Alternative medicine encompasses many bizarre treatments, but one of the weirdest must be craniosacral therapy (CST). The assumptions underlying CTS are:
- light manual touch of the head moves the joints of the cranium;
- this movement stimulates the flow of the cerebrospinal fluid;
- the enhanced flow has profound and positive effects on human health.
None of these assumptions are supported by evidence. In fact, they are as implausible as assumptions in alternative medicine get.
CST was developed by the osteopath John Upledger, D.O. in the 1970s, as an offshoot osteopathy in the cranial field, or cranial osteopathy, which was developed in the 1930s by William Garner Sutherland. Apart from this confusing terminology, we are also confronted with a confusing array of therapeutic claims; CST seems to be recommended for most conditions.
And the evidence? As good as none!
This is why any new trial is worth a mention. A recent study tested CST in comparison to sham treatment in chronic non-specific neck pain patients. 54 blinded patients were randomized to either 8 weekly units of CST or light touch sham treatment. Outcomes were assessed before and after treatment (week 8) and a further 3 months later (week 20). The primary outcome was pain intensity on a visual analogue scale; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients’ global impression of improvement and safety.
In comparison to sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 as well as at week 20. Minimal clinically important differences in pain intensity at week 20 were reported by 78% of the CST patients, while 48% even had substantial clinical benefit. Significant differences at week 8 and 20 were also found for pain on movement, functional disability, physical quality of life and patients’ global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8; anxiety only at week 20. No serious adverse events were reported.
The authors from the Department of Internal and Integrative Medicine, University of Duisburg-Essen and the Institute of Integrative Medicine, University of Witten/Herdecke, Germany, concluded that CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and quality of life up to 3 months post intervention.
Oddly, this is not even close to the conclusion I am going to draw: inadequate control for placebo and other non-specific effects generated a false-positive result.
Who is correct?
I suggest we wait for an independent replication to decide.
50 Responses to Craniosacral therapy: wild assumptions, flimsy science and wrong conclusions
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I learned a bowdlerized version of CST and practiced it on and off for 7 or 8 years. I still wince in admitting that the physiological mechanisms most probably don’t exist — I really thought I could detect them, and even verified it several times as well as I could by checking surreptitiously whether my teacher was detecting the same cycle as I was. But I must have picked up other non-verbal signals from him….
Anyway, my suspicion is that this study the researchers may have failed to find a sham treatment that effectively replicated CST.
CST does involve a tremendously sensitive touch, and depending on which specific techniques were used in the study, some very gentle and slow movements. It can be quite deeply relaxing, and as far as I know, (I’m not trained in any form of medicine!) it could well assist with some forms of muscle tension, as well as the obvious niceties of simply lying on a table while a kind caring person touches you in a comforting way.
Finding a sham treatment that would still replicate that kind of touch would be difficult, I suspect. I would want to blind it on several levels — sham practitioners would need to believe they are possibly presenting a genuine treatment; and if the CST practitioners were indeed using subtle manipulative massage techniques that a really a form of massage, the sham practitioners would need to do that too.
And I would want to know in what modalities the sham practitioners were trained in. There would be plenty of chances for shenanigans in the selection process! I can easily imagine how I would set up a study like this to skew the results — allow CST practitioners to use techniques that have some kind of effect regardless of whether or not the theoretical basis of CST is real, and get the sham people to so dome kind of random unsystematic touch that would make the patient feel less than comfortable.
It doesn’t surprise me, even as a skeptic, that patients felt better after receiving CST. But this is no more a confirmation of its theoretical basis, than it would be to say that massage works because of the chi flowing through the partitioner’s hands.
Lacking an untreated control group, I find it remarkable that the study was allowed to be published.
Findings are significant and raise questions for more research. I practice biodynamic CST in a context of Structural integration and and regularly see next to miraculous change in pain, ANS activation, ROM, strength and function in acute and chronic conditions in 1-3 sessions. Light touch to the head and face provides sensory input to the cranial nerves that communicate with the social nervous system-(Porges, polyvagal theory) to activate the parasympathetic nervous system, the “rest and recover” input so necessary for the body’s tensional balancing systems to function effectively. I have a cash based practice and have no lack of clients; I know the system exists in the body and my clients/results demonstrate that. This study BEGS for further investigation–but because of the difficulty of control of practitioner skill/technique it would be very difficult to measure a linear predictable result.
