This thread has certainly gotten an incredible response. In order to help those poor folks out there like J.D. who are downloading these threads onto their abbacus, I'm continuing this on a new thread.
As I understand it, the 2 issues that the group had deemed worthy of discussion are 1) therapeutic touch (TT) and its validity, and 2) the advertisment of a chi manipulation device. These topics extended to other modalities of medical treatment.
And while we are at it, I would hope that we keep to issues and away from egos and emotion. It's one thing to watch Lori and J.D. playfully (yes, folks, they respect each other) abuse each other in a spirited debate. It's another to take personal offense. Let's keep it passionate, but free of uncontrolled emotion.
Continuing to be pissed.....
Moderator: Available
-
Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Continuing to be pissed.....
Bill - In the old thread, I read with great amusement (and pride!) that you only bring out your title to play the status matching game with physicians. There was a great article/editorial in the Wall Street Journal a couple of years ago asking the question: "Are physicians really doctors?" The gist of the article was that physicians adopted the academic title of doctor to give themselves more credibility 
(growing out of the barber/physician era).
To keep on topic: I don't have a problem with advertising something on these pages as a chi machine. The rules of consumer behavior (and particularly real-estate!) explicitly state BUYER BEWARE. That the name of the product (subsequently changed) hit such a nerve and prompted so much debate virtually ensured that it will not soon be forgotten!
There is a seminal article on marketing in the Harvard Business Review that I strongly recommend to all who have problems with marketing and advertising:
McKenna, Regis (1991), "Marketing is Everything," Harvard Business Review, Vol. 69, No. 1 (Jan./Feb.), pp. 65-79.
McKenna does a great job of "telling it like it is" in terms of the place of marketing in the emerging information age.
[This message has been edited by Steve (edited 06-02-99).]
(growing out of the barber/physician era). To keep on topic: I don't have a problem with advertising something on these pages as a chi machine. The rules of consumer behavior (and particularly real-estate!) explicitly state BUYER BEWARE. That the name of the product (subsequently changed) hit such a nerve and prompted so much debate virtually ensured that it will not soon be forgotten!
There is a seminal article on marketing in the Harvard Business Review that I strongly recommend to all who have problems with marketing and advertising:
McKenna, Regis (1991), "Marketing is Everything," Harvard Business Review, Vol. 69, No. 1 (Jan./Feb.), pp. 65-79.
McKenna does a great job of "telling it like it is" in terms of the place of marketing in the emerging information age.
[This message has been edited by Steve (edited 06-02-99).]
-
Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Continuing to be pissed.....
J.D.
In response to your criticisms about the (science? art? voodoo?) of chiropractic, I have several responses. First of all, I agree that the mechanisms that you quoted (spinal misallignment, subluxations, etc) is - in a word - hogwash. Here we agree.
However....
You should know that the Agency for Health Care Policy and Research (AHCPR) funded a PORT study of acute low back pain> This led to some treatment guidelines. And those guidelines included an endorsement of palliative treatment of LBP with chiropractic care. Now am I contradicting myself? Maybe not.
The problem with chiropractic medicine is that it was practice long before people understood anatomy, physiology, neurology, etc. Osteopaths cracked backs and the patients indicated they felt relief. It could have been a placebo effect. It could have been regression to the mean. And most of the time this is indeed true. The AHCPR-funded PORT review of the literature suggests that doing nothing is often the best course of treatment. However they did suggest efficacy of chiropractic care in some cases of accute low back pain.
Is it a problem that something works and yet those who use the technique have no idea how? Consider that aspirin was used (in purified, properly-dosed form) for years before people understood why it worked. Now we know about things like prostaglandins and cyclooxygenase. And now we have COX-2 inhibitors at $1.20 a tablet. Buy drug company stock, and be ready for your next insurance premium increase!
The best explanation I've heard for why chiropractic works has to do with immobility or just plain stiffness. The spine is a series of joints. Just as we can get tight in the hips and shoulders, so it is possible for some vertebral spaces to develop a degree of immobility. As I understand it, the problem sometimes comes from the neighbor spaces that must undergo hypermobility to compensate for the lack of movement in the neighborhood. This can lead to nerve irritation. What the chiropractor can do (via "back cracking") is to restore that mobility through the length of the spinal chord.
And if this mechanism is the case, then it would explain the study you cited that suggests physical therapists can do just as good a job. Makes sense to me! In fact, my brief encounters with chiropractic care (mostly through a fellow martial artist who provided me with some professional courtesise) reinforced my belief in the strength and flexibility program I have for my back and midsection. And it has kept me free of back pain.
But that's just another anecdote.
