Flashback - Ignoring The Facts

[This one comes from January 2012 and is still one of my favorites. People, who are involved in a test that proves that a $30 item is not effective, continue to insist on buying one. Note, they didn't just hear on TV or read on the internet that the item is bogus - they were actually involved in testing it and shown the results. It didn't work as advertised, but they still wanted one regardless of what their eyes were telling them because of all the hype they had heard elsewhere! Being swayed by marketing promotions and celebrity endorsements is not wise behavior.]

While looking for a different article on the Placebo Effect, I found this interesting video. As you know, the Placebo Effect causes people to recover or show improvement even when they are given only a fake remedy, the familiar sugar pill. The power of the mind is amazing.

I recall an article a number of years ago stating that the improvement within the control groups in certain drug studies increased as the power of the real medicines increased. They were getting the sugar pill but believed they were getting the latest, stronger medicine, so they experienced even better results. It was all psychological. It is easy to understand how this reaction could play into the hands of "snake oil" salesmen. They sell you a useless cure and let your mind do the rest. Then they get a few believers who help them sell more. That's why I always say, "Endorsements are not evidence."

Here is the  CBS News video testing the claims of a particular performance wristband, one endorsed by famous athletes, and touted to improve athletic performance. When test subjects were given the advertised wristband, their performance on physical and balance tests did improve. But when they were given a one-dollar replacement band and told it also was special, performance on physical and balance tests improved comparably. The video also explains how the bracelet company sets up tests to ensure the perception of improved performance.

The scariest part is the ending where, despite the fact that the $30-wristband claims had been debunked, shown to be no more effective than the $1 bands or even not wearing a wristband at all, the participants still wanted one!

This is not critical thinking! This is the kind of decision-making that leads people to spend money on worthless items instead of using it wisely. Then they wonder why they get into debt and can't afford to retire. It's the kind of thinking that leads us to vote for candidates based on endorsements or personal appearance or charisma instead of the leadership and ideas we need. It's the kind of thinking that contributes to the decline of America!

The Latest Big Thing – CBD Oil

I began to wonder about CBD oil when I saw on the local television news a very non-critical report about a new store in town. It was like a press release from the store that the reporters used as an excuse to fill airtime with a very positive interview of the owner, but without questioning any of the exaggerated claims about the its curative powers. I knew that it had been until recently illegal, making good scientific research very difficult and sparce, and that researchers generally look at only one effect at a time when testing any treatment. How could this substance arise out of the blue with so many promises?

This webpage, for example, lists seven benefits including: relieving pain, reducing depression and anxiety, alleviating cancer related symptoms, reducing acne, having neuroprotective properties and benefiting heart health. Of course the last three are conditioned with “may," “might” and “could.” It warns: “Although CBD is generally considered safe, it can cause adverse reactions like diarrhea and fatigue in some people. It may also interfere with certain medications.”

Based on such reviews, it appears to fall into the familiar too-good-to-be-true category. So I was not surprised to find the headline: “FDA warns company marketing unapproved cannabidiol products with unsubstantiated claims to treat cancer, Alzheimer’s disease, opioid withdrawal, pain and pet anxiety.” And if you are going to advertise in the realm of too good to be true anyway, why not throw in that it counteracts the growth of [and/or] spread of cancer, kills breast cancer cells, treats Parkinson’s disease, reduces the severity of opioid-related withdrawal, addresses symptoms of chronic pain, anxiety and ADHD, and helps with PTSD, schizophrenia, fibromyalgia and eating disorders. The FDA objects to all these claims (and more) as “unsupported and unapproved.”

 WebMD calls it “all the rage” but warns that “experts say the evidence is scant for most of these touted benefits." Like many other over-the-counter products and supplements, it is “being produced without any regulation, resulting in products that vary widely in quality.” Dosages vary from one product to another, possibly from one production run to another and from one brand to another. “Only one purported use for cannabidiol, to treat epilepsy, has significant scientific evidence supporting it.”

Last April the USA Today piled on, asking: “Is this hemp plant derivative snake oil or a legit remedy?” In addition to all the powers listed above, they add that it’s also hyped as a cure for inflammation, stress, unsatisfying sex and PMS.  But it's sold at local pharmacies (including the one that stopped selling cigarettes because they care so much about our health) in the form of creams, lotions, oils, tinctures, pills, powder or liquid. But this story also comments that the marketers' therapeutic claims are "rarely supported by medical evidence that CBD is significantly better than a placebo.”

