MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

I have recently gone to the trouble of evaluating 150 different modalities from the realm of so-called alternative medicine (SCAM) in a book. This is what it tells you about Reiki:

Reiki is a form of paranormal or energy healing popularised by Japanese Mikao Usui (1865-1926). Rei means universal spirit (sometimes thought of as a supreme being) and ki is the assumed universal life energy.

    1. Reiki is based on the assumptions of Traditional Chinese Medicine and the existence of ‘chi’, the life-force that determines our health.
    2. Reiki practitioners believe that, with their hands-on healing method, they can transfer ‘healing energy’ to a patient which, in turn, stimulates the self-healing properties of the body. They assume that the therapeutic effects of this technique are obtained from a ‘universal life energy’ that provides strength, harmony, and balance to the body and mind.
    3. There is no scientific basis for such notions, and reiki is therefore not plausible.
    4. Reiki is used for a number of conditions, including the relief of stress, tension and pain.
    5. There have been several clinical trials testing the effectiveness of reiki. Unfortunately, their methodological quality is usually poor.
    6. A systematic review summarising this evidence concluded that the evidence is insufficient to suggest that reiki is an effective treatment for any condition. Therefore, the value of reiki remains unproven.[1] And a Cochrane review found that there is insufficient evidence to say whether or not Reiki is useful for people over 16 years of age with anxiety or depression or both.[2]
    7. Reiki appears to be generally safe, and serious adverse effects have not been reported. Some practitioners advise caution about using reiki in people with psychiatric illnesses because of the risk of bringing out underlying psychopathology.

PLAUSIBILITY

Negative

EFFICACY

Negative

SAFETY

Positive

COST

Positive

RISK/BENEFIT BALANCE

Negative

[1] https://www.ncbi.nlm.nih.gov/pubmed/?term=lee+pittler+ernst%2C+reikiv

[2] https://www.ncbi.nlm.nih.gov/pubmed/25835541

So, Reiki is both implausible and unproven. Now a new, large trial has emerged that might change this verdict. The main purpose of this study (published in JCAM) was to measure the effect of a single session of Reiki on physical and psychological health in a large nonclinical sample.

The study design was a single arm effectiveness trial with measures at pre-and postintervention. The study took place at private Reiki practices across the United States. Reiki practitioners were recruited from an online mailing list to participate in the study with their Reiki clients. A total of 99 Reiki practitioners met the inclusion criteria and participated in the study. Reiki practitioners were instructed to give a flyer to each of their Reiki clients that contained information about the study and invited the client to complete a survey before and after their Reiki session.

Trained and certified Reiki Masters conducted the Reiki sessions in person, with each session lasting between 45 and 90 min. The 20-item Positive and Negative Affect Schedule was used to assess affect, and brief, single-item self-report measures were used to assess a wide range of physical and psychological variables immediately before (pre) and after (post) the Reiki session.

A total of N = 1411 Reiki sessions were conducted and included in the analysis. Statistically significant improvements were observed for all outcome measures, including positive affect, negative affect, pain, drowsiness, tiredness, nausea, appetite, shortness of breath, anxiety, depression, and overall well-being (all p-values <0.001).

The authors concluded that the results from this large-scale multisite effectiveness trial suggest that a single session of Reiki improves multiple variables related to physical and psychological health.

Really?

This ‘large scale’ effectiveness trial’ could make you laugh and cry at the same time.

  • Laugh, because it is almost comically daft.
  • Cry, because the conclusion is bound to mislead a lot of gullible people.

Without a control group, the study cannot even attempt to determine anything like the effectiveness of Reiki. What the results truly show is that consumers who consult (and pay) a Reiki master expect to have a positive effect. The expectation translates into a sizable placebo response. The investigators seem to be clueless scientists, or they wilfully mislead the public (the senior author is from the ‘The Center for Reiki Research‘ which, according to its mission statement, is dedicated to gaining acceptance for the practice of Reiki by the medical community).

The only conclusion that can honestly be drawn from the data is that consumers who pay for a serivce often like this service (otherwise they would not use it!). It’s a bit like the thing with the hamburger joint that I often cite: if you ask people eating in a McDonalds whether they enjoy hamburgers, most will answer in the affirmative.

But there might be a valuable lesson in this paper after all: never trust the JACM further than you can throw it.

16 Responses to A large-scale multisite effectiveness trial of Reiki

  • “Never trust the JCAM further than you can throw it.”

    That’s why it’s the Journal of Alternative Medicine.
    (Though beware, JCAM is also Elsevier’s Journal of Computational and Applied Mathematics – and the Jewish Cemetery Association of Massachusetts!)

    JCAM is for people with alternative mindsets and ways of thinking. (Or advanced computers.)
    Sad, but at least ithe medical JCAM does what it says on the tin – it reports alternative theories.

    What evidence is there that any rational person trusts JCAM?

  • EE: “The investigators seem to be clueless scientists. . .”

