Articles

Reiki

Reiki (pronounced raykey) is a form of “energy healing,” essentially the Asian version of faith healing or laying on of hands. Practitioners believe they are transferring life energy to the patient, increasing their well-being. The practice is popular among nurses, and in fact is practiced by nurses at my own institution (Yale).

From reiki.org, we get this description:

Reiki is a Japanese technique for stress reduction and relaxation that also promotes healing. It is administered by “laying on hands” and is based on the idea that an unseen “life force energy” flows through us and is what causes us to be alive. If one’s “life force energy” is low, then we are more likely to get sick or feel stress, and if it is high, we are more capable of being happy and healthy.

Reiki is therefore a form of vitalism – the pre-scientific belief that some spiritual energy animates the living, and is what separates living things from non-living things. The notion of vitalism was always an intellectual place-holder, responsible for whatever aspects of biology were not currently understood. But as science progressed, eventually we figured out all of the basic functions of life and there was simply nothing left for the vital force to do. It therefore faded from scientific thinking. We can add to that the fact that no one has been able to provide positive evidence for the existence of a vital force – it remains entirely unknown to science.

But the discarded science and superstition of the past is the “alternative medicine” of today. There are many so-called “CAM” modalities that are based on vitalism, including Reiki. Reiki, in fact, is very similar to therapeutic touch, another energy healing modality that was popular among nurses, and although it continues to be used it is much less popular after 9 year old girl (Emily Rosa) performed an elegant experiment to show that it was nothing but self-deception. Reiki nicely moved in to fill the void.

The research on Reiki, and energy healing in general, is similar to that of many similar modalities – those with very low scientific plausibility that are not taken very seriously by medical scientists. The research is of generally low quality, poorly controlled small studies that seem designed to justify Reiki rather than see if it actually works. The most recently published study, for example, looks at anxiety levels and self-reported well being in cancer patient and finds, unsurprisingly, that patients feel better when they receive the kind attention of a nurse. The study is completely uncontrolled, and therefore of dubious value. One might consider such a study a complete waste of time and effort, as the results were never in doubt.

A 2011 review of reiki studies concluded:

The existing research does not allow conclusions regarding the efficacy or effectiveness of energy healing. Future studies should adhere to existing standards of research on the efficacy and effectiveness of a treatment, and given the complex character of potential outcomes, cross-disciplinary methodologies may be relevant. To extend the scope of clinical trials, psychosocial processes should be taken into account and explored, rather than dismissed as placebo.

In other words – existing research is a such poor quality we cannot draw any useful conclusion from it. I disagree, however, that this necessarily means that more research is needed. The low plausibility of using magical energy that has never been demonstrated to exist by medical science argues otherwise. Further, the last sentence is odd – it suggests the authors are trying to spin placebo effects into real effects. This is increasingly the strategy of alternative medicine advocates as it becomes clear that most of the modalities they favor do not work any better than placebo (which means they don’t work).

Reiki is now squarely in that camp. Published at about the same time as the review (and therefore not included in the review) is a well-designed study of Reiki where Reiki was compared to placebo Reiki (someone not trained in Reiki simply goes through the motions) vs usual care (no intervention). Not surprisingly, both the real Reiki and the sham Reiki groups did better on self-reported well-being than the no intervention group, but they were indistinguishable from each other. Therefore Reiki did not better than placebo. That means Reiki doesn’t work (at least in the regular world of science-based medicine).

The authors conclude:

The findings indicate that the presence of an RN providing one-on-one support during chemotherapy was influential in raising comfort and well-being levels, with or without an attempted healing energy field.

I notice the authors did not conclude “Reiki doesn’t work.” This is odd, given that both the treatment and placebo groups had the same effect on subjective outcomes. With regular medical interventions we conclude from this outcome that the treatment does not work. Imagine a pharmaceutical company concluding:

The findings indicate that taking a pill during chemotherapy was influential in raising comfort and well-being levels, with or without an active ingredient.

Therefore – taking pills is helpful. Let’s not fret about whether the active ingredient has any specific physiological effects. Reiki supporters appear to have taken a page out of the acupuncture handbook. If real and sham acupuncture are both better than no intervention (they argue), than acupuncture works, whether real or placebo.

