Be less curious about people and more curious about ideas.
– Marie Curie’s advice to journalists
Harvard psychologist Ellen Langer was on CBS This Morning News explaining plans for a psychosocial intervention study with women with Stage IV metastatic breast cancer. The project would attempt to shrink women’s tumors by shifting their mental perspective back to before they were diagnosed.
Seeing her on TV unsettled me because I had just supplied a journalist with quotes for his article in the New York Times about Langer. I hadn’t been following her recently. Instead I focused on her now-famous study from the 70s. Langer had claimed that giving nursing home residents a plant for which they were responsible cut their mortality by half (the nursing home residents, not the plant), compared to residents whose plants were attended by staff. The paper continues to get uncritical coverage in the media and in introductory psychology texts.
I looked up the Timesarticle after seeing CBS This Morning News, and it accurately quoted me:
The study that arguably made Langer’s name — the plant study with nursing-home patients — wouldn’t have “much credibility today, nor would it meet the tightened standards of rigor,” says James Coyne, professor emeritus of psychology at the University of Pennsylvania medical school and a widely published bird dog of pseudoscience. (Though, as Coyne also acknowledges, “that is true of much of the work of the ’70s, including my own concerning depressed persons depressing others.”) Langer’s long-term contributions, Coyne says, “will be seen in terms of the thinking and experimenting they encouraged.”
However, the quote from me was the single discordant note in a longread article singing the praises of Langer’s medical studies in which:
Results were almost too good. They beggared belief. “It sounded like Lourdes,” Langer said.
The study providing plants to nursing home residents had a key role in shaping her thinking:
To Langer, this was evidence that the biomedical model of the day — that the mind and the body are on separate tracks — was wrongheaded.
In the CBS News interview, Langer explained further:
CBS Anchor Gayle King: What is your theory? How does it work?
Langer: The mind-body unity theory. Right now this problem around forever is “how do you get from this fuzzy thing called a thought to the body?” Although everybody knows there is an effect. Walking down the street, the wind blows in your face, you get startled, your blood pressure increases, your house, and so on, till you see that it is only been a leaf. And so I said, well, let’s forget about how you get from one to the other… And see those as just words, mind and body. You put the mind and body back together and anything you putting into the mind you necessarily putting into the body.
I had been familiar with only one side of Ellen Langer’s career. She had done a number of famous psychology experiments, sometimes loosely controlled and extravagantly interpreted, but nonetheless respectable. But in the article and TV interview she comes across as a New Age quack. I learned elsewhere in the Times article that Deepak Chopra:
credits Langer with a profound influence on his thinking as a young doctor, and later as an author and lecturer on spirituality and mind-body medicine.
(You can find interviews of Langer by Chopra here and here)
And Langer has been labeled as the mother of positive psychology:
Tal Ben-Shahar, who taught a popular undergraduate course at Harvard on the subject until 2008, calls Langer “the mother of positive psychology,” by virtue of her early work that anticipated the field.
I dug out Langer’s 1978 nursing home study, confirmed my skepticism, and blogged about it. Any mortality effect in this small study was likely spurious and disappeared anyway in an obscure erratum that has received none of the attention of the original report.
But let’s get back to the medical claims for which she claims support from 40 years of personal research.
Langer described a study in which she manipulating the sense of time of patients with type II diabetes using a special clock that could be set to display accurate time or run at half or double speed. Details presented in the Times article are sparse, but Langer hypothesized that their blood glucose levels would fall according to the time presented by the special clock, rather than actual time:
In other words, they would spike and dip when the subjects expected them to. And that’s what her data revealed. When a student emailed her with the results this fall, she could barely contain her excitement. “This is the beginning of a psychological cure for diabetes!” she told me
The Times article described the study as “yet to be published” (In press, submitted, or not yet written?). In the CBS Program, she described it as “hot off the press” but still in need of replicating. Langer does not have a record of ever replicating her studies before announcing their results. And if the study is not ready for peer review or even a presentation before a professional audience capable of expressing skepticism, how is it ready for national TV and the New York Times?
The nursing home study may be the one mentioned in textbooks, but it is the so-called Counterclockwise study that garners the most media attention, in part because of Langer has written the book about it with that title and having relentlessly promoted it.
