Reply to complementary medicine for fatigue and cortisol variability in breast cancer survivors


We wish to clarify some misconceptions put forth by Coyne, Johansen, and Gorski regarding our reported randomized controlled trial.1 First, the intervention used was not therapeutic touch but a specific hands-on technique commonly used in many types of biofield therapies for ameliorating fatigue. Second, there is an evidence base for biofield therapies.2, 3 Third, the study was designed to examine nonspecific and placebo elements that may drive responses: This is why we used the mock healing group as a comparison along with the waitlist control group. We also examined patient expectancy, belief, and patient ratings of practitioner attributes—all elements of placebo—as potential predictors. Fourth, despite Coyne et al.'s seemingly contradictory statements (stating that the study is underpowered while also suggesting cortisol slope results should have been Bonferroni corrected), the power analysis and statistics are correct and clearly described.

The study identified clinically and statistically significant reductions in fatigue for both the biofield and mock healing groups, with fatigue in the biofield group dropping to levels observed in the general population and, in the mock group, to the levels observed in patients with breast cancer patients chemotherapy. Diurnal cortisol variability, a marker with significant relevance for cancer patients in terms of disease status and symptom prevalence, improved specifically in the biofield group. Adherence was high with no noted side effects. Mechanisms still need to be investigated.

The larger issue is what constitutes “pseudoscience” and what information is worthy of dissemination to the public. Should the data from our well conducted, rigorous, randomized controlled trial be dismissed because the mechanisms are unknown or because some scientists do not believe in the specific therapy? We make no claims surrounding mechanisms. We do note that this intervention has significant promise for reducing fatigue, which is the most common complaint among cancer patients, and the therapy produces no harm. Therefore, it merits further investigation. Premature rejection of findings from rigorous randomized controlled trials are as big a threat to science as the continuation of falsehoods based on belief. Thus, as clinicians and scientists, our highest duty to patients should be to investigate promising solutions with high benefit/risk ratios, not to act as gatekeepers of information based on personal opinion.