Thursday, January 14, 2010

WOO......Why it may work and why science cant prove it.

I have been blogging for about 3 yrs now and have listened to many people talking about health care. In many instances there is a side that is very much againsnt what they called "Woo" or "alternative" therapies. By this, they mean many of the touch based therapies such as, Acupuncture, Reiki, Therapeutic touch, Chiropractic and also my profession, Massage Therapy. It seems that unless science conclusively backs up certain treatments then many of these individuals want nothing to do with it. If there is some anecdotal evidence showing some success they many times pass that off as just a "placebo". I wonder though, whats the difference if your pain relieved by placebo or a drug? Also isnt it common that many of the drugs only work for some people and not all? Why is it that someone would feel more certain of a therapist using ultrasound for a muscle strain when many times physical touch has the same benefit. I believe this belief system actually has hurt much of our health care system and is in dire need of an overhaul.
I am going to point out that there are many things that science(to this point) is unable to accurately measure. So because of this I believe that many of these so called "Woo" therapies are actually beneficial and vital to our health.
When assessing these touch based therapies is it possible to account for many of the emotional factors that come into play when being treated?

Empathy
Trust
Compassion
Nurturing

If any or all of these emotions are not outwardly apparent to the patient, wouldnt it stand to reason that they may be hesistant or resistant to the therapists performing their treatment? And if so, wouldnt that factor in to the quantifiable results of the treatment? How from a science perspective do we measure these powerful forces? It is similar to friendship. Why are some people our friends and others are not? How do you scientifically measure it? So, is it more likely that a therapist that is trusted and liked more capable of getting better results than one that isnt?
There is another area I believe to be beyond science(at this moment), and that is the calibre of treatment being performed. There are multiple reasons why this may be the case when a therapy is being applied.

Pressure
Awareness
Body Type
Sensitivity
Technical Skill

A major factor that plays into my profession is the skill of the therapist and the response of the patient. What I mean by this is that many patients that I see dont respond to my techniques but do respond to another therapist. Does that mean I am not a good therapist? Of course not, it just means I am not the "right" therapist for those individuals. Now I ask you this, how would we be able to measure this scientifically and have it relatable to the therapy rather than the therapist? It has been very apparent to me in my profession that certain individuals respond to certain techniques. There are so many factors that play into this that I wonder if it is even remotely possible(at this time) to scientically measure it.
If I go see any of these so called "Woo" therapies with pain and I leave feeling better and my life returns to a relatively normal existence, I dont really care whether science says that is "real" or a "placebo". All I know is that Im pain free. Im sure there are millions of people who would agree.
For all those that dont, I suggest you get a Massage and Chill out(science agrees with that one).

14 comments:

Ian said...

Well I think you're right and wrong.

There's nothing wrong at all with taking benefit from placebo. Placebo is basically a catch-all term for a range of non-physiological effects. We've come to view it as somehow wrong. But placebo is instinctive. Not a day goes by without our son receiving placebo treatment from my wife or I.

So to say that other modalities work via placebo (i.e. they have no direct physiological effect) shouldn't be a problem. But in my experience those who promote altmed treatments aren't comfortable with calling them placebo.

So they posit that there's something more going on. Acupuncture changing the flow of Qi, homeopathy generating a sympathetic reaction, and so on. And those things we can measure, easily*, and they don't check out.

But does acupuncture or homeopathy work? You betchya, it works by the same placebo effect. It has nothing to do with Qi, or placement of needles or the substance that started out in the dilution. Those things you can, very easily, test for and measure, irrespective of skill of the practitioner. And again, they don't correlate.

What's a shame is that we often pharmacize conditions that are self-limiting where placebo treatment would be the stand-out best and most cost-effective way of treating. We do that because both sides of the altmed debate are scared of the word 'placebo'. So no reasonable effort goes into understanding it, improving its effectiveness or using it for its own sake.

Instead there's this phony war between those who claim their treatment isn't really placebo but actually has some intrinsic effect and the scientists who show that it has no such effect and then casually dismiss it as 'placebo'.

And that false-arguing is dangerous because, by being anti-evidence about these therapies, it has created a culture of anti-science in medicine. And that, unfortunately, allows those with very dangerous views (such as those who advocate refusal of chemotherapy for cancer, or discourage vaccination of children, or who try to promote homeopathic prophylactics for AIDS) to exploit a culture of suspicion.

* Incidentally you seem to have a pretty poor view of what can be measured. Every one of your 'can it be measured' has the answer 'yes'. I'd love to expand but this comment is unwieldy already.

Tit for Tat said...

Ian

Thanks for the response. I am sure I have a "poor" view of many things. I would love to see how we can measure most of the things I mentioned. Considering our views on many things are constantly evolving(even the physiological response stuff). Im curious Ian, do you not believe that acupuncture can affect our physiology in certain conditions? For benefit that is.

Ian said...

Poor - sorry, that might be a transatlantic english thing. I meant 'a poor view' as a 'low' or 'not very optimistic', rather than 'bad' or 'fallacious'.

Acupuncture - I think, in principle acupuncture could have a beneficial physiological effect, yes. But so far no studies that have controlled for it have found one. Those that don't control for it find a strong effect. Which is consistent with the effect being entirely or mostly placebo (i.e. the best you can say is that the physiological effects don't form the majority of the benefit).

Talking about your practitioner skill, for example, one recent study used random locations for acupuncture and found no significant difference in response. If acupuncture is entirely placebo, then you'd expect it to be dependent on the skill of the practitioner, not their knowledge of the correct insertion locations, their ability to skilfully maximise the placebo effect.

