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I subscribed to The Atlantic for many years, having been introduced to through my mother’s subscription while I was in high school and college and then subscribing to it myself after I had moved away from southeast Michigan. That all stopped in 2009 when I noticed that the magazine had taken a distinctive turn away from medical evidence in the form of articles spreading misinformation about the H1N1 pandemic, promoting the “integration” of quackery, mysticism, and pseudoscience into medicine, revisionist history of the “evolution” of “integrative medicine,” and even apologetics for chelation therapy. I guess that’s not enough pseudoscience for The Atlantic, though, because over the weekend I became aware that apparently the editors of the magazine are all in for reiki, as demonstrated by a recently published article by Jordan Kisner:

What a title!

I hadn’t heard of Jordan Kisner before; so I did a bit of Googling. She’s a writer who’s published in several major magazines. She’s written a book called Thin Places: Essays from In Between, titled after an essay she had written about an experimental neurosurgery developed to treat severe obsessive-compulsive disorder. Her article has been noticed, and she’s aware of the pushback:

To be honest, I really didn’t think that The Atlantic could go much lower in terms of promoting quackery, but, damn, did they prove me wrong! Reiki? Seriously? If there are two quackeries battling it out for the title of The One Quackery To Rule Them All, based on their sheer ridiculousness and disconnect from reality, homeopathy is obviously a contender, but so is reiki. Reiki is based on the belief that a reiki master is able to channel “healing energy” from something called the “universal source” into another person, with therapeutic effect. Of course, as we’ve discussed more times than I can possibly remember over the years, no one has ever detected or demonstrated the existence of this “life force” or energy (or a “universal source,” for that matter), much less anyone’s ability to control or channel it. Basically, reiki is faith healing that substitutes a different mystical belief system for Christianity. Replace the word “God” or “Jesus” with “universal source”, and there really is no conceptual difference in what is happening. It’s the laying on of hands, pure and simple.

Ms. Kisner starts with the rightful skepticism that many express regarding reiki:

“When I started it, they all just called it that crap. Like, ‘Oh, they’re over there doing that crap.’ ” This nurse, whom I’ll call Jamie, was on the line from a Veterans Affairs medical center in the Northeast. She’d been struggling for a few minutes between the impulse to tout the program she’d piloted, which offers Reiki to vets as part of their medical care, and the impulse to “tread lightly,” because some of the doctors, nurses, and administrators she works with still think that Reiki is quackery or—you know.

Reiki, a healing practice codified in the early 20th century in Japan, was until recently an unexpected offering for a VA medical center. In Japanese, rei roughly translates to “spiritual”; ki is commonly translated as “vital energy.” A session often looks more like mysticism than medicine: Healers silently place their hands on or over a person’s body to evoke a “universal life force.” A Reiki treatment can even, practitioners believe, be conducted from miles away.

Yes, reiki masters do claim to be able to heal over distances, in which case reiki resembles intercessory prayer more than anything else. Of course, there’s no evidence that they can, in fact, do anything of the sort.

I nearly coughed up the coffee I was drinking as I wrote this when I read the next paragraph:

Reiki’s growing popularity in the U.S.—and its acceptance at some of the most respected American hospitals—has placed it at the nexus of large, uneasy shifts in American attitudes toward our own health care. Various non-Western practices have become popular complements to conventional medicine in the past few decades, chief among them yoga, meditation, and acupuncture, all of which have been the subject of rigorous scientific studies that have established and explained their effectiveness. Reiki is the latest entrant into the suite of common additional treatments. Its presence is particularly vexing to naysayers because Reiki delivers demonstrable salutary effects without a proven cause.

Take that, skeptics! How does your science explain that? Well, let’s see what I’m supposed to be explaining:

Over the past two decades, a number of studies have shown that Reiki treatments help diminish the negative side effects of chemotherapy, improve surgical outcomes, regulate the autonomic nervous system, and dramatically alter people’s experience of physical and emotional pain associated with illness. But no conclusive, peer-reviewed study has explained its mechanisms, much less confirmed the existence of a healing energy that passes between bodies on command. Nevertheless, Reiki treatment, training, and education are now available at many esteemed hospitals in the United States, including Memorial Sloan Kettering, Cleveland Clinic, New York Presbyterian, the Yale Cancer Center, the Mayo Clinic, and Brigham and Women’s Hospital.

