From Abracadabra to Zombies
24 July 2011
Thanks for responding so carefully to my letter back in March on Qigong. (See below.)
I have done more reading on the subject. Let me try again as follows.
1. As to the effect of Qigong meditation and exercises on the health of people who practice them, you have stated that you accept the notion that Qigong might make people feel better, but insisted that there is nothing special about Qigong. There are several recent published studies suggesting otherwise.
The Annals of Oncology is one. Here is the url if you do not have ready access to it: http://tinyurl.com/3dzx4rs. This was a randomized controlled trial, the use of Medical Qigong(MQ) compared with usual care to improve the quality of life (QOL) of cancer patients. QOL and fatigue were measured by Functional Assessment of Cancer Therapy—General and Functional Assessment of CancerTherapy—Fatigue, respectively, and mood status by Profile of Mood State. The inflammatory marker serum C-reactive protein (CRP) was monitored serially. Clinically significant, statistically significant improvements were reported in the Medical Qigong treatment group.
A controlled randomized study with repeated measures on fibromyalgia syndrome found similar results. See http://tinyurl.com/3z8lsql.
A study of varsity swim team members found that upper respiratory infections "showed a significant non-linear association with frequency of qigong practice (R2 = 0.33, p < 0.01), with a strong, inverse relationship between practice frequency and symptom scores in swimmers who practised qigong at least once per week (R2 = 0.70, p < 0.01)." See for yourself at: http://tinyurl.com/3j5cwly
The American Cancer Society reports a pilot study from the state of Washington (see http://tinyurl.com/3ww6b45) that compared to two different control groups, "Qigong therapy for 12 weeks resulted in signiﬁcant reductions in fasting glucose levels in patients with type 2 diabetes and demonstrated trends toward improvement in insulin resistance and A1C."
The most arresting studies have to do with measurable changes in blood chemistry among cancer patients receiving chemotherapy. In one study (see http://tinyurl.com/3oebq78 ) the experiment group (n = 32) received a 21-day Chan-Chuang qi-gong therapy, whereas the control group (n = 35) did not. White blood cells, platelet, and hemoglobin were measured on the day before chemotherapy and on days 8, 15, and 22 during chemotherapy. According to this study, there were significant differences in white blood cells (F = 115.76, P <.001), platelets (F = 25.29, P <.001), and hemoglobin (F = 15.39, P <.001) over the 3-week therapy between the experiment and control groups. Chan-Chuang qi-gong therapy may decrease leukopenia in breast cancer patients treated with chemotherapy.
There is more where these came from. It seems to me that it is time to modify your entry to something along the following lines: "Reports from China have made substantial claims about the beneficial effects for people suffering from a range of diseases and disorders if they were taught to perform Qigong exercises and guided meditations. Although I do not accept the Chinese reports as authoritative, for reasons that I have discussed in other sections of this site, the number of traditional controlled studies in recent years justifies this limited claim: Qigong appears to consistently produce positive changes in mood and feelings associated with well being. Such psychological and emotional changes have been found to be associated with improved health outcomes on a variety of diseases and ailments. Therefore, it is not surprising that some association is emerging between Qigong and positive health outcomes, but that proves only that Qigong is a good way to improve one's psychological and emotional state. It cannot, standing alone, be cited as evidence for the proposition that increasing the among of positive "Qi" in one's system is the cause."
reply: Thanks for doing the rewrite, Roger.
2. You have gone further to assert that Qi does not exist.
reply: Not true. I say there's no evidence that qi exists and I say that everything that can be explained by qi can be explained without it. I don't say qi doesn't exist. I don't even know what that claim would mean, since qi is word used to refer to some undetectable "energy" or "force" that can't be detected by any of our most sophisticated instruments.
