How dangerous is Shiatsu? Science and polemics (Dr. Eduard Tripp)

The original article was published on July 9, 2019 („Wie gefährlich ist Shiatsu? Wissenschaft und Polemik“;
/wie-gefaehrlich-ist-shiatsu-wissenschaft-und-polemik)
Translation by Dr. Eduard Tripp and Chris McAlister.

Under the title „Shiatsu: do the benefits outweigh the risks?“ Edzard Ernst, the former Chair of Alternative Medicine (University of Exeter) and well known in Great Britain, comes to a devastating conclusion: „… the proven benefits do not outweigh the potential harm“. In his opinion therefore, Shiatsu can only be advised against. If one examines his contribution in detail, however, one sees a wholly tendentious and partly falacious account – his report appears under the cloak of science, but does not correspond with it in certain essential points.

Inhalt

Preamble

Evidence is probably one of the most important terms in the field of health at the moment: proven efficacy and proven patient safety are the cornerstones of a method´s evaluation. Naturally, there are inequalities between those methods that are backed by financially strong interests and those that are not (keyword: research is expensive). In addition, different methods can be brought into a meaningful research design with differing degrees of ease or difficulty.¹ But all of this does not change the understandable fact that politicians, actors within the health sector and, of course, clients/patients orient themselves primarily through research results.

According to Duden, the standard German spelling dictionary, evidence is (among other meanings which are less important in this context, such as „the place where data or documents are collected“) „an irrefutable fact„, „being an evident; immediate and complete insight, clarity, certainty“ and – especially in medicine and pharmacy – „proof of the efficacy of a preparation, a form of therapy or the like„.

Science separates facts from opinions. Facts (something that has happened, a given circumstance) can be (relatively) objectively established. Theses are accordingly falsified (refuted) or confirmed; something is either true or false. Opinions, on the other hand, are personal views, beliefs and attitudes that someone has about something (e.g. a certain fact). Opinions can be different; unlike facts, opposing opinions can coexist.

Science, as it is defined by the Duden, is a researching activity that produces knowledge (well-founded, ordered and considered to be secured), which, although the Duden does not explicitly state this in its definition, is also committed to objectivity. In this it differs from polemics (attacks without objective arguments) as well as from one-sided, tendentious and/or distorted representation of facts and events.²

However, the scientific method (scientificness) does not only mean the existence of scientifically collected and processed data; the handling of these data must also be scientific. This means in particular traceability and care in dealing with the sources on the one hand, as well as the separation of facts from opinions on the other. According to the philosopher Hannah Arendt, „blurring the line between facts and opinions is one of the forms of lying“.³

For the sake of scientificness, all sources and their contents are listed in the present article as far as possible in a comprehensible manner, which, however, impairs the legibility of the text. In order to enable a (halfway) fluent reading flow, explanatory and supplementary contents are located in indentations and footnotes.

On the person of Edzard Ernst

Edzard Ernst, a native German (Wiesbaden), who became a British citizen in 1999, is a man of science, as his titles „MD, PhD, FMedSci, FRSB, FRCP and FRCPEd“⁴ alone prove. Wikipedia informs us that he is „emeritus professor of alternative medicine in Great Britain. He was the first chair holder in this field„, and is „a member of the Advisory Board of the AlterMed Research Foundation, a foundation that promotes scientific research in alternative medicine“ as well as „Editor-in-Chief of the two medical journals Perfusion and FACT (Focus on Alternative and Complementary Therapies)„.⁵

Mr Ernst is undoubtedly „active“ in the field of science, as he himself states on his website⁶: „I have published 53 books and well over 1000 articles in the peer-reviewed medical literature. My work has been awarded with 16 scientific awards, most recently (2015) with the ‚John Maddox Prize‘ for standing up for science, and the Ockham Prize (2017).“ He continues: „During the last 25 years, my research focussed on the critical evaluation of (almost) all aspects of alternative medicine. I do not aim to promote this or that therapy, my goal is to provide objective evidence, reliable information and critical assessments. This ambition does not endar me to many believers in alternative medicine, including Prince Charles.“⁷ His current books, as he further explains, are „SCAM – So-Called Alternative Medicine„, „More Harm Than Good„, „Homeopathy, the Undiluted Facts„, „A Scientist in Wonderworld, Looking for Truth and Finding Trouble“ and „Trick or Treatment„, which are mainly written for laymen.