Why do you believe the findings from such a flawed trial are ‘significant’?
And what research (if any) is currently being done into CST?
I’ve re-worded your comment using the qualifiers, so that it clearly distinguishes between fact and assertion.
—
I would argue that the findings are significant and raise questions for more research. I practice biodynamic CST in a context of Structural integration and and regularly perceive what I would loosely describe as next to miraculous change in pain, ANS activation, ROM, strength and function in acute and chronic conditions in 1-3 sessions. Of course this is only my subjective impression, because as we see with this study it is extremely difficult to measure the results and clearly identify cause and effect.
I speculate that light touch to the head and face may provide sensory input to the cranial nerves that possibly communicate with the postulatedsocial nervous system-(Porges, polyvagal theory). >b>Assuming this to be true, it may further be postulated that this might activate the parasympathetic nervous system, the “rest and recover” input so necessary for the body’s postulated “tensional balancing systems“ to function effectively if it in fact exists as postulated.
I have a cash based practice and have no lack of clients, which I realize has nothing to do with any scientific discussion. I believe the system exists in the body and my clients/results at the very least do not contradict this belief.
This study BEGS for further investigation–but because of the difficulty of control of practitioner skill/technique it would be very difficult to measure a linear predictable result and until it can be effectively studied, we can’t know how well, or even *if* it works.
—
How was that?
@Yakura,
Your first problem is re-framing Deborah’s rambling, ill-structured prose into paragraphs and logical form. It now reads as if written by someone who had a logical mindset which Deborah does not display.
The second is thinking she will understand what you’ve written and why. As much as I find a sensible way to express the same thoughts, alas Deborah is of the ilk of jm, Sharma and any number of alt-meds who possess magical thinking. while they are quite happy to use the fruits of scientific research and love their mobile phone, somehow they believe medicine is removed from science and can be practised by opinion.
(All of which you know, of course; my post is rhetorical.)
Yep…. thanks…
I was thinking that maybe instead we should start explaining to alt med people how to present their case. They never realize and are certainly never told during their training that their teachers are using drastically reduced/non-existent standards for evidence. They learn the system and are evaluated entirely on their understanding of the system and simply told that it works. They usually get a solid foundation course in anti-scientific thinking too of course. And they paid good money for it and have built a career on something they’ve been assured works. Even though it “can’t be tested”. Unless the tests show positive results then it suddenly can be tested after all, but only until the positive results are debunked…
(I know you know all that too…!)
Please read this:
http://www.csicop.org/si/show/why_bogus_therapies_seem_to_work/
I agree that the premise behind CST is likely not the mechanism of action
And, 250,000 people died from dr error every year making it the number 3 leading cause of death. 1/3 of all the people who are in the hospital are there because of something that happened IN the hospital. Yet we accept it and spend time trying to debunk methods of people being in deep presence with each other. Now that is a sham we should talk about.
Very best
What’s your point?
You’ve used a Tu Quoque and, possibly, Red Herring using some dodgy figures to illustrate what? That real medicine has some failures?
Did you find the figures on how many deaths were prevented during that period by real medicine, though, I suspect, you aren’t interested so long as someone feels good getting their scalp rubbed. I admit I find it relaxing and pleasant BUT it is not a form of healthcare.
Please come back when you have something sensible to say?
Most sensible people realise that this tiresome meme about so and so many patients “killed by doctors” is simply a red herring, a lie made up by abusing the truth.
Most attribute this meme to a debate article published in JAMA in 2000. There the author was arguing for reform in the famously fallible US health care system. Figures in the article were purely speculative. You often see references to this article when woo-worshipers argue that their mojo is stronger than the medical system’s, like here by the dangerously devious charlatan Joe Mercola
The meme in no way represent the rather complicated truth. For those interested, there is a detailed overview of the subject on Wikipedia under the keyphrase “Medical error”.
Really? Light manual touch can move the bones of my head? Does anyone seriously believe that?
I like to think I am held together a bit more robustly than that; presumably anyone who thinks this therapy is correct would be really frightened of tripping over a rug, for instance, because their brains (if any) would be spilled all over the floor.