You state that there have been many similar claims in the past, all of which have been disproved eventually, and therefore the burden of proof is on those who claim that Qi exists to prove it by using conventional measurements. It seems to me that you need to include a citation to the article by Dr. Dr. Kevin W. Chen of the University of New Jersey, who has done a review of the evidence on this point. See http://qigonginstitute.org/html/Chen/Waiqianalysis_0704.pdf. Qigong masters have demonstrated an ability to emit infrasonic sound waves, produce changes in the temperature of their palms and the skin of patients several inches removed, to alter the chemical properties of liquids and cells. While it is correct that many of these studies were done in Asia, the measurements of sound waves, heat, chemical properties and biological properties seem harder to fake than people falling backwards at a party. It appears that people who practice qigong can create effects on the air and on objects near them. However, the effects are so small that they can only be measured by specialized instruments, and there is no reason to think that such small effects, if they are occurring at all, are having any effect on human health.
reply: The authors assume that there are only three possible explanations for their observations: chi, psychological effect, or a known biological process. They reject that any effect observed is either psychological or biological, and then they conclude that it must be chi. Nice try. But I am afraid that investigators outside of China might look at these possibilities a bit differently and a little more critically.
As to the claim that it "appears that people who practice qigong can create effects on the air and on objects near them" I remain skeptical. The evidence is underwhelming.
3. Finally, you insist that "emitted qi," even if it exists, could not possibly have the beneficial effects that have been claimed for it.
reply: I do? I don't know why I would say such a thing. If I did, I take it back.
A small number of controlled studies using animals and animal cells have emerged that ought to make you concede that your conclusions are not as airtight as you previously believed. Take this one, as one example: http://tinyurl.com/3vj79tr Rats are not as suggestible as humans, this study tests the effects of qigong therapy in the treatment of morphine-dependent rats and mice. In three randomized control experiments, morphine-dependent mice, after external qigong(EQ) therapy, had decreased incidence of jumping and lower jumping frequencies, and attenuated loss of body weight. After EQ therapy, morphine-dependent rats had reduced withdrawal scores and body weight loss was inhibited. In the conditioned place preference test, the time spent in the drug-paired box was significantly shorter for the qigong group than for the morphine group. These results suggest that qigong might have an inhibitory effect on withdrawal syndrome, and reduce the dependence potential in mice. Three different designs confirm that the impact of qigong therapy on morphine-abstinent mice and rats is reliable and substantial.
reply: The operative word is 'might.' The results suggest that qigong might ....Then again, it might not. The Journal of Alternative and Complementary Medicine is not a first-tier journal, but if larger studies confirm that qigong therapy can help drug-addicted rats, I might have to change my mind about the power of qigong.
After re-reading your response, it seems that you said, over and over, that people have made claims LIKE these in the past, and some qigong advocates have made outlandish claims, and that settles it. So, I repeat myself: Are you a skeptic or a curmudgeon? To put it another way, how many studies must there be to prove that Qi exists, or that Qigong practitioners are something other than the latest in a long life of charlatans? Or, are you really saying, there is nothing that could convince me unless I can see it with my own eyes?
reply: It seems obvious that if chi existed, one of our machines would have detected it by now. To keep falling back on concepts like "subtle energy" or "qi" to indicate some type of reality that has an explanatory function and then to speculate about manipulating it, controlling it, channeling it, balancing it, harmonizing it, etc. is just multiplying entities unnecessarily.
25 March 2011
I am a lifelong skeptic, consumer of a fair amount of psychology and modern (legal) psychoactive drugs, I recently decided to try out qigong at the suggestion of a friend. to help me with some back problems that have never yielded to modern medical science.
reply: I'm not psychic, but I think I know where this is going. (OK, so I read the rest of your email and don't really need psychic powers to know your intentions.)
Anyway, I want to comment on your claim to being a "lifelong skeptic." It is possible that there are "skeptic genes," genes that promote the production of certain hormones or neurochemicals that result in a personality trait or disposition that manifests itself as skepticism. Can you make a skeptic out of a born dogmatist? Can skepticism be taught? These are interesting questions that your claim brings up, but I don't know enough about the genetics of skepticism to say much of interest about genetic determinants of skepticism. I do know, however, that human societies from families to nations must be built on a foundation of trust. Children are probably naturally disposed to trust those who care for them from their earliest moments outside the womb. My parents and the society they most associated with, St. Patrick's Catholic parish in Joliet, Illinois, instilled in me from birth various ideas I now consider not just false but idiotic. Most of the ideas I'm thinking of in this context were religious ideas concerning God, sin, Satan, salvation, miracles, the Resurrection, the Incarnation, the Trinity, and Transubstantiation. I was also taught to believe in Santa Claus and the Easter Bunny. I have no childhood memory of my being skeptical of the religious notions I was taught, but I do remember taking a peek in the refrigerator on Christmas eve when I was no more than 8. For some reason, I decided to count how many oranges were in the refrigerator on Christmas eve and then again on Christmas day. There were four missing oranges. I have three sisters and we each found an orange in our Christmas stockings. The next year we were living in San Diego on Christmas and oranges were no longer that special. We had them growing on a tree in our back yard, along with guavas, peaches, limes, figs, and macadamia nuts. I may even have spent my first Christmas in California in the sunshine at the beach instead of the freezing cold of Illinois. Who could blame any child for not believing in the goodness of God under such conditions?
