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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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In the Pipeline: Don't miss Derek Lowe's excellent commentary on drug discovery and the pharma industry in general at In the Pipeline

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January 14, 2009

Qi Gong and Placebo Effects

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Posted by Derek

I’ve been hearing from all sides since I took my swipe at Deepak Chopra et al. the other day. The biggest subgroup with a grievance have been the people who weren’t happy with my comments about Qi Gong.

Part of the problem is that “Qi Gong” means different things to different people, ranging from “Chinese-derived low-impact exercise program” to “manipulation of universal healing energies”. That’s a lot of ground to cover, but I obviously have no problem with the first of those. Exercise is clearly beneficial in a number of different ways. I go to a gym myself, and emerge with sore muscles and a glow of self-righteousness.

But it’s hard to get away from that second definition. Different practitioners put different amounts of woo into it (as Orac puts it), but if you just go grab pages off the web or brochures from a local class, odds are very good that you’re going to start hearing about energy fields and such. And that’s where I get off. I have yet to see any convincing evidence for any such “energy lines” or “concentrations of the life force” (whatever that is) that show up in a lot of (semi-)mystical exercise programs.

If the people boosting Qi Gong and the like stick to claiming that exercise is good, and that these are good ways to get people to exercise, then fine. If they want to claim that Qi Gong is more effective than other sorts of exercise programs, then that’s fine, too, because we can subject that to empirical tests: blood pressure, muscle strength, joint flexibility, per cent body fat, resting heart rate, fasting glucose and triglyceride levels. So far, I haven’t seen anything that convinces me that it is – many of the studies that claim this seem to me to be very small and poorly controlled. The ones that address these issues tend to be a wash, or to show the reverse. But post some literature references and we’ll talk.

But claiming greater effectiveness gets tricky, because many of the people who do that aren’t just saying that Qi Gong (or what have you) is more effective for physical reasons. It’s a quick slide into the syrup from here, and in no time we’re aligning our energies and tapping into ancient wisdom. (I’m not that good a customer for ancient wisdom, myself. I don’t think that people were any wiser or more virtuous in the past, however misty and distant, and given the mixed-up course of history, I think that anything really ancient that’s survived has probably done so by accident as much as anything else. But that’s another subject).

And any of these comparisons will have to deal with the placebo effect, which is what I was getting at with my proposal for the Don Ki Kong protocol. There are, no doubt, patients that will show more benefit from an exercise program that they believe comes from the Ancient Orient than they would from a very similar set of moves that just got marketed in Santa Barbara. Some other patients may well show the reverse, depending on their attitudes. If you’re going to claim specific benefits for Qi Gong (or any other such system), you’re going to have to show that it isn’t due to such effects. Is it something that still works whether you believe in it or not? If belief is important, do the details of what you believe matter or not, or is it just a general placebo effect that depends on thinking that something beneficial is underway?

We have enough confusion with placebo effects already with our supposedly mechanistically targeted drugs. It varies, though – for depression, it’s a relatively huge effect in clinical trials. For post-surgical bleeding, not so much. For an exercise and lifestyle program, especially if we’re going to be measuring things like mood and outlook, I’d think that placebo effects would be quite meaningful. Blood pressure will show up there, too, and a number of other things that are tied in to cortisol and other stress responses.

And if you can improve those, fine. Just don’t try to convince me, unless you have good evidence, that it needs to be these particular Chinese gestures, because I’ll ask you what would happen if you did all of them in reverse instead (would your blood pressure go up?) And especially don’t try to convince me that the effects are due to fuzzily defined life energies that Iron Age shamans are tuned in to, but which we somehow can’t detect.

Comments (40) + TrackBacks (0) | Category: Snake Oil


COMMENTS

1. HelicalZz on January 14, 2009 9:29 AM writes...

Can you be given the evil eye over the internet?

Zz

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2. The Pharmacoepidemiologist on January 14, 2009 9:32 AM writes...

It's not as though there can't be something similar to the endorphin high associated with exercise. It took a long time to identify that as the reason people liked exercising. Same thing may be at work here.

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3. MarkySparky on January 14, 2009 11:50 AM writes...

"I don't think that people were any wiser or more virtuous in the past, however misty and distant"

+1^100

I expect you'll get some backlash for that statement, though. The "noble savage" idea is responsible for a large percentage of the current trends in "wellness" today. Organic/natural/raw/etc foods, herbal supplements, mystical rituals, etc. They all are based (to different degrees) on the assumption that man/nature began in a perfect state, only to be debauched by technology.

