Wrapping up my 3 part review of Qigong research abstracts from the gigantic, poorly compiled PDF presented at Spring Forest Qigong’s website, I downloaded one more complete study after finding the abstract interesting. It is a study done on fibromyalgia by Kevin Chen. I’ve previously written about Chen’s research after finding that an abstract mentioning only External Qi Healing also involved massage and “painful acupressure” which were only mentioned in the full study paper. Chen is a Qi Gong practitioner and in his book review on Dr. Yan Xin’s Qigong experiments, displays a greater belief in intercontinental telekinesis than suspicion that Dr. Yan’s asking observers to leave the room during an experiment indicates fraudulent intent to mess with research equipment.
Here’s the fibromyalgia abstract in its entirety:
A pilot study of external qigong therapy for patients with fibromyalgia.
Chen KW, Hassett AL, Hou F, Staller J, Lichtbroun AS.
Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, NJ, USA. firstname.lastname@example.org
OBJECTIVES: Although qigong is an important part of Traditional Chinese medicine (TCM) based on a philosophy similar to acupuncture, few studies of qigong exist in the Western medicine literature. To evaluate qigong therapy as a modality in treating chronic pain conditions such as fibromyalgia syndrome (FMS), we report a pilot trial of 10 women with severe FMS who experienced significant improvement after external qigong therapy (EQT).
DESIGN: Ten patients with FMS completed five to seven sessions of EQT over 3 weeks with pre- and posttreatment assessment and a 3-month follow-up. Each treatment lasted approximately 40 minutes.
OUTCOME MEASURES: Tender point count (TPC)and Fibromyalgia Impact Questionnaire (FIQ) were the primary measures. McGill Pain Questionnaire (MPQ), Beck Depression Inventory (BDI), anxiety, and self-efficacy were the secondary outcomes.
RESULTS: Subjects demonstrated improvement in functioning, pain, and other symptoms. The mean TPC was reduced from 136.6 to 59.5 after EQT treatment; mean MPQ decreased from 27.0 to 7.2; mean FIQ from 70.1 to 37.3; and mean BDI from 24.3 to 8.3 (all p < 0.01). Many subjects reported reductions in other FMS symptoms, and two reported they were completely symptom-free. Results from the 3-month follow-up indicated some slight rebound from the post-treatment measures, but still much better than those observed at baseline.
CONCLUSIONS: Treatment with EQT resulting in complete recovery for some FMS patients suggests that TCM maybe very effective for treating pain and the multiplicity of symptoms associated with FMS. Larger controlled trials of this promising intervention are urgently needed.
Prev Cardiol. 2007 Winter;10(1):22-5.
This abstract clearly presents this research as testing “external Qigong therapy” (EQT) which specifically means a type of distance healing where the healer projects energy (usually from his hands) with the intent to change the energy and health of the subject. Even from this abstract we can tell it’s not a meaningful study, as there is no control group or placebo group, and there were only 10 test subjects. Due to the well-known placebo effects of healing ritual, we should expect all subjects to report improvement. Fibromyalgia is largely a self-reported condition (i.e. there are no lab tests that can get an objective measure on it). Pain is the most likely phenomenon to respond well to placebo.
Here is the entire study paper: http://www.qigonginstitute.org/html/papers/QigongFibroJacm2006.pdf
Note that this is published on the Qigong Institute’s site. Their page for Scientific Papers has many links to Kevin Chen’s articles. In fact, it looks like the majority of actual research (rather than theoretical discussions) is done by Kevin Chen. Therefore it is very important that Kevin Chen has good methodology and honest presentation of results if we are to give credence to the idea that external Qi healing has scientific validation.
Dear reader, I know you are expecting me to drop a bomb after that leading last sentence, and I will not disappoint you. What is the biggest problem with the fibromyalgia “external qigong therapy” study?
EQT treatment by this specific healer consisted of administering acupressure, qi emission, qi balancing, and magnetic cupping on each individual. The following is a brief description of the main steps in the specific EQT of this healer, and the presumed functions of these various steps in the treatment process…
Acupressure and magnetic cupping??!! CUPPING!
The acupressure would have also invalidated this as a test of External Qigong Therapy, but cupping takes the cake. Kevin Chen is either extremely credulous, intentionally deceptive, or (my guess) both. This is the second abstract by Chen that only makes reference to External Qi projection but uses very physical methods only talked about in the full paper.
Here’s what Chen has to say about this study design:
Although we cannot eliminate the possibility that placebo effect or suggestibility explain some of the positive results in this trial due to the lack of a control group and belief in CAM therapy, we are encouraged by the lasting effectiveness of EQT for reducing pain and related symptoms. We started this anecdotal trial without financial support with the intention of testing master Hou’s claim that he could “cure” FMS patients with 12–15 treatments of EQT. None of our patients were paid for their participation, nor were they charged for the EQT treatment. Although we did not carry out the protocol as planned in terms of the number of treatments, the results surprised us as much as the patient participants.
