We in the British Columbia Skeptics have been stung a number of times in this way. Our longtime supporters will probably recall the case of Linda Pitney, the Toronto graphologist who surfaced in the wake of The Write Stuff, the book debunking handwriting analysis my brother Dale and I published in 1992. Pitney contacted us via a national radio program we were on. She congratulated us for helping to weed out the many unqualified amateurs, crooks, and charlatans in the graphology business and grandly volunteered to show us what a “scientifically trained” graphologist like herself could accomplish. Dale and I set about designing the testing protocols and Pitney set about milking the media for free publicity for herself, based on her consent to the upcoming trials. Since all claimants must agree in advance that a proposed measure is a fair and adequate test of what they say they can do, they must be involved from the outset. Pitney strung us along for quite a while, gathering more publicity while she dragged things out with increasingly irrelevant quibbles. Once she began attributing our refusal to weaken the experimental controls to bias on our part, it became apparent that she was not going to agree to a decisive test of her abilities and negotiations broke off. Nonetheless, we heard from members of the Ontario Skeptics that Pitney continued to trade for quite some time thereafter on her assertion that she was about to take part in a scientific test to be run by the BC Skeptics.

Our long-suffering friends will probably also recall the infamous case of the Vancouver qi gong master, Mr. Ge. Mr. Ge, a recent immigrant from China, made all the usual claims of this nonsensical sect and offered to back them up with a demonstration before a meeting of the BC Skeptics. We said that he could address the group as he wished, as long as he consented to being tested after his talk. One of his many fanciful declarations was that he could beam his mystical qi energy into pure water, imparting a sweet taste to it. This seemed like the sort of thing that was amenable to a test at one of our meetings, so my then-graduate student Elliot Marchant and I set out to design a double-blind trial. We obtained two vials of distilled water from the Simon Fraser University Chemistry Department. On the night of his talk, Mr. Ge was to have beamed his qi into either (randomly chosen) vial A or vial B. This would be in Elliot’s presence, but out of sight of the audience and me. I was then supposed to administer with an eye dropper to the tongues of audience members a drop of first one then the other liquid, in randomized order. Each participant would have been required to guess which of the pair was the “irradiated,” and hence now sweet, droplet. At the end of the trial, the code was to be broken and we would have seen if the audience did any better than chance in telling which vial had received Mr. Ge’s ministrations. We’ll never know the result, because Mr. Ge didn’t live up to his end of the bargain. We agreed that he would have forty-five minutes to tell us anything he wanted us to know about the history and achievements of qi gong, to be followed by the test, whose exact procedures he had promised to follow. After rambling on for more than two hours in the most disjointed and vacuous lecture I think our group has ever had to suffer through, Mr. Ge announced that it was now too late in the evening; he was exhausted and wouldn’t be able to do the test after all. His qi was just too drained to proceed. We remained civil in the face of this cop-out and he promised to make himself available for testing at a later date. We phoned him repeatedly after that, but there was always some reason why he just couldn’t make it. We’re still waiting and he’s still taking credit for having taken on the skeptics on their own turf.

Which brings me to our latest drubbing. One day last year I received a phone call at my office. A Mr. Frank McL. (we’ll call him “Big Mac” for short—I promised him anonymity) wanted to tell me about the miraculous diagnostic abilities of his psychic teenaged son (we’ll call him “McNugget”). Apparently, several local physicians (none of whom had agreed to be quoted or contacted, of course) had been impressed with McNugget’s astounding ability to diagnose illnesses, not only from a brief visual inspection of a fully-clothed patient, but even from a photo of said sufferer! Now, I get several crank phone calls a week and I was rushed and harried that day, as usual. In my invariably polite way though, I declined to investigate his son because, I said, I had seen too many failed demonstrations of this sort in the past. Big Mac responded in a hurt voice, saying that apparently I wasn’t the fair-minded skeptic he’d been told I was, because I was obviously too closed-minded to examine the evidence when it was being offered. Bang! He had me. Citing (real and pressing) time constraints, I said I wouldn’t be able to get to McNugget until after the current Semester-from-Hell was over. He said that would be okay and that he’d call to remind me (which he did practically on a weekly basis, by phone or e-mail).

During one of these pestering phone calls, Big Mac suggested we do a preliminary test, because McNugget could diagnose from photographs too, as he reminded me. I asked if he needed a full body likeness, but Big Mac said no, a head-and-shoulders one would do. So I suggested that they go to the Simon Frazer University Web site and download my photo and see what McNugget could come up with. Big Mac agreed and I gently resisted his efforts to pump me for a few clues as to what kinds of infirmities I might be subject to—he did manage to worm out of me the useful admission that I was in pretty good health overall though. I kicked myself afterwards for falling for that sucker punch. When Big Mac got back to me by e-mail a few days later, McNugget’s “diagnoses” were even more vague and open to retrofitting than I had expected. To the best of my recollection, this was the first time Big Mac had also asserted that his son could heal as well as diagnose. Here’s what he had had to say:

Hello Dr. Beyerstein,
As per our phone conversation I had my son take a long distance look at your body’s energy using your picture from SFU. He said that there really wasn’t anything major. He found some problems in your upper neck that went down to your right shoulder; some small problem in the tailbone; little bit in your knees (but not bad). He did say that if you were going to notice anything it would be down the front of both legs from hips to above the knees. I ask [sic] him to take a close second look and he said he found a slight foggy green in the chest area but very slight. All in all you look pretty good compared to some of the people we have been looking at. If any of these areas are problems for you, please let us know and we will fix it up.

F.M.

Recall that I had already told them I was a pretty healthy puppy. The things McNugget thought were wrong with me were way wide of the mark, even allowing for his generous built-in fudge factor. He didn’t identify the minor complaints I do have (which will have to remain secret in case I am dumb enough to get drawn into this kind of mug’s game again at some future date). Big Mac seemed quite surprised that I wasn’t impressed and perhaps I didn’t let him down as gently as I ought to have if I had really wanted to retain their cooperation. At any rate, I told him we were preparing a proper in-person test session and we began to discuss procedures and how the test could be worked around McNugget’s school schedule. Big Mac was quite concerned that his son’s gifts not be revealed to his school chums for fear of ridicule, hence the anonymity rule. Graduate student Ian Webb, my brother Dale, and I had begun assembling a group of people with various unobtrusive afflictions. At this point, I detected the first note of worry in Big Mac’s voice—he obviously wasn’t prepared for what a genuine test would entail.

Unbeknownst to me, however, Big Mac had already begun scheming behind my back. Though I might not have been moving as quickly as the Mac clan had wished, I had very firmly agreed to get the test rolling—and had begun to do so. Nonetheless, Big Mac decided to contact Dr. Bruce Clayman, SFU’s Vice President for Research, to complain. In his e-mail, he impugned the intellectual curiosity and questioned the open-mindedness of certain un-named SFU faculty. Luckily, Bruce Clayman is a friend and an ardent supporter of the skeptical movement. An eminent physicist before becoming vice president, Bruce and I had actually collaborated on some research years ago. He suspected immediately to whom Big Mac was alluding and forwarded the Big Mac attack to me. I replied to Bruce that I had in fact set things in motion before this had been sent to him and he responded to Big Mac with a marvelously terse rejoinder, copied to me. It was fun watching Big Mac try to squirm out of this embarrassment with one lame excuse after another, but it was sobering to think that, had his missive not ended up on the desk of a good friend and ally in the senior administration, his duplicity could have had unfortunate consequences for my reputation in the university.

At this point, enter McNugget’s mother, MacMom. Even though Big Mac had been a bit slow on the uptake regarding what a valid test would entail, MacMom had quickly sensed that McNugget might be getting in over his head. My less than enthusiastic endorsement of the preliminary “test” results had obviously set off her alarms. Believing that the best defense is a good offense, MacMom phoned to demand that I justify the enormous privilege I was being granted in getting a peek at their gifted son. Her holier-than-thou demeanor at this late stage was rather off-putting, but I decided to ignore her rude and condescending manner. MacMom said she had done some checking on me on the Internet (finally!), and she wasn’t quite sure I was the sort of fair witness they had been looking for. I seemed terribly negative and (horrors!) biased, she said. MacMom seemed inordinately interested in whether I had any religious or spiritual beliefs, as if that mattered for what they had been persistently begging me to do for them. Her son was a sensitive soul, she said, and she wasn’t sure he could perform adequately under the cold-hearted, sterile conditions we were imposing. All we had asked (and they initially agreed to) was that McNugget present himself at our lab where we would have assembled fifteen or twenty volunteers with properly-diagnosed and documented medical conditions—ones that would have no obvious outward signs like an arm in a sling or a death-rattle cough. McNugget would not be allowed to pump them for information, just look them over, as the MacFamily had repeatedly assured me would be sufficient. McNugget would then be asked to check off for each of our volunteers those items that he thought applied to each person, from a very specific symptom checklist we had devised. I had also insisted that the whole proceeding be videotaped, to deal with the expected attempts to wiggle out of the results with ad hoc pettifogging at a later date. MacMom and I sparred a bit more on the phone and she said they’d have to “think it over.” That is, decide whether to renege on what Big Mac had already firmly agreed to.

A few days later, I received the following e-mail from Big Mac:

Hello Dr. Beyerstein,

I appreciate all the time you have given us. We have done some research on some of your studies and have decided that we will not put our son through this type of test. My son who is 15 said that he probably could put a fire in your hand and you would deny that it exists. He feels that you have years of reputation as a skeptic that would have to be thrown out the window when you witness what he does. We have met with qigong experts as well as a grand master and we didn’t see anything that comes near to what my son is capable of doing. The qigong masters were quit [sic] impressed with what he does. [I had told Big Mac about the disappointing results with various qi gong masters I had seen in China and in Vancouver.] Anyone can design a test to disprove just about anything.

Maybe if you could witness what he does and set out to prove that he does have this ability then we would be interested. But I know that won’t happen. It is a shame that intellectuals like yourself are wasting precious time to disprove everything. I first approached you with the idea that I could get some professional advice as to what is happening with my son. I am not really interested in making a circus show out of him. He is connecting to people and is able to see inside their bodies. Do you really think that we would be imagining this. We are a typical suburban family that has had their lives changed forever because of this. I don’t understand what is going on with him but I do know that it is real. I think we would be better off connecting with people who are truly interested in the science behind this phenomenon. Why can’t I just get a psychologist to look at him and advice [sic] what is happening rather than someone who is trying to disprove it. You are welcome to visit us anytime you feel you can come outside the paradigm. I am not saying that in a negative sense, we all have paradigms that we live within. It just so happens that our son has shifted the boundaries of our paradigm forever. Please excuse me if I sound brash in this letter. You have to put yourself in our shoes and imagine what it is like to endlessly try to convince people of something that you witness every day.

Thanks again for your time,

F.M.

So, after hectoring me for months, demanding my participation, the MacFamily backed out, claiming they are the open-minded ones and I am the one who refuses to challenge his entrenched beliefs. The following was my reply:

Dear Mr. McL[ . . . ]:

I’m sorry you feel this way about our proposed test of your son’s psychic diagnostic abilities. What I suggested to you was simply the standard way the scientific community always goes about investigating any claim; nothing more or less. The burden of proof is always on the claimant. It’s not up to the skeptic to prove the claimant wrong. I never proceed on that basis. It’s the job of the person who wishes his or her assertions to be accepted to supply satisfactory evidence. It is the job of the fair-minded but properly skeptical scientist to provide an opportunity for someone who claims to be able to do something to demonstrate it under conditions that control for the very human tendency we all have to see what we expect or want to see when we make informal, unblinded observations.

Without that kind of evidence, no one in the scientific community takes any claim seriously, whether it’s in conventional areas of research or in ones that seem to defy scientific orthodoxy. Despite what you and your son may feel about my objectivity toward such claims, I assure you I would change my mind if the data, collected with sufficient safeguards against error and fraud, warranted it.

In fact, the fame and fortune that would accrue to me for being the one who finally produced scientifically acceptable proof of such a phenomenon would be more than sufficient to compensate for any temporary embarrassment I’d experience in having to eat a bit of crow. Fraud has rarely been involved in my personal experience with such tests, but my testing of such claims over the past 25 years has shown me that subtle forms of self-delusion (that are part of the psychological make-up of each and every one of us, and which the controls I proposed help to eliminate) must be ruled out before accepting any fringe claim.

The last 100 years of psychological research on human cognitive biases, belief systems, and self-deception makes it quite clear that honest, sincere, intelligent, and well-educated people can easily fool themselves into believing what they hope to be the case if these controls are not in place before proceeding with an investigation. The infamous “N-Ray” episode is but one example of where even highly competent scientists have duped themselves. These procedures are just as necessary to control for the alleged biases of skeptics as those of the true-believers. Only then can the data speak for themselves.

It doesn’t matter what the observers’ preconceptions, hopes, or biases are if these controls are tight enough. It’s as the novelist Primo Levi once said, “Science respects what is.” You accuse me of not being open-minded. Open-mindedness requires nothing more than providing a fair opportunity for the claimant to demonstrate what he or she can do, under conditions that minimize the kind of cognitive slippages that can make things seem to be what they are not. It is not mere bias, as you seem to assume, to insist that such criteria be met before assenting to a claim. We demand no less of those who would try to sell us a used car.

In declining to take my friend James Randi up on his offer to pay US$1,000,000 to anyone who can perform satisfactorily under controlled conditions like the ones I proposed, those who talk big then duck his challenge typically cite the same concerns expressed by your son. However, in Randi’s tests the final decision on success or failure is actually made by an independent panel agreed upon in advance by Randi and the claimant, so it does not matter if Randi accepts the claim in the end or not. Still, the money, so far, has remained in the bank. If we could both agree on a similarly constituted panel who had the requisite knowledge and competence to oversee a test of your son under mutually-agreed upon experimental conditions, that would be a possibility we could discuss further.

The test I suggested to you would hardly have been a “circus,” as you suggest. That would defeat the purpose of the investigation, which is to arrive at the truth of the matter under believable conditions. A claimant cannot be expected to “strut his or her stuff” in an atmosphere that is not calm, orderly, and mutually respectful, with all procedures and end-points agreed upon by both parties in advance and strictly adhered to throughout. I am confident that if you were to ask anyone whom I have tested in the past, he or she would agree that I and my colleagues are low-key, courteous, and respectful in dealing with those we test. One such individual even said on a CBC radio program we were on that, even though she failed, I was the nicest skeptic she had ever met.

I have never publicly ridiculed any of the people I have tested, even though none has been able to pass the various tests we have conducted. To act otherwise would be counterproductive, for if we wish people to cooperate in future tests we must have a reputation for fairness and congeniality. In my opinion, it is a cop-out and, frankly, a bit insulting to claim I wouldn’t believe the data if they unambiguously supported your case. On the other hand, if someone makes a claim to have special abilities, but declines to demonstrate them under scientifically rigorous, but polite and non-threatening conditions, it raises serious doubts about the validity of the claim. Since in properly conducted tests all procedures must be agreed to by both parties in advance, the claimant gets to stipulate what the acceptable atmosphere will be. If all provisions are not agreeable to both sides, the test doesn’t proceed.

