Dore: nothing in it?

The ten23 campaign looked at homoeopathic pills: there’s no active ingredient in them, once diluted beyond a certain level.  This post is going to look at the Dore treatment for dyslexia, dyspraxia and ADHD: and suggest that there’s no good evidence it works and (aside from the placebo effect) there may be nothing in it.

Following an ASA ruling that claims made in Dore’s advertising were misleading, we were involved in putting out a press release: to publicise this ruling.  My mobile number was on there, and I was surprised to get a call about the release from Phil Hall Associates: Dore’s PR agency.  I subsequently spoke with them about Dore on the phone – which they asked me to keep off the record – and, at the agency’s suggestion, e-mailed them some questions about Dore.  These questions and their responses are below; I will then look at what questions they have failed to answer, and why this suggests that there may be nothing in Dore.

I asked Phil Hall Associates the following questions about Dore:

– I’d be interested in details of how Dore might have responded more strongly to the ASA. If there is good evidence that Dore can treat dyslexia, aspergers, ADHD and dyspraxia, I’d be very interested in seeing this.
– I’m pleased to hear that the new management and ownership seek to improve practice. Could you specify which practices are being revised? And can you let me know who the new owners are?
– The Balsall Common study has been removed from the ‘research’ part of the Dore website. Could you summarise why this has been removed – how does Dore currently feel about this research?
– In terms of the new research, can I see what there currently is? And can you let me know who is conducting any ongoing research – are independent researchers involved?
– Does Dore keep records re the completion rate of the programme and on what percentage of those who complete achieve a successful outcome? If so, can I see the figures? Also, how does Dore assess ‘success’ on the programme?
– Do Dore and PHA feel that there is currently enough evidence to justify promoting the programme as a treatment for dyslexia, ADHD, dyspraxia and Aspergers Syndrome? If so, what evidence do you see as justifying this?
– I gather that Dore may be moving away from ‘miracle cure’ rhetoric. What is Dore’s position on Wynford’s book still selling with that title? And do you feel that current claims (around, for example, addressing the root causes of learning difficulties) are justified?
– Was and is Roy Rutherford’s Autism Treatment and Prevention Centre linked to Dore? And is Dr Rutherford still involved with Dore?
– What evidence would it take to convince Dore and PHA that the Dore programme is not an effective treatment for some of the conditions it is advertised for? And what course of action would be taken in such circumstances?

PHA’s response is below

Firstly, thank you very much for your email in which you raised a number of issues. As you may be aware the Dore Programme has been under new ownership since January 2009 and, as such, has a totally different management team to previous administrations. We are fully committed to communicating with people in an open and honest way as we genuinely believe that the Programme could have a huge impact on the lives of people suffering with learning difficulties.

Over the past ten years (since the Programme was first established) we have consistently received feedback from our clients to indicate that the Programme has helped thousands of children and adults and, for many, this has had a transformational impact on their capacity to learn and function in everyday life.

Although we fully accept ours to be an innovative approach, we continue to be reassured by what our clients tell us and by the ongoing involvement of a number of recognised experts and higher educational establishments. Their academic and clinical input will ensure that the science underlying these observed benefits can be more easily understood and further developed.

However, we also recognise that a start-up organisation can sometimes get absorbed in its passion to bring about change and to survive. As such, there have been lessons learned and the new management team genuinely understands why some people will be wary of the Programme. We want to address these concerns as, ultimately, our goal is to help people (especially children) to overcome the impact of learning difficulties early on in their lives before the more debilitating psychological and social consequences take hold. To achieve this we actively want to promote an environment in which individuals and organisations work together rather than against each other.

The paragraphs below aim to address some of your particular concerns, however, we would be delighted to offer you the opportunity to visit our new centre in Stratford upon Avon and speak with members of the clinical and/or management team.

1. Our method has always been to treat the root cause of learning difficulties with individually designed, physical exercises designed to stimulate the cerebellum. We recognise there are different schools of thought regarding how best to treat people with dyslexia, dyspraxia and ADHD and we believe that many of these strategies have an important role to play.

