What am I talking about? Yesterday, Peter sent me a brain-meltingly bad study in so-called “complementary and alternative medicine” that shows me just how bad a study can be and be accepted into what I used to consider a reasonably good journal. I say “used to consider,” because the fact that this journal accepted a study this ludicrously bad indicates to me that peer review at the journal is so broken that I now wonder about what else I’ve read at that journal that I should now discount as being so unreliable as to be not worth taking seriously. Maybe everything. I don’t know. What I do know is that seldom have I seen such a blatant example of quackademic medicine in action, and, worse, seldom have I seen such a bad study in such a good cancer journal.
No doubt at this point, some of you are thinking that I’m being way too harsh on the editors of this journal for having accepted such a steamy, stinky turd of a paper. I expect that you’ll come around to my way of thinking after I describe the paper. In fact, I fully expect that some of you will come to the conclusion that I didn’t go far enough after you take a look at this paper. So let’s dig in, shall we? The journal is Cancer, which is the official journal of the American Cancer Society and has an impact factor of 5.131, which is, as we say, not too shabby. The investigators are from the Samueli Institute, the University of California San Diego, the RAND Corporation, and Healing Light Center Church, and the paper is Complementary Medicine for Fatigue and Cortisol Variability in Breast Cancer Survivors A Randomized Controlled Trial. It’s about as perfect an example of what Harriet Hall refers to as “Tooth Fairy Science” as I’ve ever seen.
Fatigue is a big problem in cancer patients, and this study is designed to test the effect of what the authors call “biofield” therapies on fatigue in 76 breast cancer patients with fatigue. For purposes of this study, “biofield” therapies are more or less the same thing as energy healing, which includes reiki, therapeutic touch, healing touch, and others. In actuality, from a scientific standpoint, the experimental design of this study wasn’t half-bad. The problem comes from how this study examines a therapeutic modality for which there is no evidence, namely something the authors call “energy chelation.” (I kid you not. That’s what they call it!) To sum up the study in a nutshell, it was a phase 2 randomized, intention-to-treat clinical trial that compared biofield healing with a “mock healing” control, and a waitlist control.
Never having heard of “energy chelation before,” I read with interest how the authors described this new woo modality:
The specific technique used in the biofield healing group is termed energy chelation, and was selected by 1 of the authors (R.L.B.), whose healing techniques have been incorporated in modalities such as Healing Touch and Therapeutic Touch.26,27 During energy chelation, the practitioner practices hands-on healing with standard hand positions, beginning with hands on the feet, then to the knees, hips, bladder area, stomach, hands, elbows, shoulders, heart, throat, head, and back to the heart. The practice of energy chelation is 45 to 60 minutes, with a practitioner generally focusing for 5 to 7 minutes on each position.
Naturally, I wondered who “R.L.B.” is and what “energy chelation” is. R.L.B., it turns out, is Reverend Rosalyn L. Bruyere, not surprisingly from the Healing Light Center Church. So I did some Googling and found her quickly. On her website, she is described thusly:
Founder and director of the Healing Light Center Church, Reverend Bruyere has committed her life to the teaching of these sacred and ancient disciplines, thereby providing her students with practical tools for living the spiritual life, while introducing them to the venerable traditions from which those tools are derived. Her goal is to encourage the compassionate healing and empowerment of the individual, believing that as we each heal, we can be of greater assistance in the healing of the world.
She is the originator of the whole-body technique known as Chelation which has become a classic, taught in many modern healing schools, as well as Brain Balancing and a pain-reducing skill which some have called Pain Drain.
Her book, Wheels of Light, A Study of the Chakras, is an invaluable text for the bridging of ancient and modern healing arts. Rev. Bruyere has studied extensively in areas of Egyptian temple symbology, Sacred geometry, ancient Mystery School rites, international shamanic practices, the pre-Buddhist Tibetan Bon-Po Ways, and various Native American Medicine traditions.
