The most meticulous regulation of nonsense must still result in nonsense.
— Edzard Ernst, M.D., PhD., professor, Complementary Medicine, Peninsula Medical School, University of Exeter, UK
One necessity of licensing so-called “complementary and alternative,” or “CAM,” practitioners is to spell out exactly what is encompassed in the CAM scope of practice. This is unfortunate for the practitioners because it forces an exposé of the nonsensical precepts underlying their claims. For example,
‘Acupuncture’ refers to a form of health care, based on a theory of energetic physiology that describes and explains the interrelationship of the body organs or functions with an associated acupuncture point or combination of points located on ‘channels’ or ‘meridians’. . . Acupuncture points are stimulated in order to restore the normal function of the aforementioned organs or sets of functions.
(Delaware acupuncture practice act.)
[Chiropractic is] the science of adjusting the cause of the disease by realigning the spine, releasing pressure on nerves radiating from the spine to all parts of the body, and allowing the nerves to carry their full quota of health current (nerve energy) from the brain to all parts of the body.
(North Carolina chiropractic practice act.)
The practice of naturopathic medicine includes, but is not limited to, the following services:. . . ordering, administering, prescribing, or dispensing for preventive and therapeutic purposes: food, extracts of food, nutraceuticals, vitamins, minerals, amino acids, enzymes, botanicals and their extracts, botanical medicines, herbal remedies, homeopathic medicines, dietary supplements and nonprescription drugs as defined by the federal Food, Drug, and Cosmetic Act, glandulars, protomorphogens, lifestyle counseling, hypnotherapy, biofeedback, dietary therapy, electrotherapy, galvanic therapy, oxygen, therapeutic devices, barrier devices for contraception, and minor office procedures, including otaining specimens to assess and treat disease. . .
(Minnesota naturopathic practic act.)
Licensing also brings into sharp focus exactly how broad those claims are.
‘Acupuncture’ means a form of primary health care, based on traditional Chinese medical concepts and modern oriental medical techniques, that employs acupuncture diagnosis and treatment, as well as adjunctive therapies and diagnostic techniques, for the promotion, maintenance, and restoration of health and the prevention of disease.
(Florida acupuncture practice act, emphasis added.)
Any chiropractic physician who has complied with the provisions of this chapter may examine, analyze, and diagnose the human living body and its diseases by the use of any physical, chemical, electrical, or thermal method; use the X ray for diagnosing; phlebotomize; and use any other general method of examination for diagnosis and analysis taught in any school of chiropractic.
(Florida chiropractic practice act, emphasis added.)
In addition to prescribing a scope of practice, licensing imposes basic education requirements, testing, board oversight, continuing education requirements, and other measures supposedly designed to protect the public health and welfare.
Perhaps this is why there is no movement by other CAM therapists, such as reiki practitioners, crystal therapists, iridologists, and the like, to seek licensing. While having one’s own licensed health care practice act conveys a huge advantage in terms of protecting one from unlicensed practice of medicine prosecutions, it also means that one must set out one’s gibberish in a form that state legislators can be persuaded to pass into law. That this is not hard to do is evidenced by the above examples of naturopath, acupuncturist and chiropractic licensing. Still, having to take tests to demonstrate one’s command of the gibberish and having to attend continuing education classes to remain abreast of advancements in practices that never advance is burdensome. Besides, the medical boards don’t seem to be particularly interested in stopping the spread of CAM practices through prosecution for the unlicensed practice of medicine, so why bother? In fact, M.D.s themselves are joining in the fun via “integrative medicine.”
Nevertheless, it is interesting to contemplate what enlarging the pantheon of licensed CAM health care practices might look like. Just how far might the state legislatures willing to go in their Legislative Alchemy? After all, practices such as reiki, crystal therapy and iridology are no more implausible and have no less a claim to effectiveness than subluxation-based chiropractic, homeopathy and acupuncture.
May the force be with you
Let’s take reiki for example. Here’s an explanation of reiki (so to speak) from The International Center for Reiki Training:
We are alive because life force is flowing through us. Life force flows within the physical body though pathways called chakras, meridians and nadis. It also flows around us in a field of energy called the aura. Life force nourishes the organs and cells of the body, supporting them in their vital functions. When this flow of life force is disrupted, it causes diminished function in one or more of the organs and tissues of the physical body.
The life force . . . becomes disrupted when we accept, either consciously or unconsciously, negative thoughts or feelings about ourselves. These negative thoughts and feelings attach themselves to the energy field and cause a disruption in the flow of life force. This diminishes the vital function of the organs and cells of the physical body.
Reiki heals by flowing through the affected parts of the energy field and charging them with positive energy. It raises the vibratory level of the energy field in and around the physical body where the negative thoughts and feelings are attached. This causes the negative energy to break apart and fall away. In so doing, Reiki clears, straightens and heals the energy pathways, thus allowing the life force to flow in a healthy and natural way.
(I apologize for the lengthy quotes throughout this post. However, I find it very difficult to summarize nonsense. Besides, the actual language is so entertaining.)
As Steve Novella pointed out, reiki is simply another form of vitalism, a long-discredited, pre-scientific notion that a spiritual energy animates all living things. As he says, “[t]he notion of vitalism was always an intellectual place-holder, responsible for whatever aspects of biology were not currently understood.” It is the same concept that underlies subluxation-based chiropractic, where it is known as “Innate Intelligence,”or, more recently “nerve flow.” In acupuncture, this “life force” is called “qi.” In therapeutic touch, it is “energy,” as it is sometimes referred to in reiki. In craniosacral therapy, this force is the craniosacral rhythm. Like those practices, there is no good evidence that reiki has any effect beyond placebo, nor is there any evidence that such a “life force” exists.