2. A fundamental issue to tackle is the ‘miracle cure’ debate. The simple truth is that Dore does not market itself as a single, one size fits all solution to learning difficulties. We consider the Programme to be part of the solution and something that works best when combined with other teaching and supporting strategies. The Programme does not teach people to read or write, but is intended to help make the process of learning easier. There are many other organisations in the field of learning difficulties who continue to deliver incredibly important work and we hope that one day we will work in partnership with them as we believe our different methods can complement each other.

3. We acknowledge that, in the past, certain marketing activities have attempted to position Dore as a ‘miracle cure’. Whilst this positioning was based on the anecdotal evidence of numerous people who genuinely considered the Programme to have worked wonders for them, we fully acknowledge that from a scientific point of view no such thing as a miracle cure exists and, accordingly, no longer brand ourselves as such. We are also extremely clear with everyone we speak to that success on the Programme cannot be guaranteed and that the positive benefits depend on many factors – including significant, long-term personal commitment. We also point out that the Programme won’t necessarily be appropriate for everyone – or work for everyone – which is why the initial assessment is specifically designed for us to identify a person’s suitability (or not) and, just as importantly, to allow the individual to make their own judgement.

4. Another criticism the Dore Programme has faced has been one of commercialism. If we genuinely want to help people suffering from learning difficulties then why do we charge a fee? The simple answer to this question is that without Government funding we have no choice but to charge for the treatment as it’s the only way we can afford to deliver and further develop the Dore Programme. Anyone who has ever been to the Dore Centre in Stratford upon Avon will realise straight away that we passionately care about helping people and in no way could be described as a profiteering organisation. Having said this we are aware that some individuals do find the Dore Programme to be beyond their financial reach and, therefore, we are currently reviewing our corporate constitution to ensure that it is aligned to our primary objective of assisting those with learning difficulties as opposed to profit maximisation.

5. There is also the issue about research. Since 2001 there have been thirteen different studies examining the impact of the Dore Programme with eleven of these conducted on an independent basis and four of which having been peer reviewed. Whilst these studies have provided large amounts of valid evidence pointing to the Dore Programme’s success we do, however, acknowledge that they have also attracted some criticism. This criticism has largely focused on the lack of placebo control groups which, as has been explained in the past, was a decision made partly on ethical grounds as it was considered inappropriate to put young children through a minimum 12-month programme of placebo exercises. It is worth pointing out that we are not aware of any other organisation operating in the field of learning difficulties who has conducted placebo control group studies and we suspect that this is for similar reasons to our own.

6. The research supported by Dore in the past is important and has given us a valuable insight into the effectiveness of the Programme. There is also plenty of research around the world (and not just from Dore) supporting the view that the cerebellum is linked to a wide range of learning, cognitive, attention and communication issues. Of course, all research projects have their critics and ours are no exception. There is still much more work that needs to be done and we are committed to undertaking further research studies and we are also keen to work with other organisations to develop these. One independent research project currently being undertaken by Ohio State University in the USA is a pilot feasibility study exploring various types of treatments for ADHD and reading disorders. This study is blind and includes a placebo control group and we look forward to learning of the outcome in due course and very much hope that this will then attract further federal funding to be able to conduct a full study.

This leaves a number of unanswered questions about Dore. I forwarded some of the most significant to Phil Hall Associates, (but have not had a response). Questions are below:

– Does Dore keep records re the completion rate of the programme and on what percentage of those who complete achieve a successful outcome? If so, can I see the figures? Also, how does Dore assess ‘success’ on the programme?
– Was and is Roy Rutherford’s Autism Treatment and Prevention Centre linked to Dore? And is Dr Rutherford still involved with Dore?
– What is Dore’s position on Wynford’s book still selling with
‘miracle cure’ in the title?
– I’d be interested in details as to how – if there is good evidence that Dore can treat dyslexia, aspergers, ADHD and dyspraxia, I’d be very interested in seeing this.

