When a "scientific study" is neither

Aug 18 2011 Published by under Absurd medical claims, Medicine

There is quite a bit of art to the practice of medicine: knowing how to get and to give information to a patient, how to create a sense of worry without creating a feeling of panic, how to use the best available science to help them maintain or return to health. Underlying all of the art is the science: what blood pressure is likely to be harmful in a particular patient? What can I offer to mitigate this harm? This science is developed over years by observation and systematic study. We have a very good idea of what blood pressure levels are optimal to prevent heart attacks in various populations. These data are hard-won. It has taken decades and it continues.

If a researcher were to discover a promising, new blood pressure intervention, they would have a long way to go from bench to bedside. They would have to prove as well as possible that it is safe and effective---and from a science-based medicine perspective, that it is even plausible. If the discovery is a drug that relaxes blood vessels, or a type of exercise, we have good reason to believe it might work and can go on to figuring out if it does work. If the intervention is wearing plaid every day, we have little reason to think this would be effective, and it probably isn't worth the time and cost of looking into it.

The well-respected journal Cancer has just wasted space in the study of wearing plaid. Well, not really; it's worse than that. The article is called, "Complementary medicine for fatigue and cortisol variability in breast cancer survivors: A Randomized Controlled Trial." There is nothing that isn't wrong with this study, and if it weren't published in a major journal, it might even be light comedy.

Tragedy wins the day, however, because cancer is a big deal, and I don't like it when people mess around with cancer.

People with cancer suffer from a number of vague and specific discomforts related to the disease and its treatment. Everything from life-threatening blood clots, to intractable pain and nausea, to depression threaten to kill or disable people with cancer. One symptom common to many illnesses is fatigue, and during chemotherapy, fatigue can be debilitating. This new "study" allegedly investigates an intervention to alleviate fatigue.

Fatigue is one of those symptoms whose study can be difficult and deceptive. It rarely has a single cause, is subjective, and waxes and wanes naturally. Because of this natural variability, it is easy to attribute changes in fatigue to an intervention when if fact we may be observing the natural course of the symptom. My patients with colds often want antibiotics. Without antibiotics, their cold will likely last a week or two; with them, 7-14 days. If I give them antibiotics, they will certainly credit me with curing their cold, but were I to take credit I would be riding nature's coattails.

In the current study, the authors have chosen to ride the coattails of nature but rather than cling to them with medicine, they have chosen "biofield therapy". My spell checker doesn't recognize "biofield" and neither should you. The authors at least acknowledge this in passing:

Biofield therapies are complementary and integrative medicine modalities often used by breast cancer patients,
and have been described as therapies that are intended to affect energy fields that purportedly surround and penetrate the human body for the purposes of healing. (Emphasis mine, PalMD)

I have a big problem with studies built around something that only purportedly exists. What's next, a study of cancer rates in Sasquatch?

This paragraph effectively nullifies everything that follows, but what follows is so horrid and humorous that we can't just stop here.

The "biofield healing" technique chosen for the study? "Energy Chelation". It's almost as if they looked for a term that took all of quackery and combined it into two simple words. Nowhere does it tell us what sort of "energy" is being "chelated"; so I looked it up.

According to the study, the technique was chosen by one of the authors, Reverend Rosalyn L. Bruyere. Is she an oncologist? A physicist?

Rosalyn L. Bruyere is an internationally acclaimed healer, clairvoyant and medicine woman.

You don't need to be a capital-S Skeptic to translate that as "con-artist", although that would simply be an opinion. The real question isn't whether or not she is a con-artist (she may in fact be very sincere despite a website that makes her look like a cult leader) but why in the world any real physician or scientist would take such a person seriously?

Still, I want to know what the hell "energy chelation" is. It's not an easy question to answer, but various searches describe it as a hands-on energy healing technique that, analogous to chelation therapy, "chelate" and remove negative energies from the body. In other words, it's a fantasy spun out of happy thoughts and a juvenile imagination.

The "science-y" bit of the study isn't any better, relying of famously inaccurate "saliva cortisol" measurements, and something called "cortisol variability", which does not appear to be a validated marker of the symptom in question (fatigue). From my reading, I'm unclear that it's ever been validated to measure anything.

For all I know, the editors of Cancer are detoxifying themselves in a sweat lodge to rid themselves of the embarrassment of publishing such dreck. I just hope they remember to drink lots of water---faith healers do not have a great track record for patient safety.
References

Jain S, Pavlik D, Distefan J, Bruyere RR, Acer J, Garcia R, Coulter I, Ives J, Roesch SC, Jonas W, & Mills PJ (2011). Complementary medicine for fatigue and cortisol variability in breast cancer survivors: A Randomized Controlled Trial. Cancer PMID: 21823103

(h/t Genevra Pittman at Reuters)

16 responses so far

  • Bioblubb says:

    How the heck did that pass peer review? And is the german term 'dreck' actually used in english?

  • Dan J says:

    Bravo!

    I'm pleased to report that at no time during my cancer treatments has any physician, nurse practitioner, nurse, technician, etc., ever offered or recommended any type of bullshit alternative or complementary treatment. Yes, I experience a certain amount of fatigue. I've never talked with a cancer sufferer who didn't.

    I read about treatments offered to me. I use PubMed and other online resources to get an idea of what will be happening to me. The doctors have always appreciated my interest in the details.

    I understand that many people are terrified by their own prospects with cancer, and cling to anything in hopes of validating their denial. When treatment options dwindle in the face of relentless cancer cells, what can you do? I choose to remain rational.

