May 10 2010

Aroma”therapy”

Language is a powerful but tricky thing – it not only is a tool for expressing our thoughts, to a large degree it shapes and frames our thoughts. This is true in every area of intellectual enterprise – where expanding one’s vocabulary literally expands the palette of ideas and concepts available, and technical or specialized language typically develops to precisely capture the necessary concepts.

This is true in my own field of medicine. I often caution students, for example, to use the proper terminology – not out of convention, but because sloppy language leads to (equals, in fact) sloppy thinking. The legs are not “below” the arms, they are “caudal” to the arms – further along the neuraxis away from the brain. Not only is it important to use terms that are precise, it is important (and a more subtle problem) to use words that are not prematurely precise. Disease taxonomy is often hierarchical, and if you commit yourself too early to a narrow branch, you will prematurely narrow your thinking as well. The patient did not present with “seizures”, they presented with “episodes” – and it is for us to determine if these episodes are seizures or something else.

Politicians and marketers use language differently from scientists and philosophers. The latter is concerned with precision and accuracy, while the former with emotion, deliberate vagueness, and false implication.

The specific example I am getting to today is a particular peeve of mine – the gross overuse of the term “therapy.” It seems you can throw the term “therapy” at the end of any activity and thereby imply that it has a specific medical application, or some benefit beyond the obvious pleasure or benefits of engaging in that activity. So now we have aromatherapy, massage therapy, music therapy, and dance therapy. “Therapy” has become a marketing term, like “natural” – rendered devoid of precise meaning and used to create vague implications.

I was once interviewed about music therapy. Now – I have nothing against the use of music in therapy. Music can affect our mood and attention and can be quite useful in a therapy setting. There is also evidence that listening to music is better for our mental health than doing nothing,  but I file that under – doing stuff is generally better than not doing stuff. Our brains and bodies function better when they are used, and suffer from the neglect of disuse. For example, if you studied the effects of playing soccer on health you would find that people who play soccer are stronger, in better shape, have more endurance, probably weigh less, and have a host of better health outcomes than people who spend an equivalent amount of time sitting on the couch. Should we call this “soccer therapy?” I would consider this false precision. Better to just say that exercise is better than being sedentary for specific health outcomes. Likewise, engaging the mind and interacting socially is better than being bored and lonely. At best music is a tool of therapy, it is not therapy itself.

I am not just being picky. Attaching the word “therapy” to the back end of an activity is an attempt to give it a status it may not deserve – and that status is subsequently used to garner insurance coverage, hospital resources, consumer patronage, and research dollars. It is also used to constrain how we think about an intervention – implying that perhaps there is some specific mechanism as work, when none need exist.

Massage, for example, is a useful technique for muscle relaxation. There are likely to be non-specific benefits also from the tactile experience which may be pleasant (depending on the techniques used). But by calling it “massage therapy” there is the implication that something more is going on – that it is a medical intervention, and that there are further mysterious biological mechanisms at work.

Aromatherapy is perhaps the most bizarre manifestation of this language abuse. Aromatherapy involves the use of pleasant scents with the implication of medical benefit. This is a brilliant marketing strategy – people like to surround themselves with pleasant scents, and there is already a vast market for scented candles, air fresheners, and all sorts of other products that essentially make the air smell pleasant. Now add “therapy” to these products, and you add the implication of a medical benefit to an already desired product. Cover it with a patina of pseudoscience and  you’re done.

A PubMed search for research into aromatherapy found the predicted assortment of studies. There isn’t much, actually, but there is a smattering of small and poorly controlled studies with the typical results you see from uncontrolled studies (such as a 100% response rate) – which is a good indicator of bias and nothing else. There are plenty of studies that are not even testing efficacy, and so are useless in this context.  I could find one controlled study of lavender and anxiety that found:

“Although this study did not show aromatherapy to be effective based on statistical analysis, patients did generally report the lavender scent to be pleasant.”

