The meaning of "Energy"

[pozorvlak]

Last night a friend of mine retweeted this:

.@marzillk What energy!? Some completely unobservable thing? Energy is simply the ability to do work. Nothing more, nothing less.
-- rhysmorgan

It turned out that this was in response to the following:

@AlabasterC My sister recommends homeopathic aconite and tapping various energy points. It is helping a bit.

When questioned further marzillk usefully clarified:

@rhysmorgan Spleen meridian boosts immune system. It's under ribs on the left hand side - find the sore point, then tap while slow breathing

@rhysmorgan I know it sounds mental but I can genuinely feel it doing something.

Now, there's so much wrong with that that I don't know where to start. But I do know where not to start: by criticising her terminology. I fired off:

@rhysmorgan right now, @marzillk's making observations and you're bitching about terminology. Pop quiz: which is more scientific?

I want to expand on that a bit.

When I went off to university ten years ago, one of the questions I wanted to answer was "what is this thing called energy?" I still don't have a good answer to that, unfortunately; if asked now I'd mumble something about Noether's Theorem and Hamiltonians of closed systems, so I am at least confused on a higher level. But let's accept rhysmorgan's definition "the ability to do work" for the moment (and pretend not to notice that we haven't defined "ability" or "work"). There's still a problem with criticising marzillk's use of the word "energy": the physicist's definition isn't the only possible definition of the term. The OED gives seven definitions, of which only the final two are related to the thing that physicists talk about. Furthermore, the word "energy" has only been in use in the physicist's sense since 1807 (and the following year, someone proposed using it for what we now call "momentum"!) So if the practitioners of traditional Chinese medicine (or anyone else) want to re-use the term "energy" (or, for that matter, "meridian") to refer to something else, I have no problem with that in principle.

What I do have a problem with is the extraordinary ignorance of biology betrayed by marzillk's use of this stuff (and if she thinks that it's irrelevant that she works in educational publishing... well, I'm afraid I disagree). I've encountered a lot of skilled martial artists who claim to find qi (or something very similar) an essential component of the way they think about their art, so I'm not willing to totally write it off (perhaps it could be made to work as a high-level abstraction over some low-level biomechanical details), but really, tapping a point over your spleen to cure a cold? How on Earth does that fit with the (extremely well-attested) germ theory of disease?

But you know what, I could be wrong. Maybe tapping your spleen somehow makes it produce more monocytes or something (would that even help with a viral infection? IANAB). But that's the great thing about science: we don't have to rely on arguments from theory. Instead, we just do the experiment; if the experiment contradicts the theory, then the experiment wins. In this respect, marzillk was being more scientific than rhysmorgan, with her "I don't understand it, but I've tried it and it seems to work", approach. XKCD nailed this one: '"Ideas are tested by experiment." That is the core of science. Everything else is bookkeeping.'

To be sure, it's a pretty dodgy experiment. Only one subject, no control, no blinding, results measured by subjective feelings of wellness. One could imagine a much better experiment, in which a large number of subjects were randomly assigned to two groups: one group would receive meridian-tapping therapy from a trained master of the art, and the other would have random points on their body tapped by actors who could spin a convincing line of bullshit about the mystic significance of what they were doing. Then you measure how long it takes everyone to get better from their colds, and see if there's any statistically significant difference in the recovery times of the two groups.

I had a brief look, but couldn't find anyone who'd done that experiment. A fascinating and well-known 2007 study did what I described for acupuncture and lower back pain, though, and found that the actors had a greater success rate than the acupuncturists!

Contrariwise, this study evaluated "Meridian three-combined therapy" (thread embedding, bloodletting, and tapping/pressing) for the treatment of psoriasis, and found a small but significant improvement in effectiveness compared to conventional treatments. However, I'm assigning that limited weight in this context, because (a) it didn't just measure tapping, (b) it was for a different condition, (c) it was painfully (hoho) obvious to the patients which group they were in, and (d) it was performed in a Chinese cultural context, and we know (from experiments!) that cultural context is very important for the placebo effect.

So, anyone with greater scholarship skills able to find anything more relevant?

Update: rhysmorgan responds "I guess my beef with her referring to it as energy was that her form of energy doesn't actually exist." I take his point, but "existence" is kinda problematic in this context. Physicists' energy is an abstraction, a consequence of the time-invariance of physical laws. You can't measure it directly, nor capture it in a pure form. In what sense does it exist? But the theory of physical energy makes useful predictions: we can do calculations with energy and arrive at correct, numerical predictions of what will happen when we perform experiments. This is the important thing. To take a more abstract example: when you learn about the conventional underpinnings of calculus, you discover that there's no object in the system called "dx" or "dy", and that statements involving them are shorthand for more complex statements about the behaviour of limits. But the theory as a whole allows you to manipulate these non-existent objects and arrive at correct results. Analogously, the important question about meridian-tapping is not "does it refer only to directly observable things?" but "does it give correct predictions?"