This article by Edzard Ernst recently published in the Guardian also discusses this Reiki study. Ernst points out that, not only is it scientifically dubious to conclude from such studies anything other than the treatment does not work, it is ethically questionable to give such treatments as a placebo intervention. He writes

By insisting that patients must not be treated with placebos like reiki, scientists also advocate that they receive treatments that demonstrably work better that placebo. For instance, massage has been shown to improve the wellbeing of cancer patients beyond a placebo effect. If a patient receives a massage with empathy, sympathy, time, understanding and dedication, she would benefit from the placebo effect – just like the reiki patient – but, in addition, she would also benefit from the specific effect of the treatment that massage does and Reiki does not offer.

This is a critical point that I have been making also. Essentially, you cannot justify ineffective treatments simply because they provide a placebo effect. That is because effective treatments also provide the same placebo effect, but also provide specific benefits because they actually work.

I would argue that there are also many potential harms from convincing patients that unscientific treatments are effective because of their non-specific placebo effects. This is a deception, violates patient autonomy and informed consent, and sets them up to perhaps rely on ineffective “magical” treatments for non-self-limiting illnesses.

Let’s get back to the authors conclusions from the Reiki study – they argue that this study shows that the:

“presence of an RN providing one-on-one support during chemotherapy was influential in raising comfort and well-being levels…”

The part about “with or without an attempted healing energy field” is entirely irrelevant, and you could just as well substitute any ineffective or magical treatment for “healing energy” is that statement. But the first part of the conclusion is also dubious, in that we did not need this study to come to this conclusion.

It has already been well-established, to the point that it is appropriately taken as a given, that people feel better when they get the kind attention of someone else, especially if they are sick and that person is a health care professional with training and experience in comforting sick patients. We don’t need to keep studying this over and over again.

Kind attention plus X makes people feel better, just as well as kind attention alone. Great. We do not need to study this with every possible form of unscientific intervention filling in for X. And it is deceptive and unscientific to suggest that whatever fills in for X has some value because of this equation.

This is what I call the “part of this complete breakfast” fallacy. Even as a child I recognized that when a commercial advertised their pastries as being part of the complete nutrition offered by an otherwise nutritious breakfast, the pastries were nutritionally irrelevant. They added nothing, and the commercial was being deceptive in trying to make me think that they were nutritious simply by their proximity to a nutritious breakfast.

Reiki, acupuncture, homeopathy, and similar methods may be “part of this feel-good intervention,” but they are an irrelevant and superfluous part. It is the kind attention of the practitioner that matters – and only that attention. So such attention might as well be part of legitimate science-based interventions that also have a specific physiological benefit.

This suggests that the real purpose of the ritual of reiki, or other superfluous placebo ritual, is not to achieve a positive end for the patient but to give the practitioner a marketable “skill” (even though the evidence shows that someone without any such skill or training can get the same results). In a recent article about reiki making its way into hospitals, Kryak and Vitale write:

There is a growing interest among health care providers, especially professional nurses to promote caring-healing approaches in patient care and self-care. Health care environments are places of human caring and holistic nurses are helping to lead the way that contemporary health care institutions must become holistic places of healing. The practice of Reiki as well as other practices can assist in the creation of this transformative process.

I submit that if the goal is to make hospitals and other health care environments more nurturing, promoting reiki and similar modalities is that exactly wrong way to do it. They are tying a worthwhile goal to blatant pseudoscience, and therefore legitimate resistance to the pseudoscience will also cause resistance to the nurturing.

If we accept that health care environments can be improved by more time and resources being applied to patient comfort, reduced anxiety, and enhanced self sense of well-being – then let’s use what works, the time and attention of a caring provider. The placebo ritual that is reiki (or acupuncture, or whatever) is wasteful, distracting, and arguably unethical. It unnecessarily complicates efforts to improve patient caring by promoting demonstrable pseudoscience.

Posted in: Energy Medicine

Leave a Comment (41) ↓

41 thoughts on “Reiki

  1. daijiyobu says:

    Re: “reiki, acupuncture, homeopathy, and similar methods…”

    Such are on like 9x% of all naturopath’s sites I read.

    -r.c.