The Times article opens with:
One day in the fall of 1981, eight men in their 70s stepped out of a van in front of a converted monastery in New Hampshire. They shuffled forward, a few of them arthritically stooped, a couple with canes. Then they passed through the door and entered a time warp. Perry Como crooned on a vintage radio. Ed Sullivan welcomed guests on a black-and-white TV. Everything inside — including the books on the shelves and the magazines lying around — were designed to conjure 1959. This was to be the men’s home for five days as they participated in a radical experiment, cooked up by a young psychologist named Ellen Langer.
The methods and procedures of this study have never been described in a peer-reviewed article, only a chapter in a book that Langer herself edited. I tracked it down and found there were no tables or basic statistics. With only 9 men in the experimental condition and 8 in the control condition, any significant results were unlikely for the battery of measures. This is glossed over in the chapter:
Joint flexibility (finger length) increased significantly more for the experimental group them for the control group. Finger length increased for 37.5% of the experimental group and remain the same for the rest of the group, whereas 33% of the comparison group actually got worse on this measure. Only one person in the latter group improved. There was also an increase in sitting height for the experimental group when compared with sitting height of the control group. Those in the experimental group were able to sit taller, and they also had gained more weight, as measured in body weight, triceps skinfold, and bideltoid breadth.
“Replications” consist entirely of made-for-TV re-enactments, one with aging celebrities.
The shrinking-tumor study will involve three groups of 24 women undergoing therapy for Stage IV breast cancer. One group is a no-treatment control. Two of the groups will be sent to a resort in Mexico supervised by Langer and her staff. One group going there will simply receive social support from the other women patients. The other intervention group will live for a week in environment saturated with cues invoking 2003, a time prior to their diagnosis with breast cancer.
They will be told to try to inhabit their former selves. Few clues of the present day will be visible inside the resorts or, for that matter, outside them. In the living areas, turn-of-the-millennium magazines will be lying around, as will DVDs of films like “Titanic” and “The Big Lebowski.”
These women will have a week of classes in art, cooking, and writing intended to distract them from their condition and re-engage them in the health that they experience back in 2003. They will also bring personal reminders of 2003 with them, like photographs. They will be encouraged by Langer’s staff to:
purge any negative messages they have absorbed during their passage through in the medical system. This is crucial, Langer says, because just as the mind can make things better, it can also make things worse.
The study raises obvious IRB concerns. The Times article suggests that the Harvard Department of Psychology institutional review board has approved the protocol, but the psychology department does not have an IRB, only the College of Arts and Sciences. I emailed their IRB and asked for the protocol. I immediately got a response.
Dear Professor Coyne
The IRB clarified with Dr. Langer after the NYT article was published whether human subjects activity had occurred since the protocol had not yet been approved. Indeed, we are waiting on the collaborating hospital to complete review; and, it was confirmed that no human subjects activity has occurred.
Please direct requests for documents on the study to the Principal Investigator.
The protocol is currently under review at the M.D. Anderson Cancer Center, where Debu Tripathy, Langer’s oncologist collaborator has now relocated from University of Southern California. At USC, the protocol ran into trouble, some of which involved the language of the consent needing to include acknowledgment that there were no known benefits:
[Langer:] They want me to add a consent form for the people to sign saying there’s no known benefit to them. But that just introduces a nocebo effect!
Aside from the need for disclosure to the patients considering enrollment in the study, what assurance does Langer and her oncologist colleague have of the likelihood of any benefit? The Times article is vague on that. It cites somebody else’s study of baldness and risk for subsequent prostate cancer. Langer’s interpretation:
Baldness is a cue for old age…Therefore, men who go bald early in life may perceive themselves as older and may consequently be expected to age more quickly.
The article also cites Langer’s unpublished study that reportedly found breast cancer survivors’ self-description as being in remission was associated with lower functioning and physical health than that of survivors who describe themselves as cured.
Langer apparently has an ongoing study as to whether mindfulness can slow progression of prostate cancer at her Mindfulness* Institute in Bangalore, India. It is unclear what IRB committee approved its protocol or what its consent form states.