Comments

[susannahf.livejournal.com]

I found three meta-analyses and one report of linked studies on acupressure. All RCTs.
1) Role of acupressure in symptom management in patients with end-stage renal disease: a systematic review (http://www.ncbi.nlm.nih.gov/pubmed/20636160). "CONCLUSION: No definitive conclusion is available. Future trials should adhere to standards of trial methodology and explicitly report relevant information for evaluation of efficacy and safety of acupressure in patients with ESRD." My translation: the studies were either done badly or reported badly, or both. No information either way
2) Do Japanese style acupuncture and moxibustion reduce symptoms of the common cold? (http://www.ncbi.nlm.nih.gov/pubmed/18955215) Not the same technique, but the same illness... "In conclusion, the safety of Japanese acupuncture or moxibustion was sufficiently demonstrated; however, a series of clinical trials could not offer convincing evidence to recommend the use of Japanese style acupuncture or moxibustion for preventing the common cold. Further studies are required as the present trials had several limitations." My translation: no evidence of effect.
3) Meta-analysis of acustimulation effects on nausea and vomiting in pregnant women. (http://www.ncbi.nlm.nih.gov/pubmed/16979105) "CONCLUSIONS: This meta-analysis demonstrates that acupressure and ETS had greater impact than the acupuncture methods in the treatment of NVP. However, the number of acupuncture trials was limited for pregnant women, perhaps because it is impossible to self-administer the acupuncture and thus inconvenient for women experiencing NVP as chronic symptoms." My translation: acupressure may work for nausea in pregnant women. (A placebo effect was also noted, but was a lesser effect than acupressure)
4) Metaanalyses of acustimulations: effects on nausea and vomiting in postoperative adult patients. (http://www.ncbi.nlm.nih.gov/pubmed/16781643) "CONCLUSIONS: This metaanalysis demonstrated that AS is just as effective as medications in reducing NVS and that acupressure is just as effective as acupuncture or electrical stimulation in reducing NVS for postoperative adult populations." My translation: not just pregnant women...

Overall, I'd say there is a lack of information generally. Most of the literature is published in journals I've never heard of, but they are in pubmed, which doesn't accept *everything*, so maybe they're ok. Or maybe not. Certainly a lot of the papers I turned up started on the assumption that it works, and then reported correlates. However, one thing that did consistently turn up is that they are *safe*. If you're going to use a treatment with no evidence for it, I'd much rather you use one that is at least known to be safe ;)

[andrewducker]

Metaphors are a perfectly good use of the English language. The fact that something may not literally exist doesn't mean that it might not still be a useful way of talking about something.

If the person is making claims of efficacy then they have to be able to back them up if they want to be believed. But if they want to use "energy" to mean "feeling good" then I'm fine with that.

[lesmondine (from livejournal.com)]

I'm surprised by the credibility given to martial arts in an otherwise fairly rational post.
Martial arts has to be one of the largest mines of spurious mystical nonsense that I'm aware of. The vast majority is explainable by conventional physiology, and the stuff that seems extraordinary can invariably be shown to be fakirism, trickery or just plain lies.

A martial artist babbling about "qi" would make me MORE suspicious.

Regarding the acupuncture study, what's interesting is that it doesn't matter where you stick the needles - providing compelling falsification of the "meridian" hypothesis (at least insofar as it applies to acupuncture).

[elvum.livejournal.com]

If you separate things out, I guess you have anger at the reuse of the word energy and anger at the belief that the concept of qi (or whatever you're using the word energy to describe) is a useful way to describe anything with real-world relevance.

I probably agree that scientists don't have much of a right to insist that their careful definitions of words like "force", "energy", "mass" etc should override previous meanings, not to mention the general free-for-all nature of the English language.

I think it's more reasonable to object to claims that qi has physical meaningfulness, so long as those objections are to the lack of scientific evidence for the theory.

Anger at the fact that hundreds of years after the Enlightenment people are still basing their worldviews on unquestioning acceptance of what they've been told by authority figures and on highly subjective interpretations of personal experience - that's probably also justified, but not really possible to blame on individual people on Twitter...

[(Anonymous)]

People with a physics background are taught to be ridiculously fussy about their choice of words, and this spills over into real life. I've had this issue with one of my PhD supervisors over my use of language in my (engineering) thesis.

Mind you, I've yet to meet a physicist who tells me that they've lost mass recently...

If you're interested in studies of chronic pain, I suggest you talk to my other half (also Mike), as this is his specialist field. Mike's general belief is that the majority of patients who present with chronic pain symptoms do so as a result of their mental state, which magnifies their physical symptoms. Simply getting people to relax and have an authority figure conduct some form of "treatment", then tell them that they ought to get better can be remarkably effective...

MPJ

[half-of-monty.livejournal.com]

Hey, "dx" is an object - it's just the dual of the operator "\frac{\partial}{\partial x}" !

And I must say, I understood basic calculus ever so much better when I knew that. In fact, I must remember to tell my first year economics students that as I teach them to differentiate. :-)