  2. windriven says:

    “presence of an RN providing one-on-one support during chemotherapy was influential in raising comfort and well-being levels…”

    “Not surprisingly, both the real Reiki and the sham Reiki groups did better on self-reported well-being than the no intervention group, but they were indistinguishable from each other. ”

    Average salary of an RN $65651*
    Average salary of a massage therapist $42945**
    Average salary of a dog $0***

    * This is the best use of time for a nursing professional, right?
    ** Salaries courtesy of salary.com
    *** In deference to Mark Crislip, don’t let the dog lick your face.

  3. JPZ says:

    @Steven Novella

    “…intellectual place-holder…”

    Nice turn of phrase! Much nicer than “…just because science doesn’t know everything doesn’t give you the right to fill in the blanks with whatever fairy tale nonsense…” (apologies to Dara O’Brieian if I mis-quoted).

  4. rork says:

    “effective treatments also provide the same placebo effect” – if they are supplied. That generally takes a diagnosis. That takes getting to see your doc and talk about issues. I very much liked the article, but the quacks have found the weak spot. They will see you tomorrow, and talk to you.

    I figure there is study on general health benefits of just getting to talk to your doc (or someone) more regularly or often, to see if that might be effective and/or save money. It’s not happening for me, so my doc must have some evidence, eh?

  5. @windriven *Minimum* fee per minute of a reiki practitioner: $1

    Often rather more.

  6. kathy says:

    “Reiki, acupuncture, homeopathy, and similar methods may be “part of this feel-good intervention,” but they are an irrelevant and superfluous part.”

    X + Y = X

    therefore Y = 0.

  7. tmac57 says:

    I once asked a Reiki practitioner how, exactly, it worked. I found her explanation just so much ‘handwaving’.

  8. David Gorski says:

    Reiki is, of course, nothing more than faith healing that substitutes “Eastern” mystical beliefs for Christianity as its religious basis. I say this all the time whenever I’m interviewed about it because (1) it is true and (2) it’s a good sound bite that boils the issue down to a single sentence. If I have time, I’ll then make the analogy between reiki and the laying on of hands, pointing out how the “universal source” from which reiki practitioners claim to channel healing energy can be viewed as just another term for God.

    If you don’t believe that this is faith healing, consider that the creator of Reiki, Dr. Mikao Usui explicitly began his search for healing methods by asking, “How did Jesus heal?” His discovery of reiki reads like Jesus’ 40 days in the wilderness:

    Some of the students asked him one day, in the 1870′s, if he believed in the miracles Jesus did (raising dead, etc.). Being a Christian Monk he answered “Yes”. They asked if he knew how Jesus had done this, “No” he said. He realized that he must find out how Jesus healed. This immediately set him on a journey of many years. Studying, first at Christian schools in the US with no results. Someone suggested Buddhist writings since the Buddha had also healed. This meant more years at monasteries in the Orient. Nowhere could he find the answers. In Japan he toured all the monasteries there asking about how Jesus or the Buddha had healed. In one small monastery, he found some ancient Sanskrit writings. After a few more years of study, he felt he had come to an understanding and that to go further required serious meditation. He went to a nearby mountain declaring his intention to fast and meditate for 21 days and that if he did not come back they should come and get his body.

    He went to the mountain and settled in with 21 stones with which to count the days. On the 21st day nothing had come as yet, and he turned over the last stone saying “Well, this is it, either I get the answer today or I do not”. At that moment on the horizon he could see a ball of light coming towards him. The first instinct was to get out of the way, but he realized this might just be what he was waiting for, so allowed it to hit him right in the face. As it struck him he was taken on a journey and shown bubbles of all the colors of the rainbow in which were the symbols of Reiki, the very same symbols in the writings he was studying but had been unable to understand. Now as he looked at them again, there was total understanding.

    After returning from this experience he began back down the mountain and was, from this moment on, able to heal. This first day alone he healed an injured toe, his own starvation, an ailing tooth and the Abbots sickness, which was keeping him bedridden. These are known as the first four miracles.

    One can’t help but wonder if he healed his own starvation by stopping at a local inn or restaurant and starting to eat three regular meals a day.

    Sarcasm aside, I don’t know how much of the above account is true, but the very fact that reiki devotees spread such stories around are strong indications of the religious nature of reiki. It’s also always interesting to see that other religions recognize reiki for what it is, which is why the Catholic bishops in the U.S. aren’t too thrilled with it. Neither are many fundamentalist preachers.

