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Garry Simpson

Consider all the evidence on alternative therapies

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“Insane”, “a joke”, and “exactly the sort of thing the NHS should not be doing!” are a few of the Twitter responses to last week’s news that Britain’s Princess Alexandra Hospital NHS Trust wants to hire a reiki therapist for a hospital in Epping. On a salary of up to £22,236 (US$34,000) a year, the appointed person “will provide Reiki/Spiritual healing to patients to enable them to cope with the emotional, physical and spiritual issues of dealing with their cancer journey”.

Critics of the advert — and there are many — advocate instead what they call “evidence-based” approaches to health care. These critics should look again at the evidence — because it shows that to dismiss the benefits of alternative therapies is simplistic and misguided.

Let’s be clear, I don’t buy into the pseudoscientific claims of reiki and spiritual healers. There is no evidence that they can tap into and manipulate human ‘energy fields’ to clear blockages and heal the body. Like many alternative therapies, these practices perform no better than placebos in clinical trials.

But that does not mean that such treatments have no distinct therapeutic value. To dismiss people’s complex psychological and physiological reactions to serious illness — and how it is treated — as mere placebo effects is not helpful.

Neuroscience studies show that placebo effects can trigger significant physiological responses that are often identical to those created by drugs, ranging from the release of dopamine in the brains of people with Parkinson’s disease to a rush of endorphins for those in pain.

The standard ‘evidence-based’ argument is that this is irrelevant. Even if alternative therapies induce a biological response, sceptics argue, patients are still better off receiving trial-proven conventional treatments, because then they benefit from both a placebo effect and the active effect of the drug.

This logic misunderstands the nature of placebo effects. Not all placebos are the same, and alternative therapies can sometimes trigger larger responses than conventional ones do. For example, in one trial, fake acupuncture relieved pain more effectively than a fake pill (T. J. Kaptchuk et al. Br. Med. J. 332, 391–397; 2006); in another, it relieved symptoms of irritable bowel syndrome with fewer side effects than available drugs (T. J. Kaptchuk et al. Br. Med. J. 336, 999–1007; 2008). It is true that if a therapy cannot beat a fake version of itself in trials, it is not working as the therapist claims. But if it triggers a big enough placebo effect, it might still be the best treatment available.

“Conventional medicine often struggles to provide human aspects of care.”

If drugs are effective and placebo responses small, this does not matter much. But people tend to turn to alternative medicine for subjective, stress-related conditions such as chronic pain, depression, nausea and fatigue (all problems that can affect cancer patients in treatment). Drugs for these conditions have significant downsides, such as unpleasant side effects and addiction, and placebo responses often account for most of the effect of the drug. So it becomes plausible that compared to popping a pill, a patient might get more relief — and fewer side effects — from an hour with a sympathetic therapist.

The benefits of therapies such as reiki and acupuncture go beyond what we normally think of as placebo effects, however. Alternative therapists do not get results just because they are particularly good at fooling people into thinking that they will get better. Many elements of the care they provide — from talking to touch — seem to have the power to relieve symptoms and even influence physical outcomes. These elements do not show up when therapies are compared against sham treatments, because they are present in both arms of a trial.

Such benefits can be indirect. For example, tackling patients’ anxiety during invasive procedures such as keyhole surgery can reduce the risk of dangerous fluctuations in heart rate. This results not only from the direct effects on physiology, but also probably from patients needing lower doses of sedatives and painkillers.

Conventional medicine, with its squeezed appointment times and overworked staff, often struggles to provide such human aspects of care. One answer is to hire alternative therapists.

This ensures that such therapies are regulated, and that patients also get the conventional treatment they need. Such ‘integrative medicine’ is now offered by dozens of major US academic medical institutes. The Stanford Center for Integrative Medicine in California offers acupuncture to help with chemotherapy side effects. If this helps patients to complete a conventional treatment by making those symptoms bearable, one therapist there told me, it might improve survival rates, too.

Critics say that this is dangerous quackery. Endorsing therapies that incorporate unscientific principles such as auras and energy fields encourages magical thinking, they argue, and undermines faith in conventional drugs and vaccines. That is a legitimate concern, but dismissing alternative approaches is not evidence-based either, and leaves patients in need.

Instead of rejecting such approaches wholesale, let’s learn from them. That means going beyond the simplistic practice of jettisoning anything that cannot beat placebo. We must tease out the real active ingredients of these therapies — things such as ritual, mental imagery, empathy, care and hope — so that we can learn how they work and find ways to incorporate them into patient care.

Journal name:
Nature
Volume:
526,
Pages:
295
Date published:
()
DOI:
doi:10.1038/526295a

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  1. Jo Marchant is a science journalist and author of Cure: A Journey into the Science of Mind Over Body, to be published in January 2016.

