“Eastern Medicine”: Placebo? Cure? Bullshit?

[jaja]

In the mare magnum of the Internet it's possible to find everything, which often results in finding nothing at all. It's really hard to find relevant informations with a standard Google search, especially on topics such as health and fitness. This forum is like a happy island filled with useful concepts; interestingly enough the knowledge shared here is often non conventional. I feel like it's the right place to ask questions about “eastern medicine”. Placebo? Cure? Bullshit?

According to common sense (at least among my peers) there's no “alternative medicine”: if something works is medicine, otherwise it's bullshit. I'm sympathetic toward this approach, yet I'm aware about the slowness of the scientific process — which plays a big factor in its reliability. Not too long ago meditation was bullshit, now it's hip. Today most people agree on the benefit of running, but to my granny's eyes it still seems like a waste of energy/time.

Most of you are rational people and experienced tinkerers who take science seriously, but there're more than a few mentions about acupuncture, gua sha, ayurveda, cupping and so on. Some of my peer and a lot of respected personalities would deem you as crazy. Well, they think I am crazy for wearing toe-shoes from time to time! ? Given your experience I'd like to know your perspective on this topic. It's a vast one, I know, but I want to keep it general as a start; more specific questions will come eventually.

PS: I'm following on Instagram a skilled physiotherapist, who's part of the “Barbell Medicine” crew. He's ahead of the game in a lot of ways: really rational, reads a lot of scientific papers and takes really serious both the placebo and nocebo effect. To him stretching serves no purpose for the general public, nor do mobility drills, and “tension” is a nocebo inducing buzzword. He knows his shit, but I know he's missing a piece of the puzzle.

[Nathan]

The question is far too general. Eastern medicine practices run the whole gamut. There are legitimate practices that science is beginning to provide evidence for, and there are quack practices. That is no different than in Western medicine. You are aware that there are very real limitations to our science, which is good. Science is simply observation, done by specific rules and with (hopefully) repeatable results. In other words, it's a best guess. It is never proof of anything. Kit, more than anyone, can speak to this subject.

Perhaps a better question is: does it work for you? If something works because of the placebo effect, does it matter why it worked? There is no right or wrong answer, but this can help guide you on whether or not you would like to pursue some practice/method. Despite science not being "fact," it is a good reference. Consider the science, consider your experience, and then make an informed choice depending on your wants/needs. That's my opinion.

[Kit_L]

As someone who researched placebo (L. for "I please") medicine for many years, I can tell you that in the pursuit of "objectivity", the baby is often thrown out with the bathwater, in the search to find the "active ingredient" or the objective process that is doing the 'real work' of bringing about a cure. I will point to two things that you may care to research.

The first is, what is the placebo effect? It is nothing more than a patient's expectation of what a practitioner can do for him/her. The placebo effect taps deeply into the mind of the patient—and even in our "scientific" medicine, can account for a significant fraction of the interaction outcome. Some researchers put this at up to 40%—hardly trivial. The mechanism of the placebo effect are completely unknown—that does not mean that they do not exist. As well, placebo effects have no side effects—this is hardly trivial either; over 20% of all deaths in all Western hospitals are from drug or surgical failures. Look up Ivan Illich and "The Medical Nemesis". These figures have not changed in 40 years.

The nocebo (L. for "I hurt") effect is common too: when, for example, a doctor (medical authority figure) puts up an x-ray of incontrovertible evidence of irreversible, debilitating change (like my lower back images): some patients see this and adopt what's called the "sick role" (look up Conrad)  and never get better.

Science is usually asking questions about mechanisms or chemistry/biology; the patient simply wants to get better. This is what @Nathan was pointing to when he wrote, "If something works because of the placebo effect, does it matter why it worked?" Science asks one kind of question, the patient another. 

Look up psychoneuroimmunology: this field of research had a brilliant 15 years or so, then faded away. One double-blind study showed how a group of AIDS patients who had been trained in meditation techniques were able to control their T-cell counts in real time. This is extraordinary, yet the research never went further—because, as a self-help technique, there were no drugs or surgery outcomes to make money from. This research is still visible, so please look for it.

@Nathan's broader point is relevant: "alternative" medicine has been helping people for 5,000+ years. such medicines were not alternative until allopathic medicine was invented, and became the dominant form of medicine in the West. The economic forces supporting this are huge, and the relationship between big Pharma, hospitals, research institutions, and doctors is well-known. Western medicine is (unsurprisingly) is at its best in accident and acute situations—these characterise Western societies (car accidents, for example). Alternative medicine is at its best for the majority of the minor aches and pains that present at doctor's surgeries daily; alternative medicine treat the lifestyles that are the deeper causes of the problems.