  9. Quill says:

    I think I can anticipate a response to this:

    Not surprisingly, both the real Reiki and the sham Reiki groups did better on self-reported well-being than the no intervention group, but they were indistinguishable from each other. Therefore Reiki did not better than placebo. That means Reiki doesn’t work….

    “Aha!,” says the enthusiast, “This actually shows that the life force is so strong, so innately intelligent and so powerful that it works without having to have the practitioner know what they’re actually doing! The life force energy naturally balances itself.”

    And for this, too:

    We can add to that the fact that no one has been able to provide positive evidence for the existence of a vital force – it remains entirely unknown to science.

    “Quantum movements! Non-locality! Aeon flux and neutrino dances! Everything is not as it appears, western allopathic medicine is controlled by 19th century mentalities, energies are boundless, and most science-y minded, left-brain dominant, fact-obsessed, close-minded, patriarchal male doctors need some therapeutic touching at least twice a week.”

  10. WilliamLawrenceUtridge says:

    tmac, did “quantum” come up?

    I’m just kidding, of course it did. All alternative medicine is “quantum”. The funny thing about quantum is, it all averages out to zero in the end. Thus it is perfectly plasuble that they are manipulating “quantum” to improve a patients’ health, the reason they aren’t getting better is because “antiquantum” is cancelling it out.

  11. HeHe, I love the line about the complete breakfast, great analogy.

  12. surfgeorge says:

    I thought I might add a comment as a Certified Reiki Practitioner.

    I was going to massage school in the 1970s (to legally practice massage in the city I was living in California you had to have a license granted by the state after passing a state-certified massage school course and written and practical exams, and then be fingerprinted at the police department!) and whenever we would work on “enegy” modalities in class I had to report that “I didn’t feel anything”. The instructor got a little exasperated with me… apparently I was the only insensitive dolt in the class of 15 people unable to detect “energy”. One day she finally clued me in: “Well, just IMAGINE what it would feel like”. Uh huh. The light started to dawn on me! They’re just making this crap up!

    A weekend Reiki certification class was coming up and I thought “well, maybe another teacher can figure out how to get me to feel energy without using my imagination”. During various exercises the instructor would ask “Can you feel that?” I had to answer “no”. She said, “That’s all right. I can feel it. You are channeling the energy.” I was? Weird, I couldn’t feel a thing. I got certified as a Level 1 Reiki practitioner (it’s strongly recommended that you spend lots more money, er, I mean take more courses and get certified at higher levels).

    I did practice massage… physical massage. Never used any of the “energy” stuff nor the reiki. I guess I just don’t have that good of an imagination. Or any kind of desire to live in fantasyland.

  13. phayes says:

    “The research on Reiki, and energy healing in general, is similar to that of many similar modalities – those with very low scientific plausibility that are not taken very seriously by medical scientists.”

    It seems to me they’re taken far too seriously by medical scientists, most of whom apparently don’t understand just how low that plausibility is and what its consequences are (i.e. why the phrase “a well-designed study of Reiki” is oxymoronic). It’s easy to laugh at the antics of the deluded crackpots in most sciences but this is medical science and there is an ethical dimension to it and the more I’ve seen of this ignorant, infantile nonsense the less amusing it has become.

  14. tmac57 says:

    Well,here’s a guy with a different view of Reiki,in: ‘Exposing The Dangers of Reiki’: (It’s not what you think)
    Seems that Reiki is satanic and demonic,and will ruin your life, maybe make you homeless,or break up your marriage (true story!)

    http://www.youtube.com/watch?v=uHPht8UZkds&feature=related

    It almost makes me feel sorry for the Reiki practitioners…almost.

    In another video,the presenter, in all seriousness,tells us that Reiki can be used on your drinking water,your computer,and even heal your car! Boy that’s some strong stuff!

  15. “In another video,the presenter, in all seriousness,tells us that Reiki can be used on your drinking water,your computer,and even heal your car! Boy that’s some strong stuff”

    Brilliant! My check engine light just came on, where can I find me a Reiki mechanic?

  16. tmac57 says:

    Apparently there is a whole ‘cage fight’ going on at YouTube:Christians vs Reiki Masters!!! Pretty entertaining.May the best woo win.

