Consider these statements:

…there is an evidence base for biofield therapies. (citing the Cochrane Review of Touch Therapies)

The larger issue is what constitutes “pseudoscience” and what information is worthy of dissemination to the public. Should the data from our well conducted, rigorous, randomized controlled trial [of ‘biofield healing’] be dismissed because the mechanisms are unknown or because some scientists do not believe in the specific therapy?…Premature rejection of findings from rigorous randomized controlled trials are as big a threat to science as the continuation of falsehoods based on belief. Thus, as clinicians and scientists, our highest duty to patients should be to investigate promising solutions with high benefit/risk ratios, not to act as gatekeepers of information based on personal opinion.

–Jain et al, quoted here

Touch therapies may have a modest effect in pain relief. More studies on HT and Reiki in relieving pain are needed. More studies including children are also required to evaluate the effect of touch on children.

Touch Therapies are so-called as it is believed that the practitioners have touched the clients’ energy field.

It is believed this effect occurs by exerting energy to restore, energize, and balance the energy field disturbances using hands-on or hands-off techniques (Eden 1993). The underlying concept is that sickness and disease arise from imbalances in the vital energy field. However, the existence of the energy field of the human body has not been proven scientifically and thus the effect of such therapies, which are believed to exert an effect on one’s energy field, is controversial and lies in doubt.

—Cochrane Review of Touch Therapies, quoted here


Science is advanced by an open mind that seeks knowledge, while acknowledging its current limits. Science does not make assertions about what cannot be true, simply because evidence that it is true has not yet been generated. Science does not mistake absence of evidence for evidence of absence. Science itself is fluid.

—David Katz

When people became interested in alternative medicines, they asked me to help out at Harvard Medical School. I realized that in order to survive there, one had to become a scientist. So I became a scientist.

—Ted Kaptchuk, quoted here.

 …It seems that the decision concerning acceptance of evidence (either in medicine or religion) ultimately reflects the beliefs of the person that exist before all arguments and observation.

 —Ted Kaptchuk, quoted here.

Together they betray a misunderstanding of science that is common not only to “CAM” apologists, but to many academic medical researchers. Let me explain.

Science: You keep using that word. I do not think it means what you think it means.

In common use the word “science” has several meanings, which may or may not be clear in context. Two that readily come to mind are 1) the growing body of knowledge about nature, accumulated over the several hundred years during which a distinctive, rational method of inquiry, or at least parts of it, have been employed; 2) that method of inquiry, also known as the “scientific method,” characterized by the collective tools of science—observation, generation of hypotheses, controlled and repeated testing of hypotheses, the use of mathematics for generating hypotheses, for aiding in complex measurements, for statistical inference, and so on.

The most important misunderstanding about science that we see in the quotations above is a conflation of the two meanings, or in some cases a complete disregard for the first. Thus, because some clinical trials have suggested “a modest effect on pain relief” for (non)Touch Therapies, there must be “an evidence base for biofield therapies,” and to argue otherwise is “as big a threat to science as the continuation of falsehoods based on belief.” Moreover, since “absence of evidence” is not the same as “evidence of absence,” and since “science does not make assertions about what cannot be true,” the responsible scientist must judge the “energy field of the human body” to be a real possibility, even if it “has not (yet) been proven scientifically.”

Such notions are nonsense: of course science makes assertions about what cannot be true. Nor will clinical research ever overturn those assertions, which are based on far more rigorous and voluminous experimental data than can be generated in the messy, incorrigible realm of clinical trials. It is the first meaning of science, as defined above, that is the more pertinent for “CAM” research. The second meaning is barely applicable, for reasons that I’ve discussed previously and that I may revisit here, if I have the time.

“What have we been doing for the past 300 years?”

The late physicist, Milton Rothman, wrote three small books that are useful for a discussion such as this. One of those books, A Physicist’s Guide to Skepticism, has an entire section titled “Laws of Permission and Laws of Denial.” The chapter on “Laws of Denial” begins as follows:

It is fashionable in some circles to insist that “nothing is impossible,” as though to admit the impossibility of some cherished goal is to “give up trying,” to have a closed mind, to be a spoilsport, a pessimist. This cliché is most prevalent in inspirational rhetoric connected with therapeutic, educational, or sporting activities. Nevertheless, one of the basic functions of science is to determine what actions are impossible in this real world. Choosing between the possible and the impossible is a task carried out by means of the laws of denial, which tie us firmly to reality even as imaginations soar unfettered through the universe.

Another fashionable cliché is that “all scientific theories are provisional,” as though physics knows nothing with a certainty, and that anything we think we know is likely to be found false in the future…If all scientific knowledge is tentative, what have we been doing for the past 300 years? How can I be so sure that the computer upon which I am typing will print out the words that I am putting into it?

A more accurate assessment of the situation is to recognize that one of the fundamental tasks of science is to critically examine all knowledge and to separate from the tentative ideas and false notions of the past facts that are so well established that to think them subject to change is to invite wishful thinking and foolishness.

Laws of denial, as explained by Rothman, are the laws of conservation of energy, momentum, angular momentum, and of electric charge; the principle of Lorentz invariance, “from which the conclusions of special relativity follow: no object, energy or information can travel faster than the speed of light”; the principle of causality, by which it is “impossible for an effect to appear earlier in time than its cause”; and the first and second laws of thermodynamics. There are other statements that can be made with a degree of certainty much higher than is necessary to preclude their being overturned by clinical research, even if they are less certain than the laws of denial. For example, since all known interactions can be explained by the 4 forces of the standard model, and since only two of those forces—gravity and electromagnetic force—explain all actions other than those at the subatomic level, there is no reason to invoke fanciful forces (the vital force, ‘biofields’) that have never been detected and that add nothing to our understanding of natural phenomena.