Lastly, your original question is too broad to be meaningful. There is plenty of research in peer-reviewed Western medical journals that show acupuncture to be effective in pain relief, yet from an acupuncturist's perspective, this is its least useful aspect. Similarly for all the extant forms of Eastern and Ayurvedic medicine; some research supports these medicines' broad claims; other research seems to debunk the same claims. What have you tried, and what has/hasn't worked for you?

As for the "Barbell Medicine" person, you know from your own personal experience that he is clueless on that point—so why engage? As for tension not existing—what planet does he live on, I wonder (here, gravity rules; tension is therefore necessary, right?). Our dictum: no unnecessary tension—that is a whole 'nother matter.

[jaja]

On 10/12/2018 at 2:06 AM, Nathan said:

Perhaps a better question is: does it work for you? If something works because of the placebo effect, does it matter why it worked?

 

7 hours ago, Kit_L said:

The first is, what is the placebo effect? It is nothing more than a patient's expectation of what a practitioner can do for him/her. The placebo effect taps deeply into the mind of the patient—and even in our "scientific" medicine, can account for a significant fraction of the interaction outcome. Some researchers put this at up to 40%—hardly trivial. The mechanism of the placebo effect are completely unknown—that does not mean that they do not exist. As well, placebo effects have no side effects—this is hardly trivial either; over 20% of all deaths in all Western hospitals are from drug or surgical failures. Look up Ivan Illich and "The Medical Nemesis". These figures have not changed in 40 years.

I'm a big fan of the placebo effect. Yet if I don't know if something effectively works, I can't confidently recommend it to others. Putting aside my personal curiosity of wanting to understand things conceptually, if I don't have some good heuristics I'm not able to discern what might be worth trying.

7 hours ago, Kit_L said:

Look up psychoneuroimmunology: this field of research had a brilliant 15 years or so, then faded away. One double-blind study showed how a group of AIDS patients who had been trained in meditation techniques were able to control their T-cell counts in real time. This is extraordinary, yet the research never went further—because, as a self-help technique, there were no drugs or surgery outcomes to make money from. This research is still visible, so please look for it.

Fascinating! I'll definitely check it! Anyway, on the bright side, I know there's still researches being made on the topic of “psychosocial factors”. Maybe there's some movement in the right direction.

7 hours ago, Kit_L said:

Alternative medicine is at its best for the majority of the minor aches and pains that present at doctor's surgeries daily; alternative medicine treat the lifestyles that are the deeper causes of the problems.

This I agree when it comes to practices such as meditation, because there's actually a new habit being established. I'm more skeptical thinking about acupuncture and cupping, though.

7 hours ago, Kit_L said:

Lastly, your original question is too broad to be meaningful. There is plenty of research in peer-reviewed Western medical journals that show acupuncture to be effective in pain relief, yet from an acupuncturist's perspective, this is its least useful aspect. Similarly for all the extant forms of Eastern and Ayurvedic medicine; some research supports these medicines' broad claims; other research seems to debunk the same claims. What have you tried, and what has/hasn't worked for you?

I posed my question as really broad because I wanted to spark an interesting conversation, but I have no problem in being specific. As I said before, I like to understand things form a conceptual standpoint, but I also have much more practical concerns. As you might recall I'm currently undergoing a training to become a shiatsu practitioner. I know there're various styles, so I have to be specific: I'm practicing what is known as “Zen Shiatsu”, originally taught by shizuto Masunaga.

This specific style makes use of the Chinese meridian system (with some modifications). I'm doing my best in keeping a “beginner's mind” (the lessons are held in a Zen monastery, after all), but at my core I'm really skeptic of the whole “energetic paths” thing. My always rationalizing mind has come up with the concept of “patterns of interaction between tissues” to explain meridians, but I don't know if it makes any sense.

The treatment itself is relaxing and in some cases has a profound effect on patients. So I'm not questioning the actual practice. I'd like to know more about its foundations, though. Does it make sense? Kit, in your book I believe you mentioned you first were skeptic about shiatsu treatments, but then you became a practitioner yourself. So maybe you can empathize with my state of mind.

So yeah, to put it simple: what are meridians (or even chakras)?

