No, wait a minute. I mean: Nooooooo!
No place is safe from the invasion of quackademic medicine. No place. As you will soon see.
As you know, I've documented the infiltration of pseudoscientific and outright antiscientific woo into institutions that really should know better, namely academic medical institutions. Specifically, over a year ago, I created the Academic Woo Aggregator, a list of medical schools and academic medical centers that have embraced "complementary and alternative medicine" (CAM) or, as it's more commonly known these days, "integrative medicine" (IM). Of course, the latter name is nothing more than yet another attempt to "rebrand" CAM as being sufficiently equal to scientific medicine that it is worth "integrating" into science- and evidence-based practice, even though no one can seem to provide either a compelling evidentiary argument for integrating such pseudoscience into "conventional" medicine. Be that as it may, institutions where I've worked have remained (mostly) untouched by this problem--fortunately. That means I have been blissfully fortunate in not having had to deal with the infiltration of psuedoscience into my workplace. I hope it stays that way, but I don't have any illusions that I'm immune. When that day comes, I'm going to have to throw down the gauntlet.
May that day be far off.
In the meantime, though, I've discovered something that has disturbed me greatly. Woo has invaded my old stomping grounds:
The door closes. Shoes come off. Rolled-up towels go under the knees, soft pillows under the head. The clatter and conversations of the hospital fade away against a backdrop of delicate, harplike music and the sound of bubbling water.The room is otherwise still and quiet as reiki practitioners, one at either end of each table, lightly lay their hands on their clients' bodies: the neck, the collarbones, the forehead, the solar plexus, the instep.
A half-hour later, the clients of Hands to Heart Reiki Clinic emerge into the bright fluorescence of the MetroHealth Medical Center hallway feeling refreshed, relaxed and, for some, pain-free.
"Oh my gosh, that was wonderful," client Fran Gonzalez tells the clinic worker who is writing down a post-therapy pain assessment.
The hospital's clinic offers unconventional therapy for those who have found conventional medicine only goes so far.
Nooooooooo! (Sorry, I couldn't help myself.)
MetroHealth Medical Center used to be Cuyahoga County Hospital. It was one of the three hospitals that made up the Case Western Reserve University general surgery residency program, which is where I did my general surgery training. I spent about 1/4 to 1/3 of my time during residency rotating there, and I also moonlighted there as a helicopter physician for Metro LifeFlight in the early 1990s while I was doing my Ph.D. work. Back in the day, it ran a hard-core, science-based, take-no-prisoners trauma program that kept me in the hospital well over 100 hours a week. There was no woo, no New Age-y nonsense. No reiki. There, I learned from some of the best surgeons I've ever seen, as well as the best surgical intensivist I've ever worked with. I'm not saying the place was perfect, but education there was based on science and evidence wherever possible. Of course, the call schedule was utterly brutal, but that's just the way it was then.
Now look what MetroHealth's become:
A group of MetroHealth nurses interested in integrative therapy -- which merges conventional medicine and complementary practices -- created the clinic about three years ago to provide free reiki sessions for the hospital's outpatients.
Reiki's effectiveness remains scientifically unproven, but the MetroHealth clients are happy -- and the clinic is operating nearly at capacity. Close to a dozen people, some regulars, some walk-ins, come to the MetroHealth Medical Center's Cancer Care Pavilion once a month to lie on the three, sheet-draped tables in a darkened room that normally is used for chemotherapy.
Janelle Goetz relaxes as reiki practitioner Anita Haynes places her hands over Goetz's body during a recent reiki session at MetroHealth. A group of nurses who received a grant from the hospital auxiliary took reiki classes and have now set up a once-a-month clinic at MetroHealth.
Dr. Mikao Usui developed reiki in Japan in 1917; Hawayo Takata brought the practice to the United States in 1938. Reiki is based on the idea that an unseen life-force energy, which is the basis of life, flows through everyone. Reiki practitioners believe they can tap into that energy, which flows through their hands into their clients. The stronger the life force, the better the person will feel.
