A new Nature column on alternative medicine is full of subtle misdirection and outright logical fallacies. “Consider all the evidence on alternative therapies” by Jo Marchant defends the view that therapies that fail clinical trials should nevertheless be supported because they provide a beneficial placebo effect. This badly argued and self-contradictory essay illuminates nothing except the author’s wholesale failure of logic.
The article starts off reporting a job ad for Britain’s Princess Alexandra Hospital, which is trying to hire a provider of “Reiki/Spiritual Healing.”
Critics of the advert — and there are many — advocate instead what they call “evidence-based” approaches to health care. These critics should look again at the evidence — because it shows that to dismiss the benefits of alternative therapies is simplistic and misguided.
Critics of these magical cures are critics because we have looked at the evidence, and the evidence says quite clearly that they don’t work. It’s clear that Dr. Marchant has looked at the evidence, too. She should listen to what it says instead of what she wishes it said.
Let’s be clear, I don’t buy into the pseudoscientific claims of reiki and spiritual healers. There is no evidence that they can tap into and manipulate human ‘energy fields’ to clear blockages and heal the body.
Good for you; you don’t believe in magic.
Like many alternative therapies, these practices perform no better than placebos in clinical trials. But that does not mean that such treatments have no distinct therapeutic value.
Yes, it does. That is exactly what it means. This is why we do placebo-controlled clinical trials: to distinguish treatments that have distinct therapeutic value from those that don’t.
To dismiss people’s complex psychological and physiological reactions to serious illness — and how it is treated — as mere placebo effects is not helpful.
Here’s a subtle piece of misdirection. We were talking about reiki and spiritual healing; now we’re talking about “complex psychological and physiological reactions to serious illness.” I’m not sure if this is a straw man or a false dichotomy (maybe a bit of both): the implication is that claiming reiki and spiritual healing “have no distinct therapeutic value” is equivalent to “dismiss[ing] people’s complex psychological and physiological reactions to serious illness.”
The rest of the article is based on this bait and switch; essentially, it is arguing that placebos can be effective. True, but irrelevant. We were talking about reiki and spiritual healing, which Dr. Marchant has already admitted “perform no better than placebos.” Which makes the next statement curious:
The benefits of therapies such as reiki and acupuncture go beyond what we normally think of as placebo effects, however.
Wait, what? Remember when I said self-contradictory? Indulge me in a liberal use of ellipsis:
…these practices perform no better than placebos in clinical trials…The benefits of therapies such as reiki and acupuncture go beyond what we normally think of as placebo effects, however.
The sky is blue…The color of the sky is not what we normally think of as blue, however.
Such ‘integrative medicine’ is now offered by dozens of major US academic medical institutes.
Blatant argument from popularity.
The Stanford Center for Integrative Medicine in California offers acupuncture to help with chemotherapy side effects…Critics say that this is dangerous quackery.
It is. Acupuncture doesn’t work, except for possibly some mild pain relief, and telling patients it does is irresponsible.
Endorsing therapies that incorporate unscientific principles such as auras and energy fields encourages magical thinking, they argue, and undermines faith in conventional drugs and vaccines. That is a legitimate concern, but dismissing alternative approaches is not evidence-based either…
Let me get this straight: rejecting magical nonsense because the evidence shows that it doesn’t work isn’t evidence-based? The essay concludes:
We must tease out the real active ingredients of these therapies — things such as ritual, mental imagery, empathy, care and hope — so that we can learn how they work and find ways to incorporate them into patient care.
Knock yourself out! We know that placebos can provide some relief from (mostly subjective) symptoms, and research into the mechanisms could be valuable. In fact, it’s being done, and not by practitioners of reiki and spiritual healing. Remember the bait and switch, though: none of this has a damn thing to do with whether or not “The benefits of therapies such as reiki and acupuncture go beyond what we normally think of as placebo effects.”
One last thought: I’ve heard arguments before that we should “harness the power of placebos,” and I always wonder why the issue of informed consent is not a part of these discussions. I would argue that a doctor who prescribes a placebo knowing that it doesn’t work is guilty of fraud, if not malpractice. We buy healthcare (or our insurance companies do), and if you sell me a product that is not what you tell me it is, that’s fraud. Prescribing an elaborate placebo such as reiki or acupuncture is no different.