-- Bill
In response to your criticisms about the (science? art? voodoo?) of chiropractic, I have several responses. First of all, I agree that the mechanisms that you quoted (spinal misallignment, subluxations, etc) is - in a word - hogwash. Here we agree.
However....
You should know that the Agency for Health Care Policy and Research (AHCPR) funded a PORT study of acute low back pain> This led to some treatment guidelines. And those guidelines included an endorsement of palliative treatment of LBP with chiropractic care. Now am I contradicting myself? Maybe not.
The problem with chiropractic medicine is that it was practice long before people understood anatomy, physiology, neurology, etc. Osteopaths cracked backs and the patients indicated they felt relief. It could have been a placebo effect. It could have been regression to the mean. And most of the time this is indeed true. The AHCPR-funded PORT review of the literature suggests that doing nothing is often the best course of treatment. However they did suggest efficacy of chiropractic care in some cases of accute low back pain.
Is it a problem that something works and yet those who use the technique have no idea how? Consider that aspirin was used (in purified, properly-dosed form) for years before people understood why it worked. Now we know about things like prostaglandins and cyclooxygenase. And now we have COX-2 inhibitors at $1.20 a tablet. Buy drug company stock, and be ready for your next insurance premium increase!
The best explanation I've heard for why chiropractic works has to do with immobility or just plain stiffness. The spine is a series of joints. Just as we can get tight in the hips and shoulders, so it is possible for some vertebral spaces to develop a degree of immobility. As I understand it, the problem sometimes comes from the neighbor spaces that must undergo hypermobility to compensate for the lack of movement in the neighborhood. This can lead to nerve irritation. What the chiropractor can do (via "back cracking") is to restore that mobility through the length of the spinal chord.
And if this mechanism is the case, then it would explain the study you cited that suggests physical therapists can do just as good a job. Makes sense to me! In fact, my brief encounters with chiropractic care (mostly through a fellow martial artist who provided me with some professional courtesise) reinforced my belief in the strength and flexibility program I have for my back and midsection. And it has kept me free of back pain.
But that's just another anecdote.
-- Bill
Continuing to be pissed.....
Dr. X - Thanks for bursting my bubble! I always enjoy reading your posts and find them quite informative, including the last one.
It is indeed fun to travel in Germany where my colleagues and students refer to me as "Herr Professor Doktor Weiss," as you and Bill have also probably experienced.
------------------
D. Steven White
swhite@umassd.edu
It is indeed fun to travel in Germany where my colleagues and students refer to me as "Herr Professor Doktor Weiss," as you and Bill have also probably experienced.
------------------
D. Steven White
swhite@umassd.edu
Continuing to be pissed.....
Hello again!
One more round of Therapeutic Touch discussion, anyone?
Contrary to one opinion, I have a good bit of familiarity with the study by Emily Rosa. I will now address heretofore omitted facts:
The authors of the paper were Emily, her mother, and "quackbuster" Stephen Barrett, MD. Emily's mother, Linda Rosa, was former Vice-President of the Rocky Mountain Skeptics, Coordinator of the Special Task Force Group on Questionable Nursing Practices and an opponent of the use of Therapeutic Touch. Emily's stepfather, Larry Sarner was the chairman of the National Therapeutic Touch Study Group, an anti-TT organization.
Dr. Barrett encouraged the paper's submission to JAMA.
Most letters to JAMA about the article have been critical. All are by credentialed professionals. For example, Andrew Freinkel, MD wrote, "As a clinician, I am surprised that [you] elected to address the important and controversial issue of Therapeutic Touch (TT) with such a simpleminded, methodologically flawed, and irrelevant study. The experiments described are an artificial demonstration that some number of self-described mystics were unable to 'sense the field' of the primary investigator's 9-year-old daughter. This hardly demonstrates or debunks the efficacy of TT." Jesse Lee, JD, wrote that the "agenda" of the study was "no doubt consistent with that of Quackwatch Inc, the Questionable Nurse Practices Task Force, the National Council Against Health Fraud, Inc, and the National Therapeutic Touch Study Group."
The J.A.M.A. article stated:
"Therapeutic touch is grounded on the concept that people have an energy field that is readily detectable (and modifiable) by TT practitioners. However, this study found that 21 experienced practitioners, when blinded, were unable to tell which of their hands was in the experimenter's energy field. The mean correct score for the 28 sets of 10 tests was 4.4, which is close to what would be expected for random guessing. To our knowledge, no other objective, quantitative study involving more than a few TT practitioners has been published, and no well-designed study demonstrates any health benefit from TT. These facts, together with our experimental findings, suggest that TT claims are groundless and that further use of TT by health professionals is unjustified."
