Reflexology theory alleges that reflex points on the foot, hand or
ear correspond to areas of the body and/or organs. Charts with organs
superimposed on the foot, hand or ear allege to map these points. This
monograph refers only to foot reflexology, but can be used to infer to
all types. Using the chart as a guide, the practitioner probes the
theorized reflex points and questions the client. (The chart does not
indicate specific diseases or diagnoses but the supposed location of the
problem).
Look for constrictions, or the places where the person feels
pain or says ´ouch´; check the accompanying charts to determine what
body part corresponds to the sore part of the foot. Tell your friend
that he either has a problem in that organ or a strong potential for one
[1].
Thus, if something is found at an alleged reflex point, it is
"proof" that the system is valid; if nothing is found, the system still
is purported to be valid because it predicts future problems. This
method represents a no-fail "heads I win, tails you lose" proposition.
As obvious as this may be to an objective observer, it is not apparent
to practitioners or clients who have been impressed by the system´s
seeming validity on a personal experience level.
A similar rationale is employed by iridologists who
superimpose organs on the iris, and auricular acupuncturists who
superimposed body organs on the ear (a homunculus in the fetal position). The methodology is similar in all of these.
Brief History
William H. Fitzgerald, MD, an early 20th century ear, nose, and
throat specialist, introduced reflexology in the United States in 1913
as zone therapy. Fitzgerald divided the body into ten vertical
zones. These zones were alleged to correspond to the fingers and toes
and he taught that "bioelectrical energy" flowed through these zones to
"reflex points" in the hands and feet. His method of treatment involved
the fastening of wire springs around toes [2]. Eunice D. Ingham further
developed reflexology in the 1930s and 1940s concentrating on the feet
[3] More recently, books by reflexologist Mildred Carter, a former
student of Fitzgerald´s, have promoted foot reflexology as a miraculous
health method [4]. Carter´s books have mixed nutrition nonsense with
extravagant health claims. A 1993 mailing from Parker Publishing Company
stated:
Not only does new Body Reflexology let you cure the worst illnesses safely and permanently, it can even work to reverse the aging process,
Carter says. Say goodbye to age lines, dry skin, brown spots,
blemishes–with Body Reflexology you can actually give yourself an at-home facelift with no discomfort or disfiguring surgery [2].
Products
A number of products (e.g., sandals, shoe inserts, foot massage
devices) are sold based upon the theory of reflexology. When medical
claims are made such would become "medical devices" under the law, and
would be subject to regulation by the FDA on the federal level, and
state food and drug agencies.
A Test of Reflexology
For several years, I had a certified reflexologist (whom I
refer to below as "RD") describe the theory and demonstrate the practice
of foot reflexology as part of a graduate course in general research
methods at Loma Linda University. I would challenge the students to
design a controlled trial that would test reflexology. After having
demonstrated reflexology before several different class sessions, RD
confided that although he believed in reflexology, he was curious to
know if it could withstand scientific scrutiny. He asked that a real
test be done. At this same time, several physical therapists at Loma
Linda University had been promoting reflexology. Kelly Ferris, a
physical therapist who was working on a Doctor of Health Science degree
in the LLU School of Public Health, was curious about the value of
reflexology. Although Ferris did not believe that "all nerves ended in
the feet," as some reflexology charts declared, he was open to the
possibility that some sort of switching point may exist in the brain
which connected body areas to reflex points on the foot or hand. Ferris
agreed to conduct a trial of reflexology´s theory under Jarvis´s
direction.
Research Problems
The research problems presented by such a test provide insight into why nonscientific health care procedures can fool honest people into believing that they work.
Potential problem #1: Testing a "no-fail" system. It would be
impossible to test reflexology´s claim that it can prevent or predict
future disease. That would have to involve huge numbers of subjects and
take a lifetime for the results. Testing the healing potential of
reflexology on sick people raised insurmountable ethical issues. It may
sound simple enough to do, but this would mean depriving sick people of
standard care, and human beings are not to be toyed with in such a
manner. However, it is possible to determine whether a reflexologist
could find disordersknown to be present. Ferris and I reasoned that a
reflexologist who could not discern that a patient had a specific
problem would be unlikely to accurately predict future stomach disease.
RD agreed. The team settled on having subjects fill out a questionnaire
that mapped their current or recent health problems according to their
locations by organs.
Potential problem #2: Overt information between patient and
therapist. People willingly share information about their health
problems with anyone who they think may be able to help them, or who
will provide a sympathetic ear. Knowing that patients could spoil the
test by providing the information a reflexologist supposedly can discern
from probing the foot, we could not allow free conversation between the
patient and therapist. To control this factor, free conversation
between the patient and therapist was not permitted. A list of words
that the patient could use to communicate was provided. Allowable words
were written on paper attached to a clipboard patients held on their
laps. Included were "that hurts… a little, some, a lot," and so forth.
Although this method presented an entirely different clinical
atmosphere than reflexologists are used to, RD agreed that it should not
prevent reflexology from working according to its theory, and he agreed
that the conditions were essential to prevent the client from providing
the information that probing the foot should yield according to
reflexology theory.
Potential problem #3: Subliminal cuing. Subliminal cuing refers
to signals that people send without realizing that they are doing so.
Conventional wisdom sometimes refers to such cues as "body language."
