In the absence of
valid scientific evidence to support health claims of alkaline water,
homeopathy, other enhanced water products (and hundreds of other 'health'
products and treatments) promoters
of the products or services must rely on testimonials or anecdotes - people's descriptions about how they
believe the product has helped them.
Testimonials are important, but ONLY as a source of
questions and ideas for further rigorous testing (blinded experiments where
practical). One person’s (or even many people’s) reaction to a treatment
that is claimed to produce health benefits is completely unreliable as a
proof the treatment actually has any effect
The problem with testimonials is that there are many alternate, and often more plausible, explanations for the
observation of increased health that have nothing to do with the 'health'
product or service being promoted. The points discussed below can
cover any of the water 'cures' or treatments that claim to produce a health
benefit including, but not limited to, water that has been: ionized, clustered, structured, exposed
to magnets, energized, oxygenated, vortexed, hydrogenated, intentionalized,
catalyzed, m-activated, infused with noble gasses, exposed to pi ceramics,
or serially diluted with succussion (shaking).
The warning to be skeptical of testimonials applies to any
product or service that does not have valid experimental evidence to support
claims of effectiveness.
Ten reasons to be skeptical of testimonials about
health benefits of any product or service:
- Placebo Effect: Results
can be caused by the placebo effect. How does one determine
whether perceived health benefits of drinking alkaline water are due to
actual biochemical effects on the body and not a result of the placebo
effect? The placebo effect and the “power of suggestion” are
remarkably compelling phenomena that can lead to the perception of
greater energy, reduced pain, and a number of other health benefits that
have been well documented over the years. The placebo effect can
even lead to biochemical changes in the body that mimic the effect of
some drugs. There is no way that reported health benefits of
alkaline water, homeopathy or other enhanced water products be
distinguished from manifestations of the placebo effect without
rigorous, unbiased experimentation.
- Spontaneous improvement: Spontaneous, natural improvement in symptoms
is attributed to a treatment. In these cases, people will often try a treatment when their symptoms are the worst – which often just happens to be when the symptom severity will normally begin to improve.
If perceived healing can be caused by
timing of the treatment, what observations or measurements could one person make to demonstrate that a given healing episode was due
to the treatment and not to ordinary healing processes? It
has be said that if you have a cold you will normally get over it in a
week, but if you take a special treatment like alkaline water or a
homeopathic remedy, you will be cured in only seven days.
- Many diseases, like colds, flu, cough, allergies, etc., spontaneous
improve over a week or two in most people regardless of treatment.
- Symptom severity in patients with chronic
ailments like anxiety, back pain, migraines, etc., may naturally
fluctuate over time.
Pretty much anything you do to treat a cold will work - eventually.
Spontaneous improvement of symptoms can lead to confusing causation with
correlation - in other words, two events might be linked in time but
there may be no cause and effect relationship between them.
Confusing correlation with causation is one of the many
logical fallacies employed by those who promote pseudomedicine and
pseudoscience and can be illustrated by the example, "Many people who have strokes are on blood pressure medications. Those blood pressure pills must be causing strokes.!"
- Misdiagnosis: The symptoms or illness could be misdiagnosed. For example, a person is informed by a care giver they have cancer (or other specific disease). They are told (or believe) the condition is incurable or would require a drastic intervention to cure. They begin to drink alkaline water,
take a homeopathic remedy or try some other treatment because a friend tells them it can help cure cancer. Two months later they have another checkup and are told there is no cancer. Is it more likely the
cure was a result of the treatment, a miracle or a misdiagnosis? In some cases people simply decide they have a specific disease, embark on a treatment protocol like drinking alkaline water, feel better after a few days/weeks, and believe the treatment cured them of their self-diagnosed illness.