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4. emv on January 14, 2009 12:29 PM writes...

Ancient wisdom refers not so much to more wisdom in the past, but the idea that if something has worked for people over thousands of years, than perhaps there is more wisdom in it than a new fad.

Just because you can't identify what works for people doesn't mean that it doesn't exist. People doubted the existence of bacteria as causes for disease as recently as Florence Nightengale. Use a bit of humility and imagination that there may be forces out there affecting our lives that we don't completely understand yet. Wouldn't it be a boring world if we'd already discovered everything?

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5. SRC on January 14, 2009 12:59 PM writes...

Ancient wisdom refers not so much to more wisdom in the past, but the idea that if something has worked for people over thousands of years, than perhaps there is more wisdom in it than a new fad.

You missed the point. Your sentence should have read "...something that is thought by some to have worked for people..."

That identifies the critical issue: does it really work, or no?

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6. Robert Bruce Thompson on January 14, 2009 1:05 PM writes...

Yeah, but most or all of those ancient remedies "work" in the same sense that tearing up strips of paper keeps Vermont elephant-free. If you double-blind test one of them and find out there's really something there, fine. But it seems as though every time someone does that, there's nothing there.

What Derek suggests is science. The woo-woo stuff is religion. Snow didn't know about cholera bacteria, but he did localize the problem to the water pumps that carried water from a particular water company. The fact that he didn't isolate the agent that caused the problem doesn't mean that what he did is any less science.

If someone can localize some of this woo-woo stuff to a particular water pump, I'd love to see their data and I'd admit that there was something there we didn't understand. But I do want real data.

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7. Hap on January 14, 2009 1:12 PM writes...

If something has been effective for thousands of years, you figure that its effectiveness would show up somewhere, right? The emphasis on data is just that - if people claim that something works (lengthens life, lowers weight, etc.) then there should be some evidence to support those claims (they are, after all, falsifiable claims which can be answered with "yes", "no", or "we can't tell"). No evidence implies, at minimum, that those claims are being made without reference to actual effects and are presumably formulated for some other reason entirely.

Lots of things that do people's lives no good (war, genocide, etc.) have also been practiced for thousands of years - the continuance of a practice over time is not necessarily evidence of its effectiveness. How long did Aristotle's (?) claim of 32 teeth for women go unchallenged until someone actually bothered to count women's teeth?

Deciding that something is true because we like it or feel that it ought to be true is an unhelpful approach, as is claiming truth for something of which we know nothing. In the absence of data (and in the presence of a testable hypothesis where we could actually have data), Science's default assumption is that something is untrue, equivalent to "Don't say something is true unless you have evidence for it to be so." The default assumption for at least some of alternative medicine is "It works because we say so." - since some of the claims could be tested and evidence provided, it seems to stretch a general understanding of human nature to assert that such claims are being so intransigently asserted for the general benefit of humanity.

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8. RoadNotTaken on January 14, 2009 1:37 PM writes...

First of all, Derek, thanks for revising your original post and clarifying the target of your mockery (the woo-woo-stuff, not the exercise).

That said, we all believe in The Placebo Effect, right? Oftentimes things that are "all in your head" like religion, meditation, or 'positive thinking' are undeniably efficacious. I think many scientists tend to scoff at these things because it's difficult/impossible to do controlled studies and therefore not worthy of consideration. For example, how could you do a double-blind clinical-trial on the effects of 'positive thinking' on metastasis? You couldn't, it's a basically impossible experiment unless you deceived people about their prognoses which would be unethical. That said, I bet most doctors would vehemently defend 'positive thinking' as efficacious when it comes to cancer outcomes. Just because something is not susceptible to analysis with The Scientific Method doesn't automatically mean that it's absurd or false. I'm as much a fan of hard data as the next scientist, but it's pretty limiting to assume that all things that cannot be tested are snake oil. I'll admit that if it can't be tested by science, it's not science... but that doesn't make it absurd. Just because the health-effects of believing in spiritual healing powers amounts to the placebo effect, that doesn't make those health-effects less real. Is that not worthy of consideration?

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9. JSinger on January 14, 2009 1:40 PM writes...

Please, please not another person using "woo". Can't we leave this bit of smarmy inside-bloggishness back patting to ScienceBlogs?

Just don't try to convince me, unless you have good evidence, that it needs to be these particular Chinese gestures, because I'll ask you what would happen if you did all of them in reverse instead (would your blood pressure go up?)

