I had an interesting conversation with a reporter today. She called me to get a “medical/skeptical” counterpoint for an article she is preparing on energy healing. Although I don’t know if she’ll faithfully represent what I had to say, we had an entertaining exchange and so I decided to capture the essence of it here. I’m curious to see which parts of our conversation remain in her final article, due out on February 19th. (Stay tuned for that).

Apparently a local hospital in Maryland is now offering nurse-guided therapeutic touch and Reiki healing for inpatients. She decided to interview the practitioners involved, and turned to me for comment. I did not have the benefit of preparing in advance or having references handy – so I gave it my best shot. I’d be interested to know how you might have responded differently.

1. Is there any scientific evidence that energy healing works?

No. There is currently no conclusive evidence that energy healing is more effective than placebo.  Furthermore, there’s no known mechanism whereby an unmeasurable energy could be manipulated to improve one’s health. Such ideas hearken back to a point in history when we didn’t understand the pathophysiology of disease. Hundreds of years ago we had no idea about bacteria, viruses, and the genetics of cancer for example. We did the best guess work we could – and chalked up diseases to mysterious energy imbalances. But thanks to scientific inquiry, we now know a lot more about the true causes of disease.

2. Why do patients turn to “alternative medicine” modalities like energy healing?

In my view, there are two things that drive people to try alternative medicine: 1) They are not satisfied with their current medical treatment – either because there is no cure or sufficient palliation for their disease/condition, or they may have been misdiagnosed, or their emotional needs have not been adequately addressed and 2) People want to feel in control of their health. Unfortunately, the human death rate is still 100%, no matter how hard we try to cheat it. There comes a time when each of us will be very unhappy with our “health outcome.”

I also think that our fragmented healthcare system (with all its perverse incentives) results in a high degree of frustration, access problems, and insufficient time actually getting to the bottom of diagnostic conundrums. Best Doctors estimates that up to 20% of patients have been given the wrong medical diagnosis – probably because the patients were rushed through a busy office without their medical history (and all the tests and medical records) being adequately reviewed. Our broken system sets people up to look further for solutions – and sometimes the path of least resistance is to pay an alternative medicine practitioner to hear your case.

3. Do you think CAM is popular?

It depends on how you define CAM. If you take the broadest definition of it (and include vitamins and prayer as types of CAM) then, yes, most people have tried it. But if you’re asking how many Americans regularly use Reiki, Reflexology, or healing touch, the number is probably less than 1%. While it’s true that more and more academic institutions are setting up “integrative medicine centers” to incorporate CAM into scientific medical practices, I’m also seeing a growing number of skeptics online and in mainstream media. Newsweek took Oprah to task for her steady parade of TV pseudoscience, Amy Wallace exposed the anti-vaccine movement at Wired Magazine, Dave Whelan is doing some quackery exposes at Forbes, and AP’s Marilynn Marchione has taken on false cancer cures. Even Washington is showing a hint of skepticism – with John McCain’s new bill essentially seeking to bring supplements back under some degree of control by the FDA.

4. Do you think that CAM practitioners are intentionally dishonest and selling their therapies for profit?

Some may be that way, but the majority probably really believe in what they’re doing. There is a tendency for CAM practitioners to support their beliefs with anecdotes, though. They believe that their treatments “work” because they’ve witnessed patients getting better. Of course, a certain percentage of patients will always get better on their own. I also think that there’s great value in “talk therapy” – discussing an illness with a empathic listener can reduce anxiety and make a person feel better. CAM practitioners spend a lot of time listening and expressing empathy – which is probably their secret to success (not the “magical” properties of energy healing).

Remember that placebos have effects, and are especially good at modulating the perception of pain or emotional disturbances. I have no doubt that many CAM therapies have placebo effects.

5. What do you think of reflexology?

The idea that body parts and organ systems can be influenced by applying pressure to the feet is part of an old fashioned system of thinking. There is no “humunculus” on the feet (or ears for that matter) and we have proven that with modern brain imaging. Reflexology was created before we understood how the nervous system works or the complex pathophysiology of disease.

But foot massage does feel good, so I can see why some people might be drawn to reflexology as a proxy for a good foot massage.

6. What do you think of healing touch in hospitals?

I’m not a fan. I think it’s misleading to patients – to use the credibility and trust of the hospital’s “brand” to make patients think that they’re receiving a scientifically-proven therapy.  There’s no conclusive evidence that touching patients makes a difference in most disease outcomes – and I would wager that blocking off time for nurses to engage in compassionate dialog with patients would have a similar positive emotional effect. Why the pretense that something scientific is happening? Let’s just make time for normal caring gestures and some good talk therapy.

7. What about yoga and Pilates?

There’s no doubt that exercise – in pretty much any form – is good for the body. Stretching exercises are a valuable part of physical fitness, and core strengthening can reduce the chance of low back injuries for example. I think that yoga and Pilates – and Tai Chi or bowling for that matter – all have a roll in healthy activity levels. These kind of low impact exercises are particularly good for the elderly, and can help to keep the mind active as well.