In my experience of altmed, good practitioners are in a whole different league to most regular doctors when it comes to reinforcing and enhancing the placebo effect for their patient's benefit. That, alone, should be worth learning from. imo.

Harvey said...

Even if we accept that massage therapy (cited only as a current example of myriad "altmed" therapies) can have a demonstrable positive effect, it is not subject to the same strictures or requirements as are traditional therapies to be accepted for public "consumption". All forms of "contact" traditional medical interventions require
1) Practitioner evidence of required (by law) training and aquisition of knowledge,
2) documented evidence that the therapy in question most often produces the desired or needed result (efficacy), and
3) That there are no unknown potential harms to be expected, unless the patient is made fully aware of the risk/benefit ratio. Whereas I am willing to agree that there are probably very few complications or injuries to be expected from massage therapy (again, only as an example) and, I suspect, that such therapists must meet certain criteria as to training and skill (i.e. licensure), the benefits of such treatment cannot be predicted with any asurance (witness the fact that some patients only benefit from identical "therapy" when they have found the "right therapist").
If we extrapolate these considerations to many other "altmed" interventions, some of which actually involve invasive procedures and/or ingestion of materials whose safety and efficacy are subject to much less stringent controls than are "traditional" medications, the problem presented by our inability to document outcomes for many of these should be obvious.
Beyond these considerations, I have no problem with patients seeking alternative therapies, providing they do so at their own expense (rather than from an already inadequately funded system that cannot even provide the most basic needed healthcare to its most needy citizens) and that these "therapies" do not prevent or delay needed "tradional" (proven) treatments.

Tit for Tat said...

Harvey

In my province Massage Therapy is very strictly regulated. Also have you not taken a gander at how many anti inflammatories or pain killers are on the market? The reason is, not all individuals respond in the same way to the same drugs. Pretty similar to the different results from different therapists or therapies. I totally agree with safety measures being implented though. Thanks for the input.

societyvs said...

I am all for alternative medical therapies - including the 'woo' aspects of 'healing'.

Now although science may not be able to back up a lot of the techniques and their benefits - it's fairly obvious there are some - and for some those therapies are much needed.

People are failing to realize that in capitalistic societies that stress is likely one of the leading causes of death (or a factor in many health problems). I think finding ways to alleviate stress is key in Western societies...even for cancer patients or people with heart conditions.

I am finding that alternative technologies may be useful in alleviating those pressures we put on ourselves. I think if your work can deal with that aspect of our busy lives - including 'touch' therapies - we are on the path to something better.

Luke said...

dude, i'm with ya! science couldn't solve my sinus issues, but Acupuncture does! my cousin is a massage therapist as well and really has helped a lot of ppl. i think that the human touch can be a very healing thing and Jesus understood that... we don't know of the exact history of his ministry but all accounts talked about how he was a master subversive story-teller and a healer.

RAWK!

Ian said...

Just listened to this Radiolab

http://www.wnyc.org/shows/radiolab/rss?utm_source=rss&utm_medium=hp&utm_campaign=radiolab

on Placebos, excellent stuff.

Kevin Beck said...

I know a certain qb in need of several therapies today. :)

Tit for Tat said...

ARRRGGGGG KEVIN

The Saints aint Dead. The refs must have had the spirit of God or something. ;)

MS said...

Right on Tat...

You're exactly right on several fronts here. If we were to limit our knowledge to what science is capable of measuring and proving, we would discard most of what we know to be true. Verificationism and logical positivism, which more or less posited that any scientifically unmeasurable proposition is devoid of meaning, was discredited and abandoned long ago for painfully obvious reasons, as it turned out, some of which you have hit on in this post.

As far as the woo factor of massage therapy goes, I'd have to question how anyone who has actually had a good massage, professional or not, can doubt the therapeutic value it possesses. I had never connected the emotional factors you cited, but now that you mention it, it sounds spot on to me and matches my experience perfectly. Moreover, as you allude to, science may progress to the point one day where it may be able to measure some of the physical factors involved. To deny such, and cry woo without further thought or evidence, is only a reverse form of god of the gaps reasoning. In this case, it represents a type of "Naturalism of the gaps" reasoning.

I recently had a haircut at an establishment owned and run by a family from the orient, although I'm not certain exactly what country they're from. After the haircut, the lady cutting my hair, to my surprise, rubbed my head with very little pressure applied, yet the effect was stunning. I entered the salon overtired, and still was after the cut, but after the rubdown on my head, I felt as though I could run twelve miles, and I was mentally energized. I don't know how she did it--I did notice her fingers on a few pressure points--but none of that matters, becuase I know she did it. The difference was unmistakable, and evidenced by my direct experience.

I don't need science to explain it to me, although that would be fine. I know how it was, because I was there. The same is true of your massages, and what you're getting at in this post. All I know is that I was pain free....well said, Tat. Don't feel belittled by those who would ridicule what you do as woo. You're exactly right on this one, and there's nothing better than a good massage. Take care...

mac said...

I don't know much about any of this. That's why I kept my trap shut ;-)

However, I stumbled across this video which may, or may not, be relevant.

BTW, for what my lack of experience is worth, I agree with you here.

Tit for Tat said...

thanks mac, great video.

The Constant Complainer said...

Dude, I'm all about living a pain free life. LOL.

This was an excellent post. Although I really can't debate medical lure, what I will say is this.

There are problems with healthcare. And people are too dependent on certain drugs. I met with a "natural healthcare provider" as a part of a wellness program we did at work. It was fascinating.