Again from USA Today in a different story: “The head of the National Institute on Drug Abuse said there’s no evidence that marijuana [or CBD] weans people from opioid addiction – and promoting such treatment might deny people a chance at recovery.”

The Mayo Clinic sums it up: “While CBD is being studied as a treatment for a wide range of conditions, …research supporting the drug's benefits is still limited." It can cause more serious side effects than those mentioned above and “can interact with other medications” such as blood thinners.

And remember that part about it being unregulated? “Another cause for concern is the unreliability of the purity and dosage of CBD in products. A recent study of 84 CBD products bought online showed that more than a quarter of the products contained less CBD than labeled. In addition, THC [the psychoactive ingredient found in marijuana] was found in 18 products.” But don’t sweat those pesky details – it’s all-natural and I heard on Facebook…!

Is It False Advertising?

A couple of years ago plaintiffs brought a class action suit against Boiron Inc., the maker Oscillococcinum, a homeopathic cold and flu remedy claiming that it didn't work. What was unusual in this case is that it went to a jury trial. Most of the time, in fact twice in the past in other lawsuits against Boiron, these types of cases are settled before they go to trial. Apparently this time the company decided it was time to take a stand and risk the decision of a jury. Surprisingly, the company won in court. The jury simply felt that the plaintiff hadn’t presented sufficient evidence that the product did not work as advertised, that is, they had not shown that it did not relieve flu symptoms.

 The reason this is coming to light now is that the plaintiff appealed to the 9^th Circuit, but the court sided with the company. The court found that “the jury appeared to have believed Boiron’s expert, clinical studies, and anecdotal evidence more than it believed the plaintiff’s expert." According to the court, there was no legal reason to overturn the verdict.

 But what exactly is going on here? Is there a scientific reason to doubt the claims of the company?

More can be learned from the website Rxlist.com. “Homeopathic products are extreme dilutions of some active ingredient. They are often so diluted that they don't contain any active medicine.” Due to legislation passed in the 1930s this type of product can be sold in the U.S. but, like dietary supplements, are not held to the same safety and effectiveness standards as approved drugs.

Oscillococcinum claims to relieve flu symptoms, but not cure the flu. It’s effectiveness is based primarily on self-reporting. The website finds “no reliable evidence that taking Oscillococcinum can prevent the flu and evidence of any beneficial effect at all is questionable “due to flaws in the study design.”

It is made by highly diluting in water a compound extracted from the heart and liver of the Muscovy duck. Its dilution rate is coded in homeopathic terms as 200C. This means there is one part duck in a solution containing 1-followed-by-400-zeros parts water. That is an insanely huge number. There isn't even a name for this number. It is more than the estimated number of molecules in the entire universe! It is physically impossible for any part of any active ingredient to survive that level of dilution. But homeopaths explain this away by saying that the water retains the essence of the ingredient (even though there is none left). The remaining water is then combined with inactive ingredients of lactose and sucrose.

“Most experts believe that it will have no beneficial effect and also no negative side effects.” How could it not be safe when it’s primarily sugar water, unless the sugar was somehow contaminated? The company relies on the placebo effect to influence customers and then uses endorsements and personal accounts in their advertising and in this court case.

In my opinion this is nothing but snake oil and that people are basically throwing money away. However, I agree with the jury and the court that they did not advertise falsely. People who are willing to pay about a dollar per dose and take three doses per day really believe in its power to reduce flu symptoms. That belief alone is often enough to make them think they feel better and to report a reduction of symptoms. (Note: Some people take it to prevent the flu, a benefit the manufacturer doesn’t even claim.)

 We each get to decide how to wisely spend our dollars. (Annual sales of Oscillococcinumin in the U.S. were $20 million in 2013, and they probably only had to use one duck!) Information on homeopathic medicines is so easy to find, but the ability to overcome most people’s longstanding beliefs is so difficult to sway.  And suppose those people who still have the flu, but strongly believe they feel better, decide to come to work or school and spread it around. What then?