Uh, if you make an enantiomer of an ACE inhibitor, what happens? A) Blood pressure goes up? B) After 20 monkeys and 500 humans I might be able to tell you?

My sense, from yoga and others' description of their acupuncture is that chi/prana describes something that isn't a plain old placebo effect. I have no doubt that any "something" that exists can be described within modern science, but that's precisely what I'd like to see happen, instead of Orac's cage-rattling and shouting "Woo! Woo! Deepak Chopra's coming for ya!"

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10. Cloud on January 14, 2009 2:00 PM writes...

@Hap- I think a lot of people would say that the fact that people continue to practice these ancient forms of exercise is evidence of them working. If the effect is just from the exercise, people get bored and move on to the next thing. After all, exercise fads are pretty common. When was the last time you talked to some who Jazzercized?

That said, I'm with JSinger- I'd love to see some proper scientific studies on this. But we won't get those if we can't at least consider the possibility that there is actually something real going on.

I read a bunch of mommyblogs as well as science blogs, and the level of distrust of the scientific community I run across is shocking- and I'm not just talking about the whole vaccine/autism hoo-ha. Sure, that is partly due to the fact that a lot of people never get a decent education in basic science. But if we scientists are incredibly dismissive of things that have worked for people, how can we expect people to listen to us when we tell them not to worry about the trace amounts of melamine found in baby formula? Would you listen to someone who said you were naive and gullible for believing in your own experience?

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11. Hap on January 14, 2009 2:04 PM writes...

If Wikipedia is correct, the placebo effect doesn't work all that often (even in depression - 30% of the time, although it's better than nothing) and is fairly unpredictable - depending on it as a treatment method is unlikely to work in the long run.

In this case, people are also likely to ask for money to support the use of Qi Gong, etc. for health care, in which case you have the question of where money is spent most effectively [as well as the time - if people try one sort of treatment and it doesn't (or can't work), then they not only lose the time they spent, but if the condition worsens over time, it makes it harder to treat]. So having some evidence to determine where you should spend your time and money would be helpful. I suspect this is not the equivalent of a lottery ticket once in a blue moon (which probably won't help but won't cost much either directly or in opportunity cost), but a more substantial payout, which should have some more evidence to support it.

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12. Mojo on January 14, 2009 2:11 PM writes...

emv wrote, "People doubted the existence of bacteria as causes for disease as recently as Florence Nightengale."

And, several years into the 21st century, there are still people who doubt that bacteria cause disease. They tend to be proponents of alternative medicine.

For example, only last year the British Institute of Osteopathy ran an event called "so you think diseases are caused by little germy wermies", which they described as "an evening seminar exposing the modern medical mythology of germ theory". The poster for the event stated: "There is no evidence base whatsoever for the germ causative theory of disease".

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13. metaphysician on January 14, 2009 2:36 PM writes...

*cough* I always figured the main active mechanism in yoga was the lymph system, with the low impact, but extremely thorough, stretching exercises keeping the lymph pumping more efficiently.

However, IANAD.

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14. Anonymous on January 14, 2009 2:39 PM writes...

awesome.

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15. Longtime Reader, Seldom Commenter on January 14, 2009 2:58 PM writes...

Is it something that still works whether you believe in it or not? If belief is important, do the details of what you believe matter or not, or is it just a general placebo effect that depends on thinking that something beneficial is underway?
Generally speaking I agree. But I think it is error to attribute every effect we don't understand to placebo effect.

For example: Someone once told me that briefly squeezing the muscle (and hence, presumably, nerves) just behind the web between the thumb and forefinger (squeezing it hard, so you can feel the mild ache from the pinch), would alleviate headache, toothache, or other more severe pain.

I was skeptical. I cannot perform a double-blind experiment upon myself to test the hypothesis. So I just tried it. Lo and behold, it tended to work, at least to my subjective perception.

I'm not learned in life sciences at all, but I conjured my own admittedly uninformed (or even downright screwy) explanation. Pinching the area sets up nerve impulses that compete with, or overwhelm, some brain mechanism that is the locus of perceiving pain from the much more severe pain that one is trying to diminish. I have no idea whether that's even in the ballpark of reasonable according to known neurology. But it's got nothing to do with woo-woo "energy fields" or other such stuff.