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  1. Avatar for Majid Ali
    Majid Ali
    Jo Marchant ‘s thoughtful article entitled “Consider all the evidence on alternative therapies” (ref. 1) calls for a diligent reading by all clinicians. “So it becomes plausible,” she writes, “that compared to popping a pill, a patient might get more relief — and fewer side effects — from an hour with a sympathetic therapist.” In non-acute illness, this is true in more instances than most physicians would imagine. “The benefits of therapies such as reiki and acupuncture,” she continues, “go beyond what we normally think of as placebo effect. ”Alternative therapies do not get results just because they are particularly good at fooling people into thinking that they will get better.” The subjects of the science and philosophy of holism in healing are vast. To participate in conversation initiated by Ms. Merchant, I offer my perspective as a past president (1996 to 2006) of Capital University of Integrative Medicine, Washington, D.C. At this school in the same classes, practitioners of diverse disciplines taught and learned from each other. The student body included internists, gastroenterologists, nutritionists, naturopaths, homeopaths, neurosurgeons, biologic dentists, acupuncturists, ophthalmologists, pathologists, and yes, some Reiki practitioners. The faculty was nearly as diverse as well. At a basic level, science is about measurement. At that basic level, integrative medicine is about measuring the long-term outcome obtained with the philosophy and science of holism in healing. I presented this view in my president’s message entitled “A Tribe of Civilized Medicine” published in the University journal in July 2001. (ref 2) Below, I reproduce that message. I discuss the matters mentioned in the address at length in the first, 10th, 11th, and 12th volumes of my textbook entitled “The Principles and Practice of Integrative Medicine.” (ref 3-6). A TRIBE OF CIVILIZED MEDICINE At Capital University, we strive to be a tribe of civilized medicine. It is a medicine about human dignity—dignity of the sick as well as of those who care for the sick and prevent disease. A practitioner of civilized medicine grows in threestages: 1. Knowledge, 2. Understanding 3. Wisdom. Learning the facts of natural phenomena in biology is the first stage of knowledge. Searching for relatedness among those biological phenomena is the second stage of understanding. Bringing that knowledge and understanding to the care of the sick is the third stage of wisdom. In civilized medicine, the practitioners seek the wisdom of: · Keeping the sick is at the center stage—the wisdom of letting the sick guide the practitioner as the practitioner guides the sick. · Holding nutritional, environmental, and stress-related aspects of modern life as the central focus of their work. · Not subordinating the empirical observations regarding hurt humans to the experimental observations regarding mutant mice. · Not sacrificing painstaking studies of astute clinicians at the altar of double-blind, cross-over medical trials. · Doing the healing work only within the “spiritual matrix of belief” about the observable as well as the unobservable in the healing phenomena. · Recognizing Nature’s preoccupation with molecular complementarity and contrariety in the health/dis-ease/disease continuum. · Recognizing the bowel, blood, and liver ecosystems as the soil and the root of the human organism, and bringing a gardener’s sense of soil and roots to nurturing the sick. · Staying focus on the energetic-molecular basis of the health/dis-ease/disease continuum. · Not sacrificing painstaking studies of astute clinicians at the altar of double-blind, cross-over medical trials. · Not mindlessly using synthetic chemicals to treat disease caused by chemicals. · Not politicking for legislative and regulatory fiats to squelch competition from other healing arts. At Capital, our tribe of civilized medicine is utterly committed to true advances in our Star Wars medical technology. Those advances allow us to observe human suffering with increasing sophistication. Our high-resolution microscopes show us the vibrant dance of cells bathing in the fluids of life. Our high-resolution technology gives us windows to the true-to-life electron dynamics of the health/dis-ease /disease continuum. There are other examples of such technical advances in focus at Capital. At Capital, the essential spirit is not of leadership. It is of service. During the last six years, the primary difference between the faculty and students has been that the former were teachers without salaries and the latter taught while paying tuition. That has been the singular manifestation of the tribal spirit at Capital. At Capital University, our tribe of civilized medicine has a belief that all of our healing work must be conducted in the state of spiritual surrender to that higher Presence that permeates each of us at all times. For the mystery of healing will forever transcend the human faculty for comprehension. Integration in medicine is a matter of integration of the spiritual dynamics of the injury/healing/injury cycles with energetic-ecologic concepts of health and disease. And those concepts must be solidly grounded on sound biomechanical, morphologic and empirical observations. Majid Ali, MBBS, MD, FRCS (ENG) Formerly, Associate Professor of Pathology (Adj) College of Physicians and Surgeons, Columbia University, New York, NY 10023 References 1. Marchant Jo. Consider all the evidence on alternative Therapies. Nature. 2015;526:295. 2. Ali M. A Tribe of Civilized Medicine. The Journal of Capital University of Integrative Medicine.2001;1: iii 3. Ali M. The Principles and Practice of Integrative Medicine Volume I: Nature's Preoccupation With Complementarity and Contrariety. New York. Canary 21 Press.1998. 2nd edition 2005. 4. Ali M. The Principles and Practice of Integrative Medicine Volume X: Darwin, Oxygen Homeostasis, and Oxystatic Therapies. 3 rd. Edi. (2009) New York. Institute of Integrative Medicine Press. 5. Ali M. The Principles and Practice of Integrative Medicine Volume XI: 3rd. Edi. Darwin, Dysox, and Disease. 2000. 3rd. Edi. 2008. New York. (2009) Institute of Integrative Medicine Press. 6. Ali M. The Principles and Practice of Integrative Medicine Volume XII: Darwin, Dysox, and Integrative Protocols. New York (2009). Institute of Integrative Medicine Press.
