lørdag 20. juni 2015

The Nobel Disease

Why we should stop quoting Tinbergen

The 1973 Nobel Laureate Nikolaas Tinbergen (1907-1988) is often quoted for supporting the Alexander technique. Alexander technique teachers seem to be unaware that this can have some negative aspects. I've been planning to write about this for some time, but was prompted into action by a short article last week in Norway's leading newspaper titled "Stupid Nobel Prize Winners" (Dumme nobelprisvinnere).(1) The article puts the technique in a less than flattering light.

The article was about Nobel Prize winners who promote or support pseudoscience and quackery. Quite a number of prize winners have done so over the years. So much so that the phenomenon has got a name: The Nobel Disease.

The most well known cases are Linus Pauling and Luc Montagnier. Pauling was twice Nobel Laureate, winning the prize for chemistry in 1954 and the Nobel Piece prize in 1962. He is probably most famous for claiming health benefits from taking large doses of vitamin C, thus being a proponent of a dubious alternative health approach which he named 'orthomolecular medicine'. Montagnier was among the scientists discovering the HIV virus and received the Nobel Prize for medicine in 2008. He has later been publishing research of questionable character and is a supporter of the totally debunked homoepathy.

With this in mind it does not necessarily count in our favour being endorsed by a Nobel Prize laureate. It is even possible that having recognition from a Nobel Laureate is more of a burden than an advantage, because there is also another reason why it is maybe not so great being associated with Tinbergen's Nobel Prize.

The first part
The article in the Aftenposten newspaper mentioned Tinbergen for supporting the Alexander technique, but this is actually not why he is listed among the sufferers of the Nobel disease.

As most Alexander Technique teachers know, Nikolaas Tinbergen used the second part of his Nobel acceptance lecture to talk about the Alexander Technique.(2) What he said in the beginning is less known. In the first part of his lecture Tinbergen presented the idea that childhood autism has environmental causes. Tinbergen said:
I cannot possibly go into all the evidence, but there are several good indications, firstly, that many autists are potentially normal children, whose affiliation and subsequent socialisation processes have gone wrong in one way or another, and secondly: this can often be traced back to something in the early environment - on occasion a frightening accident, but most often something in the behaviour of the parents, in particular the mothers.

Tinbergen's Nobel lecture has some credibility issues even disregarding what Tinbergen says about the Alexander Technique. But there are also some problems with what he had to say about the technique.

The second part
Although Tinbergen's enthusiastic support for the technique was a scandal in scientific circles, it seems as if the negative reactions came just as much from the Alexander community.(3) In a letter to the New Scientist Patrick MacDonald wrote:
The Alexander technique is an educative process in which the pupil is taught to practice conscious inhibition and direction in the activities of his daily life [...], the whole mainspring of the technique is simply omitted from Professor Tinbergen's catalogue of observation. [...] I, the present senior practising teacher of the technique in this country, cannot allow Professor Tinbergen’s ludicrous description of it in his Nobel address to pass without comment.(4)
Edward Maisel, the editor of a book containg a compilation of Alexander's writings, said in an interview in New Scientist that
Professor Tinbergen's description of what appears to be some form of osteopathic treatment has very little to do with the Alexander Technique.(5)
In his Nobel lecture Tinbergen invariably denotes the Alexander Technique as "therapy", the lessons "treatments" and the pupils "patients". He says about the technique that:
It consists in essence of no more than a very gentle, first exploratory, and then corrective manipulation of the entire muscular system.
It can be hard for anyone to describe the Alexander Technique. One reason for this is that we Alexander Technique teachers traditionally have not differentiated between the technique itself and the method(s) of teaching it. Tinbergen, having at the time of writing had about fifteen lessons,(6) described the lessons as he had experienced them. He did not describe the technique, but the teaching of it. The result is that Tinbergens Nobel lecture may give the reader the wrong impression of what the Alexander Technique actually is. We have to ask ourselves whether Tinbergen's version of the Alexander Technique is something we wish to promote.