    Clueless? Yes. But they don’t deserve to be called scientists.

  • Ernst, dear chap,

    I thought your readers might be interested in the the distinction between an effectiveness trial and what they are so used to critiquing.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912314/
    A Primer on Effectiveness and Efficacy Trials
    “Although efficacy and effectiveness studies are both important when evaluating interventions, they serve distinct purposes and have different study designs. Unfortunately, the distinction between these two types of trials is often poorly understood. In this primer, we highlight several differences between these two types of trials including study design, patient populations, intervention design, data analysis, and result reporting.”
    “Although effectiveness studies sacrifice some internal validity, they have higher external validity than efficacy studies”
    Comparators could be feasibly employed but are somewhat optional, depending on the question asked.

    I often say that all research is interesting, but should not be thought to say more than it actually has to say.
    I also caution against “argument from ignorance” (which I call the prime pseudo-skeptic fallacy – that if we don’t know something for certain, it can’t be so).

    Whether results are due to a mooted, little understood and unproven “placebo effect” is irrelevant to the question posed. I suspect that is simply the first alternative hypothesis many people stop at if they don’t like the data. Indulgence in cognitive ease.

    As for plausibility – in particular with investigations of the paranormal – that is very much in the eye of the beholder, and a matter of experience. Considerations either way may run dangerously close to reliance on authority.

    I would say your concerns about this choice and execution of research, potentially misleading gullible people are misplaced. Such people will always find things to mislead them, as your blog attests (we are probably thinking of different people). I don’t believe considerations which tend towards censorship and prohibition have a place in science.

    Myself, I don’t like the pyramid-selling aspect of Reiki certification, but the thing itself remains intriguing.

    I wonder if a trip to a Reiki practitioner would make you, personally, feel better or worse, Edzard? Perhaps you should give it a go!

    • why so complicated?
      effectiveness trial = test under ‘real life’ conditions
      efficacy trial = test under tightly controlled laboratory conditions.
      the study I discussed was neither

    • I have had Reiki; it did nothing. but this is irrelevant.

    • I’m not sure why, but proponents of these silly treatments and others like them often say “well, you should try it” as if that would change my mind.

      Two reasons why I wouldn’t bother trying them. First, what they are promoting is usually implausible. No amount of trying it will change that. Thinking that pins in your face, as another example, will cure your ED is just wackiness, at best.

      Second—and do I really have to say this again?—anecdotes, even lots of them, are not evidence!

      Does that mean I will never try them? No. But don’t wait up.

      • Ron,

        “I’m not sure why…”

        Hypothetically, one reason would be so you could get better information. You brought up acupuncture in regards to plausibility. If your understanding of acupuncture (or Chinese medicine) is limited to websites (like this one)…it certainly would seem implausible. You’re likely to think that “energy” runs through imaginary “meridians”, for instance.

        Hypothetically, let’s say you talked to an actual practitioner (no need for a treatment, and most practitioners would love to explain Chinese med theory). Hypothetically, you might find out that the term “meridian” was a translation of a term that means “vessel” – and the translation was done by a bank clerk who had the hobby of translating Chinese. You might find out that the bank clerk had no experience with older Chinese script, medical terminology, or medical theory.

        You might also find out that experts on the subject say things like “It is a fact that more than 95 percent of all literature published in western languages on Chinese medicine reflect western expectations rather than Chinese historical reality.”. Or more specific to ‘meridian’: “The term ‘meridian’, introduced by Soulie de Morant in his rendering of the concept of jing, is one example among others of what might be called a creative reception of Chinese medicine in Europe and North America in recent years that disassociates itself from historical facts.”

        Hypothetically, you could talk to the practitioner about the term ‘qi’. You might find out that the same expert says “the core Chinese concept of qi bears no resemblance to the Western concept of ‘energy’.” Other experts say pretty much the same thing. But, the bank clerk also had an interest in Indian medicine, and superimposed some yogic concepts onto Chinese med – because it was his best guess.

        Anywho, ‘energy’ running through ‘meridians’ is a commonly accepted weird superficial translation, based on mis-understandings of a bank clerk. Probably not the best to base an opinion of plausibility on. Maybe that’s a reason why you hear “well, you should try it” – simply to get some decent information. Maybe not.

        • jm,

          Thanks for all of that but it’s still woo. No amount of me trying it or having someone try to blah, blah, blah their way through an explanation of it is going to convince me otherwise.

          You know what would convince me? Science. Seriously. If real science took us to that conclusion, I would rent billboards proclaiming, “We’ve found the qi to health!” I would also be the first one to get pins in my face.

          I leave you with this quote from Carl Sagan. “It is far better to grasp the universe as it really is than to persist in delusion, however satisfying and reassuring.”