  2. Avatar for Nicolas Grisouard
    Nicolas Grisouard
    I can understand that the human body and mind are complex systems and that modern medicine is barely scraping the surface when it comes to understanding it. I can agree that alternative medicine can trigger reactions of the body and/or mind that are not on the radar of doctors treating patients (although I don't see how this could be anything but dumb luck, but the author of this piece reads like it could agree with we). But what is the practical use of considering alternative medicines? If I was working at NHS, how could I make any decision in terms of funding or hiring about these alternative medicines? My own wet-finger estimate is that the number of alternative medicines is equal to the number of "alternative doctors" multiplied by the number of "alternative patients". In the absence of a robust scientific structure to support these medicines, uses and interpretations cannot be anything other than individual, even if "alternative treaties" exist. In this context, any initiative aimed at considering what can be learned from alternative medicines is bound to be long, extremely arduous and marginally productive at best. And to do it on tax payers' money and NHS work hours would be wrong on so many levels.
  3. Avatar for Jo Marchant
    Jo Marchant
    I agree, and I don't think we need big research programmes into acupuncture and reiki! But I think we should acknowledge that alternative therapies do help some patients (particularly those with symptoms like chronic pain, fatigue etc) and that instead of pretending this isn't happening, we should learn from it. This means taking seriously the role of the mind in physical health, and recognising that factors such as social support, empathy, expectation and mental imagery (all things employed by alternative therapists) can be therapeutic in their own right. I'd love to see more evidence-based research into how we can incorporate these kinds of elements into patient care.
  4. Avatar for Peter MetaSkeptic
    Peter MetaSkeptic
    So basically, people who defend science lack social skills and empathy. That's, pretty much, the common definition of sociopathy. I'm really sorry to tell you that you will not be on my list for Thanksgiving. P.S: When do people like you show empathy to people who defend science?
  5. Avatar for Mark Stidham
    Mark Stidham
    To paraphrase a highlighted quote, Alternative medicine always struggles to provide supernatural aspects of care. There is an abundance of science-based medicine that needs scrutiny and development. The scrutiny will help clarify sham science-based treatments from effective treatments and highlight directions for improvements. But it is criminal to dilute the science with the alternative. Furthermore, the alternative is both endless and unprovable; no magnitude of resource could address the directive to 'tease out the real active ingredients of these therapies.' There are no active ingredients! The Nature editor(s) who let this shameless book promotion into the journal should be dismissed.
  6. Avatar for Brian
    Brian
    Time that y'all got yourselves up to speed on paradigms and paradigm changes.
  7. Avatar for James Foucault
    James Foucault
    I am thrilled that Nature is finally giving Harry Potter the credit that he is due. Reciting spells in Reiki is just as powerful has Harry Potter's wand.
  8. Avatar for Michelle S
    Michelle S
    You might want to take a look at the studies at: http://www.centerforreikiresearch.org/ Just because Reiki cannot be measured by our current 'scientific' standards does not mean it is not useful or helpful. The most important thing to remember is that if it helps the patients, it doesn't matter what 'scientific' measurements say. So, why not have a quality Reiki Master work in this position and see how people respond. Isn't that what really matters? Not the 'scientific measurement' of such therapies? You might also want to look at the work of Bruce Lipton, PhD https://www.brucelipton.com/about , Nassim Haramein http://resonance.is/explore/nassim-haramein/ , Gregg Braden http://www.greggbraden.com/about-gregg-braden/ and others at the leading edge of modern science rather than relying on outdated scientific methods.
  9. Avatar for Alan Henness
    Alan Henness
    What can't be measured?
  10. Avatar for Jo Marchant
    Jo Marchant
    There seems to be a common assumption - held by many commenters below - that saying alternative medicines may help some patients (and that we should investigate and incorporate the underlying mechanisms) automatically means accepting or endorsing the dodgy principles on which therapists claim those treatments are based. But these are two very different things. To conflate them shuts down debate (with anyone who tries to raise the issue accused of "defending quackery"), and it blocks a line of research that might be helpful for patients. It also rejects/denies the experiences of the millions of people who feel that they have benefited from alternative medicine, which I think in itself risks undermining confidence in science.
  11. Avatar for David Colquhoun
    David Colquhoun
    I'm sorry, but your response shows that you are still not distinguishing between placebo responses (a real,if small, benefit) and regression to the mean (an artefact, with no benefit) . In fact there is no evidence that alternative medicines work on a subgroup of people. In fact there is very little evidence that any medicines work on a subgroup of people. May I suggest that before writing again on this topic, you familiarise yourself with the following ideas. (1) The statistical hazard of subgroup analysis (2) Regression to the mean (3) The distribution of the individual effective dose
  12. Avatar for Michal Svoboda
    Michal Svoboda
