Anna Miller tried to answer the question of whether or not children benefit from energy healing in an article that I missed until this week. She fails in this endeavor and leaves the reader confused as to whether or not rank pseudoscience is legit.
Miller was a former senior health editor at U.S. News. She has written about nutrition and fad diet in the past, and she has a degree in psychology. Her bio claims that she is a health expert that is often called upon to educate the public.
Understanding pseudoscience in medicine is not something that is easy to understand. Highly intelligent and accomplished medical professionals often fail when it comes to complex issues, and we are all at risk of being fooled. This problem requires a mental skill set to be learned. Proponents of implausible, unproven, or even thoroughly disproved therapies learn new tricks all the time, so frequent updates to our critical thinking algorithms are essential. Old tricks that haven't been used in a while in order to get past our cognitive defenses are what they like to dust off.
The use of an emotional anecdote as a hook is one trick that has never gone out of style. Miller begins his article with a triumphant success story that involves the use of energy healing. It isn't meant to be critically evaluated but to lower the reader's defenses and make them more receptive to the low quality evidence that is ultimately provided This narrative raises more questions than it answers, and I think it is biased.
A young patient with leukemia was in pain and inconsolable, and the hospital staff was at a loss. She had not slept in a while.
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Dr. Joy Weydert was the chief of pain management at Children's Mercy Kansas City at the time. The girl, who was about 13 years old, had maxed out on pain medications and refused therapies like guided imagery and massage, even though she had found relief from them before. She was so uncomfortable that she was beside herself.
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Weydert, a clinical professor at the University of Kansas Health System in Kansas City, Kansas, decided to use energy healing as a new tool in her toolkit. The practice involved gentle touch and guidance on breathing regulation.
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Within 10 minutes, the patient began to settle down, and within 20 she stopped breathing. The girl was asleep for the first time in days after no more than 30 minutes had passed. She woke up the next morning and said, "Do that to me again!" Weydert recalls. The mother continued to use the technique at home. She was able to help out because of it.
There is a lot to unpack. A lot. Miller claims in the article that energy medicine has been proven to help with a wide variety of medical conditions in children. This is not true. She cites a clinical report from the AAP in a way that is not true.
There is limited evidence in babies and children, but it is still encouraging to see biofield or energy therapies like healing touch, therapeutic touch and spiritual healing among those alternative medicine therapies.
Here is the entire report about energy medicine.
Therapeutic touch, healing touch, and spiritual healing are some of the healing practices that comprise biofield therapies. The biofield therapies are meant to affect energy fields that surround and penetrate the human body and are based on concepts of compassion, positive intention, self-empowerment, the mind-body-spirit triad and the body's innate tendency toward healing. Therapeutic touch and healing touch have been used successfully in children with cancer.
I didn't like the report when it came out. Pure pseudoscience is what the definition is used for. The concept of energy is not defined and is just saying it works by magic. Miller uses a similar approach in her article, and also incorporates the concepts of compassion and positive intention into the definition. The concept of positive intention and the mind-body-spirit triad are just marketing terms designed to distract from nonsense about mysterious energy fields. New age spiritualism and positive psychology are what inspired it.
The study that was cited in the report on energy medicine for children with cancer was garbage, and didn't even look at pain, and didn't tease out energy therapy as a specific intervention from the theater that surrounds it. I said in a previous post that the AAP has a problem. They allowed a group of biased believers in quackery to establish an official Section, which gives them undeserved credibility, and then loops back around to provide justification for the Section's existence. The report uses proven science-based interventions to prop up the nonsense and it is not a serious source that can be used to declare energy medicine effective for anything.
Miller's opening story was included in order to convince readers that energy medicine is a legitimate treatment. It is being offered in children's hospitals. The way the story was presented has some issues with me. I have a different interpretation.
The reader is forced to make assumptions in the opening anecdote. Dr. Weydert told us that the hospital staff was at a loss regarding the patient's pain and insomnia, which is implied to be related to her leukemia. I am not sure if the team was as lost as she remembers. The use of that kind of language shows a significant bias and there is a high likelihood that the memory has been altered over the years as she has retold it.
It is plausible that a child with leukemia might be in pain, but we don't have any specific details to help determine the cause. Patients with leukemia might have pain in their bones. Patients undergoing treatment for cancer might experience pain from mucositis, an inflammation of the GI tract. She could have had the disease from the leukemia in the central nervous system. She may have developed pain from her treatment.
She may have been experiencing pain related to the stress and anxiety associated with her diagnosis. Patients often have a perception of pain even when there is no injury or inflammation. This doesn't mean they aren't in pain or that the pain isn't real. They say that pain is all in the brain. It is important that we understand the source of the patient's pain so that we can determine the best treatment for it.
I think that Dr. Weydert's recollection of the team being at a loss just means that they had ruled out pain related to her leukemia. They consulted the pain management team because they suspected that her pain was functional in nature, not because they believe in energy healing or homeopathy, but because they are the team who gets consulted for difficult to manage pain at that facility. My suspicion is that Dr. Weydert sees herself as a lifesaver for patients like this and that the primary treatment teams are made up of hospitalists and oncologists. I suppose we are all the heroes of our own stories. It would be interesting to get the perspective of the doctor who did the consult.
