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Reflections from the 7th Annual Symposium on Advances in Pain Research

June 18, 2012
Dr. Briggs
Josephine P. Briggs, M.D.

Director
National Center for Complementary and Alternative Medicine

View Dr. Briggs's biographical sketch

Two weeks ago was the occasion of the NIH Pain Consortium 7th Annual Symposium on Advances in Pain Research. It was a great meeting, and we heard some terrific science presented. Modern neuroscience is clearly opening up our understanding of how the brain processes painful stimuli, and is yielding insights about how emotional states (or even placebo pills) modify the processing of pain in the brain. We heard about intriguing work on novel therapeutic targets, such as the adenosine pathway, a long-time scientific interest of mine, and learned about a number of highly innovative approaches to the development of new analgesic drugs. I also really enjoyed hearing about rigorous studies testing nonpharmacological approaches, such as massage, behavioral therapies, and mindfulness meditation.

Nevertheless, all is not well. My delight with the good science was tempered by my awareness, that despite progress, we do not have satisfactory answers for many, perhaps most, patients with chronic pain. As one colleague at the meeting commented, the great strides we are making in basic research are just not automatically connecting to clinical results. The recent IOM Pain report is a powerful summary of how much remains to be done. Dr. Volkow, in her introductory comments, also reminded us of the enormous burden on our communities caused by the abuse of prescription pain medications. Clearly, there is a big gap between what patients and clinicians need and what we are achieving in pain management. A holy grail of analgesia research is the development of a drug that would retain the impressive impact of opioid receptors to reduce pain, but eliminate other opioid effects, such as depression, cognitive impairment, risk of falling, and potential for abuse. It is not clear whether this is possible, but certainly it is a desirable goal.

Clearly, drugs are, and will remain, critically important in managing pain, but drugs alone are not enough. There is another important piece to pain management—patients also need strategies for self-care and ways to harness the huge impact that context, attention, emotional state, and reassurance can have on pain. NCCAM is bringing a special contribution to pain research by pursuing promising, nonpharmacological approaches to pain management; about 30 percent of our total research budget is focused on pain. Our research is built on evidence, still incomplete, that various mind and body approaches, such as meditation, guided imagery, yoga, tai chi, massage, and spinal manipulation, may have value as adjuncts in pain management. Some of these techniques are being integrated into pain management in health care facilities around the country. And, while there is a growing evidence base for their value, and a number of “real world” testimonials, there are still many areas of uncertainty. It’s my belief that NCCAM, by funding the kind of research that builds a critical, rigorous evidence base, can truly have an impact on pain management.

But, there are so many unanswered scientific questions in this field. Thus, part of our task is continuing to work to define the most important questions that are amenable to rigorous study and will help meet the enormous needs. We want to hear from you: Where can science have the most impact on pain management? What do you see as the key research questions? What do you suggest as important priorities in this often equally perplexing and rewarding field?

Comments

Comments are now closed for this post.

Stop wasting our tax money by doing “research” on all of this nonsense.

Great blog! One of the questions posed was “Where can science have the most impact on pain management?” Studying the efficacy of low tech. self help techniques that afford people the ability to address thier own pain with very little training could have an amazing impact if available on a large scale. For example, meditation, mindfulness, gentle movements that encourage a person to intrinsically learn where their pain comes from, what relieves it (eg:deep breathing or gentle Yoga stretch… or not)and any effects derived from taking analgesics. These can be taught in a group setting, are probably relatively low cost and shift the ownership/power to the patient versus a technique or pill administered by a doctor. Perhaps these would not work well with people with extreme pain, but maybe be helpful with many lower level chronic pain sufferers. As pointed out in the IOC report, gathering more data on the type of pain people are experiencing would be helpful. I like this quote by Howard Cutler “To diminish the suffering of pain, we need to make the crucial distinction between the pain of pain, and the pain we create by our thoughts of pain. Fear, anger, guilt, loneliness and helplessness are all mental and emotional responses that can intensify pain.” The internal arts mentioned above give a window of insight into the experience of pain for a person. And, as the IOC pointed out…pain is highly personal and the treatment should be too.

A well explanation about Reflections from the 7th Annual Symposium on Advances in Pain Research is present on this page, it is happened due to your struggle, thanks!

Looking into ways to help people manage pain through self-directed mental and physical exercise would be extremely useful. Pain is highly amenable to placebo responses and higher order neuronal modulation (as per Melzack’s gate theory of pain which has been refined but remained the mainstay of understanding pain perception). Moreso, we know quite well that the perception of a painful stimulus is just as important, if not more, than the actual painful stimulus. In other words, the context of pain and the impact it has on lifestyle are hugely important in the level of pain and how debilitating it is.

As such, providing education on meditation, exercise, contextualization, and goal oriented improvement would be highly successful as adjuncts to chronic pain therapy.

The important point to note, however, is that there is nothing mystical about these effects. Fabrizzio Benedetti has much to say on the topic of placebo effects and has elucidated many of the mechanisms involved. However, potential “alternative” therapies such as reiki, therapeutic touch, and acupuncture or mired in mysticism that is touted as the mechanism of action when in reality any effects seen are readily explained as placebo effects, especially considering the incredibly low a priori likelihood of the proposed mechanisms of action of these “alternative” therapies.

In the case of herbal decoctions we find ourselves with a case of placebo effect or relegating our research to the well established field of pharmacognosy, searching for active biologicals that modulate the pain response.

In any event, legitimate research into pain management needs to recognize these facts and not become overly enamored with illogical and implausible mystical mechanisms of action. In such cases, we find that “alternative” becomes a misnomer, since with actual rigorous scientific evidence of efficacy it is merely “medicine.”

Sir whatever information given it is very good for every one. I seen the website for the first time,thanks a lot for the contents which your provided in this site.

It is important when referring to “other therapies” that the correct terminology is used. NYBGRUS mentions Reiki as an Alternative therapy. Reiki is NOT an alternative therapy it is a COMPLEMENTARY therapy that works alongside all other therapies and medicines.
With regard to the “placebo effect” which many use as a reason to discount the benefits of Reiki treatments perhaps the following article may be of interest:…….

It’s very peculiar that when scientists research the effects of Reiki, they tend to conclude that the effects are no more than what would be expected from a placebo. We’ve been led to believe that there is something wrong with the placebo effect, something suspicious that we should not trust. In Spontaneous Healing, Dr. Andrew Weil describes how most doctors dislike placebo effects because they cause complications in their experiments. These doctors prefer “real treatments that work through identifiable biochemical mechanisms.” Placebo effects are invoked whenever direct causation cannot be measured scientifically. Weil enthusiastically embraces placebo effects, regarding them as pure examples of healing elicited through the power of the mind. Rather than seeing this as a nuisance, Weil sees placebo effects as a “therapeutic ally” to heal disease. Have we forgotten that people heal naturally without dangerous chemicals and without actually understanding the vehicle of causation? Remember, the human body has remarkable built-in healing mechanisms.