    I heartly welcome Jo Marchant's the article and, looking at the storm of hostility and missunderstanding below, I admire Jo's courage to come up with such a theme. Whether we like it or not, alternative therapies are here to stay and the only way forward is to embrace what is good in there and discard what is not. This can only be done using scientific tools and appropriate trial design and not much more has been said. Are we afraid to look in the telescope to see the spots in the sun? Unfortunatelly, for most "alternative" methods a treatment - no treatment design is more appropriate than placebo control. By the way, how would you deliver sham foot sole massage or reiki treatment? Or perform a sham meditation? This design definitely would not discern the "placebo" effect from the "net effect" of the treatment. But does it really matter? When in front of a patient, is our aim to tell placebo effect from that of reiki itself or to help the patient? Whenever a treatment providing a positive outcome while being safe is available, it should be made available to the patient. Last but not least, how long is that when we knew nothing about the role of gut flora in immunity, obesity, and even brain development? It is thus well possible a "real" physiological base for some treatments labelled today as alternative might be found... (by the way an article on possible explanation of health effect of massage has been published by this Journal).
  13. Avatar for E.K. FR
    E.K. FR
    A simple question: will the patient be informed of this lack of scientific evidence behind those alternative quackery when subscribing to such "spiritual healing" session? Will they be informed that "there is no evidence" and it is all based on the placebo effect? I am guessing not. What happened to the "informed consent" part of the patient's agreement to a health intervention? People don't choose to take drugs or undergo treatments in the hope that the placebo effect will cure them. We choose them because - while a placebo effect is a possible outcome - we hope for the scientifically proven, therapeutic effect to occur. This is especially troubling for mental health patients, not only because there is a lot of stigma associated with mental illness already prevalent in our society, but also because those "alternative therapies" put the burden of the outcome of a therapy on the patient. If you would only believe, you would get cured. After all, that is how a placebo effect works. But reversely, if you don't get cured, it is because your faith wasn't strong enough. "Mind over Body", indeed. And this at the same time that Nature publishes a fascinating article about the links between our gut microbiome and the brain. I'd rather the editors of Nature decided whether they want to keep publishing scientific news, or quackery adverts too, because this entire article reads like a sales pitch for the author's upcoming book.
  14. Avatar for Jo Marchant
    Jo Marchant
    Thanks all for further comments, but this isn't about whether to embrace magical thinking. Hiring alternative therapists is an approach some medical institutions are taking to a very real problem; my argument is that what's needed instead is evidence-based research into the role of the mind in health. That will take a shift in attitudes and some different trial designs - placebo-controlled trials are great for testing drugs but not appropriate for assessing psychological factors (for the reasons outlined in my article). It would be great to move beyond arguing about whether or not pseudoscience is good for medicine -- it's not -- and talk about how we can develop and provide the best, evidence-based care for patients with conditions (such as pain, fatigue, depression) that are not well treated by conventional drugs.
  15. Avatar for Peter MetaSkeptic
    Peter MetaSkeptic
    With all due respect, your approach has nothing to do with the scientific method. Astronomers don't call astrologists for help to understand the big mystery of the universe. Physicists don't call magnetic healers for help on how superconductivity works. California doesn't ask first nation people for a rain dance, and we can go on, and on... When conventional medicine doesn't work you may have to accept that there is no solution, even if it is about side effects. Your approach is very akin to those of religious people and Pascal's Wager.
  16. Avatar for Michael Weinberg
    Michael Weinberg
    A placebo is fake medicine by definition. It's unethical to sell people fake medicine like homeopathy, acupuncture, or reiki. People act like the placebo effect is some mysterious force but it really comprises several effects, including Hawthorne effects, confirmation bias, distraction, regression to mean, and other effects that can cause fake medicine to look effective. Quote from the article:
    Conventional medicine, with its squeezed appointment times and overworked staff, often struggles to provide such human aspects of care. One answer is to hire alternative therapists.
    In other words, the writer endorses hiring of fake doctors because real doctors are too expensive. What an absurd recommendation.
  17. Avatar for Brian
    Brian
    This isn't logical. If Reiki treatment produces a better outcome than ordinary treatment in particular contexts, as the article claims, then, whether of not we ascribe this to placebo, if nothing better is available, it makes sense to try Reiki. Refusing to do this, whatever the arguments for so doing may be, is to give in to dogma.
  18. Avatar for mikerbiker
    mikerbiker
    First consider whether it is ethical to sell a patient a fake treatment like reiki. It is not acceptable to lie to a patient. And while most practitioners of fake medicine like reiki really believe in their treatments, it's not acceptable to allow these practitioners to defraud patients.
  19. Avatar for Brian
    Brian
    'Belief in the treatments' would seem to be confirmed at least to the extent that patients do better under them, with reiki practationers, than under conventional treatment not involving reiki practationers. I'd throw the argument back to you, and ask whether it is ethical under those circumstances to insist that people be <em>denied</em> this kind of treatment. I might add that I don't see any<em> scientific</em> argument here against subtle energies or whatever, beyond the fact that science does not currently accept them, which is hardly proof (if physics has been forced to admit zero-point energy and 'dark energy', what might it have to admit next?).
