In a 2018 article that I managed to miss until this week, journalist Anna Miller attempts to answer the question of whether or not children benefit from energy healing. Unfortunately she fails in this endeavor and leaves the reader confused, if not fully believing that there actually is some degree of legitimacy to such rank pseudoscience.
Miller, a former senior health editor at U.S. News appears to have the background to appropriately cover a topic like this. She had written about nutrition and fad diets in the past, as well as so-called complementary medicine, and she has a degree in psychology. Her bio even claims that she is a health expert that is frequently called upon to educate the public.
But as readers of SBM know, understanding pseudoscience in medicine is not something that tends to come naturally. We are all at risk of being fooled, and even highly intelligent and accomplished medical professionals often fail when it comes to such a complex issue. This problem requires a mental skill set that must be learned and developed over time. Frequent updates to our critical thinking algorithms are also essential because the proponents of these implausible, unproven, or even thoroughly disproved therapies learn new tricks all the time. They also like to dust off old tricks that haven’t been used in a while in order to get past our cognitive defenses.
One trick that has never gone out of style is the use of the emotional and deceptive anecdote as a hook. Miller’s article begins, as many do, with just such a triumphant success story that involves the use of “energy healing”. It isn’t meant to be critically evaluated but to lower the reader’s defenses and make them more receptive to the low quality evidence that is ultimately provided. In my opinion, this is a clearly biased narrative that raises more questions than it answers:
The hospital staff was at a loss: A young patient with leukemia was writhing in pain and inconsolable. She hadn’t slept in days.
Then Dr. Joy Weydert, a pediatrician who was chief of integrative pain management at Children’s Mercy Kansas City in Missouri at the time, stepped in. The girl, who was about 13 years old, had maxed out on pain medications and refused integrative therapies like guided imagery and massage, even though she’d found relief from them before. “She was beside herself she was so uncomfortable,” Weydert remembers.
So Weydert, now a clinical professor of integrative medicine and pediatrics at the University of Kansas Health System in Kansas City, Kansas, pulled one more tool out of her toolkit: energy healing. While the practice can take many forms, in this case, it involved gentle touch and guidance on breathing regulation.
Within 10 minutes, the patient began settling down, and within 20, she stopped wiggling and steadied her breathing, Weydert says. After no more than 30 minutes had passed, the girl was asleep for the first time in days. When she woke up the next morning, she said, “Do that to me again!” Weydert recalls. She taught the technique to the girl’s mother, who continued to use it at home each night. “It empowered her to be able to help out,” Weydert says.
There is a lot to unpack here. A lot. In fact, I think that’s what this post will focus on, although I do want to point out that later in the article Miller claims that energy medicine has been proven to objectively help with a wide variety of medical conditions in children. This is simply not true. She cites a 2017 clinical report from the AAP in a misleading way:
In babies and children, the evidence is more limited, but still encouraging enough that a clinical report on pediatric integrative medicine written by the American Academy of Pediatrics’ Section on Integrative Medicine included biofield or energy therapies like healing touch, therapeutic touch and spiritual healing among those complementary and alternative medicine therapies that are safe and effective for children.
Here is the totality of what the AAP report has to say about energy medicine:
Biofield therapies encompass several healing practices that include therapeutic touch, healing touch, and spiritual healing, among others. The biofield therapies are “intended to affect energy fields that purportedly surround and penetrate the human body” and are “rooted in concepts of compassion, positive intention, self-empowerment, the mind-body-spirit triad, and the body’s innate tendency toward healing.” Therapeutic touch and healing touch have been used successfully in pediatric oncology patients as a nonpharmacologic approach to reduction of pain and stress.
I wrote about this report when it came out and I wasn’t impressed. The definition used by the AAP is pure pseudoscience. Energy is never defined and the whole concept is akin to just saying it works by magic. Miller uses a similar approach in her article, and also incorporates the concepts of compassion and positive intention into the definition. Obviously compassion for our patients is a good thing, and a key aspect of what most would consider to be a helpful bedside manner, but concepts such as positive intention and “the mind-body-spirit triad” are just catchy marketing terms designed to distract from nonsense about mysterious undetectable energy fields. It’s meaningless jargon appropriated from new age spiritualism and positive psychology.
