Reiki (pronounced raykey) is a form of “energy healing,” essentially the Asian version of faith healing or laying on of hands. Practitioners believe they are transferring life energy to the patient, increasing their well-being. The practice is popular among nurses, and in fact is practiced by nurses at my own institution (Yale).

From reiki.org, we get this description:

Reiki is a Japanese technique for stress reduction and relaxation that also promotes healing. It is administered by “laying on hands” and is based on the idea that an unseen “life force energy” flows through us and is what causes us to be alive. If one’s “life force energy” is low, then we are more likely to get sick or feel stress, and if it is high, we are more capable of being happy and healthy.

Reiki is therefore a form of vitalism – the pre-scientific belief that some spiritual energy animates the living, and is what separates living things from non-living things. The notion of vitalism was always an intellectual place-holder, responsible for whatever aspects of biology were not currently understood. But as science progressed, eventually we figured out all of the basic functions of life and there was simply nothing left for the vital force to do. It therefore faded from scientific thinking. We can add to that the fact that no one has been able to provide positive evidence for the existence of a vital force – it remains entirely unknown to science.

But the discarded science and superstition of the past is the “alternative medicine” of today. There are many so-called “CAM” modalities that are based on vitalism, including Reiki. Reiki, in fact, is very similar to therapeutic touch, another energy healing modality that was popular among nurses, and although it continues to be used it is much less popular after 9 year old girl (Emily Rosa) performed an elegant experiment to show that it was nothing but self-deception. Reiki nicely moved in to fill the void.

The research on Reiki, and energy healing in general, is similar to that of many similar modalities – those with very low scientific plausibility that are not taken very seriously by medical scientists. The research is of generally low quality, poorly controlled small studies that seem designed to justify Reiki rather than see if it actually works. The most recently published study, for example, looks at anxiety levels and self-reported well being in cancer patient and finds, unsurprisingly, that patients feel better when they receive the kind attention of a nurse. The study is completely uncontrolled, and therefore of dubious value. One might consider such a study a complete waste of time and effort, as the results were never in doubt.

A 2011 review of reiki studies concluded:

The existing research does not allow conclusions regarding the efficacy or effectiveness of energy healing. Future studies should adhere to existing standards of research on the efficacy and effectiveness of a treatment, and given the complex character of potential outcomes, cross-disciplinary methodologies may be relevant. To extend the scope of clinical trials, psychosocial processes should be taken into account and explored, rather than dismissed as placebo.

In other words – existing research is a such poor quality we cannot draw any useful conclusion from it. I disagree, however, that this necessarily means that more research is needed. The low plausibility of using magical energy that has never been demonstrated to exist by medical science argues otherwise. Further, the last sentence is odd – it suggests the authors are trying to spin placebo effects into real effects. This is increasingly the strategy of alternative medicine advocates as it becomes clear that most of the modalities they favor do not work any better than placebo (which means they don’t work).

Reiki is now squarely in that camp. Published at about the same time as the review (and therefore not included in the review) is a well-designed study of Reiki where Reiki was compared to placebo Reiki (someone not trained in Reiki simply goes through the motions) vs usual care (no intervention). Not surprisingly, both the real Reiki and the sham Reiki groups did better on self-reported well-being than the no intervention group, but they were indistinguishable from each other. Therefore Reiki did not better than placebo. That means Reiki doesn’t work (at least in the regular world of science-based medicine).

The authors conclude:

The findings indicate that the presence of an RN providing one-on-one support during chemotherapy was influential in raising comfort and well-being levels, with or without an attempted healing energy field.

I notice the authors did not conclude “Reiki doesn’t work.” This is odd, given that both the treatment and placebo groups had the same effect on subjective outcomes. With regular medical interventions we conclude from this outcome that the treatment does not work. Imagine a pharmaceutical company concluding:

The findings indicate that taking a pill during chemotherapy was influential in raising comfort and well-being levels, with or without an active ingredient.