The English and the Italian Osteopaths have long argued the point on whether or not the cranial bones move, whether or not the sutures that stitch them together are fused or not. The English physicians have studied anatomy on embalmed cadavers. With such treatment, the sutures became inflexible. The English way of seeing this system of the body had its obvious bias and influence in the US.
The Italian physicians studied anatomy on untreated cadavers. They could see that in fact the sutures have flexibility; they know that minute movements of the cranium occurs.
http://www.iahe.com/images/pdf/2586_001.pdf
BB Karpe said:
What’s the magnitude of these ‘minute’ movements and what (if any) are the clinical implications?
During the part of my life I was active in trauma surgery I opened (drilling and sawing) enough skulls to be able to first hand confirm with certainty that there is no way that CST charlatans can either feel movements of the adult skull or manipulate the bones in relation to each others. The claims based on Sutherland, Upledger and other’s fantasies are not silly, they are plain stupid. The synarthrodial joints are so interlocked that an intact living skull is in principle totally rigid. Any movement would require sensitive instruments to detect.
The force required to cause any manually detectable movement would in effect crush the skull.
https://youtu.be/8YfuR6UI7OU
The big actor in this YT scene is a fellow countryman. (We are not all 7ft tall). It has been calculated that a human, even of his magnitude would not be able to crush a skull with his bare hands as can be deduced from this:
https://youtu.be/KVQQTLZMkFY
BB Karpe, Had you attended further education classes in basic Materials Engineering Science, you wouldn’t have written your asinine comment.
Here is one study that you might find interesting – and it wasn’t too difficult to find either:
http://www.upledger.com/pdf/Influence%20of%20CST%20of%20Anxiety,%20Depression%20&%20QoL%20-%20Fibromyalgia.pdf
Further on research side of things, The Lancet published recently study about cranial movements:
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(15)00226-4/abstract?elsca1=etoc&elsca2=email&elsca3=1474-4422_201512_14_12_&elsca4=Neuropsychiatry%7CInternal%2FFamily+Medicine%7CNeurology%7CLancet
@Carita
I admire your will and effort but I am afraid you have been seriously misled. Neither of these links are interesting in the way you think.
In the first article you referred to (the link to a pdf on Upledger-dot-com) the trial is said to have been a double blind placebo controlled one. If you read the methods section it is absolutely clear it was neither. The authors clearly do not know what they are talking about and have no idea of what placebo is or even how to conduct proper research. Their results and conclusions are totally invalid.
Seeing that they are listed as affiliated with a University, this is really a sad example of incompetent research. I am afraid this is not the only example of totally useless University research. I have some similarly gruesome examples from our National University.
The authors write eminently about the aim of their intervention being
This is pure nonsense. There is no “normal” movement of the cranial bones after the sutures close. There is NO movement possible. And the ultralight touch of CS therapy may promote an excellent relaxation but it can not mechanically intervene in the autonomic system by releasing some imagined bone and membranous restrictions. This is fiction not fact. The whole effect they observe in this attempt at a study comes from the difference in attention and attitude of the person delivering the intervention.
Your second link is to an article that is not about Craniosacral therapy, not even close. Did you actually read it? Or perhaps you do not understand the english? It is about something completely different and irrelevant to CST
This doesn’t seem to be the open-minded forum looking for new answers to old questions that I thought it would be, especially being hosted by such a learned individual in complementary medicine. Never mind.
My apologies to Björn Geir, for upsetting you with wrong library: you can find the fibromyalgia study also in PubMed NCBI, here: http://www.ncbi.nlm.nih.gov/pubmed/19729492
Could you enlighten us what exactly was wrong with the study methods? So that this blog host – or perhaps yourself – could advice the Spanish researchers and thus avoid further mishaps. Especially seeing there’s another study: http://www.ncbi.nlm.nih.gov/pubmed/20702514 and both conclude that craniosacral therapy had been beneficial. Even though it was mere patients’ subjective observations… Who else could possibly assess the level of pain?