Maybe it really doesn't even work. But it worked for me. It didn't work because I believed a bunch of woo-woo balderdash. It also didn't work because I believed my own dumb post hoc explanation. Maybe it worked because I expected it to work. But at least subjectively I just tried it with an attitude of experimental skepticism: If it works, good; if it doesn't work, then it won't cost much to try, and it will do no harm.

Could a neurophysiologist convince me that it doesn't really work at all? That it's "all in my mind"? Maybe. But he'd have lots of 'splaining to do.

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16. Hap on January 14, 2009 3:00 PM writes...

Cloud - the problem is that people may be doing Qi Gong for reasons other than health. If you do low-carb dieting and it doesn't work (doesn't help you to lose weight or eat better), there isn't another reason to do it. If there is a cultural context to it, though, something that allows you social interaction or a way to make your life more meaningful (to fit your life into a meaningful narrative), then you would be likely to continue to do it because it makes you feel better even if it doesn't have the desired health effect.

It is arrogant, but the relevant aphorism for why people might not want to trust their own feeling versus evidence is "The plural of anecdote is not data." - individual feeling doesn't correspond consistently to a general effect. The placebo effect is one effect that might make something appear to work for certain (unknown ahead of time) individuals but not work in general.

I think the lack of trust over melamine, etc. is a combination of a lack of understanding (because it requires time and education lots of people don't or can't have) and previous dishonesty which makes people unwilling to trust chemists. At some level, people do trust drugs (though they may not like their costs and may be or feel deceived by their claims vs. effects) - I wouldn't figure so many supplements would be trying to make their packaging look like drug packaging if they didn't feel they gained a sales advantage in doing so (or an advantage which they couldn't earn or get more cheaply another way).

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17. RoadNotTaken on January 14, 2009 3:08 PM writes...

"Two extremes: to exclude reason, to admit reason only."

--Blaise Pascal

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18. Cloud on January 14, 2009 3:25 PM writes...

@Hap- I think you misunderstood what I was saying. I am all for well-designed, controlled scientific studies. But I also think that telling people they are naive and/or making fun of them when they tell you something works for them just because they don't have scientific studies to back them up is unhelpful. You haven't done that, but this is what my first comment was about.

And it is particularly mean to dismiss peoples experience on these alternative treatments if you couple it with ridiculing the institute that would be the only likely source of funding to perform the studies you are demanding to see. When we, as scientists, do this sort of thing, we undermine our argument that science is an impartial system in which what we believe to be true is based entirely on evidence. And when we do that, we undermine our chances of getting the general public to listen to us about other things, like whether vaccines cause autism or whether trace amounts of melamine found in American baby formula is something to worry about.

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19. NS29 on January 14, 2009 4:23 PM writes...

That reminds me of an analogy a cabaret artist (and physicist) coined to explain the difference between science and religion: "Imagine a closed fridge and you wonder whether there is still some beer in it. As a scientist, you will use some method to determine whether beer is in it or not (x-ray the fridge, or simply open it). As a theologian, you believe there is beer in the fridge but you pursue no further measures to find out if it is actually so. As a mystic, you still say there is beer in it even though the fridge is open and somebody nicked the last beer."

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20. Hap on January 14, 2009 4:28 PM writes...

NIH was supposed to do trials on alternative medicines - they would be (would have been) an organization with sufficient funding and incentive and trusted by at least the public and scientists in general. They also don't necessarily have an ax to grind. Insurance companies would seem to have an incentive as well - though they aren't all that well trusted by the public (people need them and hate them, never a good combo), if they found that some natural protocols gave either similar outcomes or better ones, they would be likely to push for their use.

When the only people exploring a set of therapies are people with incentives to support them, it's harder for unassociated people to tell whether the therapies are good and the people are doing good research or if they are being misled (either consciously or unconsciously) by their own beliefs and incentives. (Alternatively, drugs are tried by the companies that made them but studied by the FDA, who (hopefully) doesn't have a stake in the outcome and has sufficient qualification to have their judgment trusted). Another way for advocates to gain trust is to have done good research in some other field, which might establish credibility - people know that they can do good work, and so are more likely to trust work they are unlikely to be able to test themselves. I don't know if that's true of the group who wrote the referenced editorial.

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21. Cloud on January 14, 2009 4:38 PM writes...

@Hap- The NIH center that does these trials is NCCAM, and that's the center I was referencing when I said people ridicule the institute that is charged with running studies of alternative therapies. Given the disparaging things you hear about that center, many career-minded scientists steer clear of it. (I don't know if the NCCAM is well-run or not, and I suspect neither do a lot of the scientists I hear make fun of it.)