On the other hand, consider the use of a bestselling pharmaceutical drug used to treat migraines: Imitrex. This drug is never criticized as merely being a placebo. Instead, we receive a disclaimer that Imitrex may cause “cardiovascular side effects including serious, sometimes fatal cardiac events such as ventricular fibrillation [uncoordinated contractions of the heart muscles], transient myocardial ischemia [reduced blood supply to the heart], and coronary artery vasospasm [constriction of the coronary artery]… Serious and/or life threatening arrhythmias including atrial fibrillation [abnormal heart rhythm], ventricular tachycardia [fast heart rhythm], myocardial infarction [heart attack]… thrombophlebitis [vein inflammation], angiodema [swelling similar to hives], cerebrovascular accident [stroke], pulmonary embolism [sudden blockage in a lung artery], shock, subarachnoid hemorrhage [bleeding on the brain associated with an aneurism], hypertension, bradycardia [slow heart rate], and precordial [in front of the heart] distress have also been reported.”

The most common response to this list of potential side effects is that all drugs have side effects. And therefore? It’s okay to take them? The example of Imitrex is by no means an exception. A little cursory research on practically every pharmaceutical drug will yield equally scary results. Can scientific, medical logic be summarized as follows? Taking pharmaceuticals drugs that have known side effects including death is more scientific, and is therefore preferable, to seeking alternative and complementary healing modalities such as Reiki (Reiki is a complementary therapy) because the latter may be nothing more than a placebo effect. Thanks. Am I exaggerating these dangers? I suggest you research this matter for yourself and find out for yourself what all those big words in fine print on your medicine labels really mean.

Is there any curiosity about why so many people express relief from headaches and migraines after receiving Reiki? Many people subjectively report relief, but does this qualify as science? Me, I would much prefer “subjective” relief from my headache than “objective” life threatening atrial fibrillation. One thing that science has truly proven is that a lot of people suffer strokes, angina or die from taking migraine medicine. Is this preferable to “messing around” with natural approaches?

Now, if you find yourself involved in a serious car accident, please don’t drive to the nearest Reiki clinic! Please, in the case of an accident, broken bones, burns and other acute cases, the allopathic profession has done miracles to save hundreds of thousands of lives. At the same time, be aware that tens of thousands of deaths are caused by misuse of prescription drugs. Even more shocking is that hundreds of thousands of people die in the United States each year alone due to “proper” use of physician prescribed drugs. All of these deaths indicate tremendous “faith” in pharmaceuticals, yet those pills are still marketed as science. Faith in pharmaceuticals is embedded in modern culture at the ideological level, ironically, in the very societies that pride themselves on objective, empirical evidence. This blind faith is physically risky and psychologically disempowering at the same time. Chemicals are accepted as medicine, by definition. Patients are perceived more as passive objects of a chemical experiment than as active participants, mentally and physically, in their own well being. Blind faith in modern chemical warfare on our bodies is standard operating procedure in many countries. Death by Prescription by Dr. Ray Strand thoroughly explains the toxic truth of the dangers of pharmaceuticals.

In all events, you need to have the wisdom, knowledge and insight to make the most suitable decisions concerning health care for you, your family and your community. You need to be aware of the strengths, weaknesses, side effects and applicability of any health care measures that you consider. If you have never considered the financial interests of Wall Street in perpetuating faith in pharmaceuticals, read Selling Sickness by Ray Moynihan and Alan Cassels. They provide a thought provoking analysis of diseases that are invented or manufactured for mass consumption and therefore, for mass medication. It’s your body, your mind, and therefore your responsibility to be aware of the options available to you. Please familiarize yourself with the potential benefits and dangers of any given healing approach. You may need to select one mode or use various modes in combination to optimize your health. Wisdom based on knowledge will lead you towards the insights you need to assure your own well-being. I suggest considering Reiki as an important element in your mental and physical health program.

Learning about the history and principles of Reiki is one small step towards a greater understanding of the healing modalities available. Best wishes,…….
Abour the Author: Tom Radzienda is a Reiki Master practicing and teaching in Bangkok, Thailand. He is the author of several books of poetry including “A Promise for Siam” and “Fire Dreams.” Tom holds a Master of Arts degree from the University of Sussex in England and the title of Associate Professor from Srinakharinwirot University in Thailand…….
http://sites.google.com/site/studyreikiinbangkokthailand/Home

Great blog! One of the questions posed was “Where can science have the most impact on pain management?” Studying the efficacy of low tech. self help techniques that afford people the ability to address thier own pain with very little training could have an amazing impact if available on a large scale. For example, meditation, mindfulness, gentle movements that encourage a person to intrinsically learn where their pain comes from, what relieves it (eg:deep breathing or gentle Yoga stretch… or not)and any effects derived from taking analgesics. These can be taught in a group setting, are probably relatively low cost and shift the ownership/power to the patient versus a technique or pill administered by a doctor. Perhaps these would not work well with people with extreme pain, but maybe be helpful with many lower level chronic pain sufferers. As pointed out in the IOC report, gathering more data on the type of pain people are experiencing would be helpful. I like this quote by Howard Cutler “To diminish the suffering of pain, we need to make the crucial distinction between the pain of pain, and the pain we create by our thoughts of pain. Fear, anger, guilt, loneliness and helplessness are all mental and emotional responses that can intensify pain.” The internal arts mentioned above give a window of insight into the experience of pain for a person. And, as the IOC pointed out…pain is highly personal and the treatment should be too.

Great article !!

@Reiki/ARC president:

I am sorry, whatever nomenclature you prefer to use it is all meaningless political posturing.

Reiki is fundamentally a ridiculous notion based in Eastern mysticism and magic invented wholesale in the 1920s. There is absolutely every reason to assert that energy healing is rank quackery and has absolutely no place alongside real medicine.

Your digression into the utility of placebo effects is also inane. Andrew Weil is also an advocate for quackery and his assertions and discussions are often not worth the paper they are printed on. Aside from that, legitimate research into placebo effects do not support your conclusion with preeminent - and actually science based - researchers like Fabrizzio Benedetti concluding both that placebo effects are “real” and can, in specific circumstances, produce some objective changes but are not suitable for clinical application.

Trying to conflate MAGIC which of course will have no side effects with actual therapy is nothing more than an idealogical argument lacking all substance.

But you are right - I should be more clear. There is no such thing as “complimentary” OR “alternative” medicine. There is medicine that works, a whole bunch of stuff that doesn’t or can’t possibly, and a fair bit of stuff that has plausibility but is yet to be proven.

Diet and exercise are not CAM, nor is reflective meditation or even herbal supplementation. The remainder of CAMs are, almost entirely, known to be completely ineffective and based in antiquated pre-scientific thinking and false understanding of disease and the natural world.

Using Reiki - which, to be clear, is neither complimentary NOR alternative but MAGIC - is a non-starter. Regardless of whether it elicits a placebo response or not, whether that response is deemed effective or not, it is still nothing more than Harry Potter-esque wizardry trying to disguise itself as a valid patient intervention.

Nybgrus: I respect your right to be a skeptic and and your tunnell vision when it comes to Complementary therapies (Please note that complementary is spelt with and E not a I) and it is not my intention to endeavout to get you to be otherwise.