Seeking to have claims verified only by someone who wants to believe in the phenomenon in question will not get you very far, in my opinion, unless he or she includes the kinds of controls I am advocating (which, in my experience, believers rarely understand or employ). If the proper controls are in place, it doesn’t matter if the test is conducted by believers or skeptics. Without such safeguards, however, the tendency that we all suffer from that makes us jump to congenial conclusions is too powerful to permit a believable investigation.

As for your imputation that the scientific community has no interest in what might underlie such abilities, I would suggest that it is premature to look for underlying mechanisms before the phenomenon itself is established. Science only tries to explain that which can be reliably demonstrated. If the demonstrations were believable, however, I assure you the scientific community would be very interested because the implications for the entire metaphysical foundations of science would be enormous. If a putative phenomenon flies in the face of other well-established data in science, however, the community is well-advised to demand a higher standard of proof before accepting the claim. That is standard procedure and why I agreed to look at your son’s abilities in the first place.

I remind you that you approached me on this matter and you were quite persistent and even approached the Vice-President of my university who asked me why I wasn’t responding to your requests (which I had done). I agreed to be shown what you say your son can do. My colleagues and I remain willing to test his abilities in the time-honored tradition of such scientific investigations, if you would care to reconsider our offer.

With regards,

Barry Beyerstein

For some reason, I never got a reply.

Heretofore largely ignored by Western philosophers of any stature, the traditionally associated (but logically independent) doctrines of reincarnation and Karma are thoroughly examined in Paul Edwards’ enjoyable and encyclopedic treatise. Edwards proceeds with his usual precision to expose the hidden assumptions, the empirical flaws, and the often unpalatable implications of these teachings that, on the surface, can seem quite appealing. It is always a pleasure to watch an incisive thinker cut right to the heart of an issue and then proceed to lay out its logical consequents in clear and concise prose. It is a double treat if that exposition is accomplished with wit and flair, as is the case here. One all too rarely gets the bonus of chuckling through a detailed and cogent analysis by an eminent philosopher. Take for instance this example of the twinkle in the scholar’s eye that appears on page 18: “It seems ludicrous that something as important as creation of a soul that is going to exist forever should be tied to such accidents as the failure of a birth-control appliance.”

The belief that some essence of ourselves survives bodily death is perhaps the most comforting of all spiritual leanings. It has provided reassurance for human beings probably since our ancestors first evolved brains of sufficient complexity to anticipate the future and contemplate their own mortality. The solace provided by any sort of expectation of an afterlife would probably have been sufficient to assure its undiminished popularity all by itself, but, as Edwards points out, the version of immortality preached by most reincarnationists offers yet another enticement. Belief in reincarnation feeds not only the hope for life beyond the grave, but in conjunction with its frequent fellow traveler, the “law” of Karma, it also provides apparent support for another widespread human longing, the desire to believe that we inhabit a just universe.

The warm glow this solution provides for believers diverts their attention from the many inherent conceptual and practical difficulties that Edwards lays bare in this book. For instance, a major difficulty for reincarnationists is what he calls the “modus operandi” problem. For magical thinkers, just imagining something can bring it about. But for the rest of us, there is the inconvenient need for a plausible chain of causal mechanisms before we can grant the likelihood of any given phenomenon. With the many advances in scientific understanding since the formulative days of the reincarnation story, it has become increasingly difficult even to conceive of a reasonable mechanism whereby a bodily attribute (such as a birthmark or deformity, which are afforded much attention in reincarnationist circles) or a mental property such as knowledge, a personality trait, or an inclination, could be packaged up at the end of one person’s lifetime, held in abeyance in non-physical form between incarnations (the “interregnum problem”) and finally implanted in a fetus in its mother’s womb in preparation for another revolution of the eternal carousel. It likewise strains credulity to accept the requirement that detailed tallies of every good and bad deed committed by every person who ever lived could be kept somewhere and weighed, let alone harnessed to transgenerational retributive mechanisms as diverse as earthquakes, bacteria, raging bulls, lightning bolts, or a large, ill-tempered bar patron named Bob.

The Canadian psychologist Melvin Lerner and his colleagues have studied various psychological needs that make the idea of transcendental fairness enforcers such as Karma perennially attractive. Lerner describes a number of payoffs for believing in what he calls the “just world hypothesis,” i.e., the soothing notion that, in life, people generally get what they deserve and deserve what they get. Many of us rebel emotionally at the realization -- easily prompted by a quick glance at the daily headlines -- that the plums and brickbats of life seem to be somewhat randomly apportioned, morally speaking. Apparently, it is too threatening for a large portion of the populace to admit that, no matter how long and hard one has tried to do the right thing, the driver of that approaching bus could still be just about to doze off. It is this motivation to salvage belief in a hidden hand that metes out deserved rewards and punishments on a cosmic scale that explains the unsavory but widely observed tendency to derogate apparently innocent victims. For example, “She must have dressed or behaved provocatively or she wouldn't have been raped, would she?”

With adult victims of misfortune, it is often sufficient merely to distort our perception of the worthiness of the individual to preserve our belief in a just world, but what of infants afflicted with excruciating and disfiguring diseases, or children orphaned and tortured by the perpetrators of “ethnic cleansing"? How could they possibly have accumulated enough demerits in their short lives to have deserved such a cruel fate? A ready answer, if you can accept it, is supplied by those two objects of Edwards’ dissecting scalpel, reincarnation and Karma. Apparently, you can take it -- accumulated moral capital, anyway -- with you, after all. Herein we have the long-sought excuse for the panorama of gratuitous evil and unearned windfalls we encounter daily. Those kids deserved it all right, but not for what they did in this brief but brutal existence. Rather, they are expiating vicious acts in one or more of an infinite series of previous lives. And, incidentally, that Wall Street junk bond dealer does deserve his Rolex, BMW, and yacht after all -- he was obviously a somewhat more meritorious character in a previous incarnation.

Neat, huh? Well, yes, sort of and even Edwards admits that this account makes more sense than the traditional Christian explanation that napalmed babies are, for reasons beyond our feeble ken, an unfortunate by-product of Adam and Eve’s predilection for apples. But wait! As is so often the case, the large print giveth, but the small print taketh away. The small print, deftly enlarged by Edwards, reveals that the doctrines of Karma and reincarnation, so conducive at first glance, carry with them some truly revolting implications, ones their devotees seem rarely to have noticed. For instance, it follows from these views that I ought not to give a donation for African famine relief because those starving wretches must deserve that fate for having blotted their copybooks last time (or times) around. Helping the afflicted just thwarts their Karma, you see.

Another stumbling block raised by Edwards is the steadily climbing world population. If the souls of every one of today’s earthlings necessarily inhabited a body in a previous generation, and -- also according to doctrine -- no new souls are being created, and there were fewer bodies on the planet then than now, we would seem to be faced with a serious soul deficit. A few reincarnationists have attempted to sidestep this impediment with mind-numbing ad hoc gyrations (upgrading of animal souls, recruiting souls from other planets or dimensions, soul sharing, etc.), but the extremes to which these apologists have gone only underscores, as Edwards notes, how fanciful the whole reincarnationist enterprise really is.

Then we come to perhaps the weightiest, and for me (as a long-time student of brain function), the most engaging objection to reincarnation raised by Edwards. A compelling reason to doubt that a packet of personality traits and abilities could leap from a dying person, into limbo, and thenceforth to a newly conceived embryo, is the evident linkage of all psychological attributes to highly specific structures and functions in individual brains. While modern neuroscience cannot conclusively rule out the possibility that disembodied consciousness could exist, the staggering amount of evidence suggesting that thinking, remembering, and feeling require an intact, functioning brain serves to make the brain-mind link one of the most well-supported postulates to be found anywhere in science. I have presented an overview of that evidence and its implications for a number of occult beliefs, including reincarnation, in a previous issue of this journal (SI, Winter 1988).

While Edwards does not advocate, as I did on that occasion, the most extreme version of the materialist position on the “mind-body problem” -- the psychoneural identity hypothesis, which asserts that mental functions are identical with states of the brain -- he argues that the manifest dependence of all mental functions on specific brain functions makes the possibility that personal traits, knowledge, or self-awareness could skip from one incarnation to the next exceedingly remote. Either way, as I noted in the above-mentioned article, if this kind of transmigration of traits and knowledge is possible, my entire chosen field of behavioral neuroscience is essentially a fool’s errand. Fortunately, after reading this book, the prudent bettor will probably conclude that the chances of the concept of reincarnation being fatally flawed are substantially greater than the probability that the fundamental tenet of neuroscience (i.e., brain-mind linkage, which, if true, makes reincarnation so improbable) is in substantial danger.

The evidence, such as it is, is exhaustively examined by Edwards. Much of it comes from seemingly credible witnesses who claim to have seen the projected “astral bodies” of others at the time of the latter’s death, or from children who seem remarkably precocious, or who “remember” people, places or events that they seem unlikely to have known about if they had not actually experienced them in a previous life. Edwards shows that the empirical evidence, like the supporting arguments put forth by past-life explorers such as Elizabeth Kübler-Ross, Stanislav Grof, Raymond Moody, and Ian Stevenson are far less compelling than the tabloid headlines would have you believe. As with most anecdotal evidence of this sort, examination reveals that tales retold by the faithful have a way of becoming tidier and more convincing as they pass from mouth to mouth.

As Leonard Angel showed in these pages some time ago (SI, Fall 1994), careful reading of the acknowledged “best cases” for reincarnation, e.g., several from the parapsychologist Ian Stevenson, reveals significant internal inconsistencies in the accounts that throw them into doubt, even before the evidence itself is examined. Edwards notes similar problems in the evidential base and has taken the trouble to trace many other “best” cases back as close to their sources as possible. Along the way, we are treated to some hilarious examples of gullibility among those seized by the will to believe. In attacking the famous “Bridey Murphy” case, supposedly one of the strongest in the reincarnationists’ arsenal, Edwards does skeptics the additional service of pointing out that some of the rebuttals that skeptics like to tout (myself among them, until I read this chapter) were themselves the products of journalistic excess and thus not to be relied upon. Edwards finds much else, however, to discredit the evidence for Virginia Tighe’s prior existence as Bridey Murphy. In the process, he supplies trenchant critiques of the use of hypnosis and related techniques to “reveal” memories of past lives. Suffice it to say that, overall, the empirical case for reincarnation fares no better than the conceptual, logical, and moral ones.

Skeptics who follow my recommendation and read Reincarnation: A Critical Examination [by Paul Edwards] will derive much ammunition for arguing not only with reincarnationists but with “near-death experience” afficianados and afterlife enthusiasts of other stripes as well. They will be treated to a good read in the process — H. L. Mencken’s essays spring immediately to mind in this regard. Reincarnation is a useful adjunct to Edwards’ earlier edited volume, Immortality and to another work that both he and I admire, Susan Blackmore’s Dying to Live. Skeptics familiar with these works will enter debates well prepared. They should be warned, however, that if the logic and evidence contained therein were the final determinants of belief, fuzzy but comforting notions like reincarnation and Karma would never have gained their substantial cultural toehold in the first place.

“Nothing is more dangerous than active ignorance.”

—Goethe

Those who sell therapies of any kind have an obligation to prove, first, that their treatments are safe and, second, that they are effective. The latter is often the more difficult task because there are many subtle ways that honest and intelligent people (both patients and therapists) can be led to think that a treatment has cured someone when it has not. This is true whether we are assessing new treatments in scientific medicine, old nostrums in folk medicine, fringe treatments in “alternative medicine,” or the frankly magical panaceas of faith healers.

To distinguish causal from fortuitous improvements that might follow any intervention, a set of objective procedures has evolved for testing putative remedies. Unless a technique, ritual, drug, or surgical procedure can meet these requirements, it is ethically questionable to offer it to the public, especially if money is to change hands. Since most “alternative” therapies (i.e., ones not accepted by scientific biomedicine) fall into this category, one must ask why so many customers who would not purchase a toaster without consulting Consumer Reports shell out, with trusting naivetë, large sums for unproven, possibly dangerous, health remedies.

For many years, critics have been raising telling doubts about fringe medical practices, but the popularity of such nostrums seems undiminished. We must wonder why entrepreneurs’ claims in this area should remain so refractory to contrary data. If an “alternative” or “complementary” therapy:

1. is implausible on a priori grounds (because its implied mechanisms or putative effects contradict well-established laws, principles, or empirical findings in physics, chemistry, or biology),
2. lacks a scientifically acceptable rationale of its own,
3. has insufficient supporting evidence derived from adequately controlled outcome research (i.e., double-blind, randomized, placebo-controlled clinical trials),
4. has failed in well-controlled clinical studies done by impartial evaluators and has been unable to rule out competing explanations for why it might seem to work in uncontrolled settings, and,
5. should seem improbable, even to the lay person, on “commonsense” grounds, why would so many well-educated people continue to sell and purchase such a treatment?

The answer, I believe, lies in a combination of vigorous marketing of unsubstantiated claims by “alternative” healers (Beyerstein and Sampson 1996), the poor level of scientific knowledge in the public at large (Kiernan 1995), and the “will to believe” so prevalent among seekers attracted to the New Age movement (Basil 1988; Gross and Levitt 1994).

The appeal of nonscientific medicine is largely a holdover from popular “counterculture” sentiments of the 1960s and 1970s. Remnants of the rebellious, “back-to-nature” leanings of that era survive as nostalgic yearnings for a return to nineteenth-century-style democratized health care (now wrapped in the banner of patients’ rights) and a dislike of bureaucratic, technologic, and specialized treatment of disease (Cassileth and Brown 1988). Likewise, the allure of the “holistic” dogmas of alternative medicine is a descendant of the fascination with Eastern mysticism that emerged in the sixties and seventies. Although the philosophy and the science that underlie these holistic teachings have been severely criticized (Brandon 1985), they retain a strong appeal for those committed to belief in “mind-over-matter” cures, a systemic rather than localized view of pathology, and the all-powerful ability of nutrition to restore health (conceived of as whole-body “balance”).

Many dubious health products remain on the market primarily because satisfied customers offer testimonials to their worth. Essentially, they are saying, “I tried it and I got better, so it must be effective.” But even when symptoms do improve following a treatment, this, by itself, cannot prove that the therapy was responsible.

The Illness-Disease Distinction

Although the terms disease and illness are often used interchangeably, for present purposes it is worth distinguishing between the two. I shall use disease to refer to a pathological state of the organism due to infection, tissue degeneration, trauma, toxic exposure, carcinogenesis, etc. By illness I mean the feelings of malaise, pain, disorientation, dysfunctionality, or other complaints that might accompany a disease. Our subjective reaction to the raw sensations we call symptoms is molded by cultural and psychological factors such as beliefs, suggestions, expectations, demand characteristics, self-serving biases, and self-deception. The experience of illness is also affected (often unconsciously) by a host of social and psychological payoffs that accrue to those admitted to the “sick role” by society’s gatekeepers (i.e., health professionals). For certain individuals, the privileged status and benefits of the sick role are sufficient to perpetuate the experience of illness after a disease has healed, or even to create feelings of illness in the absence of disease (Alcock 1986).

