Another reason for me to weigh in is that Orac, it seems, is beginning to feel a little lonely and frustrated in his battle to restore scientific integrity to academic medicine:
I'm beginning to wonder if I should just give up this quixotic battle to try to insist on evidence-based medicine in academic medical centers. I'm clearly losing the battle, and sooner or later I'll be relegated to the sidelines along with the other dinosaurs who advocate scientific medicine over unproven, non-evidence-based therapies. If I were to join the Dark Side, I could probably attract a bunch of grants to fund clinical trials to look at whatever the woo du jour is. I'd never do that, of course, if only because as a former skeptic I'd represent a truly valuable scalp for the world of non-evidence-based medicine, but I feel as though I'm increasingly alone in holding out.
Yes, it must get a little lonesome. Out here in the hinterlands I can only wonder what’s going on in academic medicine these days. Is there anyone there for whom the standards of science mean anything at all? Well, there must be. There are plenty of people who teach and write about evidence based medicine. And how about the rising chorus of voices calling for the purging from academic medicine of the biased influence of drug companies? They claim to stand for scientific purity, so why do they (with the notable exception of Arnold Relman) remain silent about woo?
What conflicts of interest might be involved? It’s partly about money. Consumers demand woo and to an astonishing degree pay for it out of pocket. There’s also the ever more lucrative pipeline of government grants to promote and “research” woo. And, as Orac pointed out, there is the dinosaur phenomenon. Increasing pseudoscientific indoctrination of medical students over the last few years means changing priorities and values for the academic medical center as these students become faculty members. As the culture of the academic medical center becomes more and more steeped in woo it must be getting difficult to stand up for science. It takes courage to risk the dinosaur label.
So, for what it’s worth, I’m weighing in. As Orac points out, not only is reiki unsupported by evidence but, even worse, it’s utterly implausible. Its purported mechanisms involve a mysterious, undocumented energy which can traverse time and space provided the proper symbols are used. (That would be mighty handy if it worked. The reiki master wouldn’t even have to show up). Such credulity in academic medicine is astonishing. What’s going on?
At the University of Maryland, as well as, I suspect, other academic medical centers, there appears to be a new standard. Alternative medicine modalities, unlike pharmaceutical agents, no longer have to be evaluated with the measuring stick of science. A different standard has been adopted, one which was articulated by the University of Maryland’s own director of integrative medicine, Dr. Brian Berman, in his BMJ editorial from a few years ago. His statement is telling (emphasis mine):
When in 1992 we developed a complementary and alternative therapy curriculum at the University of Maryland we thought it was important to present the therapies in the context of their own philosophies and models of health and illness.
The Baltimore Sun piece quotes Berman as saying patients’ reactions to reiki therapy make it “ripe for study”. And I had to laugh at this:
At Shock Trauma, a clinical research study is under way to look at the effectiveness of acupuncture on trauma patients, to see whether it lessens a patient's reliance on drugs. A reiki study could follow, which might quiet skeptics who still wonder whether its power is little more than one of suggestion.
Well, I’ve got news for reporter Stephanie Desmon. It’ll take more than “a study” to quiet the skeptics and move reiki out of the category of extreme woo, especially considering the type of study that’s most likely to be conducted. In order to evaluate reiki’s energy based claims, and test whether it’s anything more than a relaxation technique it would have to be compared with those same techniques. It would require a control group of patients undergoing an equivalent form of relaxation, stripped of the name “reiki” and all its associated energy and religious woo. It might also be necessary to blind patients to the fact that there is a comparison group. (Suppose you told the control patients they were only receiving “reiki light” and being compared with patients getting the real thing. What would that do to the placebo effect?). Suppose reiki demonstrated a positive effect. What then? Well, reiki is an extraordinary claim. The results would need to be duplicated at other study centers, preferably those (if they exist) which have no interest in promoting woo. If a robust effect were observed repeatedly then the basic scientists would need to get to work in search of a mechanism.
Like Orac, I lament the fact that woo seems to be running rampant in academic medicine. I know there are leaders there who share my concerns. I hope they’ll comment here. I’d like to know why they remain largely silent and what, if anything, they are doing to stand against this trend in their own institutions.