I would also point out to you that your abstract is not correct, You quoted ..researchers like Fabrizzio Benedetti concluding both that placebo effects are “real” and can, in specific circumstances, produce some objective changes BUT ARE NOT SUITABLE for clinical applicatio. What Dr. Benedetti actually said is that he is NOT SURE that they will lead to any clinical application.
Suffice to say that thankfully there are a growing number of Doctors, Specialists and genuine Health Care administrators who are embracing complementary therapy (including Reiki) programs into their facilities in countries such as USA, Canada, Australia, United Kingdom, Ireland to name a few.
These people are seeing the benefit of Reiki on their patients and even though many of them may not be practitioners themselves they are open to providing these services for the benefit of their patients.

Indeed there is a rapidly growing base of evidence and ongoing research into the benefits of Reiki.
Here in Australia for example one of a number of cancer hospitals (a leading teaching hospital) through one of it’s complementary therapies units has carried out TEN years of research into their benefits and concluded that REIKI is of great benefit.
There are numerous research studies into Reiki and I name a few examples below. Unfortunately I cannot format this reply box so it is a little difficult to separate them.
A Phase II Trial of Reiki for the Management of Pain in Advanced Cancer Patients Karin Olson, RN, PhD, John Hanson, MSc, and Mary Michaud, RN Faculty of Nursing and International Institute for Qualitative Methodology (K.O.), University of Alberta; Alberta Cancer Board (J.H.); and Cross Cancer Institute (M.M.), Edmonton, Alberta, Canada

Effects of Reiki Treatment on Anxiety and Depression: A Randomized Control Trial
Vera A. Porter, ThD, PhD, David A. Eicher, PhD and Nanci Avitable, PhD
Results: There were statistically-significant levels of improvement in all three measures in Group 1: State Anxiety (p<.001), Trait Anxiety (p<.001) and Depression (p<.001) from Baseline to Post-test. In Conclusions: Findings indicate approximately 10% reduction in State Anxiety, Trait Anxiety and Depression after completion of the three Reiki treatments. These reductions were maintained at the 30-day Post-Intervention measure.
A Randomised Controlled Single-Blind Trial of the Efficacy of Reiki at Benefitting Mood and Well-Being
Deborah Bowden, Lorna Goddard, and John Gruzelier Psychology
Effects of Reiki Treatment on Anxiety and Depression: A Randomized Control Trial Vera A. Porter, ThD, PhD, David A. Eicher, PhD and Nanci Avitable, PhD
Pilot Crossover Trial of Reiki Versus Rest for Treating Cancer-Related Fatigue
Kathy L. Tsang, BA, Linda E. Carlson, PhD, CPsych, and Karin Olson, RN, PhD
PMID: 20635803 [PubMed - indexed for MEDLINE]
Effects of complementary therapies on clinical outcomes in patients being treated with radiation therapy for prostate cancer. Beard C, Stason WB, Wang Q, Manola J, Dean-Clower E, Dusek JA, Decristofaro S, Webster A, Rosenthal DS, Benson H. Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts.

I for one together with the responsible Health Departments here in Australia will continue to facilitate the ingegration of Reiki into mainstream for the benefit of clients and patients.

“(Please note that complementary is spelt with and E not a I) ” Spelling pedantry is the weakest form of discussion, left for those who have little of actual substance to say.

I will add that one of my undergraduate degrees is in medical anthropology in which I extensively studied CAM and did indeed think it quite a worthwhile pursuit. I even wrote in my med school personal statement that I believed CAM modalities would be useful to be integrated into “mainstream” medicine.

Then I actually did rigorous post-grad research based on my other undergraduate degree in evolutionary biology and discovered what you and all those others whom you cite have not - how incredibly easy it is to fool oneself. You would do well to learn from Richard Feynman, especially one of his most famous (and my favored quote):

“The first principle is that you must not fool yourself—and you are the easiest person to fool. So you have to be very careful about that. After you’ve not fooled yourself, it’s easy not to fool other scientists. You just have to be honest in a conventional way after that”

“What Dr. Benedetti actually said is that he is NOT SURE that they will lead to any clinical application.”

I fail to see the distinction in context. I said there are no suitable clinical applications for placebo based therapy currently and there is doubt there EVER will be. This is exactly what Benedetti says - as does Edzard Ernst, also a former CAM and “integrative medicine” practitioner until he stopped fooling himself.

You then go into argumentum ad populum by describing how many people are finding CAM to be interesting and useful. This in and of itself is not at all interesting. Truth is not voted upon.

I also find it funny that you mention your work in Australia… because I am a listed member of the Friends of Science in Medicine which is an organization started in Australia specifically to combat the infiltration of quackery like reiki and homeopathy and chiropractic into academic institutions.

And lastly all the studies you have cited are a prime example of not listening to Richard Feynman. They are poorly done, poorly designed, and do not have the implications proponents of CAM would like us to believe they have. But being able to understand that requires a lot of education, practice, and intellectual honesty.

Reiki is, by definition, magic. There is simply no other way to describe an attempt to channel “energy” from “the one universal source” into a human body to promote health and well being, especially since it was invented by a Japanese man on a mountain who claims to have seen an orb of light which filled his head with the knowledge of how to “heal like Jesus” which was his intent from the outset.

Falling back on placebo effects to justify the application of such practices is simply not scientifically, clinically, or ethically justifiable.

The idea that “patients also need strategies for self-care” is very important. Pain can turn anyone into a helpless victim but given the opportunity for realistic self-care you at least feel you are doing something. I have a family member with a rare pain condition in her head and the slightest touch or breeze can send her into severe pain. She has been given some strategies for control and this helps becuase she can at least do something.

@reiki president:

Your reference to me as a skeptic seems to be almost used as a pejorative in the sense that you would tolerate it though find it a negative.

However, I can assure you that I have no tunnel vision - I am wide open to evidence and am always ready and willing to change my mind based on that. The problem is that the evidence for pretty much everything that is typically dubbed “CAM” is non-existent or absolutely non-convincing to anyone with reasonable scientific training. And Reiki is most certainly such an example.

The studies you have cited either do not say what the authors contort the abstract and conclusions into or are of such poor quality that no reasonable person should do more than use them as an example of how to teach undergraduate students how to recognize poor studies and improve their own scientific technique.

The problem inherent to the study of such things - reiki specifically - is that you are looking for an effect of a putative mechanism that has not been demonstrated to exist and even moreso has significant evidence for its lack of existence. Channeling a mystical source of universal energy to treat disease is pure fantasy. By the statistical nature of the universe however, positive results can be seen when testing things that genuinely don’t exist or don’t work. N-rays and cold fusion are examples found in the physical sciences. How this can be is something every undergraduate science student should learn, since ignoring it leads to exactly what we have here - a list of study titles that aren’t worth the kilobytes of web space they occupy. By the nature of frequentist analysis, no matter WHAT you study, you will find a positive result when there is absolutely nothing there 5% of the time. That is called the alpha-error and it is 5% in the most perfect of circumstances. In real life, that number is genuinely much larger and hence Ionnadis’ article in The Atlantic. It also is a facet that explains the “decline effect” - as more and more studies are done, especially more rigorous ones, then this statistical uncertainty becomes pinned down and effect sizes are decreased… in the case of reiki and most CAM (I say most, because often nutrition, diet, and exercise are called “CAM” even though there is absolutely nothing complementary nor alternative about it since they are integral to proper medical care) the effect goes down to essentially zero.