I really hate credulous articles like this, where barely is heard a skeptical word, and I hate that my old stomping grounds have allowed quackademic medicine to infiltrate. As blog bud PalMD tells us, reiki is a steaming, stinking, fetid load of rotting dingo's kidneys, scientifically speaking, or, as PalMD put it, "absurdist ridiculosity." In fact, reiki is far more akin to faith healing and the laying on of hands popular in some Christian traditions and sects than to anything scientific. Indeed, take a look at what reiki is, as described by believer:
Reiki is a Japanese word meaning "Universal Life-Force-Energy". The "Ki" part is the same word as Chi or Qi, the Chinese word for the energy which underlies everything. Reiki is a system for channeling that energy to someone for the purpose of healing.
If you read the story of Mikao Usui, what becomes apparent is that his story resembles that of--believe it or not--Jesus. Indeed, after a long search for how Jesus healed, Usui claims to have gone up a mountain in order to fast and meditate for 21 days, with this result:
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.
Note the similarity to the story of Jesus going up the mountain for 40 days and 40 nights of fasting in preparation for his ministry.
After this, Usui taught others, who taught others, and reiki spread--much like a religion, actually, which is what it resembles more than anything else. It postulates the existence of a universal life energy and claims that healers can, through the use of concentration and various sacred symbols and magical gestures (there really is no other way to describe the "sacred words" of reiki) redirect the flow of that life energy or even replenish it, all for healing effect. Often this involves tracing sacred letters in the air or over the client's body. First degree Reiki practitioners use a series of 12 specific hand positions placed gently on the body, either touching or not touching. These hand positions, with concentration, supposedly result in the flow of reiki energy through the practitioner to the person being "healed, with the practitioner being a "conduit" for the reiki energy.
This is one reiki master demonstrating some of the basics of how it's done:
Moreover, many reiki practitioners even claim that, because reiki involves energy healing, they don't even have to be in the same location as those being healed. That's right, reiki masters claim that they can "heal" at a distance. This "distance healing" involves the use of special symbols which are claimed to involve opening up to the experience of the energy and "listening to one's inner voice." That is what second level reiki masters claim to be able to do. The pinnacle of reiki is the third level reiki master, who trains for a year or more working as an apprentice with another reiki master, during which time he or she learns to "embody the energy," such that he or she can ultimately teach reiki to others.
Of course, there is no evidence that reiki "works." First off, there is no evidence that the "life energy" field postulated by reiki believers has never been detected, and it's not as though it hasn't been sought. Second, there is no evidence that reiki masters can either detect or manipulate any such fields. Third, virtually every rigorous trial of reiki has failed to show an effect greater than that of a placebo, aside from the number that might be expected to be "positive" by random chance alone. The bottom line is that whatever benefits appear to derive from reiki are almost certainly placebo effects.
Never mind all that. Here's what disturbs me:
They sought and received approval from the hospital's cancer board medical director to open the Hands to Heart clinic. They developed a policy for energy therapies, which the medical staff accepted and sanctioned. They also established credentialing guidelines for the volunteers who wish to practice at the clinic.
Since then, the initial group -- who have taken the classes required to become reiki masters -- have themselves trained nearly 100 people from the community and established a reiki circle, where MetroHealth employees trained in reiki practice on each other.
Rosanne Radziewicz, one of the three founders, says reiki has found acceptance among the hospital's nurses as a complementary therapy. But the doctors are "a bit of a more challenging group to get," she said, because there are no medical studies that prove reiki's effectiveness.
How do you "credential" faith healing? How do you "credential" quackery?