Of course, both Dore and Phil Hall Associates are quite within their rights not to answer my questions. If they’re going to be phoning me up unexpectedly, it seems a bit of a shame if they’re not wanting to answer questions about the evidence for their treatment – but that’s entirely their call, of course. If Dore or Phil Hall Associates belatedly decide that they would like to answer my questions, I will quite happily link their response or post it on this blog.

Currently, though, there’s not any good evidence that Dore works, though – I mean, a ‘pilot study’ taking place after they’ve been selling a horribly time-consuming and expensive ‘cure’ for years… I therefore can’t help but think that there’s really nothing in Dore.

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11 Comments

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11 responses to “Dore: nothing in it?

  1. 2 – We consider the Programme to be part of the solution and something that works best when combined with other teaching and supporting strategies. The Programme does not teach people to read or write, but is intended to help make the process of learning easier.

    If it works, we did it, not the other programs you simultaneously attended. They just taught the child to write.

    the 3 – positive benefits depend on many factors – including significant, long-term personal commitment. We also point out that the Programme won’t necessarily be appropriate for everyone – or work for everyone

    If it didn’t work, it’s your fault.

    There’s caveats and then there’s wooveats…

  2. Pingback: Dore become a Community Interest Company despite known problems with evidence base « gimpy’s blog

  3. Whilst your article is fair and the avoidance of certain questions by Dore is typical, especially relating to completion rates, I must highlight a problem in your opening paragraph.

    …there’s no good evidence it works and (aside from the placebo effect) there may be nothing in it…

    Linking Dore with the placebo effect is bad science, regardless of your stand on the treatment.

    A placebo effect is a short-lived, but real, change in symptoms brought about by the patient’s belief in the treatment.

    Unlike mild and subjective illnesses like colds, dyslexia is a neurological problem with some easily measurable metrics – e.g. spelling tests and reading speed. For children in school the existence, or lack of existence, of any improvement in these areas would be very obvious to both the child and parents. Any perceived gain from the placebo effect would be wiped out by the next set of test or school reports showing no improvement.

    For the placebo effect to be in operation in Dore’s treatment, the patient’s spelling and reading speeding would have to improve over the course of the entire treatment and beyond. However I know of no study lasting 12 months or more that has demonstrated a continual placebo effect. Especially when a patient has access to very obvious feedback on the effectiveness of the treatment.

    Another aspect of the placebo effect argument that does not stand up to scrutiny is the idea that doing a set of exercises for 12 months has no effect on a person.

    Whilst the Dore programme’s effect on dyslexia may be highly debatable, the training programme is straightforward – A series of progressively harder exercises involving balance, hand/eye coordination and short-term memory. For someone to not to improve in these areas after 12 months of exercises would be a real miracle.

    Which leads to the central debate about any placebo effect on dyslexia.

    It may be that Dore’s exercises lead to better coordination and control which translates in greater confidence. Which in turn leads to better improvement in school work. This would be a true placebo effect where a non-effective treatment leads to a genuine improvement in symptoms.

    However leading experts in the field say that dyslexia is an untreatable neurological problem but the effects can be ameliorated through intensive language based training.

    For the placebo effect to work on dyslexia, it would suggest that the experts are wrong and serious reading / writing problems are not permanent conditions.

    There are any number of other explanations as to why some Dore patients report improvements. The patient or their parents may be simply deceiving themselves, not willing to admit they wasted £2500 and a year of their lives. But this or any other of the possible explanations is not the placebo effect.

    Whatever is happening with the Dore programme, whether it is working or not, the timescales it operates over, the nature of dyslexia and the amount of measurable feedback a patient receives means that the placebo effect is not involved.

    • Linking Dore with the placebo effect is bad science, regardless of your stand on the treatment.