Cancer is Nothing to Toy With

Last week some troubling news came by way of a Harris Poll conducted for the American Society of Clinical Oncology. Based on a sample of 4,038 adults and an additional 849 cancer patients, they found that 39% strongly or somewhat agreed with the statement, "Cancer can be cured solely through alternative therapies, without standard cancer treatment(s)" despite clear evidence that those patients “have much higher mortality rates.” Another  statement, "Alternative therapies are a good supplement to standard cancer treatments(s)," reached a level of 75% overall agreement. 

Some experts commented that the high level of agreement likely was due to strong promotional efforts by the alternative and complementary medicine industry combined with a weak public understanding of science. The opposite of alternative medicine is called evidence-based medicine. In the latter case there is evidence from well-conducted experiments to back up the efficacy of treatment; in the former there are only stories, endorsements, myths, legends, ancient wisdom and uncorroborated, so-called clinical trials. To paraphrase one doctor, “There is no alternative medicine; there is only medicine that works.” (Late addition, 11/20/2018: Spain plans to ban alternative medicine in health centres.)

Walking down the vitamin and supplement aisle of any pharmacy or grocery store exposes the shopper to a wonderland of miracle cures and preventive pills and potions. The only problem is that many studies have shown them to have little or no value (unless prescribed by a doctor for a specific need). And news about supplements found to contain little or none of what’s printed on the label, and sometimes containing dangerous substitutes comes out periodically. A law passed decades ago with a boost from the nutritional supplement lobby ties the hands of the FDA until after problems are reported. 

The industry survives on heavy promotion, a vast amount of shelf space and the placebo effect. But cancer is serious business and should be treated as such.

Here is a case in point involving Robert Young, author of the bestselling pH Miracle books. Sixteen months after going to jail for practicing medicine without a license he has been ordered to pay over $100 million in a civil trial brought by one of his cancer patients. Her suit alleged negligence and fraud after he advised her “to forego chemotherapy and traditional treatment, and instead go with treatment in line with his alkaline theories.” She now has stage four cancer and her oncologist gives her three to four years to live.

The 39% who say they would do this on a survey may be overstated. When it’s life and death people will make more considered decisions than when checking a box on a Harris Poll. But it does happen and every instance is unfortunate and avoidable.

I have advised many times in the past that words like miracle in "health" ads are clear warning signs of something fishy. After Young was found guilty of two counts of practicing medicine without a license, to avoid further jail time he “had to make a public admission [in court] declaring that he is not a microbiologist, hematologist, medical or naturopathic doctor or trained scientist." He may have been sincere about his belief in his miracle cure, but he had no evidence to back it up – as it turns out, and to the distress of his patient, he had just the opposite.

I like people to be able to do what they want with their time and money. If they want to throw it away on dubious pills, oils or ancient remedies, let them be. But when it comes to serious illnesses like cancer, please apply some critical thinking, and stick with real medicine from trained doctors. The odds are so much better.

One More Time – The Placebo Effect

Way back in early 2012, I first brought up the placebo effect – the tendency of the body to heal itself when belief in the cure is strong. How it works is still a mystery but that it does work is indisputable.

The example I used over 6 years ago was a $30 performance wristband, one endorsed by famous athletes and touted to improve athletic performance. In a test people were given the advertised wristband and exposed to some physical performance and balance tests. The before and after results showed some improvement. Then they were given a similar-looking one-dollar replacement band and told it was also special, performance on physical and balance tests improved comparably. Conclusion: it wasn’t the band at all; it was the perception that they were getting some extra, outside help – mind over matter.

Since then I have mentioned the placebo effect in essays warning about vitamins, acupuncture, forest bathing, chiropractic, healing crystals, gluten-free diets, cryotherapy, homeopathy, ear candling, essential oils and a few other subjects. (Wow, that’s a lot of toes to step on in only six and a half years!)

The point is not to make people angry and defensive, but to make them aware of the difference between science and marketing, and how the placebo effect can lead to an erroneous conclusion that a treatment really works.

When a cure is proposed, competent scientists will split a relatively large group in two, randomly assigning one to test the treatment while giving the other a placebo. Both groups usually show some improvement due to the placebo effect. To validate the treatment however, the improvement of the treated group must be significantly better than that of the control group. Otherwise they declare the treatment “no better than a placebo,” that is, no better than no medicine at all.

