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Therapeutic Illusion

There was an interesting commentary in the March 31st issue of the New England journal of Medicine called “The Science of Choosing Wisely-Overcoming Therapeutic Illusion.” The article pointed out the propensity of human beings to overestimate the effects of their actions. This is an offshoot of a well-defined reasoning fallacy referred to as “faulty cause.” With this reasoning fallacy a causal relationship is assumed when only a temporal relationship exists. One of my favorite examples is an article called “Deaths after chiropractic.” It may interest you to know that after chiropractic treatment 100% of patients die. Sometimes sooner and sometimes later. Sometimes many, many years later.

This “faulty cause” fallacy is reinforced by our very early training in Newtonian physics where we learned that every action has an equal and opposite reaction. Consequently it is natural for us to expect that our intervention will result in some sort of outcome. This adds to the illusion that we can influence events over which we have no true control. This is why we might blow on the dice before we roll them or knock on wood. Heck, I’ve heard myself say that the fact I’m carrying an umbrella makes it less likely it will rain. I really don’t believe I can influence the weather with my ‘talisman’ umbrella but it does illustrate that this illusion of control is a real part of human psychology.

There are organized approaches to addressing the consequences of this “illusion of control,” or for clinicians, “therapeutic illusion.” A campaign called “Choosing Wisely” encourages clinicians to avoid or at least consider carefully therapies and tests different medical societies have identified as being overused or used inappropriately.

For an individual clinician to avoid therapeutic illusion is more a matter of awareness than anything else. It is important when you see a positive result to consider things other than your intervention that may have contributed. When your patient comes in saying “Doc, I’m feeling great! I’m exercising and sleeping well and I’ve lost some weight because I’m eating right. I’m doing so much better since I’ve come to see you.” You might consider that it’s not just your intervention that explains the patient’s state of health.

Casarett D. The Science of Choosing Wisely–Overcoming the Therapeutic Illusion. N Engl J Med. 2016 Mar 31;374(13):1203-5.

Ernst E. Deaths after chiropractic: a review of published cases. Int J Clin Pract. 2010 Jul;64(8):1162-5.

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