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The Mayo Clinic is a prestigious medical institution with a deserved international reputation. It also promotes rank pseudoscience. It does this, apparently, for all the reasons we have explored here at SBM over the years. I have seen first hand how one or a few true believers can promote so-called alternative medicine at their institutions, meeting little resistance from colleagues and administrators who are “shruggies”. They don’t really understand the phenomenon and are content to let the “experts” take the lead.

In this case we see an article published on the Mayo Clinic website promoting the pseudoscientific practice of Reiki. As I and others at SBM have discussed many times before, Reiki is an Asian form of faith healing or laying on of hands. It purports to manipulate an unseen energy field surrounding living things. Proponents make mostly vague claims about “healing” or “wellness” and that the practice will reduce stress and subjective symptoms.

The Mayo Clinic article, by nurse Kenneth Rooth, states:

“Simply put, Reiki is a Japanese healing technique that aims to reduce stress and shift energy in the body. It was discovered by Master Mikao Usui in 1922 and slowly grew in popularity as a healing modality that is now practiced worldwide.”

That’s always a red flag of pseudoscience – when an entire practice was “discovered” by a single individual. What did he discover, exactly? The idea of life energy is ancient. It’s a pre-scientific superstitious idea that was largely a placeholder of our own ignorance of biology. What did the life force do? Whatever we did not understand about biology. Eventually, as science advanced, there was nothing left for the life force to do.

We now also have at least a century of scientific research that has failed to find any clue that such a mysterious life force or life energy exists. It cannot be detected, measured, or confirmed in any way. Also, there isn’t a single energy-based practice that has been shown to have any effect beyond placebo.

On that point, Rooth has this to say:

“When I first started exploring Reiki, I was surprised to find a number of studies that tested Reiki. Some of them were very compelling. In fact, from 1989 to 2018, a total of 74 peer-reviewed research articles have been published on Reiki. Of the higher quality studies, those comparing Reiki to a control “sham” form of Reiki or standard-of-care largely support the hypothesis that Reiki may reduce pain, anxiety, depression, and burnout and may increase relaxation and well-being.”

He then cites a couple of small studies. This is where the Mayo Clinic is truly delinquent. It’s one thing to soft peddle claims of making patients feel better. It’s another to misrepresent clinical science. That has negative effects beyond the topic at hand, and demonstrates a lack of dedication to the science of medicine that should be embarrassing for such an institution.

For context, perhaps the biggest question is medicine is how we know what works and what doesn’t work. This is the overarching question that defines any medical system. Starting around a century ago the medical profession became increasingly dedicated to the idea that the way to know what works is through high quality scientific research. Anecdotes, personal experience, and authority were not enough. This is when the era of scientific medicine truly began. In the 1980s the profession doubled-down on this approach with the advent of evidence-based medicine (EBM).

Since that time, however, there have been essentially two main forces at work within the medical profession. There are those who explore and promote increasingly rigorous standards of EBM, working out the kinks in the system to get to more and more reliable scientific conclusions and evidence based practice.

At the same time there has been an insurgent movement of “alternative medicine” which seeks to weaken the scientific standards within health care, to allow for “other kinds of evidence”. But in reality they are just promoting old-school medical pseudoscience by reverting to anecdotes and authority-based medicine. They are also exploiting some inherent weaknesses in the ways that EBM are conducted, such as insufficiently considering the role of scientific plausibility in calculations of probability. Promoters of alternative medicine have been quick to exploit the weaknesses in EBM.

This is exactly why we formed SBM, to fix the weaknesses in EBM, and to explicitly reject calls to go back to pre-scientific methods in health care and to weaken or in some cases even eliminate the science-based standard of care.

Reiki is a microcosm of this entire struggle. Here were have a practice based upon no foundational science. It is based upon magic and faith healing. Proponents have not established their basic claims, that the life energy exists, has any relationship to health, disease, or symptoms, and can be manipulated by practitioners. Instead they study subjective outcomes with small and poorly designed studies, the kind designed to generate false positive outcomes. But they have never established that Reiki works for anything, not so a reasonable scientific degree.

Reading the systematic reviews give a perfect summary of the weakness of the evidence and how exploitable EBM can be. They generally tout the positive outcomes, but then admit the weakness of the evidence buried deep in the conclusions. For example:

“To date, there are a small number of studies in each area, therefore findings are inconclusive and, more RCTs controlling for placebo in Reiki research are needed. Most included studies were also assessed as having a risk of bias of some concern.”

and

“It is recommended to conduct more randomized controlled trials with a high methodological quality that examine the effectiveness of Reiki application for patients with cancer.”

A better review comes from The Office of Science and Society at McGill University:

“The individual studies listed in this review, as well as most papers testing Reiki, are a teachable encapsulation of bad science. They often involve a single Reiki session with no follow-up; they test small groups, which leads to noisy data that can look positive by chance alone;”

We have only small poorly designed studies looking at subjective outcomes without any plausible mechanism. This is a poster child for alternative medicine. By promoting this practice, and a completely biased review of the scientific evidence, Mayo Clinic is planting its flag on the side of pseudoscience in medicine, and dealing a blow to the institution of scientific medicine.

They may not realize they are doing this. I suspect, as if often the case, we are again seeing a true believer promoting pseudoscience while the shruggies pay no real attention. The alternative is worse – that an institution like the Mayo Clinic, who stakes its reputation on clinical excellence, does not fully appreciate the role of science in medicine. Or perhaps they collectively don’t appreciate the philosophical battle that is happening in our profession – a fight over the proper role of science, over the standard of care, and the nature of clinic evidence.

None of these options are good. For an institution like the Mayo Clinic they are devastating.

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Posted by Steven Novella