Tooth Fairy Science and the Constitution

Tooth Fairy Science and the Constitution

Harriet Hall coined the term “tooth fairy science” which is

to doing research on a phenomenon before establishing that the phenomenon exists….You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists.

The concept encompasses most of pseudo-medicine and usually studies look for results based on interventions not based on reality. Much of traditional Chinese medicine is based on concepts divorced from anatomy and physiology and are perfect grist for tooth fairy science mill. 

An example comes from the introduction of The Association between Yang-Deficient Constitution and Clinical Outcome of Highly Active Antiretroviral Therapy on People Living with HIV

Before you read further, a warning. If you are drinking, swallow now, so liquid does not squirt out your nose and onto the computer.

…more evidence is emerging that much of the wisdom of traditional medicine can in fact be explained at genomics level (Joshi et al. [2] and the references therein). Recently, HLA class II polymorphisms were found associated with the physiologic characteristics defined by Traditional Chinese Medicine (TCM) [3]. In TCM, constitution is believed to be a distinct characteristic of an individual [4]. Constitution has been used to guide disease prevention, health care, and medical practice [5]. Yang-Deficient Constitution is one of the major constitutions, which is characterized by chills, cold limbs, and also spontaneous sweating; loose tools and/or profuse clear urine; and lassitude.

so they decided to

systematically investigate whether there is any association between Yang-Deficient Constitution and complications incurred from HIV infection and design evidence-based treatment, we conducted a prospective observational study for evaluating the association between Yang-Deficient Constitution and clinical outcomes.

On a scale of 1 to 5 they asked HIV patients the following questions to see if they were Yang-Deficient:

  1. Do you feel cold at your limbs?
  2. Are you sensitive to cold at stomach, back, waist, or laps? Are you usually sensitive to cold weather and dress more than others?
  3. Are you more sensitive to cold air (such as outside of winter, air-conditioning, or electric fan)?
  4. Do you have flu- or cold-like symptoms more frequently or easily than others?
  5. Do you feel uncomfortable or worried for cold water or foods?
  6. Do you have pulpy bowel after having cold water or foods?

I have taken care of AIDS patients since the beginning of the epidemic and I cannot imagine how those questions could be relevant in any way to HIV, its treatment and complications, or even a surrogate except to note perhaps patients with more advanced disease would be more likely to have the above symptoms.  HIV leads to those symptoms, not being Yang-Deficient.  Recognizing cause and effect not being a strong point in the world of pseudo-medicine.

They then collected a tonne (English measurement, it is that large) of data and ran it through the old p value machine and found some barely significant results. They concluded

Yang-Deficient Constitution score has a potential to be developed as a predictor for early HIV-related mortality and side effects. The interrelation and underlying mechanisms should be further investigated for evidence-based design of a more appropriate treatment strategy.

They go so far as to suggest it is the mitochondria. Medication toxicity in HIV is often due to mitochondrial toxicity. Mitochondria are important for energy. Yang deficiency syndrome patients have weak or imbalanced energy. Therefore

Yang-Deficient Constitution is susceptible to mitochondrial toxicity is worth further investigation. At least quantum effects are not blamed.

I keep going back to Ioannidis and there are at least three reasons, besides thinking the idea that constitution is valid, that the conclusions of the study are false:

  • Corollary 3: The greater the number and the lesser the selection of tested relationships in a scientific field, the less likely the research findings are to be true.

  • Corollary 4: The greater the flexibility in designs, definitions, outcomes, and analytical modes in a scientific field, the less likely the research findings are to be true.

  • Corollary 5: The greater the financial and other interests and prejudices in a scientific field, the less likely the research findings are to be true.

I guess they did not read the paper. Few in the pseudo-medical world seem to. Data mining garbage does not lead to diamonds. Tooth fairy science at its more pure. Supported by the Chinese Government and Stanley Ho Centre for Emerging Infectious Diseases. Good money thrown away.

Look on my works, ye Mighty, and despair!"

Nothing beside remains. Round the decay

Of that colossal wreck, boundless and bare

The lone and level sands stretch far away.

Points of Interest: 1/25/2014
Points of Interest: 1/24/2014