      A placebo effect is a short-lived, but real, change in symptoms brought about by the patient’s belief in the treatment.

      Thanks for the detailed comment. In haste – I wasn’t intending to say that improvements which sometimes accompany the Dore programme were only down to the placebo effect. There can certainly be other factors involved (for example, regression to the mean or the benefits of additional study) – but these are not down to the Dore programme. Also, it is plausible that, for example, 1-2 years of extra attention might encourage a child sufficiently that they could get over some of their problems with reading.

    • Daniel

      Dear Chris,

      I believe you have a rather narrow view of the placebo effect. I would, for example, not know why it had to be short-lived.

      But that aside, the problem with the studies is that they don’t have a control group. Since anything could be responsible for the improvements we have no idea how big the impact of the Dore exercises was.

      Their claim is: “Our exercises make learning easier” or so. The way to test that would be to have the control group use exercises which -according to the Dore hypothesis- would not be (as) efficient. If the two groups perform equally well in the end, then there’s nothing in Dore.

      They are of course calling this unethical – but it is not. Since we at present do not know whether Dore is better (or possibly worse!) than any form of physical exercise, there is NO ethical dilemma.

      Greetings,
      Daniel

  4. marc

    Thanks for publishing the interesting PR responses from the new agency working for Dore. As I represent a competitive product, I make it my business to follow the goings on in the industry and reading your post is no exception.

    The only notion I take exception to is that the absence of positive “research proof” of effectiveness is by definition proof of “there’s nothing really in it.” There are many scientific advances that are initially viewed as snake oil or that lack “evidence” of cause and effect relationships that are eventually understood (with the 20/20 perspective of hindsight) to be quite effective but until science catches up to demonstrate the case, must rely on anecdotal evidence and faith in the model being proposed to make their points.

    This is the case that Learning Breakthrough Program find itself in. We lack the types of peer reviewed, placebo-tested research results that would lend credibility to our cause but in our case this has more to do with the incredible financial commitment needed to pursue such such an effort and the time and expertise that our staff would need to put forward to make it a reality. Fortunately, we are increasing our ability to provide meaningful research into balance and sensory motor development treatment effectiveness and will be thrilled to share those results whenever they are available. We are talking years in our case though but are none the less committed to undertaking the efforts and are working to build the relationships in the scientific community that will hopefully lead to having the work undertaken by highly credible and thorough professionals. Research of this nature is not undertaken by companies themselves as much as by interested independent academics who publish their finding regardless of the positive or negative outcomes that the results suggest. This is at least the case in the honest research world we are interacting with.

    I have several problems with Dore’s marketing approach, research standards, promotional claims, expensive program cost, history of client abandonment, mysterious ownership claims and the disservice they have done to reputable occupational therapy and brain fitness-based programs like ours. With that said we, and many of our clients and the therapists that serve them, believe deeply that with a program of proper balance challenge (like that provided by our unique and individually adjustable balance board) and thoroughly designed movement components, certain people (not all) can overcome neurological barriers with relatively simple exercise programs like our own. The logic behind the sensory integration and vestibular remediation model that Dr. Belgau pioneered, and that was later noticed by Dore as he worked with his daughter, is available for all to see on [website URL and plug removed]

    • Marc – it’s important to trial treatments before widely promoting them, so that you know whether they work (or at least are worth investigating further) or whether they are useless/harmful. If you promote a treatment, for a prolonged period, without testing it then you run a serious risk of promoting an approach with nothing in it – or which is even harmful. Your Google ad says your programme has been running since 1982 – how many sales have you made since then? And how much have you spent on sales/marketing? Are you really claiming that good quality research has not been possible in approx 28 years.

      I note you acknowledge that Learning Breakthrough lacks “the types of peer reviewed, placebo-tested research results that would lend credibility to our cause”. However, your website makes much stronger claims: for example

      The Learning Breakthrough ProgramTM helps to better organize the way the brain processes information and speeds up brain reaction time. Everything we do, such as reading, writing, speaking and playing sports involves our brain sending signals to our body parts. If your brain works better, you will perform better.