Unless we can tease apart the many factors that contribute to the perception of being ill, personal testimonials offer no basis on which to judge whether a putative therapy has, in fact, cured a disease. That is why controlled clinical trials with objective physical measures are essential in evaluating therapies of any kind.

Correlation Does Not Imply Causation

Mistaking correlation for causation is the basis of most superstitious beliefs, including many in the area of alternative medicine. We have a tendency to assume that when things occur together, they must be causally connected, although obviously they need not be. For example, there is a high correlation between the consumption of diet soft drinks and obesity. Does this mean that artificial sweeteners cause people to become overweight? When we count on personal experience to test the worth of medical treatments, many factors are varying simultaneously, making it extremely difficult to determine what is cause and effect. Personal endorsements supply the bulk of the support for unorthodox health products, but they are a weak currency because of what Gilovich (1997) has called the “compared to what?” problem. Without comparison to a similar group of sufferers, treated identically except that the allegedly curative element is withheld, individual recipients can never know whether they would have recovered just as well without it.

Ten Errors and Biases

The question is, then: Why might therapists and their clients who rely on anecdotal evidence and uncontrolled observations erroneously conclude that inert therapies work? There are at least ten good reasons.

The disease may have run its natural course.

Many diseases are self-limiting — providing the condition is not chronic or fatal, the body’s own recuperative processes usually restore the sufferer to health. Thus, before a therapy can be acknowledged as curative, its proponents must show that the number of patients listed as improved exceeds the proportion expected to recover without any treatment at all (or that they recover reliably faster than if left untreated). Unless an unconventional therapist releases detailed records of successes and failures over a sufficiently large number of patients with the same complaint, he or she cannot claim to have exceeded the published norms for unaided recovery.

Many diseases are cyclical.

Arthritis, multiple sclerosis, allergies, and gastrointestinal complaints are examples of diseases that normally “have their ups and downs.” Naturally, sufferers tend to seek therapy during the downturn of any given cycle. In this way, a bogus treatment will have repeated opportunities to coincide with upturns that would have happened anyway. Again, in the absence of appropriate control groups, consumers and vendors alike are prone to misinterpret improvement due to normal cyclical variation as a valid therapeutic effect.

Spontaneous remission.

Anecdotally reported cures can be due to rare but possible “spontaneous remissions.” Even with cancers that are nearly always lethal, tumors occasionally disappear without further treatment. One experienced oncologist reports that he has seen twelve such events in about six thousand cases he has treated (Silverman 1987). Alternative therapies can receive unearned acclaim for remissions of this sort because many desperate patients turn to them when they feel that they have nothing left to lose. When the “alternatives” assert that they have snatched many hopeless individuals from death’s door, they rarely reveal what percentage of their apparently terminal clientele such happy exceptions represent. What is needed is statistical evidence that their “cure rates” exceed the known spontaneous remission rate and the placebo response rate (see below) for the conditions they treat.

The exact mechanisms responsible for spontaneous remissions are not well understood, but much research is being devoted to revealing and possibly harnessing processes in the immune system or elsewhere that are responsible for these unexpected turnarounds. The relatively new field of psychoneuroimmunology studies how psychological variables affect the nervous, glandular, and immune systems in ways that might affect susceptibility to and recovery from disease (Ader and Cohen 1993; Mestel 1994). If thoughts, emotions, desires, beliefs, etc., are physical states of the brain, there is nothing inherently mystical in the notion that these neural processes could affect glandular, immune, and other cellular processes throughout the body. Via the limbic system of the brain, the hypothalamic pituitary axis, and the autonomic nervous system, psychological variables can have widespread physiological effects that can have positive or negative impacts upon health. While research has confirmed that such effects exist, it must be remembered that they are fairly small, accounting for perhaps a few percent of the variance in disease statistics.

The placebo effect.

A major reason why bogus remedies are credited with subjective, and occasionally objective, improvements is the ubiquitous placebo effect (Roberts, Kewman, and Hovell 1993; Ulett 1996). The history of medicine is strewn with examples of what, with hindsight, seem like crackpot procedures that were once enthusiastically endorsed by physicians and patients alike (Skrabanek and McCormick 1990; Barrett and Jarvis 1993). Misattributions of this sort arise from the false assumption that a change in symptoms following a treatment must have been a specific consequence of that procedure. Through a combination of suggestion, belief, expectancy, cognitive reinterpretation, and diversion of attention, patients given biologically useless treatments can often experience measurable relief. Some placebo responses produce actual changes in the physical condition; others are subjective changes that make patients feel better although there has been no objective change in the underlying pathology.

Through repeated contact with valid therapeutic procedures, we all develop, much like Pavlov’s dogs, conditioned responses in various physiological systems. Later, these responses can be triggered by the setting, rituals, paraphernalia, and verbal cues that signal the act of “being treated.” Among other things, placebos can cause release of the body’s own morphinelike pain killers, the endorphins (Ulett 1996, ch. 3). Because these learned responses can be palliative, even when a treatment itself is physiologically unrelated to the source of the complaint, putative therapies must be tested against a placebo control group — similar patients who receive a sham treatment that resembles the “real” one except that the suspected active ingredient is withheld.

It is essential that the patients in such tests be randomly assigned to their respective groups and that they be “blind” with respect to their active versus placebo status. Because the power of what psychologists call expectancy and compliance effects (see below) is so strong, the therapists must also be blind as to individual patients’ group membership. Hence the term double blind — the gold standard of outcome research. Such precautions are required because barely perceptible cues, unintentionally conveyed by treatment providers who are not blinded, can bias test results. Likewise, those who assess the treatment’s effects must also be blind, for there is a large literature on “experimenter bias” showing that honest and well-trained professionals can unconsciously “read in” the outcomes they expect when they attempt to assess complex phenomena (Rosenthal 1966; Chapman and Chapman 1967).

When the clinical trial is completed, the blinds can be broken to allow statistical comparison of active, placebo, and no-treatment groups. Only if the improvements observed in the active treatment group exceed those in the two control groups by a statistically significant amount can the therapy claim legitimacy.

Some allegedly cured symptoms are psychosomatic to begin with.

A constant difficulty in trying to measure therapeutic effectiveness is that many physical complaints can both arise from psychosocial distress and be alleviated by support and reassurance. At first glance, these symptoms (at various times called “psychosomatic,” “hysterical,” or “neurasthenic”) resemble those of recognized medical syndromes (Shorter 1992; Merskey 1995). Although there are many “secondary gains” (psychological, social, and economic) that accrue to those who slip into “the sick role” in this way, we need not accuse them of conscious malingering to point out that their symptoms are nonetheless maintained by subtle psychosocial processes.

“Alternative” healers cater to these members of the “worried well” who are mistakenly convinced that they are ill. Their complaints are instances of somatization, the tendency to express psychological concerns in a language of symptoms like those of organic diseases (Alcock 1986; Shorter 1992). The “alternatives” offer comfort to these individuals who for psychological reasons need others to believe there are organic etiologies for their symptoms. Often with the aid of pseudoscientific diagnostic devices, fringe practitioners reinforce the somatizer’s conviction that the cold-hearted, narrow-minded medical establishment, which can find nothing physically amiss, is both incompetent and unfair in refusing to acknowledge a very real organic condition. A large portion of those diagnosed with “chronic fatigue,” “environmental sensitivity syndrome,” and various stress disorders (not to mention many suing because of the allegedly harmful effects of silicone breast implants) look very much like classic somatizers (Stewart 1990; Huber 1991; Rosenbaum 1997). When, through the role-governed rituals of “delivering treatment,” fringe therapists supply the reassurance, sense of belonging, and existential support their clients seek, this is obviously worthwhile, but all this need not be foreign to scientific practitioners who have much more to offer besides. The downside is that catering to the desire for medical diagnoses for psychological complaints promotes pseudoscientific and magical thinking while unduly inflating the success rates of medical quacks. Saddest of all, it perpetuates the anachronistic feeling that there is something shameful or illegitimate about psychological problems.

Symptomatic relief versus cure.

Short of an outright cure, alleviating pain and discomfort is what sick people value most. Many allegedly curative treatments offered by alternative practitioners, while unable to affect the disease process itself, do make the illness more bearable, but for psychological reasons. Pain is one example. Much research shows that pain is partly a sensation like seeing or hearing and partly an emotion (Melzack 1973). It has been found repeatedly that successfully reducing the emotional component of pain leaves the sensory portion surprisingly tolerable. Thus, suffering can often be reduced by psychological means, even if the underlying pathology is untouched. Anything that can allay anxiety, redirect attention, reduce arousal, foster a sense of control, or lead to cognitive reinterpretation of symptoms can alleviate the agony component of pain. Modern pain clinics put these strategies to good use every day (Smith, Merskey, and Gross 1980). Whenever patients suffer less, this is all to the good, but we must be careful that purely symptomatic relief does not divert people from proven remedies until it is too late for them to be effective.

Many consumers of alternative therapies hedge their bets.

In an attempt to appeal to a wider clientele, many unorthodox healers have begun to refer to themselves as “complementary” rather than “alternative.” Instead of ministering primarily to the ideologically committed or those who have been told there is nothing more that conventional medicine can do for them, the “alternatives” have begun to advertise that they can enhance conventional biomedical treatments. They accept that orthodox practitioners can alleviate specific symptoms but contend that alternative medicine treats the real causes of disease — dubious dietary imbalances or environmental sensitivities, disrupted energy fields, or even unresolved conflicts from previous incarnations. If improvement follows the combined delivery of “complementary” and scientifically based treatments, the fringe practice often gets a disproportionate share of the credit.

Misdiagnosis (by self or by a physician).

In this era of media obsession with health, many people can be induced to think they have diseases they do not have. When these healthy folk receive the oddly unwelcome news from orthodox physicians that they have no organic signs of disease, they often gravitate to alternative practitioners who can almost always find some kind of “imbalance” to treat. If “recovery” follows, another convert is born.

Of course, scientifically trained physicians are not infallible, and a mistaken diagnosis, followed by a trip to a shrine or an alternative healer, can lead to a glowing testimonial for curing a grave condition that never existed. Other times, the diagnosis may be correct but the time course, which is inherently hard to predict, might prove inaccurate. If a patient with a terminal condition undergoes alternative treatments and succumbs later than the conventional doctor predicted, the alternative procedure may receive credit for prolonging life when, in fact, there was merely an unduly pessimistic prognosis — survival was longer than the expected norm, but within the range of normal statistical variation for the disease.

Derivative benefits.

Alternative healers often have forceful, charismatic personalities (O'Connor 1987). To the extent that patients are swept up by the messianic aspects of alternative medicine, psychological uplift may ensue. If an enthusiastic, upbeat healer manages to elevate the patient’s mood and expectations, this optimism can lead to greater compliance with, and hence effectiveness of, any orthodox treatments he or she may also be receiving. This expectant attitude can also motivate people to eat and sleep better and to exercise and socialize more. These, by themselves, could help speed natural recovery.

Psychological spinoffs of this sort can also reduce stress, which has been shown to have deleterious effects on the immune system (Mestel 1994). Removing this added burden may speed healing, even if it is not a specific effect of the therapy. As with purely symptomatic relief, this is far from a bad thing, unless it diverts the patient from more effective treatments, or the charges are exorbitant.

Psychological distortion of reality.

Distortion of reality in the service of strong belief is a common occurrence (Alcock 1995). Even when they derive no objective improvements, devotees who have a strong psychological investment in alternative medicine can convince themselves they have been helped. According to cognitive dissonance theory (Festinger 1957), when experiences contradict existing attitudes, feelings, or knowledge, mental distress is produced. We tend to alleviate this discord by reinterpreting (distorting) the offending information. To have received no relief after committing time, money, and “face” to an alternate course of treatment (and perhaps to the worldview of which it is a part) would create such a state of internal disharmony. Because it would be too psychologically disconcerting to admit to oneself or to others that it has all been a waste, there would be strong psychological pressure to find some redeeming value in the treatment.

Many other self-serving biases help maintain self-esteem and smooth social functioning (Beyerstein and Hadaway 1991). Because core beliefs tend to be vigorously defended by warping perception and memory, fringe practitioners and their clients are prone to misinterpret cues and remember things as they wish they had happened. Similarly, they may be selective in what they recall, overestimating their apparent successes while ignoring, downplaying, or explaining away their failures. The scientific method evolved in large part to reduce the impact of this human penchant for jumping to congenial conclusions.

An illusory feeling that one’s symptoms have improved could also be due to a number of so called demand characteristics found in any therapeutic setting. In all societies, there exists the “norm of reciprocity,” an implicit rule that obliges people to respond in kind when someone does them a good turn. Therapists, for the most part, sincerely believe they are helping their patients and it is only natural that patients would want to please them in return. Without patients necessarily realizing it, such obligations are sufficient to inflate their perception of how much benefit they have received. Thus, controls for compliance effects must also be built into proper clinical trials (Adair 1973).

Finally, the job of distinguishing real from spurious causal relationships requires not only controlled observations, but also systematized abstractions from large bodies of data. Psychologists interested in judgmental biases have identified many sources of error that plague people who rely on informal reasoning processes to analyze complex events (Gilovich 1991, 1997; Schick and Vaughn 1995). Dean and colleagues (1992) showed, using examples from another popular pseudoscience, handwriting analysis, that without sophisticated statistical aids, human cognitive abilities are simply not up to the task of sifting valid relationships out of masses of interacting data. Similar difficulties would have confronted the pioneers of pre-scientific medicine and their followers, and for that reason, we cannot accept their anecdotal reports as support for their assertions.

Summary

For the reasons I have presented, individual testimonials count for very little in evaluating therapies. Because so many false leads can convince intelligent, honest people that cures have been achieved when they have not, it is essential that any putative treatment be tested under conditions that control for placebo responses, compliance effects, and judgmental errors.

Before anyone agrees to undergo any kind of treatment, he or she should be confident that it has been validated in properly controlled clinical trials. To reduce the probability that supporting evidence has been contaminated by the foregoing biases and errors, consumers should insist that supporting evidence be published in peer-reviewed scientific journals. Any practitioner who cannot supply this kind of backing for his or her procedures is immediately suspect. Potential clients should be wary if, instead, the “evidence” consists merely of testimonials, self-published pamphlets or books, or items from the popular media. Even if supporting articles appear to have come from legitimate scientific periodicals, consumers should check to see that the journals in question are published by reputable scientific organizations. Papers extolling pseudoscience often appear in official-looking periodicals that turn out to be owned by groups with inadequate scientific credentials but with a financial stake in the questionable products. Similarly, one should discount articles from the “vanity press” — journals that accept virtually all submissions and charge the authors for publication. And finally, because any single positive outcome — even from a carefully done experiment published in a reputable journal — could always be a fluke, replication by independent research groups is the ultimate standard of proof.

