If you were a scientist, how would you study reiki or other energy therapies? How would you go about determining the effectiveness of a multi-pronged treatment plan? And how in the world do you measure Qi? These are some of the quandaries that face researchers who study complementary and alternative medicine (CAM). The traditional randomized, controlled trial can be an excellent way to look at single agent therapies like pharmaceuticals. Unfortunately, this kind of trial doesn’t quite fit when you’re looking at systemic, individualized, or unknown entities.
The way a study is designed can have everything to do with the results. Unfortunately, the study results are usually all that are reported in news headlines, while little details like poor instrumentation, a lousy control, or numerous confounding factors don’t usually see their way into print. In addition, a number of CAM therapies have unknown mechanisms, which makes it awfully difficult to figure out how to study them. (Click here for an excellent paper on the difficulties of establishing a correct sham [or placebo] for a modality whose mechanism is unknown).
Acupuncture is a good example of this. There are a number of theories on how acupuncture might work, but no one is certain. If you were to set up a randomized, controlled trial of acupuncture for shoulder pain, what would your control be? You would have to make it something that felt like a true acupuncture treatment, so perhaps you would instruct the study practitioners to insert the needles in non-acupuncture points. Maybe you would use retractable needles, so that the patient would feel a pinch, but the needle would not actually be inserted into the body. But what if something about that control treatment caused the same effect that ‘real’ acupuncture does? The results would come out looking like acupuncture was no different than a placebo control, when in fact both were causing a therapeutic reaction. This is an illustration of just one of the dilemmas facing CAM researchers.
While there is a push to build an evidence base behind many CAM treatments, research on these modalities is still in its infancy. Until science is advanced to the point where CAM is a little less mysterious, the medical and scientific community runs the risk of shunning potentially beneficial treatments or conversely, embracing useless therapies based on faulty research findings.
So, what to do? Be healthily skeptical when you read a news article declaring once and for all that a particular modality is completely ineffective, or reliant on placebo effects. On the other hand, be wary of unquestioningly accepting the results of a study that supports your particular worldview – there’s danger in that as well. Citing a poorly done study as proof that a treatment works or doesn’t work does nothing to further intelligent discussion on CAM modalities. Open-minded skepticism is better than close-minded cynicism or naïve conviction any day. Better yet, join the cadre of scientists who are working to establish ways of studying CAM, and in doing so, are pushing the boundaries of scientific thought.