Respectful Insolence

Clinical trials of magic

magic

I’ll partially apologize here. The reason is that I said I’d be back to business dishing out the Insolence as usual, be it in the form of my usual 2,000 word gems, or slightly shorter, or a lot longer. However, fate intervened. First, there were new developments in the Frank Arguello threat machine. Go back to this post for updates. More importantly, a really cool thing finally happened. Steve Novella and a person regular readers of this blog know and love managed to do something that we need to do more of: Get the viewpoint of science-based medicine published in high impact biomedical journals. And that’s just what’s happened.

Even better, at least for now, you can read it too, because it doesn’t appear to be behind a paywall. (I’m at home as I write this, and I can read the whole thing on my wifi, no VPN needed.)

The article is entitled Clinical trials of integrative medicine: testing whether magic works? There’s also been a fair amount of news coverage on the article, and I’ve been frantically doing interviews over the last couple of days, including:

There are likely to be at least a couple more, given what my “inside” information tells me. In any case, one quote that particularly caught my attention was this one by reiki advocates in this story:

When it comes to treating patients, traditional physicians and spiritual healers often butt heads. Long Island-based mother-daughter spiritual healers, AnnMarie Citarella, a Reiki master teacher, and Theresa Citarella, a Reiki practitioner, explained to Medical Daily their feelings on Gorski and Novella’s proposition. “I’m disappointed because I think that with clinical trials that they can actually prove the benefits of Reiki. They will prove that this is such a wonderful and positive way to deal with people who are sick,” AnnMarie said.

Regardless, her daughter, Theresa, added that she doesn’t feel a lack of clinical trials on the alternative healing would seriously affect Reiki’s popularity. “Obviously the science will help it if there is solid research backing it. There are people in this world that need that science,” she said, adding that even without trials, “Reiki will continue on.”

And:

“If they do stop the trials, reiki will never stop,” concluded AnnMarie, alluding to an aspect of her healing that is simply immeasurable in scientific terms. “You have to experience it. You can’t talk about it. Everyone should at least experience it just once to understand.”

In other words, reiki don’t need no steekin’ evidence!

In any case, Trends in Molecular Medicine is good in that it published our article and it’s a pretty high impact review journal, but it doesn’t have a section for comments. So consider this a comment section for the article.

Comments

  1. #1 lilady
    August 21, 2014

    Congratulations Orac…your article is right on target about integrative “medicine”.

    If only…we could convince gullible people that water has no memory, like does not cure like, craniosacral “therapy” cures nothing and can be downright dangerous and there’s no energy field that Reiki practitioners tap into.

  2. #2 Michael Finfer, MD
    Edison, NJ
    August 21, 2014

    Congratulations. It is about time that someone stood up to this nonsense in a high profile journal.

    The quotes from the the Reiki master show Reiki for what it is, a religion, not a form of medical treatment. Hopefully, if the research funds dry up, so, eventually, will interest, at least on the part of the general public. Quacks will continue to be quacks.

    I fully expect that you will have the privilege of being hauled in front of a congressional committee for a good lambasting. I hope you put them in their place on national television!

    Unfortunately, I am away from my PC, and I can’t get that article on my ipad. All I get to see is a nice blue box that says Cell publications. It will have to wait until next week.
    No need to apologize, by the way. You have a really good excuse.

  3. #3 Eric Lund
    August 21, 2014

    water has no memory

    Among the people you have to convince of that, unfortunately, are the people who were editors of Nature in 1988, when Jacques Benveniste published his infamous paper. Interestingly, his Wikipedia page does not include a reference to that paper, but it does include, twice, his (non-refereed) follow-on paper: Benveniste, J.; P. Jurgens, W. Hsueh & J. Aissa (1997). “Transatlantic Transfer of Digitized Antigen Signal by Telephone Link”. Journal of Allergy and Clinical Immunology – Program and abstracts of papers to be presented during scientific sessions AAAAI/AAI.CIS Joint Meeting February 21–26, 1997. The latter paper earned him a second Ig Nobel Prize, to go with the one he won for the 1988 Nature paper.

    there’s no energy field that Reiki practitioners tap into

    To paraphrase Dave Barry: Reiki is based on the scientific principle that if you can talk soothingly to a person about balancing his qi and his chakras, you can get this person to give you money.