Rosalyn’s knowledge of ancient traditions and practices has led to requests for her technical assistance on several films and documentaries. Among the more notable features on which she has served as technical consultant are “Resurrection” and “The Last Temptation of Christ”.
Although I don’t recall having blogged about it before, let me just mention right here that Brain Balancing is pure quackery. Pain Drain is a healing touch technique in which the
quacktitioner practitioner holds one hand above an area of complaint until the pain recedes and then places the other hand near the area of relief. In other words, it’s quackery too. As for energy chelation, I Googled that as well and found quite a few links describing it. For instance, here is a Q&A by a healer named Kay Morris Johnson who charges $65 an hour for her energy chelation who ensures us that it “works by moving heavy or stagnated energy, once this movement takes on a transformation then your whole body system reacts similar to downloading, accepting the changes in your energy field into your physical being” and that there is indeed detoxification with energy chelation (much like real chelation, I would imagine). She even gives a helpful primer on the difference between energy chelation and reiki:
Reiki is best use for general consistent work to maintain your energy whole field balance. Energy Chelation is best applied to detailed energy needs in defined areas of one energy field. Energy Chelation also has different vibrations associated with it, such as sound energy. Sound Energy is described as a deep vibration and is very effectively use on areas of old stagnate energy, such as childhood issues. These old issues are stubborn dense often times large energy blocks that require that extra boost of vibration to initiate movement.
Well, that’s useful. Reiki is faith healing in which the person being healed is usually not touched but the practitioner believes that he’s channeling healing energy into the patient from a “universal source,” while energy chelation “hands on” energy healing. They’re, like, totally different, dude! Really!
Another website helpfully proclaims the “physical reality on which human energy chelation therapy is based” as:
Human Energy Chelation Therapy (HECT), a process of transmitting or channelling energy, is based on the electromagnetic nature of the human body. The body’s electromagnetic or auric field is generated by the spinning of the chakras. As it spins, each chakra produces its own electromagnetic field. This field then combines with fields generated by other chakras in the body to produce the auric field. An individual’s auric field is manifested via a combination of energies from three chakras. Generally these are the first, third and fifth chakras, which empower the person’s physical, intellectual, and etheric bodies. It is a combination of these three chakras that produces the primary auric field (the inner shell of the aura), which can be physically felt by the therapist’s hand as it is passed over the client’s body in the process of scanning.
And where does energy chelation get its name? Here’s an explanation:
Heavy metals are toxic to the human body. Chelation has been a tried and true method in removing them from the body. The toxins must be removed before the body can benefit from any health promoting actions.
Stuck emotions are very similar to heavy metals in that they too are toxic to the body, mind and spirit. Healthy emotions are energy in motion. However when emotions are stuck, not acknowledged, stuffed and ignored they become like heavy metals and are toxic to the human system. They need to be removed before health-promoting actions can produce beneficial results. Just like chelation removes heavy metals from the body, energy chelation is a method which removes sticky, heavy dark energy from the human energy field.
Is “sticky, heavy dark energy” anything like the long, dark tea-time of the soul? It rather sounds that way to me. In actuality, it might as well be because energy chelation is every bit as much a work of fiction as anything ever written by Douglas Adams. In any case, I love it when CAMsters start using metaphors as names for their woo. Be that as it may, the next question I had, after having learned that energy chelation is
the laying on of hands for faith healing hands-on energy healing was what the control group would be. In other words, what was “mock healing”? (And please note that it is taking all of my limited self-discipline not to make a whole bunch of jokes riffing on the term “mock healing.”) You’ll see why I resisted in a minute, as the mock healing group is funny enough without my forced sarcasm. Here is a description of the mock healing control group taken straight from the Methods section of the paper:
Mock healing practitioners were skeptical scientists who were trained to use the identical hand placements as biofield healing practitioners. Mock healing practitioners were asked not to intend to heal the patient when touching, but rather to disengage into ”planning mind” by contemplating current and upcoming research-oriented studies and grants they were currently involved in. Given that biofield healing practitioners would have more familiarity with working with patients than mock healing practitioners, to preserve participant blinding mock healing practitioners practiced procedures with study personnel until the mock healing practitioner demonstrated mastery of the hand placements and confidence interacting with and fielding potential questions that a patient might ask the mock healing practitioner before or after the session.