Emily's stepfather spelled out, in an article written for SKEPTIC magazine, the rationale behind conclusions reached by the JAMA article. Sarner asserts that for Therapeutic Touch to be effective, the human energy field must exist; differences in the human energy field must be related to illness or injury; a TT practitioner must be able to perceive the human energy field; a TT practitioner must be able to manipulate the human energy field; and the practitioner's hands must be able to manipulate the energy field. Emily's experiment proved that the practitioners could not detect Emily's field (under the conditions of the experiment.) The question I asked was, does the failure of perception in this limited experiment justify claims that TT is a sham? To me, such claims fall so far afield of the usual balance exhibited by medical scientists as to suggest an emotional agenda. Thus my reference to Noam Chomsky, philosopher and professor of linguistics, who writes prolifically and convincingly about the need for "intellectual self-defence" against vested interests.
Opponents claim that energy field perception is critical to TT and ought to be demonstrable apart from the meditative, interpersonal, or other "holisitic" aspects of the encounter. The founder of TT, Delores Krieger, has written, "Therapeutic Touch is basically a healing meditation; that is, the primary act is to center oneself in a natural, tension-free manner and to maintain that center throughout the entirety of the Therapeutic Touch process."
TT can and has been proven to be profoundly relaxing and helpful in pain relief. It conveys some of the best qualities offered by "bedside manner." In this it is not unlike other stress reducing therapies (as described, for example, in Kabat-Zinn's "Full Catastrophe Healing.")
Therefore I opened -- and now close -- with the question, "what's all this fuss?" Stress reduction promotes healing, prayer promotes healing, bedside manner promotes healing, TT promotes healing. What's so god-awful wrong with that? (Well, this discussion had an awful moment or two, but to paraphrase one bit of advice, I don't have to get into the ring if I don't like the way the contestants are sparring.)
From Voltaire:
"I have never made but one prayer to God, a very short one: 'Oh Lord, make my enemies ridiculous.' And God granted it."
Cheers, tallyho, hoo-hah, alakazam, and SWISH! for three,
Fool-for-Life,
Picked up and dusted off,
Michael
One more round of Therapeutic Touch discussion, anyone?
Contrary to one opinion, I have a good bit of familiarity with the study by Emily Rosa. I will now address heretofore omitted facts:
The authors of the paper were Emily, her mother, and "quackbuster" Stephen Barrett, MD. Emily's mother, Linda Rosa, was former Vice-President of the Rocky Mountain Skeptics, Coordinator of the Special Task Force Group on Questionable Nursing Practices and an opponent of the use of Therapeutic Touch. Emily's stepfather, Larry Sarner was the chairman of the National Therapeutic Touch Study Group, an anti-TT organization.
Dr. Barrett encouraged the paper's submission to JAMA.
Most letters to JAMA about the article have been critical. All are by credentialed professionals. For example, Andrew Freinkel, MD wrote, "As a clinician, I am surprised that [you] elected to address the important and controversial issue of Therapeutic Touch (TT) with such a simpleminded, methodologically flawed, and irrelevant study. The experiments described are an artificial demonstration that some number of self-described mystics were unable to 'sense the field' of the primary investigator's 9-year-old daughter. This hardly demonstrates or debunks the efficacy of TT." Jesse Lee, JD, wrote that the "agenda" of the study was "no doubt consistent with that of Quackwatch Inc, the Questionable Nurse Practices Task Force, the National Council Against Health Fraud, Inc, and the National Therapeutic Touch Study Group."
The J.A.M.A. article stated:
"Therapeutic touch is grounded on the concept that people have an energy field that is readily detectable (and modifiable) by TT practitioners. However, this study found that 21 experienced practitioners, when blinded, were unable to tell which of their hands was in the experimenter's energy field. The mean correct score for the 28 sets of 10 tests was 4.4, which is close to what would be expected for random guessing. To our knowledge, no other objective, quantitative study involving more than a few TT practitioners has been published, and no well-designed study demonstrates any health benefit from TT. These facts, together with our experimental findings, suggest that TT claims are groundless and that further use of TT by health professionals is unjustified."
Emily's stepfather spelled out, in an article written for SKEPTIC magazine, the rationale behind conclusions reached by the JAMA article. Sarner asserts that for Therapeutic Touch to be effective, the human energy field must exist; differences in the human energy field must be related to illness or injury; a TT practitioner must be able to perceive the human energy field; a TT practitioner must be able to manipulate the human energy field; and the practitioner's hands must be able to manipulate the energy field. Emily's experiment proved that the practitioners could not detect Emily's field (under the conditions of the experiment.) The question I asked was, does the failure of perception in this limited experiment justify claims that TT is a sham? To me, such claims fall so far afield of the usual balance exhibited by medical scientists as to suggest an emotional agenda. Thus my reference to Noam Chomsky, philosopher and professor of linguistics, who writes prolifically and convincingly about the need for "intellectual self-defence" against vested interests.