I have only one other early childhood memory that might be deemed skeptical, or at least philosophical. I was still living in Joliet when I wondered whether it might not be the case that only Joliet existed and everything else was made up. There was no outside world beyond the borders of Joliet. It was all faked, even the newspaper stories were made up to make us believe another world existed. I don't know how old I was when I had these thoughts, but I know I didn't think of them for very long and never considered this bizarre idea again until I saw the movie Truman. I know I didn't consider this idea seriously by the time I was 8, because it was then that I got on a train with my dad and left Joliet for Chicago to see my first major league baseball game at Wrigley Field. The outside world was definitely real, at least as far as Chicago, and I had no reason to think that somebody would go to all the trouble to make the rest of the planet seem real when it really didn't exist. As I grew to adulthood and began examining the many beliefs I had been taught as a child by my parents and teachers, I rejected all of the religious beliefs and the beliefs about the Easter Bunny and Santa Claus, but I still retain an irrational loyalty to the Cubs.
Now, back to your back pain. I and almost every other member of the human species who doesn't still live in a state of nature knows about back pain firsthand. Our bodies evolved for life on the savannah, not for sitting at school desks, in front of television sets or computers, or in cars, buses, trains, and airplanes. If you were to design a pain-free back for humans living in our civilized societies, you would use a different plan. Another reason we suffer back pain is because we evolved to walk upright. During this process the "human spine has been transformed into a weight bearing column, putting it under unprecedented stresses and dooming us to the likelihood of back injuries and pain."
These inevitable back problems have meant full employment for those who promise relief. Back pain usually resolves itself because when the pain gets greater, we tend to avoid the kinds of things that cause the pain and some of us do things to stretch and relax the muscles in the back. Because of this natural regression with back pain and the likelihood that one will try some pill, treatment, or exercise to get rid of the pain only when it is near its worst point, many things get credit for causing relief when in fact they had nothing to do with it.
From what I know about qigong, the exercises it promotes could well be beneficial to someone with chronic back pain....at least in the short run. One might get the same results, however, from a new bed, new pair of shoes, new chair, doing a few simple stretching exercises every morning or every time the pain flares up (at least for lower back pain). Chiropractors and some New Age energy healers often exploit their customers by getting them to think that because they feel better after the treatment, the treatment should be given credit for the relief even though it may have had little or no effect on the condition.
Anyway, back to your story.
It's pretty easy to knock the more extreme claims of this group, but it seems to me the foundational claim is beyond dispute: When qigong experts teach people to breathe, and when people follow their advice, the overwhelming majority report that they are more relaxed, less stressed and more clear-minded immediately. I am curious to know if you think this statement is an exaggeration. If you do, I'll have to dig out some research.
reply: I don't know if an "overwhelming majority" report these positive benefits. Maybe they do; maybe the experts have selective memories. In any case, it would not surprise me that many people would find breathing exercises relaxing. I've done them myself as a member of the Self-Realization Fellowship some 45 years ago. I recall that, as part of a set of techniques designed to aid meditation, the breathing exercises were relaxing.
Relaxation almost always helps reduce stress, but I can't say that it results in being more clear minded. I'm not even sure what that means or how one would test "clearmindedness," or how you would tell the difference between feeling clear minded and being clear minded. Breathing exercises and meditation helped me feel more focused and less distracted by unpleasant thoughts and perceptions, at least for short periods of time.
If you do accept this as accurate, then what is the next step in a good skeptic's logic train. Isn't it to ask, "why does this work?" and "how?"
reply: Logic train? I don't know about the logic train, but I do know that the benefits of qigong have nothing to do with chi or magical energies. These benefits can be seen in other forms of placebo medicine, such as healing prayer, acupuncture, homeopathy, and many other forms of so-called energy healing.
