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December 1, 2024 - 7:00pm
I have long harboured a dream to visit an evidence-based spa. I very much enjoy sybaritic relaxation, but the infrequency of my spa-visiting is directly related to the rage induced when claims for the effectiveness of various administered “therapies” are made, usually when in a prone and near naked state. I like massages, scented oils, warm towels and luxuriance, but I do not like pseudoscience and fake claims — and I definitely don’t want to be wasting money on it.
Radio DJ Zoe Ball has resigned from her Radio 2 show after writing that she has been having significant problems with her TMJ — the temporomandibular joint, which connects the jaw to the skull. Pain from the joint is relatively common and can be very unpleasant, leading to headaches and often painful chewing. The condition is sometimes connected to anxiety and stress. She has reportedly visited a clinic that offers “lymphatic drainage massage” and thanked them for helping her. The clinic also provides “cup therapy”, which is in vogue, with famous people on red carpets revealing the circular marks on their flesh that result from it — vacuum suction is applied to skin via “cups” with the intention of removing “toxins”.
People should be able to spend their money how they want, and many people find massage soothing and a good distraction from pain. But look online, and you will find vast claims made by multiple vendors — and that is my issue. While some people can afford, and be willing, to pay for things that offer a short-lived placebo effect, it would be fairer to explain that is, in fact, what they are purchasing. (And there is some evidence that beneficial placebo effects can still be generated even when the person is told they are being given a placebo. In other words, it’s possible to be transparent and still feel a bit better). Many clinics offer lymphatic drainage massage — which sounds science-y — and indeed the lymph system is one of the most under-appreciated parts of our anatomy, continually and quietly protecting us from infections.
However it is touted on multiple beauty therapy websites as a means to “reduce the signs of ageing”, again via a release of “toxins”. (The lymphatic system will carry on doing that for us, regardless). A variety of hand-held implements, including rollers made of jade, are available for doing the “lymphatic massage” job if one does not wish to visit a therapist. (This is quite different from the physical treatments for lymphodema, a condition where the lymphatic system is blocked, resulting in limb swelling, which can be a consequence of some types of cancer surgery.) And again, there is a distinct lack of evidence that this can help pain.
But it is also true that neither does traditional medicine have great answers, although physiotherapy can help. There are some ways to mitigate the pain, such as “occlusal splints” — a mouthguard usually worn at night — but the evidence quality on them is poor. Meantime, a self-management programme, designed to help people control their physical and mental response to pain does seem to have an impact. But it is far better to be honest about the limitations of what’s on offer. First, interventions that can’t help you can only harm you (either financially or by side effects) and second, if we keep doing the same thing that doesn’t work, then we will never get any better treatments for anyone.
So what’s the problem, then, if people take an alternative path? If a placebo effect works, or people get temporary relief from pain, isn’t that a good thing? Yes and no. I want the same standards for all — whether it’s conventional medicine or labelled “alternative” (and as Richard Dawkins once said, “when alternative treatments are shown to work, they are no longer called alternative medicine, just medicine”). People with chronic pain are often suffering badly. If we are sold treatments without decent evidence of benefit and with promises beyond what can be achieved, we are potentially exploiting people, whether it’s labelled “alternative” or not.
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SubscribeDo people care about Zoe Ball?
yes, but I suspect not many of them would read Unherd (cue ageist comment)
Yes.
But if the alternative path becomes frowned upon, then banned in favour of approved medicine/treatment, then the State will control access to ‘approved health’ too.
It seems fanciful to call massage or acupuncture acts of rebellion… for now.
My acupuncturist voted for Brexit, and when I queried his decision, he said was because the EU were clamping down on any alternative treatments, including Chinese herbs.
Currently the companies producing pills are able to direct research money to getting their treatments tested and approved, when cheaper approaches might often be more effective. E.g. exercise, sleep, fasting, using existing cheaper medications off-label.
One solution would be for government to make a couple of billion pounds / dollars a year available for doctor-directed research. Once a year everyone with a medical license gets to vote on which therapies get large, high quality studies. (Having a small panel of experts direct the funding just lands us where we already are, with big pharma buying off the experts.)
The worried well, they’ll buy anything that reinforces their sense of specialness.
or people with a condition for which orthodox medical science doesn’t have an answer, like MECFS.
Aka laziness, gross self indulgence and strategy to regularly effect semblance of specialness
Resistance against quackery is useless. While I know nothing of Zoe Ball, there are thousands of her ilk out there promoting useless therapies to a gullible public. It has always been thus. Just look at how many religions there are all claiming an exclusive path to a heaven.
Ah quackery will always be with us as will celebrity endorsements of quackery.
As an almost 30-year practitioner, educator and school principal for massage therapy, I can tell you that I am absolutely appalled at the state of our profession and the attachment of the “wellness industry”. For decades, massage therapists and educators worked to bring legitimacy and separate themselves from the specter of prostitution…only to eventually find themselves completely captured by the snake oil factions that were always somewhat present but never really a threat. The sad part is, today we have spectacular new research and data on the pain experience and what we are actually providing our clients with when we center their participation in the therapeutic process. Its really amazing and next level! But nope, I want my fast and easy cupping and gua-sha psedo BS that I can learn in a week and if it doesn’t work for a client? Then the client must have done something wrong, or just didn’t “believe” hard enough. Its utter rubbish. And dont get me started on toxins…..
I feel for you. Up until recently I didn’t even know what “wellness” was and simply confused it with well-being. There’s actually something pretty cult like about it. And as you say, it drives out all the good stuff, and makes it hard for the naive to tell the difference between the two.
While I understand where the author is coming from, this is an enormous industry, and along with other fads, fancies and luxuries, a central part of the modern economy.
The era of producing real products and services to meet the real needs of real people is long behind us. Future economic growth depends on selling nonsense products and services to gullible people with money to spare. It’s something the U.K. needs to embrace.
It’s ‘Lymphedema’ and yes, even if one does not have a disease of the lymphatic system, massage can help in various ways, from increasing circulation in painful areas, to releasing tension in muscles. The various failings of Western medicine and the NHS in particular have indeed left patients looking for an alternative, without the toxic side effects or lack of efficacity of Western treatments. Not long ago pregnant women were being prescribed Thalidomide, let’s not forget, and the various horrors of the Covid vaccines are only just coming to light. How much did you get paid, as a GP, for injecting this poison into pregnant women and young children? Western medicine completely ignores diet, nutrition and the effects of vitamin and mineral deficiencies. You have a lot to learn, and some humility, let alone lifelong learning to improve your set of skills, would not go amiss.
Lymphoedema in proper English. While she may have spelt it wrong so too have you.
Sadly keyboards cannot accommodate the ‘oe’ or ‘ae’ dipthong.
I agree. I cured my TMJ by moving my jaw to the left and right several times a day. If I’d believed the doctors I would have been in line for an operation which is often unsuccessful. I’m tired of hearing that western medicine is the only solution. I hope Zoe Ball gets relief from whatever treatments work for her.
Welcome to UnHerd Margaret. I have long admired your writing and look forward to reading your sensible musings on evidence-based (or non-evidence based) health related matters