I agree that there’s NO cranial bone movement once the sutures close, as in after death. Can you tell us when do the cranial sutures close completely, B.Geir? E.Retzlaff et al seem to have reached 1978 a conclusion that adult human cranial sutures have ‘the presence of viable myelinated and unmyelinated nerve fibers, nerve receptor endings, a potentially functional vascular network, and collagen elastic fiber complexes’. Or perhaps this is another ‘flimsy’ study carried out in unscientific manner?
For the other link previously posted, I apologise, mistake is all mine.
One problem with the second study is that the placebo is markedly different to CST. I assume they simply lay on a table without any physical contact with a practitioner. That is very different to lying on a table and being gently touched by a kind and caring practitioner. In other words, the study fails to distinguish between the relaxing effects of light touch and presence of a carer, and the supposed effects of CST. Given that it measures perception of pain, this is an important failure.
@Carita,
“This doesn’t seem to be the open-minded forum looking for new answers to old questions that I thought it would be,”
That just might be because this is a blog by a professor and doctor of medicine looking at the claims made by alternative “therapies, not a forum aimed at analysing new therapies for efficacy. If you are proposing that CST is a “new” answer, the obvious response is; what is the question? It was invented in the mid-seventies (by an osteopath), so claims of newness are stretching it.
“especially being hosted by such a learned individual in complementary medicine. Never mind.”
Prof. Ernst is a medical doctor and researcher who relies on evidence. Unsurprisingly, he states when there is no evidence or where the research is poor. I cannot see why anyone would complain about this.
In the first study you cite, (http://www.ncbi.nlm.nih.gov/pubmed/19729492) I find the abstract interesting.
_____________________________________________________________________________
Abstract
Fibromyalgia is considered as a combination of physical, psychological and social disabilities. The causes of pathologic mechanism underlying fibromyalgia are unknown, but fibromyalgia may lead to reduced quality of life. The objective of this study was to analyze the repercussions of craniosacral therapy on depression, anxiety and quality of life in fibromyalgia patients with painful symptoms.
_____________________________________________________________________________
Although it acknowledges the cause of fibromyalgia is unknown, it proposes using a “treatment” on the basis of speculation it may do something. Then, the “real” treatment is differentiated from the sham by not turning on the ultrasound machine. I can’t speak for anyone, but I find this unconvincing. Will any next study use a different comparative therapy, such as massage?
Another significant problem for CST is its vitalistic nature, as well non-specific claims about being an universal treatment. This website http://www.normanallan.com/Med/CST.html says this;
“CranioSacral Therapy is comprehensive technique, good for almost anything, but difficult to define. A friend called it “the membrane’s edge” between mind, body and spirit, and that’s where it excels – where mind, body, and spirit meet. Created by osteopath Dr. John Upledger, CranioSacral Therapy is composed of five or six separate pieces, and to explain it we had best describe each piece in turn.”
As always, the onus is one the one making the claims. To date, there is no evidence in support (putting aside the vitalism).
@Carita Myyryläinen
(Thank you for writing under your real name Mrs Myyryläinen. That I appreciate and respect)
You do not seem to have read my comment properly.
I did not write that there was anything wrong with your linking or the site where it led. I only mentioned it to secure you understood which of your two posted references in two separate comments, I was referring to. The link led to the full article, which is fine. No need to try to impress with a PubMed link also. The fact that you can find something in Pubmed or other research database does in no way lend it any credibility. There is as much nonsense in there as there is wisdom, some say even more. Most of it is about alternology.
As has been pointed out by another commenter, the main problem with this so called research (by the Spaniards) is that they compared thought they were doing a blinded placebo controlled trial when they were doing nothing of the sort. They even say so themselves in so many words when they describe their methods. They describe how the “verum” therapy consisted of the ministrations of what they call an “expert CS therapist”
This they compared with something they describe as poking the subject with an ultrasound probe that is not turned on.
How on earth do they imagine that anyone can believe this to be double blind and placebo controlled?! There is no way this article would have passed real peer review.
They are comparing two entirely different procedures as if it were placebo vs. true intervention. As they describe the intervention and placebo, there is no way the “therapist” was blinded to the fact he was giving the true therapy (the “verum”) and there is no way the described placebo sessions could be as comfortable, soothing, relaxing etcetera. Such factors, along with the therapist’s empathy and attention, significantly influence the perception and well being of the subject, especially one with a condition like fibromyalgia, which is extremely stress and anxiety related.