  17. JPZ says:

    I wonder if reiki can be used during dating. And, if so, is this yet another thing I need to check when screening potential boyfriends for my kids?

    No condom in wallet: check
    No offensive body art or clothing: check
    Reiki master certification database check: GET OUT!!!

    Me: “Why do you keep trying to date these guys?”
    Daughter: “I don’t know Dad. They start waving their hands around, and I can’t help myself.”

    ;)

  18. tmac57 says:

    Michele-Just be careful! You wouldn’t want to end up with a satanic mechanic ;)

  19. @tmac57, I’ve had a Christian tree service, so maybe I should try a satanic mechanic for spiritual balance. I’ll just have to be very careful when he asks me to sign off on the cost of repairs.

  20. AHodges says:

    When I get into discussions/debates about quackery such as homeopathy, reiki, etc., I have a friend who asks, “If people like it and feel like they get benefit from it, even if it is placebo, what’s the harm?” I’d be interested in the answer to that from some of the SBM commenters.

    1. Harriet Hall says:

      @AHodges: What’s the harm? This has been thoroughly covered, but I’ll provide a quick summary.
      1. Check out the What’s the harm? website http://whatstheharm.net/.
      2. Placebos are unethical: we can’t condone lying to patients.
      3. We can elicit a similar placebo effect to enhance a treatment that has actual benefit.
      4. Placebos waste time and money.
      5. Using placebos may delay or take the place of effective therapies.
      6. Believing one pseudoscientific claim makes people more likely to reject real science in favor of other belief-based treatments.
      7. Placebo effects are generally of small magnitude and are not long-lasting.
      8. People may think they feel better while their disease is getting worse, so they may fail to seek lifesaving emergency treatment. See http://www.sciencebasedmedicine.org/index.php/asthma-placebo-and-how-not-to-kill-your-patients/

      One of our commenters came up with a telling analogy: people perceive wine as tasting better when it costs more. How would you like it if your wine merchant overcharged you just to get the placebo effect of enjoying your wine more?

  21. qetzal says:

    @tmac

    A toast! ;)

    Well played!

  22. nybgrus says:

    Dr. Hall, I am totally stealing that list for future use. Excellent summary :-D

  23. BillyJoe says:

    AHodges:

    ““If people like it and feel like they get benefit from it, even if it is placebo, what’s the harm?” I’d be interested in the answer to that from some of the SBM commenters.”

    Or you could just read the article!
    Here are some relevant quotes from it:

    - you cannot justify ineffective treatments simply because they provide a placebo effect. That is because effective treatments also provide the same placebo effect, but also provide specific benefits because they actually work.

    - This is a deception, violates patient autonomy and informed consent, and sets them up to perhaps rely on ineffective “magical” treatments for non-self-limiting illnesses.

    - Kind attention plus X makes people feel better, just as well as kind attention alone…it is deceptive and unscientific to suggest that whatever fills in for X has some value because of this equation.

    - If we accept that health care environments can be improved by more time and resources being applied to patient comfort, reduced anxiety, and enhanced self sense of well-being – then let’s use what works, the time and attention of a caring provider. The placebo ritual is wasteful, distracting, and arguably unethical. It unnecessarily complicates efforts to improve patient caring by promoting demonstrable pseudoscience.

  24. tmac57 says:

    @quetzal-Cheers! (clink)

    @Dr Hall, Ill add to the list

    9. Apparently placebos might be satanic (according to very reliable sources found on YouTube)
    10. Divorce (self evident)
    11.Loss of employment (Benny Hinn needs work too,and Reiki could put him out of business)
    12.Homelessness.

    (BTW-Is it wrong that the ‘wine overcharge’ analogy is the one that really speaks to me?)

    Finally,a philosophical question.Is it ethical to pay for your Reiki treatments using counterfeit money?

  25. Mojo says:

    @Dr Hall

    How would you like it if your wine merchant overcharged you just to get the placebo effect of enjoying your wine more?

