Testimonials

The Problems with Testimonials as Medical Communications  

"testimonials seem to affect recipients' decisions and intentions... if they are vivid and come from a person who is much like the recipient with whom the recipient can identify

(Dillard and Main, 2013). 

Testimonials by lay persons are similar to case reports by physicians, each are based on observations.

"For centuries doctors used leeches and lancets to relieve patients of their blood.

They KNEW bloodletting worked. EVERYBODY said it did. When you had a fever and the doctor bled you, you got better. EVERYONE knew of a friend or relative who had been at death’s door until bloodletting cured him. Doctors could recount thousands of successful cases."

~ unknown attribution

Bloodletting is largely discounted in modern medicine based insights into the biology of diseases. It was still used in the 1920s because it was believed to help cure a variety of ailments, including cardiac problems (Humors theory).

... It was thought to balance the body's humors, or bodily fluids, which were believed to influence a person's health. An imbalance of humors was thought to cause most ailments (Sanguinistic symptoms).

... Pain, fever, inflammation, and dropsy were thought to indicate excess blood, making bloodletting a logical treatment. It was a common therapeutic method in Medieval Europe and was still recommended for pneumonia in a 1942 medical textbook.

Observations can provide useful information - providing it's the basis for further inquiry by the patient, or further study by medical professions.

The MANY issues with testimonials, and similarly with case reports:

Testimonials can't inform us about what would have happened if nothing was done, or something else. Like the blood-letting done throughout history to relieve the blood of humors, without a controlled study we can't know if the patients would have done well anyway. Testimonials can't inform about the number of persons who have used the intervention and did not benefit or were harmed. Did 1 of 5 or 1 of 300,000 benefit? People sometimes win the lottery, but this does not make playing the lottery a good bet.  Compare with prospective clinical research where the number of participants are prespecified - providing a denominator, which provides rates of good and bad effects. People who die from an intervention or in spite of it, can't tell their story Is the account truthful - relating the entire story? We cannot know if the person reporting the benefit online really has the medical condition, or if he or she is reporting the outcome accurately? Does she have a financial conflict of interest or strong belief?  Dose he sell the product or charge a fee for dispensing the information? What are the biases or motives of the person telling the story? Is it a way of validating her personal decision process and theories? Did the story teller relapse shortly after the testimonial? What are details of the case, such as the natural history of the disease? Is the condition self-limiting - does it sometime self-correct with time? Many conditions wax and wane. Even for cancers with a very poor prognosis there are case reports in the literature of spontaneous remissions, independent of any intervention. Some types of cancer behave indolently-- and do not progress to a point requiring treatment.  How was the reported benefit measured, when, and by whom? Was the reported success objectively measured and validated by independent physicians? Is it a patient-reported outcome? Was it that the patient felt better?  What tests were used to measure it? What happened later? What other medical treatments were given shortly before or after? For example, CT scans may show lesions after standard treatment that are necrotic scar tissue. Credit might be given to an alternative practice used AFTER standard treatment treatment, when it was merely the resolution of a scar tissue over time. Was the diagnosis accurate? Was it a false diagnosis of a cancer, or a cancer of a type with an indolent course? For all of these reasons it's prudent to regard a testimonial with suspicion - particularly if it's the entire basis for promoting a medical practice. Case reports by doctors have many of the same limitations - such as these reports cannot establish causality - that an off-label intervention, for example, caused the result; and can't be a strong basis for recommendations made to other patients.