At least I'm glad to hear that the doctors are a "more challenging" group. Some of the surgeons I used to work with are still there, even 13 years after I finished my residency. I can only imagine what they think of this nonsense; that is, if they think about it at all. My guess is that they privately (and correctly) think it's a load of B.S., but the fact that this was allowed to proceed tells me that they probably have a bit of the "shruggie" attitude in that they don't care enough to stop it. Obviously, they're not challenging enough, because this reiki clinic exists and its believers are planning on metastasizing to the hospital itself:
The results at MetroHealth have been encouraging, Radziewicz says, judging by the pre- and post-session pain ratings from clients. With the support of MetroHealth, plans are in the works to take reiki sessions to patients staying in the hospital.
"We have a lot of work to do to bring people back down into what I call holism -- to heal in different ways," Radziewicz says. "It has to come slowly."
"Wholism" is a sham, too, by the way. As used by CAM advocates, it's very much like the word "integrative." It's a way of claiming to be somehow taking care of the "whole" person when in fact, unlike scientific medicine, CAM has no basis in science or physiology, and can only offer illusion. One of the nurses claims that it helped her "reconnect" with her nursing instincts because nurses touch their patients all the time, but not in a "the compassionate way that sick people need." (I daresay that my wife, who is a nurse, would beg to differ.) Reiki, to this nurse, blithely says: "Reiki can fill that need."
I would retort that you don't need to invoke religious, pre-scientific, New Age nonsense in order to "fill the need" of ill patients for compassionate touch. I would also point out that single arm, uncontrolled "before and after" patient pain surveys are pretty useless for determining whether reiki as practiced at MetroHealth Medical Center does one whiff of good for chronic pain. The placebo effect alone would guarantee that scores would improve. What would be needed is a randomized controlled trial.
Seeing quackademic medicine infiltrate my old stomping grounds is profoundly depressing to me. Thinking of why MetroHealth might have acquiesced to this blight upon its reputation, I think I have an idea. Over the last few years, MetroHealth has been managing to attract more upscale patients, patients with actual insurance. My guess is that it's now trying to attract more with the honey of a bit of woo.
In any case, I have no choice now but to add MetroHealth to my Academic Woo Aggregator the first chance I get.
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Without wholistic treatment, you will never conquer dis-ease.
After all, conventional medicine only goes so far. You never heard of anyone getting cut/burned/poisoned by reiki for cancer, now did you, huh.
"...why MetroHealth might have acquiesced to this blight upon its reputation, ... MetroHealth has been managing to attract more upscale patients..."
in my view, it's not just trying to attract upscale patients, but also trying to attract patients who are basically healthy and who will lead MetroHealth to less "medical loss" (an insurance industry term for spending money on real patient care).
What, Orac, no belly for the fight? (And, yes, I know it's cheap talk since I'm on the sidelines in this one.)
The "great silent majority" of honest health practitioners sure aren't doing much to plug the sewage-pond dike. Maybe there's some serious opposition going on behind the walls of the ivory towers, but out here we aren't hearing of it, so it looks like academic medicine is also playing shruggie.
That leaves a handful like you and the others at sciencebasedmedicine.org who are actually standing up and calling shenanigans on Dr. Weil's new clothes. Not terribly effective when you're in another time zone from the front lines.
So, and I mean this with respect and affection:
Sorry, Dude, but I can't think of anyone whose lap I'd rather this splatted into. The sooner the better.
I'll leave us all with the words of R. Tarfon:
"It may not be for you to complete the task, but neither are you free from taking it up."
@Dangerous Bacon
What I often say to people who spout alternative medicine, especially the laying on of hands, is that if magical energies can affect the body then it reasonable to assume that they can be hurtful if used incorrectly or with malice.
This is the kind of thing that keeps me away from the local massage therapist conventions. The bonus of being able to take cadaver anatomy isn't enough incentive to make me sit through the energy work advice and testimonials.
It makes me cringe every time I see an article like this. I am disappointed that nurses are such a credulous lot. Like you I want to wear some kind of a mask to hide my face when others of my profession do something this stupid.