The placebo effect explains many of the endorsements we hear from celebrities, friends and neighbors. They sincerely (and enthusiastically) believe whatever they are recommending has beneficial effects, but with no scientific evidence it may be “no better than a placebo.” When you buy one of these products, the money spent is money wasted. That’s why the small print in ads, where they explain how the FDA has not approved their magic formula, they often add something like “results will vary.”

That takes us to a health story from England where the BBC reported a pure placebo experiment. With help from University of Oxford, they tried to see if they could “cure real back pain with fake pills.”

One hundred people with severe back pain were asked to participate in a study of a powerful new painkiller. What they didn’t know is that everyone would be given realistic looking pills that were really placebos, “capsules containing nothing but ground rice.”

The blue-and-white-striped pills “came in bottles, carefully labeled, warning of potential side effects and sternly reminding patients to keep out of the hands of children” to further the impression that this was powerful stuff.

Three weeks later researchers found “nearly half of our volunteers reported a medically significant improvement in their back pain” and that those who spent a little more time with a doctor merely discussing the pills were more likely to improve. In one case, a man went off his morphine but continues to take the ground-rice pills.

Placebo effect is not a trick that works only on the gullible. Taking a placebo can cause the body to release endorphins, natural painkillers. And sometimes subjects improve even when they know they are taking a placebo.

But that doesn’t mean the gullible aren’t tricked. In the earlier case of wristbands, even after the people learned that there was no difference and the improvement in both cases was psychological, they still wanted to buy the $30-wristband over the equally effective $1 bands. It’s like when people think the same wine tastes better when the bottle has a higher price tag. 

It does no good to understand science when critical thinking fails to kick in.

Making Your Feet Happy

I recently ran across an ad for a product that will make your feet happy, make your legs happy, make your back happy, and let you throw away your pain meds and lead a stress-free life. All this from a simple shoe insert! It sounded too good to be true! Being a skeptic at heart, it also sounded to me like the work of a company that follows a philosophy often attributed to P.T. Barnum: “There’s a sucker born every minute.” Time to investigate.

My first stop was the company website which confined their promises to a short video and gave some FAQ-type information below about sizing, care, cleaning and the warrantee. It does mention feeling better with every step and healing from the inside out, whatever that means. And it has a free shipping countdown clock which reset at 2:30:00 every time I opened the site – not exactly a deadline.

The video tells how these insoles, using 400 massage points and special magnets, work a number of wonders including: relieving overall body pain, cooling and soothing the feet and boosting endurance. The second is the most plausible.

The video continues by telling how one feature is directed “toward the chakra of personal power,” another “toward the chakra of body function” and still another “toward the chakra of body energy.” None of this chakra stuff has any scientific basis.

Finally, they will balance your mind and body, reduce stress and naturally flush toxins, all by hitting the right pressure points and using magnets.

Another related site looks like a more scientific explanation of the same product, except none of it sounds like science. It explains that the insole wearers were inclined “to visit the bathroom more often and were thirstier. This is your body’s way of naturally cleansing toxins and eliminating them from your body!” True, visiting the potty is a natural way to eliminate toxins, but do you need shoe inserts to make it happen? Then they tell us, “Based on the theory of reflexology, magnets are believed to balance your body’s natural electromagnetic levels.”

Well, the theory of reflexology may think so, but the FDA differs. “To date, the FDA has not cleared for marketing any magnets promoted for medical uses.” And the National Center for Complimentary and Integrative Health, a group typically sympathetic to these kinds of claims, says, “Magnets have not been proven to work for any health-related purpose.”

After searching through various sites for about 15 minutes, I finally found what I was looking for, the expected standard disclaimer. Here is an abridged form:

“ALL CONTENT AND INFORMATION…ARE FOR INFORMATIONAL PURPOSES ONLY AND ARE STRICTLY NOT INTENDED TO DIAGNOSE, TREAT, CURE OR PREVENT ANY DISEASE, FOOT PROBLEM OR ANY OTHER MEDICAL CONDITION. YOU SHOULD ALWAYS CONSULT WITH YOUR HEALTHCARE PROVIDER BEFORE USING OUR PRODUCT….

“Testimonials and comments found within our website are unverified results…which are…not intended to guarantee that everyone will achieve the exact same results.

“Our website content…is solely for informational purpose only…. We do not represent in any manner whatsoever that the content of our website contains the opinions of a healthcare professional.”