As skeptics, we want more evidence than a pile of anecdotes. The qigong experts say they are doing something from outside the patient's body to influence what happens inside the patient's body.
So, to explore whether that is possible let's look at the other extreme version of their claims: That qigong experts can influence a patient's body to fight cancer. Here's the link to a recent review of 50 Chinese Studies. This is research funded by the Robert Woods Johnson Foundation, and I doubt they've been taken over by fringies or lunatics. From the abstract: "Although no double-blind clinical trials were found among patient studies, many had a control. The qigong groups showed more improvement or had a better survival rate than conventional methods alone. In vitro studies report the inhibitory effect of qi emission on cancer growth, and in vivo studies find that qigong-treated groups have significantly reduced tumor growth or longer survival among cancer-infected animals." Hmm. Unless the Chinese scientists are a bunch of liars, seems like there is something here, right?
reply: Why stop with the claim that qigong is a healthy alternative to science-based treatments of cancer? You can find many studies in China that tout the benefits of various elements of traditional Chinese medicine. The Wikipedia article on qigong claims that
Qigong practice serves both a preventive and curative function. It is considered to be effective in improving the effects of many chronic conditions such as hypertension, diabetes, allergy, asthma, arthritis, degenerative disk disease, cancer, depression, anxiety and addiction. Qigong works by improving the practitioners’ immunity response, increasing a person’s self-healing and self-recovery capabilities and enhancing one’s self-regeneration potential.
I'm sorry, but there is no compelling scientific evidence that qigong or any other form of energy healing improves the immune system, and there is copious scientific evidence that any increase in self-healing by reduction of stress is no more significant than a placebo. Read Bausell's Snake Oil Science: The Truth about Complementary and Alternative Medicine or Ernst and Singh's The Undeniable Facts about Alternative Medicine.
I also think you're creating a false dichotomy by claiming that either the conclusion of the authors is right or the Chinese scientists are liars. And, you are making a false implication when you imply that the study must have merit because it was funded by a foundation that is not likely controlled by lunatics.
I don't have access to the journal Integrative Cancer Therapies, so I will have to take your word for it as to who funded the study. The fact that the two authors of the study identify their affiliation with the Robert Wood Johnson Medical School indicates to me that they are probably not lunatics. But I know enough about medical schools to know that many of them now cater to so-called integrative medicine. And I know enough about medical doctors to know that many of them adhere to ideas that can't be defended except by appeals to things that can be explained by placebo effects and to general banalities like "science doesn't know everything." (See my entry on the Nobel disease for a list of these M.D.s whose beliefs transcend the empirical evidence by leaps and bounds.) Breast cancer specialist Dr. David Gorski of the blogs Science-Based Medicine and Respectful Insolence has been following this expanding inclusion of non-scientific therapies by medical schools. He gets especially irritated by the kind of work you recommend to me: integrative oncology. I suggest you search his blogs for references to the many schools, including Harvard medical school, that now cater to the "alternative" medicine crowd.
Metastatic deposits of quackademia have infiltrated the University of Texas-M.D. Anderson Cancer Center, UCSF, Memorial Sloan-Kettering, and many others. It's quackademic medicine victorious out there; or at least so it seems.
In any case, I don't have much faith in integrative medicine studies, especially those coming out of China. (See my entry on acupuncture for some comments on Chinese studies on this subject. I don't claim that the Chinese scientists who publish these studies are liars, but I do question their competence and their bias. I think you should, too, just from the fact that the authors "reviewed more than 50 studies of qigong therapy for cancer in China, in 3 categories: clinical studies on cancer patients, in vitro studies on laboratory-prepared cancer cells, and in vivo studies on cancer-infected animals." Obviously, they did not study breathing exercises or any other kinds of exercise when they studied cancer cells in the lab or non-human animals with cancer.
