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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