When we do use Tinbergen's Nobel lecture in marketing it is usually by quoting what he has to say about the health effects. But this could be problematic as well.

It was Tinbergen's daughter who played the cello who first had Alexander Technique lessons, then subsequently Tinbergen himself after having read Barlow's book 'The Alexander Principle', and his wife.(7) In what is probably the most quoted passage Tinbergen says:
... between the three of us, we already notice, with growing amazement, very striking improvements in such diverse things as high blood pressure, breathing, depth of sleep, overall cheerfulness and mental alertness, resilience against outside pressures, and also in such a refined skill as playing a stringed instrument.
He continues:
So from personal experience we can already confirm some of the seemingly fantastic claims made by Alexander and his followers, namely that many types of under-performance and even ailments, both mental and physical, can be alleviated, sometimes to a surprising extent, by teaching the body musculature to function differently. And although we have by no means finished our course, the evidence given and documented by Alexander and Barlow, of beneficial effects on a variety of vital functions no longer sounds so astonishing to us.
He then goes on to list conditions that may benefit from the technique:
... rheumatism, including various forms of arthritis; but also respiratory troubles, even potentially lethal asthma; following in their wake, circulation defects, which may lead to high blood pressure and also to some dangerous heart conditions; gastro-intestinal disorders of many types; various gynaecological conditions; sexual failures; migraines and depressive states that often lead to suicide ...
This list of health claims, without the context of case studies, with not much of a hypothesis about why these improvements occur, from something that could be interpreted as mere manipulations, and for even potentially lethal conditions, gives a whiff of snake oil. Go to any site on the internet promoting an alternative therapy and you could find similar lists.

The Alexander Technique definitely has an impact on health, as proven by the positive results from the ATEAM trial on Alexander Technique and back pain. Had Tinbergen's list been restricted to musculoskeletal and associated disorders, there would have been no problem. But what about 'potentially lethal asthma', 'dangerous heart conditions' and 'depressive states that often lead to suicide'? Tinbergen's claims are highly speculative. Coming from a respected scientist in his Nobel lecture it is even verging on the irresponsible.(8)

What Tinbergen presents is anectodotal evidence. In science, anecdotal evidence is not regarded as evidence. Ironically, Tinbergen is often quoted in connection with Alexander technique and science, but quoting Tinbergen's Nobel lecture does not make the Alexander Technique more 'scientific'. On the contrary, it only shows lacking understanding of scientific principles.

The Reafference Principle
Tinbergen fortunately did give something of scientific value to the Alexander Technique in his Nobel lecture. He proposed that what is called 'The Reafference Principle' may give an explanation to how we go wrong and develop 'faulty sensory appreciation':
There are many strong indications that, at various levels of integration, from single muscle units up to complex behaviour, the correct performance of many movements is continuously checked by the brain. It does this by comparing a feedback report, that says ‘orders carried out’, with the feedback expectation for which, with the initiation of each movement, the brain has been alerted. Only when the expected feedback and the actual feedback match does the brain stop sending out commands for corrective action. Already the discoverers of this principle, von Holst and Mittelstaedt, knew that the functioning of this complex mechanism could vary from moment to moment with the internal state of the subject-the ‘target value’ or Sollwert of the expected feedback changes with the motor commands that are given. But what Alexander has discovered beyond this is that a lifelong mis-use of the body muscles (such as caused by, for instance, too much sitting and too little walking) can make the entire system go wrong. As a consequence, reports that ‘all is correct’ are received by the brain (or perhaps interpreted as correct) when in fact all is very wrong. A person can feel ‘at ease’ e.g. when slouching in front of a television set, when in fact he is grossly abusing his body.(9)
The reafference principle can be seen as related to control theory and cybernetics. Tinbergen may be said to have contributed to a modern explanatory model of the technique. Sadly it is Tinbergen's claims about health effects that are quoted from his lecture, not his scientific contribution.