Also, the study cited in the AAP report in support of energy medicine for children with cancer was garbage that didn’t even look at pain and didn’t tease out energy therapy as a specific intervention from the theater that surrounds it. As I said in my post back then, the AAP has an integrative medicine problem. They allowed a group of biased believers in quackery to establish an official Section, which gives undeserved credibility to that quackery that then loops back around to provide justification for the Section’s existence. As with all integrative medicine, the AAP report uses proven science-based interventions to prop up the nonsense and it is not a serious source that can be used to declare energy medicine effective for anything.
But I am supposed to be focusing on Miller’s opening story, which was clearly included in order to convince readers that energy medicine is a legitimate treatment. It’s being offered in academic children’s hospitals, after all. But I have a few issues with the way the story was presented. I also have a different interpretation.
In the opening anecdote, there are several assumptions forced upon the reader. Right off the bat we are told by Dr. Weydert that the hospital staff was at a loss regarding the patient’s pain and insomnia, which is implied to be related to her leukemia. I’m skeptical that the team was as lost as she recalls. The use of that kind of language reveals what I think is some pretty significant bias and there is a high likelihood that this memory has drifted from the reality of the events over the years as she has reinterpreted and retold it time and time again.
While it is certainly plausible that a child with leukemia might be in pain, we aren’t given specific details to help determine the actual cause. Patients with active leukemia might have severe bone pain. Patients undergoing treatment with chemotherapy might have pain from mucositis, which involves inflammation and injury to the lining of the GI tract. She could have had meningitis from leukemic infiltration of the CNS, or from the chemotherapy used to treat it. She might have developed neuropathic pain associated with her chemotherapy regimen.
She might also have been experiencing pain related to the stress and anxiety associated with her diagnosis and multiple hospitalizations. Patients often have a perception of pain even when there is no tissue injury or inflammation, or any so-called “organic” cause. This does not mean they aren’t in pain, or that the pain isn’t real. Pain is pain and it’s all in the brain, as they say. The distinction is only important because having an understanding of the source of a patient’s pain helps us to determine the best treatment for it.
I think that Dr. Weydert’s recollection of the team being “at a loss” just means that they had actually ruled out pain related directly to her leukemia. They likely strongly suspected that her pain was functional in nature and had consulted the integrative pain management team for help, not because they believe in energy healing or homeopathy, which Weydert also believes in, but because that’s the team who gets consulted for difficult-to-manage pain at that facility. My suspicion, and that’s all I can say that it is, is that Dr. Weydert probably sees herself as a bit of a savior for patients like this and feels that the primary treatment teams, whether they be made up of hospitalists like me or oncologists caring for a child with leukemia, are often lost without her services. We are all the heroes of our own stories, I suppose. It sure would be interesting to get the perspective of the physician who put in the consult in this case.
Another clue that Dr. Weydert might have a biased memory and that the primary treatment team had determined that the patient had pain that would be more amenable to nonpharmaceutical interventions is that the patient was “maxed out” on pain medications. This isn’t a term we typically use, at least not in my experience. I’ve personally never put that in a chart and I don’t really know what it means in this context.
I think that Dr. Weydert is at least implying that this is a patient who was on multiple medications for pain, meaning scheduled doses of ibuprofen and acetaminophen as well as a scheduled intravenous opioid such as morphine or hydromorphone (Dilaudid). She might even be receiving a continuous infusion of one of these opioids. And at 13 years of age, she is old enough to be able to press a button to self-administer an extra bolus dose when needed, with appropriate limitations on frequency and dose.
When it comes to the use of drugs like morphine for pain, we worry about the side effect of respiratory depression so we are careful about initial dosing. Parameters like the time to peak pain reduction and peak respiratory depression are well known with these drugs, so if a patient has persistent pain after the initial dose we can safely give more of that opioid until a patient is comfortable. As long as thought is put into the timing of additional doses, and how much each dose is potentially increased, the risk of some kind of bad outcome is extremely low. In general, with IV morphine for example, if 20-30 minutes have passed, and a patient is in pain and breathing normally, you can safely give another dose and even increase it by 50%.
So when I see that this specific patient was “maxed out” on pain medications, but still “writhing in pain”, it tells me that likely one of two things were happening. One possibility is that her treatment team believed that her pain was related to her leukemia and was opioid responsive, but for unknown reasons they chose to provide inadequate pain control and not increase the dose of her opioid. Because we don’t typically allow patients to suffer from severe opioid responsive pain like that, the more plausible possibility is that her team recognized that her pain was not opioid responsive, and that it may be related to stress and anxiety.
