søndag 14. desember 2014

Research on health benefits

Health claims from Alexander Technique teachers were recently labelled "wishful thinking" by an expert on research on complementary and alternative medicine (CAM). In the following discussions in social media there were some instances of argumentation not conducive to a constructive debate, something which I described as unwanted "habitual reactions". Most of the discussions, however, were engaging, stimulating thought provoking and instructive. The discussions made me think about the fundamental question: should we bother about research on health benefits? The Alexander Technique is after all an educational method.

Ulterior motives
One of the things that perplexed me in the recent discussions was that there seemed to be an underlying assumption that the reason for doing research on health benefits from the Alexander Technique was for the technique to be 'accepted by science'. Again and again this theme cropped up. I think this is entirely the wrong reason for doing research.

What does 'accepted by science' mean anyway? As I mentioned in my last article I have followed the debate on CAM in recent years. This thing about being accepted seems to be a recurring theme. Alternative health practitioners seem to have a yearning for being accepted, probably because research on CAM for the most part have yielded negative results, so they feel rejected. They haven't really got the hang of how science works. If the hypotheses of claimed health benefits fail the test they have to go somewhere else for acceptance.

I believe there is economical reasons for wanting to be 'accepted by science'. Health claims are made to promote methods of alternative therapies. Promotion is a necessary element of trying to make money to earn a living. This is fair enough, but should not be the main motive for doing research.

The reason for doing scientific research is for gaining knowledge. With a better knowledge about to what extent the Alexander Technique can benefit people healthwise we can give more correct information. This will help people to take more informed decisions.

As an Alexander Technique teacher I seek to be professional. To be professional about health claims I would find it very useful to have some knowledge beyond personal experience and shared anecdotal evidence. There are some questions I would in particular like to have some more clarity in. There are claims of health benefits out there made by Alexander Technique teachers which I think there could be reasons to question.

In the Cochrane database of systematic reviews there is one mention of the Alexander Technique. This is on asthma. Evidently someone have found the claims made on behalf on the Alexander Technique concerning asthma prevalent to such a degree as to be worthy of inspection. As there is yet no research the effects of Alexander Technique on asthma the conclusion in the Cochrane paper is that: "Robust, well-designed randomised controlled trials are required in order to test claims by practitioners that AT can have a positive effect on the symptoms of chronic asthma and thereby help people with asthma to reduce medication."

Another issue I would like to have some more clarity in is the effect the Alexander Technique might have on 'frozen shoulder syndrome' (adhesive capsulitis). As mentioned in the article Wishful thinking, the very experienced Alexander Technique teacher Walter Carrington once said that the technique had limited effect on such conditions. Was he right? And what about the Alexander Technique and trigeminal neuralgia, or what about torticollis or focal dystonia?

There is information on the internet indicating that the Alexander Technique may give help with these conditions. I think it is only natural and right that these claims should be put to the test so that sufferers can have better information about to what extent the Alexander Technique may help.

But to do my work as an Alexander Technique teacher, do I really need to know in detail what conditions the technique can help or not? No, not really.

Should we stop making health claims?
One teacher in the recent discussion concluded that: "Let's just stop making claims. Period. We don't need them". Coming to the Alexander Technique via the field of music making and teaching I have great sympathy with this view. and if possible I think it is also the best position to take.

As Alexander Technique teachers we help people using themselves to their best advantage in anything that they do. Health benefits are incidental. We teach, we don't cure.

The problem is that the claims of health benefits are out there, and we have to deal with them. Putting forward claims of health benefits has been part of the tradition of Alexander Technique teaching during all its history. I think it is unrealistic to believe that the Alexander Technique profession as a whole is going to follow an admonition about stop making claims.

There is also another reason why stop making claims is not realistic, and that is the fact that the Alexander Technique actually give health benefits. The results from the ATEAM trial on Alexander Technique and back pain is a strong indication of this.

It is very natural to point out that the Alexander Technique may have an impact on health. We just have to make sure that it is done in an appropriate manner. I would expect all professional organisations to have some rules about what is appropriate. In addition the practice of Alexander Technique teachers is subject to the laws and regulations of the country of the teacher. I think the regulations in Norway which allows general claims but rules out claims of helping specific conditions gives a good general guideline.