I am sorry to say, but his “research” is a joke. That the same group published another paper with comparable conclusions does not improve its credibility. I admit that I did not find it interesting enough to have a look at the whole article as the abstract describes exactly the same mistakes.
What about your other reference?
Perhaps you did not read the whole of my comment Mrs Myyryläinen, because you mention nothing about your blunder with the other reference, the one to an article in the Lancet about Cranial movement disorders. I hope you understand that by referring to this as support for CST, you made it crystal clear to us that either you only read the title and thought it was about movements in the cranium, or you have no idea how to read scientific papers.
As for “movement” of cranial bones.
I happen to have cut open more craniums than I like to remember, both in infants, children and grown-ups. I have also cut up craniums in a lot of corpses. I can tell you with confidence that there is no way you can manually effect any movement in adult, fused sutures, especially not with the light touch that CST-ists exert. As for the so called “primary respiratory mechanism” that CST is all about, it does not exist. It has never been demonstrated and the “rhythmical movements” or pulsations or whatever the “therapists” think they can feel , it is clearly and simply explained by the ideomotor phenomenon.
I can confidently confirm this as I have sat myself for hours working inside living craniums and I have observed many intracranial pressure tracings. There simply is no (zero, engin, ни одной, ninguno, aucun, ei mikään) movement there other than the obvious one from the normally pulsating circulation.
If this movement of the cerebrospinal fluid and its surroundings existed, it would be easily demonstrated by sensitive equipment such as strain gauges or intracranial pressure sensors. This has been tried and failed. Doctors often measure the pressures inside the cranium and would have long since found this “movement” if it were real.
There is no “primary respiratory mechanism”. How difficult is it to understand that if you cannot confirm something that should be so easily confirmable, then it does not exist?!?!
Please try to understand that this whole idea of CST is confirmed nonsense that originated as a figment of imagination of Sutherland, who made it all up without any research or trials and others (namely Upledger) who later found it to be a good way of obtaining respect and relieving people of their money.
The theoretical basis of CST is almost more absurdly far fetched than homeopathy.
As to the histological findings of Retzlaff et al. in 1978??
Yeah, sure. If you look under a microscope, of course you can find nerves and other histological structures in the cranial sutures. What they found was the elements of living tissue which should be there. The very thin, sturdy tissue layer in between the cranial bones is living tissue, which is supposed to contain these elements. The bones and their fixings are living tissue. It proves nothing about cranial bone movement or the CST theory.
“the disconnected probe (4 cm in diameter) was applied to the cervical area (10 min), lumbar region (10 min) and both sides of the knees (10 min).”
Ah, that explains it — the sham treatment is based on the assumption that the “cranio-sacral system” (with the supposed rhythmical circulation of CSF from sacrum to cranium) is real.
This study is far worse than I thought. (I can only access the abstract.) You can’t study the effects of the therapy on a physiological system, unless the system has been shown to exist, and you know how it functions.
Björn:
““rhythmical movements” or pulsations or whatever the “therapists” think they can feel”
Yes — as a former amateur CST practitioner, I can say that I really thought I could feel it, and really believed I had confirmed this by comparing my perception of “flexion” and “extension” while working together with my teacher on a client. But I eventually had to admit to myself the fact that I could just as clearly feel the “rhythm” on a plastic model of a skull.
First hand experience of biodynamic craniosacral as having caused me deep harm. Practitioner would not take any responsibility. They take responsibility only when the patient thinks they have been helped but deny responsibility when things go wrong. Word needs to get out— it’s no cure all. And has potential to harm. I pray for a day I may recover from this type of treatment.
I’m sorry to hear that and I hope that someday you recover from what went wrong. However, without knowing the details, it will be hard for the CST community to know what went wrong and what we need to do different.
It caused me head trauma and after three years I am still in a downward spiral. The person was no caregiver she could not have cared less. And when I told her I was traumatized by the session she advised me to have some tea and to allow the healing crisis to work.
Carita is this person;
http://www.iahp.com/Carita-Myyrylainen/
who has been doing this stuff in Tanzania, for a while apparently. She certainly has a lot of skin in this scam.