  20. Avatar for Katie Hay
    Katie Hay
    Right, another answer is to just put more resources where they are needed in the current system... or even just hire trained, certified, counselors to talk with patients. There's no need to leap to the land of unsupported conjectures.
  21. Avatar for Alan Henness
    Alan Henness
    Secular Medical Forum rebukes NHS for advertising £22,000 spiritual healing job http://www.secularism.org.uk/news/2015/10/secular-medical-forum-rebukes-nhs-for-advertising-gbp22000-spiritual-healing-job
  22. Avatar for William Anderson
    William Anderson
    While it can be argued that orthodox medicine in its pursuit of safety, efficacy and economy may lag somewhat in its attention to comfort and support it is nonetheless wrong to encourage patients to espouse a range of irrational interventions which have no demonstrable superiority to cheaper and less dramatic options. The rational, the scientific, response is to better study and understand the support and comfort needs of patients and to provide those seamlessly alongside mainstream and at times admittedly distressing though effective treatments. That is where "integrative medicine" can be provided and not in the determinedly exploitative purlieus of those modalities which by definition do not work. Nature has done a great service by highlighting the siren songs being emitted from this bizarre social phenomenon.
  23. Avatar for Guy Chapman
    Show parent comment
    Guy Chapman
    Yes, give patients support, empathy and counselling, but do it without lying to them, sticking needles in them, or selling them magic sugar pills.
  24. Avatar for Katie Hay
    Show parent comment
    Katie Hay
    Exactly, it's like saying "there's a 15 ft. crack up the water dam? Oh, well this little piece of scotch tape will probably do the trick!" This is a known issue, there is a shortage of primary care doctors and a deficiency in training them how to interact with patients. We should be recruiting/training staff and refining methods, not allowing cookie aunt crystal to to baby sit.
  25. Avatar for Katie Hay
    Show parent comment
    Katie Hay
    I'd recommend also looking up Dr. Gorski's contributions to the Science Based Medicine blog https://www.sciencebasedmedicine.org/
  26. Avatar for Jo Marchant
    Jo Marchant
    It’s great to see such a heartfelt response to my article, but I'd like to clear one thing up – I’m not arguing that we should embrace magical thinking! Integrating pseudoscientific principles into medicine misleads patients, instills false hope, and undermines confidence in conventional drugs and treatments. My point is rather that to dismiss alternative therapies as having no benefit for patients (or to say that any benefit they do have is somehow worthless) isn’t helpful either. There’s plenty of evidence on the mechanisms and significance of placebo effects: studies by Fabrizio Benedetti in Turin and Ted Kaptchuk at Harvard are a good place to start. And there are lots of examples of large placebo effects in trials of alternative medicines. One is a trial of spiritual healing for chronic pain, carried out in 2001 by Exeter University’s Edzard Ernst[1]. He found no difference between real therapists and actors but patients in both groups improved dramatically, with some, Ernst said later, who “practically abandoned their wheelchairs during the study” (http://www.theguardian.com/society/2005/feb/15/health.medicineandhealth1). There’s also plenty of evidence from other fields that many elements of the care provided by alternative therapists can relieve symptoms and even influence physical outcomes. Massage suppresses inflammation while switching on genes involved in cell repair[2], for example, while patients who use hypnosis and positive imagery to relax while undergoing keyhole surgery suffer fewer complications[3]. Women who receive continuous support from a single caregiver while in labour require fewer interventions, from pain relief to surgery, and their babies are born in better shape[4]. In a trial of patients with terminal lung cancer those able to discuss their situation with a palliative care therapist not only had better quality of life, but lived longer[5]. Rather than rehearsing old arguments about “bunk” and “quackery”, my article is a plea to move beyond polarized positions, and to develop a rational, scientific approach that harnesses these effects to help patients. Instead of either embracing or dismissing alternative treatments, let’s study why they relieve symptoms so well, and integrate those principles into conventional medical care in an evidence-based way. That’s going to require some different trial designs. It’ll also take a shift in attitudes -- and funding -- away from a focus purely on drugs and physical treatments, towards accepting that our mental state is important for our physical health. In the meantime, should cancer patients struggling with nausea, pain and fatigue be offered reiki alongside their chemotherapy? For me, there’s no black-and-white answer – as with all medical treatments there are both risks and benefits. The risks could perhaps be mitigated by explaining to patients that any benefits they experience are likely to result from mind-body pathways. Either way, instead of responding with kneejerk insults, let’s consider all the evidence and keep the welfare of patients at heart. REFS: 1. Abbot, N. C. et al. Pain 2001; 91: 79-89 2. Crane, J. D. et al. Science Translational Medicine 2012; 4: 119ra13 3. Lang, E. V. et al. The Lancet 2000; 355: 1486-1490 Lang, E. V. et al. Pain 2006; 126: 155-164 Lang, E. V. et al. Journal of Vascular and Interventional Radiology 2008; 19: 897-905 4. Hodnett, E. D. et al. Cochrane Database of Systematic Reviews 2012; issue 10, article no: CD003766 5. Temel, J. S. et al. The New England Journal of Medicine 2010; 363: 733-742
  27. Avatar for Guy Chapman
    Guy Chapman