In summary, the shoe inserts will yield a large number of miraculous results from your head to your feet. You will have higher energy, less stress and all parts of your body will be happier – including your chakras! But if it doesn’t work for you, don’t blame the company.

But what about all those endorsements from satisfied customers? Can you say placebo effect?

Chiropractic - Handle With Care

Several months ago I noticed a couple of friends going to the chiropractor on a regular basis and tried to talk them into trying a yoga class instead.  They said they were too old and stiff for yoga, a typical response, and besides, Medicare paid for the chiropractor.  I wasn’t sure this was correct, but let it go.

Recently though, I ran across a fact sheet from the government and learned the following: “Spinal manipulation is a covered service under Medicare. However, maintenance care is not considered by Medicare to be medically reasonable and necessary, and is not reimbursable by Medicare. Only acute and chronic spinal manipulation services are considered active care and may, therefore, be reimbursable.”  It went on to define maintenance therapy, which sounded exactly like what my friends were getting.  Of course, I don’t have all the information and may be wrong, or the chiropractor may be violating the law.

From what I have read most chiropractors are honest and sincere.  They and their patients believe that treatment of subluxations in the spine provides relief from pain and other back problems.  Likewise Medicare recognizes subluxation as a problem that calls for medical attention.  But this in itself may be a problem.

One of many skeptical sources shares a different view.  “According to classical chiropractic, a ‘subluxation’ is a misalignment of the spine that allegedly interferes with nerve signals from the brain. However, there is no scientific evidence for spinal subluxations and none have ever been observed by medical practitioners such as orthopedic surgeons, neurosurgeons, or radiologists. On May 25, 2010, The General Chiropractic Council (GCC), a UK-wide statutory body with regulatory powers, issued the following statement:  The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.”  It’s like a metaphor that American professionals and  their patients take seriously.

Besides proper coding and billing, chiropractors must also be careful about the results they promise.  Some have advertised that spinal manipulation can improve general health, cure many different diseases, cure children of earaches, autism, and asthma, and prevent spinal degeneration.  None of these claims have any scientific backing.

Then there are the cases of unethical behavior like this one in Utah where the doctor was disciplined for financially abusing two patients and failing to cooperate with board investigations among other offenses.  But ethical failings happen in every profession.

In short, it is smart to be skeptical about the benefits of a visit to the chiropractor.  Maybe yoga, physical therapy or some other stretching routine will yield the same benefits.  Maybe most of the effect is placebo, based on a belief it will work.  All I know is that when I do a weekly review of medical articles, information about an investigation of problems with one chiropractor or another – ethics, false claims, and other problems – appears quite often.

(For a comprehensive scientific critique of the practice, see this YouTube video.  But I know many will read this or even view the video and still ignore facts that don't agree with a worldview they don't want to change.)

Understanding Randomness

Randomness is defined as the lack of a pattern in a series of events.  Since there is no pattern or apparent logic to the appearance, randomness allows for no predictability.  This may seem straightforward, but a poor understanding of randomness leads people to make untrustworthy decisions.

The lottery consists of a near-random selection of winning numbers.  In most big-money lotteries there are millions of combinations, so the odds of winning are much greater than a million to one against any individual player.  Suppose the numbers 5, 10, 15, 20, 25, 30 were drawn this week in a certain lottery.  Most people would not consider picking those numbers next week.  “What are the odds of the same numbers coming up two weeks in a row?” they would reason.  BUT because the numbers are chosen randomly, the odds of them coming up again next week are exactly the same as they were of coming up this week.  And the odds of those numbers coming up this week were exactly the same as the odds of any other combination.  To shy away from them because we have seen them so recently is not a sound strategy at all.

Everyone knows that if you flip a fair coin, it should come up heads about half the time and tails about half the time.  So if you flip a coin ten times in a row, most people would expect to see 5 heads and 5 tails.  BUT because the coin comes up randomly each time, the probability of getting 5 of each is only about one in four.  There is a three-times greater chance of getting some other combination.  The coin has no memory from one flip to the next.  It doesn’t know it’s supposed to come up one way or the other. 

In fact it is possible, but not very likely, that the coin could come up all heads.  Flip a coin ten thousand times and ten heads in a row somewhere in the sequence would not be that surprising at all.  It happens, but not very often.