    How would you know? ;)

  26. ThinkingAboutIt says:

    I think if people go to alternative medicine first instead of the doctors, there’s a danger of delaying proper treatment. HOWEVER, I’ve heard too many cases of people going to MDs and are told to wait a few weeks for test x and wait a few months to get test y and wait another few months to see specialist z. During this whole time they’re not being treated either, or are simply given pain killers. Sometimes after all the tests the doctors still cannot figure out what’s wrong, meanwhile the patients feel like crap for being pushed around from specialist to specialist. I think this is why many people go see alternative medicine practitioners instead. Even though the treatments may not pass double blind clinical trials, the patients psychologically feel being taken care of while the body does its own healing that happens with or without the reiki/herbs/acupuncture.

  27. pmoran says:

    I am not keen on unqualified “it doesn’t work” statements., especially if some benefits are then as much as admitted by being attributed to “kind attentions”, and there follows some consideration of whether the mainstream should be better harnessing similar elements of medical care.

    If it “doesn’t work”, why bother with it at all? I realize this is the shorthand of normal scientific discourse and I expect most readers understand what is meant, but I am sure sharp people within CAM will eventually pick up on this apparent inconsistency.

    Also, it is possible, but not certain that “kind attentions” of a degree practical within the mainstream could perform the same as Reiki. Remember that Reiki is represented to the patient as a treatment. It is the perception that they are being exposed to a mysterious Oriental healing art that is responsible for the apparent benefits in both Reiki and sham Reiki groups and also for the significant differences from untreated controls.

    Kind attentions will certainly help them feel better but may be interpreted by most as their due.

  28. Enkidu says:

    My university was promoting reiki earlier in the week as part of a day-long conference on lung cancer. Disgusted that they were promoting this on Twitter, I tweeted back some pointed words and links. I guess because I used the word “reiki” in my tweets, I picked up a doctor promoting reiki (among other CAMs) as a follower. Amused, I went to his website, where he claimed he could do reiki over the phone! LOL

    Needless to say, one day later he is no longer following me. Must have been something I said.

  29. lonnie123 says:

    Steve,

    As a Registered Nurse out in Cali I can tell you that there exists ZERO energy healing from any of the nurses I have worked with. I know the practice exists in nursing, but I have never even come across another nurse who knew who most of these terms mean (Reiki, Naturopathy, Homeopathy,etc…). I have run into exactly one health care professional (a Paramedic) who had an interest in this topic beyond doing their job at the hospital.

    Perhaps the only reaction I ever see to those products and treatments are snickers and groans, at leat signaling a base level of understanding that they are useless at best.

    My schooling also contained exactly zero instruction on these types of treatments, although some of the texts had little boxes with information on them they received no class time. I have seen a BSN text that dealt exclusively with “alternative treatments,” which was largely uncritical and left every decision in the patients hands. ie – “This may be something for your patient to consider…”

    TL;DR – These practices, while they do exist, arent all that pervasive in nursing. Most of them don’t even know what they are and we receive no schooling on them.

  30. NYUDDS says:

    I think it is worth noting that Dr. Oz’s wife is a “reiki master.” I have often wondered if Dr. Oz, to keep peace in the family, bends a bit toward the “woo side” every so often. His recent program with Dr. Novella certainly indicates his abandonment of the scientific method as it pertains to alternative methods and materials and his disdain for the null hypothesis:

    Seattle, WA (PRWEB) January 9, 2010 — Reiki Masters across America and the world had cause for celebration on January 6 when Dr. Mehmet Oz revealed his Ultimate Alternative Medicine Secrets for 2010 during his nationally broadcast afternoon talk show. He ranked Reiki #1. Dr. Oz said, “Reiki is one of my favorites, we’ve been using it for years in the Oz family, and we swear by it.”

    It’s a tough row to hoe when America’s favorite MD, with excellent credentials (he was voted by his peers as one of the top cardio-thoracic surgeons in NYC) constantly pumps up non-scientific material that some viewers follow to a “T.”

  31. pmoran says:

    NYUDDS:Seattle, WA (PRWEB) January 9, 2010 — Reiki Masters across America and the world had cause for celebration on January 6 when Dr. Mehmet Oz revealed his Ultimate Alternative Medicine Secrets for 2010 during his nationally broadcast afternoon talk show. He ranked Reiki #1. Dr. Oz said, “Reiki is one of my favorites, we’ve been using it for years in the Oz family, and we swear by it.”
    It’s a tough row to hoe when America’s favorite MD, with excellent credentials (he was voted by his peers as one of the top cardio-thoracic surgeons in NYC) constantly pumps up non-scientific material that some viewers follow to a “T.”