    Have you ever heard of Minchin's Law? By definition, alternative medicine either hasn't been proven to work, or has been proven not to work. The name for alternative medicine that has been proven to work is: medicine. Remember: for 2,400 years, people trusted that doctors were doing them more good than harm. For at least 2,300 of those years, they were wrong. It's only since the scientific method has been used to test hypotheses and discard those which are wrong, that medicine has started to meaningfully increase life expectancy. Some people cherish some of the nonsense that has been shown to be wrong, and that seems to be taken as a good reason to use it anyway. Just as well bloodletting and purging don't have the fan base of homeopathy or acupuncture, really. Bizarrely, it only seems to be medicine where this ridiculous view has any traction. Nobody is asking the government to use astrology as a tool in fiscal planning (apart from David Tredinnick, perhaps). But when people are sick, they want the shamen along for the ride as well as the doctors, just in case. Which would be fine, if it weren't for the fact that they then credit the shamen for their recovery. The successive rebranding of alternative medicine as CAM (i.e. legitimate complementary therapies we already used, plus nonsense) and then integrative medicine (i.e. integrating nonsense with real medicine in the hope of a halo effect) does not in any way undermine or obscure the reality. The thing that makes it alternative, is the absence of evidence. And that means it has no place in practice, for ethical and all kinds of other reasons.
  28. Avatar for Dana Ullman
    Dana Ullman
    It is very typical of skeptics of alternative medicine to view the world in black and white terms...such as the above statement. When you consider that the BMJ has reviewed approximately 3,000 treatments and found only 11% were found to be beneficial. (Ref: What conclusions have Clinical Evidence drawn about what works, what doesn't based on randomised controlled trial evidence? BMJ, 2015. http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html) Many skeptics of homeopathy have insisted that the NHS stop funding any clinical services by physicians who use homeopathic drugs, and yet, these same skeptics are typically silent about de-funding conventional medical treatments that are ineffective (and that are dangerous!). These same skeptics quote a recent report from the Australian government that deemed (incorrectly!) that there is no scientific evidence that homeopathic medicines are effective for any condition. However, these skeptics show “bad faith” by not acknowledging that this Australian report deemed ANY clinical trial to be “too small” if study was less than 150 subjects, and although there are numerous such trials showing beneficial results from homeopathic treatment, this Australian report deemed that unless there were three studies of 150 subjects each and that each trial had to be conducted by three separate groups of researchers, the studies were considered to be “unreliable.” For the record, the above mentioned review of research by the BMJ deemed 20 subjects (!) to be a relevant minimum number of subjects for reliability. Needless to say, if the Australian government's report used similar guidelines as those used by the BMJ, homeopathy would be determined to be an effective (and safe) treatment by numerous conditions. However, here is where serious biases against homeopathy and alternative medicines rear their ugly head...and show that "junk science" is created when strong biases exist...and "junk journalism" becomes rampant when such biases are hidden or not acknowledged.
  29. Avatar for Katie Hay
    Katie Hay
    It's not bias to look at the body of evidence, come to a conclusion. At this point it would be a waste of resources to pursue it further. It was examined, found not to work, and put aside. Imagine all the times any other pharma group tried to put out a drug that was just as or less effective than what's already out there. They get reamed, it's inappropriate, saying that homeopathy doesn't work and should not be funded or promoted as effective is equal treatment. The FDA doesn't have the authority to regulate it because of politics, and slowly nations willing to examine it in an official capacity have come to the same conclusions the rest of science has.
  30. Avatar for Dana Ullman
    Dana Ullman
    Wow...are you that daft? It IS bias to determine that any high quality study published in a high-impact journal should be completely ignored just because it has less than 150 subjects in it, This bias becomes additional obvious when the Australian government's report actually fabricated a reference for making this 150-subject minimum their "rationale." Further, the BMJ has determined that 20 subjects is reasonable. Obviously, Katie Hay is grinding an axe here or is simply writing about a subject for which she knows little or nothing. Then, for Ms Hay to say that the FDA doesn't have the authority to regulate homeopathic medicines shows additional ignorance. At this point, I hope that she apologizes.
  31. Avatar for Katie Hay
    Katie Hay
    I'm not sure it's truely ethical to allow patient's to be 'treated' with disproved methods. It's a multibillion dollar industry which tells people not to go see doctors and misleads them as to what the reality of medicine is. We must be dedicated to providing care with as little harm as possible, maybe means improving training given to our doctors, providing more staff, and encouraging longer consultations or discussions with medical counselors. Compare it to how many hospitals deal with religion, there is often religious counsel available, but it will rarely interfere with treatments, and ethics departments are there for hard decisions when necessary. This brings up issues like right-to-try laws, one of which was just struck down in California. Legitimizing fake medicine allows for people like Stanislaw Burzynski to take advantage of dying patients and their families, or chiropractors to manipulate infants' spines. It's a dangerous slippery path that doesn't end with someone drawing a line in the sand and saying "There, everyone will be happy with Reiki, what a wonderful compromise!"