Yes, it is true that, unfortunately, reiki has infiltrated quite a few respectable hospitals. Heck, I’ve been bemoaning this development a long time, ever since I first discovered the ridiculous reiki pamphlet published by the Cleveland Clinic that touts reiki as “hands-on natural healing using the universal life force energy…which means vital life force energy that flows through all living things. Reiki, an abundant, gentle spiritual energy is not tied to any specific religion or nationality.”

What about the studies that Ms. Kisner linked to? The first one is utterly worthless. It’s not randomized. There’s no control group. It’s not blinded. It’s just a single arm study in which subjects underwent reiki sessions and filled out an online questionnaire immediately before and after. There is nothing in the positive results reported in this study that couldn’t be easily explained by a combination of placebo effects and relaxation from lying on a table for an hour while someone pays attention to you.

The second study is only slightly better. It’s basically a randomized trial of reiki versus classical music versus nothing in patients recovering from acute coronary syndrome (heart attack). It’s unblinded as well, and there’s no result reported there that couldn’t be explained by a combination of human contact, placebo effects, and relaxation. It’s also a ten-year-old study, and a pilot study at that. I was unable to find a follow-up. This is really, really thin gruel to be basing such expansive claims for the effectiveness of reiki on.

So what else does Ms. Kisner have? Anecdotes, of course:

When Jamie introduced Reiki at the VA center 10 years ago, she overrode the objections of some colleagues who thought it was pseudoscience and out of step with the general culture of the VA, where people are inclined to be suspicious of anything that might be described as “woo woo.” But she insisted that the VA—which also offers yoga, acupuncture, massage, clinical hypnosis, and tai chi—should explore any supplementary treatment for chronic pain and PTSD that doesn’t involve pharmaceuticals, especially narcotics. The veterans started coming, slowly, and the ones who came started coming back. Jamie didn’t promise anything other than that it might help them feel calm or help them with pain. The Reiki practitioner she hired was a local woman, somewhat hard-nosed, not inclined to offer anyone crystals. Soon after the program began, Jamie was getting calls from doctors and nurses: “Hey, is the lady here? Someone wants that crap.”

The effects were startling, Jamie told me. Veterans who complained that their body had “forgotten how to sleep” came in for Reiki and were asleep on the table within minutes. Others reported that their pain declined from a 4 to a 2, or that they felt more peaceful. One patient, a man with a personality disorder who suffers from cancer and severe pain, tended to stop his normal routine of screaming and yelling at the staff when he came in for his Reiki sessions.

Has she ever done any sort of rigorous studies to try to determine if reiki, in fact, does what she claims it does? Reiki research is, of course, plagued with the same sorts of methodological flaws that so much research into “alternative” medicine is plagued with. It’s uncommon to find a serious attempt at blinding, for instance, even single blinding the patients, and most studies have sample sizes that are way too small to make much in the way of conclusions. Then there is the issue of prior plausibility. Again, there is no evidence that there is any mystical magical energy field that another human being can impact by channeling mystical magical energy from a mystical magical universal source. If you’re going to convince me that reiki is worth investigating, there has to be concrete evidence that its effects go beyond that of just placebo, regression to the mean, and confirmation bias.

Later in the article, Ms. Kisner describes her experiences after she decided to train to be able perform reiki. She signed up to be able to learn to do hands-on practice and distance healing. (Master training is the next level up, where one can teach others reiki.) There were actually some unintentionally hilarious bits in this section of the article, in which Ms. Kisner described some of what she was taught, and this question and answer session with the reiki masters teaching the course:

You can do Reiki on animals, they told us. “Cats are extra attuned to Reiki—cats almost do Reiki on their own. They can heal you.” No one questioned this. The same goes for plants, the masters suggested. Get two roses and give Reiki to one; that rose will live longer. A student raised her hand. “But you told us never to give Reiki without consent. How can you get consent from a flower or a tree?”

“You can talk to a tree!” one of the masters said. “You should always ask the tree’s permission. Maybe it will tell you to Reiki the next tree.” I glanced around the room for raised eyebrows, but there were only more eager questions: Can you Reiki someone who has transitioned to the afterlife? Yes. Can you Reiki your food to make it healing? Yes, and you should.

We were told that once the masters attuned us, our bodies and spirits would vibrate at a higher frequency than before, and we would stay on that higher frequency for the rest of our life. This would constitute a permanent transition in our physical and spiritual states. I was silently indignant: I do not believe in permanently alterable personal vibrations, whatever that means, and anyway I wanted mine left alone.