Getting insurance companies to run the studies is an interesting idea. I know my worker's comp insurance paid a fortune for traditional treatments that didn't really work long term. They don't pay for the yoga that eventually helped me get my RSI under control. But then again, maybe they like it that way! Yoga is never going to "cure" me- done regularly, it keeps my symptoms from recurring, but if I stop, the symptoms come back. They'd be stuck paying for my classes for life.

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22. Sili on January 14, 2009 4:47 PM writes...

Edzard Ernst have done lots of studies on 'alternative med' in England from his own personally endowed chair, funded by, lo!, a true believer. But he has complete academic freedom and, surprise!, he can find nothing but placebo effects no matter how hard he looks.

Now, what do the alties do in response? Call him a corporate shill, of course. My impression is that the poor naïve professor has been rather surprised by the vehemence with which his former friends are attacking him, because he won't just roll over and remove all scientifically controlled aspects of his trials.

"Two extremes: to exclude reason, to admit reason only."

--Blaise Pascal


The guy with the vager, right? (Yes, I know that's an argument about statistics, not theology.) Could it be that he was, you know, wrong?!

Hear, hear, dr Lowe(/Love). This is why I read you.

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23. Don on January 14, 2009 5:44 PM writes...

To Longtime reader, seldom commenter,

I am a neuroscientist (research), Physical therapist and PT instructor. One of my students told me about what you described and said that it worked. One problem that he said is that it only works as long as you apply pressure. I have tried it short term and it does work.

Related to this: If someone hurts a part of there body, they will often rub the area or apply pressure. This decreases the perception of pain, and there is a real, scientific reason for this. If you are interested, look up "gate control theory of pain". There some forms of electrical stimulation that are used to reduce pain that mimic the pressure or rubbing (TENS, transcutaneous electrical stimulation).

There is another type of therapy termed "craniosacral therapy" I have used some of the techniques to help my patients. The therapy proposes that the sutures between the bones of the skull can move, and that there are rhythyms of fluid movement within the brain and on the surface of the brain. Craniosacral therapy is supposed to 'correct' these rhythyms. I personally think that 'craniosacral therapy' uses standard PT techniques (gentle pressure on muscles and gentle manual traction of the neck) to produce muscle relaxation and remove possible pressure on nerves, which then causes relief of pain. So I use the techniques of craniosacral therapy and have found that they help some patients, but I have little belief that the supposed underlying theory is correct, or that the therapy is benefitting the patient through changes in fluid movement rhythyms. So a therapy may work, even if the theory behind why the therapy works may not be that good.
Don

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24. bio-friend on January 14, 2009 6:41 PM writes...

Per your request - Clin Rheumatol. 2008 Dec;27(12):1497-505.

Qigong is not the only concern I have with pharma scientists discounting alternative health strategies it was just the most egregious attack not supported by the literature. I agree with your comment, qigong studies on pain produce a mixed bag of results and are susceptible to placebo/exercise effects. And I appreciate your comment that small molecule and biologic studies suffer the same problem, you are probably aware depression compounds only require efficacy in 2/3 placebo-controlled PHIII studies (that is - 1 failure allowed) for FDA registration due to placebo responders with psychiatric diseases.

My main problem with your post, evoked comments, and Orac's post is not appreciating what "integrative medicine" means and how difficult it is to test integrative ideas. Integrative medicine requires simultaneous application of multiple strategies to improve health. That is, qigong plus meditation plus a supplement (or lipitor or omega3 or...). American medicine is typically un-integrated because our health care system typically reimburses for pills without facilitating diet and/or exercise and/or other behavioral changes.

Pipeline readers can appreciate why American doctor/insurance gatekeepers do not incentivize a patient to take a statin plus eat better food plus exercise and/or pay for facilitated stress reduction. Such treatment combinations make sense but no controlled studies exist to prove which integrative combination is necessary, cost-efficient and leads to optimal CV outcomes. Now let's pass that appreciation along to the more complex 'alternative' integrative strategies. Imagine the clinical study required to compare a supplement versus small molecule versus placebo with and without co-incident qigong versus exercise versus bed-rest with and without stress-reduction or whatever else while accounting for all conditional interactions. A huge, expensive unwieldy study right? But now we want to know if it will work for everybody so we must account for individual differences using a cross-over study design powered to detect sex effects, account for age-groups, and amenable to post-hoc comparisons between pre-existing conditions.

