Saturday, December 10, 2016

Reiki and Therapeutic Touch. Compare and Contrast.

capa_do_livro pattern

What? I’m not on vacation? I have to write a post? Crap.

Remember those college essays? Compare and Contrast two topics and fill a Blue Book with your wisdom. Do they even use Blue Books anymore? I always hated the fact they were wide, rather than college, ruled. Now it is all about using Word and Microsoft doesn’t have a Blue Book mode.

See? There can be human progress. In Blue Books if not in medical education. I was annoyed to learn that reiki was being offered for continuing medical education at one of my institutions. We have so little pseudo-medicine where I practice that duty rarely calls.

I could not let such an abomination pass without comment. So I fired up the interwebs to find my SBM post on the topic…only to find such a post does not exist. I did a podcast on the topic back in the early days before my SBM life. Who wants to listen to a podcast from 2008? I am not even going to listen to it in preparation for this blog post.

I needed to write a review on the topic, not only to send to those who are offering reiki for CME, but also for the wider world. Reiki, and to a lesser extent its identical twin Therapeutic Touch, are remarkably popular in integrative medicine clinics. And, of course, because the world needs more Mark Crislip™ even if I was recently described on iTunes as an:

arrogant, intolerant, obscene verbal bully.

It is nice to know people are paying attention. Maybe that should be my motto.

RATTing out the science

To make my life easier, when applicable I will lump the two pseudo-medicines together as RATT, Reiki And Therapeutic Touch.

RATT is a form of ‘energy’ therapy and, when it comes to ‘energy’, RATT practitioners are evidently great fans of the Princess Bride, but then, who isn’t?

Energy is, as us physics pedants like to point out, the ability to do work, and comes in many forms, from chemical to thermal.

The ‘energy’ of RATT (and all of CAM) is none of these energies known by science. It isn’t even dark energy. It is ‘energy’, man, and what Thomas Jefferson had in mind when he famously said

Ridicule is the only weapon which can be used against unintelligible propositions. Ideas must be distinct before reason can act upon them; and no man ever had a distinct idea of the CAM ‘energy’. It is the mere Abracadabra of the mountebanks calling themselves practitioners of reiki.

Jefferson would probably have been called an arrogant, intolerant, obscene verbal bully for a comment like that. ‘Energy’ deserves the scare quotes, much the in same way you know that ‘fresh’ fish isn’t really fresh. There is no ‘energy’ and if the scare quotes had a brain they would recognize the fact.

Yes. I had to do that. Must…Write…Awful…Puns.

This ‘energy’, be it in RATT or Traditional Chinese Pseudo-Medicine or Chiropractic, is undetected and undetectable by reality-based measurements. We can detect gravity waves but not the human energy field. My theory is that the ‘energy’ is propagated by vibrating (yes, there are vibrations) N rays. There must be a carrier by which these ‘energies’ are transmitted. RATT and N rays do have the same key characteristic: they are detectable by their proponents until the ability of the observer to fool themselves is removed.

There is always the chance, however remote, that there is a new form of hitherto unsuspected ‘energy’ that humans produce and can be detected only by humans, although by what anatomical structure is uncertain. It took a PhD physicist to demonstrate that N-rays were a figment of an overactive imagination. For therapeutic touch it required a 6th grader.

Most readers of SBM are aware of Emily Rosa who, in 6th grade, tested the ability of TT practitioners to detect a human ‘energy’ field with a simple and elegant protocol. They couldn’t detect the ‘energy’ and Emily got a publication in JAMA.

Not that such a study dissuaded TT practitioners. Like a dowser who can’t find water under controlled circumstances, the experience was not disconfirming of the intervention. Arguments were raised to the JAMA results but as best I can tell, TT proponents have never bothered to prove the basis of their practice.

So we have established that there is no human ‘energy’ as is understood by reality-based science and, even if there was a new ‘energy’, its proponents cannot prove it exists outside of their reiki box and the power of imagination.

So why does RATT even exist?

TT was, invented? discovered? pulled out of thin air? Just what to you call the process of producing works of fiction? Oh yeah. Created.

TT was created in the 70s by a Professor/RN and a “gifted energy healer”. Gifted? Says who? How does someone get the designation of “gifted energy healer”? I cannot imagine the steps required reach that lofty goal. Just imagine the recertification test. And a google search reveals a step above, the truly gifted energy healer. Somehow much better than a false, terrible energy healer.

I suspect that the popularity of TT derives from the urge in nursing to find a unique way to interact with patients that allows independence from physicians. And unlike much of quackademia, TT started at the quackademic hill top and then rolled down like, well you know the metaphor.

Reiki (bad spell checker. Not reeky. Yes more GOT, perhaps, but stop it) started at the bottom, in fact rock bottom.

Usui Mikao created reiki. After being unable to hold down a steady job he became a Buddhist priest and, after 21 days of fasting and prayer, hallucinating from hypoglycemia and sleep deprivation, it is said he came up with reeky. That’s about right. Most medical acupuncture courses for example, are about three weeks long. It doesn’t really take that much to learn most pseudo-medicines, much less invent a whole new system. DD Palmer seems to have put together chiropractic in a couple of days.

