Dore pwned in medical journal: expensive and unproven ‘cure’

29 Sep

The Dore programme is an interesting ‘cure’ for all kinds of things: as Dorothy Bishop puts it, “Dore Achievement Centres are springing up world-wide with a mission to cure cerebellar developmental delay, thought to be the cause of dyslexia, attention-deficit hyperactivity disorder, dyspraxia and Asperger’s syndrome. Remarkable success is claimed for an exercise-based treatment that is designed to accelerate cerebellar development.” Sound great, doesn’t it. Except, as Bishop shows in a new journal article, this is not supported by good evidence and it is therefore the case that “the claims made for this expensive treatment are misleading”. While academic journals are normally pretty restrained, this is about as close as I’ve seen to a thoroughgoing fisking in a journal article: Dore, and their research, are really pwned here. Given that – according to Ben Goldacre in the Guardian – a course of Dore treatment costs around £1,700 (and takes a load of time) I’d want much better evidence of efficacy before splashing out.

Dore is certainly well-promoted. Google “Asperger’s Syndrome” and it brings up an advert for Dore’s “Proven Long Term Drug-Free Solution Relieving the Symptoms of Aspergers”. Google “dyspraxia” and an advert informs one about Dore offering a “Proven Long Term Drug-Free Solution Relieving the Symptoms of Dyspraxia”. Google “dyslexia” and an advert promotes Dore as a “Proven Drug-Free, Exercise Based Dyslexia Remedy”. As a slick Dore promotional DVD puts it: “Now Dore Centres are able to offer real hope to those in despair” due to suffering from ‘learning disorders’. This includes Asperger’s Syndrome, which Dore’s UK site describes as “a problem associated with poor social behaviour.” Dore is apparently “suitable for those with high functioning Asperger’s Syndrome and Autism” (are any alternative treatments nowadays not marketed as suitable for people on the autistic spectrum?).

This marketing might make Dore seem appealing. Bishop notes that, “Although most of the promotion of the treatment is based on personal testimonials, these are backed up by research. Dore pointed to a study showing that treatment led to a nearly fivefold improvement in comprehension, a threefold improvement in reading age, and a 17-fold improvement in writing.” Sounds good, right? But the quality of the research was pretty dismal. Among other problems, while the research did include a control group

there were no data corresponding to a time when the treatment group had had intervention and the control group had not – because the control group had embarked on treatment at the end of the first phase. Accordingly, the authors presented the data only from the treated group.

‘Oops’, is all I can say…Bishop puts it more eloquently, making clear that “The publication of two papers in peer-reviewed scientific journal (Dyslexia) has been presented as giving further credibility to the treatment. However, the research community in this area has been dismayed that work of such poor standard has been published.” I wonder how the researchers justified this poor control to Dyslexia – maybe the good old excuse that ‘the dog ate my control group’?

This might sound bad for Dore, but that’s not the half of it – Bishop also takes apart Dore’s posited mechanism of action:

The gaping hole in the rationale for the Dore Programme is a lack of evidence that training on motor-coordination can have any influence on higher-level skills mediated by the cerebellum. If training eye–hand co-ordination, motor skill and balance caused generalised cerebellar development, then one should find a low rate of dyslexia and ADHD in children who are good at skateboarding, gymnastics or juggling. Yet several of the celebrity endorsements of the Dore programme come from professional sports people.

So, aside from lacking a plausible mechanism of action, and lacking good evidence of efficacy, Dore seems like a great idea. If that leaves anyone rushing to get out their cheque book, Bishop kicks the dead horse a few more times. It’s therefore also worth quoting Bishop’s key points about the Dore treatment:

1 The treatment offered by Dore Achievement Centres is being promoted as a “drug free” alternative to conventional treatment for ADHD, and as a ‘miracle cure’ for dyslexia. It is presented as having a neurological rationale and gains credibility by appearing to be medical treatment.
2 The publication of two papers in peer-reviewed scientific journal (Dyslexia) has been presented as giving further credibility to the treatment. However, the research community in this area has been dismayed that work of such poor standard has been published.
3 The research purporting to show efficacy of the treatment does not show sustained gains in literacy scores in treated vs. control children. Furthermore, the intervention has not been evaluated on the clinical groups for which it is recommended.

Ouch. If only more articles in science journals were like this – clear, well-written, and brutal in a rather entertaining way – they’d make much better weekend reading…

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4 Responses to “Dore pwned in medical journal: expensive and unproven ‘cure’”

  1. Schwartz September 30, 2007 at 07:01 #

    More crap being published in peer-reviewed journals. It’s no wonder many people have lost confidence in the system.

    It just re-enforces my position, that the fact a study was peer-reviewed is no guarantee of good science. The scary part is that this type of garbage is not restricted to alternative medicine.

    Drugs are very often applied to populations which were not part of the safety or efficacy study group. Gardacil comes to mind as a recent example.

    I wonder why this particular journal suddenly decided to go after this case?

  2. Shinga September 30, 2007 at 08:40 #

    I wonder why this particular journal suddenly decided to go after this case?

    Possibly because there seems to be legitimate concern about the efficacy of the programme? Parents are having to fund it at present and need to know that they are investing in something that is known to be effective and ‘does what it says on the tin’? If there were a move to have the UK educational system pay for it, then certainly, we need systematic reviews of the studies that have been done so far.

    What did you consider to be amiss with the Bishop review that reduces its value to “garbage” in your estimation?

  3. Jon September 30, 2007 at 11:19 #

    as to why the journal decided to go after this case – as Shinga has said, there is a real public interest in this area. It’s also possible that the journal did not specifically choose to focus on this – but were presented with a good article from Bishop, and were happy to publish it.

    Schwartz- I’m not sure where you’re coming from here. If what you mean is that Bishop’s paper showed that some garbage was published in Dyslexia then, while ‘garbage’ might be slightly strong 😉 I can see what you’re getting at. If you view the Bishop review itself as garbage, I’d be interested to know why.

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  1. I wish I was special, so fucking special* - learning disability profit-mongering « gimpy’s blog - October 3, 2007

    […] http://www.dore.co.uk/  – £1700 according to Ben Goldacre, torn apart by Dorothy Bishop, and blogged by leftbrainrightbrain. […]

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