The scope of science

I've received a question about the PowerPoint presentation I put up. I've responded to the questioner, but I think this point may be of more general interest, so I'll put it up here as well.

But you mentioned how science can't measure what's not measureable. Is there any way you can expound on this point? I understand what you mean, but I'm more curious about any additional stories or anecdotes you may have shared about this point. I'm also curious WHY you brought this up? Is there some research you're doing that fits under this category? Does this fall into the qualitative type of research?

I myself am not doing any research on this point at the moment, but I find that it is something that is very important to a lot of people and that, if they think it is an obstacle to doing science, they will not make the attempt. So I want to go out of my way to reassure them that science does not need to take away from spirituality--the head does not come at the expense of the heart and soul, if you will.

I want *more* people to investigate doing science--and it will not be for everyone, but I want them to decide that for themselves on the basis of looking at it, and consciously deciding--not on the basis of the belief that they will be forced to let something very important go if they want to pick up science as another approach to life.

Here is a personal example; I hope that it illustrates what I am getting at.

For years, I worked at the Refugee Clinic at Harborview Medical Center in Seattle, where I performed massage for people from Southeast Asia, East Africa, Afghanistan, and other places. The people I treated had not only severe injuries from trauma, torture, and accidents, but often were severely depressed, or anxious, or had other psychological aftereffects of the trauma.

At first, I was quite afraid to take the job, because I thought that working around so many people with such difficult experiences would take its toll on me. I expected that, hearing their stories, I myself would grow more and more despairing at how cruel life can be in some places in the world, and to some people. But I had a friend who worked there, and he kept urging me to, and I agreed to try it and see how it worked out.

Strangely, I found that working with the refugees in the clinic provided strength and solace for me--I found a certain level of reassurance and meaning in the fact that, despite all the obstacles they had faced, they had survived and made their way here. I think that it is not enough to be strong--many strong people died along the way. They had to be lucky as well. And seeing them, even knowing that in their present state, there was a solid core of survival in them, made me more optimistic for humans than I had previously been. It was encouraging to me to see their desire to live, even though their present difficulties often put a heavy mask over it.

So what does that have to do with science? Well, science can measure how many people I treated, and it can describe their symptoms and measure any improvement. It can even explain the difference between depression and exhilaration in terms of brain chemicals. What it cannot do is explain how I was able to take meaning out of a situation where other people take desperation and depression--and indeed, where I expected that from myself before I started.

That I could extract personal meaning out of this situation--and that every other individual involved extracts their own, which may or may not overlap mine to some degree--that is something that science has nothing to say about. It is the domain of ethics, of spirituality, of that part of psychology which is not science--but it is not a measureable part of the natural world, and so it transcends science.

That is what I was getting at. At the same time, learning and doing science has taken nothing away from my ability to derive meaning and see beauty in the power of the human spirit to survive such hardships--and so I want to make that point very clear to people, who may unintentionally take themselves out of trying to learn anything about science because they fear--as some people say--that they will be forced to choose between head and heart.

My take-home message is that you do not have to choose--you can have both. What you do have to decide is where and how you want to dedicate your time for the maximal benefit of yourself and others--and once you have done that, to the degree that you want to learn about science, I want to provide the tools to help you do that.

I hope that made sense! Please let me know if it did; if not, I will try to express the point in another way.

Shor-Posner 2004: Introduction

(moved up to resume discussion, so that all the Shor-Posner discussion will be together)

Shor-Posner 2004: Massage treatment in HIV-1 infected Dominican children...

(moved up to resume discussion, so that all the Shor-Posner discussion will be together)

The structure of a research article: IMRaD

One of the themes that we will keep returning to in our discussions is that the community of science has tools that you can use to access the body of research literature on massage. One of those tools is the structure of a research article, often referred to as IMRaD, for the parts of the article, indicated by headings: Introduction, Methods, Results, and Discussion.

You can think of these sections as the "skeleton" of the paper: the organizational structure which holds the report together. Knowing that structure will help you navigate the paper, as well as knowing what to expect.

Introduction: the author explains "what" and "why"--"what" research question is being investigated (the "hypothesis"), and "why" this is an important issue.

Example: all examples are from Shor-Posner 2004, which we are about to look at in more depth:

"Why" (motivation):

In developing countries, where antiretroviral medication are not yet readily available to slow disease [meaning: HIV/AIDS] progression, massage therapy may have the potential to provide an important, safe, and sustainable form of immuno-stimulation.