With a spiritual patina and Scientology-like levels, reiki does have the appeal, I suppose, of the mysterious and ineffable.

Homeopathic touching

To me the most amazing characteristic of RATT is, for the most part, the patient is not touched. Hands are just waved over the patient. Watch as a professor of nursing brushes flies off the, er, I mean balances the vibrational energy or some such of her client. Client. Doesn’t she mean mark? Just don’t watch while drinking milk.

And reiki? They seem to have the same creepy propensity of chiropractors for demonstrating on pretty, scantily clad, females. And what is it up with THAT? TT as Therapeutic Trump? Trump Touch?

But RATT is often the homeopathy of touch. Nothing there at all. No energy, no touch. Do not even have to worry about good hand hygiene.

Having a RATT session does look beneficial. Who wouldn’t want to lie down and relax during a busy day? An excuse for a nap is always welcome as long as the whole” inappropriate groping disguised as energy balancing” thing didn’t occur.

RATTy research

But the fact that RATT is a fiction wrapped inside a charade inside a fraud doesn’t mean there isn’t research. It just means the research stinks on ice. Meta-analyses suggest a lack of methodological rigor. As one reiki meta-analysis noted:

The serious methodological and reporting limitations of limited existing Reiki studies preclude a definitive conclusion on its effectiveness.

Although I would disagree about the need for high quality studies for reiki.

Another review, including therapeutic touch, suggested:

The methodologic limitations of several studies make it difficult to draw definitive conclusions about the efficacy of distant healing.

With a follow-up several years later suggesting:

Since the publication of our previous systematic review in 2000, several rigorous new studies have emerged. Collectively they shift the weight of the evidence against the notion that distant healing is more than a placebo.

I keep re-reading the last sentence to parse the meaning. If Hemingway had written the conclusion he might have said the evidence indicates that the effects of distant healing are due to placebo. And noted the dried and frozen carcass of a leopard.

With RATT trials, and in fact all pseudo-medical studies with no basis in reality, you want a good placebo control, you want to know if blinding was successful in the patient and, above all, you do not want a study that compares RATT to usual care.

As has been noted by Dr. Edzard Ernst, a study design that compares a treatment to standard care will ALWAYS yield a positive result, also stating:

They do not represent an honest test of anything, simply because we know their result even before the trial has started. They are not science but thinly disguised promotion. They are not just a waste of money, they are dangerous – because they produce misleading results – and they are thus also unethical.

And there is that whole prior plausibility problem. Sitting right at zero, it is as certain as the sun rising in the east that any positive study of RATT is going to be a false positive.

So I will mostly limit myself to studies that have a placebo control. Which oddly brings up this article, I suppose because it contains “No touch” in the abstract. Sometimes you have to wonder about PubMed.

And now the completely expected results

Reading these studies is partly for amusement, but I find as I age they also generate a bit of angst. About 75% of my life is over and it is a time to look back on what I have accomplished. The thought of having spent the prime years of one’s life immersed in a worthless pseudo-science is so sad.

RATT has been tried for a variety of processes for no rational reason, the old ‘when you have a hammer everything is a nail’ problem. RATT has been used for everything from agitation to carpal tunnel to, I hear, raising the dead, and the results tend to be all over the map, some positive but mostly negative. As is often the case with pseudo-medicine, the better the methodology, the less the effect.

A curious study with placebo is “Therapeutic touch for nausea in breast cancer patients receiving chemotherapy: Composing a treatment.”

Their placebo was:

the practitioner’s hands-to-patient’s body distance was different (more than 20 cm) and in fact there was no energy transfer.

No energy transfer! And they know that how? It was followed by the classic post hoc torturing the data until it confessed. Three different statistical analyses were used to generate significance, one for each table, for reasons never explained. Oddly placebo was better at decreasing the frequency of nausea but not noted as such. It is a study with opaque reporting at best.

In “Investigating the effect of therapeutic touch on the intensity of acute chemotherapy-induced vomiting in breast cancer women under chemotherapy,” TT was compared to placebo and standard care. Connoisseurs of SBM will not be surprised by the results.

…there was a statistically significant difference between the control group and the intervention group and between the control group and the placebo group (P < 0.0001). However, there was no significant difference between the placebo and intervention groups (P = 0.07).

TT had no effect on carpal tunnel compared to sham TT; but why would it?

The other hint as to the mechanism of Reiki is found in “Reiki’s effect on patients with total knee arthroplasty: A pilot study” where reiki was effectively compared to usual therapy except in the post-anesthesia recovery, were patients have little awareness as they wake up. Just what is expected in a placebo therapy.

I think one trial sums up the effects of ‘energy’ therapy best:

The findings indicate that the presence of an RN providing one-on-one support during chemotherapy was influential in raising comfort and well-being levels, with or without an attempted healing energy field.

A caring provider is what is needed to help patients cope; not a pseudo-medicine based on pseudo-science that only offers fraudulent placebo effects.

Reiki and Therapeutic Touch. Compare and Contrast. Mark Crislip

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