And there is aromatherapy in a nutshell – it may not do any actual therapy, but it smells nice. Seriously – why even study that. If you want people to have a pleasant smelling pre-operative experience, then knock yourself out.

But the term “aromatherapy” has granted pleasant odors a healing mystique that appeals to certain individuals – even in the military. A few dedicated believers are trying to inflict pseudoscience on our soldiers, first with battlefield acupuncture, now with aromatherapy. I think our men and women in uniform deserve better.

Perhaps a solution to all of this madness is a heavy dose of skeptical therapy.

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19 responses so far

19 Responses to “Aroma”therapy””

  1. SpicyCupcakeon 10 May 2010 at 9:32 am

    Excellent article! I am less of a word enthusiast than you by far, but “therapy” is something that has recently been driving me insane. Every time I turn around I have someone telling me about some new “therapy” I can do for sinus/allergy issues, canker sores, bad ankles, headaches, or any other reoccurring/chronic problems. At the point someone recommended Aroma therapy for my sinus/allergy symptoms I nearly screamed (scented items normally make it worse)! Most people unabashedly accept opinion articles or “interest” stories, in magazines, that speaks of a new “therapy”. Then turn around and give this great advice to others.

    I think another underlying frustration with this is the result of misinformation that is passed virally through the public consciousness. All it takes is a hasty conclusion by a writer, an article (or other media) with enough exposure to go into the echo chamber, and then is seems that in short order something is just “common knowledge” and simply confirmed through friends who have heard the same misinformation. It’s like the problem with insular groups, but on a societal scale!

    (This is likely my own exaggerated perspective of the situation, but frustrating for me)

  2. cyberdracoon 10 May 2010 at 10:08 am

    “Perhaps a solution to all of this madness is a heavy dose of skeptical therapy.”

    And the great thing about skeptical therapy is that it can be applied at will without monetary loss.

  3. Watcheron 10 May 2010 at 10:12 am

    I tend to be partial to this type of “aromatherapy”

    http://www.nydailynews.com/lifestyle/food/2010/05/07/2010-05-07_if_you_luv_the_smell_of_burger_white_castle_candles_selling_fast.html

    :D

  4. theshortearedowlon 10 May 2010 at 10:41 am

    I’ve been reading this blog for some time now, and this is the first article that I’ve outright disagreed with any part of.

    Music therapy is not a protected term; I’m sure there are therapists who just play music and tell people they feel better. I know of it through the North Yorkshire Music Therapy Centre, who use music as alternative way of allowing autistic children (usually severe end of the spectrum) to communicate.

    The idea is to explore a different way in which the autistic spectrum child can engage with another human being, if normal language isn’t, shall we say, appealing to them. The therapist improvises music to match the moods or actions of the child, and encourages them to respond using another instrument.

    Obviously, there is little if any research associated with this, but they’ve had some very promising results, including major breakthroughs with kids that the parents were told would never talk. Yes, I understand that this is anecdotal evidence, but I think this is a plausible therapy that deserves further research.

    Aromatherapy, on the other hand, smells nice.

  5. Steven Novellaon 10 May 2010 at 11:04 am

    As I said – I have nothing against using music as a tool of therapy. It is a good hook into human attention and emotion. My problem is with the dubious and casual use of the term “therapy.” It get’s legitimized by treatments such as music therapy, and then abused by nonsense such as aromatherapy.

    In medicine the term “therapeutic” specifically refers to something that is disease modifying or curative. It has a mechanism of action that is acting upon the pathophysiology of the disease or disorder. It is distinguished from interventions that are “symptomatic.”

    So even if something works (which is incidental to my core point) it still may not be properly therapeutic, and misleading to call it therapy.

    In the psychology world, “therapy” has a different connotation (and this does cause some confusion) in that it refers non-specifically to any intervention that basically involves talking to the client – talk therapy or psychotherapy.