Opponents claim that energy field perception is critical to TT and ought to be demonstrable apart from the meditative, interpersonal, or other "holisitic" aspects of the encounter. The founder of TT, Delores Krieger, has written, "Therapeutic Touch is basically a healing meditation; that is, the primary act is to center oneself in a natural, tension-free manner and to maintain that center throughout the entirety of the Therapeutic Touch process."
TT can and has been proven to be profoundly relaxing and helpful in pain relief. It conveys some of the best qualities offered by "bedside manner." In this it is not unlike other stress reducing therapies (as described, for example, in Kabat-Zinn's "Full Catastrophe Healing.")
Therefore I opened -- and now close -- with the question, "what's all this fuss?" Stress reduction promotes healing, prayer promotes healing, bedside manner promotes healing, TT promotes healing. What's so god-awful wrong with that? (Well, this discussion had an awful moment or two, but to paraphrase one bit of advice, I don't have to get into the ring if I don't like the way the contestants are sparring.)
From Voltaire:
"I have never made but one prayer to God, a very short one: 'Oh Lord, make my enemies ridiculous.' And God granted it."
Cheers, tallyho, hoo-hah, alakazam, and SWISH! for three,
Fool-for-Life,
Picked up and dusted off,
Michael
Continuing to be pissed.....
Bravo, J.D.
I thought King Lear also had a line about showing oneself more the knave than the fool. I was going to offer that in response...but in fact Cervantes' Don Quixote or Marlowe's Tamburlaine the Great shared that characterization. (Am I creating giants of windbags -- I mean, windmills?)
By the way, thanks for not misinterpreting the Voltaire quote. I did not expect you would. I think it is a rather apt comment on how people of divergent viewpoints fail to appreciate one anothers logic. "Logic?" you reply, (using quotes around the word,) "'Logic?' Nay, 'opinion.'" Trot out the Emperor in his new clothes -- butt naked.)
Hanged Man indeed! I love it! A highly charged symbol found in various cultures, from Artemis to medieval Tarot. The meaning is of voluntary submission, e.g. of ego to heart, of physical to spiritual. Obi Wan submitted to Darth Vader in this spirit. Shamanism also requires this kind of submission.
And so I shall swing, singing, chortling, ever the faithful familos: "this is the work of Dr. X! He hath stripped me and suspended me thus. Venture not lightly into verbal exchange with him, my lambs! This dove hath the cunning heart of a snake.
Michael (the Swinger)
[This message has been edited by Knight (edited 06-03-99).]
[This message has been edited by Knight (edited 06-03-99).]
I thought King Lear also had a line about showing oneself more the knave than the fool. I was going to offer that in response...but in fact Cervantes' Don Quixote or Marlowe's Tamburlaine the Great shared that characterization. (Am I creating giants of windbags -- I mean, windmills?)
By the way, thanks for not misinterpreting the Voltaire quote. I did not expect you would. I think it is a rather apt comment on how people of divergent viewpoints fail to appreciate one anothers logic. "Logic?" you reply, (using quotes around the word,) "'Logic?' Nay, 'opinion.'" Trot out the Emperor in his new clothes -- butt naked.)
Hanged Man indeed! I love it! A highly charged symbol found in various cultures, from Artemis to medieval Tarot. The meaning is of voluntary submission, e.g. of ego to heart, of physical to spiritual. Obi Wan submitted to Darth Vader in this spirit. Shamanism also requires this kind of submission.
And so I shall swing, singing, chortling, ever the faithful familos: "this is the work of Dr. X! He hath stripped me and suspended me thus. Venture not lightly into verbal exchange with him, my lambs! This dove hath the cunning heart of a snake.
Michael (the Swinger)
[This message has been edited by Knight (edited 06-03-99).]
[This message has been edited by Knight (edited 06-03-99).]
-
Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Continuing to be pissed.....
I have some general comments
* Interesting mix of fact, opinion, and biases on all parts. The the mix of the three varies from person to person (I'm not going there).
* Biases in research are not uncommon. In fact I would venture to say that they are quite common. Perhaps it helps to know them. However if the scientific method was properly applied and the peer review process worked, then the biases which cause the individual(s) in question to investigate and publish are immaterial. Of course....folks will publish what they want and can choose to omit what they don't agree with. This happens.