    Our bald “X doesn’t work” message is also liable to come unstuck the very next time someone’s friend says “it certainly worked for me”. It is also an insult to the public’s intelligence, for they know as well as we do how people can think themselves into illness and also out of it. In that sense we can predict that X will “work” for the suitably disposed.

    I still favor a simple but slightly more expansive message, one that actually adheres more scrupulously to what “the science” permits us to say, while being more informative, less overbearing, and more directly addressing where the major risks of CAM lie — Something like “these methods may well help people feel better through fairly well understood psychological processes but they cannot be relied upon as treatments for serious illnesses.”

  32. Badly Shaved Monkey says:

    Posted a link at JREF highlighting my favourite part of Steve’s commentary.

    http://forums.randi.org/showthread.php?t=222238

    @Harriet Hall

    7. Placebo effects are generally of small magnitude and are not long-lasting.

    I’d like to add another point, which I have described before. “Placebo effect” risks being merely an artefact of the experimental set-up effectively as a corollary of the Hawthorne effect. In other words, it may exist only in the context of the trial itself. In these Reiki/sham Reiki or Acupuncture/sham Acupuncture trials, everyone knows they have enrolled in a trial. Consent is required by ethics committees. We really have no idea of whether there is a “real placebo” effect at work when researchers with clipboards are not hanging around asking questions.

    It seems to me that Harriet’s estimation of the placebo effect as “small magnitude” and “not long-lasting” is, in fact, an estimate of its maximum size and the real benefit in the wild state is smaller, where smaller may include zero.

    But we do have a problem of definitions; how do we recognise a placebo effect? I think we can, by now, dismiss out of hand the idea that placebo effects are big effects on biological physically measurable outcomes. We are, pretty much, firmly in the realm of the self-reported subjective impressions of patients themselves.

    When advocate-users of SCAM pop up telling us how it worked for them, does this represent the power of placebo firing them up? For this the answer is surely, no. They are mostly deceived by the natural history of their disease.

    What experimental set-up would we need to look for a “real” placebo effect?

    Four Groups: Real X, Sham X, No Intervention (Consciously enrolled), No Intervention (Secretly enrolled).

    Two lines of assessment on each group: Overt and Covert.

    Ignoring the possible objections of a hypothetical ethics committee, would it work?

  33. pmoran says:

    BSM:It seems to me that Harriet’s estimation of the placebo effect as “small magnitude” and “not long-lasting” is, in fact, an estimate of its maximum size and the real benefit in the wild state is smaller, where smaller may include zero.

    A 30% reduction in opiate usage for equivalent reported pain relief in Benedetti’s studies cannot be sneezed at.

    There are also many reasons for expecting better results in the wild state than in the rather bland psychological environment of the typical clinical trial, wherein placebo effects compete with any true therapeutic signal and are suppressed where possible.

    Note also that the subjects of those studies, if properly informed, don’t know whether they are supposed to get better or not. Telling someone “you might receive an inactive agent” is a sure way to dampen any placebo influences.

    When advocate-users of SCAM pop up telling us how it worked for them, does this represent the power of placebo firing them up? For this the answer is surely, no. They are mostly deceived by the natural history of their disease.

    That is also not in accord with the evidence. In those studies where treated and untreated (e.g. waiting list) groups are compared, then the untreated group should serve as a rough approximation for the natural history of the complaint. The main uncertainty in those studies is how much of the sometimes substantial differences is due to patient reporting biases i.e. the patients are sayinig they are better while knowing they are not.

    I think the waiting list group is the closest that anyone has been able to come up with so far to a “secretly enrolled” (natural history) group, and the differences with placebo still hold.

    A few studies actually do show more prolonged benefits from placebo, and I know of none thatlook at what happens if the same (or another) placebo is reintroduced upon relapse. Nevertheless I allow that the effects may extinguish if not reinforced in some way.

    Also, as I have said before, placebo medicines and CAM are mainly used when there are no entirely satisfactory medical treatments, so that even small benefits for many or larger benefits for a few cannot be too lightly dimissed. No one is forcing doctors to use them, and the ehtical constraints only apply to them.