She belongs to “The International Alliance of Healthcare Educators”, of which John E. Upledger, D.O., O.M.M. is a member; however, he died on October 26, 2012. How he remains a member is a mystery to me, but he is the one who invented CST, along with;
SomatoEmotional Release
The Brain Speaks
Upledger Intensive Therapy Programs
CranioSacral – Dolphin Integrative Therapy Programs
CranioSacral – Post Traumatic Stress Disorders (PTSD) Programs
The Alliance has an interesting legat statement, in which it seeks to distance itself from its own advice;
_________________________________________________________________________________________
Legal Statement
In no event will IAHE be liable for damages of any kind, including, without limitation, direct, incidental or consequential damages (including, but not limited to, damages for lost profits, business interruption and loss of programs or information) arising out of the use of or inability to use IAHE’s Web site or its content, or any other information provided on the Web site or in specific products and services offered through the Web site.
While IAHE takes reasonable steps to determine the accuracy and completeness of the content contained on its Web site, IAHE disclaims all warranties as to the accuracy, completeness, adequacy, timeliness and your ability to use such content. You assume sole responsibility for your results using any content from IAHE’s Web site.
________________________________________________________________________________________
They don’t seem to have any confidence in the guidance it willingly dispenses to its flock of True Believers.
It seems to have a sister organisation, The International Association of Healthcare Practitioners, which describes itself in these terms;
A league of worldwide healthcare professionals dedicated to offering innovative therapies and solutions.
Provides a united voice in the field of complementary healthcare – one that would be heard by legislative bodies, insurance regulators, patients, clients and other healthcare providers.
Carita describes CST thus on her webpage;
_______________________________________________________________________________________
CRANIOSACRAL SYSTEM AND THERAPY (CST) Craniosacral system is relatively recently recognized physiological and functional system. It is a semi-closed hydraulic system contained within an elastic membrane (Dura Mater) within the skull and spinal column. An important function of this system is the production, circulation and re-absorption of cerebrospinal fluid which maintains the correct physiological environment in which the central nervous system functions.
CST aims to release any tensions and traumas in the body. Dysfunctions and stresses can be detected by analyzing the delicate rhythm of the system (symmetry, quality, amplitude, rate) in various parts of the body. Using very light manipulation techniques osteal, membraneous and fascial tensions can be removed, thus improving the form and function of the whole. Craniosacral therapy benefits all age groups and is used to treat most conditions (excluding active intracranial bleeding of any kind).
Typically a CST session takes place in a peaceful setting, client remaining fully clothed, relaxing on a bed or massage table. Individual responses vary, but generally include deep relaxation, realignment and balance throughout the body – a true deep tissue release.
Balancing the craniosacral system enhances health and well-being in general by freeing the central nervous system to perform at its best, and is used successfully to relieve pain, illness and dysfunctions in many areas.
________________________________________________________________________________________
What I find particularly amusing is the reference to remaining fully clothed. Björn, do you make any similar claims about patients retaining their clothing during treatment by you, or do you find that gets in the way of your surgical procedures?
Sorry, I can’t control my amusement at the very nature of all this quackery.
Well, to be fair, clients do remove some or all of their clothes for a massage, which some clients feel reluctant about. And it’s not uncommon for other clients to expect or demand “extras”, so practitioners want to discourage that.
Apart from that, yes, Upledger transitioned gracefully from proposing a hypothetical physiological system, to full blown vitalism with extra dolphins thrown in for fun and profit. Pity really, because there a few nice relaxing techniques in CST that I haven’t seen anywhere else in the (admittedly few) massage techniques I learned over the years. Some people don’t know when to quit. (As symbolized by Upledger’s continued presence as a board member!)
@Frank Colllins, yes it’s me. Who are you?
Thank you for your answers and thoughts, and myself (and I dare to talk on behalf of Upledger Institute too) would welcome more research (and of course the kind that meets most rigorous criteria) about craniosacral therapy. And why it works so well (although this forum is not for the efficacy, but underscoring research). Perhaps there is lack of funding? Or difficulty in setting parameters? Can patients be trusted to tell the truth?
Each person naturally has unique style in expressing critique – I prefer constructive style. Would prof Ernst be overwhelmed with results if he asked various practitioners (e.g. as categorised in blog) to provide any research data they can find for re-evaluation? Rather than bask in ‘yet another fault found’ -attitude?