There is an additional human subjects’ issue that is not easily resolved. Part of the justification for involving humans in research, beyond any benefit they individually receive, is the promise of them contributing to scientific knowledge and human welfare. But there is little reason to believe that a study involving a week at a spa for 24 women with metastatic breast cancer will produce statistically-significant results publishable in a peer-reviewed journal. I would be quite curious to find any study, even of a biomedical intervention, that has ever yielded statistically-significant changes in tumor size in two dozen stage-IV breast cancer patients with only a week of treatment.
Arguments can be made that even attempting to conduct such an underpowered study is unethical because it denies human subjects the promised opportunity to make a contribution to science. Most cancer centers require a review of studies by some sort of Clinical Trials Scientific Review and Monitoring Committee, in addition to IRB clearance. Statisticians pour over the evidence for likely benefit, including formal power analyses based on relevant data. I cannot imagine that this study would pass muster.
My concern is that this spa retreat will not produce credible scientific data, but will get these breast cancer patients involved in providing anecdotes and even videos for use in Langer’s self-promotion. That is not an unreasonable concern. Past studies of support groups with metastatic breast cancer patients have yielded videos used on television and in well-paid talks to lay audiences, despite the lack of evidence that support groups extend survival. Similarly, an underpowered fMRI study conducted by James Coan and Susan Johnson has yielded a video used in promoting Johnson’s workshops, even though results were not significant.
Conflict of interest
Journalist Bruce Grierson has inordinate interest in Langer’s involvement in multiple resort projects around the world. These details might inspire awe among some readers, but they also indicate a potential conflict of interest between doing science and collecting real estate and franchise deals:
Langer told me that she chose San Miguel for her new counterclockwise study primarily because the town had made “an offer I couldn’t refuse.” A group of local businesspeople, convinced of the value of having Langer’s name attached to San Miguel, arranged for lodging to be made available free to Langer. They also encouraged her to build a Langer Mindfulness* Institute, which will take part in research and run retreats. (A local developer donated a beautiful casa, next to his Nick Faldo-designed golf course, to serve as staff quarters for the institute.) Starting sometime next year, adults will be able to sign up for a paid, weeklong counterclockwise experience, presumably with a chance at some of the same rejuvenative benefits the New Hampshire test subjects enjoyed. Langer says she is in conversation with health and business organizations in Australia about establishing another research facility that would also accept paying customers, who will learn to become more mindful through a variety of cognitive-behavioral techniques and exercises…
To my question of whether such a nakedly commercial venture will undermine her academic credibility, Langer rolled her eyes a bit. “Look, I’m not 40 years old. I’ve paid my dues, and there’s nothing wrong with making this more widely available to people, since I deeply believe it.”
And what about the women being recruited for the shrinking tumor study? Will they pay for their spa experience? If not, is being sent to an expensive Mexican spa an inappropriate inducement for consent to participate in the study? And if they survive their stay at the spa and wish to continue, will it be for free or at reduced rates, or will the study participation become an introductory offer for which they will have to continue to pay?
Such enterprises are based on the assumption there is some medical value in the spa experience. This adds to the pressure on Langer to demonstrate such a benefit. Her active involvement in the “experiment” gives her ample opportunities to attempt to influence the results.
Scientist as New Age guru – Once a guru, does the scientist remain?
Ellen Langer’s identification as an eminent, well-published Harvard psychologist is an important part of her branding and the promotion of herself and her products. The promotion is infused with references to her 40 years of research. Yet, she assumes none of the responsibility that goes with being a scientist. She does not consistently submit her work to peer review. She makes references to unpublished studies, even those that have remained so for many years. Some of her studies are described only in an ostensibly peer reviewed journal, Perspectives on Psychological Science, but with insufficient details to allow any independent evaluation of her claims. There is evidence of deliberate, selective publication from her direct quotes in the New York Times article. She talks about ongoing studies in ways that suggest biases being introduced by her monitoring incoming data. She is flippant in presenting her theoretical model and the sources of her hypotheses. There are discrepancies between claims that she makes to the media and what is available in published accounts of her research. And finally, she is dismissive of the basic responsibilities of a scientist conducting biomedical research to justify the work with reference to plausible mechanism and to provide patients with an accurate sense of the evidence base supporting or not supporting treatments.