    Here calling any intervention “therapy” does not necessarily distinguish therapeutic from symptomatic (hard to do anyway with many psychological problems). There is a separate problem here – being overly specific or “splitting.” This gets back to the “soccer therapy” comment. Can’t we just call it exercise – do we have to name every possible type of exercise as a separate “therapy” – implying that there is something specific about it, even when there isn’t?

    This causes fuzzy thinking. We should endeavor to identify what the key components are – weight bearing exercise, aerobic exercise, stretching, etc. – and not name every possible version of these things as if they were distinct intervention. This implies there is specific benefit from the soccer variable, when in fact it is non-specific benefit from exercise.

    This may be a subtle point – but it matters. When you call poking someone in random locations with a toothpick “acupuncture” you are making the exact same kind of language mistake, that results in the same mental mistake.

  6. locutusbrgon 10 May 2010 at 11:19 am

    Call me jaded by an plethora of psuedoscience, but this is one battle I do not address in the office. It is my opinion that this is a waste of money, and time. However it is plausibly a relaxation technique since people often associate pleasurable memories with certain scents. I am in no way advocating it as a treatment. I agree in principle with medical vocabulary precision. As for lay people I think we need to surrender therapy to psuedoscience. That is hole I am not willing to try to fill in. People think they know what it means. So Just like “light years ahead” is scientifically inaccurate it is colloquially understood to mean advanced. Try to change that type of broad based confusion would most likely produce irritation, confusion, and frustration on my part. So I may have to pass in my skeptic’s badge, but when it come to aromatherapy I put my falange tiparas bilaterally into my external auricular canals and literally throw caution to the wind.
    Steve p.

  7. HHCon 10 May 2010 at 1:59 pm

    Battlefield acupuncture makes sense if you believe in the infliction of pain upon others to solve problems. Afterall, that’s what war is all about, inflict strategic pain upon the enemy and voila, you will have a truce. Basic training with its hazing cannot prepare you handle multiple tours of duty. The human nervous system along with the body must rest. Post-traumatic stress disorder is an expected phenomenon from the current military regimen of multiple tours.

    Now why would a military physician choose the ear to apply acupuncture. This is simple. The soldier must attend to and hear his superior to follow orders. Pricking the ear essentially stimulates the soldiers attention to attend to another human beings presence or words, and refocus his attention from his traumatized memories of the moment.

    Oh my its lunchtime, Watcher! I think I will go to White Castle, for the real thing. I don’t think GE CEO Jack Welch needs my $10 to support his daughter’s charity, Autism Speaks.

  8. SARAon 10 May 2010 at 2:34 pm

    I could not agree more. In fact I love essential oils that are used in “aroma therapy” because I love to use them in bath oils. But I am often reluctant to mention it because I then it is assumed I believe that I will cure my skin, breathing, and even heart issues by smelling roses, lavender, etc.

    Its disheartening that we have such a large section of society that lacks critical thinking. A group of people will take medical advise from “Suzie” at work, who assures them that aroma therapy is most healing and in reality it amounts to snake oil. Although pleasant smelling snake oil.

  9. HHCon 10 May 2010 at 5:22 pm

    With respect to aromatherapy, the local hospital integrative medicine department uses a lavender scented oil as part of its massage therapy. After experiencing the treatment, I find that its simpler and cost-effective to buy a lavender hand or body product than pay out a Benjamin for the therapeutic experience. The muscle relaxation has successfully been paired with the scent after one time.

  10. ccbowerson 10 May 2010 at 6:25 pm

    We should worry about accuracy foremost when it comes to terminology much more than anything else. The sloppy thinking thing sounds more like a pet peeve than a true phenomenon… unless by sloppy you mean inaccurate. Caudal actually refers to being closer to the tail… Inferior is just as accurate and more intuitive (and means the same thing in humans), since we have no tail and walk upright.