The correction to this is a Bayesian framework which assigns a prior probability to the likelihood of an effect being there. The Bayesian prior for Reiki is extremely low. In fact, the only prior that is likely to be lower is homeopathy. While calculating an exact number is often difficult if not impossible, reliance on basic principles and fundamentals of scientific knowledge can give an estimate such that one can assess whether a “significant” p-value actually means anything or not. In the case of reiki, even a well designed study with a p-value of 0.01 is still not reasonably considered significant because the Bayesian correction for the frequentist interpretation demonstrates the true p-value to be non-significant. As Richard Feynman said - extraordinary claims require extraordinary evidence. And reiki is making an extraordinary claim - magical distance healing via a universal energy source of mystical origin - and providing us with extremely pedestrian evidence. The first principle is not to fool yourself, and you are indeed the easiest person to fool.

So please, don’t attempt condescension by asserting that my skeptical attitude is giving me tunnel vision and then throw a bunch of poor studies at me in a Gish Gallop, for it is you that is at risk of having your mind so open that your brains fall out.

Thus you are ultimately left relying on placebo effects to justify the “treatment” as being beneficial. While that is an interesting topic of discussion, it is itself a very large one. Suffice it to say, it is reasonable to conclude at this time that therapeutic modalities based SOLELY on placebo effects are not clinically useful and are certainly medically unethical. Claiming a particular putative mechanism of action that simply cannot exist is clinically not useful and medically unethical.

But no matter how you slice it, there is no reasonable conclusion to draw except that reiki and most other “CAM” is nothing more than elaborate (and sometimes not so elaborate) placebo which seems justifiable only when one does not recognize the logical fallacies and cognitive biases in play.

The rub becomes the fact that indeed, there does exist truly beneficial therapeutic modalities out there that will not be discovered (or at least not in a timely fashion) because application of a reasonably scientific Bayesian framework will exclude them from research. And if we had a crystal ball that could see the future we could mitigate that, but not otherwise. Since we cannot throw money, time, and research potential at absolutely every random idea that MIGHT work, we must make educated and rigorous decisions. And pursuing research into something as ridiculous as reiki for pain management is a waste of resources that would be much better spent on rigorous research of placebo effects - which is all that reiki is, after all.

We are pleased to receive numerous comments in response to this blog post. In the interest of fostering a collegial space, we would like to remind commenters to be respectful. You may want to review our comment policy at nccam.nih.gov/tools/commentpolicy.htm.

Thank you nybgrus for taking the time to write all that. I am slightly amused at how you wrote around your failure to correctly spell complementary in relation to the topic.
I genuinely do respect your right to be a skeptic, and I do not expect you to respect my right to believe in what I do. Skeptics in the past have had many a highlighted profile, I have read that at one time the earth was considered to be flat. I also read that it took science 70 years to actually figure out how Asprin worked, so I can wait for science to catch up on how Reiki works.
With regard to your involvement in the Australian group Friends of Science I wonder if you have seen the following article.
I abstract a paragraph and place it at the top….The Australian Medical Association president has withdrawn his support from the lobby group. A number of researchers and doctors have also pulled out of FSM reportedly saying they were not aware of the full picture….. The full article is as follows…..The issue has had significant media coverage, but one question has failed to be properly answered.
Why is a group of prestigious doctors and scientists who have the backing of the most profitable industry in the world according to Fortune 500 – the pharmaceutical industry – targeting a few poorly-funded natural medicine courses?
The official line of the group is that these “alternative medicines” are making Australia look bad and “trashing” the universities’ reputation. But is that really the reason? With all the countries and all the universities in the world that provide alternative medicines?
A similar move was made in the UK recently – the British will no longer be able to study certain natural medicine degrees – this does not include chiropractic or osteopathy – at publicly-funded universities from this year. Yet natural medicine has been utilised across Asia and Europe for thousands of years.
The United States and Canada are pioneers of chiropractic as we see it today, providing university courses long before they were ever offered in Australia. Also, nearly 85 per cent of US medical schools offer elective courses in alternative medicines.
According to the World Health Organisation (WHO), 80 per cent of the world’s population relies on natural therapies. The figures in Australia are much the same.
So why Australia? What is FSM so worried about?
The group seems to be particularly concerned about an increase in chiropractic courses after it was announced recently that Central Queensland University would be offering a new chiropractic science degree. The move could also be partly to do with the ruling in 2010 that all chiropractors in Australia may use the title ‘Doctor’.
FSM has accused what it labels as Australia’s “lesser” universities that offer alternative medicine courses of “putting the public at risk”.
However, this is a difficult notion to fathom when you compare the tiny number of injuries inflicted on natural medicine patients compared to the hundreds of thousands of deaths recorded each year due to medical errors.
WHO estimates that one in 10 hospital admissions leads to an adverse event while one in 300 admissions leads to death. WHO puts medical errors as among the top 10 killers in the world. According to the US’s Institute of Medicine, preventable medical errors kill 98,000 people in the US alone each year and injure countless more.
One of the group’s biggest complaints, according to FSM co-founder Emeritus Professor John Dwyer from the University of NSW, is that natural medicine “doesn’t strive to be tested”. He says that modern medicine is “totally devoted” to taking an “evidence-based approach” and “do good science and do good research into the things we do to people”.
The argument that modern medicine is evidence-based as opposed to other types of medicine is an argument that is often used by medical lobbyists, and tends to be generally accepted by the public. However, according to a report by a panel of experts assembled by the prestigious Institute of Medicine, “well below half” of medical care in the US is based on or supported by adequate evidence.
According to the report, between 1993 and 2004 there was a more than 80 per cent increase in the number of medications prescribed to Americans. The panel believes this boom in pharmaceuticals is outpacing the rate at which information on their effectiveness can be generated. “If trends continue, the ability to deliver appropriate care will be strained and may be overwhelmed,” the report concluded.