Langer has published in scientific journals, but she is not otherwise acting like a scientist. One of her studies involved telling hotel chambermaids that their work involved lots of exercise, with the result that the women lost weight without increasing their actual exercise. These implausible results are reported in the peer-reviewed journal Psychological Science, with Langer with the same sort of mental frame explanation. If I am skeptical, do I owe it to her to carefully examine this article before dismissing it? I don’t think so. Her other activities establish sufficient prior probabilities it will not be worth the effort.
An embedded journalist and gullible CBS anchor people
Bruce Grierson went to Langer’s kitchen in Cambridge while she was preparing lasagna for her lab staff. He attended lab meetings where over 30 ongoing studies are discussed. He even went to her second home in Puerto Vallarta. He seems quite in awe of her, generally accepts everything that she says, even justifying the expensive resort experiences by suggesting the added expense will increase the placebo effect. I am the only skeptic in his article mentioned by name. Grierson sets up a narrative in which:
Medical colleagues have asked Langer if she is setting herself up to fail with the cancer study — and perhaps underappreciating the potential setbacks to her work.
But the crucial issue is not between Langer and skeptical colleagues whom she is challenged to prove wrong. And not the possibility of a setback to her work. It’s a matter of her proceeding with medical experimentation on women who are chosen because they likely have a short time to live. It’s a matter of proceeding without any encouragement from available evidence and lots of evidence to the contrary.
When I googled Bruce Grierson, I was taken to a webpage where he was described as a social science writer. Among his books is What Makes Olga Run?, which is described as “the mystery of the 90-something track star and what she can teach us about living longer, happier lives”. An earlier book, U-Turn, asks the question “what if you woke up one morning and realize you are living the wrong life?” Does U-Turn parallel Langer’s Counterclockwise? Is he an Ellen Langer wannabe? Certainly he lacked the distance to challenge some of her outrageous claims.
Someone from the New York Times called me to check carefully whether direct quotes from me were exact and whether my position was accurately portrayed. Why did so much else in the article survive fact checking?
The anchor crew on the CBS This Morning Newswas certainly not in CBS 60 Minutes investigative reporting mode. Can you imagine a muckraking 60 Minutes account announced with “Harvard Professor operates foreign resort franchise giving incurable cancer patients false hope”? The 60 minutes cameras would be brought down to Mexico and the deals with local businesses would be exposed. Experts in white coats would challenge any evidence that such experiences could be beneficial for survival. Harvard officials would decline comment.
Gayle King and Norah O’Donnell seemed totally charmed by Langer and competed for her attention. Only Charlie Rose evinced skepticism and ended with a wry, mumbled comment at the end, seemingly “we hope that everything you say proves to be right”.
This seemed to be genre confusion going on. Certainly Ellen Langer was entertaining, almost like a standup comic at times. But this was not a sitcom in which we don’t have to worry about the protagonists. This is an utterly uncritical publicizing of a biomedical study with no evidence of background research having been done.
Essentially Langer is offering a quack treatment similar to Simonton’s visualization technique. Indeed, Langer’s approach is warmed over and re-served Simonton, and her theory cannot explain why visualization would not work. Her shrinking-tumors experiment is being undertaken with no more support from evidence than the Greshon organic coffee enemas, also offered at a Mexican resort. The main difference between what Langer is serving up and Gershon is that a stay at her resort would be less messy and more pleasant than a coffee enema.
The readership of the New York Times and the viewing audience of CBS This Morning News expect properly-vetted and carefully-researched coverage of biomedical topics, especially any involving life-and-death issues like cancer. Desperately vulnerable patients and their families are seeking hope, even a false hope, but will be led astray by sources they thought they could trust.
*“Mindfulness” as in mindfulness meditation? Hardly. An article in the Harvard Magazine clarifies:
“Mindfulness” might evoke the teachings of Buddhism, or meditative states, and indeed, the name and some of these concepts do overlap. But Langer’s version is strictly nonmeditative (“The people I know won’t sit still for five minutes, let alone 40,” she quips). Hers is a simple prescription to keep your mind open to possibility.