“Mental health apps offer a head start on recovery” – Irish Times, 18/01/18

Here is a piece by Sylvia Thompson on a recent First Fortnight panel discussion I took part in on apps in mental health.

Dr Séamus Mac Suibhne, psychiatrist and member of the Health Service Executive research technology team says that while the task of vetting all apps for their clinical usefulness is virtually impossible, it would be helpful if the Cochrane Collaboration [a global independent network of researchers] had a specific e-health element so it could partner with internet companies to give a meaningful rubber stamp to specific mental health apps.

“There is potential for the use of mental health apps to engage people with diagnosed conditions – particularly younger patients who might stop going to their outpatients appointments,” says Dr Mac Suibhne. However, he cautions their use as a replacement to therapy. “A lot of apps claim to use a psychotherapeutic approach but psychotherapy is about a human encounter and an app can’t replace that,” he says.

Here are some other posts from this blog on these issues:

Here is a post on mental health apps and the military.

Here is a general piece on evidence, clinical credibilty and mental health apps.

Here is my rather sceptical take on a Financial Times piece on smartphones and healthcare.

Here is a piece on the dangers (and dynamics) of hype in health care tech

Here is a post on a paper on the quality of smartphone apps for panic disorder.

Review for TLS of Rose Shapiro’s “Suckers: How Alternative Medicine is Making Fools of Us All” , 2008

Original text of review for TLS of Rose Shapiro’s “Suckers: How Alternative Medicine is Making Fools of Us All”

The TLS published this with slight tweaks, I will try and use Lexis/Nexis to get the final text.  I suppose my view on “alternative medicine” comes across here. Wellness and health are ultimately subjective, and experienced at an irreducibly individual level. This doesn’t mean every wild claim should be taken at face value.  Books like Suckers are exercises in shooting fish in a barrel. What is really interesting about alternative medicine is why so many people are drawn to it. This may be because of failings of mainstream medicine, but ultimately I believe says more about society in general. Increasingly life expectancies and an increasing  expectancy of an active older age do not necessarily mean that our expectations of what it means to be healthy are realistic, or even achievable. The WHO’s grandiose definition of health doesn’t help. Ultimately the popularity of alternative medicine is an attempt to sate a need that mainstream medicine doesn’t even begin to address – nor should it.

Suckers: How Alternative Medicine Makes Fools Of Us All by Rose Shapiro – Harvill Secker 2008

In the UK, £4.5 billion is spent each year on Complementary and Alternative Medicine (often usefully abbreviated to CAM). CAM is a broad term. As Rose Shapiro observes towards the end of this astringent book, these treatments are on a continuum, with some herbal remedies and relaxation techniques being incorporated into the mainstream. Somewhere beyond these therapies are the likes of acupuncture – with some possible efficacy for pain and nausea – and further along we get to the bulk of CAM “therapies”, of which Shapiro gives many lengthy and non-exhaustive lists – from ear candling to Bach flower remedies and from homeopathy to cranial osteopathy – all of which are unproven and with a theoretical basis positively antithetical to physiological, biochemical, chemical and anatomical knowledge.

CAM therapies and have recurrent features, and their pioneers and proponents have recurrent tendencies. Emblematic is the life of Daniel David Palmer, inventor-prophet of chiropractic. Canadian-born, in the 1890s Palmer had established a magnetic healing practice in Iowa and styled himself “Doctor” (despite their disdain for the medical establishment, CAM practitioners seem keen to claim the title and trappings of the profession) and decided that there must a single cure for all diseases, another familiar theme.

In the world of CAM, anecdotal experience trumps repeatable scientific study. Palmer claimed to have restored a local janitor’s hearing by manipulating his spine (a claim disputed by the janitor’s family) thereby discovering “subluxations”- a borrowing from orthodox medicine which in chiropractic refers to any spinal deviation, the supposed cause of 95% of disease. Palmer lost control of chiropractic, the idea for which had been revealed to him during a séance, to his less mystical and savvier son B J Palmer, who realised that the real money was in training further chiropractors. Much entertaining brouhaha ensued, with the elder Palmer dying after being hit by a car whilst protesting at the annual jamboree held by his son’s school of chiropractic (internecine feuding, no surprise with so many “discovering” the cure to all disease , seems another feature of the CAM landscape).

Shapiro wittily illustrates other CAM traits, the misuse of scientific-sounding words like “quantum” and “paradigm”, the paranoid stance towards conventional medicine which is in conspiratorial cahoots to suppress the hugely profitable CAM, the paradox that CAM practitioners stress the timeless, ancient qualities of their remedies while often trying to cloak it in the terminology of state-of-the-art technology. She has read widely, yet there is little evidence of original research or observation. There is not much here that not covered in more depth in other popular books, or even more pertinently websites such as Stephen Barrett’s quackwatch.com. Shapiro takes Barrett’s impatient, take-no-prisoners approach, which plays well with fellow sceptics but does little to convert the undecided. There is more of a UK focus than in other books on the subject, with issues such as availability on the NHS and should B.Sc. degrees in CAM practices (Bachelor of Science without the science, as one critic points out) be offered discussed.

The “therapies” are so many fish in a barrel, and Shapiro does her debunking work with glee. And yet there is a sameness to it all, a sense of missing the wider point. The post-industrial West is a world with unprecedently high life expectancy and freedom from serious life-shortening disease. This is also s world where “Dr” Gillian McKeith markets a snack bar listing “Unconditional Love” as an ingredient. Why are the legions of educated, high-disposable-income middle-aged, middle-class women– identified by Shapiro as the key consumers of complementary/alternative medicine – so keen to abandon critical thinking when it comes to their health? Shapiro makes some unexceptional observations about CAM offering these women some control and power over their lives, but does not explore these issues in depth.

Why do the majority of the headaches, back aches, fatigue and non-specific pain that comes the way of general practitioners have no physically identifiable cause? Why has having an illness become somehow desirable; why for instance are the “ME lobby” so vehement in their insistence that the condition has a purely physical cause? The World Health Organisation has defined health as “a stage of complete physical, social and mental well being and not merely the absence of disease or infirmity”, a statement of awesome fatuity which renders health unattainable in this world. And if health is considered a right, and not a blessing or or what the Stoics would have called a “preferred indifferent” (to be desired, but out of one’s control and therefore not should try and view with indifference) – its unattainability becomes unbearable.

We are often told that CAM is a reaction to authoritarian, impersonal mainstream medicine. The irony is that there are few graduates from medical schools nowadays who fit the paternalistic stereotype. Medical students are taught to beware personal authority and experience and to follow the impersonal calculus of evidence-based medicine. As Shapiro writes, it is mainstream medicine that suggests a holistic, biopsychosocial approach to ME, and it is the alternative medical world that promotes a unitary physical cause. The cult of personality of the trust-me-I’m-a-doctor archetype is more likely to be found in the world of CAM

Shapiro quotes Richard Dawkins’ observation “either it is true that a medicine works or it isn’t – it cannot be false in the ordinary sense but true in some ‘alternative’ sense.” The contemporary sense of what health is renders this commonsensical statement – which perhaps could be the epigraph of Shapiro’s book – unworkable. What does it mean anymore for a medicine to “work”? CAM promises panaceas where mainstream medicine is humble and promises palliation. If health is promoted as complete well-being, we should not be surprised if the public falls for the deceptive and unlimited promises of completely unproven therapies