What do you think about popular writers who exploit weak science to promote fringe treatments?
Norman Doidge’s book “The Brain’s Way of Healing: Remarkable Discoveries and Recoveries From the Frontiers of Neuroplasticity” is a worldwide bestseller and has been widely praised for providing new hope for people who suffer from a wide variety of neurological ailments, chronic pain, and psychological problems. Unfortunately, it is also a fine example of how a good writer can use bad science to promote treatments that simply don’t work.
As we have been building the platform for our consumer-centred Myndplan app, I have been immersed in neuroscience research. While this may not be most people’s idea of a fun time, it has actually proven to be a very exciting process that has me constantly learning new things. Recently, I built a comprehensive set of interactive Guides for mental health treatment based on current research and consistent with international clinical practice guidelines. This will be part of an AI treatment planning interface for use by consumers. So I guess you could say I was exactly the wrong guy to read Norman Doidge’s The Brain’s Way of Healing: Remarkable Discoveries and Recoveries From the Frontiers of Neuroplasticity (Whew!).
When I’m not working on Myndplan or seeing my therapy clients, I like to relax with a good book. To be honest, I usually pick a corny science fiction novel for my fun reading. I enjoy hard sci-fi, which is kind of like a literary form of Sudoku puzzle that teases you to try and figure out what is actually happening in the story. The science in hard sci-fi is usually pretty sound. But in the end the process of the story is all fantasy and speculation. As an added bonus for a psychologist like myself, today’s hard sci-fi is often all about the implications of modern neuroscience. But unlike my kind of sci-fi, Doidge’s book sounded like hard science without the fiction. Still, I was willing to give it a try. After all, this was a gift from my wife, who has listened to me talk endlessly of the miracle of neuroplasticity and brain function and thought that perhaps a bestseller on the topic might be suited to my tastes.
Norman Doidge is a psychiatrist and psychoanalyst, researcher, and author. He is on the faculty at the University of Toronto’s Department of Psychiatry, and research faculty at Columbia University’s Centre for Psychoanalysis. I had first read about him in an interview published in the Globe and Mail a while back on the “new neuroscience”. The article was in-depth and interesting. On reading it I was impressed with what it said about Doidge and his writing. Here was someone like me who could see the amazing implications of new research into brain function and its relevance to all sorts of human pathology. Based on my take from the Globe interview and other reviews, pretty well everyone seemed to be impressed. Plus the guy has sold millions of books. I’m a psychologist and a budding writer who hasn’t sold any books. Maybe I could learn about more than just neuroscience by giving it a read.
When I start reading The Brain’s Way of Healing it quickly became apparent that the critics might be correct in their estimation of his storytelling, but for all the wrong reasons. To be fair, Doidge’s book starts off with some interesting facts that I have been researching myself of late, such as how chronic pain can be unlearned, and the benefits of exercise on mental health.
However, before I know it I am being taken out of orbit into the realm of magical cures and snake oil remedies. Wait a second – I had thought this fellow was a psychiatrist!
Please don’t get me wrong. Doidge has some of his facts right. He has done his homework when it comes to the anatomy of the brain, and how the various parts relate to one another. He is pretty good at making the complex physiological and chemical properties understandable to the layperson. He seems to make neuroscience easy to understand. But by the time he has pulled me through chapter three, which introduces the idea of energy therapies and neuroplastic healing, I’m getting really uneasy. His account of the brain seems so clear and concise – yet my impression after combing through thousands of research articles is that on virtually every front there is controversy. Whether it concerns the exact boundaries of an anatomical piece of the brain, its precise function, the chemistry that makes it work, the things that can go wrong, or the treatments that can correct this, no one seems to agree on any but the most obvious things. And why haven’t I stumbled across these treatments that Doidge is praising as I’ve been conducting my own research? My suspicion has been aroused, but I’m still willing to give the guy a chance.
I read on with my enthusiasm fading, and my skepticism grows. I’ve spent years working on treatment guidelines, plowing through review articles and meta-analyses. So I’m primed for all the signs that an intervention is either well supported by research or on weak legs. All of my alarm bells are suddenly sounding at once. I had been suspicious when Doidge relied on a long case study in chapter 2 to illustrate how exercise could be used to cure symptoms of Parkinson’s disease. Wow. I am well aware of the value of exercise, and recent studies are looking very positive regarding its role in slowing the progression of many conditions. At the memory clinic where I work, we make a point of referring anyone with early stage dementia to a local exercise program for this reason. But the research is still pretty fresh, and by no means is exercise a cure for anything, never mind a chronic, deteriorating condition like Parkinson’s.