I've never felt the need for woo to enhance my profession. In fact, it seems to me that it would hinder my ability to be an advocate for my patients since many of the people I need to interface with to do so would think less of me.
I think a lot nurses take this up because they feel powerless and this "ability" makes them feel special. It sets them apart from those doctors who only look at the disease and not the whole person. I'm sure the fact that I've always worked in surgery where I've been an integral member of a collaborative team helps keep me falling into the madness. Although I do know many O.R. nurses who buy into some form of woo, usually on the supplement side of things.
So far I don't know of any outright woo going in my facility and I don't how I would respond if I found out about it. I think I'm safe until I get into our new building (6 months from now) as everyone is too busy to go there. But I am in Southern California so it may not be far off.
I thought I had diagnosed the cause of the woo invasion and could enlighten Orac, but right at the end, he nailed it. In other words-Follow the money. Chris
"planning on metastasizing to the hospital itself"
lol!
I wonder if anyone has thought to call up some of the local churches to let them know occultism is being practiced at the hospital. It would be fun to see the two superstitions go head to head.
Another thought is to come up with ones own version of reiki woo (maybe different hand signs and some tea thrown in) and offer it as an alternative to the alternative. Fight their refusal to certify you as an attempt by Big Reiki Medicine to silence you.
Deliver us from credulous nurses. They also, IME (direct and indirect) seem to be the most sadistic ones. A friend of mine who was in St. Vincent's burn ward could tell you horror stories about whackaloon fundamentalist Christian nurses there...
flo nightinggale is turning over in her grave. I'll do whatever I can here to combat this craziness in nurses whenever I find it.
I'm a former magical-thinker who has experienced many of the CAM I/M "modalities". I have a reasonable grasp on why I allowed myself to believe in such woo (fear/denialism). But having returned to sanity and embraced a rational, science-based approach to the world, I'm more fascinated than ever by the science of the placebo effect. Who is the foremost authority on placebo? How is it being studied? Are there books or papers on it?
Depends on who you ask. Around here, daedalus2u certainly has more to say on the subject than anyone else :-)
Apparently, Reiki isn't very useful for jaundice.
That fawning Plain Dealer article reminds me of why I shed no tears for all the newspapers that are going under or having severe financial problems. Investigative reporting is a dead trade.
I agree that Florence Nightingale is turning in her grave.
She was apparently a good statistician (first woman elected to the Royal Statistical Society).
"Almost all superstitions are owing to bad observation, to the post hoc, ergo propter hoc; and bad observers are almost all superstitious. Farmers used to attribute disease among cattle to witchcraft; weddings have been attributed to seeing one magpie, deaths to seeing three; and I have heard the most highly educated now-a-days draw consequences for the sick closely resembling these."
Florence Nightingale, Notes on Nursing
I feel your pain, Orac.
After seeing my med school in the news next to some bit of quackery, I wrote to a faculty member offering to pay for a student to attend the Science Based Medicine conference at TAM. In the email I said something snarky about "integrative" medicine being irrational, because if some CAM thing works, why not prove it and so remove the need for integration?
Dr. X thanked me for my generosity and forwarded my email to the director of Integrative Medicine.
LOLOLOLOL. Didn't know they had that there. Guess I should read those alumni things they send me.
@Dangerous Bacon
What I often say to people who spout alternative medicine, especially the laying on of hands, is that if magical energies can affect the body then it reasonable to assume that they can be hurtful if used incorrectly or with malice.
*laughing* Actually, that bit of woo exists. It's called Dim Mak, Tien Hsueh or Death Touch. It is routinely invoked in classical Asian martial arts. The most common rendition is to poke with fingers or weapons at the same points that are invoked by acupuncture to heal. Still, there are martial arts that believe they can kill by laying on of hands in the way that Reiki claims to heal. Best test of efficacy is to ask the unjailed master if they've ever gotten it to work;-)
Ugh, this totally reminds me of an issue of the local free 'news paper' here in Santa Cruz (which, BTW, is chalk full of woo-quakery). They devoted an entire issue to 'health' a few weeks back, and it was the biggest piece of hogwash in the world. Had to main articles, one about a guy trying to do the Iron Man competitions and couldn't 'get it together' until he met some Shaman, the second was about one of these "life force" or "Chi" clinics. Needless to say, it made me sick to my stomach (I couldn't even get through the Chi article). Such a cool town here, but SO full of crappy new age shit.