I’m tellin’ ya, ya can’t make stuff like this up. (At least, I can’t.)
OK, OK, in actuality, it’s not a bad control group–if you accept the premise of the study. What is that premise? It’s that there is a human energy “biofield” that healers using “energy chelation” can manipulate to therapeutic intent and that there has to be a degree of belief for that to work. I do like how that evil “planning mind” (as opposed, I suppose, to a “believing mind”) can destroy the woo rays that supposedly heal by chelating all that bad energy. Damn, we skeptics are powerful that way, aren’t we? Or perhaps it’s that the woo is actually so weak.
So, after all that, what were the results? What do you think they were? I’ll give you a hint. These results were entirely consistent with placebo responses or effects or whatever you want to call measured changes in outcome due to placebos. Basically, there was no difference in total fatigue levels between biofield healing and mock healing. Both produced a decrease in fatigue that patients on the waitlist control did not. In other words, “biofield” therapy didn’t work compared to the “mock healing” placebo control. So, given this completely negative result, what did the authors do next? They did what any good woo-meister does (and, for that matter, all too many scientists do) and started mining the data for associations, delving into the Multidimensional Fatigue Symptom Inventory short form subscales. Not surprisingly, they found barely statistically significant differences between biofield healing and mock healing in a couple of measures. They also measured salivary cortisol levels and found a significant decrease in cortisol slope over time for the biofield healing versus both mock healing and control. What this means, I have no idea, given that they measured salivary cortisol rather than serum cortisol, and salivary cortisol “variability” (which they calculated) isn’t really validated as a reliable diagnostic tool for anything that I’m aware of or correlated with fatigue.
I’m not impressed. Here’s why. First, I can’t help but note that none of these differences were mentioned in the abstract, which implies to me that even the authors didn’t consider them particularly significant. More importantly, we have multiple comparisons among small groups of patients. (Remember, there were only 76 patients in this study.) Finally, fatigue is a variable symptom that waxes and wanes frequently. it’s very prone to regression to the mean, placebo responses, and reporting bias. It’s very hard to say a lot about whether these barely detectable differences in a couple of subscale measures are in any way clinically significant. Probably not. Not that that stops the authors from laboring mightily in the discussion section to make it sound as though their biofield therapy is the greatest thing since sliced bread.
There are a number of terms that are so spot-on in terms of describing a phenomenon that I wish I had coined them. One, of course, is “quackademic medicine,” which I did not coin but which has become associated with me because I use it so much. Another is “tooth fairy medicine,” which perfectly describes what this study is. As Harriet Hall puts it:
You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists.
Exactly. The investigators never established that “biofields” even exist, much less that “energy chelation” is anything more than the laying on of hands. They’ve gotten a bunch of data that seems as though it might show something, but, even if it all were anything more than random noise and experimental bias producing false positives, they haven’t shown anything other than having measured whether the payoff from the Tooth Fairy is different if the tooth is wrapped in Kleenex. It’s quackademic medicine triumphant.
“Energy chelation” is just one of several ways to remove interphasic parasites which live in subspace rifts and feed on the biogenic fields of organic life-forms who encounter them while using warp drive. . . .
Wait, you mean my Star Trek fanfiction can get published in peer-reviewed medical journals now? Well, if that don’t just take the Vulcan biscuit!
Yup. That about describes this particular study.
Jain, S., Pavlik, D., Distefan, J., Bruyere, R., Acer, J., Garcia, R., Coulter, I., Ives, J., Roesch, S., Jonas, W., & Mills, P. (2011). Complementary medicine for fatigue and cortisol variability in breast cancer survivors Cancer DOI: 10.1002/cncr.26345