    I loathe charlatans like Rosalyn L. Bruyere. Preying on the fears of cancer patients is one of the more disgusting things I've ever seen.

    • Alexis says:

      Both of my parents have had cancer (in my father's case, twice--breast cancer and then large B cell lymphoma). My father's oncologist did suggest (in a roundabout, "this isn't legal in this state so I didn't actually say what I am saying" way) that he try pot when Zofran didn't do the job. I'm not sure how alternative that is, any more.

      Various means of relaxation were suggested for both of them, but nothing as silly as reiki or "energy chelation," and it was never promoted as actual medical treatment. My father is a born skeptic, my mother much less so (she did one of those silly diets that involve acupressure balls behind the ears) so I'm keeping an eye on it. My mother has CLL, which does leave her very tired and isn't really treated as such, so I wonder if she's a walking target for woo.

  • Blake Stacey says:

    "Energy chelation" is just one of several ways to remove interphasic parasites which live in subspace rifts and feed on the biogenic fields of organic life-forms who encounter them while using warp drive. . . .

    Wait, you mean my Star Trek fanfiction can get published in peer-reviewed medical journals now? Well, if that don't just take the Vulcan biscuit!

    • A. Marina Fournier says:

      Thank you for that--got a good chuckle out of me! Yes, I am a Trekfan from the day it started...

  • Puff the Mutant Dragon says:

    This is RIDICULOUS. I can't believe they published this. "Energy Chelation"? What next, "Cancer and the Spirit World"? "How Magic Can Cure Quantum Cancer"? Whoever reviewed this paper must have out of their mind.

    The "integrative medicine" business is serving as a Trojan Horse to smuggle quackery into mainstream medicine, and the worst thing about it is it's working. It would all be very funny, if only it weren't true.

  • Melissa G says:

    "Energy chelation" is when the practitioner removes my intrinsic field and I turn into Dr. Manhattan, right?

  • daedalus2u says:

    I looked up "energy chelation" and found a site that said it was used to remove "auric debris".

    Auric debris seems to be debris made of gold. Which seems just about right. Any loose gold laying around and a few courses of energy chelation will take care of it.

  • Old Geezer says:

    The article was published in the April 1st edition?

  • I understand the scepticism and I do not write in support of this therapy (I am a sceptic, but certainly not dogmatically so). However - I think you are being somewhat unfair here. Everyone asks for the evidence, where are the trials? etc. Well here is one, in a top journal, peer reviewed that seems to have some positive results. I'm sure that as well as chance there are a 1,000 reasons other than "energy chelation" or whatever for the results.

    But... since it has been published in Cancer it's not enough to say that it's ludicrous, or that they must be con artists. You could say that if it was published in some kooky journal but it wasn't. Sceptics demand the studies,it cannot be had both ways, they cannot just be trashed with insults and indignation when they are published in a serious outlet. You need to use science yourself in this case, you need to analyse the study, correspond with the authors and editor if necessary, and you need to find out or at least offer, other possible explanations for the results. On the other hand you may think that is too much effort to be worthwhile - but then you should not trash it unless you are prepared to analyse it.

    • X-p3riMental says:

      You seem to have missed most of the details in the post. Not only has PalMD provided much more plausible explanations for their results (i.e. the natural course of fatigue without ANY interventions), he has analyzed the study and pointed out where their methodology was flawed (i.e. using measurements that have never been shown to correlate with what they are trying to validate).

      What PalMD is saying in his post is that someone has conned off the equivalent of publishing an article that "proves" that a regular diet of All-Bran can speed the growth of your hair by measuring the volume of your urine output. The independent and dependent variables aren't related to the question they were trying to answer so it is a reprehensibly useless study that the journal should be ashamed for having published. Don't be fooled because it's in a reputable journal, it's still bad "science".

      • I read the post and the paper - they did not use cortisol as a measure of fatigue, that was a secondary outcome. Fatigue was measured using
        something called "The Multidimensional Fatigue Symptom Inventory-short form" - which I have no experience of but which is reported in other (serious!) studies to be a validated method. Natural course of fatigue that "waxes and wanes" is not an acceptable explanation because both healing groups were better than controls. That's what controls are for, to reduce artifacts caused by natural variation.

        It may well be bad science but the post does not demonstrate that - it would have been far more effective if it had concentrated on the study rather than calling one of the authors a con-artist (she may be one, but that doesn't emerge from the paper).

        There is a serious weakness in the study for which I think it should not have been accepted - the numbers:

        Healing, n=27 Mock, n=30 Control, n=19

        This is especially relevant because the mock healing also improved fatigue scores, although the "Healing" was apparently more effective. But with such small numbers this is more likely to be either a) chance or b) factors unrelated to "biofield healing".

        The authors themselves suggest that the rest and touching (relaxing, like a massage) involved will have contributed to the fatigue improvement in the mock healing group, but they maintain that the "active" healing was even better so there must be something more. I disagree - the simplest explanation, given the unknown and unexplainable nature of "biofield healing" is that the trained "healers" were better at inducing relaxation (for purely physical and technical reasons) compared to the "sceptical scientists" who were briefly trained in touching technique. This explanation is more likely than it being a real effect of "biofield healing" and for this reason the paper should not have been accepted - the results don't support the conclusion.

        Or it could have been accepted as a pilot study suggesting that touch and relaxation therapy can improve symptoms of fatigue - that aspect in itself seems worthy of note and follow-up, no need to introduce anything more complex than that.