      I would have serious ethical concerns about making such claims without conducting good quality tests to find out whether or not the treatment works.

      I note that your Google ad claims that the Learning Breakthrough programme can “Reduce ADD symptoms in 30min/Day.” Thanks for bringing this to my attention – I will submit a complaint to the ASA shortly.

      A final point – I have removed links to your product and a bit of what reads like promotional text. In the absence of evidence that it works (or even that it’s safe) I do not want Learning Breakthrough to be promoted on this site.

  5. marc

    John:

    We deal with skeptics all the time. And our response is always the same…it may not be for you. My only point is that respectable alternative approaches to addressing learning challenges do exist and reputable promotion of them is not illegal or unethical in any sense.

    You would be underwhelmed at the marketing dollars we have spent (or have to spend) in the three-plus years we have been working to distribute the Belgau’s program. As I mentioned before, we are in pursuit of the types of research validation that would open the door to more serious consideration by those who would ignore years of value with similar techniques found in the work of occupational therapists, developmental optometrists and other neurophysiological specialists. We are the only people to ever pay the developers of Learning Breakthrough a penny since THEY first published the program in 1982 and there have been many groups that have used LBP’s vestibular training model without such concerns or acknowledgment. We make no over-the-top claims and simply point out the successful experiences of our clients while working to close what we freely acknowledge is a research gap. Our work (and the Belgau’s) is of a slow and steady sort. In this case it seems thankless as well, but we do not resort to exaggerated claims or high pressure sales tactics and work diligently to support those who do see value in program.

    My original point remains. Although I cannot claim to have excellent research supporting exactly why balance and sensory integration exercises work for some people, the absence of such proof is not proof of a program without value. Being tarred with the same brush as the Dore Programme is the only issue of concern I have and I thought I would make the distinction here, not knock down your analysis or even your well-understood questions about the programme’s efficacy.

    • Marc – I never sought to say that Learning Breakthrough are the same as Dore (I don’t think they were mentioned on this blog before you commented). However, making claims like “helps to better organize the way the brain processes information and speeds up brain reaction time” is highly problematic – unless you’ve got good evidence that the programme works. ‘Good evidence’, here, means much more than just testimonials.

    • Daniel

      “[O]ur response is always the same…it may not be for you. My only point is that respectable alternative approaches to addressing learning challenges do exist and reputable promotion of them is not illegal or unethical in any sense.”

      I take exception to that.

      1) “It may not be for you” sounds like the very definition of cherry-picking, the type always present when relying on testimonials.

      2) “not illegal or unethical in any sense” – That is simply wrong. Ask an ethicist (best: medical ethicist) at the nearest university: As long as you have not proven to be better than bogus treatment, USING or PROMOTING your product is unethical.

      As I have detailed above, a trial would not be terribly complicated: You (or Dr. Belgau) has an hypothesis as to which physical exercises help the brain best. To test whether this concept is true, randomize your patients into two groups, one using the allegedly beneficial, one receiving allegedly less or inefficient exercises. Compare the results after whatever time you feel appropriate and see whether the “beneficial” group performs better than the “useless” group. (Caution! Good blinding is mandatory!)

      In case you want to argue that “DEPRIVING poor children of our treatment” was unethical, you are mistaken. Since there is at present no good evidence that “your exercises” are better (or worse) than “any exercise”, it is equally likely that GIVING children your treatment may in fact be unethical. You are making the logical fallacy to already ASSUME it is better than “sham exercise.”

      In short, you can only “deprive” someone of something that is already PROVEN to be beneficial. Your exercises are not.

      And, see above, testimonials are cherry-picking and do not count.

      Greetings,
      Daniel

  6. gimpy

    I covered Learning Breakthorugh in an early blogpost of mine. This is also a company that when Dore went into administration launched a google ads recruitment effort targetted at Dore’s client base.

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