Such studies will never be run by corporations (who do most of the medical research in this country) because they have no financial incentive to test if lifestyle changes plus pill administration works better than IP protected pill alone. Pharma does not run 'better' studies we run simpler studies - one compound versus placebo and maybe (but rarely) an active comparator on one or two dependent measures in a well-screened patient group (Orac). Alternative medicine strategies should be rigourously tested but without corporate sponsors only taxpayers can fund studies to learn if vitamin C with or without stress reduction and/or green tea treats cancer better than VEGF inhibitors with or without coffee versus radioactive enemas.

Finally, what *really* irritates me is the assumption that pharma scientists want to improve health but Chopra, Ornish, Roy and Weil do not. Such galling arrogance, reproaching people who want to harness all available healing powers (more on 'placebo' effects later) to improve health just because they criticize some side effects in some synthetic compounds. Let's respond intelligently by encouraging federal support for head to head comparisons between modern and ancient methods. After all, we are all trying to reduce disease and suffering, right Derek?

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25. Handles on January 14, 2009 8:25 PM writes...

@RoadNotTaken: "That said, I bet most doctors would vehemently defend 'positive thinking' as efficacious when it comes to cancer outcomes. Just because something is not susceptible to analysis with The Scientific Method doesn't automatically mean that it's absurd or false."

But you also cant assume something is true just because its vehemently defended by a majority. Doctors are as susceptible as the rest of us to spotting false patterns in randomness. The only way you can know something works is to do a proper controlled trial, and when you do, the evidence suggests that changing your mental state does nothing for your chances of surviving cancer.

The placebo effect certainly works for some of those hard-to-treat illnesses with a strong psychosocial component. The problem comes when you lie to your patients when using it to treat.

Is it necessary to lie to benefit from the placebo effect? Maybe not...

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26. Still Scared of Dinosaurs on January 14, 2009 9:03 PM writes...

>> Pharma does not run 'better' studies we run simpler studies

and we run our studies better. Bad pharma studies are run to much higher standards than most good academic studies. Admittedly that's mostly 'cuz we spend more per data point and are subjected to far more rigourous review.

And I've posted here before that the term "placebo effect" has many meanings. In this case the effect is quite likely due to the exercise itself and the effect of a ritual that tells you to think about your health. It's the same as the fact that most diets work (at least initially) because people are paying more attention to what they eat regardless of what rules they are imposing.

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27. Longtime Reader, Seldom Commenter on January 14, 2009 11:19 PM writes...

Don wrote on January 14, 2009 5:44 PM:

I am a neuroscientist (research), Physical therapist and PT instructor. One of my students told me about what you described and said that it worked. One problem that he said is that it only works as long as you apply pressure. I have tried it short term and it does work.
Thanks. It's good to know that if I am nuts or deluded, at least somebody who knows more neuroscience than I do is as well.

My larger point is that I've heard all manner of nontraditional medical and health related treatments and practices peremptorily dismissed as pure hokum by docs and bioscientists, and their practioners dismissed as deluded, or just charlatans. But seldom do I see a researcher actually investigate whether there might be a credible reason for some treatment or practice to work.

I certainly agree that extraordinary claims demand proof, but I think some in the scientific community peremptorily dismiss claims without even thinking about evidence, simply because the treatment doesn't fit the prevailing paradigm and is readily labled "folk medicine" or "superstition".

To some degree this is an understandable prejudice, because there are plenty of actual charlatans and deluded true believers. But on the other hand, sometimes "folk medicine" gets it right. Aspirin and willow bark comes to mind, and there are other pharmaceuticals that were first discovered by "folk medicine."

If someone says "my uncle lived 110 years by following his shaman's advice; he ate a diet of salmon, coriander and citrus fruit, and ran 10 miles a day, while all his siblings ate salted hog jowls and coconut marzipan, slept all day and dropped dead from heart attacks at 50, then maybe, just maybe, that uncle was doing something right and his siblings weren't. The shaman's advice wasn't the result of a controlled experiment, but absence of a controlled experiment is no reason to dismiss the possible effects of diet and exercise without further investigation.

A scientist would test the hypothesis. A religious believer pretending to science would dismiss it out of hand as "folk medicine" and not worthy of investigation. The former is not "sliding into the syrup", but the latter is definitely confusing the message with the messenger.

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28. bcpmoon on January 15, 2009 7:00 AM writes...

Don wrote:

So a therapy may work, even if the theory behind why the therapy works may not be that good.

