Thursday, September 28, 2017

I suppose the short version is: "Never read any science coverage in New York magazine"

Let's see, since we started occasionally checking in with the science desk of New York magazine, we've seen questionable often lapsing into irresponsible treatment of autism, homeopathy, beds of healing crystals, magical heuristics and Gwyneth Paltrow's goop. [See here, here, and here] Now we can add manipulation of "energy" fields.

[As a general rule, I don't care much for the use of scare quotes, but what else can I do here?]

By now, pointing out bad science in a NYM article no longer justifies a post. Water is wet. To make this worth our time, we have to look at the specific ways that this piece personifies bad science journalism. In this case, Arianna Rebolini provides excellent examples of a number of genre defining traits.

1. The inexplicable encounter

Before reading something like this, one should probably put on and appropriately eerie piece of music, perhaps and appropriate soundtrack from Bernard Herrmann or (my personal favorite) Jerry Goldsmith. The inexplicable encounter is very much the stuff of movies. The seemingly rational journalist visits a guru or lies down on a bed of magical crystals and soon finds him or herself facing the mysterious, usually resulting in a quest for explanations:

Six months ago, when I walked into my first reiki appointment at a Santa Fe oxygen spa, I had only ever heard the word in passing, and I didn’t really know what to expect. The spa’s description spoke vaguely about healing and relaxation; I thought I’d paid for a massage. What I got was one of the strangest experiences of my life: an hour in which my practitioner waved his hands over me and blew smoke across my body, to which my body responded with warm tingling in my arms and hands, mysterious pressure on my chest, and uncontrollable tremors in my legs. It was unexpected, a little scary, and definitely not relaxing.

According to my practitioner, these sensations indicated an energy blockage being released; they were merely signs that the session was working. He told me my body was returning to its natural state, i.e. “nearly orgasmic” energy. But it didn’t feel orgasmic. It felt crazy. I tend to be a cautious believer, but even I couldn’t accept this as the cause and effect. I needed to know: what had happened to my body?

Side note: you have to admit there's a certain perfection to the "Santa Fe oxygen spa" detail.

2. "How can we say something is impossible when we understand so little?"

Advocates of pseudoscience frequently point out ongoing areas of uncertainty in medicine and other scientific research. The implicit and sometimes explicit message is that so-called scientists don't know everything about their own field so how can they question ours?

The National Center for Complementary and Integrative Health (NCCIH) lumps reiki, along with similar but distinct practices like therapeutic touch and Chinese qigong, within the category of “biofield therapy,” but any definition of “biofield” is maddeningly vague. The clearest description we have is from a 1992 conference, when the NIH defined it as “a massless field, not necessarily electromagnetic, that surrounds and permeates living bodies and affects the body”; however, the NIH has since backed away from that description. In an emailed statement, the NCCIH told me, “to our knowledge there is no current definition of biofield that has been determined by the NIH.” When I asked Miles for more clarity, she explained the NIH’s proposed term describes “the purported subtle vibrational field that surrounds and penetrates the human body,” adding that it’s still a working definition. To my understanding, reiki practice holds that it is the manipulation of this field which causes either physiological distress or allows self-healing. No scientific proof of the biofield exists.

According to [Pamela] Miles, this mystery around the biofield and, in turn, the underlying mechanism of reiki itself doesn’t negate the power of the practice. Indeed, medical professionals have a long history of using medicine before understanding its mechanism of action. Bayer released aspirin in 1897 and it became the most widely used drug in the world; we didn’t know how it worked until 1971. Scientists are still theorizing how anesthesia works. Ditto antidepressants. What’s more, Miles emphasizes, reiki, like meditation, is at its core a spiritual practice being used in medical intervention, and the mechanism of spiritual practice isn’t necessarily provable by scientific technique. But that shouldn’t have any bearing on reiki’s effectiveness, Miles argues.

Putting aside the part about not necessarily being provable by scientific technique and holding off on the meditation comparison until the next point, let's zero in on the part about using medicine before understanding its mechanism.

On the trivial level this is, of course, always true. There will invariably be unanswered questions about any complex process, particularly in the field of medicine, but when the system works properly, we have a general idea of how things work and, more importantly, strong evidence of a causal relationship. (And, no, placebo effects don't count. More on that later.)

3. There is an important difference between a hypothesis that is generally compatible with well-established principles and one that requires you to, for example, invent entirely new laws of physics.

We did talk about anesthesia here, but meditation may make for a more interesting example. This would generally fall in the alternative medicine category. We could go back and forth about its effectiveness and practicality for addressing various problems and conditions, but the broader assertion that thoughts, attitudes, and emotions could have direct (blood pressure) and indirect (quality of sleep) medical implications is not at all controversial. Therefore, the question is one of specifics. Does this special case work and if so does it suggest a productive line of treatment? This certainly puts meditation below anesthesia, which we know works and is highly effective in certain situations, but it also puts meditation above anything that relies on the existence of a "biofield."