The authors write: "In vitro studies report the inhibitory effect of qi emission on cancer growth, and in vivo studies find that qigong-treated groups have significantly reduced tumor growth or longer survival among cancer-infected animals." This claim raises no red flags with you? What the heck is "qi emission"? and how do you think it is observed or measured? The claim about animals I take to mean that somebody claiming to be able to manipulate chi (ki) in some way performed his magic over the animals. Then some way of evaluating the size of different tumors in different animals was used to determine which shrunk the most. You might be willing to accept at face value the claim that the chi-treated animals lived longer and that is good evidence for the effectiveness of qigong, but I have a few questions. How many animals were studied? Were they randomly assigned to a chi group or a control group? Were they screened so that their tumors were of the same kind and the same size to begin with? If you are familiar with the kind of work that finds its way into journals in China that advocate traditional Chinese medicine (TCM), then you should be somewhat skeptical of these claims. You might also like to know that Mao never used TCM and those in power today who promote the use of TCM never use it. They take advantage of science-based medicine. I guarantee you that when King Abdulla of Saudi Arabia, or any other of the world's richest men, needs top medical care, he doesn't fly to China.
That leaves the clinical studies on cancer patients to examine. A double-blind trial is essential, especially with TCM studies where there is a long history of biased observation and inadequate controls. It would not be difficult to randomly assign cancer patients to a qigong group and a control group. They should be evaluated before the study begins and after the study ends by someone who does not know which group they are in. The evaluator should have no contact with the treating qigongers or their supervisors. There should be a large number in the study and both groups should receive the best that science-based medicine has to offer in addition to real or fake or no qigong. I'm sorry, but I am not willing to assume that these controls were in place in the Chinese studies.
I also doubt that the authors could have gotten this paper published in a first-tier cancer journal, but that is another story.
But it wasn't double blind, the gold standard. OK, look at this one, a randomized control trial on the effect of qigong on patient's fatigue, mood, and inflammation (as measured by a protein) while being treated for cancer. Again, from the abstract: Conclusions: This study indicates that MQ [medical qigong] can improve cancer patients’ overall QOL and mood status and reduce specific side-effects of treatment. It may also produce physical benefits in the long term through reduced inflammation."
As a former profession [?] you will appreciate the level of statistical significance between the groups: "Results: Regression analysis indicated that the MQ group significantly improved overall QOL (t144=−5.761, P<0.001), fatigue (t153=−5.621, P<0.001), mood disturbance (t122 =2.346, P=0.021) and inflammation (CRP) (t99=2.042, P<0.044) compared with usual care after controlling for baseline variables."
reply: Again, I don't have access to the article, but I do know that as long as I have no idea what exactly the MQ consisted of and as long as I have nothing to compare the MQ group to except a group that got standard care and nothing else, I have no reason to believe that what was measured had anything to do with chi. The effects could be placebo effects or they could be effects that arose from getting the extra care and attention, patient expectation, relaxation, or ? To be meaningful, the MQ group would have to be compared not to a group that received no extra care but to a group that receive sham MQ. If you don't understand why, please read my entry on sham acupuncture. The same kind of mistake is made in many acupuncture studies. The researchers compare the acupuncture group to a group that didn't get acupuncture instead of to a group that received sham acupuncture. Those researchers who use sham acupuncture have found that effects they thought were due to acupuncture were placebo effects, i.e., effects that came from such things as patient expectation, the effect of the ritual, relaxation, etc.
Then there is a recent sleep study, which found as follows: "Our findings revealed that while the practice of qigong for one month did not alter serum cytokines, it enhanced psychological well-being, including sleep duration." Now, if they had been testing a pill, and the people who invented the pill said it would help people have enhanced psychological well-being and sleep duration," we'd say that the pill helped them even if we weren't sure how. Isn't that correct "skeptical" thinking?
reply: Correct thinking wouldn't credit a pill with enhancing psychological well-being or sleep duration unless it was tested under rigorous conditions. The study would have to involve a significant number of subjects (at least 100) and would have to be replicated. The study would have to be randomized and double-blind. One group would receive the pill and the other group would receive a placebo that looks like the pill and is taken the same way the pill is. Neither group would know whether they were getting the pill or the placebo. The researcher who keeps track of who is in which group would not be the one who evaluates the data. Once the data have been evaluated, the unblinding can take place. If there is a statistically significant difference between the two groups, then we would say that the hypothesis that the pill enhances psychological well-being and sleep duration has been confirmed. Sleep duration is quantitative and should be a simple matter to define and keep track of. Psychological well-being is trickier, but some sort of instrument would have to be used that measures it and measurements would have to take place before and after the test. The length of the test would have to be specified in advance.