If the practitioner claims persecution, is ignorant of or openly hostile to mainstream science, cannot supply a reasonable scientific rationale for his or her methods, and promises results that go well beyond those claimed by orthodox biomedicine, there is strong reason to suspect that one is dealing with a quack. Appeals to other ways of knowing or mysterious sounding “planes,” “energies,” “forces,” or “vibrations” are other telltale signs, as is any claim to treat the whole person rather than localized pathology.

To people who are unwell, any promise of a cure is especially beguiling. As a result, false hope easily supplants common sense. In this vulnerable state, the need for hard-nosed appraisal is all the more necessary, but so often we see instead an eagerness to abandon any remaining vestiges of skepticism. Erstwhile savvy consumers, felled by disease, often insist upon less evidence to support the claims of alternative healers than they would previously have demanded from someone hawking a used car. Caveat emptor!

References

• Adair, J. 1973. The Human Subject. Boston: Little, Brown and Co.
• Ader, R., and N. Cohen. 1993. Psychoneuroimmunology: Conditioning and stress. Annual Review of Psychology 44: 53-85.
• Alcock, J. 1986. Chronic pain and the injured worker. Canadian Psychology 27(2): 196-203.
• —. 1995. The belief engine. Skeptical Inquirer 19(3): 14-8.
• Barrett, S., and W. Jarvis. 1993. The Health Robbers: A Close Look at Quackery in America. Amherst, N.Y.: Prometheus Books.
• Basil, R., ed. 1988. Not Necessarily the New Age. Amherst, N.Y.: Prometheus Books.
• Beyerstein, B., and P. Hadaway. 1991. On avoiding folly. Journal of Drug Issues 20(4): 689-700.
• Beyerstein, B., and W. Sampson. 1996. Traditional medicine and pseudoscience in China. Skeptical Inquirer 20(4): 18-26.
• Brandon, R. 1985. Holism in philosophy of biology. In Examining Holistic Medicine, edited by D. Stalker and C. Glymour. Amherst, N.Y.: Prometheus Books, 127-36.
• Cassileth, B., and H. Brown. 1988. Unorthodox cancer medicine. CA-A Cancer Journal for Clinicians 38(3): 176-86.
• Chapman, L., and J. Chapman. 1967. Genesis of popular but erroneous diagnostic observations. Journal of Abnormal Psychology 72: 193-204.
• Dean, G., I. Kelly, D. Saklofske, and A. Furnham. 1992. Graphology and human judgement. In The Write Stuff, edited by B. and D. Beyerstein. Amherst, N.Y.: Prometheus Books, 342-96.
• Festinger, L. 1957. A Theory of Cognitive Dissonance. Stanford: Stanford University Press.
• Gilovich, T. 1991. How We Know What Isn't So: The Fallibility of Human Reason in Everyday Life. New York: Free Press/Macmillan.
• —. 1997. Some systematic biases of everyday judgment. Skeptical Inquirer 21(2): 31-5.
• Gross, P., and N. Levitt. 1994. Higher Superstition. Baltimore: Johns Hopkins University Press.
• Huber, P. 1991. Galileo’s Revenge: Junk Science in the Courtroom. New York: Basic Books.
• Kiernan, V. 1995. Survey plumbs the depths of international ignorance. The New Scientist (April 29): 7.
• Merskey, H. 1995. The Analysis of Hysteria: Understanding Conversion and Dissociation. 2d ed. London: Royal College of Psychiatrists.
• Melzack, R. 1973. The Puzzle of Pain. New York: Basic Books.
• Mestel, R. 1994. Let mind talk unto body. The New Scientist (July 23): 26-31.
• O'Connor, G. 1987. Confidence trick. The Medical Journal of Australia 147: 456-9.
• Roberts, A., D. Kewman, and L. Hovell. 1993. The power of nonspecific effects in healing: Implications for psychosocial and biological treatments. Clinical Psychology Review 13: 375-91.
• Rosenbaum, J. T. 1997. Lessons from litigation over silicone breast implants: A call for activism by scientists. Science 276 (June 6, 1997): 1524-5.
• Rosenthal, R. 1966. Experimenter Effects in Behavioral Research. New York: Appleton-Century-Crofts.
• Schick, T., and L. Vaughn. 1995. How to Think About Weird Things: Critical Thinking for a New Age. Mountain View, Calif.: Mayfield Publishing.
• Shorter, E. 1992. From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era. New York: The Free Press.
• Silverman, S. 1987. Medical “miracles": Still mysterious despite claims of believers. Psientific American (July): 5-7. Newsletter of the Sacramento Skeptics Society, Sacramento, Calif.
• Skrabanek, P., and J. McCormick. 1990. Follies and Fallacies in Medicine. Amherst, N.Y.: Prometheus Books.
• Smith, W., H. Merskey, and S. Gross, eds. 1980. Pain: Meaning and Management. New York: SP Medical and Scientific Books.
• Stalker, D., and C. Glymour, eds. 1985. Examining Holistic Medicine. Amherst, N.Y.: Prometheus Books.
• Stewart, D. 1990. Emotional disorders misdiagnosed as physical illness: Environmental hypersensitivity, candidiasis hypersensitivity, and chronic fatigue syndrome. Int. J. Mental Health 19(3): 56-68.
• Ulett, G. A. 1996. Alternative Medicine or Magical Healing. St. Louis: Warren H. Green.

In Part 1 of this report (SI, July/August 1996) we discussed the principles of Traditional Chinese Medicine (TCM) and our observations of how it is practiced today in the People’s Republic of China. We also described research we had observed during our visit to China that is attempting to identify those empirically verifiable portions of TCM that could be incorporated into scientific medical practice. This opportunity was afforded us by an invitation from the China Association for Science and Technology (CAST) to visit various centers in China and to participate in a symposium on pseudoscience held in Beijing in June of 1995. In this article we address the broader topic of the growth of pseudoscience in China, and present additional observations of-TCM as seen in centers in Shanghai.

The CAST Symposium

Part of our stay in Beijing was occupied by a seminar sponsored by CAST and the State Science and Technology Commission. There, Chinese scholars and physicians described the problems created by pseudoscience in their country. These authors and their fellow member of the delegation (Andrew Skolnick of the Journal of the American Medical Association) traded similar experiences from the U.S. and Canada. We had expected this to be one of the highlights of our trip, and we were not disappointed. CAST had assembled an impressive roster of social, physical, and medical scientists from various parts of China who described the obstacles that belief in Qigong¹ and some of the extreme claims of TCM have put in the way of their efforts to improve scientific literacy. From these presentations we achieved many insights that would otherwise have been much more speculative.

All Chinese speakers at the symposium made a clear distinction between ‘internal Qi’ and ‘external Qi.’ The former equates roughly to what we would call ‘psychosomatic medicine’; while believers consider the latter to be a supernatural life force that, like psychokinesis, can affect matter outside one’s body (believers refer to this as ‘special ability’ or ‘extraordinary functions of the human body’). Belief in this dubious power was repeatedly defined at the symposium as China’s major pseudoscience problem. Qigong was briefly outlawed during the cultural revolution (1966-1976) because it seemed too spiritual for the reigning Marxist materialists. It has since managed to stage a comeback by masquerading as a science. Qigong masters and their disciples routinely defraud the public with conjuring tricks and falsely present themselves as spiritual healers (Lin et al., in press). Honest practitioners of TCM eschew such deceptive practices, but they still adhere to the mystical notion that an imbalance of internal Qi energy underlies all illness. Many of the TCM doctors we interviewed still believe that specially gifted healers can use their external Qi to cure diseases by restoring the balance of a sufferer’s internal Qi.

A few Chinese scientists we met maintained that although Qi is merely a metaphor, it is still a useful physiological abstraction (e.g., that the related concepts of Yin and Yang parallel modern scientific notions of endocrinologic and metabolic feedback mechanisms). They see this as a useful way to unite Eastern and Western medicine. Their more hard-nosed colleagues quietly dismissed Qi as only a philosophy, bearing no tangible relationship to modern physiology and medicine.²

The first group of speakers at the CAST symposium concentrated on external Qi. After Chinese investigators and the earlier CSICOP delegation had exposed several prominent Qigong masters as charlatans (Alcock et al. 1988), the government was persuaded to crack down on their ilk (some have gone underground, but many still continue to enjoy protection provided by high-level state officials). We did not determine the extent of the crackdown, but we learned that many Qigong masters are still active, especially in the countryside. We were also told that we would not be able to observe any masters or ‘special ability’ children because they would no longer cooperate. This was disappointing but it is a tribute to our hosts’ debunking efforts that local performers are now too wary of being caught, as they were when exposed by James Alcock, James ‘the Amazing’ Randi, and the other members of the first CSICOP delegation.

Mr. Lin Zixin, the retired editor of China’s Science and Technology Daily and a CSICOP Fellow, was one of our principal hosts. At the symposium, which he helped organize, he discussed the extent of belief in pseudoscience in China. He credited the 1988 CSICOP delegation with helping to tarnish the reputation of the Qigong ‘superman,’ Xiao, but admitted much remains to be done. He compared widely held superstitions about the power of external Qi in China to the beliefs that inspired the Japanese sect, ‘Aum Shinri Kyo’ (the cult that attacked the Tokyo subway with nerve gas). Mr. Lin, one of China’s top scientific journalists and policy experts, described the extent of superstition in China as shameful and a threat to the nation’s technological development. Scientific literacy is more important than ever as China tackles the arduous task of modernizing its economy, he said, but superstition continues to impede progress. Mr. Lin firmly reiterated his organization’s support for CSICOP’s efforts to combat pseudoscience worldwide.

Professor Qui Renzong of the Chinese Academy of Social Sciences compared the development of American and Chinese pseudoscience. He drew parallels between the concept of external Qi and the mysterious nonmaterial forces posited by parapsychologists, such as psychokinesis and extrasensory perception. Professor Qui echoed Mr. Lin’s assertion that the Qigong movement has had a negative influence on Chinese society. Professor Qui lamented the fact that it has also been psychologically damaging for some devotees, and that even some scientists have been duped into believing in the power of external Qi-for example, an ardent promoter is Professor Qian Xuesen, China’s foremost rocket scientist and a former professor at the California Institute of Technology. Professor Qui concluded with the memorable phrases: ‘It’s only your private experience, if it is not repeatable,’ and ‘pseudoscience is an infinite regression of excesses.’

Professor Wang Guozheng of the China Society for Dialectics of Nature continued the theme that pseudoscience is becoming a major social problem. He described his investigation of ‘seeing with ears,’ a trick similar to the ‘blind reading’ exposed by Martin Gardner in his famous article on the ‘peek-down-the-side-of-the-nose’ ruse.³ Professor Wang ended this inquiry when he concluded that it was a worthless fad that would disappear on its own. Apparently it did not, despite its affront to official Marxist dialectical materialism. In ten years, not one claim had been substantiated, yet popular belief continued to grow. Such concerns led Professor Wang to found the Society for the Protection of the Scientific Spirit. Its aim is to promote scientific attitudes and combat the growing influence of pseudoscience. The society has encountered opposition from paranormalists, such as when a Qigong advocate who was rejected as a speaker at one of its meetings disrupted the proceedings by trying to force his way onto the program physically. It seems Chinese skeptics are vulnerable to many of the same tactics as those endured by their Western counterparts.

Dr. Zhang Tongling, professor of psychiatry at Beijing Medical University, presented her research on negative effects of Qigong practices. She believes that there is no such thing as Qi, but she found that some vulnerable people, drawn into the Qi subculture, have been harmed psychologically by obsessional involvement with these breathing, meditative, and movement exercises. Dr. Zhang now runs a clinic for former Qigong extremists. Her study of 145 cases from ten provinces found that these casualties were relatively well educated- about half were high school graduates or above. Forty-four were classed as workers, thirty-nine were government employees, thirty were students, and thirty-one were engaged in scientific research. The group was found to be highly suggestible and their symptoms were related to various alleged effects of Qi contained in books they had read. Dr. Zhang described their responses as a form of mental illness, probably the result of latent psychiatric problems that were exacerbated by fanatical immersion in Qigong exercises. Many of these problems looked like those we would call hysterical or psychosomatic symptoms (Shorter 1992). For example, they reported feeling Qi surging through various parts of their bodies, and some would experience overwhelming lassitude that they attributed to Qi suddenly draining from their bodies. In other cases, experiences were provoked that were psychotic, including visual and auditory hallucinations, delirium, and feelings of being possessed by animal spirits. Some exhibited symptoms we would classify as paranoid, such as the conviction they were being harmed by the master’s power or that Qi had imbued them with extraordinary skills and a mission to cure diseases or save humanity. Some patients felt elated, perhaps manic, after their prolonged exertion, while others were left uncomfortably anxious, depressed, and suicidal. The severity was the worst in those who spent many hours per day immersed in Qigong exercises and in those with a long history of preoccupation with religious or superstitious pursuits. Dr. Zhang’s portrayals were reminiscent of people we had encountered who were obsessed with alien- abduction fantasies or had become fanatically immersed in Transcendental Meditation, Scientology, or irrational health schemes, leading at times to behavior that bordered on the delusional.

Professor Guo Zhengyi, deputy director of CAST, has visited the United States where he studied organizations dedicated to spreading pseudoscience. In his talk, he compared them to similar movements in China. He described a Mafialike network in China that has spread its influence by promoting (allegedly real) magical powers and fortune-telling in conjunction with acrobatic shows. These shady figures bill themselves as the future of science but, like pseudoscientists everywhere, they mangle all valid scientific principles. Their lucrative scams include Qigong demonstrations composed of fake acts of clairvoyance, superhuman physical strength, and ‘ possession by animals.’ Professor Guo likened the practices of these roaming hucksters to practices that were common in feudalistic times, a theme that was taken up by his colleague, Dr. Yuan Zhong. Dr. Yuan emphasized that official materialist doctrines have merely suppressed, not eliminated, the strong desire of the masses to believe in ancient spiritual entities and magical powers. The pseudoscientific patina of Qigong has allowed these old religious beliefs to reemerge in a way that is less likely to arouse official ire. Dr. Yuan referred to Qigong as a pseudoreligion, one that is growing as the regime relaxes its demands for strict ideological conformity. Occasionally, the chicanery of some of these impostors reaches proportions that spur the government to intervene. The official responses were not spelled out, but we discovered in private conversation that these tricksters are usually warned and fined.

Professor Zu Shuxian of Anhui Medical University was one of the most trenchant critics of Qi as a medical concept. Having done postgraduate training in epidemiology at the University of Virginia, he was well qualified to discuss why problems of medical quackery are worse in developing countries. Particularly in rural areas, folk-healing traditions and modest education make it difficult for people to distinguish between legitimate and bogus doctors. In addition, developing countries have as yet little in the way of consumer movements that could help protect citizens from quacks. Dr. Zu denounced the press for promoting quackery and for its apparent inability to distinguish between scientifically valid and sham treatments. He lamented the tendency to credit patient satisfaction instead of rigorous testing as the measure of therapeutic success. Fraudulent medical institutions are now competing with legitimate ones for money, while government funding for university research is diminishing. Once again, China’s problems parallel our own.