The practice of reiki, as does chiropractic, therapeutic touch, acupuncture and other CAM methods, depends on the practitioner convincing the patient that he (or she) can influence this “life force” via some action on his part. In reiki,
. . . energy flows from the practitioners hands into the client. . . The practitioner places her/his hands on or near the client’s body in a series of hand positions.
As might be expected from a treatment that purports to affect all organs and tissues of the body, the advertised benefits of reiki appear to be virtually limitless. Here are some I found on the internet:
Stress relief, improves well being, minimizes discomfort from acute or chronic pain conditions, reduces recovery time from injuries, sets new habits, promotes emotional healing, reduces side effects of medical treatment including chemotherapy, post operative pain and depression, improves the rate of healing, reduces time in hospital, relaxation, improves sleep, accelerates the body’s self-healing abilities, reduces blood pressure, breaks addictions, adjusts the energy flow of the endocrine system, reduces side effects of drugs, postpones the aging process, aids spiritual growth, increases the vibrational frequency of the body, accelerates healing from bruises, aids mental/emotional imbalance, benefits pregnant women and their unborn children, relieves back problems, PMT, menstrual problems, sinus problems, head or stomach aches, bee stings, colds, flu, tension and anxiety, heart disease, cancer, leukemia, asthma and eczema. And, of course, it cleanses the body of toxins. As an added bonus, it can benefit both animals and plants. All in all, “reiki always helps and in some cases people have experienced complete healings . . .”
Oddly, though, the reiki practitioner “will not offer any diagnosis or prognosis.” Hmmm. If the practitioner doesn’t diagnose or prognose, then how does he know what the patient is suffering from and how can he tell that there has been an improvement in the patient’s condition? After all, reiki practitioners claim that reiki is always beneficial. One puzzles at this contradiction.
. . . sometimes a person will have what is called a healing crisis. As a person’s vibration goes up, toxins that have been stored in the body will be released into the blood stream to be filtered by the liver and kidneys and removed from the system. When this happens, sometimes a person can get a headache or stomach ache or feel weak. If this happens, it is a good idea to drink more water, eat lighter meals and get more rest. The body is cleansing as part of the healing process so this is a good sign.
A beginning Reiki class is taught on a weekend. The class can be one or two days long. I recommend that the minimum time necessary be at least six to seven hours. Along with the attunement, it is necessary that the student be shown how to give treatments and also to practice giving treatments in class.
For the uninitiated, an “attunement”
. . . is the process by which a person receives the ability to give Reiki treatments. The attunement is administered by the Reiki Master during the Reiki class. During the attunement, the Reiki Master will touch the students head, shoulders, and hands and use one or more special breathing techniques. The attunement energies will flow through the Reiki Master and into the student. These special energies are guided by the Higher Power and make adjustments in the student’s energy pathways and connect the student to the source of Reiki. Because the energetic aspect of the attunement is guided by the Higher Power, it adjusts itself to be exactly right for each student.
Licensed Reiki Masters?
Assuming, arguendo, that the claims of reiki practitioners are true, then we can fairly state that:
- Reiki improves, and in some cases fully resolves, a wide, perhaps unlimited, range of human and animal (and plant) illnesses and conditions.
- Reiki requires training which includes establishing a minimum proficiency in giving treatments.
- Reiki can have side effects.
- Reiki practitioners say that they do not make diagnoses or prognoses. However, they necessarily employ some type of diagnosis in the form of measuring improvement in the patient’s condition. (Otherwise they could not claim effectiveness.)
- Reiki is essentially based on the same principles (vitalism) as two other licensed health care practitioner types, chiropractors and acupuncturists.
States have the inherent power to regulate the practice of medicine, as well as other health care practices, to protect the public’s health, safety and welfare (called the “police power”). Based on the characteristics of reiki shared with other licensed health care providers, I conclude, by analogy, that the state could constitutionally regulate the practice of reiki by enactment of a reiki practice act, defining a scope of practice, authorizing oversight by a Board of Reiki, and instituting minimum requirements for training and continuing education requirements, whether the reiki practitioners desired such regulation or not.
We could go through the same exercise for any number of CAM practices, such as craniosacral therapy, Kirlian photography, iridology, crystal therapy, aroma therapy, angel therapy, Matrix Energetics®, reflexology and polarity therapy, to name a few. Just imagine – a Board of Polarity Therapy! A licensed and regulated Iridologist! Crystal Therapy continuing education! A Matrix Energetics® scope of practice act! Given the fact that all that is necessary to create a new CAM practice is to make something up, state legislatures would be working year-round just to draft and pass practice act legislation accommodating the seemingly endless varieties of CAM.
If all of this seems silly – and it most certainly is – it raises an important question: why do the states license any form of CAM practice? Homeopathy is no more plausible or effective than Matrix Energetics®. Subluxation-based chiropractic is no more plausible or effective than crystal therapy. Acupuncture is no more plausible or effective than iridology. If the prospect of licensing Matrix Energetics® practitioners, crystal therapists and iridologists is ridiculous, then why isn’t licensing homeopaths (or naturopaths who practice homeopathy), subluxation-based chiropractors, and acupuncturists equally ridiculous? What’s the difference?
In fact, the next time you find yourself in a discussion with an acupuncture proponent, heartily agree with him (or her) that of course acupuncture should be a licensed health care profession, available to everyone, as should angel therapy. When he demurs on the ground that angel therapy is totally absurd, ask him to explain exactly how acupuncture is any different.
Dr. Ernst is entirely correct. The regulation of nonsense must still result in nonsense. Rather than fooling themselves into thinking they are protecting the public with CAM practitioner licensing, state legislators should concentrate on protecting the public from CAM.