One of the recurrent themes of this blog is to point out, analyze, and discuss the creeping infiltration of pseudoscience into medicine. In particular, it irks me that so many physicians, who really should know better, so easily fall for the siren song of quackery for whatever reason, be it a misguided desire to be nonjudgmental, to give the patients what they want, or through an inadequate understanding and appreciation of the scientific method. Indeed, there are whole specialties dedicated to “integrating” woo with science-based medicine to the detriment of science-based medicine.
Still, there’s one place where, back in my old, innocent days, I would never have expected to see “alternative medicine,” “complementary and alternative medicine” (CAM), or “integrated medicine” (IM). That place is the intensive care unit. Of course, it wasn’t too long before I was disabused of the notion that the ICU is no place for magical thinking, prescientific vitalism, or outright quackery. For example, it’s not for nothing that I refer to homeopathy as The One Quackery To Rule Them All. Yet that doesn’t stop it from being “integrated” into use in the ICU. It’s also not for nothing that I’ve referred to reiki as faith healing substituting Eastern mysticism for Christian beliefs. (In fact, I was interviewed by a reporter doing a story on reiki in hospitals yesterday and I used that very line.) Yet somehow reiki has found its way onto the trauma service and into the ICU of one of the premier trauma hospitals, while in the ICU and elsewhere the University of Maryland has morphed into the Hogwarts of medicine. Actually, that’s an insult to Hogwarts. In the world of Hogwarts, magic works. In the real world, not so much.
One thing about the world of the ICU is that it’s the world of the ICU nurse. A good ICU nurse is hard-ass and data-driven, knowing what all the monitor readings mean, able to manage multiple drips and devices, and unruffled by patients crashing, which allows them, to know what needs to be done to bring them back. Back in my days as a surgical resident and later, when I used to moonlight as a trauma surgeon, on several occasions I can remember a savvy ICU nurse helped me out or prevented me from making a bad mistake, particularly early on when I was an intern and later a junior resident.
All of which is why it was really depressing to see this article in the latest issue of Critical Care Nursing Quarterly entitled Reiki Therapy: A Nursing Intervention for Critical Care. It’s bad. How bad? Real bad. As credulous as it comes. So bad that it would more appropriately find a home in a dedicated alternative medicine journal. Don’t believe me? Then check out the opening paragraph:
Complementary and alternative medicine (CAM) is not generally associated with the complexity and intensity of critical care. Complementary and alternative medicine is more often associated with slow, calming interventions that seem to be in direct contrast with the fast-paced, highly technical nature of critical care. However, patients in critical care often find themselves coping with the pain and stress of their illness exacerbated by the stress of the critical care environment. Florence Nightingale viewed the spirit and body as inseparable. When there is disruption in the body, the energy fields within and surrounding the body are also disrupted. Energy fields, though we cannot see them, are part of the body as well as the spirit. Although we, as nurses, may be primarily focused on the care of the body, we are also in a unique position to address the needs of the spirit through the use of complementary therapies. Reiki is a complementary therapy that addresses the needs of both the body and the spirit and could easily be integrated into critical care uniting the science of nursing with the art of nursing.
As I read this, I was astonished. I couldn’t believe I was reading such a thing in a critical care nursing journal. It’s nothing more than vitalism. Being ill supposedly means “disrupted energy fields,” and these fields are “part of the spirit.” It made me wonder whether I was reading a religious tract or a critical care nursing article. Of course, remembering that reiki is faith healing, I quickly realized that what I was reading was religion infiltrating itself into what should be an ostensibly scientific (or at least technical) article. Now, I have no doubt that reiki could easily be integrated into the critical care setting. After all, all it involves is the practitioner waving his or her hands over the patient in special symbols. The real question is: Should it be?
The answer, of course, is no, at least not by the nurse. A critical care nurse has far more important things to do when taking care of a critically ill patient than to waste time attempting to channel energy from the “universal source” into the patient to heal him. Think about it: You’re in the ICU after having survived a serious car crash, on the ventilator, with monitors and lines protruding from multiple places on your body. Do you want your nurse wasting time waving hands over your and wishing for the “universal source” to heal you? Or would you rather have the nurse be monitoring your vitals, your central venous pressure, your blood gases, your urine output, and whatever other measurements that need to be taken? Wouldn’t you rather have the nurse making sure that your drips are being administered at the correct rate, that you’re getting your medications on time, that the dressings on your wounds are being changed properly, that you are being repositioned regularly to avoid decubitus ulcers? I know I would. It’s a zero-sum game in the ICU; time taken to try to use magic to heal a patient is time taken away from actual useful interventions.
Robin Toms, the author of the article, then goes on to discuss the history or reiki. I see no need to repeat it, given how many times I’ve discussed the history of reiki right here on this very blog other than to reiterate a couple of points. First, reiki is not ancient. It was invented after a Jesus-like 21 day fast on a mountain by Dr. Mikao Usui in the 1920s and brought to Hawaii in the 1930s. Eventually it found its way to California in the early 1970s. However, as Toms acknowledges (sort of), reiki is a skillful repackaging of ancient concepts of “life energy” (also called qi or prana). In other words, Toms, whether she realizes it or not, has basically admitted that reiki is based on prescientific vitalism. That the National Center for Complementary and Alternative Medicine (NCCAM) acknowledges two types of “energy healing,” biofield therapies and bioelectromagnetic-based therapies, matters not at all regarding the validity or existence of such “biological energy fields.” Like all other CAM advocates, NCCAM’s never been able to produce compelling evidence that these fields even exist, much less that practitioners can manipulate them to therapeutic intent.