I wonder how widely this blog is read?
May I suggest a small change —
“…And why it *seems to* work so well…”
Until there are decent studies, it is impossible to know whether or not it works. (Obviously, until one can isolate the variable, which one cannot do in a normal session, one can’t know if any changes one perceives are indeed real, or if they are really caused by CST.)
I mentioned on another thread that it would be extremely difficult to develop a sham CST. But it’s also made harder by the fact that the therapy is based on a hypothetical system, which despite what the trainers say, has also never been validated and for which no plausible mechanism for the “healing” of things like fibromyalgia have even been seriously put forward. This makes it very difficult to design experiments, because one doesn’t know what kinds of variables need to be controlled for.
I would suggest that people working in such fields express themselves a little more honestly in this respect. Instead of saying that various illnesses “can be treated with” CST, just say no one knows whether or not it works because it hasn’t been studied yet. You can still say that some sufferers have reported feeling better afterwards. (Or better still, like I used to do when I was giving amateur sessions, just say it can be relaxing.)
@Carita Myyryläinen
“Would prof Ernst be overwhelmed with results if he asked various practitioners … to provide any research data they can find for re-evaluation?”
Do you have even the vaguest clue how research is done?! To evaluate a therapy a clinical trial, like any scientific experiment, needs to be prospective — you have to decide beforehand what methodology will be used, exactly what question you want to answer, what you will use as a control group, how many patients will be required to provide an answer that is statistically dependable. You can’t just ask people who happen to read a blog to “provide any research data they can find”. If people have done research it should have already been submitted for publication in a respectable journal and peer reviewed. Then the publication can be included in a meta-analysis. You don’t just email a few anecdotes or blog comments to someone central and expect them to turn this material into a piece of research.
Small wonder so much “research” in the field of Big Quackery is of barrel-bottom quality, if practitioners think this is how to do it.
She has demonstrated with profound clarity in her comments above, that she has no idea what research is or how it works.
Carita Myyryläinen said:
Perhaps you can tell us about the research that is currently being done and when the results will be published?
Meanwhile, can you say what claims being made for craniosacral therapy are currently substantiated by good evidence?
@Alan Henness
The best way to get accurate information is to contact Upledger Institute in Florida, US. You can find all contact details easily enough.
they are bound to be very impartial!
Carita Myyryläinen said:
Like Prof Ernst, I doubt that very much.
@Carita,
“@Frank Colllins, yes it’s me. Who are you?”
Someone who uses their real name, and is curious about why you are so supportive of scalp massage? I always find it interesting to find the reason why supporters of alt-med are so. In many cases, such as yours, they are practitioners of the brand of witchcraft being scrutinised by the good prof. Having said that, I enjoy a scalp massage, however, I know it won’t cure any real or imagined illnesses.
You are fortunate, in one respect, in that you don’t offer anything apart from comfort to the worried-well; I have discounted the spurious claims about fibromyalgia because they are ridiculous. Another fortunate aspect, for you, is the worried-well are willing to pay for a scalp massage dressed up as a medical-type therapy, without realising it does nothing other than make your scalp feel good. If CST was to claim efficacy for anything serious, such as a cancer, it would pass from charlatanism too deadly fraud.
While on the subject of cancer, suppose you developed. say, ovarian cancer? Would you want the chemo or radiation therapies to have been rigorously tested, or would it be enough for a couple of non-doctors to have a natter over a cup of coffee about the anecdotal outcomes of a couple of treatments they had administered? These treatments would, of course, not be documented properly (as in the case of alt-med), and no follow up to determine whether the recipients were still alive?
“Can patients be trusted to tell the truth?”
Only an alt-med would consider this a reasonable question. The answer is an emphatic no. James Randi’s examples of the ideomotor effect in water-divining show how easily and quickly perception can be altered, without any realisation by the person. It happens in medicine and most human activities. Studies are placebo-controlled for a very good reason. One of the most pervasive traits of humans is delusion.
“Rather than bask in ‘yet another fault found’ -attitude?”
It is called critical analysis, another foreign concept to the alt-med type.