[AlexanderEgebak]

10 hours ago, Kit_L said:

As someone who researched placebo (L. for "I please") medicine for many years, I can tell you that in the pursuit of "objectivity", the baby is often thrown out with the bathwater, in the search to find the "active ingredient" or the objective process that is doing the 'real work' of bringing about a cure. I will point to two things that you may care to research.

The first is, what is the placebo effect? It is nothing more than a patient's expectation of what a practitioner can do for him/her. The placebo effect taps deeply into the mind of the patient—and even in our "scientific" medicine, can account for a significant fraction of the interaction outcome. Some researchers put this at up to 40%—hardly trivial. The mechanism of the placebo effect are completely unknown—that does not mean that they do not exist. As well, placebo effects have no side effects—this is hardly trivial either; over 20% of all deaths in all Western hospitals are from drug or surgical failures. Look up Ivan Illich and "The Medical Nemesis". These figures have not changed in 40 years.

The nocebo (L. for "I hurt") effect is common too: when, for example, a doctor (medical authority figure) puts up an x-ray of incontrovertible evidence of irreversible, debilitating change (like my lower back images): some patients see this and adopt what's called the "sick role" (look up Conrad)  and never get better.

Science is usually asking questions about mechanisms or chemistry/biology; the patient simply wants to get better. This is what @Nathan was pointing to when he wrote, "If something works because of the placebo effect, does it matter why it worked?" Science asks one kind of question, the patient another. 

Look up psychoneuroimmunology: this field of research had a brilliant 15 years or so, then faded away. One double-blind study showed how a group of AIDS patients who had been trained in meditation techniques were able to control their T-cell counts in real time. This is extraordinary, yet the research never went further—because, as a self-help technique, there were no drugs or surgery outcomes to make money from. This research is still visible, so please look for it.

@Nathan's broader point is relevant: "alternative" medicine has been helping people for 5,000+ years. such medicines were not alternative until allopathic medicine was invented, and became the dominant form of medicine in the West. The economic forces supporting this are huge, and the relationship between big Pharma, hospitals, research institutions, and doctors is well-known. Western medicine is (unsurprisingly) is at its best in accident and acute situations—these characterise Western societies (car accidents, for example). Alternative medicine is at its best for the majority of the minor aches and pains that present at doctor's surgeries daily; alternative medicine treat the lifestyles that are the deeper causes of the problems.

Lastly, your original question is too broad to be meaningful. There is plenty of research in peer-reviewed Western medical journals that show acupuncture to be effective in pain relief, yet from an acupuncturist's perspective, this is its least useful aspect. Similarly for all the extant forms of Eastern and Ayurvedic medicine; some research supports these medicines' broad claims; other research seems to debunk the same claims. What have you tried, and what has/hasn't worked for you?

As for the "Barbell Medicine" person, you know from your own personal experience that he is clueless on that point—so why engage? As for tension not existing—what planet does he live on, I wonder (here, gravity rules; tension is therefore necessary, right?). Our dictum: no unnecessary tension—that is a whole 'nother matter.

One aspect to the placebo-effect worth noting: It is also a conditioned response. The expectations to an intervention can be greatly enhanced by former exposure.

I like this post by Jarod Hall: https://www.facebook.com/drjarodhalldpt/photos/a.741226812748092/966337000237071/?type=3&theater

I am more inclined to say that placebo effect of most interventions accounts for 80-90% of the effect because the explanation models of most interventions have been proven wrong. Take for instance fascial release which cannot be deformed by hands on treatment. Something happens, clearly, placebo, and then to some extent reflex activation/inhibition and gate control with sensory information competing for second neuron transmission and in the end competing for cognitive realisation. But fascial release in general works no better as a stand alone treatment for pain than other interventions, mostly, and works no better or only a little better than placebo in high quality evidence.

I disagree about placebo having no side effects. It has been demonstrated that you can get addicted to the placebo effect - you can simply get withdrawal symptoms from a placebo! And if we go down the rabbit hole I would claim that "placebo" is being used to justify the use of ineffective standalone treatment modalities (as proven by science) and acts as a way of withholding patients from a more active strategy. Hardly, passive placebo treatments are not designed around providing self-efficacy and a locus of control.

Essentially, the placebo effect can become a long term nocebo effect if utilized improperly. First of all a treatment modality should be chosen based on the largest possible specific effect, and then you can try to enhance the non-specific effects (placebo - or meaning responses) - disregarding the ethical discussion about patient deception here. The only exception to this rule should be if you clinically reason that the placebo effect of a certain treatment would be very large for a patient. Then doing this modality and then transittioning to a more active strategy would be both clinically sound and help you build a therapeutic alliance with the patient otherwise hard-to-gain.