Rothman distinguishes between “ideological skepticism” and “pragmatic skepticism”:

Ideological skepticism is disbelief based on deep-seated psychological factors…It includes disbelief in conservation of energy and other laws of denial because you can’t stand authority figures telling you what you cannot do. [It] encourages you to think that we can’t know anything for a certainty, and that, as a result, anything is possible.

Pragmatic skepticism is disbelief in phenomena that contradict laws of nature that have been thoroughly verified by experiment and observation. It is based on a well-founded understanding of those natural laws, and of their uses and limitations.

It should be clear that pragmatic skepticism—the kind that makes real scientists and SBM authors skeptical of “biofields,” homeopathy, psychokinesis, and all the rest—is based on neither “personal opinion” nor “the beliefs of the person that exist before all arguments and observation.”

Rothman asks, “how do the laws of physics give us the power to make any statements about biology or psychology, about evolution or human behavior?”

The answer lies in the laws of denial. While we are unable to make good predictions about what things will do using the laws of permission, we can make very precise predictions about what they cannot do.

Rothman then offers a few negative predictions of his own, with explanations based on the laws of denial. In summary:

  1. I will never be able to jump as high as the moon, at least not without mechanical aid.
  2. I will never suddenly burst into flames.
  3. I will never suddenly levitate and rise up off the floor, no matter how hard I will it…
  4. No one will ever build a flying vehicle that is capable of hovering high in the air while supported by nothing but magnetic fields.
  5. No one will build an antigravity machine…
  6. No one will ever build a time-travel machine.
  7. No one will ever make a killing on the stock market by foreseeing the future.
  8. Nobody will ever send a message through space that does not diminish in intensity as it travels away from the sender.
  9. No one will ever send or receive any kind of message that travels faster than the speed of light.
  10. No one will ever influence the position or motion of any kind of physical object from a distance just by thinking about it.
  11. No one will ever demonstrate that astrology really works.

Number 10, a reference to psychokinesis, pertains to a large category of “CAM” claims, including ‘biofields,’ Therapeutic Touch, and ‘distant healing.’

When you think of science, please think of it first as a way—the only accurate way that we have—to understand nature. If, instead, you think first of P-values or confidence intervals or randomization or blinding or allocation concealment, you’re misled. Some of those may be important tools for some kinds of research, but they do not constitute science any more than rulers or scales or graph paper or chromatography constitute science, and those whose expertise is limited to such tools may be smart and useful for some scientific pursuits, but they are not scientists.

“A Subtle Change in the Balance of Medical Authority”

Nearly 4 years ago we saw these quotations from a real biomedical scientist, Steven Goodman, who also happened to have learned Bayesian inference:

An important problem exists in the interpretation of modern medical research data: Biological understanding and previous research play little formal role in the interpretation of quantitative results. This phenomenon is manifest in the discussion sections of research articles and ultimately can affect the reliability of conclusions. The standard statistical approach has created this situation by promoting the illusion that conclusions can be produced with certain “error rates,” without consideration of information from outside the experiment. This statistical approach, the key components of which are P values and hypothesis tests, is widely perceived as a mathematically coherent approach to inference. There is little appreciation in the medical community that the methodology is an amalgam of incompatible elements, whose utility for scientific inference has been the subject of intense debate among statisticians for almost 70 years…

This method thus facilitated a subtle change in the balance of medical authority from those with knowledge of the biological basis of medicine toward those with knowledge of quantitative methods, or toward the quantitative results alone, as though the numbers somehow spoke for themselves.

That appears to explain why “More studies on HT and Reiki in relieving pain are needed,” and why they will continue to be ‘needed,’ ad nauseam. And now, thanks to commenter phayes, I’ll go back to my new, favorite treatise on how to use probability theory to make sense of incomplete information. Hint: it isn’t what the frequentists who now claim “medical authority” use.

The Prior Probability, Bayesian vs. Frequentist Inference, and EBM Series:

1. Homeopathy and Evidence-Based Medicine: Back to the Future Part V

2. Prior Probability: The Dirty Little Secret of “Evidence-Based Alternative Medicine”

3. Prior Probability: the Dirty Little Secret of “Evidence-Based Alternative Medicine”—Continued

4. Prior Probability: the Dirty Little Secret of “Evidence-Based Alternative Medicine”—Continued Again

5. Yes, Jacqueline: EBM ought to be Synonymous with SBM

6. The 2nd Yale Research Symposium on Complementary and Integrative Medicine. Part II

7. H. Pylori, Plausibility, and Greek Tragedy: the Quirky Case of Dr. John Lykoudis

8. Evidence-Based Medicine, Human Studies Ethics, and the ‘Gonzalez Regimen’: a Disappointing Editorial in the Journal of Clinical Oncology Part 1

9. Evidence-Based Medicine, Human Studies Ethics, and the ‘Gonzalez Regimen’: a Disappointing Editorial in the Journal of Clinical Oncology Part 2

10. Of SBM and EBM Redux. Part I: Does EBM Undervalue Basic Science and Overvalue RCTs?

11. Of SBM and EBM Redux. Part II: Is it a Good Idea to test Highly Implausible Health Claims?

12. Of SBM and EBM Redux. Part III: Parapsychology is the Role Model for “CAM” Research

13. Of SBM and EBM Redux. Part IV: More Cochrane and a little Bayes

14. Of SBM and EBM Redux. Part IV, Continued: More Cochrane and a little Bayes

15. Cochrane is Starting to ‘Get’ SBM!

16. What is Science? 



Posted by Kimball Atwood