Therefore – taking pills is helpful. Let’s not fret about whether the active ingredient has any specific physiological effects. Reiki supporters appear to have taken a page out of the acupuncture handbook. If real and sham acupuncture are both better than no intervention (they argue), than acupuncture works, whether real or placebo.

This article by Edzard Ernst recently published in the Guardian also discusses this Reiki study. Ernst points out that, not only is it scientifically dubious to conclude from such studies anything other than the treatment does not work, it is ethically questionable to give such treatments as a placebo intervention. He writes

By insisting that patients must not be treated with placebos like reiki, scientists also advocate that they receive treatments that demonstrably work better that placebo. For instance, massage has been shown to improve the wellbeing of cancer patients beyond a placebo effect. If a patient receives a massage with empathy, sympathy, time, understanding and dedication, she would benefit from the placebo effect – just like the reiki patient – but, in addition, she would also benefit from the specific effect of the treatment that massage does and Reiki does not offer.

This is a critical point that I have been making also. Essentially, you cannot justify ineffective treatments simply because they provide a placebo effect. That is because effective treatments also provide the same placebo effect, but also provide specific benefits because they actually work.

I would argue that there are also many potential harms from convincing patients that unscientific treatments are effective because of their non-specific placebo effects. This is a deception, violates patient autonomy and informed consent, and sets them up to perhaps rely on ineffective “magical” treatments for non-self-limiting illnesses.

Let’s get back to the authors conclusions from the Reiki study – they argue that this study shows that the:

“presence of an RN providing one-on-one support during chemotherapy was influential in raising comfort and well-being levels…”

The part about “with or without an attempted healing energy field” is entirely irrelevant, and you could just as well substitute any ineffective or magical treatment for “healing energy” is that statement. But the first part of the conclusion is also dubious, in that we did not need this study to come to this conclusion.

It has already been well-established, to the point that it is appropriately taken as a given, that people feel better when they get the kind attention of someone else, especially if they are sick and that person is a health care professional with training and experience in comforting sick patients. We don’t need to keep studying this over and over again.

Kind attention plus X makes people feel better, just as well as kind attention alone. Great. We do not need to study this with every possible form of unscientific intervention filling in for X. And it is deceptive and unscientific to suggest that whatever fills in for X has some value because of this equation.

This is what I call the “part of this complete breakfast” fallacy. Even as a child I recognized that when a commercial advertised their pastries as being part of the complete nutrition offered by an otherwise nutritious breakfast, the pastries were nutritionally irrelevant. They added nothing, and the commercial was being deceptive in trying to make me think that they were nutritious simply by their proximity to a nutritious breakfast.

Reiki, acupuncture, homeopathy, and similar methods may be “part of this feel-good intervention,” but they are an irrelevant and superfluous part. It is the kind attention of the practitioner that matters – and only that attention. So such attention might as well be part of legitimate science-based interventions that also have a specific physiological benefit.

This suggests that the real purpose of the ritual of reiki, or other superfluous placebo ritual, is not to achieve a positive end for the patient but to give the practitioner a marketable “skill” (even though the evidence shows that someone without any such skill or training can get the same results). In a recent article about reiki making its way into hospitals, Kryak and Vitale write:

There is a growing interest among health care providers, especially professional nurses to promote caring-healing approaches in patient care and self-care. Health care environments are places of human caring and holistic nurses are helping to lead the way that contemporary health care institutions must become holistic places of healing. The practice of Reiki as well as other practices can assist in the creation of this transformative process.

I submit that if the goal is to make hospitals and other health care environments more nurturing, promoting reiki and similar modalities is that exactly wrong way to do it. They are tying a worthwhile goal to blatant pseudoscience, and therefore legitimate resistance to the pseudoscience will also cause resistance to the nurturing.

If we accept that health care environments can be improved by more time and resources being applied to patient comfort, reduced anxiety, and enhanced self sense of well-being – then let’s use what works, the time and attention of a caring provider. The placebo ritual that is reiki (or acupuncture, or whatever) is wasteful, distracting, and arguably unethical. It unnecessarily complicates efforts to improve patient caring by promoting demonstrable pseudoscience.

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