  4. #4 weirdnoise
    August 21, 2014

    They’ve already done clinical trials of the placebo effect — it sometimes works! The problem testing Reiki is that it’s impossible to come up with a sufficiently similar sham treatment for the control arm without the Reiki folks claiming (after results prove identical) that it “accidentally” really is Reiki.

  5. #5 Mark Thorson
    August 21, 2014

    Integrative medicine does wonders for Ebola.

    http://www.dailymail.co.uk/news/article-2730488

  6. #6 Wesley Dodson
    August 21, 2014

    The question is, can a clinical trial get enough Reiki masters who are actually good at magic?

    Everyone should have a doctor. If they cannot afford a doctor, a witch-doctor should be consulted. What is necessary to a good life is a doctor-patient relationship. The interventions of modern medicine are a staggering bonus.

    If someone does have cancer, and has received the best of modern medicine, and has had years added to her life, and is told she now has three months to live, maybe she should eat some mushrooms with a doctor present. Is it going to slow or stop her cancer? No. Is it going to make her feel better? Yes. She needs a shaman, which is to say, a practitioner of magic, a witch-doctor if not a doctor, or someone to play that role. But where the shaman offers belief in invisible forces (and the mushrooms proof), the doctor relies only on what has been known and seen. Perhaps integration is ultimately the answer, but that will depend on universal health care. Then you can leave Reiki in the dust.

  7. #7 Denice Walter
    August 21, 2014

    A few thoughts:

    – I f@cking love the article especially the last paragraph.

    – It’s always bothered me that woo/ altie tripe is considered cool/ hip/ *au courant*/ fashionable amongst certain groups of individuals:
    what is cool or fashionable about being immersed in a fantasy-based explanatory system wherein one is periodically rooked by charlatans, tall tale tellers and outright liars? Or where one is dependent upon the ideas and memes of rather low-functioning hucksters/ role-playing nitwits who wouldn’t recognise a clever thought if it struck them over the heads with a brick?
    We should expose woo as the joke it truly is. A joke that wastes a lot of money.

    – Press coverage means that the article will wend its way downwards through net filtration into the slimey, vile realm of web woo-meisters and their alt media dream factories. I fully expect that this will result in critiques by said idiots and perhaps ( oh please, please, say that it will!) visits from their most loyal minions and supporters ( i.e. those who enrich both their egos and their bank accounts) to RI.

    – Being in the news may also alert the writing teams of social critics/ comics who routinely search for timely material. I’m sure that Mssrs Gervais, Stewart, Oliver and Colbert might find the article right up their respective alleys. Wouldn’t that be fun?

  8. #8 JGC
    August 21, 2014

    The question is, can a clinical trial get enough Reiki masters who are actually good at magic?
    No, the question whether or not there’s any evidence demonstrating Reiki is effective at treating injuries or illnesses in the first place. Only once that’s established can we begin dividing Reiki practicioners into pools of ‘good’ and ‘bad’ masters.

    She needs a shaman, which is to say, a practitioner of magic, a witch-doctor if not a doctor, or someone to play that role.

    Why? What exactly is the shaman providing that someone who doesn’t pretend that they can perform magic could not also provide?

  9. #9 Denice Walter
    August 21, 2014

    Here’s a question for woo-supporters:
    why is it that when you read in detail about alt med practitioners you often find that they seldom leave a lucrative career in a respectable profession behind for their ‘true vocation’ but instead, you find an un-impressive educational record and a paltry occupational history? What did they do prior to becoming a reiki master, herbalist or a chakra-balancer?

    In additon to money, these neww occupations enable their grandiosity and give them power over people’s lives.

  10. #10 Mike
    United States
    August 21, 2014

    Orac, very well presented. I read the blogs, but don’t often get to read the published journal articles.

    @Eric:

    I thought all CAM/IM modalities were based on the scientific principal that if you execute convincingly, people will give you money.

