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Tuesday, July 27, 2010

Woo reconsidered!?

Today, a very interesting paper was revealed to me, by the magic and mystery that is Google Reader.

Now, as some of you may know, I am currently researching placebo. As part of this, I've read a lot about alternative medicine and interviewed some of the practitioners. This has all been very interesting, but until quite recently, i wasn't aware of any high quality studies which suggested that there are measurable effects (apart from placebo). It appears that this may be changing. Lutgendoprf et al, writing in Brain, Behavior and Immunity suggest that Healing Touch may contribute to improved immune function in women with cervical cancer.

I read this paper quite closely, so here's the deal.
It was a randomised controlled trial, which had three groups.
The first group was the Healing Touch group, the second was a relaxation group, and the third was usual care. The study was not blind, given that its difficult to conceal treatment allocations to psychosocial interventions. This may (or may not) be a fatal flaw to your way of thinking.

Now, there were a number of outcomes and covariates. They were looking at immune function, depression, anxiety, you know, all the good stuff. The major finding of the study was that the patients in the Healing Touch group maintained NK cell activity throughout the course of chemotherapy, while the other two groups showed declines. Pretty crazy eh? Maybe faith healing does work after all....

Its interesting that the authors actually considered the biofield hypothesis, albeit seeming to prefer others.

Now, I have a few caveats about the study, coming from my perspective as a placebo researcher.

1) The HT was given by nurses, while the relaxation technique was facilitated by graduate students. Its quite possible that the patients may have attributed more credibility to the nurses than too the grad students (a pain I know all too well....).
2) The second issue is that the nurses were licensed practitioners of HT, and as such may have been far more enthusiastic about the treatment, which can definitely exert influences on healing.
3) The authors note that they measured expectancies at baseline and after treatment, and that these did not contribute to outcomes. This is very weird, given that there is a lot of literature that suggests that perceived reality of treatment may be an important predictor of outcome, for acupuncture at least (Bausell et al 2005; Linde et al 2007)
4) The impact of touch - there was no touch in the relaxation group while there was in the Healing Touch group (obvious, but still important). It seems plausible (warning, speculation ahead) that the touch of others can contribute significantly to a placebo response). For my money, I would have preferred a real HT group given by professionals, versus a HT group given by naive patients who are taught the movements, but not the energy manipulations regarded as important by practitioners. Alternatively, use practitioners with different levels of training, to examine if there is a HT effect rather than a placebo/expectancy effect.

All of that being said, its an extremely interesting study, which builds on a recent meta-analysis of MBSR in cancer which suggests that psychosocial factors may have large impacts on the physical (d=.2) and psychological (d=1) measures of well-being. Interesting stuff.

Funnily enough, there was a Yale professor, Harold Saxton Burr, who claimed that electromagnetic fields were a prime mover in health and disease. He was mostly ignored, as were his students. I find it quite sad that such an obvious explanation for biofields (if they do exist) is ignored, given the potential for rewards from this kind of research. Then again, I'm not a biologist or physicist, so I might be horribly confused here. It does, however, remind me of the case of Wilheim Reich, a student of Freuds who claimed to have discovered a universal energy. I suppose at least Burr wasn't thrown into prison, which is progress (of a sort).

I do also note, however, a recent paper in Medical Hypotheses (i know, I know...) by Irmak where he argues that Merkel cells are specially adapted for electromagnetic perception and he hypothesised that these are responsible for the effects of Reiki and other healing touch modalties. Its all very strange, but it makes you think (or at least it makes me think).

That being said, I love a controversial theory, so your mileage may vary.

Coming up next: theories about the placebo (unless I get distracted again)

Susan K. Lutgendorfa, b, c, d, Corresponding Author Contact Information, E-mail The Corresponding Author, Elizabeth Mullen-Housera, Daniel Russelle, Koen DeGeestb, Geraldine Jacobsonf, Laura Hartg, David Benderb, Barrie Andersonb, Thomas E. Buekersb, Mich (2010). Preservation of immune function in cervical cancer patients during chemoradiation using a novel integrative approach Brain, Behavior and Immunity : doi:10.1016/j.bbi.2010.06.014

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