"Placebo" is a placeholder for "no treatment." That placeholder includes all non-specific effects, such as the passage of time, natural course of the illness, emotional benefit of connecting with a health professional, positive thinking, negative thinking, dumb luck, etc.
It is not a "force" of any kind.
I am sorry you all feel that way. I am registered nurse and I have my own healing touch practice. Everyone I have ever touch has had astounding results. Whether its Reiki , Healing Touch, Therapeutic Touch, it is basically the same they just use different techniques. There is plenty of scientific research out there clear back to Isaac Newton physics, Albert Einstein's Theory of Relativity, and 1971 Dennis Gabor received a Nobel Prize for his first hologram. Healing Touch International has several case studies on energy work and on Feb 23, 2009 Science Daily had a case study on Healing Touch reduces pain. Jesus know how the energy fields worked and he used it to heal the sick and lame with laying on of the hands. They laughed and scorned Jesus also. Jesus said " the works that I do you can do also and greater works you will do."
"established a reiki circle"
Circle jerk of healing?
Case Western Reserve University is where one of my nursing school profs received his PhD in Nursing. All at the same time he was dealing with all the therapeutic touch and Martha Rogers nonsense invading academic nursing, doing his scientific research, teaching Vermont nursing students, and raising two young sons with his wife.
This was while I was in Nursing school and still dabbling in teh woo myself. Dr. Ross gave me some cassettes from the old Caltech skeptical lecture series, trying to cultivate the seeds of reason he apparently saw in me. Eventually I weeded all the woo from myself. Dr. Ross is gone, but I remember him with respectful gratitude.
I don't get it. Really, I don't. How can intelligent people fall for this stuff? How can you get through nursing school and not be intelligent?
Now, that I've got that off my chest, I do believe touching is therapeutic. I'm just not so sure that going to a stranger once a month for touching has the same effect as an 'untrained' hug from someone who cares about you.
"You never heard of anyone getting cut/burned/poisoned by reiki for cancer, now did you, huh."
You also never heard of anyone getting cured, either.
Dr. Benway, it seems like you're trying to say that there is no placebo effect -- after listing some of the mechanisms by which the placebo effect works. Oh, sure, some of them actually explain why an illusory placebo effect would be perceived (natural course of the illness, dumb luck) but other mechanisms you yourself name fit squarely within the parameters of the classic placebo effect, namely an effect that happens because the patient thinks he is being treated. Is the emotional benefit of connecting with a health professional truly that strong? Does positive thinking really help that much? Having seen what profound effects depression can have on general health, I think it would be only wise to see if we can understand and harness the mechanisms by which more positive states of mind may more positively effect health.
I warned you, and warned you, and warned you. You will respect me one day, Orac, I know it:
If you had taken real action, when I first brought this up, you wouldn't be writing this now.
Keep waiting, Buddy: this cultism is working it's way to you.
Becky Cochran wrote:
Uh huh.
One of the significant things about science is that it must all work together. Biologists do not use a different chemistry than chemists, chemists do not invoke a form of physics different than what physicists work with. If "chi" or life energy exists, it won't just be something used and useful in medicine: it will send shock waves through all scientific disciplines -- most especially physics.
A form of energy they haven't dealt with before -- one associated with life alone? OMG. The "dark energy" of cosmology would be nothing to it. Strong, repeatable evidence for vitalism would merit a Nobel Prize to itself, and researchers would be falling over themselves trying to make new testable predictions and change the mainstream model in science. You wouldn't just see it being taught to nurses for "healing." There would be a frenzy of activity in every physics department in academia, every lab around the world.