  11. #11 Leigh Jackson
    August 21, 2014

    Nice one.
    Of course Reiki etc will go on without trials. They presently go on despite the results of trials, not because of them. CAM-ID is not about the rational; not about scientific evidence; not about science and therefore not about real medicine. It’s as far away from such things as it can get.
    Which is exactly why forcing them together may be financially lucrative for all concerned but debases the currency of real medicine.

  12. #12 qetzal
    August 21, 2014

    @Eric Lund #3:

    Among the people you have to convince of that, unfortunately, are the people who were editors of Nature in 1988, when Jacques Benveniste published his infamous paper.

    That’s not really true. Nature agreed to publish Benveniste’s paper only after the results were seemingly replicated at several other labs. And even then, Nature published it along with an editorial saying they (the editors) didn’t necessarily believe it, but felt obligated to publish due to the multiple independent replications and lack of apparent methodological flaws.

    In retrospect, there were certainly methodological flaws, and you can fault Nature for overlooking them if you like. But it’s not really fair to say they believed in water memory.

  13. #13 Denice Walter
    August 21, 2014

    OT but are anti-vax investigations into supposed CDC scullduggery EVER truly OT @ RI?

    Today Brian Hooker was featured on Null’s Woo-topia ( @ PRN, taped, seconf half of show) and gave details of his investigation of CDC malfeasance surrounding fixed data and his interactions with a whisteblower who has supplied him with thousands of pages of secret data.

    There may be a class action suit in the future. J. Emord is standing by we’re told by the host.

  14. #14 Narad
    August 21, 2014

    There may be a class action suit in the future.

    Against whom?

  15. #15 Denice Walter
    August 21, 2014

    @ Narad:

    Beats me.
    -btw- apparently the host thought that that phrase sounded both impressive and threatening.

    I suppose they’ll sue the CDC/ de Stefano et al who are REALLY the vaccine manufacturers in disguise.

    As we are as well.

  16. […] Clinical trials of magic [Respectful Insolence] (scienceblogs.com) […]

  17. #17 Krebiozen
    August 21, 2014

    @weirdnoise #4,

    They’ve already done clinical trials of the placebo effect — it sometimes works!

    It depends what you mean by “works”. I have yet to see convincing evidence that placebos have any objective effects at all; in fact by definition they do not. I see no evidence of them sense of triggering an ‘inner healer’ either, which seems to be the popular way of looking at it. Most of the time when this is claimed, closer examination reveals it’s an artefact caused by comparing results after treatment to baseline instead of to a no-treatment control group.

    I can believe that a calm person with less cortisol in their blood may heal better than someone running around in circles fueled by sugar and caffeine, but that’s about it.

    The problem testing Reiki is that it’s impossible to come up with a sufficiently similar sham treatment for the control arm without the Reiki folks claiming (after results prove identical) that it “accidentally” really is Reiki.

    One reason I particularly dislike despise Reiki is the claim that you have to be ‘attuned’* by a Reiki master – which can cost a lot of money – before you can heal people. At least the therapeutic touch people say that anyone can learn to direct imaginary healing energy at will, no payment necessary.

    It seems to me that they couldn’t claim “accidental Reiki” without admitting that the payment and attunement is unnecessary.

    * The spiritual equivalent of tuning a bell, or balancing a wheel, one assumes. Without filing bits off, or sticking on bits of lead, obviously.

  18. #18 ab
    Pittsboro, NC
    August 22, 2014

    Excellent paper, and extremely readable – even for us working stiff sys admins. :)

  19. #19 Daniel Corcos
    France
    August 22, 2014

    @ Krebiozen
    The chance to have a p-value less than 0.05 is 1 out of 20. This means that if you make 20 clinical trials, whatever their silliness, you will succeed in showing an effect. If for instance, I try to test my placebo against 20 different diseases, in one clinical trial in average I should find an effect. But with a placebo (sold as such), there will be no money to make. If, on the contrary, it is possible to make money (for quacks or for drug companies), then the best choice is to multiply clinical trials, in order to find significant p-values, allowing to sell the drug. If there is no money to make, there is no way to make clinical trials, as for CIAC:
    http://www.ncbi.nlm.nih.gov/pubmed/24156014

  20. #20 Narad
    August 22, 2014

    The chance to have a p-value less than 0.05 is 1 out of 20.