The primary treatment team determined that the patient wasmaxed out on pain medications because they were more likely to work with nonpharmaceutical interventions. This isn't a term we typically use. I don't know what it means in this context, I have never put that in a chart.
I think that Dr. Weydert is implying that this is a patient who was on multiple medications for pain, meaning scheduled doses of acetaminophen and ibuprofen as well as a scheduled IV opiate such as morphine or hydromorphone. She could be receiving a continuous injection of one of these drugs. At 13 years of age, she can press a button to self-administer an extra dose if she needs it, with appropriate limitations on dose and Frequency.
We worry about the side effect of respiratory depression when we use drugs like morphine for pain. We are careful about the initial dose. If a patient has persistent pain after the initial dose, we can give more of the drug until they are comfortable. The risk of a bad outcome is very low if you think about the timing of additional doses and how much each dose is potentially increased. If a patient is in pain and breathing normally, you can give another dose of IV morphine and increase it by 50%.
It tells me that one of two things were happening when this patient was maxed out on pain medications but still writhing in pain. It is possible that her treatment team believed that her pain was related to her leukemia and that they should have given her more pain control, but they chose not to. It is possible that her team recognized that her pain was not responsive to the opiate and that it was related to stress and anxiety.
The team tried massage and guided imagery to treat the child's pain. This is a good example of how standard science-based nonpharmaceutical interventions can be co-opted. Please ignore the acupuncture in this otherwise excellent summary in order to provide cover for nonsense like homeopathy and energy healing. The patient wasn't interested in continuing the massage and other stress reduction and distraction techniques because they didn't benefit her. Nonpharmaceutical interventions can be very helpful for any type of pain, even allowing some patients to achieve reasonable comfort with lower doses of opioids or without them at all depending on the source and severity of the pain.
The claim that the patient's pain medications were maxed out tells me that they probably weren't dealing with responsive pain. The next step in pain control can be very difficult. If you want to convince a patient that their pain is caused by stress/anxiety and that you want to stop the morphine that they might strongly believe is helping despite all the objective evidence that it isn't, imagine trying to do that with a patient who is old enough to be part of Sometimes we have to put a hold on increasing the dose and then reduce it over time in order to preserve the relationship.
The best approach for pain caused by stress and anxiety is nonpharmaceutical interventions. The approach needs to be bought into by patients and caregivers. When we go down this path, it often requires help from people who are experts in treating patients directly, such as with cognitive behavioral therapy, massage or play therapy, or in teaching patients and caregivers how to take an increasingly active role themselves, such as with massage, exercise, deep breathing exercises
There is no magic in these interventions. They tend to distract the patient from the pain or teach them how to see it differently when they work. There are many reasons why certain interventions might not work for a particular patient. A patient might not be able to participate. They might not want to be involved. They might not trust the person working with them. They might be angry. They may be depressed. They might have an altered mental status due to injury or medication. It is a long list.
Sometimes the specific person providing the nonpharmaceutical intervention can make a huge difference. There is no such thing as energy healing. It is made up. The absurdity of the whole concept is shown by the story, if gently touching a patient in a caring way and talking them through deep breathing exercises can be labeled as energy healing. When I sit with a patient and assure them that they will have a full recovery, am I doing it? Is it possible to explain to a patient that the medication I am ordering will cure their pneumonia? Is there any form of energy healing that I don't do?
It is possible that Dr. Weydert is good at connecting with people. It is possible to establish a therapeutic relationship in a short period of time. The patient described in this anecdote had a positive response in a short period of time, but it probably wasn't as dramatic as she says. It is possible that Dr. Weydert was in the right place at the right time. Maybe the patient was in a better place to be receptive to nonpharmaceutical interventions.
Nonpharmaceutical interventions can help reduce pain.
Your child doesn't need a healing tool. Energy healing is silly. It is not more plausible than homeopathy. It has no place in the treatment of patients with any condition. Some people will respond to the fantasy narrative, but that isn't okay if it involves deception. Lying to a patient about a treatment is not ethical.
It's okay to help patients understand a treatment that isn't how I would discuss it with colleagues outside the room. Dr. Weydert could discuss the mysteries of the human mind and how things like massage and gentle touch can change the way our bodies perceive pain, instead of using the manipulation of mysterious and undetectable human energy fields. There is good evidence that nonpharmaceutical interventions can help some patients. This doesn't interfere with the desired distraction and also engenders potential non-specific "placebo" treatment effects without the need for any deception or magical thinking.
The problem is that the people who are giving these interventions tend to be believers in the magic. Dr. Weydert is an example. The articles like this make patients believe in it as well. Miller quotes an energy healer who does remote healing that works on a quantum level. Her article is just propaganda that fails to educate the public and there isn't even token skepticism to counter these claims.