That is why I am both for and against placebo treatments. In the world of physical therapy the justification of placebo is that "it works" - but does it really work? Would they have gotten better without any treatment? Any considerations for regression to the mean? Would a more active strategy have worked long term instead of just short term? Any nocebic expressions from the clinician? Usually this mentality is due to a lack of trust in whether the patient even can get better which also reflects a lack of knowledge about what pain essentially is. Which is a huge problem. But placebo treatments results in short term relief and gets patients back which in turns gets the clinician money. And therefore the clinician thinks he is being helpful because people come back for pain relief, and the people that dont come back are "cured". I like the term "outcome measures measures outcome, not intervention". Most people make the logic mistake of A intervention results in B outcome due to a lack of critical thinking. All this creates a nocebic behavior with the patient, and some patients will get worse and go elsewhere for a treatment. That always happens.

I disagree about the evidence for acupuncture providing pain relief. High quality randomised control trials state that it works as well as placebo. Tooth picks also work as well as needles, and it does not matter where you stick the needles. I can find the evidence of that for you if interested.

It is really an interesting study that you mention. Can you find it? Reminds of the study on Wim Hof's apprentices who where able to direct their immune system towards the injection of a virus.

There is so much new stuff about placebo going on now. I will probably write my thesis on the specific and none-specific effects of a certain treatment and comment on the relevance of distinguishing between the two in the clinic

[Nathan]

5 hours ago, jaja said:

So yeah, to put it simple: what are meridians (or even chakras)?

Kit will be able to give you a much better response than I to most of your post, so I will just leave you with this link that you might find interesting in the meantime: Review of Evidence Suggesting That the Fascia Network Could Be the Anatomical Basis for Acupoints and Meridians in the Human Body.

[Kit_L]

@AlexanderEgebak: all I will say is that nothing is ever "proven" by science; I spent a great many years researching just exactly what science does do, at both Master's and PhD level.

And my strong suggestion is to not "comment on the relevance of distinguishing between the two in the clinic "; reason is (as I wrote above) in the clinic, these are answers to two completely different and almost non-intersecting questions: one is an objective inquiry into mechanisms of an interaction; the other is a patient who simply wants to get well and who has come to you for a solution to that problem. I have run a clinic for 30+ years, and patients' main concerns are simply to get over their problem and to learn what they need to do for themselves in this respect. This is why we prescribe exercise of different kinds: the patient has to do these themselves to have any effect; this is empowerment.

And when you ask, "Any considerations for regression to the mean?", that perspective has zero relevance for an individual: all statistical analyses show is tendencies within groups large enough to show such tendencies. These questions are of interest to researchers who are interested in this large-scale perspective, not an individual who wants treatment.

@jaja: 

I studied Zen Shiatsu in Japan, at the feet of Masunaga's most brilliant student; Suzuki sensei. I studied with him for three years or so.

You wrote,

Quote

I'm doing my best in keeping a “beginner's mind” (the lessons are held in a Zen monastery, after all), but at my core I'm really skeptic of the whole “energetic paths” thing

Then you are as far away from beginner's mind as you can be. 

[jaja]

10 minutes ago, Kit_L said:

Then you are as far away from beginner's mind as you can be. 

Sigh.

[Kit_L]

BUT, grasshopper, there's a solution: simply open your heart and listen to what you are being taught with your whole body. What Westerners do not understand is that the scientific/logical/rational way of looking at how the world works is just one way and, what's more, the choice of using this mode constrains other modes. There are many other modes. 

Doing what I suggest does not prevent you from using the scientific/logical/rational ways of thinking—when that is the most useful mode to use. When you are learning to feel something subtle, though, these faculties need to sit on the back burner, way back. Otherwise learning something new is simply impossible—you will literally be wasting your time, because the scientific/logical/rational modes will stop the other modes from even starting to operate.

This is what Shoshin, or Beginner's mind means: adopt the attitude of a beginner—enthusiastic, open, in wonder, heart open, an so on. Unless you do, learning just can't happen. Shoshin does not mean abandoning critical thinking.

[Sai]

Fascinating discussion!

 

On 10/14/2018 at 3:33 AM, Kit_L said:

BUT, grasshopper, there's a solution: simply open your heart and listen to what you are being taught with your whole body. What Westerners do not understand is that the scientific/logical/rational way of looking at how the world works is just one way and, what's more, the choice of using this mode constrains other modes. There are many other modes. 