And yet she went through with the class anyway.

Still, based on this sort of question and answer session, it’s hard to conclude that reiki is anything but magic. You can aim it at anything you want and magically make it better, more “healthy”. Cats, being creatures long associated with witchcraft, are naturally more receptive to reiki and even able to do it. One wonders, though. If reiki is magic, can it be used for evil? Just as there is black magic, is there black reiki? Inquiring minds want to know!

As for the “attunement” that the masters did at the end of the course to grant their trainees the “power” to do reiki, it sure sounds a lot like a religious initiation ceremony than anything else:

And then, the moment for attunement having arrived, we were led in small groups to a narrow, darkened room. Before we passed through the doorway, one of the masters traced Reiki symbols in the air over each of us. “You guys,” said the other, making what I hoped was a joke, “we’re going to visit some other planets.” I can’t describe what happened next, because our eyes were closed while the masters performed silent rituals that aren’t explained to nonmasters.

I will give Ms. Kisner credit for one thing. In her paragraph of token skepticism, she quotes Steve Novella and me:

Many physicians and scientists still believe that allowing Reiki to share space with medicine is at best silly and at worst dangerous. In 2014, David Gorski, a surgical oncologist, and Steven Novella, a neurologist, co-wrote an article calling for an end to clinical trials of Reiki and other forms of energy medicine. To assess approaches rooted in “prescientific thinking” with tools designed to evaluate “well-supported science- and evidence-based” treatments, they argued, degrades “the scientific basis of medicine.” It saps resources from research into valid therapies, and misleads patients.

Well, yes. Nothing’s happened in the nearly six years since we published that article to make me change my mind. Ms. Kisner’s response:

Other doctors and researchers have accepted the line of argument that Miles and many other Reiki advocates have put forward: The practice has no known negative side effects, and has been shown by various studies that pass evidentiary muster to help patients in a variety of ways when used as a complementary practice. Unlike the many FDA-approved medications that barely beat a placebo in studies and carry negative side effects, Reiki is cheap and safe to implement. Does its exact mechanism need to be understood for it to be accepted as a useful therapeutic option? For decades, experts weren’t precisely sure how acetaminophen (Tylenol) eases pain, but Americans still took billions of doses every year. Many medical treatments are adopted for their efficacy long before their mechanisms are known or understood. Why should this be different?

This is a common trope invoked by supporters of quackery; so I’ll tell her why it’s different. We might not have known the biochemical and physiological mechanism of aspirin and acetaminophen, but, unlike the case for reiki, we had strong evidence that they actually did relieve pain and, in the case of aspirin, inflammation. Furthermore, we knew that, however they worked, the mechanism did not involve invoking mystical magical energy fields and a physical mechanism that violates the laws of physics and chemistry.

In fact, some reiki advocates, like Pamela Miles, seem to understand this very objection:

Miles falls on the conservative end of Reiki evangelists in that she’s careful not to make claims about its mechanisms or efficacy that can’t be supported in a scientific context. She does not, for example, subscribe to the belief that Reiki energy is a substance that can be given, received, or measured. No evidence of this has been confirmed, she pointed out. “Reiki is a spiritual practice,” she said. “That’s what it was to the founder, Mikao Usui. And all spiritual practices have healing by-products because spiritual practice restores balance, bringing us back to our center, and enhancing our awareness of our core selves.” When I asked her to explain what that meant practically, she chose her words carefully. “Through an unknown mechanism, when a Reiki practitioner places their hands—mindfully and with detachment—it evokes the healing response from deep within the system,” she said. “We really don’t know why this happens.”

Of course, this is still faith healing, laying on hands. The difference is that it invokes mystery: We don’t know. Also, there’s no evidence that reiki “evokes a healing response from deep within the system.” There’s no convincing evidence of any specific effect from reiki that can’t be explained by a combination of placebo effects, regression to the mean, confirmation bias, and perhaps relaxation.

Still, this brings me to how I would handle reiki. Personally, I view reiki as more of a religious practice. It is not medicine; so it should not be treated as medicine. Don’t “integrate” reiki into medicine, because, again, it is not medicine. Don’t make any health claims for reiki Instead, treat reiki masters like chaplains and their visits to patients the same way health care facilities treat visits by priests, ministers, rabbis, and imams.

As for The Atlantic, stop publishing utterly credulous paeans to quackery like this article.

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Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.