4. When discussing fringy subjects, your main sources should not be true believers and interested parties.

Remember the Pamela Miles we mentioned earlier?

So far, the research cautions that reiki should be used in conjunction with, and never instead of, conventional treatments for conditions like pain, anxiety, or depression. But if reiki is to be used with conventional medicine, then there first needs to be clarity around what, precisely, reiki even is. Practitioners going rogue, blending multiple spiritual practices into something new and naming it reiki, muddies the already sparse data. One person who is working toward a singular definition of the practice for patients, practitioners, and medical professionals is Pamela Miles.

Miles, author of Reiki: A Comprehensive Guide, is the unofficial leader of the movement to legitimize reiki in the mainstream. Having practiced and researched reiki for over 31 years, Miles has published in multiple peer-reviewed medical journals, collaborated on NIH-funded medical research, taught reiki at medical schools, and spoken about reiki in the media. Though she doesn’t necessarily advocate for uniform regulation of the practice, she does emphasize the importance of continued research on its effectiveness, and for the education of those receiving it. When I described my experience to Miles over the phone, she wasn’t entirely convinced she’d call what happened “reiki” at all.

5. "Where there's the perception of the smell of smoke, there must be fire."

Testimonials and satisfied customers do provide a low level of evidence, enough to justify limited research, but not enough to stand on its own, particularly when both research and first principles strongly argue that there's nothing there.
But this is a service, often a pricey one (insurance rarely covers it, and treatment can cost up to $400 per session), and customers wouldn’t be paying and returning if they weren’t benefiting from it. That evidence is mostly anecdotal, seen in gushing testimonials by patients — like Anne in Rochester, New York, who said reiki gave her the “gift of freedom,” attributing a “release of depression, anxiety and feelings of abandonment” to the sessions. And there’s no denying that medical professionals are recommending reiki to patients or training as masters themselves. About 60 U.S. hospitals offer reiki sessions, including New York-Presbyterian, Memorial Sloan Kettering, and UCLA Medical Center; as of 2014, over 800 hospitals offer reiki training.

6. "Even if it's just the placebo effect, doesn't that count as helping people?"

The placebo defense is the last resort of the snake oil defender. Rather than backing away from the possibility that the pseudoscience treatment works, to the extent that it works at all, strictly through the power of suggestion, the advocate simply treats placebo effects as another kind of benefit. If the patient feels better, what else matters?
One possible explanation of reiki’s observed benefits might have to do with recent findings on placebos — that is, that the “placebo effect” might offer more opportunities for symptom management than previously thought. This research is led by Ted Kaptchuk, director of Harvard Medical School’s Program in Placebo Studies & Therapeutic Encounter. Kaptchuk’s past research has demonstrated what is now commonly known about placebos (that when delivered with a suggestion of possible side effects, trial participants will often self-report those side effects) but a recent discovery is more surprising. It turns out sugar pills can ease symptoms in patients even if those patients know they’re receiving sugar pills, and even if those pills are given without any suggestion about the results the patients might see. It suggests a holistic look at the experience of healing, a therapeutic element to the doctor-patient interaction in full.

There are a number of problems with the placebo defense, enough to demand a commitment of time I can't provide at the moment and a level of expertise that is well above my pay grade. Here, however, are a few of the more obvious points.

a. There are clearly serious ethical problems with any treatment based on misleading patients.

b. There are also serious ethical and practical concerns with promoting procedures that have no effectiveness outside of the placebo effect. It's true that the author repeatedly makes the point that this "energy manipulation" is not meant as a substitute for conventional treatments, but no amount of caveats will get around the possibility that some patients will forgo the necessary but unpleasant for the trendy and overhyped.

c. As a bit of a side note, advertisers have known about the marketing power of the trappings of medicine for easily a century. As had regulators (back when we had regulators) who imposed rules about models and spokespersons wearing lab coats. In response to this, there was an infamous commercial featuring a soap opera star in street clothes who started his pitch by saying "I'm not a doctor but I play one on TV."

d. Even if we limit ourselves to practical considerations, placebo-based approaches are problematic at best. With real medicine, we have an idea of how likely something is to work or stop working, what the signs of a change might be, and what to do in each of the different contingencies.

To sum up, this is yet another example of New York magazine not only flirting with pseudoscience, but doing so in a tired, standard narrative that would still qualify as bad writing even if it weren't such bad journalism. As we've said before, New Journalism started out by proving that great reporting also be great literature. Articles like this (and far too many others) remind us that lazy and dangerously misleading reporting often comes in the form of a wretchedly the shade story.

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