    I think there’s something missing here.

  21. #21 Daniel Corcos
    August 22, 2014

    @ Narad
    Something missing: maybe your link?

  22. #22 herr doktor bimler
    August 22, 2014

    I can believe that a calm person with less cortisol in their blood may heal better than someone running around in circles fueled by sugar and caffeine,

    I guess that puts me in the control group.

  23. #23 Krebiozen
    August 22, 2014

    Daniel Corcos,

    If, on the contrary, it is possible to make money (for quacks or for drug companies), then the best choice is to multiply clinical trials, in order to find significant p-values, allowing to sell the drug.

    That’s why all clinical trials need to be registered and the results made available, even if negative, to prevent unscrupulous drug manufacturers from exploiting the ‘file drawer effect’, as it is known. I support Dr. Ben Goldacre’s efforts to bring in effective legislation to this effect (laws do exist but are widely ignored and unenforced).

  24. #24 Daniel Corcos
    France
    August 22, 2014

    Krebiozen

    You are right, but in the example I have given, how could you prove that the absence of effect of a drug on 19 pathological conditions is evidence for no effect on the 20th condition, while the manufacturer will say that this is good evidence for the specificity of the drug? Science may work better with theories and their possible falsification than with clinical trials with conflict of interests.

  25. #25 Mephistopheles O'Brien
    August 22, 2014

    @Daniel Corcos,

    What you have described seems to be 20 unrelated trials, one of which provides positive results. Presumably more trials would be required by regulators to replicate that result, and that would seem to a layman like myself to be required whether this were CAM or standard pharmaceuticals.

    Say for example we ran single trials of penicillin to treat the following diseases:
    – erectile dysfunction
    – headache
    – influenza
    – Ebola Zaire
    – strep throat
    – bubonic plague

    Would the results of the influenza trial have any particular significance for the strep throat trial or vice versa? Most likely not, as one is a viral disease and the other caused by bacteria.

    Likewise in your example – yes, someone might try homeopathic duck liver against 20 different diseases and by chance find barely statistically significant results in one trial. That trial stands by itself as a single positive trial and, frankly, I suspect it is right that it should. However, a single typically small trial is not sufficient to prove effectiveness and more, larger trials should be done to replicate the results.

  26. #26 Eric Lund
    August 22, 2014

    The chance to have a p-value less than 0.05 is 1 out of 20.

    Obligatory XKCD link.

  27. #27 Daniel Corcos
    France
    August 22, 2014

    @ Mephistopheles
    “However, a single typically small trial is not sufficient to prove effectiveness and more, larger trials should be done to replicate the results.”
    The trial showing an effect of homeopathic duck liver on Ebola fever has not been replicated.
    Does this mean that:
    1) One should try to replicate the results?
    2) Duck liver is the only efficient treatment of Ebola fever?
    3) There is no time to loose on this kind of trial?
    I choose the third answer. And I would go further than Orac: not only these kinds of trials are a loss of time, but its a loss of time to argue against.
    @Eric
    Nice link.

  28. #28 Rogue Medic
    http://roguemedic.com/
    August 22, 2014

    Congratulations.

    The Reiki Masters provide further anecdotal evidence that the gullible are resistant to logic and that alt med people lack enough compassion for their patients to find out what works.

    These treatments have already been studied enough to answer the question of whether they work – they don’t.

    .

  29. #29 Mephistopheles O'Brien
    August 22, 2014

    @Daniel Corcos – That would all depend on how strong you believe the individual study to be and what your interest is (financial or otherwise) in proving or disproving the results.

    Let us suppose, for a moment, that a study showed that treating Ebola with 200C homeopathic duck liver increased the survival rate from 54% (placebo) to 56% (duck liver placebo) with statistical significance. I personally wouldn’t want to recommend the treatment or perform further study because, hey, it’s a relatively small effect if it exists at all.

    However, let us suppose that the study showed an increase in the survival rate to 90%. Would it at least be worth looking into the methods and possibly repeating? I’d suggest yes – even though it’s wildly implausible that 200C duck liver has any affect on anyone, unless someone is lactose intolerant (assuming pills).

    Anything in the middle is, of course, a judgment call.

