Comment by ZeljkoS | Hacker News Reader

Comment by ZeljkoS | Hacker News Reader

> Reiki can’t possibly work, so why does it?

It doesn't. Intro section on Wikipedia [0] already lists five studies that concluded it doesn't work: "Clinical research does not show reiki to be effective as a treatment for any medical condition, including cancer,[4][5] diabetic neuropathy,[6] or anxiety and depression,[7] therefore it should not replace conventional medical treatment. There is no proof of the effectiveness of reiki therapy compared to placebo. Studies reporting positive effects have had methodological flaws.[2]"

[0] https://en.wikipedia.org/w/index.php?title=Reiki&oldid=94822...

[2] Lee, MS; Pittler, MH; Ernst, E (2008). "Effects of reiki in clinical practice: A systematic review of randomised clinical trials". International Journal of Clinical Practice (Systematic Review). 62 (6): 947–54. doi:10.1111/j.1742-1241.2008.01729.x. PMID 18410352. "Most trials suffered from methodological flaws such as small sample size, inadequate study design and poor reporting....In conclusion, the evidence is insufficient to suggest that reiki is an effective treatment for any condition. Therefore the value of reiki remains unproven."

[4] Russell J; Rovere A, eds. (2009). "Reiki". American Cancer Society Complete Guide to Complementary and Alternative Cancer Therapies (2nd ed.). American Cancer Society. pp. 243–45. ISBN 9780944235713.

[5] "Reiki | Complementary and alternative therapy | Cancer Research UK". about-cancer.cancerresearchuk.org. Retrieved 2020-02-12.

[6] Bril, V; England, J; Franklin, GM; Backonja, M; et al. (2011). "Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation" (PDF). Neurology. 76 (20): 1758–65. doi:10.1212/WNL.0b013e3182166ebe. PMC 3100130. PMID 21482920.

[7] Joyce, Janine; Herbison, G Peter (2007-10-17), "Reiki treatment for psychological symptoms", in The Cochrane Collaboration (ed.), Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd, pp. CD006833, doi:10.1002/14651858.cd006833

An interesting point TFA makes is that it doesn't have to beat placebo: the placebo effect itself provides therapeutic benefit!

> Ted Kaptchuk, a Harvard Medical School professor and one of the lead researchers, theorizes that the placebo effect is, in the words of the Times article, “a biological response to an act of caring; that somehow the encounter itself calls forth healing and that the more intense and focused it is, the more healing it evokes.”

I dug up an article in which he explores this further and it's an angle I haven't considered before [1]:

> More recently, however, experts have concluded that reacting to a placebo is not proof that a certain treatment doesn't work, but rather that another, non-pharmacological mechanism may be present.

> How placebos work is still not quite understood, but it involves a complex neurobiological reaction that includes everything from increases in feel-good neurotransmitters, like endorphins and dopamine, to greater activity in certain brain regions linked to moods, emotional reactions, and self-awareness. All of it can have therapeutic benefit. "The placebo effect is a way for your brain to tell the body what it needs to feel better," says Kaptchuk.

> But placebos are not all about releasing brainpower. You also need the ritual of treatment. [...] You receive all kinds of exotic pills and undergo strange procedures. All this can have a profound impact on how the body perceives symptoms because you feel you are getting attention and care."

If reiki can evoke this effect consistently, reliably and cheaply at scale (and this is believable, because according to TFA, the lot of the practice is just physical touch in ways that the body might perceive as caring?) - perhaps there actually is value in it?

[1] https://www.health.harvard.edu/mental-health/the-power-of-th...

Yeah, but how does placebo actually work? :D

If it works, why don't we use it for our benefit?

We do, but often not very explicitly. But it's definitely practiced in medicine all the time. The doctor silently thinks for a while, then gives some stern warnings and prescribe some pills. You leave, so grateful for living in a civilised time and place.

> ...but how does placebo actually work?

Whatever the mechanism factors turn out to be, I would not be at all surprised if it involves areas of study that clinical studies currently dismiss as unimportant.

> If it works, why don't we use it for our benefit?

Currently difficult to control outcomes because we understand so little of it, and a possibility that it would depress the financial results of a lot of current US "medical/healthcare industry" stakeholders if it turns out for example, having a doting Israeli grandmother dropping by each day with steaming hot matzo ball soup with some unmentionable ingredient that still tastes bitter as hell, a handful of friends calling with jokes, and a couple hours a day in the sauna works cheaper and just as well as a $200 antiviral prescription.

I think that is exactly what Reiki is!

Ted Kaptchuck is not a credible source. He is an altmed activist who plays games with the definition of placebo to push his agenda. His studies are universally flawed[0] and manipulated.

0. https://sciencebasedmedicine.org/ted-kaptchuk-versus-placebo...

That's not what your link actually says:

> He’s the Director of the Program in Placebo Studies, Beth Israel Deaconess Medical Center, and a professor of medicine at the Harvard Medical School. His work on placebo effects has been a frequent topic right here on this very blog and has been a mixed bag. On the one hand, Kaptchuk sometimes does interesting work, but on the other hand he can’t seem to help himself when it comes to overselling it.

And frankly I think the idea stands on its own regardless of who it's coming from. We know that there are placebo effects that convey therapeutic benefits [1], and aren't currently sure exactly where these come from. But why not make use of them anyway? TFA points out that we did that with aspirin for decades, and are doing that with antidepressants right now (which [1] points out may be mostly industrialised placebo as well). This seems like good practical thinking.

[1] https://en.wikipedia.org/wiki/Placebo#Effects

I'm not particularly familiar with reiki, but the issue with anything that contends with placebo tends to be that they're not cheap, and people are being lied to and not being told that they're a placebo, expecting a cure-all. You can even buy homeopathic medicine on the shelf, and you're essentially paying $10 for a 2 ounce bottle of water.

I'm not sure of reiki rates, but many of the other things I consider placebo replacements (based on studies of effectiveness) are not cheap. Essential oils, homepathic medicines, rare earth jewelery, etc. All are sold as cure-alls, fail to deliver their promises to a large percentage of the population, and take advantage of people's trust in anecdotal evidence.

If any of these were being marketed in a truthful way I'd be more supportive of them, but currently they seem to be taking advantage of people and promising cures for things that they can't cure. This is actively doing harm to a certain percentage of the population that is trying to use them to cure things like cancer.

I'm fully supportive of doing things that you find helpful. I don't mind my family buying essential oils, or doing whatever they want really. But they also need to understand the truth and limitations.

Placebo is known to be good!

It's reasonable that Reiki should be compared with no intervention, which is the realistic alternative.

Reasonable if evaluating your treatment options, and those are the only two available to you.

Not reasonable if you are trying to determine the best treatment options and others exist, such as "anything with actual clinical trials that show it more effective than placebo", which is hardly an unrealistic alternative.

The article emphasises that Reike should only be used in combination with actual proven clinical treatment, and not as a replacement of those (which is obvious and dangerous quackery). So compare clinical treatment with Reiki on the side to clinical treatment without Reiki. And maybe also clinical treatment with a more conventional placebo on the side.

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