- Undocumented treatment: Switching or adding treatments or changing behavior may cause a real improvement in symptoms, but the ‘cure’ is attributed to the original treatment. An example might be if someone who has been working hard lifting heavy objects develops lower back pain and begins taking a homeopathic pill that’s ‘guaranteed to reduce pain’. They would probably also stop lifting things and they might go to bed and use ice and heat treatments. After a few days on the homeopathic remedy their back feels better. It’s likely that the homeopathic
treatment will receive credit for the cure (because they had to actively
pursue and purchase the treatment) and the contribution of the other life-style changes will be
overlooked. With a testimonial there is no way to know what else the person might have done
to try and improve their health.
- Subjective symptoms & outcomes: There are almost
never measurable reference points or targets for the symptoms or
treatment goals in testimonials. In other words what does “increased energy”, “increased mental acuity”,
or "increased heart health" or other common claims like
"better hydration", or "increased detoxification" really mean? What measurable characteristics
can be documented before and after drinking alkaline water? In the absence
of specific measurements and documentation, the mind can create any story it
likes based on a desire to become healthier. Even if an individual created and documented measurable
reference points and recorded some health benefits after drinking alkaline
water or trying an enhanced water product, that would only suggests a correlation, not a cause and effect
- and could not rule out the placebo effect.
- Sample size of One: How does one know what would have happened if
they had not tried alkaline water, a homeopathic remedy, another enhanced water product,
or some other treatment? I submit that it is
impossible to know “what might have been” if only I had done something
differently. A testimonial I received about alkaline water, for
example, claimed that “Except for the roughest allergy season I've
experienced in my 45 year memory, I haven't been sick in almost 5 years
now.” Does that mean alkaline water is not effective against allergies?
Might some of the allergic symptoms actually have been a cold? Can anyone really know
what their health would have been over five years if they had not been drinking alkaline
- Cognitive biases: There are a number
of unconscious psychological phenomena that conspire to influence
people's perception of reality and can lead to the reporting of an
effective treatment (or otherwise skew reality) when there was no actual
physical change. Examples include: Confirmation Bias (people
naturally seek information that supports their beliefs and disregard
disconfirming evidence - self fulfilling information gathering),
Bandwagon or Herd Effect (people tend to follow the crowd and interpret
their experiences as others in their circle do), Social
Desirability (the tendency of people to answer questions in a way that will be viewed favorably by others
- related to the bandwagon
effect), Selective Perception (the tendency for expectations to affect perception -
a component of the placebo effect where there is no actual physical change).
It is informative to go through
this list and see what other biases might fit.
- To put it bluntly, people lie – particularly when there is a profit to be made. There is usually no way to determine whether testimonials used in marketing materials are sincere reports of people’s experiences, paid ads, or complete fabrications.
- Only positive outcomes reported: Testimonials (at least as used by those marketing placebo products) only document
and report positive outcomes. There is no way to know how many people used the product and experienced no positive benefits or got worse because their condition was not effectively treated.
Marketing for FDA approved
medications must include all reported side effects – at least there is some transparency in traditional medicine. On the other hand, there is no requirement to demonstrate the effectiveness of alternative medical
treatments or report the number of patients who do not improve or who get worse after treatment.
The only requirement necessary to market alternative treatments is to
add the Get Out of Jail Free Disclaimer everyone has seen, "This
statement has not been evaluated by the FDA. This product is not
intended to diagnose, treat, cure or prevent any disease."
- Used to
Testimonials are regularly used by placebo marketers to bypass FDA and
FTC regulations against using untested, unsupported claims about
specific disease treatments. A company seldom directly states that drinking alkaline water, for example, can cure cancer, diabetes or other illnesses, but they list testimonials from consumers who claim to have been cured or
alternative practitioners who claim to have treated or cured a specific disease.
The points above describe why I am skeptical about relying
on testimonials to any support health claims for any product. The only thing that would reduce my
skepticism would be a well-designed, double blinded study which demonstrated specific health benefits of alkaline water
or other product were significantly greater than
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|Copyright © 2005 Randy Johnson. All rights reserved.
Updated November 2011