I get comments on my blog. Since there was so much to address with this particular one, I decided to turn it into a separate post.
“This post should be titled, "Attack of the Straw Men."
No, I prefer it the way as is. What I don’t think the world needs more of is condescending platitudes.
“…you're mixing apples and elephants. Hypnotherapy, guided visualization and biofeedback (essentially relaxation therapy) are qualitatively different from Reiki, acupuncture and chiropractic (magical thinking in lieu of any plausible scientific basis.) Lumping them all together is a "Trojan Horse" strategy, per Orac, via Dr. RW (see comments section from this post for the full quote)”
Not sure who put Dr. RW in charge of all convening opinions, but according to Panda and others, this is an all or none proposition. It’s either science based medicine or it’s hooey – there is no in between. Now I’m being told that some alternatives are now suddenly deemed “okay” by the medical community – going so far as to question why they were even called “alternative” in the first place? I don’t believe this for a minute. Acceptance from the medical community comes in degrees, and it’s based solely on the fact that some methods are easier to swallow than others.
You’re now giving Biofeedback its due? Why? It’s mind/body medicine, after all.
Biofeedback as taken from the Mayo Clinic:
Biofeedback is a type of complementary and alternative medicine called mind-body therapy. It's designed to enable you — in mind-over-matter fashion — to use your thoughts and will to control your body. Biofeedback is based on the idea, confirmed by scientific studies, that people have the innate potential to influence with their minds many of the automatic, involuntary functions of their bodies.
Guided Imagery (visualization), as defined by Web MD:
Guided imagery is a program of directed thoughts and suggestions that guide your imagination toward a relaxed, focused state. You can use an instructor, tapes, or scripts to help you through this process. Guided imagery is based on the concept that your body and mind are connected. Using all of your senses, your body seems to respond as though what you are imagining is real.
Hypnotherapy as defined by University of Maryland Medical Center:
Hypnotherapists typically use exercises that bring about deep relaxation and an altered state of consciousness, also known as a trance. Many people routinely experience a trance-like state while they are watching television or sitting at a red light. A person in a trance or deeply focused state is unusually responsive to an idea or image, but this does not mean that a hypnotist can control his or her mind and free will. On the contrary, hypnosis can actually teach people how to master their own states of awareness. By doing so they can affect their own bodily functions and psychological responses.
This is mind/body medicine, folks, alternative medicine. And this is okay with you? I find the irony staggering. There is no more “science” to these alternative healing methods than there is with acupuncture, reiki, and chiropractics. The only way to determine the level of healing is asking the patient how he feels. By all admissions, this isn’t acceptable.
I’m confused as to how guided imagery can be easier to accept than Reiki, acupuncture, or chiro. At least with chiropractics, you have the benefit of x-rays. It’s pretty easy to see if a disk or hip is back in place after the course of treatment.
The truth of the matter is that the fraction of docs who don’t believe alternatives have any place in medicine have never done the research. They go to the sites and literature that only support their bias. How can I make such an inflammatory statement? Because of the many docs I researched who do use integrative medicine in their practices. I’ve been told time and time again that the literature is out there. It’s just that the docs aren’t listening. Or they’re being selective.
A key issue is that when looked at scientifically, the data you speak of for
Then why and how is it that biofeedback, hypnotherapy, and guided imagery get a pass, according to Orac and Dr. RW. They’re alternative medicine, no matter how one tries to justify it. You simply cannot rewrite the rules to fit your needs, and that’s exactly what it sounds like you’re doing.
The "respectability" of those promulgating it is irrelevant.
Are you kidding me? First I’m told that “some” alternatives are okay. Now you’re telling me that the opinions from respected and renowned docs who utilize integrative medicine in their practices are irrelevant. Why are their opinions irrelevant? They earned their reputations because they were recognized as being superior at what they do. This appears to be a case of, “I don’t like what I’m hearing on this particular issue, so I’m going to dismiss it, regardless of who said it. But, boyo, his opinions on heart valve surgery is bang on.” This is talking out both sides of your mouth.