  11. ccbowerson 10 May 2010 at 6:30 pm

    The term “therapy” is just one of many terms which are shared by both medicine and everyday language. Anytime there is overlap you will have this problem, because medicine needs to be precise and everyday language does not need this level of precision.

  12. theshortearedowlon 10 May 2010 at 10:25 pm

    @ Stephen Novella

    Thanks for that clarification. I agree about the problem with fuzzy usage of words. “Shock” is another bad one.

  13. brainwiseon 11 May 2010 at 7:28 am

    Steven, correct me if I am wrong but I think what you are getting at is the use of the term therapy in regards to the correct meaning of the word. Therapy is derived from the Greek word ‘therapeia’ which pertains to ‘to cure, treat’.
    As such, it should then be used only for those treatments which have evidence to be a cure or treatment for a disease/condition. As stated, the evidence-base for the use of such things as aromatherapy is non-existent, so should it be used in the same way as medical/psychological therapy (which have strong evidence-bases)? I think not given that a large majority of people are unable to tell the difference.

  14. tmac57on 11 May 2010 at 9:57 am

    Now, if we can just get the general public to understand the word ‘Skepticism’ in the sense that we use it.

  15. theshortearedowlon 11 May 2010 at 11:46 am

    Just realised, in a post complaining about inaccurate use of words, that I spelled the author’s name wrong. Heh.

  16. Calli Arcaleon 11 May 2010 at 3:35 pm

    Aromatherapy involves the use of pleasant scents with the implication of medical benefit.

    That’s debatable. “Pleasant” is a matter of opinion, after all, and frankly, I find a lot of aromatherapy products to smell quite obnoxious. This is probably because most of them smell like flowers, and I’m allergic to a great many of those, so the mental association is one of imminent misery.

    Aah…haa…CHOO!!!!

    I was so happy when department stores stopped spritzing perfume straight in my face, after realizing they could get their butts sued (and possibly even get criminal charges for assault). Now it’s been replaced with aromatherapy, which is almost as bad for me, physiologically, and every bit as annoying (since the scents are usually excessive and cloying), but is kept on the presumption that nobody would sue for something that’s supposed to make you *better*.

    Argh. I hate aromatherapy. To anyone selling it, take your stinking candles and oils and incense and get out of here!

    (BTW, it’s also hazardous. We don’t need to burn candles for light anymore, but people now burn them for the scent, often with less appreciation for the fire hazard. Obviously scented plug-ins and the like don’t have that problem, but the candles do.)

  17. hippiehunteron 12 May 2010 at 5:02 am

    I am a registered nurse working in aged care in Australia.
    I kid you not we have a publicly funded aromatherapist who has her own little office where she makes her potions.
    The medical notes of the residents have care plans in place by this naturopath aromatherapist that just clutter the notes and she gives talks to the staff promoting woo.
    I have actually arranged to not work on the day she is in because I can only bite my tongue for so long.
    The reason we have an aromatherapy office and associated woo is the facility gets funding for it .
    Should be in Ripley’s Believe it or Not !

  18. MarkWon 14 May 2010 at 4:44 am

    I’m reminded of something Billy Connoly (I think?) said: If aromatherapy works, why do you not get someone at the scene of a road accident shouting “everybody stand back! I’m an aromatherapist”?

  19. Jeffon 28 May 2010 at 1:01 pm

    How can we as laymen determine which studies are valid and which are poorly controlled? I went to the lavender study link you posted (http://www.ncbi.nlm.nih.gov/pubmed/17273013) and was personally pleased with the results, but then followed another link in the pubmed sidebar (http://www.ncbi.nlm.nih.gov/pubmed/19968674) which concludes that “lavender scent reduces state anxiety in dental patients.”

    If I use the first study as supporting confirmation to friends that aromatherapy is bogus, how do I respond when they read those other studies which all say that it works? I’m not a scientist and don’t know how to spot flaws in studies.

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