True, and something everybody will agree to. But what makes scientists nervous, is that alternative practitioners take it as proof of a theory that something "explained" by it works, without really showing a causal link. An altie sees an effect, imagines a underlying cause and stops the intellectual process.
Herein lies the danger of sCAM: The altie thinks
a) massage helps in relieving pain
b) that is because the fluids become aligned to mars
c) if we align the fluids to mars through magnetic pyramids, then we can relieve pain. Or cure cancer.

I do not think this is harmless.

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29. Robert Bruce Thompson on January 15, 2009 11:11 AM writes...

Apropos this discussion, here's a proposal to cut funding for investigating alternative medicine.


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30. G Experiment on January 15, 2009 5:44 PM writes...

There have been studies on how meditation affects brain waves as far as I know. Alternative healings and energies are more subjective. I can't speak for anyone but myself from my own experience. Yes I'm a scientist making drug for the future but I enjoy regular yoga practice and meditation. And that is how I know what 'well-being' feels like. And I'm not talking about never taken a sick day or catch a cold or flu from colleages for the last 8 years I work here (which is the case).

The difference between modern medicine and alternative one is the reductionism approach and wholism approach they take. I hope one day we'll tackle the root cause of dis-ease rather than treating its symptoms like we do today.

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31. SRC on January 15, 2009 9:49 PM writes...

Finally, what *really* irritates me is the assumption that pharma scientists want to improve health but Chopra, Ornish, Roy and Weil do not.

I think that what at least the first and last of these worthies want to improve is their public profile and thereby their bank balances and/or level of ego gratification.

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32. Hap on January 16, 2009 2:06 PM writes...

If your primary goal is making people healthier, doesn't it make sense to be able to know whether that is in fact the case? If that's your primary goal, and you insist on using methods to achieve that ends whose effects can't be measured, then you have no idea whether you are wasting your time - either you are stupid or clueless, or making people healthier isn't your primary goal. You can still be interested in making people healthier even if you are more interested in getting people to believe in your philosophy or religion, but your credibility is somewhat lowered (because your advice could be motivated by your interest in others' health or by your desire to convert them to your ideas, and the two are not necessarily consistent with one another).

Pharmaceutical companies exist to make money, and in some cases (DTC?) that interferes with their desire to do so by improving health - but the FDA (and the FTC) at least provide a brake on their ability to compromise health effects to sell product and in the case of the FDA provide a way to test their claims (so that their health advice doesn't just depend on the pharma companies' desire to sell product). The (seemingly endless) potential income in promoting altmed claims and their underlying philosophies provides a lot of alternative motivations for their claims which do me no good at all, and the lack of data on their effects gives me significant reason to think that their claims have little to do with improving my well-being. (If I say something and have no idea whether it's true, either I am too clueless, stupid, or reckless to have any idea that I don't know what I'm talking about, or I have other reasons for saying it with respect to which the truth of the statement is irrelevant.)

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33. Anonymous on January 17, 2009 10:19 AM writes...

Re #31 "I think that what at least the first and last of these worthies want to improve is their public profile and thereby their bank balances and/or level of ego gratification."

How is that different from the mode of operation of a pharmaceutical company? Whose bottomline is also about adding to the bank balances (otherwise you will be a non-profit organization not a pharmaceutical company). I don't see why that should be about ego when it's just one person doing it and not a bunch of people under the umbrella of a 'company'.

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34. anonymous on January 17, 2009 3:24 PM writes...

I think Pan Qing Fu, a Chinese wushu expat now in Canada, said something to the effect of "If the ancient masters could really jump 30 feet in the air, then why did they invent stairways?"

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35. Brutha on January 17, 2009 10:28 PM writes...

Visualising those energy fields is part of Qi Gong manipulating of universal healing energies claim.
If you simply exchange the movements and visualsing is the thing that improves health you haven't disproven Qi Gong.

You will even find people in that field who think that they can manipulate universal healing energies without any movement at all.
[quote]If Wikipedia is correct, the placebo effect doesn't work all that often (even in depression - 30% of the time, although it's better than nothing) and is fairly unpredictable - depending on it as a treatment method is unlikely to work in the long run.[/quote]Blame the theory instead of the effect if you can't predict.
Theories predict stuff.

If you buy the argument that modern science is unable to really predict how the placebo effect works there is room for a lot of optimization and you therefore can't treat the placebo effect as constant that you can easily remove to get a "real" effect.
Purposeful thinking about being healthy and visualising good energy flowing through your body might create a more effective placebo effect.

