Nature publishes an article about alternative therapy

Very interesting decision from the one of the leading scientific publications to publish an article about Reiki therapy.

http://www.nature.com/news/consider-all-the-evidence-on-alternative-therapies-1.18547


[Edit: should be Nature publishes an article about alternative therapy]

31 comments, sorted by
magical algorithm
Highlighting new comments since Today at 5:22 AM
Select new highlight date

The article isn't so much about Reiki as about intentionally utilizing the placebo effect in medicine. And that there is some evidence that, for the group of people that currently believe (medicine x) is effective, the placebo effect of fake (medicine x) may be stronger than that of fake (medicine y) and (medicine x) has fewer medically significant side effects than (medicine y).

Placebo doesn't affect objective outcomes anyway.

Elaborate? I'm pretty sure that's not correct, at the very least when it comes to pain, immune system things, autonomic stuff, and possibly some musculoskeletal stuff.

I first read that idea from the Science-based Medicine blog. Here's an example:

We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed.

Let’s break this down a bit. First, they found that when you look at any objective or clinically important outcome – the kinds of things that would indicate a real biological effect – there is no discernible placebo effect. There is no mind-over-matter self healing that can be attributed to the placebo effect.

What the authors found is also most compatible with the hypothesis that placebo effects, as measured in clinical trials, are mostly due to bias. Specifically, significant placebo effects were found only for subjectively reported symptoms. Further, the size of this effect varied widely among trials.

Only few people are interested in studying placebos. However, there are a few papers (Gotzsche is one of the few).

Pain (or nausea) isn't an objective outcome anyway.

Sorry the misleading title and thanks for downvoting :D.The author goes much further than just ”utilizing the placebo effect”. The article is basically about endorsing alternative medicine. You can easily see this from the following quotes .

There are many shady arguments in 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.”

--> Just because there are challenges in medicine like overworked stuff does not mean alternative medicine practicioners should be hired.

”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.”

-->Dismissing alternative approach does not mean that the patient is leaved ”in need.” If the patient is in need the answer is not necessarily alternative medicine.

I have problems seeing the problem of utilizing placebo using evidence based medicine and at the same time NOT "hiring alternative therapists".... While acknowledging the limits of placebo.

The question is whether the word "placebo effect" is a good way to think about the issue or whether it's more sensible about thinking about maximizing healing of sick people.

Speaking as someone who finds that placebos cure my headaches as well as painkillers do, I dispute that that is the question. When placebos work, they are a method of healing. Of course, you may not consider headaches to an illness, in which case I will not object, but will only point out that medicine does deal with headaches, so shifting that part of your caseload to a placebo dealer should help maximize your healing of sick people.

"Speaking as someone who finds that placebos cure my headaches as well as painkillers do, I dispute that that is the question.."

You should consider regression to the mean and illusion of correlation.

I have. I have no evidence that either pain killers or placebos work in any sort of medical sense; I have clear evidence that swallowing a pill causes me to relax, resulting in a immediate reduction in pain. This is stupid, and I am working on eliminating the pill, but still, if this is what works, I will continue to use it frequently until I find something better.

I think one of the major reasons that people dislike the idea of placebos is because they think that they are being medicine. This has not been my experience. Placebos are better than medicine, because they work directly on your mind, and your mind (my mind, anyway) is sometimes too stupid to pay attention to medicine. I would have been better off, and a bit wealthier, if a doctor had realized this before trying the medical route.

Don't think of it as "causes me to relax", you're the one doing the relaxing. You already know how to do it without the pill too, just pretend you're taking it. And then pretend you're pretending. And then practice a couple of times until you can do it automatically and don't need to think about it anymore.

I have. I have no evidence that either pain killers or placebos work in any sort of medical sense; I have clear evidence that swallowing a pill causes me to relax, resulting in a immediate reduction in pain.

Do you take the pills with water, and if so, have you tried just drinking the water? I find that water reduces a great many pains for me, including headaches, muscle cramps, and digestive difficulties, so it wouldn't surprise me in the least if the effects you're observing are from water taken with both the pain killer and placebo.

I find that water reduces a great many pains for me

Have you tried just drinking more on a regular basis? If you find yourself constantly dehydrated, just fix it preemptively.

Have you tried just drinking more on a regular basis?

Yes, but since the presence of such pains is the main thing that tells me I've not had enough, it doesn't help too much. An amount that seems sufficient can be easily overwhelmed by say, some hard work and sweating, and/or the use of the car air conditioner to recover from said hard work. Giving a talk or just having a talk with someone can do it, too. So unless I over-drink some of the time, there will always be situations where I end up under-drinking, in the absence of some finer-gauge way to tell my hydration state. I do at least know now to start chugging after I give a workshop, for example. Before I figured out the hydration link, I used to spend many painful hours recovering after each talk I gave.