        • Ron,

          “If real science took us to that conclusion…” I’m not sure what “conclusion” you’re talking about. I was simply suggesting that you get some accurate information before talking about plausibility. What you’ll get on this site (and according to experts…”95 percent of all literature published in western languages on Chinese medicine”) is some of that delusion Sagan is talking about.

          Probably best that you avoid the whole plausibility thing…stick with talking about results from studies and such. Carl would be much happier.

          • @jm

            Just out of interest… You tell us that “…experts on the subject say things like “It is a fact that more than 95 percent of all literature published in western languages on Chinese medicine reflect western expectations rather than Chinese historical reality.”” I don’t think I’m being unreasonable to ask which ‘experts’? And where have they recorded their words of expertise?

          • Frank,

            The quotes are all Paul Unschuld. The “95 percent” one is from an interview he did with Matthew Bauer
            (https://www.acupuncturetoday.com/mpacms/at/article.php?id=28481&no_paginate=true&no_b=true). The others are from one of his textbooks (Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in Ancient Chinese Medical Text).

            I don’t have the exact quote, but somewhere Unschluld talks about how the one-word translations for Chinese med ideas are all equally crap…so just pick one and go with it (severe paraphrasing). Every Chinese med practitioner I’ve talked to says basically the same thing.

            If you’re really interested, you need a teacher. But it is kind of…curious…to see how many people throw around the “implausible” idea without actually understanding what it is they’re evaluating. It always reminds me of the flat earth folks, or the anti-vax folks.

          • @jm

            First of all, thank you for your sanctimonious and condescending response. I appreciate how you must have sweated blood putting it together. I also know and appreciate that I am lucky in that logic (and these responses) comes easy to me. This is not the case for everyone.

            Second, this character you quote is, well, just a little biased. (A little. . . hehehe) As such, to me, he has about the same credibility as you. That is to say, none.

            Oh, sorry. Am I responding in kind? My apologies. (As a Canadian, unnecessary apologies are in my DNA.)

            Yes, I could spend considerable time reading even more research than I’ve already read with respect to acupuncture. Or, as suggested by other skeptics, I could simply ask this: Given the law of physics and what we already know about this topic thanks to SCIENCE, is it even plausible? Is it even plausible that the 2,000 or so acupoints (give or take, depending who you talk to) are connected with various organ and systems within my body? (Sidebar: If at least you guys could agree what connects to what, it would be helpful.)

            If the answer is no, I waste more more time with it. Just like I will waste no more time with you.

            I leave you with this thought. Voodoo on real people is still voodoo. And you can quote me.

          • Ron,

            “Second, this character you quote is, well, just a little biased. (A little. . . hehehe) As such, to me, he has about the same credibility as you. That is to say, none.”

            I’d rather quote you on that, instead of the cute voodoo thing. Quite the cautionary tale…

  • @jm

    I don’t take very kindly to people who exaggerate their case by saying “experts” when they mean “one expert”.

    Paul Unschuld nevertheless seems to be worthy of the designation, and has come up many times before on this blog (as you well know: we have had previous exchanges around this topic). See here and here (merely for starters).

    Personally, I’ve been aware for many years that TCM as currently practised in the West, (most notably acupuncture) is an invention from the Maoist era. But when you say “If you’re really interested, you need a teacher.” we enter the realm of “jm-approved teachers”. Just because modern, Western practitioners of the nonsense known as TCM may have got their understanding of the terms wrong doesn’t mean the original Chinese practice of medicine wasn’t mostly nonsense also.

    The history of medical science is one long story of reason slowly emerging from a welter of misconceptions propounded by people who were considered “experts” at the time. I don’t see why China should be an exception to this rule. To our shame people too often use the appeal to antiquity as justification for woo.

    • Oh for gods sake Frank: “I don’t take very kindly…”. I picked Unschuld because he’s considered the leading expert on translating that type and era of Chinese text. There are several others…take your pick. They all agree – but Unschuld is the most accessible. Good grief. You know better than that.

      More good grief: “Western practitioners of the nonsense known as TCM may have got their understanding of the terms wrong…”. That’s not what I said. Practitioners understand the terms perfectly well, and know that they’re superficial shorthand. They know “energy” and “meridians” are crappy translation. But so is every other translation. So you either pick a crappy one-word translation or use the Chinese terms. Either way, they need explanation. Sorry to ruffle your feathers with the word “teacher”. Feel free to substitute “explainer” if it makes you feel better.

      “Personally, I’ve been aware for many years that TCM…” Yeah, so has everyone else. Most also know that “invented” means that it’s actually a mish-mash of medicine systems throughout China, kind of a lame “greatest hits” album. Like TCM, “greatest hits” are quite incomplete. A sometimes catchy introduction. On the other hand, the lazier folk out there figure “invented” means it was conjured out of thin air. Some fools believe the lazy. So it goes.

      You’re also smart enough to know that if you say “this isn’t plausible”, it really doesn’t mean much if you’re basing that on “energy” and “meridians”. Unless you’re talking with gullible pseudo-skeptics.

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