A perhaps under-appreciated accelerant of so-called “complementary and alternative” medicine’s metastasis throughout our culture is CAM’s inherent elasticity. While what is now known as conventional medicine must stick to the science, a fantasy-based CAM can morph into any number of variants, limited only by the imagination of its practitioners. Acupuncture is a perfect example. The concept of a nebulous energy flowing through our bodies via “meridians” unknown to anatomy, and the putative ability to manipulate this energy via needles stuck into “acupoints”, has birthed battlefield acupuncture, acudetox, acupressure, and electroacupuncture, all creatures of the modern era (not to mention the dozens of pre-modern varieties that also exist).
Another progeny of this fecund acupuncture racket was brought to my attention recently by a new article in Medical Acupuncture (the gift that keeps on giving) titled “Aroma Acupoint Therapy for Symptom Management Patients: Early Experiences from School-Based Health Centers”.
You know you’re in for a heaping helping of integrative ideology when the very first sentence is:
Complementary and integrative approaches to medicine are essential for holistic and patient-centered care.
Which is complete hooey.
The article describes “aroma acupoint therapy”, or “AAT” (the specifics of which we’ll get to in a moment), for symptom management in a variety of ailments suffered by adolescent patients presenting at school-based health centers in New York City. Evidently, the institution of AAT is the brainchild of Melanie A. Gold, DO, DMQ, who is board certified in “medical acupuncture” and is medical director of seven of these health centers. (“DMQ”, which I’m guessing stands for “Doctor of Medical Qigong”, refers to a particular type of certification in qigong, a form of Chinese “energy medicine”. There is no national certification standard in qigong practice.) Gold was herself trained in AAT by its creator, Peter Holmes, and, in turn, trained the school health center medical staff.
With the approval of the institutional review board of Columbia University Irving Medical Center, a retrospective review was conducted of electronic medical records of adolescent patients treated with AAT. We’ll get to the findings of this review shortly, but first, let’s take a look at acupoints and aromatherapy and how they were combined to create aroma acupoint therapy.
Briefly, as mentioned above, acupuncture points, or “acupoints”, are points on the body, mostly located on meridians, through which “qi”, or energy, flows. According to acupuncturists, insertion of a needle at these points influences the flow of energy, which somehow treats disease and improves health. Acupoints, qi, and meridians are fictional and research reveals that acupuncturists cannot reliably find acupoints on the body. As we’ve pointed out many times here on SBM, acupuncture is a theatrical placebo.
I assume that the “aroma” in the term “aroma acupoint therapy” refers to aromatherapy because AAT employs essential oils and aromatherapy is the use of inhaled essential oils (volatile compounds that contain the “essence” of the plant from which they are extracted) with a therapeutic intent. Essential oils are also applied topically for the same purpose. While the use of essential oils is a billion dollar a year business in the U.S. (expected to exceed $11 billion by 2022) and they are touted for many purposes, there is currently no reliable evidence that either inhalation or topical application is effective for any condition and it is, in fact, illegal for an essential oil to claim it can mitigate, treat or cure any disease.
I say “assume” here because the therapeutic intent of using essential oils in AAT is (supposedly) achieved via application to the skin, not inhalation. Of course, that is the beauty of CAM – nothing has to make sense, even the terminology used.
Which brings us, finally, to an “explanation” of AAT. Here I quote extensively from the article because I find it difficult to summarize gobbledygook.
AAT is a safe and gentle treatment that involves placing specific essential oils on specific Chinese acupoints to trigger energetic changes in patients’ bodies. The acupoints are the same as those used in acupuncture, with essential oils replacing needles as the stimuli . . .
The origins of AAT go back to the early 1990s, when Mr. [Peter] Holmes [an acupuncturist and herbalist and the inventor of AAT] began experimenting with using essential oils on acupoints in his acupuncture practice. Finding them very compatible with acupuncture, he gradually developed techniques of using them alone on acupoints, not just in preparation for needling. Over the years, Mr. Holmes also developed the functional diagnostic system of the Six Conditions that became the theoretical backbone of AAT, as well as the model of Fragrance Energetics for tracking the effects of essential oils on individuals . . .