By the time Doidge starts into his case studies in Chapter 4 to illustrate the amazing benefits of Low Light Laser Stimulation, I’ve gone from doubter to atheist. Once again, he spends a lot of time getting very personal with a few case studies. He also goes out and talks to the people who invented the “LLLS” device, patented it, and have used it on “over a million” cases. I do my homework. A recent meta-analysis of 221 studies using this method for low back pain could only find five that met the criteria required to include them in the analysis. When these five were looked at, there was no significant effect of the treatment on disability or range of motion, though some weak evidence that pain levels improved. Looking at osteoarthritis pain the results are similar. LLLS studies were found to be of low quality, and while they may help with pain, there is no effect on physical function 1.
In yet another study, LLLS actually turns out to be harmful, with shoulder symptoms worse after treatment 2. I found this out in less than 20 minutes. Doidge doesn’t seem to have bothered to even look.
More important perhaps is what is missed entirely in this chapter – all of the studies to date looking at treatment of joint or osteoarthritic conditions show very clearly, using very sound study design, across thousands of individuals, and with large effect sizes, that exercise and weight loss are the best options for both reducing pain and improving mobility and function 3. Doidge seems to have left these solid facts back at the beginning of chapter two and instead is striking out into the no-man’s land of flaky science and gimmicky devices.
It’s like your doctor handing you a pamphlet about the benefits of polio vaccines for kids and then lecturing you for half an hour on how childhood vaccinations cause autism.
Chapters 5 and 6 moves on to something called the Feldenkrais Method, which involves a patented and trademarked technique for teaching a sort of judo-like treatment for stroke victims, kids with cerebral palsy, or just regular people with sore necks or stiff backs. Once again, the case studies are dramatic and the claims of miraculous change are bold. The science is also very effectively made to appear sound. And after all, there are hundreds of centers throughout the world providing this method of therapy, so how could it be wrong? However, when I look into the research literature I find lots of google ads, books and magazine articles, and… hardly any scientific studies. When I do burrow down and uncover a recent review of the research, I learn that the neurophysiological changes claimed by Doidge and Feldenkrais’ adherents don’t hold up. The treatment has some mild positive effects, but largely those you would expect from teaching relaxation methods 4.
This pattern is repeated for chapter 7, which introduces us to a device called the PoNS. The PoNS uses electrical stimulation to prompt all kinds of supposed neurological changes and neuroplastic improvements. Again, a dramatic case study. Again lots of impressive scientific arguments. But no actual science. I hunt through the literature again. Ads. More Ads. Some books on the topic. A website or two. One recent meta-analytical review. I’m curious and read it through from start to finish. I’ll admit I’m a bit intrigued now. The study reports that findings are positive. Then my brain turns back on. The review seems to lack rigor. There is no mention of Cochrane criteria – steps that should be taken to weed out the weak study design, or bias in the authors.
Perhaps that is because the authors of this particular study just happen to be the same fellows that Doidge interviews in his book, who are the same guys with the patent on the device (which they fail to mention in their research article).
There is another chapter on the use of “sound therapies” plus some appendices looking at matrix repatterning and neurofeedback techniques. I could go on, but all of this follows the same pattern. Doidge cites a few dramatic individual cases, he throws out loads of impressive sounding clinical arguments, he encourages us to share his enthusiasm. And always, none of the techniques are extensively researched, if they are researched at all. Those studies with any credibility fail to find the kind of strong effects that Doidge enthuses about throughout his book. When positive review articles exist, they are critically flawed and do not meet Cochrane criteria. Negative review articles are never mentioned.
The process is repeated with such precision that it is hard to conclude anything other than Doidge doesn’t actually want to know what the research world has to say about all these amazing techniques. Instead, his main purpose is to convince you to believe him.
This is not where I thought I would end up when I began reading Doidge’s book. I really, really wanted things to work out. I’ve had clients bring his book in and explain how it had inspired them to try one or another therapy that I’d never heard of. I had assumed that perhaps I was falling behind on my reading, not that the book was selling the equivalent of snake oil remedies. What makes it all the more tragic is the fact that Doidge uses the field of neuroscience as the foundation for his arguments, and in the process does a disservice. In The Brain’s Way of Healing, Norman Doidge tells a great story, but file this one under Fiction. Maybe even hard science fiction. Seems my wife got the book right after all.
For those of you who’d like to do some of your own research on just about any topic, keep an eye out for my upcoming handout summarizing tips and tricks based on what I’ve learned over a lifetime of searches.