Oct 17 2011

Reiki Doesn’t Work Either

I don’t think I have written specifically about Reiki before. This is a form of “energy healing,” essentially the Asian version of faith healing or laying on of hands. Practitioners believe they are transferring life energy to the patient, increasing their well-being (sound nonspecific enough?). The practice is popular among nurses, and in fact is practiced by nurses at my own institution (Yale).

Reiki is very similar to therapeutic touch, another energy healing modality that was popular among nurses, and although it continues to be used it is much less popular after 9 year old girl (Emily Rosa) performed an elegant experiment to show that it was nothing but self-deception. Reiki nicely moved in to fill the void.

The research on Reiki, and energy healing in general, is similar to that of many similar modalities – those with very low scientific plausibility that are not taken very seriously by medical scientists. The research is of generally low quality, poorly controlled small studies that seem designed to justify Reiki rather than see if it actually works. A 2011 review concluded just that:

The existing research does not allow conclusions regarding the efficacy or effectiveness of energy healing. Future studies should adhere to existing standards of research on the efficacy and effectiveness of a treatment, and given the complex character of potential outcomes, cross-disciplinary methodologies may be relevant. To extend the scope of clinical trials, psychosocial processes should be taken into account and explored, rather than dismissed as placebo.

In other words – existing research is a such poor quality we cannot draw any useful conclusion from it. I disagree, however, that this necessarily means that more research is needed. The low plausibility of using magical energy that has never been demonstrated to exist by medical science argues otherwise. Further, the last sentence is odd – it suggests the authors are trying to spin placebo effects into real effects. This is increasingly the strategy of alternative medicine advocates as it becomes clear that most of the modalities they favor do not work any better than placebo (which means they don’t work).

Reiki is now squarely in that camp. Published at about the same time as the review (and therefore not included in the review) is a well-designed study of Reiki where Reiki was compared to placebo Reiki (someone not trained in Reiki simply goes through the motions) vs usual care (no intervention). Not surprisingly, both the real Reiki and the sham Reiki groups did better on self-reported well-being than the no intervention group, but they were indistinguishable from each other. Therefore Reiki did not better than placebo. That means Reiki doesn’t work (at least in the regular world of science-based medicine).

The authors conclude:

The findings indicate that the presence of an RN providing one-on-one support during chemotherapy was influential in raising comfort and well-being levels, with or without an attempted healing energy field.

Hmmm…I notice they did not conclude “Reiki doesn’t work.” That’s odd. Both the treatment and placebo groups had the same effect on subjective outcomes. With regular medical interventions, we conclude the treatment does not work. Imagine a pharmaceutical company concluding:

The findings indicate that taking a pill during chemotherapy was influential in raising comfort and well-being levels, with or without an active ingredient.

Therefore – taking pills is helpful. Let’s not fret about whether the active ingredient has any specific physiological effects. Reiki supporters appear to have taken a page out of the Acupuncture handbook. If real and sham acupuncture are both better than no intervention (they argue), than acupuncture works, whether real or placebo.

This article by Edzard Ernst recently published in the Guardian also discusses this Reiki study. Ernst points out that, not only is it scientifically dubious to conclude from such studies anything other than the treatment does not work, it is ethically dubious to give such treatments as a placebo intervention. He writes

By insisting that patients must not be treated with placebos like reiki, scientists also advocate that they receive treatments that demonstrably work better that placebo. For instance, massage has been shown to improve the wellbeing of cancer patients beyond a placebo effect. If a patient receives a massage with empathy, sympathy, time, understanding and dedication, she would benefit from the placebo effect – just like the reiki patient – but, in addition, she would also benefit from the specific effect of the treatment that massage does and Reiki does not offer.

This is a critical point that I have been making also. Essentially, you cannot justify ineffective treatments simply because they provide a placebo effect. That is because effective treatments also provide the same placebo effect, but also provide specific benefits because they actually work.

I would argue that there are also many potential harms from convincing patients that unscientific treatments are effective because of their non-specific placebo effects. This is a deception, violates patient autonomy and informed consent, and sets them up to perhaps rely on ineffective “magical” treatments for non-self-limiting illnesses.

Let’s get back to the authors conclusions from the Reiki study – they argue that this study shows that the:

“presence of an RN providing one-on-one support during chemotherapy was influential in raising comfort and well-being levels…”

The part about “with or without an attempted healing energy field” is entirely irrelevant, and you could just as well substitute any ineffective or magical treatment for “healing energy” is that statement. But the first part of the conclusion is also dubious, in that we did not need this study to come to this conclusion.

It has already been well-established, to the point that it is appropriately taken as a given, that people feel better when they get the kind attention of someone else, especially if they are sick and that person is a health care professional with training and experience in comforting sick patients. We don’t need to keep studying this over and over again.

