Whenever someone criticizes the irrationality of alternative medicine, the call goes up that the critics are just defending big pharma. Since the alternative medicine movement largely grew up in opposition to the pill pushers, it is assumed that anyone who criticises them must therefore be backing the pharmaceutical industry.
It is, of course, hard to see how the large pharmaceutical corporations can have any real commercial interest in curing chronic ailments since their market depends largely on sustaining the need to manage these conditions. It is vastly more profitable to keep people swallowing pills than to remove the need. So clearly, there's every reason to be suspicious of the over-willingness of general practitioners to prescribe more and more pills.
There have been numerous cases of drugs that have had to be withdrawn because of problematic side-effects, and that, too, is cause to question the methods used to develop and market drugs.
Because the big pharma corporations are in competition, much of the research is repeated and kept secret, wasting a vast amount of resources and slowing progress. Since the profits are huge, there is enormous pressure to reduce the time to market and this encourages biased research and cut-backs on the necessary testing strategies. The FDA is there precisely to address these pressures and maintain patient safety.
So for all sorts of reasons, big pharma is hardly trustworthy as the champion of patient interests. But does that necessarily put us in the alternative medicine camp? Absolutely not.
The pharmaceutical industry, for all its faults, relies on the scientific investigation of the pharmacological properties of materials related to the treatment of diagnosed illnesses. It is based on science, establishing to a demonstrable standard, that it is working with facts. Clinical trials of the drugs have to show, in unbiased, peer-reviewed research, that they have an impact significantly greater than the placebo effect. In other words, they have to prove themselves to be effective.
Now there are all kinds of problems with some of this research. Institutes sponsored by the pharma companies can be attacked as being biased, the research may focus on the commercially advantageous rather than the medically expedient, and so on. But at bottom, it's based on identifying real causes, real effects.
Now contrast that with alternative medicine where the explanations stop at the point of a fanciful theory, where we never get close to evidence, where we rely only on customer testimonials, where we don't even see controlled trials. When someone suggests homeopathy or Reiki as an alternative to pharmaceuticals, they are not just rejecting the conventional drug industry. They are placing their reliance on unproven and irrational theories. They are rejecting not just the pharma companies, but science as a whole. They confuse the two.
Article comments
— go to most recent comments1 - Kelley
The article creates a false argument because there have been thousands of studies on various natural modalities. Some have produced strikingly good outcomes...far better than any drug.
Meanwhile, a hallmark of a medicore scientist is to ignore a good anecdotal account. Sir Alexander Fleming relied on an anecdotal event to discover penicillin.
2 - Bob Lloyd
These many thousands of studies have themselves been studied and found to be flawed. For example, reliance on anecdotal evidence is the acceptance of bias. Anyone can say anything in an anecdotal report without it necessarily reflecting the truth. Someone reporting that they feel better may be feeling better for reasons other than the treatment.
Double-blind controlled trials are needed to remove this bias. As Alexander Fleming realised... As soon as he noticed the effect of the mould on bacterial growth, he conducted systematic controlled studied to prove that the effect was due to the mould.
Although alt-med enthusiasts all repeat that there's plenty of evidence, and the alt-med industry keeps putting out the claim, it relies on the anecdote.
Just ask yourself. If you've just spent a lot of money buying an alt-med therapy, are you likely to want to publicise that you've been had? That's why anecdotal evidence is biased, almost always positive. That's why we double-blind trials to remove that bias and get at the objective evidence.
3 - Joseph Putnoki
A fairly good article. Refreshing amongst the propaganda. The alternative camp is criticised on a level that is bordering on hostility. Both camps have their charlatans. It is unfortunate that not enough benefactors provide financial support to finance clinical trials of complementary medicine. My G.P. a decent doctor yet captured by the allopathic camp is scared to think outside the square and baulk at controversial information published in the same reputable medical journal as the propaganda is now masquerading as good science. He rejects the validity of some anecdotal evidence despite the effectiveness and only accepts scientific evidence. Yet not everything can be evaluated by the later. The writer also put Homoeopathy in the cross-hairs. Let me remind us that just because we don't understand the mode of action of a medicine while demonstrably effective is no valid scientific attitude to dismiss it. The placebo effect need to be respected and used in healing more. I said charlatans exist in both camps. I also say complementary medicine if more effective in the hands of talented practitioners. The best outcomes is when cooperation rather the competition is in play. Outlandish claims is one thing. Arrogant and hostile dismissal is another. Please listen carefully: animals are treated successfully with acupuncture and homoeopathy. This is a verifiable fact. And other animals apart from us are not subjected to the placebo effect! This may be an inconvenient fact for critics frothing at the mouth.-
Be well!
joseph.
