"Alcoholics Anonymous as treatment and as ideology"; comments on the article by R. E. Tournier.

Abstract

tectomies cure cancer of the breast. The rockbottom requirement for such proof consists of random assignment of matched patients to different modalities with a follow-up of the patients over adequate periods and agreement about definition of recovery. Recently, such a study was attempted with regard to radical mastectomy, but the study was so flawed that the conclusions could not be trusted. Surgeons simply will not consent to participate in such a study because they are convinced that radical mastectomy is superior to simple mastectomy, lumpectomy, radiation or any combination or nothing. They are convinced because they have performed the operation on many women and many recover. This comes under the category of clinical impression, not science. There are a number of histological types of breast cancer, each with a different natural history and outcome. Even those types with the direst outcomes sometimes smolder along for years and the patient may die of old age before she dies of breast cancer. The same problem exists in evaluating Alcoholics Anonymous. It is inconceivable that believers in the efficacy of A.A. would consent to participate in a randomized study. They have seen A.A. work. To deny an alcoholic A.A. would be viewed as close to criminal. There have been a few attempts to compare treatments for alcoholism by random assignment of patients. Results have been inconclusive because many alcoholics have decided in advance what kind of treatment they want and nowhere is there a law that prevents them from seeking out this treatment. Some treatments for diseases are so effective that controlled studies with random assignment are not necessary. Penicillin for pneumococcal pneumonia is an example. However, with alcoholism it is clear that