So -- how do you explain the fact that this isn't happening?
Satan?
Becky, I'm pretty sure Mr. Randi would gladly give you a million dollars if you can grow an amputee's limb back with a touch. Case studies have their uses, but they are really just elaborate anecdotes, which do not data make.
I work at a hospital in a woo-filled town with a lot of New Agers and naturopaths (don't even get me started). The only woo I've noticed here is prayer or pastoral care, and that is not intercessory, but considered supplementary and only at if the patient wants it. The hospital is religious one, but the religiosity comes second to actual medical care.
I do despair when I hear about hospitals falling for the woo. Private practitioners of it are bad enough. Being in hospitals gives it a credibility it has not earned. Use proper controls in a real study and prove the case is more than placebo or GTFO.
PS: Spell-check doesn't believe in naturopathy, either.
Please explain to us how Newtonian Physics provides evidence in support of energy healing modalities. This one I've got to hear.
I don't know--there might be something to this Reiki stuff. After all, I have never seen a higher quality treatment for the third eye than what that Reiki master showed us in the video.
Antaeus Feldspar, if you put your mind to it you might be able to design a workable experiment comparing illness course to "take this sugar pill." I do wonder who would volunteer to participate.
Studies comparing a med to placebo don't separate belief in the pill from all the other nonspecific variables. So if 30% get better on placebo, that doesn't tell you that sugar pills can do stuff if people believe in them.
Man, you guys are so damned smart and yet, at the same time, so stupid it boggles the mind. Folks, this is cultism, and you're not going to stop it by using logic (Do you seriously think logic could wrest Tom Cruise from Scientology?) all you can do is demand woo be taken out of medicine - or else you'll take yourselves out. That's the only hand you have:
It's doctors or the hand wavers, period.
These people don't care about facts, right and wrong, placebos, killing people, or anything else - they only want what they want - and if your profession gets turned into a NewAge joke (which glorifies them) so be it. They are The Borg and you will be assimilated.
Back when I first met Orac (online) he doubted the cult angle, but he doubts it no more, though I still don't think he grasps the parameters (or the implications) of it. That's O.K. because all that's important is knowing how to stop it. And stop it you can. You merely have to put your foot down and don't move it - what I call "The Macho Response" - because then everyone (the cultists, the shruggies, etc.) knows you mean business.
It really is your credibility or theirs, people. Which side you on?
The correct phrase is actually "old stamping grounds" not "old stomping grounds". It's a common mistake that I would have let alone had you not used it four times in this post.
Oh, and the video is deeply embarrassing. I am very sorry to hear reiki has come to this hospital.
(of course "mistake" becomes "common usage" after awhile, and we're probably there already in the U.S., so perhaps this horse has left the linguistic barn).
Dr. Benway --
You are completely correct that it would be difficult to design a truly foolproof study comparing placebo treatment to no treatment.
But if such an experiment confirmed that people receiving placebo do in fact do better than those receiving no treatment (and if we didn't take this very seriously as a possibility then we wouldn't bother giving placebos to control groups!) then it would behoove us to examine specifically why those on placebo did better. Saying "there is no placebo effect occurring; it's just the fact that people who think they're going to get better soon experience less stress and this stress-reduction in turn helps them heal faster" is missing the forest for the trees.
Hasn't the positive effective of placebo over doing nothing been demonstrated in accupuncture studies where the "real" accupuncture and sham accupunture groups both do significantly better than the do-nothing group.
Becky,
and 1971 Dennis Gabor received a Nobel Prize for his first hologram.
It is interesting that you cite holograms in support for the plausibility of energy healing. Both are illusions, with nothing there...
Also, saying that people laughed at Jesus. I have heard of the Galileo Gambit, but is this the Jesus Jingle?
