I wanted to address survivor bias because I often talk about how to achieve positive outcomes in mind-body health care. I felt it would be unethical not to mention the reality that not everyone heals. It is so tempting to stay focused on those who heal and how they did it, but ultimately, it can be really hard to discern what caused the healing, especially because I tend to advocate that my clients pursue a multidisciplinary route to healing.
It should also be noted that there is a lot of privilege at times in being able to pursue a multipronged healing approach. I personally sit with grief that transformation is not available to all who desire it.
Here are some of the way that survivor bias interferes with our ability to better understand the crux of healing in both mainstream and alternative healthcare:
Survivor Bias in Mainstream Healthcare
Survivor bias in health outcomes refers to the distortion that can occur when analyzing data or drawing conclusions about health based only on individuals who have survived or reached a certain point in a study, treatment, or condition. This bias arises when individuals who did not survive or dropped out of the study are not included in the analysis, leading to an incomplete and potentially misleading understanding of health outcomes.
Here are a few examples to illustrate survivor bias in health outcomes:
Clinical Trials: If a clinical trial only reports the outcomes of participants who completed the study and ignores those who dropped out due to adverse effects or lack of improvement, there may be a biased representation of the treatment's effectiveness. Including only "survivors" in the analysis can overstate the positive effects and underestimate potential risks.
Longitudinal Studies: In studies tracking the health outcomes of a particular population over time, survivor bias can occur if the analysis is based solely on individuals who have reached a certain age or milestone. This may lead to an overly optimistic view of the population's health, as those who experienced negative health outcomes or premature death are not considered.
Disease Registries: When compiling data from disease registries or databases, survivor bias can occur if only individuals who are still alive or actively seeking treatment are included. This might lead to an underestimation of the severity of the disease or the effectiveness of certain treatments.
Observational Studies: In observational studies where individuals self-select into treatment groups, survivor bias may occur if only those who respond positively to a particular intervention continue to participate or report their outcomes. This could create a falsely positive impression of the intervention's efficacy.
To address survivor bias in health outcomes, researchers need to consider the entire population under study, including those who did not survive or dropped out. Analyzing complete datasets allows for a more accurate assessment of the factors influencing health outcomes and helps avoid drawing conclusions based solely on individuals who have "survived" a particular point in the process.
Survivor bias in Alternative Health Care:
Survivor bias can also be relevant when evaluating health outcomes in the context of alternative healthcare practices. In this context, survivor bias may manifest in various ways, potentially affecting the perception of the efficacy and safety of alternative treatments. Here are a few scenarios where survivor bias might be observed in alternative healthcare:
Self-Selection Bias in Testimonials: Individuals who have positive experiences with alternative healthcare treatments may be more inclined to share their success stories or testimonials. This self-selection bias can create an unrepresentative sample, as those who did not experience positive outcomes or had negative reactions may be less likely to report their experiences.
Online Communities and Forums: Discussions in online health forums or communities may primarily involve individuals who have had positive experiences with alternative treatments. Negative experiences or lack of efficacy might be underrepresented, leading to a skewed perception of the success rates of these treatments.
Long-Term Follow-Up: Alternative healthcare practices often lack rigorous long-term studies and follow-up assessments. If individuals who initially report positive outcomes are followed up, while those who did not experience benefits or faced adverse effects drop out of follow-up studies, survivor bias may lead to an overestimation of treatment success.
Exclusion of Unsuccessful Cases in Research: Some alternative healthcare studies may selectively report positive results and exclude cases where the treatment did not work or caused harm. This can lead to an inflated perception of the overall success of the treatment.
Underreporting of Adverse Events: Individuals who have adverse reactions to alternative healthcare treatments may be less likely to report these events, especially if the treatment is perceived as unconventional or not widely accepted in mainstream medicine. This can result in an incomplete understanding of the potential risks associated with alternative therapies.
To mitigate survivor bias in alternative healthcare, it's essential to approach the evaluation of treatments with a critical and evidence-based perspective. Researchers and practitioners should strive to collect comprehensive data, including both positive and negative outcomes, and conduct well-designed studies that account for potential biases. Additionally, individuals seeking alternative healthcare should be aware of the importance of reporting both positive and negative experiences to contribute to a more balanced understanding of the treatments they explore.
Humility and Balance
In acknowledging the reality of survivor bias, it's crucial to foster a compassionate and honest dialogue about the complexities of healing in both mainstream and alternative healthcare. While we often share success stories and pathways to positive outcomes, it's equally important to recognize that not everyone's journey leads to healing. This acknowledgment doesn't diminish the value of those who find transformation but instead invites us to approach discussions with humility and empathy. Healing is multifaceted, and the pursuit of well-being is often influenced by various factors, including access to resources and personal circumstances. As we delve into the challenges posed by survivor bias, we're presented with an opportunity for growth and a commitment to understanding health outcomes more comprehensively. By encouraging a transparent and inclusive approach in research, we can navigate the complexities of both mainstream and alternative healthcare, ensuring that the experiences of all individuals, regardless of their outcomes, contribute to a more nuanced and balanced understanding of health and healing.