The theoretical concept proposed by Mr. Holmes is that the natural bioenergetic frequency of an essential oil provides information to an acupoint. In the principle of resonance, the synergy between a certain oil and a particular point can trigger a specific type of therapeutic action in a patient. The key to successful treatment is creating the right synergy between certain oils and certain points. The treatment protocols of AAT reflect decades of Mr. Holmes’ experience with synergistic oil–point combinations when performed in a specific sequence.
Tense and Tense Alternating with Weak are 2 conditions or syndromes defined by Mr. Holmes that include physical as well as psychoemotional attributes. In general, Tense conditions (also called Wired) have the quality of contraction, spasm, increased sensation or pain, irritability, anxiety, nervousness, or restlessness. Tense Alternating with Weak conditions (also called Wired and Tired) are similar to Tense conditions but with elements of fatigue, exhaustion, and/or mood dysregulation. Mr. Holmes developed 2 protocols, 1 each to treat Tense and Tense Alternating with Weak conditions utilizing AAT, which he has found to be clinically safe, often effective after 1 treatment, and easy to teach health care providers and patients. . . .
The Tense protocol . . ., also called Calming Therapy, involves placing 1-2 drops of 4 different essential oils on 5 acupoints bilaterally for 90 seconds on each acupoint in [a particular sequence].
Thus, for example, lavender drops are placed on the “Pericardium meridian 6 or PC 6 (Neiguan) on the inner wrist 3 fingers’ breadth from the wrist crease between the tendons of the palmaris longus and flexor carpi radialis”. The accuracy of this, one assumes, is based on the well-established anatomical principle that everyone’s fingers are of exactly the same width.
In other words, other than the acupoints (which, remember, no one can reliably find), Holmes made the whole thing up.
Yet, despite the fact that Holmes’s assertions of safety and effectiveness remain wholly unsupported by evidence and that his proposed mechanism of action is fantasy-based, Gold and her staff proceeded to treat adolescent patients at the school clinics with AAT. Whether informed consent was obtained is not disclosed.
Based on the “Tense” and “Tense Alternating with Weak” “protocols”, 15 students presenting with symptoms of headaches, menstrual cramps, nausea, shortness of breath, pain, and dizziness (7 of these were assessed by the health care provider as attributable to anxiety) were treated with AAT in addition to standard medical therapy, such as ibuprofen. There was an average decrease in pain score of 4 on a 10-point scale.
To the authors, this case series demonstrated that AAT is safe and noninvasive, easily taught, and well-received by providers and patients and, as well, the “potential” for adopting AAT as an “effective treatment modality for symptom management in adolescent patients”. It “opens the door for robust studies of the clinical efficacy of AAT”.
In fact, there is no record of the patients’ receptivity to AAT reported in the article and no mention of monitoring for side effects. Irritation and allergic reactions to topically-applied essential oils have been reported and some may act as endocrine disruptors. The National Institute of Environmental Health Sciences reports a possible link between the topical use of essential oils and the onset of male gynecomastia (development of breast tissue).
Moreover, nothing in their research comes even close to suggesting that AAT is effective, or warranting further trials. In what might be called quintuple Tooth Fairy Science, the authors credulously assume the existence of (1) acupoints, (2) a “bioenergetic frequency” of essential oils, (3) the ability of this “bioenergetic frequency” to transfer information to an acupoint, (4) the ability of the acupoint to accept this information, and (5) a “synergy” between the oil and the acupoint that triggers a “therapeutic action”. No one has bothered to establish that any of these phenomena actually exist. Of course, the presumed effectiveness of AAT can more plausibly be attributed to the usual medical care patients received and other factors, such as the fluctuating nature of pain and the placebo effect of a novel treatment requiring additional time out of class and administered by enthusiastic providers, who reported AAT as “enjoyable” and “efficient”.
Given the utter implausibility of AAT, my view is that clinical trials would be unethical and informed consent to treatment impossible because of the misrepresentations involved. But since lack of evidence of safety and effectiveness was no barrier to AAT’s use on adolescent patients at school clinics and, indeed, negative trials have not ever stopped the use of any CAM treatment that I am aware of, clinical trials would be superfluous anyway.