Also familiar to us was an interruption by a student at this session. He complained that scientifically trained Chinese physicians do not spend enough time with patients and do not offer enough emotional support, and that this feeds the popularity of quacks.

Beyerstein, Sampson, and Skolnick delivered papers dealing with various aspects of fraud and pseudoscience in health care and the proper methodology for testing putative treatments.

The CAST conference made it apparent, as Michael Fumento has titled his recent book, that science is under siege-not just in North America and Europe, but in China, as well.⁴ There, as here, superstition, quackery, and pseudoscience have infiltrated academia, and some prominent scientists and philosophers are among the leading apologists. Their appeal to ancient magical ways of thinking, cloaked in pseudoscientific language, sounded depressingly familiar to us. In China, pseudoscience is becoming increasingly competitive with science for public support and government funding. The extent to which Chinese criminal elements have used superstition and pseudoscience to bilk the gullible public was news to us, however. Chinese academics are becoming more aware of possible psychological harms resulting from involvement with pseudoscience and quack sects and cults. In 1994, awareness of these growing problems led the Chinese government to issue a proclamation decrying the rise of superstition and pseudoscience and the erosion of science education (Sagan 1996). It seems that for many Chinese, the concept of Qi supplies an all-encompassing vision of life and its role within the cosmos as a whole. Qi has become a comfortable explanation for everything. Unfortunately, something that purports to explain everything explains nothing.

On to Shanghai

After a day spent trekking the Great Wall, our tour of China then moved on to Shanghai. There we were hosted by friends of CAST officials who were academics, but not themselves associated with scientific institutions. They were able, however, to introduce us to a variety of practitioners of TCM. Before exploring local TCM facilities, we were given a chance to interact with conventional biomedical scientists during a most interesting tour of the brain research laboratories at Shanghai Medical University. The research problems, techniques, and apparatus we encountered at this well-equipped institute were familiar to us; and the work we discussed with these Chinese neuroscientists revealed that they are working at the forefront of their fields. After this tour, our focus shifted back to TCM.

We next visited the Shanghai University of Traditional Chinese Medicine and its affiliated Shu Guang Hospital-the largest TCM complex in China. The views expressed there were somewhat different from those we had encountered at the Beijing TCM Institute (Beyerstein and Sampson 1996), especially with regard to integration of scientific and traditional medicine. At the Shanghai institute, where the primary mission was the teaching of TCM, the president, Dr. Wang Ling Tai, was also a gastroenterologist who practices scientific biomedicine. As in Beijing, we were told that TCM was requested by less than twenty percent of the patient population. (It seems that self-medication with herbs is more pervasive in the country as a whole, however. The fifteen-to-twenty-percent figure refers to those patients who choose to see a TCM doctor.) After a long and enjoyable meeting with Dr. Wang, we were shown through the complex, which appeared similar in setup to the clinic complex in Beijing. We were shown a major manufacturing facility for antibiotics that we were told were derived originally from traditional herbal medicines. This aspect of TCM made sense to us because we knew that penicillin, for example, was derived from molds that had long been used in European folk remedies (there are frequent historical references to use of moldy bread for dressing dirty wounds).

While in Shanghai, we also toured the largest herbal pharmacy in China. TCM diagnosticians occupied booths around the periphery of each floor in this multistory building, while herbalists busily moved about the center, filling prescriptions according to the diagnosticians’ recipes. With rapid, animated movements, they grabbed handfuls of dried vegetable and animal matter from rows of drawers stacked in massive cabinets that resembled floor-to-ceiling library card files. The ingredients were dropped somewhat unceremoniously on hand- held balances and then mixed on large sheets of paper. These were then folded into dispensing packets and sold to waiting patients, mostly for preparation as herbal teas. The measurements struck us as rather imprecise by Western pharmaceutical standards, but greater accuracy might have been illusory because a perennial problem with herbal remedies is that the concentrations of active ingredients in the raw materials can vary greatly from source to source (due to climate, soil conditions, etc.). Also on sale were a variety of over-the-counter remedies that we also saw in department stores, corner pharmacies, tourist centers, and airports throughout China. Some of these, to our dismay, included preserved bear gall bladder, ground horns and penises of various wild animals, and other animal parts apparently sold primarily for their alleged ability to enhance sexual potency.⁵

We also saw North American ginseng prominently displayed in these stores — it is highly valued in China. Although many bold therapeutic claims are made for ginseng, its scientifically demonstrated effects are more modest. Its complex chemistry stimulates several bodily systems. Ginseng can act as a pick-me-up in a number of ways: it produces caffeinelike effects in the central nervous system, enhances carbohydrate metabolism and glycogen synthesis, and may stimulate the heart because it contains some digitalislike components (similar to those found in the common foxglove). It also has histiminic activity, and it contains steroids that can affect the hormonal system (Siegel 1979).⁶

At the Shanghai traditional pharmacy, we encountered for the first time TCM doctors who still use the ancient technique of pulse diagnosis (see WallnÜfer and von Rottauscher 1975). People are said to have fifteen different pulses detectable by traditionally trained healers although these have never been demonstrated scientifically. For us, the doctor placed his fingers on the pulse, stared vacantly into the distance for about a minute, as if absorbing its meaning, and then told us our diagnoses (none of which was accurate). He then wrote a TCM prescription for an off-the-shelf concoction that we filled at the counter. We were also diagnosed by a woman who held our hands and placed a small electrical probe at various points on our palms. From our muscle spasms, grimaces, and verbal descriptions of the tingling sensations, she arrived at a diagnosis, again one that would be news to our family physicians back home.

A Meeting with Professors of TCM

Our main conference in Shanghai was with about a dozen prominent TCM physicians affiliated with Shu Guang Hospital. Here, the flavor was quite different from the CAST symposium in Beijing, skepticism being much less pronounced. The Chinese doctors, most of whom had scientific medical training in addition to their traditional specialties, each gave brief introductory statements. The session was then opened for discussion and questions. We can best describe the event with a sample of our questions and the answers given. We asked our questions as naive Westerners, but with a perspective of scientific inquiry. The answers, as will be evident, highlighted the differences between the scientific outlook and that of TCM. The answers are not verbatim in every case because some were conveyed through a translator.

Q: How are the roles of Western-trained and TCM physicians different?

A: One example is a woman with cancer who failed with Western treatments and was then treated with TCM and lived four years longer than expected. [This exemplifies one of our major conclusions, namely that TCM still relies predominantly on anecdotal evidence-its practitioners exhibited very little understanding of the need for controlled clinical trials. Most of the group seemed to lack knowledge about how to do scientifically valid evaluations of their techniques.]

Q: Do you treat different cancers differently, or do you use the same treatment for all?

A: Every case is different, and treatment is different. [Ironically, TCM sees all disease as resulting from the same cause (Qi imbalance), but it sees each patient’s case as unique. This answer also illustrates TCM’s preoccupation with surface manifestations rather than trying to reveal a more limited number of underlying pathological processes that might manifest themselves in a wider variety of symptoms.]

Q: How do the different cancer remedies work, and what are the biochemical mechanisms for combatting cancer cells?

A: We are trying different methods to prevent cancer, especially in high-risk breast cancer patients — 17,000 professional women. [Perhaps something was lost in translation.] Many traditional medicines are static. TCM is developing. We are examining curative effects and theoretical basis. We regard the patient as oneness. Every patient is ‘a small world.’ A major reason for interest in natural developments is traditional Chinese herbs. People are panicking about environmental chemicals, effects now being reversed by TCM. There are breakthroughs. Look at TCM from the Chinese perspective. We say, ‘Water the ponies [peonies?] well.’ [For example, pay attention to internal stresses of the patient.] Rather than killing cancer cells, increase internal factors to bring one into balance. TCM doctors see a change in the patterns of things. TCM treats imbalance of the negative and positive sides of things. [In other words, it does not treat disease processes per se.] TCM works well in circulatory disorders — it corrects blood circulation. [This was typical of many answers we received in that it sidestepped the original question and substituted a rambling string of metaphors instead.]

Q: How about ephedra - herbs containing ephedrine - are there two concepts of how it works - pharmacological and TCM?

A: We have adopted several new ways of treating, and that is one [a probable translation problem, so we tried again].

Q: What is the rationale for the treatment with ephedra?

A: We have a division here - TCM and Western ways. Doctor recommends the method - surgery, medicine, or TCM - and the patient decides. Most doctors would use Western medicine first for acute problems, then TCM if needed. Such as with gallstones: operation first, maybe we would use TCM afterward. Same with cancer. Doctors agree on how to combine them. [It was apparent we were not going to obtain a direct answer, and so we moved on. The gist of the remainder of this part of the discussion was that TCM is seen as a way of strengthening the body to resist disease in general, not a means of combatting specific diseases.]

Q: [To a nephrologist (kidney specialist) who also uses TCM.] How does TCM treat a new disease or change as new concepts of disease arise? Does TCM change?

A: We combine TCM and Western medicine in treatment of kidney disease, but we have different ways in different phases of the illness. At first, we use TCM to prevent progression. In later stages, we also adopt Western ways. We also use TCM in transplants. [Again, we did not pursue this indirect answer.]

After the question-and-answer session, several TCM physicians tried to clarify earlier comments with the following statements:

Because of difficulties with cults, we have different definitions [for Qi, etc.]. TCM and Western medicine have sharp differences in their concepts.

Practice speaks the loudest. Results count most. Science is not absolute; it has its limitations, and is also developing. So, each has its own advantages. For example, Western [medical] science used to be [exclusively?] biological. Now it is biological and societal. Combining the biological, psychological, and societal occurred 1,500 years ago in China. Western medicine is developing in the same way. TCM was ahead of Western medicine.

TCM works and cures where Western medicine does not; Western medicine is more toxic,⁷ so they are complementary and can learn from each other. We hope TCM and Western medicine can help and understand each other.

Western proponents say they know what works and now present a body of knowledge. Another way to look at it is that TCM considers the macro or whole body; Western medicine considers the micro. TCM does not apply to all cases; it is better for recuperative and chronic cases.

Patients understand this and know where to go. TCM has not only a philosophy, but a background. It is bidirectional. Both TCM and Western medicine concern homeostasis; TCM includes heart and spirit. From the lab perspective, TCM can improve senile dementia, especially Alzheimer’s [disease]. Some biochemical levels return to baseline. We also see aging retarded in humans and animals, and there are other neurochemical and immune changes as well.

A notable exception to the generalities presented by most of the rest of this group of TCM physicians was a discussion we had with Dr. Yan De Xin. A scientist who studies the chemistry of traditional herbs, he expressed the belief, in private conversation, that many traditional medicines will be found to contain active ingredients of interest to scientific medicine (some of this has already happened - see, e.g., Lewis and Elvin-Lewis 1977). But, unlike most of the sentiments expressed during the Shanghai conference, Dr. Yan was only willing to grant that efficacy on the basis of scientific trials. He has been trying to extract possibly active ingredients from a number of traditional herbs and to subject them to proper double-blind tests. His understanding of what needs to be done was impressive but, like researchers everywhere these days, he has been hampered by funding shortages.

Our meeting with this group of TCM experts ended with a formal dinner, each of the numerous courses flavored by a different Chinese herb used by traditional Chinese physicians. It was explained to us that TCM makes little distinction between the health-giving properties of foods and medicines.

External Qigong

Although we saw no external Qi demonstrations in China, both of us have observed such exhibitions in the large immigrant Chinese communities in our home cities. One was at an American Medical Student Association meeting in San Francisco, April 8, 1995. It was performed by Effie Poy Yew Chow, R. N., for an audience of about one hundred students. She seemed to advocate a combination of Ju Jitsu, suggestion, and ‘applied kinesiology.’⁸ She also claimed (but could not demonstrate), as we heard in China, that Qigong masters can transport Qi energy several thousand miles to alter the molecular structure of water. The students seemed to enjoy the lecture and, surprisingly, none challenged Ms. Chow’s rather extreme claims. Barry Beyerstein had an equally unfulfilling encounter with a famous Qigong master in Vancouver.⁹ Previously, this author’s brother, Dale Beyerstein, had investigated some prominent TCM practitioners in the Vancouver area and found them dangerously wanting in medical knowledge (D. F. Beyerstein 1990).¹⁰

Conclusion

Looking back at our discussions with TCM proponents in China, it often seemed that our questions and their answers came from two different worlds. It soon became apparent to us that this is equally true when the scientific and traditional medical communities in China try to communicate. This was obvious in the wide gap between the remarks of the academics and physicians gathered by CAST in Beijing, and the answers given by most of the TCM physicians we encountered in Beijing and Shanghai. The former spoke in terms we could understand, emphasizing the requirement to support claims with evidence and the need to understand such demonstrable effects TCM might produce in terms of scientifically verifiable biological mechanisms. Although the speakers at the CAST meeting in Beijing tended not to demean TCM during their presentations, several of them dismissed it in private conversations. The rest refrained from making rationalizations for TCM.

The statements of the TCM physicians, on the other hand, tended to be rambling, global, and tangential (this was not merely a language barrier, for many of them spoke excellent English). The traditionalists were difficult to pin down because when they had no available answer, the question would be redirected. While TCM physicians downplayed the importance of statistical approaches and placebo-controlled clinical trials, they did not hesitate to enlist such data when it seemed to their advantage. We came away with the strong feeling that the TCM community, with a few exceptions, does not really understand the power of the placebo effect nor the need for double-blind clinical trials. They seemed not to comprehend why we were not impressed by testimonials or anecdotes about individuals who had recovered after TCM treatments. Many claims seemed inflated, such as that for TCM’s effectiveness in Alzheimer’s disease and AIDS (see, e.g., Hou 1991). In the end, we were left with the same sense of frustration we often felt after arguing with advocates of ‘alternative medicine’ at home. Both exhibit an essential vagueness when explaining the mechanisms presumed to underlie their treatments. Both are prone to assume that metaphors count as explanations and that anecdotal evidence can substitute for systematic verification of claims.

Several speakers in both Beijing and Shanghai laced their discussions with political references, for example, to the evils of feudalistic times, the unwillingness to be subjected to logic (dialectics), and inhibitions to social progress. It seems that the practice of TCM and the concepts of internal and external Qi place China in a dilemma. Advancement of these ideas, especially overseas, increases China’s prestige and is a matter of cultural pride. Yet the inherent mysticism and magical thinking in these notions are an embarrassment to the Marxist rationalism of the government and to the scientific community as a whole. Furthermore, the growing involvement of criminal elements in paranormal spheres, as occurs to some extent in all countries, is considered a growing threat to social order. Overall, we perceived a delicate balancing act, between toleration and encouragement of TCM on the one hand, and attempts to restrict its more extreme manifestations, such as external Qi quackery, on the other.