“I wonder how widely this blog is read?”
Widely enough for you to find it and post.
This attitude of Medics in this dialog is alarming, but at least you are open about your attitude so that people who take responsibilty for their own health can be aware to avoid you.
I’m a grateful patient of CST whose recovery form Neurological and Cardiological issues was so impacted by CST as to gain my neurologist’s interest, among others. I later became a practitioner and have worked with physicians who do respect the results of CST.
Just the term “alt-med” is one of the blocks that only obstructs the collaborative inclusion of scientific and natural medicine, or “complimentary” medicine. I quote one of the Royal Family’s physicians as saying “it’s all Medicine … Medicine is beautiful … although one might need to stay away from some doctors”.
Thank Goodness for CST and thank goodness not all medical doctors have such a closed and limited attitude – not to mention lack of respect – are like those who have flaunted their lack of experience here.
@Carlotta
I’m not a medic myself, but I find your post alarming. It embodies a blinkered approach to evidence and, apparently, a belief that if ‘results’ occurred after CST then they must be due to CST — an attitude that has confused and confounded human thought for millennia.
You raise the quote “it’s all medicine”, which neatly blurs and confuses the borders between science and nonsense. The more usual response to proponents of alternative and complementary (note the correct spelling, by the way) medicine is “You know what they call complementary and alternative medicine that works? Medicine!” If you’re going to blindly include every half-witted, pseudoscientific approach that calls itself a therapy within the boundaries of medicine then there’s no end to the damage you can do to peoples’ health.
I’m sure the underlying raison d’être for Edzard Ernst’s blog is the same as that underpinning consumer protection efforts: to provide a reality check against the claims of unreasonably enthusiastic or unscrupulous individuals who purvey, for whatever intention, things that do not match up to their hype.
@Carlotta
Would you care to speculate on why pseudo scientific and unevidenced nonsense such as CST is called ‘altmed’?
What you are failing to do is accurately record your results. You ascribe improvements to CST without controlling for other variables. It’s fine to make personal decisions without regard for the distinction between observation and inference, but it’s irresponsible to present it to others without acknowledging this.
As I noted above on this thread, alt med people would avoid a lot of trouble and avoid doing a lot of damage if they learned to record their results systematically and honestly. And if they they genuinely had a new and valuable treatment, proper recording methods would allow them to make a real contribution to science and human well being. Instead, any alt med treatment that perhaps really does work, is being kept unusable by practitioners who don’t bother to keep systematic records or do any systematic research.
“inadequate control for placebo”. I will publicly ask you the same question. What would be an adequate control?
there are several possibilities. for instance, one could train people who know nothing about CST to administer the ritual only.
Hummm….
So you would not worry about the confounding effects that arise from difference in training (learn a ritual vs much longer advanced training), and years of experience (nothing at all vs many years) in the way patients might perceive the treatment and thus respond differently? I would think this sham treatment would exacerbate the differences between treatment and control for that reason…. I would think this would be more likely to generate a false positive…..
perhaps, but I don’t think so [if well done]
anyway: suggest something that minimises bias more effectively.
If well done, I really do not see a problem with using trained therapists to administer the sham treatment as they would at least eliminate the issue of training and experience differences in the sham. I actually think that is better because if their training seeps through in the sham treatment, you more likely will end up with a false negative result which is better than a false positive result.
Many suggestions to minimize bias have been suggested and none have held up to critics like yourself, so I think it is nothing more than fair to ask the critics what they would consider a good sham treatment…
AND I DID!
You did, and on examination of the merritts, that method would most likely result in more false positives then the sham you criticized. There is a reason medicine studies use randomized DOUBLE-BLIND designs, because they figured out very quickly that the doctor administer the fake pill would give unintended cues to the patients that they would get the placebo or real treatment.
With that in mind, what would be needed is to develop a complete false treatment protocol and train people in it as if it was real and have them get sufficiently experience with it before recruiting those therapists into a research study. The problem is that many would not finish the training and their clients would not be amused due to the lack of results. And that would mean deceiving many clients during the experience-gaining phase with a treatment protocol that was designed to be ineffective. I would find that unethical.
Based on that, I think the sham treatment in this study is probably one of the best options to actually minimize the number of false positives.
good for you!