In which Dr Aust muses on foot flim-flam.
The night before last I went along to a rather good Skeptics in the Pub talk by the excellent Simon Perry.
As Simon was going through the ways he had got interested in debunking preposterous claims by Alt therapists, he mentioned Reflexology as being one of the first Alt.Therapies that had caught his eye.
Reflexology, for anyone that doesn’t know, is one of the more laughably daft quackeries, especially popular with New Age types. It is based on the idea – needless to say, an idea with no kind of basis in anatomy, or anything else – that a “map” of the body’s areas can be found on the sole of the foot, and that massaging these areas can help with the “mapped” bit of you.
Like many a choice quackery, reflexology in the form we now have it is a surprisingly recent invention. As the Wikipedia page on reflexology explains, it dates from around the time of the First World War, and was then elaborated and codified in the 30s and 40s. It gained greatly in popularity during the 60s and 70s, when Woo became fashionable along with other kinds of mysticism and “stoned thinking”. I am in two minds whether to blame Marin County or the Glastonbury Festival.
Less surprisingly, reflexologists like to claim that reflexology is based on “Ancient Healing Wisdom”.
Now…. where have I heard that before? Oh yes, for just about every piece of Alt.Therapy quackery you can possibly think of.
The Association of Reflexologists – yes, I’m afraid they have an association – tells us:
“The art of reflexology dates back to Ancient Egypt, India and China”
Fancy, just like chiropractic. Now who’d have thought it?
Now, I don’t know if the reflexologists have followed the chiropractors in being miraculously able to detect the practice of their Nonsense of Choice“Art” back to before there were actual written records – remarkable how they manage to do that – but I wouldn’t be terribly surprised. It is amazing just how ancient that ol’ wisdom becomes when you are trying to sell it to folks. Just sayin’.
When the topic of reflexology comes up, as it did in conversation with one of my Nursing degree student groups the other day, I am given to referring to it as:
“A pricey foot massage with added Mumbo-Jumbo.”
– a description I like to think even my friend David Colquhoun might approve of, since it is shorter than the potted summary of reflexology in his Patients’ Guide to Magic Medicine.
There’s no Woo too far…
Now, it is a measure of just how much mainstream medicine currently bends over backwards to be respectful of complementary medicine (CAM) – and quite contrary, by the way, to what the CAM advocates, who always complain they are not taken seriously enough, would have you believe – that there have been quite a number of randomised controlled trials of reflexology. I shit you not. Indeed, there is a recent Systematic Review of them by the ever-punctilious Edzard Ernst:
Med J Aust. 2009 Sep 7;191(5):263-6.
Is reflexology an effective intervention? A systematic review of randomised controlled trials.
Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, United Kingdom. Edzard.Ernst@pms.ac.uk
OBJECTIVE: To evaluate the evidence for and against the effectiveness of reflexology for treating any medical condition. DATA SOURCES: Six electronic databases were searched from their inception to February 2009 to identify all relevant randomised controlled trials (RCTs). No language restrictions were applied. STUDY SELECTION AND DATA EXTRACTION: RCTs of reflexology delivered by trained reflexologists to patients with specific medical conditions. Condition studied, study design and controls, primary outcome measures, follow-up, and main results were extracted. DATA SYNTHESIS: 18 RCTs met all the inclusion criteria. The studies examined a range of conditions: anovulation, asthma, back pain, dementia, diabetes, cancer, foot oedema in pregnancy, headache, irritable bowel syndrome, menopause, multiple sclerosis, the postoperative state and premenstrual syndrome. There were > 1 studies for asthma, the postoperative state, cancer palliation and multiple sclerosis. Five RCTs yielded positive results. Methodological quality was evaluated using the Jadad scale. The methodological quality was often poor, and sample sizes were generally low. Most higher-quality trials did not generate positive findings. CONCLUSION: The best evidence available to date does not demonstrate convincingly that reflexology is an effective treatment for any medical condition.