Basically this comes down the fact that many docs will never see eye to eye on the integrative issue. The methods of dismissal are akin to politics – if one talks it up or down enough, it becomes real “because I say so.” That’s not reality, and thankfully, there are many, many docs who disagree with you because they’ve had success with alternatives and use any number of those methods in their practices - including Reiki, acupuncture, and stuff I've never even heard of. The face of medicine is changing to include other forms of healing.
As I've said a million times, I would never proscribe anyone turning their backs on their docs. But I don't believe that docs know everything there is about how the mind and body integrate in healing. Some things are, indeed, seemingly magical because there's no science that can back it up. But that doesn't make it irrelevant. It makes it compelling.
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7 comments:
Uncle.
Such hash. Opinions are like bellybuttons - everybody has one. It's painfully easy to find a published opinion to mirror one's personal beliefs. But it doesn't make them right. It makes them unwilling to research the other side.
Lynn, I both agree and disagree. You address an issue that has been muddled by many, especially when we define our medicine with 'labels'. allopathic vs alternative, traditional vs complimentary. It's all so confusing?!? Because of this there are some people who take a strong stance over the 'labels', when what is needed is BALANCE (referring to one of your previous posts)
As an example, for years I have seen patients with a relatively common, but often misdiagnosed condition known as vocal cord dysfunction. (sadly I lack the ability to place links but if you google it there are some good definitions at eMedicine etc). Anyway, therapy for these patients often involve things like biofeedback, relaxation techniques etc. Personally I have never considered this to be complimentary medicine or alternative medicine, just the appropriate treatment for this patient with this type of condition.
The question then arises, should those therapies really be labeled as complimentary or alternative? Personally I don't think so. There is an excellent article in the NEJM on this topic and serindipitously this topic is also a recent post on Oracs blog, 'Respectful Insolence'. But the article can be found here:
http://content.nejm.org/cgi/content
/full/339/12/839
Here is a quote from that article:
"...since many alternative remedies have recently found their way into the medical mainstream [there] cannot be two kinds of medicine - conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted."
Certainly the things you mention such as biofeedback, guided imagery have been shown to be helpful in treating certain conditions and as I have said I often refer patients with VCD for biofeedback with good success. To me it is "Medicine".
Part of the problem is that things that have no evidence of benefit or effect are often lumped into this label of complimentary or alternative, such as homeopathy, which has never shown any benefit above placebo in the relatively few well-designed trials that have been done. (Ofcourse placebo has been discussed recently as well).
The problem is that many MDs, including myself, sometimes view this label of CAM or alternative medicine as being more 'snake oil' and homeopathy than anything else. To me massage therapy, biofeedback, and Chiropractic medicine can be useful in appropriate patients.
As another example, my wife has scoliosis and often suffers from backaches, instead of taking a lot of pain relievers she will get a massage or has seen a Chiropracter and has good relief without using systemic pain relievers. Again, to me this is traditional medicine and not alternative. It has benefit in treating these conditions. Now, if she went to see a Chiropracter to treat diabetes or kidney disease, I would have trouble with that.
I probably could go on but I think it's best to stop here.
Kindest Regards
Mark, I can’t disagree with anything you’ve said, and I really enjoy hearing your thoughts. If any of my family members thought a chiro could cure cancer, I’d shoot them out of a canon. The same goes for any of my family who believes that Reiki can cure cancer. It very well may, and I have seen cases where this has happened. But to depend on it as their sole treatment is putting them at extreme risk. That’s why I’m a huge proponent of integrating these alternatives into mainstream medicine.
Which brings me to your point about labels. The various labels came into being from the medical community as a way of distinguishing (and often ridiculing) the differences between petrie dish science and methods that had more esoteric leanings.
What’s interesting about the post from Orac’s blog is that it wasn’t that many years ago that biofeedback and guided imagery were scoffed at just as much as Reiki or acupuncture. Interestingly enough, acupuncture is now earning its chops more and more among docs. Suddenly biofeedback is being called mainstream medicine. I remember the days when docs laughed them out of their zip code.
“Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.”
So it boils down to the acceptance factor – what are docs willing to accept and, therefore, test? If they like it, they absorb it into the medical paradigm. I applaud this. However, some things seem too far out there, and I sympathize. When I first heard about Reiki, I laughed my fool head off. But it was part of my research for my book, so I slogged through.
But how many docs are researching Reiki and its potential benefits? I’m betting not many due to the WTF? factor. It’s a new concept to the medical community, and I’ve noticed that the medical community fears anything new that they can’t explain. Instead, they rely on Quackwatch, which has its own agenda, and the scant results listed in the NIH database. No one goes over to GW Center for Integrative Medicine or The Continuum Center for Health and Healing. Instead, they stick their heads in the sand and denigrate what they aren’t ready to understand – just as they did with guided imagery and biofeedback.
In these cases, few appear to be ready to perform the rigorous tests to determine its safety and effectiveness.
"So it boils down to the acceptance factor – what are docs willing to accept and, therefore, test? If they like it, they absorb it into the medical paradigm."
"But how many docs are researching Reiki and its potential benefits? I’m betting not many due to the WTF? factor."
Here is where you and I may disagree.
Yes it does boil down to an acceptance factor and data to support. Interestingly it is well documented in the medical literature that it can take as long 10-20 years before well researched proven medical therapies are incorporated into mainstream medicine. A prime example of this is the use of inhaled steroids in medicine, it has been standard of care for well over 20 years now and yet I still see the occasional asthmatic not being treated appropriately. Certainly a lot less than I did 10 years ago however.
Who should do the research? A very good question, but why not the practitioners of Reiki, shouldn't they be responsible for supporting the claims they make?
I am a Pulmonologist and I research asthma, my Cardiology colleagues typically research questions that relate to Cardiology and so on. If Reiki is as good as it is touted it should then be very easy to set up a Well-designed clinical trial to prove it, and who better to do that than the actual people performing Reiki.
If a pharmaceutical company tried to pass off a drug that hadn't been tested and it turned out not to have any effect then you can bet the lawyers would be all over it. As is recently being played out with the Vytorin study,although it did what is was supposed to do (lower cholesterol) it didn't have any effect on preventing heart disease (not absolutely correct but the jist of the study).
Shouldn't these therapies be held to the same standard we uphold for all our healthcare? Granted, it is not perfect, science is not always perfect, but it does change with time as our knowledge increases and we abandon therapies that are not effective. Before science we had treatments such as bloodletting and trepanation, research showed that these were ineffective therapies. Bloodletting was performed into the early 1900's, thats not that long ago in the grand scheme of things.
As I have mentioned before, if one of my patients came to me and said he/she was using Reiki or Acupuncture to treat their asthma, I would be fine with that as long as they continued to treat their disease with appropriate medical therapy and I would continue to do what I always do with them, which is to find the lowest dose of medication to control their symptoms or add on medication if their symptoms are not well controlled. I would also hope that these practitioners were in the process of performing a well-designed clinical trial to support their claims.
How do they get the money to run these trials you might ask? Well the NIH has an entire study section devoted to Complementary and alternative medicine.
I have written about it on my blog in the past but more as it relates to supplements.
http://mouseasthma.blogspot.com/2006/10/alternative-tails.html
As usual, even if we disagree, I still respect your opinion.
Mark’s tails asked:
Who should do the research? …why not the practitioners of Reiki, shouldn't they be responsible for supporting the claims they make?
As always, you ask great questions. Absolutely Reiki practitioners should provide compelling data, and they are in the works of doing exactly this. Since I’m not involved in any of the data gathering, I’m keen to find out how they plan on providing compelling data that will satisfy the medical community.