Note that the tested claim was that the healer could “cure” the patients. 2 out of 10 reported a cure, which is a 20% success rate. That’s a fail. Why didn’t they do the full protocol? Why wasn’t there a longer follow-up period (which likely would show the 2 “cures” were not really cured)? Making the conclusions he did shows Chen “moved the goal posts” as they didn’t address the initial intent of the study.
As noted, we cannot exclude the possibility of nonspecific treatment effect such as placebo, psychological effect, or the statistical phenomenon of regression toward the mean (occurring when extreme scores that are invariably measured imperfectly move closer to their average level when measurement is repeated) accounting for part of our positive results. Moreover, it is likely that only patients with confidence in CAM would agree to participate. These patients were motivated and curious about CAM therapy. The other limitations of this open trial are that the sample is too small to be conclusive for any substantial result (n = 10), and that this study was based on a single healer, so it is not clear whether the treatment outcome was due to the specific healer or to the healing technique. It would be particularly helpful if we can involve two or more healers with the same technique in the future study with a larger sample.
Perhaps even more than with acupuncture, we are confronted with the challenge that a well-controlled trial of EQT is difficult to design and implement. Qigong therapy is, in essence, like psychotherapy; the healing is in the interaction between the therapist and the patient. Sham healers have been employed in qigong studies using nonhumans and cell lines.7 It is more difficult in human studies, given the confidence and strong presence the master exudes, as well as the biases of the subjects. In any case, this open trial was a necessary first step in establishing a potential effect in FMS. Given the results herein, properly controlled studies are justified.
Chen has familiarity with basic research design terminology. It is telling that he doesn’t mention cupping or massage as a variable that may have contributed to the results. I bolded the statement that “even more than with acupuncture… a well-controlled trial of [External Qigong Therapy] is difficult to design and implement” because that is quite a ludicrous statement.
For starters, as previously mentioned, if you’re going to test External Qigong Therapy, the first step is to not let the healer touch the patient. That means no massage, and no acupressure. It particularly means NO CUPPING!!! This is not challenging research design, it is basic common sense.
Acupuncture is more difficult to research because of the difficulty of doing a credible placebo treatment. This is because the acupuncturist sticks needles through the skin, and it’s difficult (but not impossible) to fake that. It’s also difficult to rule out any subtle communication cues from an acupuncturist about whether they’re doing “real” points or “sham” points. Slight difference in tone of voice, eye contact, confidence of posture and insertion technique, etc. are “confounding variables.” External Qigong Therapy does not have those problems.
Research design is so simple for External Qigong Therapy that I suspect it’s not done because it won’t produce positive results. Qi healers claim they can alter another person’s physiology without touching them. That could include blood pressure, heart rate, body temperature, etc. Even perception of pain can be a testing target, though it’s very subjective.
Let’s say a Qi healer agrees she should be able to slow a patient’s heart and lower their blood pressure by beaming Qi at their heart through their back from a distance of 1 foot. We’ll use 10 test subjects, 1 healer, and then we need 9 non-healers and a few meter readers. The test subjects can all have high blood pressure or can all be ‘normal’ people. The 10 test subjects sit or lay facing a wall, so they can’t see the healers. They should have earplugs in and blindfolds on to make it better. They all have pulse and blood pressure meters (heck, toss in those neat little blood oxygen sensors on the finger), ideally with wiring that goes to another room so there isn’t a biofeedback effect (of the patient seeing or hearing their heartbeat or blood pressure reading and using that to focus on relaxing to slow it down even more). That wouldn’t matter so much with the 10 patients and the blinding process, but still, we’re trying to set this up as a good study. It’s usually not more expensive to do a good study, it just requires some care and thought. Since a bad study produces no useful results, it is never cost-effective to do one. Bad studies of extraordinary claims just strengthen skepticism and undermine credibility of the entire field, so it’s better to not do a study than to do a poorly designed one.
The test subject is randomly determined by rolling a 10-sided die (or picking a number out of a hat, or by using a computer’s random number generator), and the healer approaches that person at the same time as the non-healers approach the other 9 people. The non-healers should mimic the healer’s body posture, but not give any intent towards the patients (or, in a twist, they can think of raising heart rate and blood pressure). No attempt to talk with the test subjects is allowed, and no touching (especially cupping!). This process can be repeated 10 times to get a nice amount of data to work with. Heck, it could be done with several different healers. One day should be enough to gather more useful data than I’ve seen in 100 other studies. The design is scalable, meaning it could be done with 2 or 3 test subjects or 50 or 100. 10 is a good number for calculating statistics. It would be almost as good without the “sham” healers there (with the blindfolds and earplugs), but it wouldn’t be as well-designed that way.
See, that wasn’t so hard! This is a solid design. If the number-cruncher doesn’t know who got the “real healer” then it can even be said to be double-blind and randomized.
The problem? There is a huge chance it would show no difference. None. Nada. As in, fantasy delusions about projecting magical forces that don’t exist. I would love to be proven wrong about my cynical hunch. In fact, I would love to do this research. It doesn’t matter to me what the conclusion is, as long as the research is well-done. This is what it means to me to be on the side of science: finding the truth is more important than twisting facts to support a dogmatic belief.