    Naturally, the same rules should apply to standard pharmaceuticals and the same skeptical thought applied when evaluating studies.

    P.S. Lest it be misunderstood, I don’t believe that 200C homeopathic duck liver is a cure for anything. I believe that there is no justification for any of the principles of homeopathy, and no indication that any “remedy” diluted past 10C has any affect (and that none diluted past 12C can possibly do anything that a placebo cannot). Likewise, the justifications for “energy” treatments are so much hand waving.

  30. #30 Daniel Corcos
    August 22, 2014

    @ Mephisto (if I may)
    If you can increase the survival rate to 90% with the homeopathic treatment (against 54%), this is possible only if your patient number is small. This does not mean that the clinical trial is flawed, since it maybe difficult to find a large number of Ebola patients in our countries. Of course, if you have a very significant p-value, then you are forced to admit that the homeopathic treatment is effective, but this never happens. And highly significant p-values are rare, even for rational treatments.
    To summarize, I think that the theory behind a cure is important, and if the rationale makes sense, then it is necessary to perform trials to prove or disprove the theory. But if the theory doesn’t makes sense for me, I would change my mind only if I see results that are very highly significant.

  31. #31 Spectator
    August 22, 2014

    “You have to experience it. You can’t talk about it. Everyone should at least experience it just once to understand.”

    Hm. If the point of Reiki is to make one feel better for a while rather than to cure a disease, that makes sense. Some people need a distraction from a chronic or untreatable illness and don’t have friends to have normal interactions with. Getting wound up in your troubles has physical effects, so if the patient can be unwound by whatever means, they may better cope with their disease.

    Perhaps an elaborate distraction, call it healing theatre, has a place. Calling it medicine is fraud, instead give it another name, like, eh, EnteSpiel ;-)

  32. #32 daniel pyron
    August 22, 2014

    A friend insisted on doing Reiki hand waving over me so I have experienced it and my experience was of nothing.

  33. #33 Lurker
    August 24, 2014

    The problem begins with that pesky word ‘energy.’

    Do you have a lot of ‘energy’ today? Does watching all the depressing world news on the telly drain your ‘energy’, or does listening to certain music boost your ‘energy’?

    ‘Energy’ in physics is ‘the capacity to do work,’ and ‘work’ is somewhat circularly defined as ‘conversion of energy from one form to another,’ such as by converting the kinetic energy of a rotating turbine into electrical energy, etc.

    The problem is the use of the same word for a physical phenomenon and for a subjective sensation. This is what enables quacks to conflate the two and equate a change in mood to a change in physical condition (other than the neurochemicals that regulate mood) and then duck any criticism by saying ‘no, I meant _the other kind of_ energy.’ If it ducks like a quack, it’s a quack.

    We need a new word for the subjective sensation of ‘energy.’ The word ‘arousal’ is technically correct but won’t work because it has sexual connotations. ‘I just had a cup of tea so I’m feeling more aroused.’ ‘Right! Well then, no watching porn at the office, let’s get back to work.’

    A new word in common use (let’s call it ‘foo’ for the moment) would force the Reiki Masters and suchlike to choose between that word and ‘energy’ in the physical sense.

    If they choose the word for the subjective state, they’re arguably on safe ground: ‘If I wave my hands over your head, you’ll have better foo’ is hardly a medical claim. I can think of people who, if they waved their hands over my head, might give me better ‘foo';-)

    The word ‘energy’ in the biological sciences can be specified to refer to real physical phenomena e.g. glucose metabolism. ‘If I wave my hands over your head, you’ll have better [glucose metabolism]’ is clearly a medical claim and can be readily falsified.

    In either case, there is no safe refuge for quacks to hide by hopping back and forth between the various denotations and connotations of a word used in an ambiguous manner.

  34. #34 Daniel Corcos
    August 24, 2014

    @ Lurker
    Energy is good for health as long as it is not measured in calories ;-)

  35. #35 Narad
    August 24, 2014

    Something missing: maybe your link?

    The link works fine for me.

  36. #36 Narad
    August 24, 2014

    ‘Energy’ in physics is ‘the capacity to do work,’

    Not really, beyond high school and something like Rocks for Jocks.

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