What FSM fails to recognise is that natural medicine courses taught at universities incorporate a much higher level of evidence-based studies, such as health science and human physiology, than if they were to be taught outside of a university.
The Australian universities that have been criticised have all defended their courses, saying they are very much evidence and science-based.
In naturopathy, for example, on top of herbal medicine and nutrition, students also learn the same things that a physiotherapist, medical doctor or nurse learn. As well as chiropractic studies, chiropractors study biology, physiology, neuroscience, anatomy and pathology, for example. These are all scientific studies.
Acting head of RMIT’s Health Sciences School Dr Ray Myers has defended its programs as “evidence-based education and practice”, saying clinical research of natural medicine treatments are funded by the National Health and Medical Research Council (NHMRC).
If FSM really was so worried about public safety they would not be trying to exclude natural medicine from universities where they are taught with much more of a medical focus. Graduates of these courses are much more likely to refer patients to medical doctors when necessary.
As Nick Klomp, dean of the science faculty at Charles Sturt University, points out, thousands of practitioners already provide alternative medicine and they are very much in demand. “I could ignore them or I could train them better,” he said. “We actually create graduates who are much better health care providers. It’s all about evidence based, science based.”
The other question to ask is just how representative the group is of Australian doctors. Dr Wardle, a NHMRC Research Fellow at the University of Queensland’s School of Population Health conducted a survey of every rural GP in NSW and found a third did not refer to alternative medicine providers, a third were incredibly open to it, and a third would refer patients to practitioners that they knew achieved results.
The Australian Medical Association president has withdrawn his support from the lobby group. A number of researchers and doctors have also pulled out of FSM reportedly saying they were not aware of the full picture.
Many Australian medical doctors recognise their limits and refer to natural providers when necessary. However, others continue to believe that modern medicine – which is only 100 years old – is the only way of curing pain.
Natural therapies have been used for more than 10,000 years, and so they deserve a place in society, in Australian universities, and even in modern medicine. According to Australian trauma and general surgeon Dr Valerie Malka, former director of trauma services at Westmead Hospital, while modern medicine is revolutionary when it comes to surgery, particularly in emergencies, for pretty much everything else, traditional, natural or alternative medicine is much more effective.
She says in particular, modern medicine is completely unable to treat or cure chronic illness. Rather than focusing on symptom control, natural medicines work on the body’s ability to heal the cause of the illness while modern medicine suppresses the body’s healing mechanism with drugs that attack the body’s natural defence mechanisms, throwing the immune system out of whack.
Dr Malka believes the attack on natural medicine has more to do with the threat to modern medicine’s power base as well as its “unhealthy relationship” with the “trillion-dollar pharmaceutical industry”.
This is not the first time natural medicines have been attacked by the medical industry.
Alternative healthcare professionals such as chiropractors, naturopaths, and midwives have been targeted by the American Medical Association (AMA) for nearly a century, in spite of a federal court injunction against the AMA in 1987 for illegally trying to create a monopoly in the healthcare market.
Up until 1983, the AMA had held that it was unethical for MDs to associate with “unscientific practitioners” and they labelled chiropractic “an unscientific cult”. They also had a committee on “quackery” which challenged what it considered to be unscientific forms of healing. Five chiropractors including Chester Wilk sued the AMA, claiming that the committee was established specifically to undermine chiropractic.
Wilk won the case, with Judge Susan Getzendanner ruling that the AMA had engaged in an unlawful conspiracy in restraint of trade “to contain and eliminate the chiropractic profession,” also saying that the “AMA had entered into a long history of illegal behaviour”.
If you look at the history of attacks on natural healthcare providers over the last 100 years, it is difficult not to associate this attack by FSM as the latest attempt to influence the public into believing that natural medicine is, as it says, “quackery” by spreading propaganda that most of the time is simply not true.
“It’s just extraordinary that such undisciplined nonsense is being taught in universities around Australia,” Mr Dwyer has said.
Why does this group feel that it has the right to talk this way about natural medicines that are ages old and used by 80 per cent of people across the world?
If FSM really was concerned about patient care and safety in Australia, then perhaps it would investigate medical practices which, unfortunately, seriously injure and kill thousands of people every year, rather than target natural medicine.

nybgrus you speak about the rigorous science and evidence base for conventional medicine, clinical trials etc etc. ..You may or may not be aware of the following which is just one of many such cases….Merck & Co to pay $950m Vioxx fine: Merck & Co (trading in Europe as MSD) has agreed to pay almost a billion dollars to settle criminal and civil claims relating to its US promotion of the arthritis drug Vioxx.
The total of $950m covers all outstanding cases in the US relating to the drug’s off-label marketing and alleged false statements regarding its safety.
Ironically, Merck’s anti-inflammatory drug has perhaps inflamed more legal trouble than any drug in recent history.
Launched in 1999, Vioxx (rofecoxib) was used worldwide for treatment of rheumatoid arthritis. Merck withdrew it from the global market in 2004, responding to evidence that it increased the risk of blood clotting and other serious cardiovascular events.
However, as early as September 2001, the FDA had sent Merck a Warning Letter directing the company to cease publishing marketing materials which it judged to be “false, lacking in fair balance, or otherwise misleading”.
The criminal charges against Merck in the USA relate to its promotion of Vioxx as a treatment for rheumatoid arthritis for three years without FDA approval. The drug was finally approved by them in that indication in 2002.
The civil charges in the USA have taken the form of thousands of private lawsuits by patients or their relatives, claiming that Merck marketed the drug in an off-label indication and/or that it made false statements to Medicaid regarding the drug’s risks.
class actions on behalf of thousands of patients have been launched in the UK and Australia.
Merck made approximately $11bn in global revenue from Vioxx, but stands to lose most of that. The company has already paid $4.85bn to settle individual lawsuits and almost $2bn in legal costs.
Under the terms of a plea agreement with the US Department of Justice, Merck will plead guilty to a single misdemeanour for its promotion of Vioxx in the US between 1999 and 2002, paying a $322m fine.
The company will settle all US civil claims with a $628m payment that covers both the off-label marketing and the claims of misleading statements. Of this payment, two-thirds will be recovered by the US Government and the rest by Medicaid.
Merck & Co commented that the civil settlement did not constitute any admission of liability or wrongdoing at the corporate level: “As part of the plea agreement, the US acknowledged that there was no basis for a finding of high-level management participation in the violation.”
The case reflects the issues facing global pharma companies concerning potential breaches of regulations by executives at lower levels………..
The most dramatic allegation regarding Vioxx has come from Australia, where a court heard in 2009 that doctors had received a bogus ‘clinical research journal’ containing pro-Vioxx articles credited to non-existent doctors and written by Merck’s marketing team

I find it amusing that you continue to base your rhetoric on the pedantry of a spelling error, legal precedent, and popular appeal rather than actual science, all while not even beginning to address the points I have made at all in yet another Gish Gallop of interesting but otherwise irrelevant points.

You are correct that it took much time before the precise mechanism of aspirin’s efficacy was determined. But there was demonstration of efficacy before hand. You are creating a straw man here in that you seem to think that being scientifically rigorous demands that the MOA be elucidated prior to efficacy being confirmed. This is simply untrue. The problem with reiki is that the data shows it does NOT have efficacy beyond placebo which demonstrates to us that there is no intrinsic efficacy to the intervention. If aspirin were shown to have no efficacy over placebo then trying to find a mechanism would be pointless. The FURTHER issue with reiki is that the PROPOSED mechanisms have no basis in reality. With aspirin we can assign a relatively high Bayesian prior because we know chemical isolates can have bio active properties. However channeling energy into a person has absolutely no evidence of being a real phenomenon in case and has plenty of evidence to demonstrate the extreme unlikelihood of it being the case.

