What’s more quackademic medicine than Harvard’s acupuncture course? Maybe Duke’s reflexology course!

[Orac note: This post on Duke Integrative Medicine’s reflexology course was supposed to be yesterday’s post, but, amazingly, I forgot to schedule it. By the time I realized my mistake it was already afternoon yesterday. So, given that I’m rapidly approaching a grant deadline, I just decided to publish this today and use last night to work on my grant application. So it all worked out in the end, I guess.]

I’ve been writing about the infiltration of pseudoscience and quackery into medical academia for 13 years now. Over that time, I’ve seen some amazingly depressing things, veritable atrocities against science committed by some of the most prestigious academic medical centers in the world, ranging from Georgetown University to Harvard University to Memorial Sloan-Kettering Cancer Center, to the University of California, San Diego, the University of Texas M.D. Anderson Cancer Center, and the University of California, Irvine, among many others. Among these, one of the most spectacular examples of quackademic medicine has been the acupuncture course offered every year since since I first started paying attention to it nearly a decade ago. The course,The International Structural Course for Physicians: A Palpation-Based Approach, a course that spans nine months and requires you to come to Boston five times for live “hands-on” teaching about meridians and the latest quackademic studies trying to show that acupuncture “works. It’s pure quackery, but you can get over 300 CME credits for it if you’re a doctor.

What quackery could be worse as far as being prescientific vitalistic mystical nonsense? True, there’s homeopathy, and I’ve caught both Georgetown and UC-Irvine being credulous to homeopathy. It’s also true that all too many academic medical centers embrace naturopathy and that you can’t have naturopathy without homeopathy because it’s part and parcel of naturopathy. Even so, most academic medical centers view homeopathy much like the way a family views its drunk uncle, part of the family through a relation (naturopathy) but something it’s ashamed of. They don’t usually publicize it or teach it, the way Harvard teaches acupuncture.

Then there’s Duke University, which appears to be dipping its toes into the quackery course game. I’m referring to a course offered this spring by Duke Integrative Medicine in reflexology. That’s right, reflexology:

Integrative Reflexology® is a foot and hand reflexology training – a mix of massage and bodywork therapies. Clients who receive reflexology work report better sleep, less pain, calmer digestion, and decreased anxiety. This unique application is easy and fun to do, without injury from over use of the thumbs. You will learn the basic techniques of foot and hand reflexology through the 4-Theory Approach. The four theories include Structural Alignment Theory, Zone Theory, Meridian Theory, and Psychoneuroimmunology Theory. The whole-hand technique that is taught makes it gentle to give and receive this work.

Therapists who complete this workshop say:

  • “Reflexology finally makes sense!”
  • “Easiest chart to follow”
  • “Gentle on the hands”
  • “Implement into my practice immediately”
  • “Most requested add-on”

Theories. You keep using that word. I do not think it means what you think it means. But what are the “four theories”? The Duke advertisement does not say other than to name them. However, it didn’t take long using Google to find out just what these “theories” are. First, there’s structural alignment “theory”:

Structural Alignment Theory is based on the fascial model from Ida Rolf, the creator of Rolfing®. Ida Rolf called the feet the great tattletellers. They let you know where the client is holding their fascial tension. For example, the shape of the medial arch in the feet relates to the alignment of the back and spine. A collapsed arch or swollen inner lower arch, near the heel, generally indicates sacral misalignment .

Rolfing? It gets better and better. Rolfing, for those of you unfamiliar with it, is a form of alternative medicine “bodywork” that is a form of deep massage that is claimed to be useful to cure almost anything. Known formally as Rolfing Structural Integration, it was developed in the 1930s by Ida P. Rolf, a biochemist from New York, after she was diagnosed with spinal arthritis. Rolf believed that the fascia was everything. Fascia is a layer of connective tissue that covers various muscle groups and other connective tissue structures, allowing muscles to move freely in relation to each other. Rolf thought that when an injury occurs, the fascia tightens around the injury, causing chronic pain and discomfort. she thought that using deep tissue massage that she called “structural integration,” she could open the fascia, restoring balance throughout the body. Basically, there’s a germ of truth here, but Rolf drove it right off a cliff. Sure, the fascia can become part of scar tissue after an injury, just like any connective tissue, but Rolf’s disciples took it beyond that, claiming that Rolfing can benefit more than just musculoskeletal problems, but also depression, eating disorders, migraines, asthma, respiratory disorders, and many more.