Likewise, if a roulette wheel stops on red four times in a row, there is no logical reason to suppose it will not come up red the next time.  Seeing such a sequence, some people will bet on black, thinking it is “due.”  They will be rewarded for their “logic” about half the time and the rest of the time will remark on the weirdness of the situation.  BUT it’s not weird.  The roulette wheel is no more intelligent than the coin.

This identifying a pattern where there is none affects everyday decisions and beliefs.  When a single research experiment reveals that a certain food or other product is healthy or harmful, it could be true – assuming the experiment was carefully set up and carried out.  The finding could also be a random result – it just happened.  It takes others repeating the experiment and getting similar results, to show the findings were valid and not just some extraordinary fluke.

Unfortunately, it’s more exciting for scientists to do an original experiment and release the findings to the press with great fanfare, than to do the boring process of duplicating the work of others, especially when getting the same outcome will help those others take all the credit.  It might also be harder to get funding for a duplicate study.  We have to understand this to keep from over-reacting to the health news discovery-of-the-week.  So many people want to hang their hat on the results of a single study that just happened to confirm what they want to believe.

There are many other examples in our random world where we can be fooled either by apparent coincidences or by expecting patterns that don’t really exist.  But one important issue concerns self-medication, the pills, foods and experiences that each of us is sure make us feel better.  Most times, unless several researchers have done extensive studies, the improvement we feel is either coincidence or placebo.  Either we remember only the favorable outcomes or we put so much faith in the cure that our brains do the work.

When the folk medicine or sports superstition runs up against a ten-heads-in-a- row situation, we take it as truth rather than randomness and swear by it for the rest of our lives.

Protect Yourself

In response to my entry one week ago about the idea that much of the consumer protection by the government is merely an attempt to protect people from their own mistakes, one of my faithful readers sent a couple of good examples of the same.  I’ll take a look at one of them.

Remember, the original piece was about a chunk of plastic that you plug into the wall to protect against negative energy of many types ranging from Blue Tooth radiation, which is real but harmless, to noxious psychic energy, which has never been proven to exist, and that’s about as harmless as you can get.  The wide range and varieties of these so-called noxious energies it protects against should have been the first clue that something was probably fishy.  That the company did not explain how their product apparently absorbed or repelled this energy and only backed up their claims with endorsements is also suspicious.  Finally, the information that after plugging in the appliance, it did not draw any electricity is very curious – why plug it in at all?

So I was tipped off about this promotion with a similar sales pitch for yet another miracle product.

This website provides detailed information about “the healing properties of gemstones and crystals.”  They present the usual references to ancient wisdom for all these health claims, secrets from the same ancient people with average life expectancies less than half of ours today.  But ancient wisdom and the mysteries of the orient are staples for these types of sales pitches as they list 42 stones with their special properties (but not their prices). 

Then they cite the science.  “On a cellular level, our bodies and quartz crystal are both made up of mineral silicon-dioxide” and “we are naturally receptive to the vibrations of crystals.”  I didn’t know crystals had cells, yet we are told that one of them acts as a “natural stress reliever that encourages inner strength and brings wealth and a strong business sense,” and another “clears the mind, balances emotions and strengthens personal power.”  Wow, problem solved!  Poverty and a host of mental health issues wiped out for the price of a couple of rocks!  Sounds too good to be true – obviously.  A little research on line shows that none of these claims have any scientific backing.  Any benefit is based on the placebo effect.

The problem is there are so many of these products advertised.  Their target is people facing serious issues in their lives who are searching for any quick and easy way out, the path of least resistance.  These are the same people who hear their doctor recommend a change in lifestyle but opt for the pill instead.  Sometimes the products are designed to solve a problem we didn’t even know we had, but people are tempted to try to make their lives a little better.  The big selling point is that it will take little or no effort.

The fact that these sell is strong evidence of problems within the behavioral dimension of discipline, looking for the easy answer or the “magic bullet.”  Careful examination of the science, if there is any, without falling for the scientific sounding sales pitch and the testimonials about how wonderful they are, usually leads to the conclusion that your money is best spent on something more worthwhile.

I thank my reader for providing the link to this example.  I always welcome comments and suggestions, whether you agree or disagree.  The behavioral model is not necessarily about common conclusions, but about arriving at any conclusions in a well thought out and logical manner without attacking the defender of those ideas personally.