Hilariously (or sadly, depending on your point of view), here is the best evidence Toms can produce for the existence of these energy fields:
Attempts have been made to photograph the energy fields surrounding the body and plant life. Kirlian photography has been used to produce images of bioenergetic radiance emanating from and surrounding plants and the human body. Creath conducted a study to image biophoton emission from and between various plant parts. A highly sensitive camera was used to image self-generated biological chemiluminescence (biophotons) in a completely dark, light-tight chamber from plant parts. More light was found between adjacent plant parts than where there were no adjacent plant parts. Creath concluded that each biological object is a weak light source that interacts with adjacent biological objects and speculated that the self- and mutual fluorescence/luminescence effects were not exclusive to plants and are present in all biological systems that emit biophotons.
Kirlian photography? Seriously? Kirlian photography is nothing more than quackery that claims to visualize auras. Back in the 1930s, a Russian named Semyon Kirlian discovered by accident that if an object on a photographic plate is subjected to a high-voltage electric field, an image is created on the plate. Believers maintain that these halos represent a physical manifestation of spiritual auras or the “life force.” These days, Kirlian photography has been abandoned by all but the woo-iest of woo-meisters. Apparently that description applies to Toms. In any case, Toms also mentions biophoton methods of visualizing “life energy,” but these, as you might expect, are also quackery, as I’ve discussed before.
Then, I saw Toms use an argument so unbelievably stupid, so ignorant, so mind-numbingly, outrageously mangling of science, that I couldn’t believe it when I saw it; so I’ll quote it almost in full for you, given that most of you can’t access the full article:
We recognize that energy and energy production is a basic component of life itself. As nurses, we remember our study of the Kreb’s cycle and recall that the body derives energy in the form of adenosine triphosphate produced from the breakdown of glucose, which is necessary for survival of all cells in the body. The use of energy to treat illness is not a new concept. Pulsed electromagnetic fields (PEMFs), electrocardiograms, and magnetic resonance imagery are each familiar tools that use energy to diagnose and treat disease.
Stimulation with PEMFs has been found to be useful for enhancing bone repair and for exerting a chondroprotective effect on articular cartilage in patients with osteonecrosis of the femoral head. Giordana et al studied the effect of PEMFs on bone mineral density. His findings suggest that PEMFs may stimulate osteogenesis and possibly osteoblastic activity in postmenopausal women with osteoporosis.
Pulsed electromagnetic fields, electrocardiograms, magnetic resonance imaging, and the like each employ the use of devices to measure and transmit energy to humans. Reiki therapy does not employ devices and is simply the transmission of energy between humans. For some, it is less difficult to accept the transfer of energy from a machine to the human body than to accept the transmission of energy from one human to another.
See what I mean? Do I even have to spell out the difference between the Krebs Cycle, electrocardiograms, magnetic resonance imaging as compared to reiki? I suppose I do, at least for completeness’ sake. Here’s a hint: the Krebs Cycle, electrocardiograms, MRIs, pulsed electromagnetic fields, and all the other electricity, X-rays, magnetism, and other forms of energy fields used in medicine are well understood. They’re properties are well characterized scientifically through decades of observation and experimentation. We know how to produce these energy forms; we know how to measure them accurately. We know how the energy fields due to X-rays and the radiowaves and magnetism of MRI interact with the human body. They result in reproducible effects that can measure the effects. As for as chemical energy goes, we know how the Krebs Cycle works and how it produces ATP in cells. We’ve known it for several decades, biochemists having painstakingly worked out all the steps and chemical intermediates a long, long time ago. Contrast these forms of energy to reiki “energy.” Reiki energy can’t be measured. No one can even prove that it exists, that it interacts with biological systems, or that reiki practitioners can manipulate it, much less use it for therapeutic effect.
Tom’s argument in essence equates magical energy (i.e., reiki energy) that can’t be measured with well-characterized forms of energy that can not only be measured but whose interaction with human tissue can be used for diagnosis or therapy to measurable effect. It’s an utterly false comparison and boils down to a complete misunderstanding of what energy is (whether willful or not, I don’t know). To a physicist, energy is the ability of a physical system to perform work. To a woo-meister, energy is an imaginary, magical, mystical thing that doesn’t have to do any work the way real energy does. It exists only to explain quackery, much like the term “quantum.”
The rest of the article consists of a list of the usual cherry picked studies that allegedly demonstrate that reiki “works.” As usual, most are small, poorly randomized or blinded, and basically worthless. Even so, Tom is impressed enough to conclude:
The universal life force energy of Reiki is available to all, is cost-effective, can be quickly learned and easily incorporated into the general care of patients particularly in critical care where patient ratios are low and nurses spend more time in direct care and monitoring of patients. Nurses are uniquely positioned to care for the spirit as well as the body through the application of Reiki therapy.
If by “caring for the spirit as well as the body,” Tom means faith healing, I suppose she has a point there.
As always, when I come across an article like this, I end up being depressed as hell. Bad science, bad theology, and bad arguments, all rolled up into an annoying little package of woo.
Critical care nurses, just like doctors, really should know better.