Kind attention plus X makes people feel better, just as well as kind attention alone. Great. We do not need to study this with every possible form of nonsense filling in for X. And it is deceptive and unscientific to suggest that whatever fills in for X has some value because of this equation.

This is what I call the “part of this complete breakfast” fallacy. Even as a child I recognized that when a commercial advertised their pastries as being part of the complete nutrition offered by an otherwise nutritious breakfast, the pastries were nutritionally irrelevant. They added nothing, and the commercial was being deceptive in trying to make me think that they were nutritious simply by their proximity to a nutritious breakfast.

Reiki, acupuncture, homeopathy, and similar methods may be “part of this feel-good intervention,” but they are an irrelevant and superfluous part. It is the kind attention of the practitioner that matters – and only that attention. So such attention might as well be part of legitimate science-based interventions that also have a specific physiological benefit.

Or – just give the kind attention by itself, without the magical mumbo jumbo. What is wrong with that? Why isn’t that good enough anymore?

Share

10 responses so far

10 Responses to “Reiki Doesn’t Work Either”

  1. locutusbrgon 17 Oct 2011 at 10:41 am

    As a nurse I am disturbed on how much this particular form of crap is pervasive in nursing. I find no evidence that supports a high percentage of nurses doing this. I think it is better to say that a lot of Reiki is done by nurses, not a lot of nurses use Reiki. I hope this is true.
    I would also like to say that when you look at the financial incentives in this practice you would see why the science conflicts with reality.
    Yes it would be best to dump the nonsense and just spend time with your patients. Most nurses work for someone else. There is very little time in current nursing situations, even hospice, where you have time to spend with your patient. In a hospital you would never be able justify extensive hand holding and comfort with patients. No hospital administrator will say to a unit supervisor, “we need our nurses sitting down talking with the patients more.”. Productivity and paperwork is paramount in the current hospital’s business models. That is what gets you paid. Having a ______ therapist, put your own woo in, allows you to justify the benefit of increased attention with patients. So I think there is a small argument in favor of crap. That in my opinion does not outweigh the damage it does. It does allow me to understand the reason why some good people continue to allow this non-treatment to be continued.

  2. Steven Novellaon 17 Oct 2011 at 11:03 am

    Locutus – I agree. The financial incentives, but also the desire to have a therapeutic modality to offer, drives “X-therapy” as opposed to just kind attention.

    But it does not justify it.

    Rather, why don’t we alter the system to provide for more hand holding, since we know how effective it is. Using woo as a backdoor for attention is not even cost effective, because the woo comes at a premium.

  3. tmac57on 17 Oct 2011 at 7:41 pm

    If we can all agree that kindness and attention is equal in efficacy to modalities such as acupuncture,reiki,and therapeutic touch,then I propose that we rename it ‘KA Therapy’. It sounds vaguely oriental,it can reasonably be said to be rooted in a tradition going back for centuries,and it is ‘all natural’. If you wrap common sense in a cloak of mysticism, it transforms itself into pearls of wisdom. (make that ‘innate’ wisdom).

  4. HHCon 17 Oct 2011 at 9:21 pm

    Reiki practitioners I have used created a general atmosphere of calm by entry into the massage, used musical sounds, and added stylized techniques to a massage. For example, practitioners may rub their hands together and apply warm hands over your eyes. As for results, sometimes the zen was there, sometimes not.

  5. Todd W.on 18 Oct 2011 at 11:52 am

    Here’s a question for which I hope you can offer some insight, Dr. Novella.

    When something like reiki invades a health care institution, how can we go about combating it, either as consumers or as employees? In particular, what general ideas/tips are there for navigating the politics involved, because, like as not, the presence of this nonsense is far more political than scientific?

  6. Amy(T)on 18 Oct 2011 at 12:47 pm

    reiki, it’s like the power balance bands of health care.

  7. LindaRosaRNon 23 Oct 2011 at 5:05 pm

    How nice to hear another nurse speaking about nursing “crap.” If locutusbrg has any ideas about why there are not more nurses critical of nursing quackery, I’d enjoy hearing locutusbrg’s thoughts on the matter.

    The very first time I heard of TT, I also thought it was a silly way to justify spending time with patients. (When I worked at a VA hospital years ago, nurses were told that even baths were optional care!) But then I learned that often TT has less social interaction than actual touch.

    Since TT and Reiki are essentially the same thing, the conclusions of the JAMA TT study (Rosa, 1998) hold true for Reiki, i.e. that further use of the practice is not justified.

    Whenever TT researchers got results that showed the same effect for TT as placebo, they suggested that the people administering the placebo treatment were unknowingly sending healing intentions to subjects. I have little doubt that the same will be claimed for this Reiki study, if not by the researchers, then by Reiki proponents.