We ended our tour unconvinced that Traditional Chinese Medicine has objectively proven its claims to cure any specific diseases. Acupuncture has some mild analgesic [lowered sensitivity to pain while conscious] properties and Chinese herbs have already yielded to scientific analysis some useful drugs - undoubtedly more will follow. We could find no scientific support for the use of cupping, moxibustion, and acupuncture for infectious diseases, deafness, and congenital deformities. We acknowledge the emotional comfort Chinese patients suffering from chronic or fatal disorders receive from TCM ministrations, but we saw no evidence to back up the oft-heard assertion that TCM actually works where Western medicine has failed. Insofar as TCM offers a degree of comfort and hope for those in difficult situations, it seems to perform a similar role to those of vitamin supplements, chiropractic, homeopathy, naturopathy, and therapeutic touch, our homegrown Western pseudomedicines.¹¹

Notes

1. “Qi” is the name Chinese philosophy gives to a scientifically undetectable “force” or “energy” believed to permeate everything in the universe. TCM asserts that imbalances in the flow of Qi in anatomically unverified “meridians” are responsible for disease, fatigue, etc. Acupuncture, Chinese herbs, massage, etc., supposedly restore well-being by rebalancing the flow of this mystical essence. Qigong is a set of mental and physical exercises akin to those ofÊTai Chi Chuan and Ai-ki-do that also promise spiritual and physical benefits by channeling this mysterious energy. With its mental disciplines and postural and breathing exercises, Qigong has long been practiced as a form of self-hypnosis that claims to promote relaxation and general health, much in the manner of certain yoga exercises. These days, practitioners of this aspect of the discipline call it “internal Qigong” to distinguish it from the much more dubious “external Qigong,” which has enjoyed a dramatic rise in popularity in China and in the West. Devotees of external Qigong claim they can control the Qi force beyond their own bodies to debilitate their foes, achieve the sorts of allegedly psychic feats familiar to Westerners, and diagnose and cure physical ailments. Qigong masters have become rich and powerful in China, filling massive sports arenas for their demonstrations of magic and faith healing. Chinese skeptics who have exposed these Qigong hoaxers were among the hosts of the delegation that included these authors (Lin et al., in press).

2. As an example of why scientific physicians consider external Qigong to be quackery, take the following advertisement for a “Qigong Herbal Pillow” that appeared in the September 1994 issue of the English-language magazine, China Today, published in Beijing by the China Welfare Institute. The pillow, which sells for U.S. $198, is claimed to be effective for high and low blood pressure as well as for “insomnia, diseases of the heart, brain, and blood vessels.” It also allegedly “reinforces the kidneys,” relieves rheumatism, “builds up the spleen,” “stops pain,” aids digestion, and “energizes the mind.” According to the manufacturers, it is a “small-radar Qigong bionic device” that “works by utilizing the synchronicity of global and human magnetic fields and of trace elements, and through the magnetization of Chinese herbal medicines.” Invented by the Qigong master Wang Shibo, it incorporates a “high-energy Qigong tube” that is supposed to generate its own power from the user’s speech, breathing, and heartbeat. This causes it to vibrate in therapeutic ways; and its radiant power can help users “develop their special bodily abilities” (a common euphemism for psychic powers). The pillow is sanctioned by the Bai Zi Yuan Shen Qigong Research Institute and, according to the ad, it is effective for three years.

3. Gardner, M. 1981. Dermo-optical perception: A peek down the nose. Science: Good, Bad, and Bogus. Amherst, N.Y.: Prometheus Books, 63-73. (Originally published in Science, February 11, 1966.)

4. Fumento, M. 1993. Science Under Siege: Balancing Technology and the Environment. N.Y.: William Morrow.

5. While we are quite prepared to accept that certain herbal remedies contain biologically active ingredients that could be useful in medical practice (some have already met this criterion of scientific proof (see Lewis and Elvin-Lewis 1977), we see no such value in those concoctions made from organs of endangered species. Their rationale, as we point out in Part 1 of this report, is purely that of “sympathetic magic,” the basis of all superstitious practices (see Note 6).

6. A good example of the “sympathetic magic” aspects of TCM (the belief that “like begets like”) is that the price paid for ginseng root is not determined by the concentration of its active chemical ingredients. Rather, it is determined by the degree to which the variegated root structure resembles a human body. Roots with a greater number of distinct parts that can be seen as a head, torso, appendages, etc., fetch a higher price.

7. Wherever we went, TCM doctors tended to emphasize the toxic side effects of Western drugs while glossing over the well-known fact that herbal medications have potential toxicities of their own (Tyler 1985). Many “natural” plant substances are virulent poisons; others can have serious side effects for the digestive, cardiac, pulmonary, hepatic, renal, and nervous systems. A major drawback among traditional herbalists of all ethnic stripes is their insufficient education concerning these potential harms.

8. “Applied kinesiology” is a scientifically discredited technique for reading the “muscle weakness” that allegedly follows (instantaneously) exposure to certain presumed pathogens (refined sugar, food dyes, preservatives, and fluorescent lighting are favorite culprits). This pseudoscience should not be confused with the authentic discipline of kinesiology, which is the scientific study of the control of bodily movement.

9. A recent meeting of the B.C. Skeptics in Vancouver, B.C., Mr. Ge Yingcai, a famous Qigong master and healer who had immigrated to Canada. Mr. Ge had promised to demonstrate, under double-blind conditions, his ability to make distilled water taste sweet by irradiating it with his Qi energy. The audience was disappointed and annoyed, however, when, after a rambling two-hour lecture, the master announced that he was now too tired to participate in the controlled test. Mr. Ge said he had a degree in nuclear physics from Beijing University, but his interactions with several professors of physics in the audience revealed significant gaps in his understanding of basic science. Likewise, in discussion with Dr. Kirsten Emmott, a physician member of the B.C. Skeptics, Mr. Ge exhibited deficiencies in elementary medical knowledge. For instance, he had no comeback when Dr. Emmott pointed out that his claim to diagnose disease in his clients’ organs by feeling pain in the corresponding ones in his own body was doubtful because the organs he referred to have no nerve supply that could signal such sensations (even if his organs could somehow magically resonate with those of his clients). Although Mr. Ge had specifically agreed to produce scientific studies to substantiate his conceptions of disease and his claimed cures, all he could deliver were the usual testimonials from satisfied customers.

   The B.C. Skeptics were similarly frustrated when they issued a challenge to be scientifically tested to the Qigong master Yan Xin during his North American tour in 1990. Yan’s associate, Wu Xutian, wrote saying that the skeptics only remained dubious because they had never seen a real Qigong master in action, but he declined to show them what his supposedly real colleague could do. In his letter of rejection addressed to Dale Beyerstein, Wu condescendingly dismissed the skeptics challenge: “. . . Dr. Yan Xin and I are not interested in the very low level test which was very popular in China ten or fifteen years ago. He is busy on some cooperating research subjects with several important organizations in U.S.” Wu suggested the skeptics should be content with some “scientific” papers by Yan which he enclosed. As usual, the claimed effects of Qigong were extremely unlikely by conventional scientific standards but were not published in peer-reviewed journals of any international scientific standing.

10. Dale Beyerstein, who suffers from diabetes, dropped several obvious hints in describing his complaint for each TCM doctor he visited (he listed the textbook symptoms but did not mention the word “diabetes”). He even prominently displayed his “Medic Alert” bracelet while having his pulses read, but none of the TCM doctors picked up on his diabetes (none even asked what the clearly marked bracelet was for!). The herbal remedies that were prescribed for Dale differed at the different offices and some of them would have been medically dangerous for a diabetic to take.

11. Many scientifically trained physicians accept that chiropractic manipulations could be beneficial for certain purely musculoskeletal complaints. However, medical scientists remain dubious about the underlying rationale for chiropractic still espoused by most of its practitioners. These theoretical “explanations” continue to fly in the face of scientific knowledge in the fields of anatomy and physiology (Jarvis 1987). Chiropractors who still insist that all diseases stem from spinal misalignments ("subluxations”), and can therefore be cured by joint manipulation, remain open to charges of pseudoscience. The same is true of the many chiropractors who continue to reject the germ theory of disease, oppose basic immunization, and use scientifically discredited diagnostic devices.

References

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• Beyerstein, B. L. and W. Sampson. 1996. Traditional medicine and pseudoscience in China: A report of the second CSICOP delegation (Part 1). Skeptical Inquirer 20(4): 18-26.
• Beyerstein, D. F. 1990. Chinese herbal medicine. Rational Enquirer 4(1): 7, 10-11. Newsletter of the B.C. Skeptics. Box 48844, Bentall Centre, Vancouver, B.C. V7X 1A8.
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In 1988 the first CSICOP delegation to China looked into the claims of several Qigong (pronounced cheegung)¹ masters and their young proteges. These child marvels supposedly possessed what Chinese admirers call “special ability” or “extraordinary functions of the human body.” They were said to be able to alter the shape or color of objects in sealed containers and perform a host of other minor miracles. What the first CSICOP delegation (composed of most of the Executive Council at the time) found was that these children could not produce their effects under close observation. In short, the whiz kids and their masters were performing unsophisticated conjuring tricks (Alcock et al. 1988). Also, in controlled tests, the delegation found the vaunted abilities of the Qigong masters to diagnose medical ailments to be unsubstantiated.

Despite such failures, medical uses of Qigong have continued to gain popularity in China. Along with other facets of Traditional Chinese Medicine (TCM), it has become increasingly fashionable in the West as well. Most observers consider TCM’s growing reputation in China in the decades following the Communist revolution (takeover in 1949) to have been due primarily to a mix of practical necessity and political expediency on the part of Chairman Mao Zedong. With fewer than 30,000 scientifically trained physicians in all of China (most of them concentrated in the large cities and suffering from politically suspect class backgrounds), the Communist revolutionaries were faced with an immediate need to be seen as “doing something” about the dismal state of medical care in China at the time. With the economy devastated, hard currency almost nonexistent, and hostility emanating from most foreign capitals, the new regime saw little hope of soon being able to afford Western medical technology and pharmaceuticals for a population that was already approaching 600 million. Thus the Communist Party began a concerted effort to convince the masses that TCM, like other aspects of Chinese culture, was not merely equivalent but superior to decadent “imperialist” alternatives. This of course carried the added political bonus of fostering national pride and solidarity among a war-weary and fractionated people.

But while TCM was being touted to the masses by the elites, top party and military officials cynically kept for themselves the best treatments scientific medicine could offer. According to Mao’s personal physician, Li Zhisui (Li 1994), Mao himself relied on Western methods to treat his many illnesses (except for a few folk practices carried over from his rural childhood). Trained in scientific medicine at an American-run medical school in China, Li immigrated to Australia after World War II. He was working as a medical officer for an Australian shipping company in 1949 when he was enticed to return to Beijing. Shortly afterward, he was appointed Mao’s doctor, the post he held until Mao’s death in 1976. Li had no other patients than Mao, Mao’s hypochondriacal wife, Jiang Quing, and a few other Mao family members and top party officials. For them, Li had the latest Western drugs, surgical techniques, and medical equipment at his disposal, and a well-equipped portable hospital that accompanied Mao and his entourage on their frequent, impulsive romps around the vast countryside.

Although the health of the masses did begin to improve following the revolution, the herbal remedies, acupuncture, and moxibustion² dispensed by Mao’s “barefoot doctors” probably contributed much less to the improvement than several phenomenal efforts in the public health sphere (after all, folk medicine had been the only treatment available to the masses up to that time and the state of their health had been far from encouraging). Recruited from the peasantry, the “barefoot doctors” were armed with exhortations from the ubiquitous booklets of Mao’s quotations and training roughly equivalent to that of first aid attendants in the West. They organized vast and successful communal health projects. Sanitation facilities and access to safe drinking water were greatly improved and several parasitic epidemics were brought under control. At the same time, the spread of sexually transmitted diseases was contained and greater social stability allowed improvements in diet, perinatal care, and basic immunization (Horn 1976; China Report 1983).

TCM had been the treatment of the Chinese people since ancient times,³ but having gained Mao’s somewhat cynical imprimatur, TCM’s leaders began to amass increasing political power in the new China. Western journalists who accompanied Richard Nixon during his historic rapprochement with the Chinese government were intensively courted by the TCM establishment, as were later delegations of Western doctors (China Report 1983; Skrabanek 1985). These delegations were shown major surgery being performed with acupuncture anesthesia. When columnist James Reston required an emergency appendectomy during Nixon’s visit, he was widely, though erroneously, believed to have been given only acupuncture as a pain killer during the surgery. It was not until much later that it was revealed that the Chinese surgical patients observed by foreign delegations had been preselected for high pain tolerance and heavily indoctrinated beforehand.⁴ It was also disclosed that these demonstration cases were routinely administered surreptitious doses of morphine in an intravenous drip that supposedly contained only hydrating and nourishing fluids (Keng and Tao 1985). In addition, it has since come to light that much of the apparently objective and well-controlled research on TCM emanating from Chinese medical schools during the tumultuous era of the cultural revolution (1966-1976) was falsified at the behest of the hospitals’ scientifically unqualified political commissars to ensure that the “research” would support the party line.

Despite this prevarication, most experts today concede that acupuncture does have some analgesic properties (though its potency has been greatly exaggerated). Similarly, many herbal remedies have already been assimilated into scientific medicine.⁵ On the other hand, proof for the hyperbole served up by some professors of acupuncture from the TCM institutes Barry Beyerstein toured during a visiting professorship in China in 1990 remains as elusive as ever. For example, he was told then that acupuncture can cure cholera, deafness, paralysis, cataracts, and mandibular overbite, among other things. Although the evidence was lacking, claims like these appealed to deep-seated longings in certain social movements that were emerging in the West during the 1970s. The “New Age” movement is only the latest in the long history of Western movements populated by seekers who have turned to the East for answers in times of disillusionment. As Huston (1995) has noted:

The history of Sino-American relations is in part a story of Americans looking to the East and interpreting a huge, complex and, to an outsider, confusing culture in such a way that they see what they desire and fear the most.

Among New Agers in Europe and North America, there was an eagerness to embrace the “natural” and “holistic” philosophy they perceived in TCM. It fit nicely with their desire to replace the scientific worldview with mystical beliefs and, in particular, their willingness to credit virtually any healing claims, providing they are ancient or hail from exotic places.

TCM’s growing popularity in Europe and North America is widely recognized. Its shaky scientific foundations and economic and politically driven push for legitimacy are perhaps less well known. When the authors’ trip to China was conceived, the movement to make TCM part of the therapeutic mainstream in the West had already been 20 years in gestation. By 1995, the U.S. Office of Alternative Medicine had been created by Congress (not by scientists, it should be noted) and was sponsoring alternative medicine projects that were expected to provide hard evidence to justify some of these treatments.⁶ TCM practitioners have recently requested that the U.S. Food and Drug Administration upgrade acupuncture needles from the "investigative device” category, and Congress has just passed a bill upgrading the official medical status of these needles. U.S. schools of TCM, felt by many to be diploma mills, are graduating practitioners who clamor for licensure. Twenty-eight states have already licensed lay acupuncturists, and most states allow physicians to perform acupuncture. Some states allow lay acupuncturists to be “primary care physicians” for industrial injuries (and be paid the same as licensed M.D.s and D.O.s). Seven states now have laws allowing any “licensed practitioner” to use any method he or she wishes, as long as the patient is informed in advance that the treatment lacks scientific validation.

