraces an anecdote to suggest that Ms. Keenen received benefit from the pseudo-medicine rather than natural history of the disease or, perhaps, getting out of  dysfunctional medical care.  But as is so often the case, the information required to really know what is happening is lacking. 

And if NPR, and most mainstream media, does such an inadequate, uncritical report on a topic about which I know something, it alway makes me wonder about the validity of rest of their content.

As of 2016 Oregon is going to pay for pseudo-medical placebos like those received by Ms. Keenan, which I have discussed before.

In Oregon, to paraphrase Simon Singh, we have had problems with airplanes. So we are going to use flying carpets instead.