You may argue that this is not the mechanism of reiki. That is fine. But we are still left with a pile of studies that demonstrate no efficacy beyond placebo and thus can still determine that it is intrinsically useless as a therapeutic modality. If a sugar pill can do what the therapy does - no matter what it is - then the therapy does not work.

You then go into a long discussion about the FSM. That is irrelevant to the conversation about the scientific validity of reiki/ Suffice it to say that I am happy to call it a moot point and move on, since there is no need to muddy the waters with political discussions.

You then proceed to commit the argument from antiquity and argument from popularity fallacies. Merely because something has been used for a very long time does not in any way demonstrate ANY validity to its use. Blood letting was done for millennia as have exorcisms and prayer. The fact that large amounts of people do something also means nothing. Power balance bands were used by millions and attested to as efficacious. That is clearly not the case. If you wish to have a scientific discussion of the validity of reiki then bringing in logical fallacy regarding irrelevant topics is not the way to do it.

Next you cite legal precedent that has nothing to do with reiki or scientific evidence of validity. Appeal to authority - in this case legal authority - is also a logical fallacy. In Kansas there is a law that women cannot drink caffienated beverages after 6pm. Would this be scientific evidence that evening caffeine consumption is deleterious to women? I think not. So citing legal precedent is also immaterial to the discussion.

You ask why a group feels the right to police the actions of 80% of the population. Besides the fact that your numbers are based on bad studies that overestimate CAM use by including exercise and diet as “CAM” (which they are NOT) this is also an irrelevant question. We see it fit to regulate the auto industy which is used by a huge amount of people. We saw it fit to regulate the food industry which is also used by, well, just about everyone. It is called safety monitoring and allowing willy-nilly whatever people would like to sell without any oversight is harmful to the public good. Which is exactly what the US was like in the late 1800’s and why the FDA and USDA were created in the first place. Upton Sinclair’s book “The Jungle” is an excellent read on the topic of why oversight and regulation are indeed necessary.

And lastly you begin to cite the harms of modern medicine commiting two fallacies at the same time. First is the false dichotomy fallacy - even if you demonstrate that modern medicine is overall more harmful than helpful, that does not prove that CAM is useful. That is the tactic that creationists use - they have no way to support their own theory and so they try and demonstrate that evolution is false. Even if they succeeded that would not validate their theory and this is the same logical mis step you are committing at this moment.

The second is that you take the harms in isolation. Nobody ever claimed that modern medicine is risk free. We must always carefully weigh the benefits and harms quite carefully to determine if the treatment we are giving is worth the risks it exposes the patient to.

Certain risks are so low that even extremely well powered studies can’t possibly hope to pick them up. That was the case with Vioxx (which yes, I am quite familiar with). The increased cardiovascular risk from Vioxx was low enough that it could not be detected in study populations, but when a large number of patients were exposed it became detectable. That is the entire point of post-marketing surveillance - to pick up these small trends.

There is also indeed the possibility of research bias, especially from studies funded by drug companies. This, however, is not an indictment of modern medicine but of research ethics and something we all strive to eliminate as best we can.

Lastly, you ignore the benefits of modern medicine. It is indeed true that a large number of people are harmed by modern medicine - many of them completely unnecessarily. But it is also true that a VASTLY larger number are helped. And it is also true that improvements to health care delivery and treatment are constantly being worked on to continue to reduce the number harmed while increasing the number helped.

Citing a bunch of law suits and payout is complety meaningless to this conversation.

Now, if you can attempt to actually understand my previous post and respond with actual rebuttals to the actual points made, without resorting to the plethora of logical fallacies that I have pointed out above, then our conversation may continue.

Being scientifically rigorous means focusing on the topic and avoiding logical fallacy, something you have not done in your most recent post. I welcome your response and until then my previous point stands.

Every human being wants to have good health and awake. The difficulty is how to keep your health and well-maintained environment, even pursued with minimum risk. Good information, thank you

Your research will provide healthy life to lots of people.. Nice information, many thanks to the author. It is incomprehensible to me now, but in general, the usefulness and significance is overwhelming. Thanks again and good luck!
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The idea that “patients also need strategies for self-care” is very important. Pain can turn anyone into a helpless victim but given the opportunity for realistic self-care you at least feel you are doing something. I have a family member with a rare pain condition in her head and the slightest touch or breeze can send her into severe pain. She has been given some strategies for control and this helps becuase she can at least do something. [commercial link removed, per policy]

Congratulations on your site, the information you share is of high quality.
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I believe nybgrus has through his long and convoluted reply actually pleased those of us who are more concerned with safe outcomes for patients through therapies like Reiki.
I have spent the last few weeks working with Doctors, Nurses and Hospital Administrators in two major hospitals here in Australia who are in the process of introducing Complementary Therapies Programs - including Reiki. It is encouraging when professional, caring and open minded people are prepared to put the patient first. It is indeed the patient that all medical practices are supposed to put first.
Also I recently attended a National Medical Conference in Melbourne at which public gratitude was given to the Friends of Science in Medicine for the huge increase in interest for Complememtary Integretive Medicine that has come about since their flawed arguments to have Australian Education Facilities remove CIM training from their courses. Listening to qualified Science based and Patient Outcome discussions from open minded (which is what I believe scientists in general are) Doctors and Researchers was encouraging.
I wish nbygrus well on his journey.

Once again you have completely missed the point of everything I have said and failed to address one iota of the science (or rather lack thereof) regarding reiki. Simply because some institutions have been duped into (or more likely see easy dollar signs) utilizing CAM or reiki specifically does NOT address the scientific validity of it. Once again, many people do many things which have absolutely no basis in reality. And many people are willing to sell many things which have absolutely no basis in reality.

So merely because someone is willing to sell reiki and someone is willing to buy it means absolutely nothing except to lend credence to the old adage that a fool and his money are soon parted.

Being “open minded” as you seem to wish me (and others) to be would mean accepting the possibility that magical incantations can have putative effects. I am quite open minded and willing to change my mind - even on something like reiki - with proper EVIDENCE. Not appeals to who is buying your product.

Anyone with a little bit of scientific acumen will be able to see quite clearly that you have spent all your time discussing marketing rather than science, since there is no good science to demonstrate the efficacy of reiki and plenty to demonstrate that it doesn’t work and that it simply CAN’T work.

You may be content that gullible people are buying into your placebo incantations, but a used car salesman selling a lemon is also quite content. No matter how you slice it, placebo medicine is unethical.

Strange that nybgrus has not once mentioned the benefit that Patients themselves report from receiving a Reiki treatment. Science will eventually be able to measure the benefits. IF something does NO harm, is provided in a non manipulative and non invasive way, is provided with informed consent, is seen by an attending Medical Doctor to be of benefit to the patient, then why on earth are people like nybgrus hell bent on trying to disprove what patients themselves report by ignoring them and shifting focus to science. Even one of the largest institutions in the world…the Catholic church is on record as saying ….just because it is not scientifically proven does NOT mean that it does not work…. I provide Reiki treatments in a Palliative care hospice and the people I treat (who also receive Chemo and Radiation treatments) are extremely grateful for the relief obtained from Reiki treatments. I prefer to listen to them than to nybgrus.
Also the fact that several times he mentions money,.. buying into …easy dollar signs etc shows me that he is easily focussed on financial implications…..NOT once did I mention money. The Reiki Programs that I spoke of in Australia are supported by genuine and caring VOLUNTEERS who are more concerned with Patient benefits.

