Thursday, August 02, 2007

Also, how reading this blog will help you slim down.

I've now read the bibliotherapy article in greater detail. And I have a few questions, mostly about methodology and the inferences drawn from the results.

1. What do they mean when they say this therapy eliminates the need for ongoing treatment in a "small but significant percentage of cases"? How small is small? And why would "small" results in this case be any more "significant" than comparably "small" results in some other study? We just finished criticizing AA for helping perhaps 20 percent of the people who attend. I have a feeling—based on the language used here—that bibliotherapy "cured" far fewer than 20 percent of those who participated in the studies. For that matter, why are they describing the results in verbal form rather than just citing stats? That should make you suspicious to begin with, since writers (or spokespeople) can characterize numbers any way they want to. But the actual stats speak for themselves.* In fact, most of the stats in the Journal piece are devoted to outlining the size and nature of the self-help book business, not bibliotherapy per se. (The writer, Kevin Helliker, even spends time telling us that bibliotherapy books can be checked out from the library "for 12 weeks, four times longer than other books." Of all the stats to give us!) I'm willing to concede that part of the problem here is just bad journalism. Good journalism, especially in stories dealing with trends, medical breakthroughs and such, is supposed to show you why the story is important, not just tell you.

2. I kind of go with Cosmic Connie here, re the fact that almost any routine-changing activity—shopping or so-called "retail therapy" comes to mind—can make a person feel better for a while. So I wonder: Were control groups used in the studies cited? Were some participants given other types of books to read (romances, mysteries, porn), yielding even smaller and less "significant" results? For a textbook example of a bibliotherapy study that was excruciatingly bad in its design, scroll a bit of the way down in this citation and read the description of the one run by Dr. Forrest Scogin at the University of Alabama. I really, really hope that this isn't what passes for research in the mental-health arts these days.

3. The final line of the Journal piece is, I think, revealing. Helliker writes, "Most research suggests that bibliotherapy is most effective when used in conjunction with conventional therapy or while waiting for conventional therapy to begin." I'm reminded of all those ads for magic-bullet diet pills and potions that say, in fine print, the product "works best in combination with an exercise program and meaningful changes in eating habits...." In such a case a consumer may reasonably wonder, Am I really losing weight because of the pill? Or because I stopped eating and started going to the gym?

Same here, folks. In fact, many people who read SHAMblog every single day report a dramatic loss in weight. (NOTE: The best results were obtained by readers who also cut their caloric intake in half and signed up for a three-day-a-week class in jazz dance.)

* Yeah, I know the famous line about lies, damn lies, etc. You can twist statistics, too. But what's more subject to hanky-panky? A raw number? Or my verbal characterization of that number?

11 comments:

a/good/lysstener said...

This is very true, Steve, the part about diet plans in particular. I've been trying to wean my Mom off fad diets for a while now, and all it usually does is create arguments because she doesn't want to hear the kind of reasoning you present here. I think I told you she also ordered one of Kevin Trudeau's books and was completely captivated by it until I sent her the link to your blog. I love her to death of course, but I'm afraid she's one of those people who doesn't want the easy answers taken away from her even if they have no basis in fact.

Steve Salerno said...

Alyssa, just tell her that my implied promise stands: If she reads SHAMblog faithfully every day, cuts her calories in half and signs up for a dance class, she will enjoy the dramatic weight loss I describe. Eventually she will even be ready for Phase 2, where she can read the blog every other day and yet continue to lose weight!

a/good/lysstener said...

Let me guess: Phase 3 is "maintenance," and for that she has to buy a copy of SHAM along with continued sensible eating and exercise.

You are a very clever man, Steve. :-)

Cosmic Connie said...

Re Kevin Trudeau: what's REALLY amazing is that last time I checked, his weight-loss book was still on the bestseller lists, even though he and the book have been pretty thoroughly discredited.

OTOH, "The Secret" is still way up there on the lists too, which is pretty depressing as well.

I gotta find me a scam...

Mary Anne said...

I just got through with a book by a former colleague turned motivational speaker and the first page of the book states, "this book is not intended to replace psychiatric help or conventional therapy." The disclaimer might as well have said, "don't try this at home." Is this the norm in self-help and diet books now?

Cosmic Connie said...

Yes, Mary Anne, those disclaimers are pretty much the norm in most self-help books (and other self-help products). It's one way the SHAMsters have of covering their behinds, legally speaking. That's how they get by with making the most outrageous promises and claims without worrying about any liability.

Steve Salerno said...

Speaking of disclaimers and side effects, my favorite currently running is the one that says to watch out for "unusual tongue swelling." That's bad enough, but I think this might be the same drug that warns you to be on the alert for sudden "sexual compulsion" or some such. Can you imagine? Walking around in a horny haze with a swollen tongue??

Cosmic Connie said...

"Can you imagine? Walking around in a horny haze with a swollen tongue??"

It could either get you arrested, or get you some very interesting dates ("interesting" in the proverbial Chinese sense, that is).

a/good/lysstener said...

Horny with a swollen tongue, huh? No further comment or I'll just get myself in trouble again.

RevRon's Rants said...

"Can you imagine? Walking around in a horny haze with a swollen tongue??"

Welcome to my world, Steve! :-)

Steve Salerno said...

I figured there had to be a reason why your "official" photo was shot from such an unusual distance...