What would be some of the other modes of looking at how the world works? The only thing I can think of at the moment are being more attendant to the various sensations of the body, such as touch, pressure, proprioception, vibration, temperature, balance, orientation, weight, etc.

Slightly related, but I've read that if one learns how to read without subvocalising, the speed of thinking increases. Has anyone had this experience? Also related is being able to think and imagine in ways other than words, such as sensations and movement. I find thinking in words is the default, predominant mode and I am curious if anyone has had strong, clear experiences of thinking and imagining outside of words.

[Kit_L]

On 5/3/2019 at 10:17 PM, Sai said:

What would be some of the other modes of looking at how the world works?

All the non-logical, non-rational approaches to living. Do some reading in anthropology: there is a group of, from memory, Amazon delta natives who believe the dream world is the 'real' world and the awake one is simply preparation for the real world. Once you start looking at this, you realise that we privilege certain ways of thinking over other ways, and for specific reasons. Western thinking has been successful (in the evolutionary sense) because it consumes everything in its path, and the culture and systems it recreates is explicitly designed to this end. Many have argued that this way of relating to the natural world, and to other humans, has led to our current crisis. Read Berman's "Reenchantment of the world": this is a great place to start. There is way more, though; have you heard the expression, "Life is a dream within a dream"? Poe was an American.

Or Zhuangzi: the monk who dreamed he was a butterfly, and on awakening, wondered if he was a butterfly dreaming he was a man.

And the larger, consensual delusion most people find themselves in: the belief that you are real, and separate from everyone else.

Re. your experience of your default mode of thinking in words: yes, very common in our culture, but even in our culture, non-exclusive. Some dancers think in movement patterns (but "think" is not what they experience; 'feel' might be closer); some musicians 'think' or 'feel' in sounds, and so on. Our language separates inseparable things. Once you start to look at this closely (or develop a meditation practise), everything you think is real is not. Yet you have a licence number and an address, as do I.

What I was talking about in the quote above (BUT grasshopper...) was that the body is talking to us all the time, but most of us are deaf to what it's saying, or do not understand the 'language' it communicates in: the world of sensations. Refining this is what our work here is about.

[Pat (pogo69)]

On 5/5/2019 at 5:31 PM, Kit_L said:

"Life is a dream within a dream"? Poe was an American.

Extra props for any Poe reference!

Placebo is fascinating, as is the research being done on/around it at the moment.  Much is being done to investigate "context effects" around placebo (no two placebos are alike, what people are told matters, the manner in which they are told matters, what people believed before given a placebo matters, etc), the ethics of using deceptive placebo (in trials as control,  as well as deliberate use in clinical therapies), non-deceptive or open-label placebo (placebo effects exist, even when patients are told they are receiving a placebo).

[Sai]

Thanks for the response Kit. Many avenues to explore. I know of Poe a little, but I haven't heard of that quote or of that specific poem. The Zhuangzi book has been on my to read list for years but I've never gotten round to it, neither had I heard of the butterfly dream quote before. I've read sections 1 and 2 so far but some of the linguistic twists he uses are a bit over my head. 😂 Related, I'm currently reading Ken Wilber's "A Brief History of Everything" and I'm divided on whether it's great or BS. Maybe it's a mixture of both. 

 

On 5/5/2019 at 8:31 AM, Kit_L said:

And the larger, consensual delusion most people find themselves in: the belief that you are real, and separate from everyone else.

 

On 5/5/2019 at 8:31 AM, Kit_L said:

Our language separates inseparable things. Once you start to look at this closely (or develop a meditation practise), everything you think is real is not.

Both of these points have been made by Alan Watts in his lectures, such as "where does my fist go when I open my hand?" and the "mountains are mountains" Zen quote. Also, what do you mean by "real" in this context? 

 

On 5/5/2019 at 8:31 AM, Kit_L said:

the body is talking to us all the time, but most of us are deaf to what it's saying, or do not understand the 'language' it communicates in: the world of sensations. Refining this is what our work here is about.

Yes, I recall an interview you had where you said, "When was the last time you felt the clothes on your body?" which always makes me chuckle when I recall it. Speaking of sensations, all the Feldenkrais explorations I've been doing has been refining my sensations in specific and novel ways, although at the moment I feel it's missing some other parts of the picture (at least in my current explorations) but I don't know what those other parts are. It's a case of "I don't know what I don't know" and I know not when I do come across new information whether it's relevant for my development. I'm pretty vague and easygoing about it at the moment though. 😊