Friday, January 02, 2009

It's the impact, stupid!

A common fallacy in ethics: well intended actions have a positive impact. If you mean well, your actions might well have negative consequences instead of the well intended. For example, a mother whose son is heavily indebted intends to do good by helping him out financially, but in fact only supports his bad behaviour. Or, an ecologist wants to eliminate nuclear power plants with the well intended aim to protect us from environmental damage, but what are the consequences? Bigger reliance on air-polluting coal plants.  Are other forms of energies better? I just read about the devastating consequences of a well-intended tax law by the German government: they support solar cells on private houses in cold Germany which has provoked an increase in the price of solar cells such that some very sunny African countries cannot afford them any more! It is a big big problem in our complex world as few see the hidden strings that intertwine our world: cut one and you affect others.

We must judge actions not by our intentions but by their impacts. Let's look at Leys' effort to make google filter out cure adverts for stuttering treatment. It is a well-intended idea in principle but what will be the impact?

Positive impacts:
a. The public hears less about cures on stuttering which helps us to change public perception on stuttering,
b. serious therapists can better compete with crackpot ones
c. the lack of cure adverts will force stutterers to study different offers in more detail.
d. stutterers will have less pressure from families or friends who refer them to these offers.
e. shows that the individuals in the stuttering community and NOT the consumer associations can make a difference and take on crackpots: using blogs and youtube.

Negative impacts:
a. less free speech on commercial ads hereby strengthening the establishment's view. What if someone suddenly found a cure, can he not advertise it?
b. we only hit the cure crackpots, but are treatments like fluency devices, medication, stuttering treatments proven to be better than those crackpot treatments? They might both be ineffective!

Null impacts (also negative because we could have spent our time otherwise):
a. Will the We will cure you not be replaced by I do not make cure claims but if you work hard enough you can achieve fluency? Is the cleaning lady better off as a facility assistant and the secretary happier as an executive assistant? Is it not the same? In fact, maybe we can detect crackpots better now, because they are the only one who make cure claims?
b. crackpots find always find other ways to trick people.
c. less stutterers will start a therapy because there is no cure claim to motivate them.
d. TV shows will still show cure-like therapies.

Decide for yourself. If you want to hear my opinion, I don't care about my analysis. It's about sending a signal to everyone who is dealing with stuttering: crackpots, therapists, researchers and the world. Get your act together: present the facts, check your evidence, engage in real debates, and take on board feedback. Or you get into trouble with us! Especially to the professionals, don't get too comfortable just because you can call yourself therapist or researcher! Your impact counts and not what you are.


Anonymous said...

Another suggestion...

Educate the consumer by researching scientific efficacy studies of different treatments for stuttering. They can be found on the internet at sites such as PubMed by entering terms such as stuttering; stuttering treatments etc. Then following up on all the studies done to show whether a particular approach has been shown in peer reviewed scientific journals to be effective and with which population.

The evidence is out there. We owe it to ourselves to find the objective research.

Tom Weidig said...


I just had a look at your website, and you write: "By the end of the first week you can be Stutter-Free in the clinic." The statement is strictly speaking not wrong. Yes, you can be stutter-free in the clinic. But is it not a bit misleading. We all know that all half-serious treatment produce stutter-free speech in the clinic, but the real issue is long-term???

The evidence is NOT out there. In theory, you are right in that we should look at scientific efficacy studies, but unfortunately they are not very reliable. I looked at some very closely, i.e. I actually read the papers line by line and did some statistical calculations. For example, the so-called Lidcombe random control trial, and it is deeply flawed.

Not saying you should not do Lidcombe with kids, but there is still no good evidence for long-term sucess.


Anonymous said...

What about treatments that do have a positive effect on some... you mentioned devices in your list and a device has helped my son (Fluency Master). They were wrong to imply in their video the significant improvement. The results, when my son stopped all other treatments (medication that was VERY effective, but mood side effects and energy side effects led him to quit), the Fluency Master has given him a way to break through the worst stuttering and has ended all the secondary movements that were really noticeable. It seems that stuttering, for him, would be more difficult to deal with, without this aid. So who decides what advertisers to sanction or exclude?