Unless you have kidney problems, the downsides of overdrinking seem to be very minor. The consequences of missing the right amount to drink seem to be strongly asymmetrical, given that don't you want to err on the side of more water?

don't you want to err on the side of more water?

Of course I do. In fact, most of my water consumption is forced, in the sense that I'm drinking without any sensation of thirst. That's the problem: I have little sensation of thirst, unless I'm already drinking. While I'm drinking water I can notice I'm thirsty, or at any rate, that drinking the water is pleasurable. But the rest of the time, I drink by forcing myself to notice that there's water in the 32-ounce glass on my desk and that I should drink it, or that the glass is empty and I should refill it.

But this doesn't help as much as you'd think, because my body doesn't seem to store the water for later demand, and just prompts me to get rid of it instead... then quickly becomes dehydrated again... all with no sensation of thirst except in certain extreme cases. But I can also get too dehydrated to function, without any sensation of thirst.

most of my water consumption is forced, in the sense that I'm drinking without any sensation of thirst. That's the problem: I have little sensation of thirst

I am keeping in mind the Typical Body Fallacy, but this seems entirely normal to me, at least for a city person with a desk job. I don't have and don't expect to have a sensation of thirst during a typical day. I wouldn't say that I'm forcing myself to drink, I just sip and drink intermittently throughout the day basically because I recognize that otherwise I will get dehydrated (thought still no actual thirst) by the end of the day.

because my body doesn't seem to store the water for later demand

Given how you were talking about pains, it seems to be a noticeable issue for you -- so maybe set up some recurring timers to, I don't know, sip 50ml every half an hour or something?

Given how you were talking about pains, it seems to be a noticeable issue for you

Yes -- it happens a few times a week, depending on circumstances.

Your advice would totally make sense if the baseline issue were that I'm not consuming enough water. But on a baseline day I consume between 1 and 1.5 gallons of water alone, not counting any water in the food I eat, or any other beverages such as almond milk. (I don't consume sodas, fruit juice, coffee, tea, alcohol, or really anything else.)

The problem is that sometimes, that 1-1.5 gallons isn't enough, and there are occasionally days where it's been not enough for a few days in a row, such that I end up running "a few quarts low". (I actually use my scale as another clue: if I've lost a pound or two from one day to the next, and my fat % is higher, then I know I'm dehydrating. But an hour or so difference in time spent sleeping can do the same thing to my weight, so it's not a very precise measurement.)

I don't know, sip 50ml every half an hour or something?

What makes you think I'm not doing that now? As pointed out elsewhere in this thread, my rate of water need is not constant. If I have a couple of days in a row where I underestimate how much I need to raise my intake to compensate for losses like having more conversations or physical exertion than usual (or the air conditioner running more to maintain the temperature inside!), then I will fall behind and experience dehydration symptoms. But if I try to consume more water as a matter of course, then that also disrupts my digestion, makes me feel cold, keeps me running to the bathroom, and so forth.

So, if you don't have some method for actually changing my body's regulation of water, I'm not interested. AFAICT I'm already doing everything that is doable with respect to changing my behavior around water consumption, given the lack of any reliable means for determining my precise water need, in a situation where both under- and over-consumption create health problems.

I'm going to tap out of this discussion now, as my original post was not a request for advice; it was an expression of curiosity about someone saying they experienced headache relief from both placebos and painkillers, making me wonder if it was water-related (since I have some experience of that).

But on a baseline day I consume between 1 and 1.5 gallons of water alone, not counting any water in the food I eat, or any other beverages such as almond milk.

That's an absurd amount of water (not from food) to be consuming every day.

Sorry. LW is populated by people with... different capabilities to manage their problems and it wasn't obvious to which category you belonged.

You may have a bad mental model of hydration -- you should probably not visualize it as being "I need 100 ml of water an hour to be perfectly hydrated". Your body can easily handle an extra cup of water without trouble, and has multiple buffer systems. If you are thirsty enough to gain any pleasure from drinking, drink. (Warning, this advice does not apply to alcohol and soda).

It is possibly relevant that blood pressure is related to hydration -- when your blood pressure goes up, your body reduces blood volume by removing some water from your bloodstream. If you find talks stressful and this raises your blood pressure, you may become slightly more dehydrated, and following this, when your blood pressure decreases, you will be "underblooded" -- which is to say, your body will have to get some water from somewhere to increase blood volume, or you will have less than ideal blood pressure. (This is a simplification). If this is a significant cause of your headaches, you might notice a correlation between having to pee (water is removed from the bloodstream into the bladder) and having a headache. However, it would be hard to test this correlation in an unbiased fashion.

Your body can easily handle an extra cup of water without trouble ... If you are thirsty enough to gain any pleasure from drinking, drink.