Here's a recent review of the literature on qigong and depression in the Journal of Health Psychology (I think it's peer-reviewed): "Qigong, a Chinese mindful exercise, is demonstrated to have anti-depressive effects. Results of our earlier studies shed light on the psychological mechanism underlying this effect. The neurobiological mechanism remains unclear. This article attempts to review extant evidence and suggests possible neurobiological pathways of the anti-depressive effect of qigong based on the neurotransmitter, neuroendocrine, and neurotropic perspectives. Further research to consolidate its scientific base is suggested."
reply: The abstract doesn't describe exactly what was demonstrated. By that I mean it doesn't go into detail what the qigong consisted of. Just what mindful exercises were involved? Breathing exercises? Tai chi type exercises?
Also, the study was done on geriatric patients. No mention of how many were involved in the study, whether they were randomized, whether a control group of any kind was used, how long the study went on, and what tools were used to measure the "anti-depressive effects." I would add, however, that I would not be surprised if tai chi type exercises proved effective in reducing depression in elderly people. Many elderly people have problems with balance, movement, and exercise. I have watched groups of elderly (and younger) people do these exercises in a public park. They're quite intriguing and seem to be perfect for those with limited movement and agility. There is a gracefulness and serenity about tai chi groups, young and old, that is blissful to watch. But I don't see why they have to bring chi into it.
So, I'm wondering: Are you a skeptic or just a curmudgeon? The latter is OK, by the way. Curmudgeons are a useful part of any society. But, it seems to me that a skeptic would include something like this in his blog: "OK, there is enough evidence out there to suggest that some form of practices labeled "qigong" helps some people with cancer have less fatigue, better moods, a better quality of life and causes their bodies to produce proteins that fight inflammation during treatment. Apparently it helps to reduce depression (or at least the symptoms of depression) in some people. And, ok, a month of qigong classes apparently helps some people overcome problems associated with a lack of sleep. I still don't buy the claim that the qigong "doctors" are "emitting qi" or "removing toxic qi" or anything else until and unless somebody can show me an instrument that can consistently measure qi. Until then, I am entitled to the position that qigong experts are inducing something like the placebo effect in some people, probably those who are the most susceptible to suggestion. I'm open to being proved wrong, but, please, no more tearful anecdotes about miracle cures. Let's see some evidence." I'll be looking for your post. Are you really a skeptic? Or just a curmudgeon?
Adjunct Professor of Law
reply: Maybe I'm a bit of both. I will say that your comments made me reexamine the entry on qigong. I should add links to some of the other articles I've posted on placebo effects, energy medicine, etc. I remain unconvinced, however, that qigong is good medicine for any serious disorder like cancer, but I agree that just about any exercise that enhances relaxation and reduces stress will benefit well-being.
July 22, 2008
I like your website very much, since critical thinking is what I really like. However, I don't think your article about chi has done its job. It's too short and does not explore all forms or claims about chi.
reply: Thank you. I always like to hear from people who like critical thinking. (The writer's first language is obviously not English. I've cleaned up his email and did my best to figure out what he was trying to say.)
Chi is a controversial subject. Many people claim to have control over it and to possess some supernormal abilities. No-touch knock down is just one of the claims that should not be claimed, based on my knowledge about chi. However, other claims, like the ability to generate heat without instruments or to heal are different. Heating is easier to replicate. Healing could happen, in my opinion, but not with empirical precision. Chi affects another body ... to reorganize it into the way it should be. But the target bodies are not the same, so the effect is not so certain. But there are several experiments that have been caught on tape by some people with sound logic and common sense, and those seem to be repeatable.
Often the best trick (or in this case the highest secret) is to do something that is not public. Say you have a very good trick to sell more product. You will only pass it to someone, in many cases, to only one person you really trust. So, we have a small sample problem.
Chi could be controlled but by some very very few people, and many people claim they can do so. Many claims cannot supported by people who say it, but some can by some very special people.
Here are two videos I hope you will look into and produce a more critical article.
reply: I think you are on your way to understanding chi when you mention the "best trick." Take a look at this video:
What Tam and eyewitnesses with cameras have observed are some tricksters engaging in deliberate deception but claiming not to be using tricks. The difference between these deceivers and real magicians is that the latter are honest. They tell you they are deceiving you.