The logical fallacy
I have mentioned the link between Nobel Prize winners, alternative therapies and quackery, and I have discussed the content of Tinbergen's Nobel lecture. But there is yet another reason why we should stop quoting Tinbergen as a means of marketing ourselves.

Tinbergen is an expert, but he is not an expert on the technique. He is only quoted because he is a Nobel Prize winner. This is appeal to authority and a logial fallacy.

Appealing to authority is a much loved sport among alternative therapies. It is probably something they resort to in desperation, not having any solid evidence for what they do. It is also very tempting to resort to this kind of marketing since people in general try alternative therapies based on what other people say and do.(10) STAT, The Society of Teachers of the Alexander Technique, has gone down this route too, by printing a booklet  containing stories about famous people who have had lessons. I think the money could have been spent more wisely.

Michael Bloch says in his biography about F.M. Alexander that Tinbergen's Nobel lecture was a turning point in the history of the technique. It gave the technique an unprecedented level of publicity. I think the question is whether it now better serves us for educational and not for marketing purposes.

Please feel free to comment below.

Related blogg articles:
Snåsakoden (Norwegian)

1) The name of the newspaper is Aftenposten. The article was published on the science pages and the author was Kristian Gundersen, a professor in biology. Gundersen is also the author of a book that can be seen as the Norwegian parallell to 'Trick or Treatment' by Singh and Ernst. In the book Gundersen spends quite a few pages on the Alexander Technique. Although he has some valuable points, his knowledge and understanding of the Alexander Technique is very limited. I have written about the book, Snåsakoden, on my blog (Sorry, Norwegian only).

2) Tinbergens nobel lecture, Ethology and Stress Diseases, was given in December 1973, but is often referenced by its publishing date in Science 1974. The last third (not the last half as is often said) which is about the technique, was published with minor alterations in Barlow's compilation of Alexander Technique related articles, 'More Talk of Alexander' 1978.

3) Gerald Foley discusses the controversy in the second of three articles on Tinbergen and the Alexander Technique: No 22 NIKOLAAS TINBERGEN (II)

4) Patrick MacDonald in 'Tinbergen on Alexander technique', Letters, New Scientist November 14 1974.

5) Edward Maisel made the statement in an interview with The New Scientist magazine:

6) The number of lessons Tinbergen had had is mentioned in Gerald Foley's first article about Tinbergen: No 21 NIKOLAAS TINBERGEN (1907-1988) (I)

7) Geralds Foley's first article is also my source for the information about how Tinbergen ended up having lessons: No 21 NIKOLAAS TINBERGEN (1907-1988) (I)

8) The article in the Norwegian newspaper by professor Kristian Gundersen especially mentioned the claim of curing asthma. This is probably because there is a Review in the Cochrane database on 'Alexander technique for chronic asthma'. As there are no trials performed, there is no meta-analysis. There is a pilot study showing improved breathing function in healthy individuals, but there is not yet any scientific evidence that the Alexander Technique can help against asthma. In Norway, a claim about effect on a specific diagnosis would be illegal. There are some Alexander Technique teachers around the world that make the claim. This is a problem.
I made a short reply to Gundersen's article that was printed the week after:

9) The Re-Afference Principle was proposed Holst and Mittelstaedt in this 1950 article:

10) Ernst and Pittler published a paper which they (somewhat jokingly) titled Celebrity-based Medicine in which they suggest that one reason people choose alternative therapies is because they imitate celebrities.

Barlow, Wilfred 1978 More Talk of Alexander. Littlehampton Book Services Ltd
Bloch, Michael 2004 F.M.: The Life of Frederick Matthias Alexander: Founder of the Alexander Technique. Little Brown Publishing Group.
Lewin, Roger (1974) Did Nobelist go too far in advocating Alexander technique? - New Scientist, 31 October 
MacDonald, Peter (1974) Letters, Tinbergen on Alexander – New Scientist 14 November
Tinbergen, Nikolaas (1973) Ethology and stress diseases: Nobel Lecture

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