For example, it wasn’t that many years ago that biofeedback and guided imagery were dismissed as befitting the granola-eating bunch and had no place within medicine. I couldn’t have been more surprised to read that this was no longer the case - depending upon who you talk to since I know many docs who still think it belongs in the Outer Limits. But Orac’s article quoted a source as stating these modalities had been incorporated into mainstream medicine so they were, therefore, no longer deemed strange. Now I don’t know who provided the data for these studies – whether it came from biofeedback engineers and guided imagery therapists or from doctors who performed the studies.
If Reiki is as good as it is touted it should then be very easy to set up a Well-designed clinical trial to prove it, and who better to do that than the actual people performing Reiki.
I agree, and for all I know, this is what is going on right now at Arizona State University, the Contiuum Center for Health and Healing, and GW Center for Integrative Medicine, and other campuses around the country. It should be interesting, to say the least. I see the problems with “proof” as tough with Reiki as I do with guided imagery. However, if the studies done on guided imagery were convincing enough to sway the medical community, then I daresay Reiki will find it’s place – provided the medical community can overcome their “ew” factor.
Shouldn't these therapies be held to the same standard we uphold for all our healthcare?
Absolutely. But it’s tough to test these modalities with mainstream standards because they weren’t created in a lab. They are nonscientific and intangible. The only information we have at our fingertips is patient outcome. Do they feel better? Is their blood pressure lowered? Are they now stress-free? Somehow we have to develop a standard unit of measure that will satisfy the medical community. Sure wish I knew how they did this with guided imagery.
It’s a bit like love. We know love exists because a huge populace has experienced the same symptoms – racing heart, wobbly knees, sweaty palms, etc. due to elevated dopamine, norepinephrine and phenylethylamine levels. But unless you’ve been in love you’re reduced to accepting that these hormone levels actually mean something. I’ve been married for 29 years. While I’m still madly in love with my husband, are those levels still off the charts? If not, what can be hypothesized? I’m I no longer “in love”? But I digress…
You talked about how therapies should be held to the same standards for all our healthcare, and I agreed. However, there is something interesting going on. I’ve seen docs whose patients have come to the end of the line with mainstream treatment recommend an alternative method – methods that still don’t fall under the mainstream standards.
One such doc at CHOC had a little guy with Neurofibromytosis, Type 2. There wasn’t anything more he could do and ended up recommending an acupuncturist who was successful getting the kid off nearly all his meds and slowing down the growths. I remember asking the doc why he did this. He shrugged and said, “What was I going to do? Let him go downhill and let him go deaf and blind? There wasn’t anything more I could do. This was a last ditch effort.” I commented that his action made a huge difference in his patient’s quality of life. He smiled, “I’ve thought about that more than once.” “Even though it’s not mainstream medicine?” I asked. “What did we have to lose?” he replied. “Acupuncture has no side effects, and I kept a close eye on the treatments at every turn.”
The thing that really brought this all home for me is that the mother would have never gone to an acupuncturist had her doc not recommended it. She didn’t believe in alternative medicine, but put her faith in her doc – rightly so. So the fact that this doc thought outside the box made a huge difference in his patient’s outcome. Was it a guarantee? No. But, as he said, what did they have to lose? This, to me, is compelling.
As I have mentioned before, if one of my patients came to me and said he/she was using Reiki or Acupuncture to treat their asthma, I would be fine with that as long as they continued to treat their disease with appropriate medical therapy and I would continue to do what I always do with them, which is to find the lowest dose of medication to control their symptoms or add on medication if their symptoms are not well controlled.
Agreed, this is appropriate and safe medicine. But what would your reaction be if your patient no longer required the meds you were prescribing? This happened to me twice. Long story short, I discovered I couldn’t tolerate my meds (Ritalin and ogen), and the only changes I’d made was that I’d had some Reiki sessions – of which I was an ardent skeptic at the time. My docs did tests and determined that I was one healthy dog and didn’t need any further meds. They were fascinated and puzzled, as was I. Because of that, my opinion regarding Reiki changed 180 degrees. If this happened to one of your patients, would you find the results compelling?
I'll make sure to get over to your blog.
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