"What" (research question):

The present study investigated the effectiveness of massage therapy in enhancing immune status in HIV-1 infected children living in the Dominican Republic, who are particularly vulnerable to rapid disease progression due to the limited access to antiretroviral therapies, prevalence of malnutrition, and increased risk of opportunistic infection.

Methods: "how" the researchers investigated their research question.

Example (don't sweat the details of unfamiliar terms and statistics now; we will talk about them in more detail. For the moment, just skim the paragraph to get the overall idea.):

The intervention design involved randomization of eligible, consented HIV+ children (n = 54) to receive either: massage therapy (20 minutes, twice weekly, for 12 weeks), or a friendly visit. The massage sections were conducted by trained nurses and followed a structured protocol of moderate pressure stroking and kneading of muscles, using a non-scented oil. Children in the friendly visit control group met with the nurse/therapist for a 20-minute session (reading, talking, quiet games) twice weekly for 12 weeks.

Results: raw numbers or other measurements of "what happened". Analysis of the results is not performed in this section; that comes next, in "Discussion".

Example (again, we'll get to all the unfamiliar terms and stats; for now, you should just get the idea here that it is a report of what the researchers observed):

Changes in mean CD4 cell count differed significantly (p < 0.03) from baseline to the last day of the 12-week study period for the massage vs. the control group.

Discussion. "what does all this mean?"--the authors discuss the results they got from the study, and interpret for us what they think it means. Additionally, they discuss limitations of their study, or problems they encountered, and they also make recommendations for future research in the same area.

Examples:

Interpretation, with study limitation:

The compelling findings of this study, while based on a small sample size, indicate for the first time that massage therapy appears to have a positive impact on immune function in HIV+ children not receiving antiretroviral medication.

Recommendation:

Restoring and preserving immune function is a key component to successfully managing HIV-1 disease, and the role of massage therapy in maintaining immunocompetence and preserving CD4, CD8, and CD3 lymphocytes may offer hope to the thousands of children worldwide without access to antiretrovirals, or who may not benefit from antiretroviral treatment.

All of this is kind of theoretical at the moment, but we will put it into practice when we start on the Shor-Posner 2004 article, and you will see how the IMRaD skeleton holds the body of the research together.

And now, at this point, if I have done my job properly, you are saying to yourself, there is a lot of material there, and I do not yet understand every detail of it, but I can see that there is a basic structure there, and I will get all the details to put on that structure--there is nothing there that is so difficult that I cannot understand it with guidance.

If, on the other hand, the task looks difficult and overwhelming, then I have not explained it well enough--because, while there is a lot of material here, we will work through it together. By the time we are done, these ideas will not be unfamiliar to you anymore, and you will have the tools to access the massage research literature.

Also...

The Vickers abstract quoted below deserves some unpacking. Tonight (Thursday) and tomorrow, I'll put up my reviews of the Shor-Posner article, as well as my response to Vickers.

As always, your comments are welcome--I am very interested in hearing how you respond.

Getting started

Andrew Vickers of the Research Council for Complementary Medicine in London writes:

While there is evidence that both massage and aromatherapy can be of benefit, practitioners make a great number of claims about the clinical effects of their treatments. These are presented in literature as simple statements of fact, often with no attempt to explain the basis upon which the claim is made. Though authors do occasionally make reference to the scientific literature, they often do so inadequately and in many cases the cited papers do not support the claims being made. Some authors have been explicit in giving personal experience as the source of their knowledge. However, there are several reasons why it can be difficult to make general statements based on individual experience. The many inconsistencies found in massage and aromatherapy literature--such as different properties being given to the same oil--provide further evidence that the knowledge base of these therapies is unreliable. Practitioners need to develop a critical discourse by which they can evaluate knowledge claims.

Source: the abstract from Vickers 1997: Vickers A. Yes, but how do we know it's true? Knowledge claims in massage and aromatherapy. Complementary Therapies in Nursing and Midwifery. 1997 Jun;3(3):63-5.

That's what we're here for--so let's develop that critical discourse to evaluate knowledge claims about massage.

We'll start with Shor-Posner 2004, an article about improving immune system markers in HIV+ Dominican children without access to retroviral medicines.

Reference: Shor-Posner G, Miguez MJ, Hernandez-Reif M, Perez-Then E, Fletcher M. Massage treatment in HIV-1 infected Dominican children: a preliminary report on the efficacy of massage therapy to preserve the immune system in children without antiretroviral medication. Journal of Alternative and Complementary Medicine. 2004 Dec;10(6):1093-5.