4 - Skepticat
Nice, balanced piece, thanks. It's hard for those of us who know about the tragedies that sometimes result from people relying on altmed, in spite of a dearth of goood scientific evidence for it, to remain calm in the face of the astonishing ignorance of people who promote it. The death of Australian baby Gloria Thomas at the hands of her homeopath father, which has been in the news recently, is a case in point.
Contrary to what Joseph says in the comment above, it is not a "verifiable fact" that animals are "successfully treated" with homeopathy or acupuncture. This is post hoc ergo propter hoc thinking and it is flawed. Animals who get better after getting one or other of these alternative treatments, would have got better without it. (It is also not true that animals are not subject to the placebo effect: there is some evidence that they are). I'm glad Joseph's GP's critical thinking skills are intact.
5 - John
Yes, it is a good article and I would agree on alot of the points... but it´s incomplete. There ARE clinical trials on complementary therapies with placebos and double blinds. Take a look at www.pubmed.com, type in the word "Reiki" and you´ll get quite a few.
Bob, here in Madrid, Spain, we are currently carrying out a clinical trial in the pain unit of the Ramon y Cajal Hospital with 300 patients over 14 months which includes real Reiki and "fake" Reiki to compare the effect on patients with chronic, long term pain.
We will shortly start another comparative trial in the La Paz hospital in Endocrinología to test the effect of Reiki on obesity which will ALSO include a placebo.
Mr. Putnoki´s comment I think summs it up as far as I´m concerned where he states that just because we don´t understand something doesn´t mean we can´t use it.
Our Foundation is called the Willow Foundation because the active ingredient of the aspirin used to come from its bark, and the Bayer Corp. happily marketed and sold aspirins for 90 years without understanding how it worked to reduce pain. (It was only until 1972 that it was discovered how aspirins worked exactly).
6 - Bob Lloyd
John, I take it that those trials include a control group, and are both double-blinded and randomised? I acknowledge that there are such trials, of course, but the overwhelming majority of them have been missing either control or double-blind. Edzard Ernst has reported a great deal about these trials and the Cochrane Collaboration too raises all sorts of concerns about the quality of the trials carried out. Some journals, especially chiropractor journals, abound in uncontrolled and non-blind trials which reduce the reports to little more than anecdote and case notes.
On Joseph's point, I agree that if it works, we can use it. But the point is establishing rather than assuming that it works. Homeopathy is a classic case where there are millions who argue it works, but no-one can demonstrate it. There's an easy £10,000 prize to be picked up from Edzard Ernst for anyone who can demonstrate that homeopathy does anything at all. It's been almost two years and no-one has even attempted to claim it... Just because people buy something doesn't mean it works - it just means they BELIEVE it works.
7 - Bob Lloyd
There was a suggestion that we should use the placebo effect but it works inconsistently. Someone can experience it once and never again, or not in the same circumstances twice. It also works on the basis of a lie, which has to be continually believed for any effect to be seen. Lying to patients is an ethical problem for many practitioners.
8 - Bob Lloyd
John, I just noticed that you mention a trial which will include a placebo for Reiki. How can you tell the difference between a placebo Reiki and one that just doesn't work? Surely you MUST also include a real control group, that has no Reiki treatment, real or fake, to establish the significance of any Reiki effect?
That's an example of what I mean when I say they have to be methodologically sound. Without that control group, you can't tell if anything or nothing happened.
9 - Jane
What is missing from the demand that all medicine be proved scientifically before use is context: specifically, what are the probable risks and benefits of using a particular alternative treatment for a particular condition at a particular time?
If I have cancer and I use an alternative treatment, maybe I am putting my life at risk by not getting conventional care. But maybe I already had conventional care, and had a relapse, and decided that the new drug which might add 10 months to my life was not worth $5,000 a month. In this case, what has a person got to lose by trying some inexpensive alternative treatments. Vitamins and homeopathic medicines are $10-20 a bottle, a good deal if they only give hope or placebically stop pain. And if some choose an expensive treatment in Mexico, it's their choice.
What about a person with a chronic illness? The doctor gives a drug which either doesn't work well, or has unpleasant side effects. The person decides to try alternative medicine.
A woman goes to a doctor complaining of aches and pains. He tells her these are a normal part of aging. He considers her one of the worried well. She goes to another doctor, same opinion. She turns to alternative medicine.
In short, the demand that ALL people submit themselves exclusively to conventional scientific medicine is unrealistic and mandarinlike, ideological, and divorced from the real world. Turning to alternative medicine is often pragmatic, the opposite of irrational.
10 - Bob Lloyd
Jane, I sympathise with much of what you're saying and I have no problem with palliative medicine when it's honestly administered. It's when it's marketed as an alternative, that there's a problem. In the terminal cancer patient, turning to something else as a palliative is really understandable, but often there are so-called alternatives which are trying to claim cures and effective treatment. One that comes to mind is the Gerson Protocol, a diet-based approach. A recent case highlighted the dangers:
See this case.