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36. Hap on January 18, 2009 1:52 PM writes...

If there's data to suggest that Qi Gong works, then there's no reason not to use it - we can use all the help we can get. The lack of data is the problem - if you posit the existence of energy fields but they have no consequence in reality, then you might as well posit fairies or invisible dwarves as well, and if it has consequence then it should yield to data analysis.

The placebo effect would be telling you that something else, not knowledge of energy fields, yields the beneficial effects of Qi Gong (if they exist) - what you're describing wouldn't be a placebo effect but a real one (because it depends directly on the substance of Qi Gong and so wouldn't be replicated by a random set of gestures without such knowledge). If the exercise itself is the key (or the belief helps people to exercise more regularly), then the placebo effect will show up. Either way, something measurable will happen.

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37. Al Gammate on March 24, 2009 10:34 PM writes...

Hello Derek:

I enjoyed reading your article.

I agree that a belief needs to be supported by evidence before it can be declared a fact.

Nevertheless, if a belief motivates you to exercise regularly (e.g., doing Qi Gong because of universal healing energies), wouldn't the belief be a good thing even though it's not supported by evidence?

I think that positive beliefs may benefit people. In fact, positive beliefs may even be necessary!

For example, the belief in a benevolent God helps millions of people cope effectively with pain, suffering, and the fear of death, giving them a better quality of life!

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38. L K Tucker on July 9, 2010 4:53 AM writes...

Sorry to be late to the party but you are missing a key piece of information about Qi Gong and Kundalini Yoga. Both exercises demand eyes-open meditation while performing a string of movements in unison with others.

What they are experiencing is Subliminal Distraction exposure. Why? When too many of the sessions are performed in a compact time frame some of the acolytes have mental breaks.

The phenomenon was discovered and solved by the office Cubicle forty years ago.

Think about it. Waving your arms and legs around with a group of like minded people summons powerful supernatural forces? Get real. But it does produce an effect.

Intense concentrated exposure causes a temporary mental event. Low-level long-term exposure produces permanent altered mental states. Those are the people who believe they can levitate, walk through solid objects unharmed, and read your mind, control your actions through mental telepathy.

Visit my site and perform the demonstration of subliminal sight and habituation in peripheral vision to witness something disappear while you observe it in peripheral vision.

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39. Marcus Santer on November 7, 2011 6:16 AM writes...

Hi Derek,

Interesting article. Sorry I'm over 2 years late! As a Qigong teacher I am obviously biased. I found your article whilst looking for more information about Qigong and the placebo effect.

It seems to me that the crux of this is belief. Does Qigong work if the student/practitioner/client doesn't believe in it, or if they have no knowledge of the theory that underpins it?

And the answer to that question, from my experience is: 'Yes' Qigong work fine.

I believe that the effectiveness of meditation is backed by significant scientific studies, as Qigong is meditation and so much more do those studies help to lend more credibility to the claims of Qigong?

I for one would love to see more 'hardcore' scientific studies of Qigong done. I believe it has much of benefit to share.

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40. Jon on September 15, 2013 12:01 PM writes...

I started practicing a static form of Qi Gong after taking a 7 class course from a Chinese Doctor. The form does not involve exercise and is rather focus on internal energy based meditation. When my teacher, Dr. Wu, talked about "Chi" I didn't understand and couldn't conceptualize it. It wasn't until months of daily practice that I understood what he meant. Not through reading superstitious books or hearing the talks about "Life Force" or "energy healing." What I can say is that there is definitely a very powerful and extraordinary power in our body that I previously had been unaware of. I know this because I deeply feel and experience it every day. It has changed my life. I have overcome much psychological and physical problems and everyday is more magical and more wonderful than before. There is no dogma to it, I was taught from a doctor and the teachings were precise and simple. It is a universal truth and exists in all of us whether we acknowledge it or not. I ask that you remember how much the scientific world still has to learn. Explaining it to someone who has not personally experienced it is like explaining orange to a blind person. We live in a paradigm and if one cements themselves in any particular paradigm it is impossible for that person to ever truly acknowledge anything outside of that perspective. I ask you to be more open to such things. After all, acupuncture has been scientifically proven effective beyond a statistical significance point and it is entirely based on the notion of chi and the meridian lines. Secondly, it seems rather disrespectful and ignorant to confront a tradition with thousands of years of development and so casually diagnose it as false.

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