Regular readers know that I’ve long been dismayed at the increasing infiltration of non-evidence-based “alternative” medical therapies into academic medical centers (1, 2, 3, 4, 5, 6, 7). It’s gotten such a foothold that it’s even showing up in the mandatory medical curriculum in at least one medical school. I’ve speculated before that academic medical centers probably see alternative medicine as both a marketing ploy to make themselves look more “humanistic” and a new revenue stream, given that most insurance companies won’t pay for therapies without solid evidence of efficacy, meaning that it’s usually cash on the barrelhead for such woo, without all that nasty hassle of filling out insurance forms and getting preapprovals from tight-fisted claims handlers.
One area of medicine that’s always been fairly immune to the lure of non-evidence-based alternative medicine therapies is trauma. After all, unlike the usual panoply of ailments that alternative medicine practitioners like to treat with their therapies, conditions which are usually not life-threatening and which are prone to a large degree of variation, regression to the mean, and psychological overlays, trauma is concrete. You can see the injuries. Broken bones show up on X-rays. Bullets rip holes in bodies. If alternative medicine modalities are good for anything, it’s been generally assumed that they wouldn’t be much good in trauma, and, for the most part, academic trauma centers have eschewed them.
Not any more. Arguably the most prestigious trauma center in the U.S., the University of Maryland’s Shock Trauma Center, is getting into woo in a big way:
Kim Holland’s biker-chick days were over not long after they began, with the 46-year-old smashed between her Harley and a guardrail in Elkridge, and a bystander saving her right leg by taking off his belt and making it into a tourniquet before paramedics rushed her to the hospital.
A week after she arrived at the University of Maryland’s Shock Trauma Center – a week filled with operations and skin grafts, narcotics by pill and by pump – she lay in bed. The lights down low, soft music playing to drown out the buzzing and beeping and ringing that make up a hospital’s soundtrack, two women slowly waved their arms over Holland’s broken body, as if trying to push away the pain.
Their motions resembled part modern dance, part pantomime, as they used a technique of laying on hands called reiki (pronounced ray-kee) to help Holland relax and, they hope, heal more quickly by restoring her “energy balance.”
In a strange pairing, high-tech Shock Trauma is opening its doors to a fuzzier sort of medicine, one that focuses less on the physical and concrete and more on the spiritual. As part of the Baltimore hospital’s pain management options, patients are being offered acupuncture, reiki and music therapy alongside OxyContin and morphine.
Reiki? They’re using reiki Maryland Shock Trauma? I can see trying acupuncture, although I’m still very skeptical that it does anything that can’t be accomplished as well or better than conventional therapy. At least there’s some evidence, albeit weak, that acupuncture is useful for certain types of pain. I would have no objection to doing clinical trials on acupuncture in a university medical center, even though I don’t buy its whole schtick of “unblocking the flows of qi” as the “mechanism” by which it “works,” and the justification at Shock Trauma for its efficacy borders on the ludicrous:
Dr. Lixing Lao, the center’s director of traditional Chinese medicine research, said acupuncture has so many possibilities because, unlike a drug, it has no specific receptor in the body. It stimulates the body to heal itself, he said. That is what gives it the power to treat diarrhea as well as constipation, he said.
“No specific receptor”? That’s why it can do so many things? Ugh. That’s pseudoscientific nonsense at its worst. If acupuncture truly does have objectively measurable therapeutic efficacy, then you can be damned sure that it works through a physiologic mechanism that can be worked out, a mechanism that will no doubt involve receptors of some sort. Just because we haven’t discovered them yet doesn’t mean that acupunture doesn’t work through receptors.
But reiki? One of the woo-iest of alternative medicine therapies out there? I used to make jokes about using reiki on trauma patients, but it would appear that it’s no joke.
Reiki, for those who haven’t heard of it, is a Japanese alternative medicine modality that claims there is a universal life energy that trained practitioners can channel by laying on hands in order to induce healing. It is arguably the purest woo among popular alternative medical therapies, given that it has practitioners who seem to honestly believe that they can channel this “universal energy” through themselves and into the patient in order to heal. Among alternative medical medical modalities, to me reiki is among the least likely to be of any use for trauma patients. As the article describes it:
Historians say reiki was developed in the early 20th century by a Japanese physician and monk, Mikao Usui, and came to the United States in the 1930s. Reiki is a Japanese word, derived from rei, which means universal, and ki, which means life energy.
Practitioners say they use the technique to quiet the body and mind. This form of laying on hands often involves very little touch, only what looks like a massaging of the air around the body, as practitioners transmit their ki to the patient.
Reiki is nothing more than religious mumbo-jumbo. Unlike acupuncture, there isn’t even a hint of a plausible mechanism, aside from the placebo effect, by which it might work. No one can measure this “ki,” much less demonstrate that reiki practitioners can do anything at all to manipulate it, much less that they can manipulate it for healing effect.
So how do the physicians at Maryland Shock Trauma justify the use of reiki? Easy. They fall prey to what alternative medicine mavens the world over routinely use to claim that their favored form of “woo” works, anecdotes:
“I was very skeptical. I was like, ‘OK, so you wave your hands over people and there are these energy fields and this makes you feel better?'” recalled Dr. David Tarantino, an anesthesiologist who runs Shock Trauma’s pain management service. “I said, ‘Obviously it isn’t going to cause the patient harm so let’s try it.’
” … The more I have become involved with this and seen firsthand what it does for our patients, the more it has piqued my interest.”
If you look at what’s actually being done, it looks more like relaxation therapy melded with guided imagery, which can be effective, grafted onto religious woo:
The mood in Holland’s hospital room is quiet and relaxed as the 10-minute session comes to an end. Audia and fellow reiki master Bonnie Tarantino (no relation to the doctor) have spent 10 minutes sharing their positive energy with Holland, slowing down her breathing to try to clear whatever blockage is keeping the energy from freely flowing. They have had her travel to happy places in her mind and to think of things the landscaper will do once her long rehab is complete.
“See yourself standing strong in the garden,” Tarantino whispers. “I want you to see yourself bending and doing everything you want to do. See yourself dancing.”
Tarantino walks to a large, milky-white quartz crystal bowl sitting on the cold tile floor. She taps the side with a mallet and the room fills with a deep sound that seems to penetrate to the core.
Holland tells them her whole body is relaxed, much like after the previous night’s treatment, which allowed her to get a good night’s sleep by shedding some of the emotional damage of the crash. Her main regret seems to be that she didn’t get in more riding before the accident. That, and giving her nay-saying husband and college-age son prime opportunities for “I told you so.”
[…]
She says a shooting pain in her leg has subsided and her four broken ribs and punctured lung are hurting a little less. She says she feels the good energy coming in and the bad flowing out.
Like almost all alternative medical therapies, reiki gets the credit for improvement even when it’s used in conjunction with conventional therapies, and the physicians and woo-meisters at Maryland Shock Trauma are facilitating this impression.
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.