So now you are backed into a corner regarding the science it would seem. There is none to support your position that Reiki has any intrinsic efficacy. At least you have conceded that point. I find your exasperation that I am so consistently “shifting the focus to science” as if that were a BAD thing. I’m sorry but this is the blog of a RESEARCH facility - a SCIENTIFIC research facility. What ELSE should I be discussing? And what other way does there exist to demonstrate the efficacy or lack thereof of something? (I’ll give you a hint - none).// As for your next point about the HARM and what patients themselves report. Well, firstly it is extremely well established that reporting bias and error are quite common - it is well documented that often patients will tell the practitioner what they think the practitioner wants to hear. Next, there are known biases in studying subjective outcomes including, but not limited to, things like the Hawthorne effect. And lastly, there is a plethora of data that FEELING better is not synonymous with BEING better. You make some vague assertion that “science will eventually be able to measure the benefits.” Well, science can measure outcomes… and there are none to be spoken of. The benefit - as an outcome measure - either exists or it doesn’t. For reiki, it is quite clear that it doesn’t.// You go on to talk about providing reiki in a “non-manipulative” way. So tell me, do you give adequate informed consent by stating that the notion of distance healing through energy fields is a thoroughly discredited notion that has no basis in reality and the extent of what you are able to provide is nothing more than the placebo effect of a calming ritual whilst waving your hands over the person as IF you were doing something, which a nice chat over a cup of tea would be just as equally capable of doing? Because if not, then you are most certainly manipulating the people whom you provide reiki to.//Next you mention the Catholic church… as if that has anything to do with anything at all. That is a desperate plea for “other ways of knowing” which simply are not valid and have no place in the scientific discourse on the treatment of patients. Believe whatever you wish in your own home on your own time, but do not try and pawn off BELIEF as an effective TREATMENT for patients.//And lastly to address the harm aspect. There IS harm involved. Beyond just costs in time and money. Edzard Ernst wrote an excellent article appropriately titled “Giving placebos such as reiki to cancer patients does more harm than good” (http://www.guardian.co.uk/science/blog/2011/oct/11/placebos-reiki-cancer-patients-harm). The Journal of the American Medical Association did a robust study which demonstrated that patient satisfaction is INVERSELY correlated with health outcomes, including cost of health care, quantity utilized, and INCREASED MORTALITY (Arch Intern Med. 2012;172(5):405-411. doi:10.1001/archinternmed.2011.1662). So yes, there are indeed HARMS in falsely placating patients with placebo medicine beyond the ethical ramifications involved (which alone are sufficient to discard reiki as a therapeutic modality).// To sum up our conversation, you have come to the realization that science in no way can support the efficacy of Reiki and that it must be purely placebo medicine. You appeal to logical fallacies such as “other ways of knowing” and ignore the current knowledge on the topic of Reiki. After appealing to how patients FEEL and ANECDOTES, I have now demonstrated why placebo medicine is beyond just unethical, it actually causes active harms and increases the cost of health care and MORTALITY. I can appreciate your attachment to the concept of Reiki (or else why would you be the President of some Reiki organization) and that you have what you feel to be compelling evidence for the utility of Reiki as a therapeutic modality. These two things undoubtedly make it extremely hard to relinquish your stance and as such I sadly doubt that you ever will. But after all this back and forth with piles of evidence presented that the use of Reiki for any purpose besides the entertainment of healthy people is simply irredeemable by any standard and from any facet. Ethics, efficacy, harm, and cost all demonstrate clearly that Reiki is not just of zero value, it is of NEGATIVE value in all relevant aspects.

I am glad to see we are finally addressing the issue of pain medication as it appears many more prescriptions are being written.

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Looking into ways to help people manage pain through self-directed mental and physical exercise would be extremely useful. Pain is highly amenable to placebo responses and higher order neuronal modulation (as per Melzack’s gate theory of pain which has been refined but remained the mainstay of understanding pain perception). Moreso, we know quite well that the perception of a painful stimulus is just as important, if not more, than the actual painful stimulus. In other words, the context of pain and the impact it has on lifestyle are hugely important in the level of pain and how debilitating it is. As such, providing education on meditation, exercise, contextualization, and goal oriented improvement would be highly successful as adjuncts to chronic pain therapy. The important point to note, however, is that there is nothing mystical about these effects. Fabrizzio Benedetti has much to say on the topic of placebo effects and has elucidated many of the mechanisms involved. However, potential “alternative” therapies such as reiki, therapeutic touch, and acupuncture or mired in mysticism that is touted as the mechanism of action when in reality any effects seen are readily explained as placebo effects, especially considering the incredibly low a priori likelihood of the proposed mechanisms of action of these “alternative” therapies. In the case of herbal decoctions we find ourselves with a case of placebo effect or relegating our research to the well established field of pharmacognosy, searching for active biologicals that modulate the pain response. In any event, legitimate research into pain management needs to recognize these facts and not become overly enamored with illogical and implausible mystical mechanisms of action. In such cases, we find that “alternative” becomes a misnomer, since with actual rigorous scientific evidence of efficacy it is merely “medicine.”
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Very good article with lots of information at all. I just pleased to read about this entry and all these information are very helpful to me. Thanks for this allocation. :lol:

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its really a good article having lots of information and have plenty of things to read .

Im impressed, I have to say. Very seldom do I discovered a blog thats both educational and entertaining, and let me tell you, youve hit the nail on the head. [commercial link removed, per policy]

Thanks for your article! I agree with Dr. Briggs. I think that the public should be more informed about the benefits of alternative forms of disease management, such as massage and exercise. Drug therapy is just one aspect of disease management, and oftentimes the more costly option. Increased funding for research in this area can only be beneficial for the general health of the population.

There is nothing “alternative” about exercise, nutrition, or even massage (unless you claim supernatural or otherwise magical effects of massage beyond relaxation, stress relief, and pain relief). They are completely science based modalities explained quite thoroughly by the standard biomedical understanding of physiology and disease. Lumping them in as “CAM” is a purely marketing device with no basis in reality. As per any attempted definition of CAM, exercise, diet, massage, and stress relief are all part of the standard “mainstream” biopsychosocial model of medicine that has been taught and practiced for a number of decades. Ergo, either by definition or by practical understanding they *cannot* be considered CAM

Thanks for your article! I agree with Dr. Briggs. I think that the public should be more informed about the benefits of alternative forms of disease management

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Isn’t it interesting that the majority of comments we find here in support of CAM are both trivially superficial and contain a commercial link?

In many cases small quantities of herbs are therapeutic, given at the correctdose and in correct proportion of herb within a formula. In larger dosesthey are often highly dangerous, for example angelica (Angelica archangelica),coltsfoot (Tussilago farfara), goldenseal (Hydrastis canadensis), licorice(Glycyrrhiza glabra), and pokeweed (Phytolacca americana). I also never advisecombining drugs and herbal medicines as their interactions are unpredictable.