As Dr. Weydert reveals, the team had already attempted to treat the child’s pain with “integrative therapies”, in this case massage and guided imagery. This is a good example of how integrative medicine often just co-opts standard science-based nonpharmaceutical interventions (Ugh. Please ignore the acupuncture in this otherwise excellent summary that I’ve linked to) in order to provide cover for nonsense like homeopathy and energy healing. Massage and other stress reduction and distraction techniques had apparently benefited the patient but for unexplained reasons she wasn’t interested in continuing them. Nonpharmaceutical interventions can be very helpful for any type of pain, even allowing some patients to achieve reasonable comfort with lower doses of opioids or without them at all depending on the source and severity of the pain.
Again, the claim that the patient’s pain medications were “maxed out” tells me that they probably weren’t dealing with opioid responsive pain. At this point, the next step in pain control can be very challenging. Imagine trying to convince a patient (if they are old enough to be part of the discussion) or a caregiver that the patient’s pain is caused by stress/anxiety and that you want to stop the morphine which they might strongly believe is helping despite all the objective evidence that it isn’t. Sometimes we have to settle for putting a hold on increasing the opioid dosing and then slowly reduce it over some period of time in order to preserve the therapeutic relationship.
Nonpharmaceutical interventions are the best approach for pain caused by stress and anxiety, but it’s complicated. Patients and caregivers need to buy into the approach. When we go down this path, it often requires help from people who are experts in treating patients either directly, such as with cognitive behavioral therapy, massage or play therapy, or in teaching patients and caregivers how to take an increasingly active role themselves, such as with massage, exercise, deep breathing exercises, or meditation.
There is no magic to these interventions. When they work, they tend to do so by calming the patient and distracting them from the pain, or by teaching them how to adjust their perception of it. Some people respond to certain interventions but not at all to others, and there are many reasons why these approaches might not help a particular patient. A patient might be in too much pain to participate. They might not want to participate. They might not care for or trust the person working with them. They might be angry. They might be depressed. They might have an altered mental status from injury or medications. It’s a long list.
What I’m getting at with this is that sometimes the specific person providing the nonpharmaceutical intervention can make a huge difference. Obviously there is no such thing as energy healing. It’s made up. And in fact, this story serves as evidence of the absurdity of the whole concept if gently touching a patient in a caring way and talking them through deep breathing exercises can be labeled as energy healing. Am I doing it when I sit with a patient and reassure them that they will have a full recovery? Am I doing it when I explain to a patient that the medication I’m ordering will cure their pneumonia? Is anything I do not some form of energy healing?
It is entirely possible that Dr. Weydert is just really good at connecting with people and gaining their trust. Establishing a therapeutic relationship in a short period of time is a skill and it can make all the difference in situations like this. Maybe that is why the patient described in this anecdote had such a positive response in such a short period of time, although, to be honest, it probably wasn’t quite as dramatic as she presents it. Of course, it is also possible that Dr. Weydert just got lucky and was in the right place at the right time. Maybe the patient was just in a better place to be more receptive to nonpharmaceutical interventions.
Conclusion: Nonpharmaceutical interventions can help reduce pain without the fantasy
Your child does not need an energy healer. Energy healing is silly. It’s fantasy and barely more plausible than homeopathy. It has no place in the treatment of pediatric patients with pain, or any patient with any condition for that matter. I get that some people are going to respond to the fantasy narrative, but that isn’t okay if it involves deception. Lying to a patient about a treatment, even if it is well-meaning and unlikely to cause direct harm, is unethical.
It is okay to develop and implement frameworks that help patients understand a treatment that might not be how I would discuss it with colleagues outside the room. For example, instead of invoking the manipulation of mysterious and undetectable human energy fields, Dr. Weydert might instead set up her interactions by discussing the mysteries of the human mind and how we don’t always understand how things like massage and gentle touch can change the way our bodies perceive pain. She could tell her patients and their caregivers there is good evidence that nonpharmaceutical interventions can be very helpful for some patients. This doesn’t interfere with the desired distraction and also engenders potential non-specific “placebo” treatment effects without the need for any deception or magical thinking.
The problem, and it is one that we have discussed many times over the years here at SBM, is that the people providing these interventions tend to be believers in the magical thinking. Dr. Weydert is a prime example. And articles like this aren’t helping because they prime patients to believe in it as well. Miller even credulously quotes an energy healer who performs remote healing that works on a “quantum level”. There isn’t even token skepticism to counter these claims and her article is ultimately just propaganda that fails to truly educate the public.