* Negative findings generally will not be published. If Therapeutic Touch had great efficacy (vs. use as a placebo), and people were actively doing proper research, then (on average) the positive findings (of any type) would far outnumber the negative in reputable peer-reviewed journals. It is actually quite rare for a reputable journal to publish negative findings; they aren't "sexy" enough. This makes the JAMA article quite significant - biases and all.
* The natural course in research is for someone else to reproduce a study. Only then can we feel certain that the results are truly valid.
* Showing one aspect of a therapy to be invalid does not necessarily debunk the therapy. But if the aspect is a fundamental precept of the modality in question, well then that's different. A logical course of proof (or disproof) is to assume that X is valid and then show a case where X is not, ergo X is invalid. So...did the study in question do that?
* I've often wondered if there are other forces at work (not placebo) in some of these "alternative" (whatever that is) therapies or - for that matter - in the whole "chi" (whatever that is) thing in martial arts. Hypnotism? Maybe.... In the case of chiropractic, we have people improperly trained in the sciences performing services for years and giving bazarre explanations for why things work. We do know (via proper research) that chiropractic is efficacious in specific circumstances - but not for the reasons that used to be given.
So....the debate goes on. Most with opinions walking into this will not likely change their own. However maybe a few fence sitters have been swayed.
- Bill
* Interesting mix of fact, opinion, and biases on all parts. The the mix of the three varies from person to person (I'm not going there).
* Biases in research are not uncommon. In fact I would venture to say that they are quite common. Perhaps it helps to know them. However if the scientific method was properly applied and the peer review process worked, then the biases which cause the individual(s) in question to investigate and publish are immaterial. Of course....folks will publish what they want and can choose to omit what they don't agree with. This happens.
* Negative findings generally will not be published. If Therapeutic Touch had great efficacy (vs. use as a placebo), and people were actively doing proper research, then (on average) the positive findings (of any type) would far outnumber the negative in reputable peer-reviewed journals. It is actually quite rare for a reputable journal to publish negative findings; they aren't "sexy" enough. This makes the JAMA article quite significant - biases and all.
* The natural course in research is for someone else to reproduce a study. Only then can we feel certain that the results are truly valid.
* Showing one aspect of a therapy to be invalid does not necessarily debunk the therapy. But if the aspect is a fundamental precept of the modality in question, well then that's different. A logical course of proof (or disproof) is to assume that X is valid and then show a case where X is not, ergo X is invalid. So...did the study in question do that?
* I've often wondered if there are other forces at work (not placebo) in some of these "alternative" (whatever that is) therapies or - for that matter - in the whole "chi" (whatever that is) thing in martial arts. Hypnotism? Maybe.... In the case of chiropractic, we have people improperly trained in the sciences performing services for years and giving bazarre explanations for why things work. We do know (via proper research) that chiropractic is efficacious in specific circumstances - but not for the reasons that used to be given.
So....the debate goes on. Most with opinions walking into this will not likely change their own. However maybe a few fence sitters have been swayed.
- Bill
Continuing to be pissed.....
I think I'll be a skeptic for a few months.
It should be informative.
(I already know where to find resources on the web.)
Michael
(What has happened here, fellow lambs, is that the shepherd has quoted T.S. Eliot's Wasteland, which happens to have a bunch of Greek and Latin shtuff in it. It will take me a while to figger out what the brain doc means by directing me hither. So far my only clue is that Ezra Pound helped Eliot complete the poem, thus the quote about "the better craftsman." But what else does the enigmatic J.D. mean to convey by using this message?
Yours truly,
The Chortling Prophet
[This message has been edited by Knight (edited 06-05-99).]
It should be informative.
(I already know where to find resources on the web.)
Michael
(What has happened here, fellow lambs, is that the shepherd has quoted T.S. Eliot's Wasteland, which happens to have a bunch of Greek and Latin shtuff in it. It will take me a while to figger out what the brain doc means by directing me hither. So far my only clue is that Ezra Pound helped Eliot complete the poem, thus the quote about "the better craftsman." But what else does the enigmatic J.D. mean to convey by using this message?
Yours truly,
The Chortling Prophet
[This message has been edited by Knight (edited 06-05-99).]
Continuing to be pissed.....
May I add,
Scoundrel,
Wag,
another quote from Eliot?
Here goes:
O O O O that Shakespeherian Rag --
It's so elegant
So intelligent.
(from A Game of Chess)
Love,
Michael
Scoundrel,
Wag,
another quote from Eliot?
Here goes:
O O O O that Shakespeherian Rag --
It's so elegant
So intelligent.
(from A Game of Chess)
Love,
Michael