I think the critical point is whether or not the alternative really is an alternative, or something else that doesn't work as a cure or treatment. After all, given how cheap and easy these alternatives all seem to be, by now it would be mainstream if they worked, even if the drug companies didn't accept them.
11 - John
"John, I just noticed that you mention a trial which will include a placebo for Reiki. How can you tell the difference between a placebo Reiki and one that just doesn't work? Surely you MUST also include a real control group, that has no Reiki treatment, real or fake, to establish the significance of any Reiki effect?"
Hi Bob,
The placebo group is told that they are taking part in an energy therapy (the word Reiki is not mentioned). They are asked to lay on a couch for 30 minutes while a specially made corset is put round their waist with cables coming out of it connected to a laptop. They also hold a GSRM (galvanic skin response monitor, used in all groups to monitor pain levels). In this way, they think they are receiving energy through the corset and the GSRM.
For ethical reasons, the placebo group then receive 8 real Reiki sessions AFTER the 8 fake sessions. This also gives us additional data to compare on top of the group that just receives real Reiki.
The control group is a group of patients monitored by the doctors in the pain unit which are just receiving standard medication but who have the same controls as the other patients and have also been told that they are taking part in a study on energy therapies.
Again, for ethical reasons they will eventually receive real Reiki, but when they are evaluated using the GSRM and the VAS (visual analogue scale) they don´t know that.
In any case, what I´m mentioning here is just one study. There are numerous studies out there both with people and mice with positive results. If you want I can send you them if you drop me a line [Personal contact info deleted]
However, I do agree that more studies are needed (which is why we do this) to put Reiki firmly in the mainstream of therapies with a scientific backing. The problem is that we don´t have big pharma to throw loads of money at these studies so things go slowly....
But on a last note, it´s important to understand that these studies are not necessary to find out if Reiki and other complementary therapies work. There are literally millions (30% of US population according the NIH) of people who know this, and hundreds of thousands of people who earn their living succesfully from applying these techniques.
It just needs to be put into a mainstream, empirical context so that even more people can benefit from them.
12 - Bob Lloyd
From what you describe, the trial isn't double-blind in that all of the patients are to be subjected to some form of Reiki. They have therefore been pre-selected. That means your trial won't be able to tell whether Reiki did anything at all.
A real control group would have no knowledge of the real purpose of the trial, nothing whatsoever to do with suggestions or information about Reiki. And the suggestion of rolling on one treatment group that had just received your placebo into an actual test group is very poor. You really won't be able to get much scientific credibility for this approach. At best, you'll get some anecdotal accounts which you won't be able to trust.
Reiki is based on the idea of transferring undetectable energy into people and your problem is in actually detecting anything at all. Anecdotal accounts won't cut it - they only show what people believe, not what actually happened. In your trial, you can't determine if anything at all happened.
13 - Bob Lloyd
John, in addition to the other problems with your trial, giving the placebo group Reiki treatment is the same as placebo if Reiki doesn't work, so you can't even use those two groups as comparison. Your trial only makes any sense at all if you've already ASSUMED AND BELIEVED that Reiki works. That's doesn't sound like a clinical trial but a search for anecdotal support. Or have I misunderstood something?
14 - John
Sorry, I didn´t explain myself fully...
All patients receive Reiki, but the data collected is only evaluated:
a) With the group receiving Reiki DURING the period they receive Reiki.
b) With the placebo group BEFORE they receive Reiki, during reception of the fake Reiki.
c) With the control group, BEFORE they receive Reiki, during weekly visits to their doctor for routine check ups.
The above instances are the cases when comparable data is collected. In this way, we compare GSRM and VAS data in the three groups to evaluate the reduction in pain in those instances.
As you say, although we roll one group into another, the data collected when the placebo group receive real Reiki is not compared with the group that is receiving real Reiki at the time.
The control group by Spanish law (Ley de Consentimiento Informado) must be told that they are taking part in a trial and that the purpose of the trial is to reduce pain. The word Reiki is not used and the term "energy therapy" is used as patients must by informed by law of the type of trials they are taking part.
The protocols for the trials have been designed by the clinical trials committee of the hospital, not by us.
We have just finished a six month "dry run" to iron out problems with 60 patients with excelent results. The purpose of Reiki here, is of course, to reduce or eliminate pain and the trial results have shown this has happened:
1. Despite the patients not knowing what was being done to them.
2. In the placebo group the pain reduction was consistent with the usual placebo effect of around 20% (this will happen with drugs, too).
3. In the control group, the pain reduction was none, as the patients are chronic pain sufferers and their medication is more or less constant.
In January we are starting the official supervised trials.