    Here is another discussion paper showing how complex this field has become — this one raised some matters new to me.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725026/?tool=pmcentrez

  34. judydel says:

    I would like to direct you to a groundbreaking study conducted at UCONN Medical Center by a Gloria Gronowicz, PhD.
    What sets this study apart is the fact that it researched the effects of Therapeutic Touch upon cells on a petri dish. This removed the mind/body component completely! The cells on the petri dish responded favorably to the Therapeutic Touch treatments. Cancer cells diminished and good cells proliferated!

    http://today.uchc.edu/headlines/2008/jul08/healing.html

    http://www.ncbi.nlm.nih.gov/pubmed/18370579?ordinalpos=4&itool=EntrezSystem2.Pubmed.Pubmed-ResultsPanel.Pubmed-RVDocSum

    http://www.ncbi.nlm.nih.gov/pubmed/18524012

  35. David Gorski says:

    To which a “friend” of mine responded when the study came out:

    http://scienceblogs.com/insolence/2008/08/maybe_we_should_use_therapeutic_touch.php

    Bottom line: The studies are lousy science.

  36. kortikosteroid says:

    myself being a sceptic, i had an interesting encounter with reiki healing as a close friend of mine had been taking some classes in it. she offered to give me some reiki, and i agreed just for fun. she asked me if there was some part of my body that needed extra attendance, and i told her that i hadn’t had my period for years, due to an eating disorder. i was back at a normal weight, but my period hadn’t returned yet.

    anyway, she did her thing, and held her hands above my stomach for some minutes, and i could feel the area getting warm. afterwards, we went to a party together, and i forgot all about it. the next day, to my utter surprise, there was a spot of blood in my underwear. it wasn’t a regular period, just one spot of blood. and then nothing more. and then, it took about another ten months or so until i started having normal periods again.

    i’m not really buying the whole energy-funneling-thing, but it seems weird that the small bleeding i had was just a coincidence. could it have been the the general warming of the pelvic area that caused some physiologic changes in the endometrium?

    thanks for an interesting blog anyway.

  37. Scott says:

    Given that there is no actual warming that takes place, no. Complete coincidence.

  38. geack says:

    Your story is an absolutely perfect example of how rational people can find it hard to reject this stuff outright. It really is a remarkable coincidence. But think about it this way: If the spotting had happened two days after the reiki session it might still have seemed like a remarkable coincidence. 10 days later? Maybe, to some people. What if you period has returned to normal two or 10 days later? That would have been an even stronger suggestion of an effect. Or what if she’d talked you into another session 10 months later, the day before your period returned? That would practically constitute confirmation that she was on to something, wouldn’t it? You know now it would’ve come back anyway, but back then…

    Our window for what qualifies as “remarkable” or “extraordinary” is often very broad, and it varies with our experience and expectations. This is exactly what makes controlled testing such a useful and necessary tool – it gives us a way to know what would have happened if we HADN’T tried x, and it helps us eliminate the confusion created by coincidences like the one you described.

  39. kortikosteroid says:

    @scott

    if you place the palm of your hand above any part of your body and keep it there for a minute or so, you will feel your skin getting warmer. if the hand is kept above a certain body part for several minutes, then maybe the temperature could rise slightly even in deeper tissue layers.

    @geack

    of course, weird or improbable things happen all the time, whether “healing”, homeopathy or “magic” are used or not. i just think that in some cases, so called alternative medicine might actually have an effect, but not because of the mechanisms its defenders claim the methods have.

    for example, acupuncture can sometimes alleviate pain, but not because acupuncturists are right about “energy flow”, or how one can “correct” it by inserting needles at specific points of the body, but because inserting needles anywhere can stimulate the body to reduce the amount of perceived pain.

  40. Scott says:

    @ kortikosteroid:

    No contact, no meaningful warming. The thermodynamics simply don’t work. You may THINK you feel something, but it’s not real. Pretty much like reiki in general.

    You’re also completely incorrect about acupuncture. It’s been quite thoroughly demonstrated that needles which don’t break the skin have the exact same “effect.” Tapping the skin with toothpicks, for instance, are identical. It is purely placebo.

    Do you have any REAL examples of CAM treatments that actually worked by some other mechanism?

Comments are closed.