Beware the Typical Bladder Fallacy. ;-) (Or just the typical body fallacy.)

You seem to be assuming that I don't already force myself to drink water to this extent. I do. The problem is that there is no sensation that tells me I am "thirsty enough", most of the time. Or more precisely, there is very little correlation between my sensation of thirst and my level of dehydration. I can be thirsty and not dehydrated, but I can also be dehydrated and not thirsty, and slip from one state to the other without noticing. This means I have to use a drinking habit as a workaround, and also check for symptoms like nasal congestion.

If you find talks stressful and this raises your blood pressure

It doesn't matter what the subject matter is, or whom I'm speaking with; what matters is the total time I spend with my mouth open; I salivate profusely and presumably lose quite a bit to evaporation. Likewise, I sweat profusely from almost any amount of physical exertion. In general. In general, my body always acts as if it thinks it has plenty of water and should get rid of it ASAP, at least with respect to those systems that acquire or eliminate water.

Water conservation systems, on the other hand (like my nasal mucus and digestive tract) do seem to notice that I am dehydrating and act to conserve water!

So in general, I notice that my body is confused. ;-) Unfortunately, I'm not yet aware of any means by which I may resolve its confusions about water.

I do not take pills with water, but I have found that water, Emergen-C, and oral rehydration fluid do help in some cases, and I highly recommend them.

As far as I can tell, dehydration is a contributing cause to my headaches, but not the primary cause. Unsurprisingly, liquids help the most after I have been exercising.

Am I alone in thinking this should be in the Open Thread? /meta

(Sorry, I forgot to reference. These quotes are from Wikipedia.)

Through the use of this technique, practitioners believe that they are transferring "universal energy" through the palms of the practitioner, which they believe encourages healing.

It is based on qi ("chi"), which practitioners say is a universal life force, although there is no empirical evidence that such a life force exists.

Most research on Reiki is poorly designed and prone to bias. There is no reliable empirical evidence that Reiki is helpful for treating any medical condition [...]

Why does anyone still call reiki "therapy"?

What are you quoting? It doesn't seem to be the article.

It is based on qi ("chi"), which practitioners say is a universal life force, although there is no empirical evidence that such a life force exists.

It happens to be based on "ki" not "qi"/"chi". "Qi" (with the alternative spelling "Chi") is a term of Chinese medicine. Reiki is a framework by a monk of Japanse Buddhism.

Why does anyone still call reiki "therapy"?

The argument against it isn't that it doesn't produce effect in studies but that the studies are "poorly designed". Poorly designed studies that find effects are no reason to update against a framework working.

Sorry, I forgot to reference. The quotes are from Wikipedia.

Also, qi = ki.

Chinese medicine makes a bunch of statements such as that chi flows through meridians. If one is actually intersted in scientific criticism it's useful to directly address an individual practice like Reiki and not meddle it up with other practices that contain a bunch of different assumptions.

Catholicism makes a bunch of statements such that the bread and the wine used in the Eucharist literally become the body and blood of Jesus. If one is actually intersted in scientific criticism it's useful to directly address an individual practice like Anglicanism and not meddle it up with other practices that contain a bunch of different assumptions. /s

Based on what I've encountered, I've interpreted the Japanese version as being more broad and metaphysical (the power of friendship, Killing intent), whereas the Chinese version is more like Alchemy: not quite science, but sorta-kinda tries to be (Fengshui and TCM, but also conservation of energy and such). There is considerable overlap, since ki is literally qi filtered through Japanese culture, but I generally expect people who talk about qi to be more interested in the Alternative Medicine route, whereas Ki indicates one or more of anime fan / Aikido practitioner / practitioner of Japanese spirituality. (These are more probabilities than hard categories; Reiki is a good counterexample.)

whereas Ki indicates one or more of anime fan / Aikido practitioner / practitioner of Japanese spirituality. (These are more probabilities than hard categories; Reiki is a good counterexample.)

Chinese spirituality/meditation practices/internal martial arts like T'ai chi ch'uan and Qigong also use the concept of qi in that sense. In fact, all Japanese martial arts and spirituality/meditation practices derive from Chinese ones.

Qi, ki, prana, etc. are pretty much the same concept, also similar to traditional Western concepts such as pneuma (spirit), psyche/anima (soul), vis vitalis, and so on. People form all cultures noticed early on significant qualitative differences between living things, specifically animals (literally, "things with a soul") and non-living things, but without a scientific body of knowledge they couldn't precisely define what life was in a reductionist way, so they resorted to broad and vague notions of "life force", typically associated with breathing.

Today we have more reductionist definitions of life, typically involving reproduction and homeostasis while in thermodynamic disequilibrium, but we still struggle with a reductionist definition of consciousness.