Likewise, unproven and possibly dangerous herbal remedies are widely sold in health food stores, herbalist shops, and by mail order in the U.S. and Canada. These products evade the regulations, which require prescription drugs to demonstrate their safety and efficacy scientifically, by means of a loophole that permits herbal remedies to be marketed as “food supplements.”

A bill before the U.S. Congress would legitimize all unproven remedies in all states; and no longer would use of scientifically discredited treatments be grounds for discipline by professional boards. Practitioners of TCM stand to gain immensely from these political gambits. Much of the willingness of North Americans to support these trends has been due to uncritical media reports concerning the extent and effectiveness of TCM in China today. As several members of the Chinese scientific community became aware of these shifting attitudes in the West, they began to worry that their reputations were being tarnished abroad by the growing acceptance of the media-driven notion that Chinese medicine was undergoing a wholesale reversion to its ancient, mystical roots. Thus it seemed a mutually advantageous time for a North American team to look into the status of TCM in China. An invitation from the Chinese Association for Science and Technology (CAST) to these authors and Andrew Skolnick, associate news editor of the Journal of the American Medical Association, afforded us that opportunity. CAST has long been a foe of pseudoscience in China and welcomed the opportunity to strengthen the cooperative ties it had already forged with CSICOP.

What is Traditional Chinese Medicine (TCM)?

Every culture, including the Western culture, has evolved an indigenous system of folk healing (Atkinson 1956). Because of the body’s natural restorative processes and the power of the placebo effect, many physiologically inert folk remedies have long enjoyed unearned credit for curing diseases. It is only in the modern scientific era that it has been possible to separate truly effective treatments from only apparently effective ones by means of double-blind, random-assignment, placebo-controlled tests. When submitted to adequate clinical trials, some ancient folk remedies have proven their worth; many more have not (Nolen 1974; Stalker and Glymour 1985; Skrabanek and McCormick 1990; Randi 1989; Barrett 1990; Pantanowitz 1994). It was our desire to see what progress the Chinese were making in scientifically evaluating traditional treatments that motivated our tour of the major TCM centers in Beijing and Shanghai during the summer of 1995.

Practitioners of TCM consider it an empirical “science” of healing that has proved its worth in Asian countries for more than 3,000 years (Wallnšfer and von Rottauscher 1975). According to Chinese government figures, there are now more than 2,000 TCM hospitals throughout the country (Hou 1991). Unlike Western scientific medicine, which aims to identify and counteract specific pathogens for different disease states, TCM views all illnesses as the consequence of a unitary cause, namely an imbalance of vital energies in the body. The term Qi, which translates roughly as “divine breath,” refers to these putative energies, which are assumed by TCM to permeate everything in the universe. With respect to biological organisms, Qi is rather like the concept of elan vital, a hypothetical “life force” that was abandoned in Western medicine when scientific discoveries made it apparent that there is no essential difference in chemical constituents or processes between living and inanimate matter.

TCM’s advocates assert that herbs, moxibustion, massage, breathing exercises, acupuncture, and certain foods are able to restore the balance of the Yin and Yang, variants of Qi energy, which are supposed to flow in invisible channels in the body called “meridians.” By balancing Qi in this way, they say, health is maintained or restored. Some of the means for achieving this balance can look rather strange to those accustomed to scientific medicine. Take, for instance, something widely sold in China, the “505 Magic Bag.” It is “shaped like an apron and, containing 50 [herbal] ingredients, [it] can prevent and treat many diseases of the stomach and intestines . . . [when] the bag [is worn] close to the navel” (Hou 1991).⁷

Critics have pointed out that TCM relies, even today, on an ancient philosophical view of the body that was formulated during an era when the Chinese, for religious reasons, were forbidden to dissect cadavers. Thus the organ systems referred to in the ancient texts that still underlie TCM’s practices are merely metaphors that bear little relationship to the anatomical systems revealed by Andreas Vesalius, William Harvey, and the other pioneers of scientific medicine.⁸ Chinese medicine of 3,000 years ago was certainly no more primitive than the folk practices from the same era that evolved into Western medicine; but just as we no longer rely on the astronomy of ancient Greece, it would seem that progress in anatomy, physiology, pathology, and therapeutics has rendered most ancient medical practices obsolete. For those who would argue that antiquity implies validity, consider the longevity of racism, sexism, or the belief in a flat Earth.

Although TCM is based on a philosophical rather than empirical understanding of bodily function, it is possible that some of its procedures might still work, but for reasons unrelated to the magical belief system that supplied their rationale thousands of years ago (Xie 1995). Open-minded physicians everywhere would welcome any treatment that could benefit their patients, regardless of its origins — providing it can demonstrate its value in properly controlled clinical trials. It was in this spirit that we approached the fact-finding mission that took us to the foremost TCM facilities in the People’s Republic.

We had been aware for some time that Chinese Qigong masters were amassing considerable wealth and political power by allegedly healing people with mysterious force fields — supposedly “external” manifestations of their Qi "energy.” Many masters subsequently immigrated to North America where they established even more lucrative healing ventures. Qigong masters were featured in Bill Moyers’s highly acclaimed but embarrassingly credulous 1993 public television series, “Healing and the Mind.” Appearing with Moyers on one segment was David Eisenberg, who enhanced his already high standing in the alternative medicine community by promoting the powers of the Qigong mentor, Master Shi. Moyers’s demonstration made it appear that Shi, this elderly, frail man, had the strength to resist vigorous shoving by his hearty young students, whereas he could apparently “push” them around from a distance with the invisible force of his external Qi. Our study of slow-motion replays led us to conclude that the student was not exerting any great muscular force on the master’s body, but was only pretending to do so.⁹ At one point, even the trusting Eisenberg is heard to shout, “Try harder. You look like you are faking it.” In response to the master’s movements, another student leaped backward, making it appear that the master’s “energy” had repelled him without physical contact. Peter Huston, writing in the September/October 1995 Skeptical Inquirer ("China, Chi, and Chicanery”) reached the same conclusion that we did from studying this performance. It looked like a well-rehearsed ballet. Various stage tricks passed off as miracles by Qigong masters have been repeatedly exposed by Chinese investigators, who were among our hosts during our tour of China (Lin et al., in press).

Eisenberg’s 1982 book, Encounters with Qi, recounts the postgraduate training in TCM he received in China. In the book he describes many supposedly proven paranormal feats performed by Qigong masters.¹⁰ Although he makes a few token proclamations of skepticism, Eisenberg seems curiously loath to ask the masters to recreate the effects he observed under conditions that would prevent the kind of stage tricks the demonstrations clearly resembled. In Encounters with Qi, he unquestioningly accepts the therapeutic benefits of balancing the body’s (internal) Qi with herbs, acupuncture, and moxibustion (also an herbal treatment). When he returned to China with Moyers, Eisenberg continued to embrace the therapeutic effects of TCM as enthusiastically as he had back in his student days when he accepted as real the kind of “external Qi” effects others have exposed as magic tricks. Moyers seemed equally willing to credit the healing powers of Qi on the basis of nothing more than patient testimonials and the word of his guides. Eisenberg now directs alternative medicine courses for medical students and physicians through Harvard University. These courses and a 1993 article he coauthored on alternative medicine (Eisenberg et al. 1993) were funded by the Fetzer Institute, a $200 million endowment for the propagation of various unproven “mind/medicine” principles.

The effects shown on Moyers’s program were said to be driven by “external Qi,” the same doubtful force invoked to explain allegedly supernatural feats, (extraordinary functions of the human body) that the 1988 CSICOP delegation exposed as conjuring tricks. Although the delegation found this “force” dismally inaccurate when the Qigong masters invoked it to diagnose illnesses, it is the same “energy” that TCM advocates say runs through acupuncture meridians to effect healing. It has always struck us as odd that proponents can accept that this mysterious energy is unable to interact with the physical matter in the sensors of measuring instruments (which could confirm its existence) while it is still able to interact with the physical matter of bodily organs to “read” their state of health and produce a cure.

It was against this background of mysticism, naive trust in testimonials, prior incidents of fakery, and a host of intertwined political and ideological considerations that we set out to look into TCM’s claims ourselves. We wanted to see if Qigong and other TCM practices were as fully integrated with scientific medicine in the Chinese health care system as proponents on this continent assert.¹¹ We had hoped to observe herbal prescribing, traditional pulse and tongue diagnoses, cupping, moxibustion, "back scraping,” and the use of acupuncture for anesthesia, analgesia, and treatment of organic disorders. Some of these we saw and others we did not, since our hosts in the TCM institutions selected our itineraries for reasons steeped in philosophy, politics, and courtesy.

Our Visit

Beijing: June 1995. While we were in Beijing, we enjoyed the superb hospitality of Madam Shen Zhenyu of CAST (the principal organizer), Mr. Lin Zixin (former editor of Science and Technology Daily and a CSICOP Fellow), Madam Shen Zhen-xin (of the Academia Sinia), and Mr. Bai Tongdong, a graduate student at Beijing University.

While touring the Forbidden City with us, Mr. Bai, a physicist and graduate student in the philosophy of science, set the tone for our later discussions with his assertion that Qi is a philosophy, not a reflection of physical reality. In his view, the principles of TCM, including Qi, are merely useful, socially determined metaphors for the realities and facts that only science can provide. He did not offer opinions on the validity of traditional Chinese medicine.

The morning of our first full day, we were taken to a major hospital and research institute at Beijing Medical University. There we were greeted by Professor Han Jishen, a world-famous neurophysiologist, and several other distinguished faculty members. Dr. Han proceeded to chair a seminar that included descriptions of the institute, its achievements in both Western and traditional Chinese medicine, and discussion among ourselves and the assembled faculty.

One of the speakers was Dr. Xie Zhu-fan, director of the Institute of Integration of Traditional Chinese Medicine and Western Medicine. In his presentation he outlined three historical phases in the resurgence of TCM in China. Dr. Xie did not mention the political contributions to this renaissance, merely saying that in the early 1950s TCM began to be taught after decades of neglect and that some Western-trained Chinese physicians had been released from their duties to study TCM. After this, he said, there followed a period devoted to documenting the clinical effects of TCM. Dr. Xie admitted, as he does in his recent book (Xie 1995), that TCM philosophy is not compatible with modern science; but that acupuncture and some other traditional techniques have been demonstrated clinically to have analgesic properties or positive effects on certain functional disorders.

According to Dr. Xie, the Chinese are now in the third phase, the investigation of mechanisms that could account for TCM’s clinical effects. For example, he said they had confirmed the ability of certain Chinese herbs to dilate blood vessels, decrease platelet activity (inhibit blood clotting), and “modulate immune responses.” Because of the multiple actions of herbs, each could be used for several different disorders. Dr. Xie did not explain how these effects had been determined: whether the mixtures raised or lowered blood pressure and just how “immune system modulation” (we're not sure exactly what he meant by this term) benefits the patient. There was no discussion of side effects. Here, and during our discussions with other TCM physicians, it seemed axiomatic that when herbal medications are ingested, only desirable outcomes follow.¹²

After the opening seminar, we were taken on a tour of Professor Han’s laboratory. Dr. Han heads an institute with a staff of thirty-seven that occupies three floors of one campus building. His support comes primarily from governmental grants, there being few, if any, independent sources of funding in China. Dr. Han also has grants from the National Institute on Drug Abuse in the U.S. and Upsa Laboratories, a French pharmaceutical company. We met several of his collaborators, whom we observed in their labs. Although the lab appointments were simple, they were serviceable. The hallways were dimly lit by single, sparsely distributed fluorescent lamps, electricity apparently being expensive. Much of the lab’s equipment had been donated by an admirer of Dr. Han’s, the distinguished opiate researcher, Avram Goldstein, who shipped his furnishings and apparatus to Beijing after retiring from Stanford University. The institute’s walls were decorated with poster presentations from research meetings that described the lab’s discoveries. Professor Han spent two more hours with us, touring the lab and summarizing the work of his group on the physiology and neurochemistry of acupuncture. Our interest was to see whether the cellular effects of acupuncture found in the animal experiments could legitimately account for the myriad clinical effects in human patients claimed by practicing acupuncturists.

A detailed account of Dr. Han’s research is beyond the scope of this article, but we can summarize some of his work, which has been widely published and presented at international conferences (e.g., Chen et al. 1994). Dr. Han showed, before the discovery of the enkephalins (the brain’s endogenous morphinelike neurotransmitters), that acupuncture caused a reduction in pain responses in rabbits and that transfusing a treated animal’s cerebrospinal fluid into a nontreated animal produced a similar effect in the second rabbit. It was suggested that acupuncture had elevated the pain threshold by triggering a release of a transmissible agent (later identified as the opioid peptides, enkephalin and endorphin). Dr. Han later showed, by using antisense DNA in the system, that the ability of acupuncture to produce analgesia [lowered sensitivity to pain while conscious] can be prevented by blocking the expression of the endorphin receptor on the surface of spinal neurons. Others have shown that endorphin-blocking drugs also reverse acupuncture analgesia.

More recently, Dr. Han’s group has shown that the peptide neurotransmitter cholecystokinin (CCK — receptors for which are believed to be distributed in close proximity to those for the endorphins) antagonizes the endorphin-related effects of acupuncture. It seems to do so by altering the endorphin receptor’s affinity for its transmitter, or its ability to conduct messages inside the cell. Dr. Han thinks that natural hyperactivity of the CCK system in about 10 to 20 percent of the human population is responsible for the finding that a similar percentage of normal people is totally “nonresponsive” to acupuncture. He said he belongs to that group of nonresponders.

Our visit was too short to assess the adequacy of the methodology or the validity of these studies, although they seemed sound and have been published in peer-reviewed journals. Nonetheless, we felt that although this research is important basic science, it does not bear directly on many of the clinical claims made by acupuncturists. For instance, a rise in endorphin levels has been attributed to a number of varied activities — running, meditating, etc. — so Dr. Han’s findings are not necessarily uniquely caused by acupuncture. The demonstration of an agent’s effect in an animal model does not automatically imply its reproducibility, specificity, or significance in clinical practice.

Dr. Han maintained that, in humans, the acupuncture point between the thumb and forefinger is specific for the results he measured; but others have found that the exact placement of the needles is unrelated to the pain relief or other clinical effects obtained (Richardson and Vincent 1986). In addition, other researchers have failed to reproduce the reversal of acupuncture analgesia by the morphine antagonist naloxone, so the conditions under which measurements are made may be important, and the optimal ones are not yet known. It should also be noted that the role of the endorphins in pain relief remains controversial because plasma endorphin concentrations are not consistently related to levels of pain experienced by humans (Skrabanek 1985). And finally, a transient rise in endorphin levels could not reasonably account for the prolonged pain relief claimed by acupuncturists, nor other avowed cures in organ systems that are unaffected by the endorphins.