Even if the titles of his books suggest a tendency towards a certain attitude towards alternative methods of treatment, who would distrust or even imply unfairness of a man with such references?⁸

The effects of Shiatsu in the mirror of Edzard Ernst’s contribution

On May 10, 2016, Edzard Ernst dealt with Shiatsu („Shiatsu: do the benefits outweigh the risks?“⁹) and writes that Shiatsu is a popular alternative form of treatment with a remarkable void of research. In the following, Edzard Ernst describes Shiatsu („according to one of the rare reviews on the subject„) on the basis of the review article „The role of shiatsu in palliative care“ by Caroline Stevensen published in 1995.¹⁰

„Shiatsu is a form of Japanese massage, working on the meridian system of the body; the energetic pathways along which the acupuncture points are placed. The theory for shiatsu is based in the system of traditional Chinese medicine, understood in China for over 2000 years. Shiatsu can be valuable for reintegrating the body, mind and spirit, helping with the general energy level of the body as well as specific symptoms… Feelings of deep relaxation, support and increased vitality are common following a shiatsu treatment. The method, strength and frequency of treatment can be varied to suit individual need.“¹¹

The abstract, which was just over 20 years old at the time, is cited in almost complete entirety. The following is however, omitted from Ernst’s article: „Its role in western palliative care is little studied to date. This paper explores the potential benefits of shiatsu in this setting and cites a case example where it has been beneficial“ and finally „Shiatsu should be considered when thinking of complementary methods of support in palliative care„.¹²

If, Edzard Ernst continues, this description seems too optimistic to the reader, he is recommended to „have a look on the Internet where where bogus claims for Shiatsu abound. But such uncritical nonsense is, of course, neither informative nor responsible“. Furthermore, Edzard Ernst refers to an earlier entry (2013) in which he has been „a little more critical about the value of Shiatsu and concluded that is an unproven therapy„. This contribution was based on a systematic summary in the Oxford Handbook of Complementary Medicine¹³, (2008), in which the authors (Edzard Ernst, among others) found only little evidence for Shiatsu and “ In fact, we concluded, that no convincing data available to suggest that Shiatsu is effective for any condition„.

Anmerkungen/Fußnoten

1
or example, the randomised controlled double-blind study can be used in pharmaceutical research, but not in many other areas, such as in Shiatsu.
2
Nonetheless, in the field of journalism there is the so-called tendency protection, called the Blattlinie in Austria. This describes the right of a publisher to determine the political opinion of a medium. In this sense, however, it has nothing to do with science.
3
Quoted after an interview („Facts are reformulated into opinions“) with the philosopher Prof. Dr. Sophie Loidolt. The Standard on March 19, 2019. https://www.derstandard.at/story/2000099763667/philosophin-sophie-loidolt-tatsachen-werden-zu-meinungen-umformuliert. Access: 5/7/19.
4
Source: https://edzardernst.com. Access: 28/6/19.
5
Source: https://de.wikipedia.org/wiki/Edzard_Ernst. Access: 28/6/19.
6
Following quotations: https://edzardernst.com/about. Access: 28/6/19.
7
This allusion refers to a scandal, as Wikipedia (ibid.) writes, which in 2005 led Ernst to refer to Prince Charles as a „snake oil salesman“. See also: Max Rauner: Edzard v. Charles. Die Zeit, 6/12/11. https://www.zeit.de/zeit-wissen/2012/01/Portrait-Ezard-Ernst/komplettansicht. Access: 28/6/19.
8
In some passages of the text I tried to correspond to the quite casual writing style of Edzard Ernst.
9
https://edzardernst.com/2016/05/shiatsu-do-the-benefits-outweigh-the-risks. Access: 28/6/19.
10
Stevensen, Caroline: The role of shiatsu in palliative care. Complement Ther Nurs Midwifery. 1995 Apr;1(2):51-8. https://www.ncbi.nlm.nih.gov/pubmed/9456709. Access: 28/6/19.
11
Source: https://www.ncbi.nlm.nih.gov/pubmed/9456709. Access: 28/6/19.
12
Ebd. The extent to which Edzard Ernst has read the underlying work cannot be deduced from this.
13
Edzard Ernst, Max H Pittler, Barbara Wider und Kate Boddy: Oxford Handbook of Complementary Medicine. Oxford University Press Print, Mai 2008. Online: August 2010. https://oxfordmedicine.com/view/10.1093/med/9780199206773.001.0001/med-9780199206773. Access: 28/6/19.

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