  32. Avatar for Jo Marchant
    Jo Marchant
    Katie, these are valid points and I share your concerns. (Although I don't think it's entirely fair to discuss the risks of alternative medicine without mentioning the huge downsides of conventional treatment -- to pick just one stat, more than 16,000 Americans die every year from overdoses of prescription painkillers: http://www.cdc.gov/drugoverdose/data/overdose.html. With painkillers offering not so much benefit over placebo, is that ethical?) I don't think it's enough to say "no reiki" though without offering patients something in its place. Better training for doctors, more staff, longer consultations and discussions with medical counselors are excellent examples of what's needed, and that is exactly the kind of the shift in attitudes/funding that I'm arguing for. But I also think we should research exactly how these things help, and who/when, and whether there are useful therapeutic elements embedded in alternative treatments (maybe mental imagery?) that go beyond straightforward aspects of care. There are some great examples of this kind of research already happening, but the amount of funding/resources going into it is tiny.
  33. Avatar for Katie Hay
    Katie Hay
    That's comparing apples to oranges and ignoring underlying cause for that number, this is a multifactoral stat. involving chronic illness, mis-use of substances with actual biological effect, and risky treatment options to those running out of options, ect. It's ok to say there is room for improvements, and we are working on it, better drugs, and stricter doctor and patient compliance measures are two examples. Additionally, to say we need to examine all the evidence and then ignore the evidence showing that the alt med isn't what causes the largest placebo effects, but the human interaction, the ritual of it and attention toward the patient, is to be dishonest as to the reality of what our data shows. You are ignoring the big picture by cherry picking out studies, and even parts of the studies, all to apparently promote a new book. We have examined over and over again the effects of alt med such as reiki and acupuncture and understand how it works (you yourself repeatedly mentioned placebo effect and such), it doesn't effect hard outcomes only perception and has minor short-term effects. To say the risks and harms of acupuncture and other "treatments" is acceptable, when counseling and better doctor training could have the same effect, is down right unethical.
  34. Avatar for Alan Henness
    Alan Henness
    But if you want to talk about the downsides of conventional treatments, please only do so if you also detail the numbers of lives saved by conventional medicine, the number of people living longer and with a higher quality of life because of conventional medicine, the number of babies who survive birth because of conventional medicine and the number of those who are suffering less and in less pain because of conventional medicine. And then give the same numbers for reiki or other nonsense so we can make a proper comparison..
  35. Avatar for Alan Henness
    Alan Henness
    Jo To quote Ben Goldacre, flaws in aircraft design that doesn't mean magic flying carpets are a better alternative.
  36. Avatar for Jo Marchant
    Jo Marchant
    No, but we should definitely try to fix the flaws in the aircraft.
  37. Avatar for Alan Henness
    Alan Henness
    Absolutely. Meanwhile, should we work with magic flying carpet salespeople and mechanics who claim they have amazing products that are an alternative to using wings and engines that work just as well?
  38. Avatar for Peter Gerard Beninger
    Peter Gerard Beninger
    Nature had already joined the politically-correct chorus on issues such as immigration, climate, and feminism - it was only a matter of time before it absorbed 'alternative' (i.e. quack) therapies. The legions of snake-oil salespeople will trumpet this from their caravans, governments will put them on the payroll, and patients will continue to be duped on an ever-grander scale. Let me know when a reiki therapist can cure herpes, autism, or dermatomyositis - three eminently bogus promises made to my wife by a 'traditional chinese medicine practitioner'. This is not the top of the slippery slope, it's approaching the bottom, beyond which there is nothing but a huge, dark hole.
  39. Avatar for Lorinda weatherall
    Lorinda weatherall
    I find it strange that almost everyone goes on about how Alternative Medicine needs to be proven scientifically. The pharma giant Bayer didn't know for almost 100 years how aspirin worked - but it did. Now we know, as technology has caught up with investigating such things. In addition, given that most scientific data is being manipulated to promote the outcomes of the financial backer, I'd say 'science' is being corrupted. This article would tend to agree. http://pathwaystofamilywellness.org/Informed-Choice/half-empty.html
  40. Avatar for Alan Henness
    Alan Henness
    Ignoring for the time being your confusion between whether reiki works with how it might work if it did, when do you think science will manage to cathch up with reiki? And (assuming your premise is correct for the time being) are studies that have been done on quackery also being manipulated by vested interests? And if they are, does that mean they're even more negative than they are?
  41. Avatar for Dana Ullman
    Dana Ullman