Next up, zone theory:

Zones have long been the foundational theory for reflexology. The original zones are basically grids on the feet and the body that correspond to each other. It has been found that stimulation in the zones in the foot create effects in the corresponding zones in the body. Integrative Reflexology uses zones that are different from the zones used in most other approaches to reflexology. The drawing here shows the Integrative Reflexology zones on the left, which curve in relationship to the curves of the body. The Integrative reflexology zones are anatomically based and correspond to the four cavities of the body – head & neck, thoracic, abdominal, pelvic.

This is “classic” reflexology, which is based on two ideas, first that specific organs and areas of the body “map” to specific areas on the soles of the feet and palms of the hand and, second, that manipulation of these areas on the palms and soles can cause an effect on the specific organs to which they “map.” Of course, as I’ve pointed out more times than I can remember, there is no physiologic or anatomic basis to support this concept.

Indeed, reflexology was introduced into the US in 1913 by William Fitzgerald, MD, an otolaryngologist who called it “zone therapy.” As noted on Quackwatch, reflexologists claim that foot reflexology can cleanse the body of toxins, increase circulation, assist in weight loss, and improve the health of organs throughout the body and treat earaches, anemia, bedwetting, bronchitis, convulsions in an infant, hemorrhoids, hiccups, deafness, hair loss, emphysema, prostate trouble, heart disease, overactive thyroid gland, kidney stones, liver trouble, rectal prolapse, undescended testicles, intestinal paralysis, cataracts, and hydrocephalus (a condition in which an excess of fluid surrounding the brain can cause pressure that damages the brain). You get the idea. They claim reflexology is good for everything that ails you. Basically, reflexology is a form of foot massage. In that, it has the same value as any other form of massage, to make the patient feel good, but there is no evidence that it has any specific therapeutic effects.

Of course, when you make anatomically ridiculous claims about the “mechanism” of reflexology, all that leaves is the vitalistic:

Meridians are energy pathways through which Chi (life force energy) flows. The major meridians begin or end at the fingers and toes. The connection between meridians and reflexology is an important part of Integrative Reflexology®. The meridians offer another way of stimulating the organs and bringing balance to the whole system – body, mind and spirit. In Integrative Reflexology, the solar plexus reflex point overlaps with the Kidney one meridian point, enhancing the calming effects of each of these points. Each meridian is also related to a season and a variety of qualities – emotion, color, sense, personalty type, foods. Meridian Theory incorporates a holistic approach to Integrative Reflexology that is both informative and functional. It honors the need for balance within ourselves in order to heal.

I guess if Harvard can teach this prescientific vitalistic superstitious nonsense about acupuncture, Duke can teach it about reflexology. Then it can throw together a bunch of woo babble (like technobabble in Star Trek, only with woo) like this as as the “fourth theory” of how reflexology “works”:

Psychoneuroimmunology Theory is based on the connection between the nervous system, the immune system and the emotions. The feet are one place in the body where we can access all three of these systems. This theory shows how an Integrative Reflexology session can simultaneously improve brain chemistry, activate a calming effect in the nervous system and stimulate the lymph system to clear toxins out of our body. Proprioceptors are the nerve endings the feet that are stimulated in an Integrative Reflexology session. They communicate with the brain and body to produce a calming effect. At the same time, congestion in the feet is being broken up and carried away by the lymph system. These physical effects, combined with the deep relaxation effect, combine to bring the body, mind and spirit into a state of being that reduces the stress response and promotes healing.

I have little doubt that Integrative reflexology can produce a calming effect. It is, after all, no more than a pleasant foot massage. As for the rest of that stuff, it’s all a word salad of woo. It means nothing. Of course, there’s “detoxification,” and no quackery would be complete without that.

I forgot to mention that “integrative” reflexology is apparently different from old-fashioned reflexology in that it “integrates” hand and foot reflexology with a number of massage techniques. What that means in practice, I have no idea. I do know that Duke charges $525 for a weekend course.

After having looked at the reflexology nonsense, I wondered what else might be hiding at Duke Integrative Medicine. It didn’t take me long to find it. For instance, you can learn reiki from Duke:

Reiki, a form of energy healing, is an ancient practice that is used to reduce stress, improve health and quality of life, and support physical and emotional healing. Research suggests that using Reiki as a complementary therapy activates the parasympathetic nervous system to heal body and mind via the relaxation response. Reiki is accessible to everyone and is easy to learn. Practitioners use specific hand positions, held for a few minutes on or near the client’s clothed body.

“Energy healing” is, of course, quackery. It postulates a form of “healing energy” whose existence no one has ever demonstrated, much less demonstrated any human’s ability to manipulate it to healing effect. Reiki is, in essence, faith healing that substitutes Eastern mystical religious beliefs in a “universal source” of healing energy for god in Christian faith healing as the source of the healing. And Duke is offering courses in it.

Quackademic medicine marches on.