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And my point still stands.

Nybgrus…. you have made your argument many times on this site (these “CAM” methods should not be in a category by themselves and should be studied the same as any other treatment). You have helped to broaden my perspective and I thank you. I ask you if you have studied the healing traditions of other cultures and places in our world and found out what they consider to be “real healing”? I speak of places where they use other medical traditions such as traditional chinese medicine as primary medicine.

PD: Thank you for the compliment. You are correct in your understanding of my argument - there is nothing unique or special to so-called CAM treatments that warrant investigation through special means. I wish to be very clear in saying that I do not, a priori, think that anything dubbed “CAM” *shouldn’t* be investigated - merely that it should be investigated in the same way, with the same rationale and prior plausibility as anything else we would investigate. In answer to your question - yes, I have studied the healing practices and traditions of other cultures. One of my undergraduate degrees is in medical anthropology with a focus on different healing traditions from Ayurvedic to Traditional Chinese Medicine to Vietnamese hot/cold therapy to herbalism, naturalism, and vitalism. As a sad commentary of the field, I was taught all of these as de facto true and verified, with many of my professors adopting the stereotypical rant against modern medicine calling it “reductionist,” “Western BioMedicine,” and saying that there was a systematic attempt at repression of “alternative” modalities not because they didn’t work, but because of some sort of egoistic turf war. I believed this to be the case and pursued an interest in what was then the very nascent idea of “integrative medicine” until I investigated it deeply enough to realize that these modalities were all politicoideological constructs with little or no scientific evidence to support them. In particular, the mythology of TCM is what struck me the most. Learning about how Chairman Mao used it to placate the masses and that the Chinese themselves knew it was pure hokum, such that the elite and educated of China never used it as anything but a way to hoodwink the masses and then as propaganda and disinformation towards the West. The history of acupuncture was also enlightening in that as it is currently practiced is an invention of the 20th century, not a “thousands of years old tradition” as commonly believed. In fact, actual ancient Chinese acupuncture was very similar to European blood letting practices of the time and the meridian points and pathways map reasonably well to veins. 

In my law practice (I handle personal injury cases exclusively), and many of my clients are in extreme pain and do get help from pain management clinics. Unfortunately, more often than not, I see people becoming addicted to pain medicine. Dr. Briggs is correct on alternative treatment. Most of my clients have had the best relief from obtaining surgery versus those who resort to pain management alone. I have now had 2 clients in chronic pain overdose and die. Its very sad. For me, for acute pain, narcotics are fine. They are not good for chronic use. Dependency and tolerance to the drugs over time is a recipe for disaster.

@E. Ryan Bradley:That is sad indeed and a difficult balancing act. One we are acutely aware of in medicine, even though we unfortunately fail at it many times. I absolutely believe that we need more comprehensive methods of pain management which include patient education, exercise, strength training, and yes even mindfulness/meditation. All of these are science based modalities and do not need to be infused with magical claims in order to make them work. We don’t need to subject patients to placebo medicine (in fact a relatively recent meta-analysis in the Journal of Pain concluded that acupuncture was NOT effective for control of back pain). But, those methods take time, patience, and skill to administer. Our attitude - both physician and patient - is to have fast and easy results. Why sit and talk, educate about the condition, and teach meditation techniques when a pill is so much simpler and easier? Personally I am of the opinion - and so far my experience has confirmed it - that taking extra time up front with patients and educating them, empowering them, and teaching them was science actually has to offer (and what the limits are) actually ends up saving time and producing better outcomes in the end. No need for so-called CAM or placebo medicine. And of course, especially in the acute phase and for breakthrough pain, we do actually need narcotics on hand. There are many science based techniques at our disposal and not using them in lieu of more narcotics is, to me, just as bad as using so-called CAM techniques. Both are lazy, don’t work, and are the easy way out.

Nybgrus…. you have made your argument many times on this site (these “CAM” methods should not be in a category by themselves and should be studied the same as any other treatment). You have helped to broaden my perspective and I thank you. I ask you if you have studied the healing traditions of other cultures and places in our world and found out what they consider to be “real healing”? I speak of places where they use other medical traditions such as traditional chinese medicine as primary medicine.

All of these are science based modalities and do not need to be infused with magical claims in order to make them work. We don’t need to subject patients to placebo medicine (in fact a relatively recent meta-analysis in the Journal of Pain concluded that acupuncture was NOT effective for control of back pain).

@mahmud mlegta:Thank you for the kind words. In answer to your question, yes I have studied the healing traditions of other cultures and places. In addition to my undergraduate degree in evolutionary biology I hold another in medical anthropology. Much of my coursework consisted of learning the healing practices and traditions of others cultures and peoples, including (but not limited to) TCM, Vietnames hot/cold, Ayurveda, and a number of energy healing practices such as Reiki and Qi-gong and even some homeopathy. My courses were taught from the perspective that these were legitimate and established medical practices and it was commonplace to use terms and buzzwords like “Western BioMedicine,” “reductionism,” and the (false) argument “Western BioMedicine” was good for acute things like heart attack and injury whilst CAM was much better for chronic illness. At that time I believed genuinely that these modalities were real, efficacious, and that CAM was a legitimate separate category of medical inquiry. I even believed that all of medicine is best viewed as a culturally based idea that is equally valid as long as it is consistent and a “whole system.” I even recall arguing with a professor from UCLA whom I’d met at an event that I believed homeopathy worked and he called me a fool (well, not exactly those words, but that was the gist). Then I started doing post-grad research, reading extensively, worked for 3 years in a trauma facility, then went to medical school and continued doing research and reading extensively. And I slowly but surely realized that all of the CAM stuff I was taught in undergrad was bunk and garbage. But, just like religion, if you are told it is true by those who you believe should be in authority and trustworthy you will believe it. Until you explore it more deeply and honestly and then you will find that the emperor has no clothes.

Great blog! Great to see thoughts on alternative treatment for chronic pain rather than just taking medication. Of course medication is a great tool in reducing the symptoms for those with chronic pain, however does medicaiton treat the actual cause of chronic pain? Pain specialists prescribe countless amounts of medication as a tool to reduce symptoms however, it does not necessarily target the cause of their pain. A classic example of medication that is prescribed continuously is Triptans medication in the aide of migraine treatment. The old theory for this medication was to vasconstrict the blood vessels in the brain, which was thought to elicit migraines. However new studies have found migraines to be a result of a sensitised brainstem. An article on this can be viewed at Brisbane Headache and Migraine Clinic</a> which explains the cause of migraines. There is now new treatment techniques to combat chronic pain, such as migraines rather than taking medication.Although chronic pain is such a broad term, I believe further studies to each class of chronic pain should be investigated to assess the cause of the problem in order to effectively treat the condition rather than taking medication. Much like migraines, a chronic pain, can now be relieved and treated without medication.Keep up the great blog, and hopefully we get more research on chronic pain managment! 

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