Good Old Edzard. How he keeps a straight face whilst reviewing this kind of ridiculous “Prior Probability Zero” nonsense I really don’t know. I am damn sure I wouldn’t be able to.
[An aside to explain why not: a decade or so ago I turned down a final interview for a rather better paid job (better paid than being a junior academic) as a mid-level administrator for a Large and Important Medical Charity. A big part of my decision was that it was clear that an atmosphere of High and Hushed Seriousness was a major part of their Headquarters House Style. It was clear to me that High Seriousness was not something I would be able to stick to for that long, being a person naturally given to Low and Childish Mockery.]
Anyway, getting back to the estimable Professor Ernst, he is a treasure, partly because he is able to do what he does with complete seriousness and great thoroughness. I suggest we should have a slogan for him:
“Prof Edzard Ernst: rigorously appraising Alt.Med research, so that you don’t have to.“
– and, indeed, long may he continue to do so.
Finally – Feynman on Foot Flim-Flam
Anyway, the point of this post, before it got sidetracked, was to say
(i) that Simon Perry gives an excellent talk, and
(ii) that reflexology is (to use a piece of British vernacular) “Bollocks”.
And finally, to re-tell a story.
I happened to ask Simon Perry if he had heard Richard Feynman’s reflexology story. He hadn’t, which makes me think it is not as well known as it could be. So I will reproduce it here. It comes from one of my favourite pieces of Feynman’s debunking work, his famous talk on “Cargo Cult Science”. The talk was given originally in 1974, at the Caltech (California Institute of Technology) Commencement Address, but thirty-six years later it remains just as apposite.
I shall leave the rest to the master:
“During the Middle Ages there were all kinds of crazy ideas, such as that a piece of rhinoceros horn would increase potency. Then a method was discovered for separating the ideas–which was to try one to see if it worked, and if it didn’t work, to eliminate it. This method became organized, of course, into science. And it developed very well, so that we are now in the scientific age. It is such a scientific age, in fact, that we have difficulty in understanding how witch doctors could ever have existed, when nothing that they proposed ever really worked–or very little of it did.
But even today I meet lots of people who sooner or later get me into a conversation about UFOs, or astrology, or some form of mysticism, expanded consciousness, new types of awareness, ESP, and so forth. And I’ve concluded that it’s not a scientific world.
Most people believe so many wonderful things that I decided to investigate why they did. And what has been referred to as my curiosity for investigation has landed me in a difficulty where I found so much junk that I’m overwhelmed. First I started out by investigating various ideas of mysticism and mystic experiences. I went into isolation tanks and got many hours of hallucinations, so I know something about that. Then I went to Esalen, which is a hotbed of this kind of thought (it’s a wonderful place; you should go visit there). Then I became overwhelmed. I didn’t realize how MUCH there was.
At Esalen there are some large baths fed by hot springs situated on a ledge about thirty feet above the ocean. One of my most pleasurable experiences has been to sit in one of those baths and watch the waves crashing onto the rocky slope below, to gaze into the clear blue sky above, and to study a beautiful nude as she quietly appears and settles into the bath with me.
One time I sat down in a bath where there was a beautiful girl sitting with a guy who didn’t seem to know her. Right away I began thinking, “Gee! How am I gonna get started talking to this beautiful nude woman?”
I’m trying to figure out what to say, when the guy says to her, “I’m, uh, studying massage. Could I practice on you?” “Sure,” she says. They get out of the bath and she lies down on a massage table nearby. I think to myself, “What a nifty line! I can never think of anything like that!” He starts to rub her big toe. “I think I feel it,” he says. “I feel a kind of dent–is that the pituitary?” I blurt out, “You’re a helluva long way from the pituitary, man!” They looked at me, horrified–I had blown my cover–and said, “It’s reflexology!”
I quickly closed my eyes and appeared to be meditating.”
Richard P Feynman