    As for “KA Therapy” (sounds more Egyptian to me), the sCAM nurses have beat us to it. Jean Watson (past dean of the U of Colorado School of Nursing and past president of the National League for Nursing) has invented the “Theory of Human Caring,” which goes to show it takes less than nothing to be considered a “major nursing theorist.” (http://www.watsoncaringscience.org/).

  8. peterwickson 30 Oct 2011 at 6:21 am

    I find it somewhat disturbing to see “works no better than a placebo” equated with “doesn’t work” on a neuroscience blog, of all places. The whole point of placebos is that they DO work. I’m not saying they’re going to cure your cancer for you, but they have all sorts of proven benefits (including helping to fight cancer for that matter, by boosting our immune system).

    It’s not that I’m disagreeing with the overall message of the article: indeed doing more research into whether/why/how Reiki works is about as pointless as doing research on astrology. But rather than condemning it, wouldn’t it be more constructive to take it as inspiration to promote placebo effects that rely less on self-deception? The rituals involved in Reiki may well be helpful for lots of people. I did a Reiki meditation that I found on YouTube the other day and I found it really helpful and relaxing. That didn’t involve self-deception – I don’t believe all the bullshit either – but I’m grateful to the person who posted the video anyway.

    Conclusion: fine to be sceptical and critical, it’s an essential means to discover the truth and the most effective remedies, but don’t throw out the baby with the bathwater.

  9. cassandratribeon 27 Jan 2012 at 6:56 pm

    Hi,

    I am late to the party but just found this blog post as a result of searching for some information. First off, I am a Reiki practitioner and I work with Hospice. Before the hackles get completely raised I want to qualify myself that I am sort of stumped at what I have witnessed as crap Reiki being offered – by Nurses or otherwise. My knee-jerk reaction is that it stems from an American corruption of the training. Anyone who thinks that they are doing Reiki by laying hands on people is totally not qualified. It’s like how yoga has become something that requires special clothes and tools, there has been a misfire in the transition. Reiki encompasses a series of medical disciplines that have a lot of clinical proof and support (stress management, psychotherapy,focal reassignment, pain assessment to name a few). Unfortunately, a lot of people who have “learned” Reiki have separated it from the rest of treatment. It is not magical, it is a form of trained attention that isn’t available or offered in most care settings. It is also NOT an ancient art, it was developed around the time of the industrial revolution in Japan in a multi-cultural setting as a direct response to the increasing de-humanization of care. Nurses used to be allowed to care for patients and now they are on a schedule. It is no small wonder Reiki has become popular in that field because it justifies time and touch with patients. Reiki is a catch-all kind of term to represent the person on a treatment team who is charged with psycho-social care and can also give the patient relief through grounding them to their environment and decreasing physical stress. But used as a placebo or by itself? Not effective and crap, that would be like telling someone they need an IV and giving them a picture of one. While there is documented effects of “faith” healing, I for one, would rather have as many possibilities actively working for me as I can. I do not at all endorse the Reiki as magical healing school of thought at all, neither do I think it is a replacement for treatment, I do think it is a compliment to medical treatment because it reintroduces a compassionate element that has been regulated and priced out of the care schedule. I am glad this discussion and criticism exists of Reiki because, of what I have seen, there is a whole lot of shim sham out there. My rule is…if someone needs to dress for it, eat for it, or do a lot of specific rituals for it – its not real. The first thing I learned in my training is that when you really know what you are doing you a) don’t need all the symbolism and b) bone up on the other aspects of treatment to make sure you can compliment. Ugh….headache now :)

  10. shideonon 28 Apr 2012 at 3:47 am

    The study you’re referring to is here:
    http://www.ncbi.nlm.nih.gov/pubmed/21531671

    It’s title is:
    Investigation of standard care versus sham Reiki placebo versus actual Reiki therapy to enhance comfort and well-being in a chemotherapy infusion center.

    So based on a study regrading reiki’s effectiveness on comfort levels you conclude that reiki must be written off entirely? Last I checked, reiki’s advocates claim it does much more in addition to improving comfort levels. Where’s the science to disprove those claims? And can we write off reiki based on a study regarding only one of the things that it supposedly helps?

    Further, you conclude by the end of your rant that…
    “Reiki, acupuncture, homeopathy, and similar methods may be “part of this feel-good intervention,” but they are an irrelevant and superfluous part”

    You write off not only reiki, but also acupuncture and homeopathy due to a study regarding reiki’s benefit on people’s comfort levels. That’s not science, nor is it critical thinking.

Trackback URI | Comments RSS

Leave a Reply

You must be logged in to post a comment.