By the way, Reiki energy is detectable. Please look at the work of Brian Josephson Nobel Prize winner, who invented the Squidometer at Cambridge University and the Japanese investigators Seto, A, Kusaka, C. Nakazato S et al 1992 "Detection fo extraordinary large biomagnetic field strengths from human hand".
An excellent book is "Energy Medicine" by James L Oschman (Churchill Livingstone) which very clearly and methodically, with ample references, explains the science behind energy work.
15 - Cindy
5 - real Reiki and "fake" Reiki
????
Unbelievable. People make up magical things and now they disparage other people's magical things as fake magical things?
16 - roger nowosielski
Goes to show, Cindy, how interest drives knowledge (one of Habermas's main points).
More on this later.
17 - Bob Lloyd
John, if your control group was on medication, then to act as a test group, so must they have been. If they were all selected for Reiki, then it wasn't double blind. Regardless of who designed the methodology, as you've explained it, it's weak to the point of being unreliable.
Josephson's work that you cite is pure speculation without any reproducible evidence at all. I'm amazed that instead of some routine, reproducible, demonstrable experimental test, you invoke speculative theorising. That's no way to collect clinical trial data, and I suspect you're well aware of the fact.
There is currently as much reliable evidence for energy medicine as there is for unicorns.
18 - Cindy
Oh yes, the placebo Reiki is the fake...sorry it wasn't clear in the first post. My mistake. Yes, I have read some of those studies. Here is an author to check out: Edzard Ernst. Trick or Treatment: The Undeniable Facts about Alternative Medicine. Ernst did a comprehensive review of the studies through 2008 called: Effects of reiki in clinical practice: a systematic review of randomised clinical trials:
"DISCUSSION: In total, the trial data for any one condition are scarce and independent replications are not available for each condition. Most trials suffered from methodological flaws such as small sample size, inadequate study design and poor reporting. CONCLUSION: In conclusion, the evidence is insufficient to suggest that reiki is an effective treatment for any condition. Therefore the value of reiki remains unproven."
My anecdotal evidence speaks for itself.
As a trained massage therapist, I was 'trained' in reiki and in aromatherapy. My opinion--they're fraudulent. There is no 'real' reiki. I have also had extensive experience with people and their various 'alternative' cures, enlightenment teachings, and life extension schemes. In order to get continuing education credit I have also had to take various courses in 'alternative' practices. Some of these people are innocents sucked in by uncritical belief, some don't want life to be without 'mystery', and some are predators who put innocent people in harm's way both healthwise and financially. This led me into a two-year research hobby on alternative cures and the nightmarish, inhuman scenarios involved in quack diagnoses and cures.
Alternative medicine and healing is a multibillion dollar industry. Many proponents have no better interest in the health or well-being of their victims than Big Pharma. And many others see no problem justifying taking huge amounts of money for magic that people are willing to pay--sometimes desperate, and always innocent people. And I am never, ever surprised that many of these alternative folks are into nothing more than getting rich quick schemes, based on selling the products of giant 'health and well-being' corporations. It never shocks me how some new agers justify being more ruthless capitalists than the Big Pharma industry they despise.
I have no problem where people find things are worthwhile and helpful. If someone tells me reiki cures their migraines, or some herbal concoction helps their digestive problem, or chiropractic helped their carpal tunnel syndrome--that's fine. I don't try and dispel anyone's beliefs. I do object when someone is being harmed, though. And I have seen an awful lot of harm from the 'alternative' crowd.
19 - Cindy
Oh, btw, good article Bob. :-)
20 - roger nowosielski
It's difficult to tell from your #18, Cindy, which are your own words and which are quoted.
21 - Cindy
The only thing I quoted was the 'discussion' and 'conclusion' of the reiki review, thus it appears in quotes. The rest is what I wrote.
22 - lol
When somebody is not well educated about a subject it is perhaps an interesting opinion but they should not be taken seriously on the subject. As here with anything that has to do with non-drug aka chemical "medicine". Thanks for the laughs it was a great articile for that lol
23 - John
"John, if your control group was on medication, then to act as a test group, so must they have been. If they were all selected for Reiki, then it wasn't double blind."
Bob, yes, they are all on the same medication. They were all selected for Reiki but as I said, the data was only compared in the control group before they received Reiki.
The Ramón y Cajal Hospital is one of the leading hospitals in Spain in terms of clinical research.
24 - John
Cindy,
Sorry that that´s your experience. All I can say is that I work with patients every day in 6 hospitals in Madrid and our 120 volunteers could all tell you anecdotes which even if Reiki WAS just a placebo, would make it worthwile to apply considering the pain and suffering we see it easing or eliminating on a daily basis.
All the best in your search.
25 - Cindy
John,
That's why I said, if something works for someone and isn't causing them harm either physically or financially, I have no interest in interfering. Placebo effects are worthwhile in those cases. Who am I to interfere with that?