The classical Greek physician Hippocrates is considered the father of modern medicine and is credited for believing that disease was caused naturally and not due to supernatural forces or the gods. With this idea, medicine as a body of knowledge began its journey into the realm of science and the scientific method to drive medical understanding and therapeutic practice.
The modern expression of this idea is the use of evidence-based medicine that leverages the best evidence from well designed and executed clinical research to drive clinical decision-making. The “evidence” is derived from the precise application of the scientific method that is based on empiricism or measurement to obtain information to test hypotheses about the physical and observable world. From this data various hypotheses about disease or treatment are rejected, modified or expanded. If the idea in question cannot be subjected to testing and empirical observation or measurement, it is set aside as material for philosophy or religion; or perhaps until scientific advances allow empirical observation or measurement of the idea. Science and the scientific method are the foundation of the house of medicine, and medical language springs from the application of these principles. The marriage of science and medicine has made all the difference, and the improvements to the human condition have been, to put it mildly, miraculous.
I recently had the good fortune to attend and speak at the American Massage Therapy Association (AMTA) 2016 National Meeting in Milwaukee, WI, this past October. The opening ceremony keynote speaker was Robin Roberts of ABC’s “Good Morning America,” who described how massage helped with her battle with breast cancer. I was surprised and impressed to learn that AMTA’s membership tops over 70,000 massage therapists. As a physician and anesthesiologist, I was indeed a “rare bird” at this particular convention.
In full disclosure, I work for my wife as her medical acupuncturist in her massage practice, since we find the combination of massage and acupuncture so effective for patients suffering from musculoskeletal pain. We had the good fortune to serve as subject matter experts on a series of systematic reviews detailing the medical evidence in support of massage therapy for treating pain in the general population,1 pain in cancer patients2 and post-surgical pain.3 The systematic review process was hosted by AMTA and the Samueli Institute (methodological details of the systematic review are available in the manuscripts).
A systematic review of a particular medical topic, in this case massage therapy for managing pain, is a critical review of existing research manuscripts from reputable peer reviewed journals that allows pooling of the data through statistical means to make general statements about the effectiveness (or lack thereof) of a given medical therapy. Systematic reviews of well-controlled medical trials are considered to be the best type of evidence upon which to base therapeutic treatment decisions. Admittedly, because the randomized trials from which these reviews are developed are produced by human medical researchers, they are subject to the same flaws and mistakes that plague all human endeavors. Nevertheless, because these results are derived from observable and measurable phenomena, the results can be re-evaluated and validated by other researchers. This is a central tenet of the scientific method: The results must be published in such a way that any researcher could reproduce the medical experiment and be reasonably certain to obtain similar results.
I was at the AMTA meeting to congratulate the organization on publishing these important reviews in the journal Pain Medicine. This scholarly effort has provided the medical establishment hard evidence supporting the use of massage therapy for pain that was in a language the community of medicine could not only understand but could not ignore. I also was providing a lecture on the importance of clinical research in support of AMTA’s goals of bringing massage into the medical mainstream.
Interestingly, despite the organization’s important step forward for making massage therapy an accepted partner in the house of medicine, this community was still rooted in too many ideas with no basis in science. This issue was most apparent in the meeting vendor hall. Pam and I visited with various vendors peddling everything from creams and vibrating metal bowls to warming blankets filled with purple crystals, and all these products were accompanied by a laundry list of health benefits. My wife was merciless with each vender, attentively listening to claims of the product’s benefits and then demanding to see the “evidence.” Many of the vendors seemed willing to do research but were unsure how to get started. I also noticed all manner of claims being backed up with discussions of improvements in my energy flow, opening of meridians or improvements in my chakras.
During my lecture, I cautioned my audience (as I will caution the reader now) that, despite the age, beauty and poetry associated with belief in energy flows, meridians, chakras and the like, these words have little to no meaning in the house of medicine. I imagine at the end of my talk there were more than a few who wanted to tear me a new chakra as I challenged these deeply-held beliefs. I am often admonished by those who hold these ideas as self evident that medicine and medicine’s instruments of measure are just not sophisticated enough to understand chakras or similar constructs. This is an argument I cannot beat because truly I am unaware of anything that can detect or measure a chakra. Therefore, while I can appreciate the beauty in the idea of chakras, this untestable theory cannot count as medical evidence. Since medical evidence is the currency of the house of medicine, clinging to these arcane terms to describe the benefit of any proposed therapeutic practice or device becomes confused and ultimately rejected by the medical establishment. Sadly, I believe the benefits of many integrative medicine techniques are lost to patients because of the insistence of some who adhere to language and ideas that defy explanation through science.
I was often asked during the meeting why massage was not being embraced by the medical establishment. I feel the reasons, like most problems in our society, boil down to breakdowns in communication. American medicine is the envy of the world, and it uses a specific language forged from the rigors of the scientific method. I am a member of this house, and I am the first to admit that it is far from perfect, but it contains truth that can be measured and observed. I fervently believe that medicine would be improved with the inculcation of massage into routine practice. For this to happen, the massage community and integrative medicine community in general will have to speak the language that the house of medicine understands. That language is science.
An old Arabian proverb says, “If the camel once gets his nose in the tent, the body will soon follow.” As I explained to my AMTA audience, if they would embrace the language of science when speaking to the house of medicine to get their “nose” under medicine’s “tent flap,” the rest of the profession to include those nontestable, beautiful ideas will soon follow. This is good advice for integrative medicine generally, as we try to get these therapies integrated into our medical tradition. As AMTA has demonstrated so eloquently with their Pain Medicine systematic reviews, the science is there. The question is whether massage therapy or any integrative practice can overcome its own hubris and learn to speak the language of medicine.
1Crawford, Cindy, et al. “The impact of massage therapy on function in pain populations—A systematic review and meta-analysis of randomized controlled trials: Part I, patients experiencing pain in the general population.” Pain Medicine (2016): pnw099.
2Boyd C, et al. “The Impact of Massage Therapy on Function in Pain Populations—A Systematic Review and Meta-analysis of Randomized Controlled Trials: Part II, Cancer Pain Populations.” Pain Medicine. (2016): pnw100.
3Boyd C, et al. “The Impact of Massage Therapy on Function in Pain Populations—A Systematic Review and Meta-analysis of Randomized Controlled Trials: Part III, Surgical Pain Populations.” Pain Medicine. (2016): pnw101.