    If we were to only accept as effective treatment those treatments that were found to be effective for randomized double-blind placebo controlled trials, virtually every surgical procedure would be deemed to be quackery...and that itself presents a compelling reason that we need to explore many ways to evaluate efficacy beyond placebo controlled studies. An additional issue here is that many physicians and scientists have considerable prejudices against alternative treatments which leads to significant misinformation about this methods. The misinformation on homeopathic medicine is a classic example. Many physicians and scientists assume (incorrectly) that homeopathic medicines are too dilute or even "non-existent" to have any biological effect. And yet, the American Chemistry Society's journal, Langmuir, published a seminal study of 6 homeopathic medicines that were diluted 1:100 six times, 30 times, and 200 times, and using three different types of spectroscopy, the researchers found significant amounts of nanoparticles of each of the original medicines. Ref: Chikramane PS, Kalita D, Suresh AK, Kane SG, Bellare JR. Why Extreme Dilutions Reach Non-zero Asymptotes: A Nanoparticulate Hypothesis Based on Froth Flotation. Langmuir. 2012 Nov 1. http://www.ncbi.nlm.nih.gov/pubmed/23083226 What is extremely compelling is that modern understanding of endocrinology and neurosciences is that many of our hormones and cell signal agents are known to operate at a similar nanodose level in which homeopathic medicines are now found to persist. Ref: Eskinazi, D., Homeopathy Re-revisited: Is Homeopathy Compatible with Biomedical Observations? Archives in Internal Medicine, 159, Sept 27, 1999:1981-7. http://www.ncbi.nlm.nih.gov/pubmed/10510983 20th century medicine seemed to assume (incorrectly) that large doses of pharmacological agents were the only way to elicit effective physiological responses, but we all now know of the dangers of this type of mind-set. It isn't hard to predict that the 21st century will explore how to utilize and optimize nanodoses of individually selected medicines for each patient.
  42. Avatar for Guy Chapman
    Guy Chapman
    It's perfectly legitimate to be "prejudiced" against treatments like homeopathy, whose core doctrines have been refuted for over a century. Readers of nature will be well aware that nanodoses are still detectable, whereas most homeopathic nostrums are diluted well beyond the point at which none of the active ingredient remains. Homeopathy uses non-doses, not nanodoses. No test can detect any difference between "remedies" as normally used, and no test has ever demonstrated any bioavailability at normal homeopathic dilutions. They will also be aware that there is no evidence at all that "like cures like" as homeopaths claim. This is not a general or even widespread principle, and is founded on a single incorrcet observation - the mistaken belief that cinchona cures malaria because cinchonism is "like" malaria, whereas in fact it contains quinine which kills plasmodium (obviously some homeopaths are germ theory denialists, but that is so obviously insane that they can be ignored). I suspect readers will also be aware that nobody other than believers ever seems to be able to produced the purported effects of which you speak. In practice, not one single outcome of homeopathy has ever been objectively proven to be incompatible with the null hypothesis. Oh, homeopaths like to claim that their trials produce effects beyond placebo (one component of the null hypothesis), but John P. A. Ioannidis has shown why their findings are false.
  43. Avatar for Dana Ullman
    Dana Ullman
    The above reply is a classic example of someone who has an unscientific attitude due to his denial of what research exists for homeopathy. For a clear example of this, my previous comment above made reference to a very respected scientific journal that published a study that confirmed the persistence of nanodoses of each of the original six homeopathic drugs, and yet, Guy Chapman wrote his comments as though he didn't even read the above comment, let alone the formal research. The bottomline is that people who say that there are "no active ingredients" in homeopathic medicines are either un-informed about good scientific evidence or they are actively trying to mis-inform others. And then, this same skeptic of homeopathy references the good work of Ioannidis, even though Ioannidis has never made any reference to homeopathy or homeopathic research. I am open to reading any such reference, though I am very doubtful that such exists. Instead, Ioannidis has provided extremely damning evidence for what is called conventional medicine, despite the truly incredible amounts of research funds devoted to scientific research.
  44. Avatar for Bob O Hara
    Show parent comment
    Bob O Hara
    I would guess that most people taking placebos also don't take conventional medicine - that's certainly true of clinical trials. As far as I'm aware it is possible to take both conventional and alternative therapies. In the specific instance of the reiki therapist, I would hope that they are told they have to work along side conventional medicine.
  45. Avatar for mikerbiker
    mikerbiker
    In a clinical trial, the subjects have informed consent and understand that they may receive fake medicine (a placebo). When was the last time a reiki practitioner told the truth: that reiki does nothing other than making people feel good about their lightening wallets?
  46. Avatar for Brian
    Brian
    Nothing other than making them feel better, isn't that the point?
  47. Avatar for Justin P
    Justin P
    Interestingly, Kaptchuk et al. (2006) found that placebo pills outperformed sham acupuncture (based on pain score) from weeks 0 - 5. Then from week 5 - 6 sham acupuncture started to outperform placebo pills (pain score 3.6 vs. 4.0 respectively). That doesn't seem to be a very large effect at all. For the Levin Score, placebo pill and sham acupuncture were neck-and-neck. For the Pransky score, placebo pill outperformed sham acupuncture the whole way through (higher scores = worse impairment). For the grip strength rating, placebo pill outperformed sham acupuncture the whole way through. Regardless, a single-blinded study.
  48. Avatar for Alan Henness
    Alan Henness
    And this, just published: In the pages of Nature, a full-throated defense of “integrating” quackery into medicine http://scienceblogs.com/insolence/2015/10/15/in-the-pages-of-nature-a-full-throated-defense-of-integrating-quackery-into-medicine/
  49. Avatar for Alan Henness
    Show parent comment
    Alan Henness
    "if it works for many" That's the moot point. What, precisely, does that mean and what's the overall (ie including the non-specific effects) harm-benefit balance?

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