Becky Cochrane wrote blah blah my personal experience etc. followed by
And the point of this non sequiter is? If you are going for the argument from authority fallacy at least try to bring the authority within hailing distance of the argument.
At one time I tried to be really "open minded" towards reiki but it just got more and more preposterous.
A human energy field - no one has measured or detected such a thing but maybe it exists.
Someone else can manipulate this energy field with their hands - that sounds very improbable but what the heck.
Reiki energy knows where to go even if the practitioner gets it wrong - sounds like religion to me.
You can send reiki from your eyes (even via a DVD) or send it over the phone - WTF!
And this is just pathetic.
Using a 2000 year old work of fiction as a reference just doesn't cut it around here.
On a side note, the Japanese calligraphy on the wall behind "Golden Reiki Master" in the first video is some of the most poorly written i've ever seen. Looks like he copied it off the internet in felt tip pen.
-Close to a dozen people, some regulars, some walk-ins, come to the MetroHealth Medical Center's Cancer Care Pavilion once a month-
Thats not very many is it. Sounds like an inefficient use of space to me.
I think the positive benefits patients experience with these 'touch therapies' is just the comfort of being touched by another human being. I know from personal experience during touch droughts when it's been too long between hugs, the thought of lying on a table in a peaceful, nice-smelling environment while someone pays attention to me for half an hour sounds good just on it's own. Although they shouldn't be claiming to cure anything.
Orac, why are you surprised that people who enthusiastically embrace political, economic, and social woo would also embrace medical woo?
Dr. Benway -
The placebo effect is clearly much stronger than "doing nothing" - one piece of evidence in this is that the placebo effect varies with the type of placebo offered. The more invasive the placebo, the greater the effect. I recall learning that injections typically produce a greater effect than pills, for example. The strong response to even sham surgeries is responsible for the fact that some surgical procedures were used for ages without the realization that they are no more effective than a sham surgery would be.
Placebo response depends on the expectation of the patient, which implies that it's different from simply doing nothing.
Oh, fer Chrissake, that takes pedantry to a whole new and annoying level.
Epinephrine,
I don't claim the placebo effect is nothing. I'm saying that in nearly every clinical study, the "placebo" category includes a range of non-specific effects - regression toward the mean, and so on.
Often people hear something like, "30% got better on placebo," and they think, "Hey, that placebo stuff is pretty cool. Maybe it's not as strong as real medicine, but at least it doesn't have nasty side effects."
That's a mistake, as we can't separate the specific change due to wishful thinking from all the other background variables.
And, in my opinion, false beliefs do have side effects. They're just difficult to quantify.
If the placebo response in a sham surgery setting is greater than a drug setting, that still doesn't tell us that wishful thinking specifically is responsible for the outcome. Maybe suffering patients who think they're getting a placebo are annoyed, and that amplifies their distress. We know pain is subjective and can be altered by social context. Some studies have shown that adversive stimuli hurt more if people believe the hurt was intentionally inflicted.
A convincing sham may be important not only for blinding, but also for removing the annoyance or disappointment factor. Sham surgery might simply be more convincing than sugar pills.
Dr. Benway: Comparing placebo to "no treatment" (not just to an actual woo or real medicine) is not that difficult - for some conditions you can use a waiting list control group, for other conditions a group that gets "treatment as usual" (instead of that + woo/a new pill/placebo treatment). I've seen that done in several studies.
Crack Emcee: Of course you can't reason Tom Cruise out of his position, but he is a special case. If those videos we've all seen are to be believed, and he wasn't on drugs at the time, he's probably bipolar w/euphoric hypomanias, and FSM knows we hate to give up our lovely lovely highs. Not believing in real medicine and psychiatry is a convenient excuse for not facing facts.
Actually, placebos are used for blinding primarily.
Yes, there are ways to strip some of the background variables away. But most clinical trials don't bother. Most compare a drug to a placebo. In a two-arm study like that, we can't separate the wishful thinking bit from natural illness course, luck, time, etc.