Dr. Han has also developed a low-voltage electric stimulator for administration of electroacupuncture, which he favors for both research and therapy. Known as the “HAN N S,” we found it used throughout China by those who prefer to deliver brief electric pulses through acupuncture needles rather than merely twirling the needles in the traditional manner. It resembles the TENS transcutaneous stimulators widely used in Western pain clinics.

Dr. Han was most gracious to us, and he is obviously a leader in his field. At the end of our tour, we wondered if he would agree, as we had read, that a number of other, less invasive stimuli can also raise endorphin levels in the central nervous system. We asked if it were not true, as Dr. Victor Herbert had shown,¹³ that any irritative stimulus, such as a pinch, might produce a similar rise in endorphin levels (this is conceded by many acupuncturists who use “acupressure” where the skin points are simply massaged rather than needled). He replied that yes, that is so, but acupuncture does not hurt as much as a pinch. We wondered at this juncture why pinch controls are not routinely included in acupuncture experiments and how one could justify clinical use of an invasive method (needling) known to be capable of producing serious complications to obtain such modest, inconsistent results. We, like Skrabanek (1985), also wondered whether suggestion and placebo effects had really been ruled out by acupuncture researchers as a more parsimonious explanation for observed clinical effects in humans. The argument that acupuncture’s effectiveness in animals eliminates the placebo explanation ignores the fact that the immobilization necessary to insert the needles in animal subjects has been shown to produce a sort of catatonia/analgesia by itself.¹⁴ At the very least, we went away wondering why, back home, a special “profession” now needs to be created to administer this procedure, so little about it having been satisfactorily proved.

We next visited several clinics at the China Academy of Traditional Chinese Medicine in Beijing. The main one was a moderate-sized room, approximately 12 by 4 meters, crowded with ten or twelve patients being treated — most with acupuncture, several with acupuncture and moxibustion, and two with cupping, as described below. The acupuncturist deftly twirled the needles in the prescribed points, leaving them in place for twenty to thirty minutes. Some patients received electroacupuncture, others the traditional method. Moxibustion, the placement of burning herbs on the surface of the body, is like the process of "blistering” common in prescientific Western medicine. Here it was administered by placing the smoldering material in a wooden box with a porous, recessed bottom that was placed on the diseased body part — in these cases, the back or the stomach. This was difficult for us to understand because we could not see how any active ingredients the burning herbs might contain could be absorbed in therapeutic quantities, and we had read previously that, for moxibustion to be effective, the herbs must be twisted into small cones and burned precisely over the appropriate acupuncture points. Moreover, the same herbal mixture seemed to be used indiscriminately for a variety of quite different complaints.

For cupping, heated clear glass vessels were placed on the upper back and shoulders, on presumed meridians or acupuncture points. As the cups cooled, skin was sucked up, much as with a vacuum cleaner. The rationale given was that the suction draws out bad or diseased energy from the body. An identical practice survived from ancient times until surprisingly recently in Western medicine as well — to draw out diseased “humors” or “vapors” that are no longer believed to exist.

While touring the TCM complex, we made several observations. The total space in this institution devoted to the practice of TCM was a relatively small portion of its holdings. The rest of the complex of several large buildings was apparently devoted to more mainstream scientific research. We asked what portion of the total medical services delivered in China was TCM, and how people were chosen to receive TCM treatments. We received some surprising answers: Patients generally request TCM treatments themselves, rather than being referred to TCM practitioners by biomedically trained physicians. Most scientifically trained doctors do not practice TCM, nor do they decide on the mode of treatment if they should refer a patient for TCM.

TCM is practiced at the institute by specialists trained in their respective techniques. We were told that most TCM students receive little scientific medical education and, overall, scientifically trained physicians seemed to have little interaction with TCM practitioners. Some physicians from abroad were studying at the institute, but most of the foreign students we met were physiotherapists, health food entrepreneurs, naturopaths, or other alternative medicine practitioners. By 1991 more than 2,000 foreign students had graduated from the thirty TCM colleges in China. At any given time, there are typically 30,000 Chinese students studying TCM (Hou 1991).

We were told that, these days, the proportion of Chinese patients choosing TCM, nationwide, is only about 15 to 20 percent, a figure that surprised us, but was consistent with the relatively small area allotted to these practices in the institute we visited in Beijing. Government publications as recent as 1991 had put the usage rate for TCM at about one-third of all patients in the country (Hou 1991). The 15 to 20 percent estimate was later reiterated by other informants who practiced TCM in Shanghai. Most TCM patients we observed were being treated for chronic problems such as indigestion, back pain, arthritis, and bursitis, which was not surprising to us. Conditions such as these often respond well to reassurance and psychological interventions and they tend to be cyclical, so virtually any treatment is likely to coincide with relief at some time. This is why placebo controls are essential in evaluating all putative therapies.

We were surprised at the low levels of personal interaction between TCM therapists and their patients. The warm, individualized attention and extended time spent with patients (a distinguishing feature of TCM according to its advocates in North America) was not evident here. Most patients arrived at the Beijing clinic with diagnoses in hand. The treatments we saw seemed to be largely symptom oriented, contrary to claims of supporters in North America who see as one of TCM’s superiorities that it “treats the whole person.” There was no attempt, in our presence anyway, to diagnose with TCM methods (e.g., by reading the fifteen unique pulses traditional healers say they can discern, or the more than 100 different diagnostic signs on the tongue [see Wallnofer and von Rottauscher 1975]). Diagnoses for the patients we saw had generally been made by biomedical physicians, and the patients had elected to receive TCM in addition to their Western treatments. We were not shown acupuncture anesthesia for surgery, this apparently having fallen out of favor with scientifically trained surgeons. Dr. Han, for instance, had been emphatic that he and his colleagues see acupuncture only as an analgesic (pain reducer), not an anesthetic (an agent that blocks all conscious sensations).

Before leaving the Beijing Institute, we were shown the largest collection of references on TCM, especially herbalism, in China. We entered through a long reading room with rows of display cases and tables. Another room branched from the side and at the end was a large vault, temperature- and humidity-controlled, containing stacks of rare, ancient volumes. Splendidly bound, they dated back many hundreds of years, some much more, and contained beautiful illustrations of medicinal plants. TCM recognizes more than 8,000 plant species as having medicinal value. Students come from all over China to study these tomes, although we saw only a few while we were there. On another floor we were shown a major project funded by the UN’s World Health Organization to establish a computer database from this storehouse of information about TCM.

Interspersed with our packed itinerary of official visits, we were shown the sights of Beijing including the Forbidden City, the Summer Palace, and several museums; and we trekked along the Great Wall. Everywhere we went, our hosts pampered and fed us in grand style. Our questions were answered frankly and we were always made to feel most welcome. In Part 2 of this report [to be published in a future issue of SI], we shall describe the major scholarly conference CAST arranged to coincide with our visit, and our further explorations of TCM in Shanghai.

Notes

1. “Qi” is the name Chinese philosophy gives to a scientifically undetectable force or energy that is supposed to permeate all things. Believers in TCM assert that imbalances in the flow of Qi are responsible for disease, fatigue, etc. Acupuncture, Chinese herbs, etc., supposedly restore well-being by rebalancing the flow of this mystical essence. Qigong is a set of mental and physical exercises akin to those of Tai Chi Chuan and Ai-ki-do that also promise spiritual and physical benefits by channeling this mysterious energy. With its mental disciplines and breathing exercises, Qigong has long been practiced as a form of self-hypnosis that claims to promote relaxation and general health, much in the manner of certain yoga exercises. These days, practitioners of this sort of discipline call it “internal Qigong” to distinguish it from so-called “external Qigong,” which has enjoyed a dramatic rise in popularity in China and the West. Devotees of external Qigong claim they can control the Qi force outside their bodies to debilitate their foes, achieve the sorts of psychic feats familiar to Westerners, as well as to diagnose and cure physical ailments. Qigong masters have become rich and powerful in China, filling massive sports arenas for their demonstrations of magic and faith healing. Chinese skeptics who have exposed these Qigong hoaxers were among the hosts of the delegation that included these authors (Lin et al., in press).

2. Moxibustion employs various herbal materials but instead of being eaten, they are twisted into small cones and set on fire. The cones are placed over hypothetical “meridians” that are supposed to supply “Qi energy” to the afflicted part of the body. There they smolder, much like lit tobacco leaves. Although this is the traditional procedure, in the clinics we observed it had mostly been replaced by one in which a wire-bottomed box containing the smoldering herbs was simply placed over the site of the patient’s complaint.

3. We should note, as Skrabanek (1985) points out, that TCM has been banned several times in Chinese history as useless, only later to be reinstated by official fiat. Mao’s resurrection of TCM rescinded the 1929 ban instituted by the Kuomintang government, which had opted for scientific medicine over folk practices but did a very poor job of delivering it to the masses.

4. Western physicians have long been aware that suitably selected patients can undergo major surgery without anesthesia and show astonishingly little evidence of suffering if given hypnotic inductions or any of a host of other, related cognitive/social manipulations (see Melzack and Wall 1982, or Skrabanek 1985). Modern psychological research has shown that pain is partly a sensation and partly an emotional reaction (the “agony component”). Any manipulation of attention, anxiety, or arousal that attenuates the emotional component leaves the purely sensory aspect of pain surprisingly tolerable.

5. Many mainstays of modern pharmacology have their origins in traditional folk remedies (Lewis and Elvin-Lewis 1977). Traditional Chinese herbalism has already provided scientific medicine with valuable medications such as ephedrine (from the plant Chinese herbalists call “Ma Huang”). Undoubtedly, many other useful medicines remain to be isolated from the huge traditional pharmacopeia.

   Unfortunately, as it stands, most traditional herbs have not yet been properly tested for safety or efficacy. Thus, herbalism remains an inseparable mixture of some safe and effective remedies, some inert placebos, and some dangerous substances. It is difficult, if not impossible, in most instances, to tell which concoctions belong in which of these categories. The encouraging news is that, particularly in China, there are increasing numbers of attempts to apply scientific methods to separate the effective herbal medications from the placebos and to isolate the active ingredients in those that actually work.

   Firmly in the pseudoscience camp must be placed all traditional remedies made from rhinoceros horns, tiger penises, bear gall bladders and other parts of magnificent, endangered species. Lucrative poaching to harvest these body parts is seriously threatening these animals with extinction. And all this for useless treatments based solely on principles of sympathetic magic; i.e., the ancient belief that “like begets like.” These are symbolically potent parts of powerful beasts, so it is believed that such organs must therefore magically transfer to the people who take them the vitality and fortitude of their donors.

6. The newly appointed director of the Office of Alternative Medicine, Joe Jacobs, soon ran afoul of the wishes of the alternative medicine community and resigned his post (Marshall 1994). Jacobs exhibited a rare and commedable mixture of willingness to entertain unconventional hypotheses and a hardheaded demand for rigorous tests before accepting them. Alternative practitioners had long contended that the only reason their treatments had not proven their worth scientifically was that the hidebound medical establishment had prevented them from receiving the necessary research funds. When Congress suddenly made grants available through the new institute, most proponents of alternative medicine proved that they didn't know how to conduct proper clinical trials and didn't really want them anyway. When they increased their demands that most of the money be turned over to them, without proper peer review, to continue gathering the scientifically useless testimonials they had always relied upon, Jacobs quit rather than perpetrate a charade. He called their demands “professionally insulting.”

7. This exemplifies another aspect of sympathetic magic in TCM. Believers in “contact magic,” say that things that are in physical proximity can influence each other by passing a mystical “vital essence,” merely by being in the same vicinity. This is why psychics believe they can tell things about absent owners of objects they are allowed to hold—the owners’ essence supposedly transferred to the object and then into the psychic, by contact.

8. For instance, no reputable scientist has ever found an anatomical basis in the circulatory, nervous, or lymphatic systems for the “meridians” through which the health-enhancing vital energies posited by TCM are supposed to flow. The energies themselves cannot be detected by conventional scientific instruments. Likewise, doubts have been raised because of the ways in which TCM remedies, such as moxibustion, are administered — it must be claimed that they interact with their target organs by some sort of dubious “vibrations” or “sympathy” because our modern understanding of the body’s integument and membrane properties rules out their absorbtion by and distribution to target organs by any of the conventionally accepted routes. For instance, take this description of a TCM product promoted by an official Chinese government publication: “Yuwang-Brand Superior Weight-Reducing Bathing Liquid is made from medicinal herb extracts mixed with high quality detergent. It cleans the skin and promotes fat metabolism, helping to reduce weight and keep the figure slim” (Hou 1991, p. 33).

9. Whether this disciple was in fact “pulling his punches” intentionally to make his master look good, or was psychologically deluding himself that he was actually applying massive force when he was not, remains a matter of conjecture. What is known is that strong believers are capable of “ideomotor actions” (or inactions) where they honestly believe their movements (such as with a Ouija board or a dowsing rod) are not being initiated and controlled by their own volition (Vogt and Hyman 1979). Similarly, there is evidence that people can sincerely convince themselves they are exerting muscular effort when in fact they are not. Various hypnotic phenomena are of this sort.

10. In a similar vein, Barry Beyerstein, when he lived in China several years ago, was told by the staff at his residence that they knew a Qigong master who could leap over buildings. Of course, they said, the skeptical foreigner could have a demonstration. Unfortunately, for some reason, the time was never quite right. When he returned to Canada, Beyerstein organzed a lecture by a famous Qigong master, Ge, who had relocated to Vancouver. Ge promised to demonstrate the power of his Qi by making distilled water taste sweet. Once again, the audience was greatly disappointed when, after a rambling, incoherent lecture, the master announced he was now too tired to do the double-blind, forced-choice test Beyerstein had prepared. Ge’s claim that he could diagnose diseased organs by passing his hands over the surface of a patient’s body and feeling a twinge in the same organ in his own body was met with a question from the floor: “And just how do you detect ovarian cancer?”

11. It was the conclusion of Barry Beyerstein, after touring several treatment facilities outside the largest Chinese cities six years ago, that the much-publicized “complete integration” of traditional and scientific practitioners was not as happy a marriage as it had been portrayed. Back then, scientifically trained Chinese doctors were more circumspect in expressing their doubts about official encouragements of TCM, but many of them expressed their reservations quietly to the visitor nonetheless. On this more recent visit most scientific critics were bolder, but still cautious.

12. This belief that if something is “organic” or “natural” it must be milder, safer, and more benign than “manufactured” drugs is a common misconception among most practitioners of herbal medicine. A moment’s reflection will reveal that strychnine, “deadly nightshade” (belladonna), and a variety of mushrooms are among nature’s most dangerous poisons. Many herbal remedies are of questionable safety, let alone efficacy (Tyler 1985).

13. In a personal communication, Herbert presented the following account of a demonstration of animal acupuncture he had observed in China. The experimenter inserted needles into the animal subject and took a blood sample that showed a rise in endorphin levels. Herbert asked if he could try pinching the skin to see if it would have a similar effect on endorphin levels to that of the needles. It did.

14. Known in the older literature as “animal hypnosis,” grabbing and rapidly turning over small mammals can produce a stunned immobility, a protective freezing response, in which they appear to be insensitive to painful stimuli.

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