Misinformation and bad math

What is a majority of people? Technically, it's a portion that contains more people than not. So anything about 51% or above would be a majority.

Then why would Remuda Ranch consider 49% a majority?

In their recent press release, RR said that the majority of women they treated (49%) had suffered childhood sexual abuse and trauma. I know it's a bit nit-picky, but still. It's NOT a majority.

Of course, RR isn't necessarily in the business of statistics. They're in the business of selling eating disorder treatment programs (at the cost of about $2000 per day). I know people who have gone onto recovery after a stay at RR- but not at the rate of 95% that their website claims.

Still, the issue of CSA in people with eating disorders is, sadly, very real. Could people with eating disorders be more likely to have been abused? Perhaps. But there aren't solid numbers on it. What appears to be the case is that CSA increases a person's risk for all kinds of brain diseases, eating disorders included. It's an incredible stress, and an incredible trauma on a growing brain.

It's a trigger, but it's not necessarily a cause.

I think you need the wiring to develop an eating disorder, period. Does abuse mean your wires may need less triggering than if you hadn't been abused? It seems likely.

But for Remuda to say that the majority of women with eating disorders have been abused or traumatized is WAY off the mark. Remuda does NOT see an even cross-section of people with eating disorders. They see the people who have decided to come to their clinic- and can afford to do so.

It's bad science, and a really tacky PR ploy.

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Tiptoe said...

I read this report too and felt similarly. 49% is not a majority whatsoever. Although I'm sure RR is a good facility and many people have done well there, is it me or they do publicize an awful lot? Not that it is a bad thing necessarily, just seems kind of odd to me.

On another note, I've known people who had a lot of CSA in their lives. Some developed other illnesses, phobias, etc., while others amazingly coped really well, found strength, move don from their past, and led normal, well-fulfilled lives.

fighting_forever said...

This annoys me as a mathematician and as someone who's never been abused. I've never been bullied (even mildly). My parents are loving and supportive (I argue like hell with my dad, but he would never hurt me in any way). I've never been raped, assulted or abused by anyone.

I hate places making a big deal about the fact a reasonable proportion (but not a majority) of eating disorder sufferers have been abused or raped. It makes those of us who haven't been raped wonder if maybe our self-diagnosis could be wrong. If people believe that you have to have been raped to have an ED, then they might assume they don't have one and not seek the proffesional help they need.

A:) said...

As our medical director said, if they really did have a 95% success rate you think it would have been published in PEER REVIEWED scientific journals?! Studies would have taken place to replicate the findings?

Let's face it -- ED's are tricky illnesses and there is no clear cut treatment. If RR had found a cure-all, ED's would be a lot easier to treat and cure and many centres would be basing their program on RR's.

As this is not happening, it really is just propoganda of a commercial organization -- kind of like weight watchers claims, or any other bogus diet industry clinic.


Claire said...

I feel the same way too. Also, I went to RR back when I was 15 and I can say that the 95 percent success rate was not true for at least the people I knew. Out of the 15 or so girls that I continued to talk to out of treatment, only a few went on to recovery. The majority relapsed after treatment or even in treatment (in the LIFE program). I know that's a small sampling, but I just don't buy it. Remuda is not a miracle treatment center.

Tiptoe said...

Oh yeah, just remembered something a friend told me. That he figure they are more than likely getting in terms of 95% success rate is because the people actually filling out the forms have done well, recovered, not relapsed, etc. However, more than likely, you are not hearing from the ones who have not fared well. And with that whole segment missing, well, the numbers all get skewed to essentially the way you want it.

Anonymous said...

Not to defend Remuda, but it appears that the reporter came up with the "majority" and "more than 50%" comments, not Remuda.

Anonymous said...

I don't think "a reporter" bears the blame since it appeared in a Remuda press release.

Their website actually claims 99% recovery, though I don't think the labeling on these graphs would fly at a middle school science fair.

There are studies of higher quality available on the correlation between CSA and EDs with associations seeming to differ by disorder.

1: Arch Pediatr Adolesc Med. 2008 Mar;162(3):261-7.
Childhood sexual abuse and eating disorders in females: findings from the Victorian Adolescent Health Cohort Study.

Sanci L, Coffey C, Olsson C, Reid S, Carlin JB, Patton G.
Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, Victoria 3053, Australia. l.sanci@unimelb.edu.au
OBJECTIVE: To examine the relationship between childhood sexual abuse (CSA) before the age of 16 years and later onset of bulimia and anorexia nervosa symptoms in females. DESIGN: A longitudinal cohort study of adolescents observed from August 1992 to March 2003. The cohort was defined in a 2-stage cluster sample using 44 Australian schools in Victoria. SETTING: Population based. PARTICIPANTS: A total of 1936 persons participated at least once and survived to the age of 24 years, including 999 females. The mean (SD) age of females at the start of follow-up was 14.91 (0.39) years; and at completion, 24.03 (0.55) years. Main Exposure Self-reported CSA before the age of 16 years was ascertained retrospectively at the age of 24 years. OUTCOME MEASURES: Incident Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)-defined partial syndromes of anorexia and bulimia nervosa were identified between waves 4 (mean age, 16.3 years) and 6 (mean age, 17.4 years) using the Branched Eating Disorder Test. RESULTS: The incidence of bulimic syndrome during adolescence was 2.5 (95% confidence interval, 0.80-8.0) times higher among those who reported 1 episode of CSA and 4.9 (95% confidence interval, 1.9-12.7) times higher among those who reported 2 or more episodes of CSA, compared with females reporting no episodes, adjusted for age and background factors. The association persisted after adjusting for possible confounders or mediators measured 6 months earlier, including psychiatric morbidity and dieting behavior. There was little evidence of an association between CSA and partial syndromes of incident anorexia nervosa. CONCLUSION: Childhood sexual abuse seems to be a risk factor for the development of bulimic syndromes, not necessarily mediated by psychiatric morbidity or severe dieting.

Anonymous said...

I'm anonymous one. Sorry, I was wrong in my comment; the "press release" linked in the original post seemed to be a report based on the press release, and so it appeared to me that the writer of the report was misinterpreting the press release. But you're right; the press release itself does use the "majority" and "more than 50%" terms. I guess this is an instance of the perils of reading on the Internet.

Why do you think that Remuda seems so eager to link eating disorders to child sexual abuse?

Carrie Arnold said...

No, I believe this is a straight press release that appeared on a PR wire service. That's what Market Watch is, anyway.

Remuda puts out several press releases each month, and many of them make scientific-esque claims without studies to back them up.


If I ever meet some of the Remuda folks, I will love to ask them why they haven't published it yet. :)


I agree that the study I cited was perhaps not the best example- thank you for the additional one.

marcella said...

I have no interest in Ramuda, but perhaps no particular axe to grind AGAINST them either as they do not operate in my country (UK). I do have to point out that they aren't the only ones who might be attract the old adage "lies, damn lies and statistics". Reputable British researchers talk about the 70% success rate with CBT - as in "70% of those who complete the course achieve full recovery" - personally my problem with this is that I've never met anyone who has completed the course....
It may be necessary for marketing (whether to individuals, insurance companies or National Health Service monitoring bodies) but this playing with statistics isn't fair to individuals and families affected by these illnesses

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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