The problem with only making claims of general nature is that it becomes like the claims from anybody else. Have a look at any web site for any 'alternative health method' and you often cannot discern between them. They all give the same promise of general wellbeing. So, maybe claims of health benefits are not, or should not be, our 'unique selling point' anyway?

It could be that the question about what constitute reasonable claims of health benefit is a question that Alexander Technique teachers in general should be more conscious about, and which needs to be discussed more.

Upcoming research
One very important reason for the need to deal consciously and constructively with the research on possible health benefits is that new research is under way. There is no way we can ignore it.

For teachers, who teach performers and who don't focus on health in their advertising or teaching, this may be not that important. But any teacher who has put claims of health benefits on their website and/or advertising material, or who puts forward claims in articles etc, are in my opinion obliged to deal consciously and constructively with information about the Alexander Technique and research on health benefits.

In the recent debate, there were teachers who were very negative towards the article by Edzard Ernst on claims of health benefits from AT teachers, and also negative towards science in general, but who had the information youtube video from the British Medical Journal on the ATEAM back pain trial prominently featured on their website. This is hypocrisy.

Dealing constructively with scientific research does not mean that we should necessarily accept everything. It means we should be able to criticise research without making mistakes like the ones I described in my article about "habitual reactions". This requires some literacy about how science works and about how medical research is carried out. It is not my impression that this kind of literacy is widespread in the he Alexander Technique community.

Defining ourselves
One thing that was striking in the recent discussions on the Alexander Technique and claims of health benefits was that there seemed to be a confusion between research on health effects and research on the mechanisms of the Alexander Technique.

To carry out research on health benefits of the Alexander Technique, it is not necessary to know the working mechanisms. What is necessary is to test something that is a representative version of Alexander Technique teaching. This poses a challenge to the Alexander Technique profession. There is no common definition of the Alexander Technique and no common agreement about what constitutes good quality Alexander Technique teaching. These are questions that themselves could benefit from scientific research.

Regardless of quality there are many different approaches one can take when teaching the technique. This also poses many questions that have to be taken into consideration when performing research on the technique, and which teachers who are involved should be aware of.

Kathleen Ballard, one of the teachers involved with the ATEAM trial, suggested in the article Public Misperceptions in Statnews (January 2008, vol . 6 issue 24), that we should make a distinction between the Alexander Technique itself, and the methods of teaching it, that is, between the skill taught (and used by the Alexander Technique teacher in the process), and the methods of teaching this skill.

This is a distinction not made by Alexander himself. To him it was all 'The Work'. I believe that for us to be clear about what the Alexander Technique is, and what we do as teachers, it is vital that we make this distinction.

A technique for prevention
Some say that the research on health outcomes of the Alexander Technique puts the technique in a too narrow frame. They are correct. But it is not medical research that do this in the first place. It is the AT teachers who put the claims forward.

Alexander himself was adamant that he did not propose a cure. His technique improved general functioning, which in turn would tend to improve health indirectly. We may use the same argument. The problem is that anyone not acquainted with the Alexander Technique will bring their own understanding to it and probably only take it as a promise for a cure. 

Alexander also stressed the importance of prevention. He argued it was prevention in a wider sense, not in the sense the term was used by doctors and others (see beginning of chapter IV, Universal Constant in Living).
Some have suggested that pointing out the possibility of prevention would be more tolerable than making claims of improvement. I think the opposite is the case. Claiming to prevent could be an even more widesweeping claim than promising improvement or relief. And maybe even harder to prove. We would still be making a claim and it would still be reasonable to wish for more than just anecdotal evidence.

To conclude. To practice as teachers we don't necessarily need verification of health effects. The Alexander Technique is an educational method. But as the technique arguably influences health, and health claims are made, the Alexander Technique community should feel an obligation to engage constructively towards the effort of research on health effects. This requires a minimum of knowledge about science and research methods, which the majority in the Alexander Technique community don't have. It also presents a challenge to the Alexander Technique teaching profession in terms of defining quality standards and explaining what we do and why we do it.

Please feel free to comment below!

Related articles:

Ingen kommentarer:

Legg inn en kommentar