Used to be, saying some treatment was no better than placebo meant the treatment wasn't good enough. But now we have this twisted logic that justifies CAM as some sort of artful manipulation of the allegedly powerful placebo effect. LOL.
"Placebo" used to be disparaging. Somehow it's become mysterious and kinda cool.
Indeed, especially as Orac's choice, for better or worse, has enjoyed widespread usage in the US for a number of years:
I sympathize with your lament for degenerating linguistic fidelity, cm, but in light of the very real problems Orac's posts have so beautifully articulated, I think this is about the wrongest place you could choose to wield your pedantic powers. If he starts posting in LOLCAT-speak, then we'll talk.
Crack Emcee, thanks ever so much for popping in and demonstrating how to really walk the walk. Removing ourselves from the practice of (or, in my case, scientific contribution to) medicine as a means of protesting the woo infiltration? Brilliant, man! Pure, rippling genius. That'll definitely show 'em we mean business.
Nurse Michele in onto something here:
Decades ago, well before the World Wide Web, I remember reading about a study of superstition in baseball. Sure enough, the most superstitious players were those that played positions where they felt relatively powerless and yet had a disproportionate part of the game riding on their shoulders -- pitchers, in particular.
The nurses want to help, yet feel powerless to do so -- and may also feel slighted by doctors who have more education and training than they do. (Yes, it's petty, but it's an all too human response.) This is the door by which woo enters.
Did you guy read this? http://news.bbc.co.uk/2/hi/health/7940149.stm
I hadn't heard of hypberbaric therapy for autism, but my alarm bells went off when I read that the principal investigator had already "seen improvement" in his own children with the treatment. That just REEKS of bias.
Orac and Danio,
Yes, I'm being kind of a goober here on the stomping/stamping, thing, and tried to backpedal a bit with the comment I made immediately following my comment. This is more word trivia than being helpful, so I hereby withdraw it (and Danio, sure, I benefit from Orac's writing and content, too!).
I can't let any "literally" or "this begs the question" errors go, though, because they destroy a nice linguistic device (whereas "stomping" is, in my opinion, equally good as stamping).
Dr. Benway, thanks for your posts (especially the one to Epinephrine)
While I never thought that the Placebo Effect was a drug or a specific mechanism (eg. Ask your doctor if Placebo⢠is right for you), I am fascinated by the effect of emotions on our health. As I said, I am a former magical-thinker and it was a series of events that forced me to deal with reality that showed me just how my fear and wishes trumped my innate skepticism where woo was concerned. I see that this is a very complicated issue to unravel. I'm glad I asked the question though, because the cascade of answers and questions that followed have been really illuminating. Sometimes I hesitate to ask the questions that reveal my woo-stained past. But I also realize that if one magical-thinking denialist stops to reflect why they believe what they believe, then it's worth the potential embarrassment on my part.
Oh, and I found this on Becky Cochrane's site:
Death Begins (at) 25 MHz
WTF? Anyone care to hazard a guess?
25 MHz? Sounds sciency. Link?
More placebo musings:
In a two arm study, placebo verses drug X, some patients will believe the placebo is the real deal and may benefit from that.
Some patients on drug X will mistakenly believe they're getting the placebo. Perhaps they won't recognize some benefit that's actually there for that reason.
Whatever the specific placebo effect --i.e., the effect of belief in the treatment apart from background variables like natural course of the illness, time, luck, etc.-- it must be operating in both the placebo and the drug groups in a blinded study.
And thus the rationale that drug X must be better than placebo before its use is justified.
I thought Reiki masters were supposed to be humble and poor and to work for free?
Alt-woo: we tried it, and people kept dying.
What is the sound of one hand cashing the checque?
Pareidolius,
My guess is that "25 MHz" has something to do with the old "mobile phone tower causes cancer" canard. Either that or the stress connected with using REALLY SLOW processors has a health impact.