Fortune tellers know it as "muscle-reading." Kenny Roger´s country
western hit "The Gambler," refers to cuing with the words, "Son, I´ve
made a life out of reading people´s faces, knowing what their cards were
by the way they held their eyes." To minimize subliminal cuing, RD and
the subjects were separated by a curtain with the subject sitting on a
chair with feet protruding through an opening in the curtain. Another
person who could see both RD and the subject watched for apparent
reactions on the part of subjects. If a reaction was noted that RD could
not see because of the curtain, the observer would wait a few seconds
and then ask RD to repeat the last 6 or 8 reflex points. RD agreed with
this arrangement.
Results
Seventy subjects completed questionnaires that asked about
possible conditions in 43 anatomical areas which were currently present,
or had been within the past two years. The reflexologist´s findings
from a form matched to the questionnaire were correlated to determine
the degree of agreement. The results were presented as a vast array of
correlations. As expected, five-percent of this number were
statistically significant at the .05 level. The important question was
whether or not any of these correlations was powerful enough to use as a
screening device that indicate a need for further diagnosis. The
strongest correlation (r=0.37) was for "stomach problems" which has a
predictive value (i.e., coefficient of forecasting efficiency) of 0.07
meaning that reflexology was seven-percent better than random guessing
for this condition. Although 7% better than random guessing is enough to
make a gambler rich who plays long enough, it is far below an
acceptable standard for medical tests. Even RD agreed that reflexology
was not an acceptable method of medical screening. Further, RD decided that
since reflexology could not reliably find conditions known to be
present, there was no good reason to believe that it was predictive or
therapeutic. From that time on his practice would involve
simple foot massages for people who wanted them with no diagnostic or
therapeutic claims.
We also designed a study of the therapeutic value of
reflexology which was not carried out. We felt that it would be
difficult to justify a therapeutic study of a healing system that had
failed our pilot test. Years later, we learned of a study with a design
nearly identical to a test that we had planned, which purports to have
effectively relieved premenstrual syndrome. In the test, 35 women who
complained of premenstrual syndrome (PMS) were randomly assigned to ear,
hand and foot reflexology or placebo therapy done on sham reflex
points. Subjects kept a daily record on 38 somatic symptoms selected
from previous PMS research questionnaires. The treatment group reported
significantly fewer symptoms than the placebo group, and these benefits
persisted for 2 months after treatment. The placebo group reported that
they thought they were receiving genuine reflexology. The authors note
that it was very difficult to develop a credible placebo control group
which may have been the study´s flaw. Normally, reflexology is
soothing, but the placebo treatment was described as "either overly
light or very rough." We believe that the differences could simply have
been differences in the quality of the massage being administered. As in
applications of sham versus genuine acupuncture, the therapists are
likely to vary the quality of the procedure in accordance with their own
expectations regarding the study´s outcome. This study suggests that
massage may relieve PMS symptoms, but does not validate the alleged
connection between reflex points and body organs [5].
Reflexology appears to mislead unsophisticated practitioners
and clients into believing it has value for the same reasons that
fortune tellers and their clients are fooled into believing that their
methods work. Like the fortune tellers, reflexologists go on a
multiple-choice fishing expedition in which they elicit information from
a client using a technique similar to the parlor game of
"twenty questions." The practitioner does what the words of an old song
says, they, "accentuate the positive, eliminate the negative, latch on
the affirmative, and don´t mess with Mr. In-Between!" Although we
considered this to be only a pilot study, we challenge anyone wishing to
test reflexology to control for the factors described above. People who
want to know the truth will work hard at eliminating confounding
factors.
It is worth remembering that the reason that so-called
"double-blind" testing evolved in medical science was that experience
taught that even honest, competent medical experts can be misled by
their expectations, and other psychological effects, into believing that
worthless methods have value. Roberts and others have examined the
deceptiveness of clinical illusions by reviewing medical and surgical
treatments that were thought to be effective at the time they were
reported in the literature, but which were later found to be
ineffective in double-blind, placebo-controlled studies. A random
search and analysis settled upon glomectomy for treating asthma,
levamisole for treating herpes simplex, photodynamic inactivation for
treating herpes simplex, organic solvents for treating herpes simplex,
and gastric freezing for treating duodenal ulcer. In all, 6,931 patients
were involved. 40% were reported to have excellent outcomes, 30% good
outcomes and 30% poor outcomes. It was concluded that nonspecific
effects in healing could be expected to produce positive effects in 70%
of cases on average in treatments that had failed under controlled
conditions. Researchers believe that these effects are optimum when both
the doctor and the patient believe strongly that the treatment is
efficacious [6]. The safety of science depends upon existence of people
who care more for the justice of their methods than any result obtained
from their use [7].
Dangers
Reflexology has almost no potential for direct harm, but its
ability to mislead well-meaning people into believing that it can be
used for screening for health problems, or that it has real therapeutic
value could lead to serious problems:
– If the system were used to tell someone that they did not
have a health problem in a body zone, when in fact they did-resulting in
delayed medical treatment.
– If reflexology were substituted for effective therapy. A more
subtle danger involves the failure to control the psychological
pitfalls discussed in the pilot study described above. Practitioners who
have great faith in the uncontrolled clinical experience can develop a
mindset that leads them deeper and deeper into trouble. A case-in-point
involved a Rosalie Tarpening, a Modesto, California woman who practiced
midwifery, reflexology, iridology, and colonics. Tarpening´s only
credential was a certificate from the defunct Los Angeles College of
Physical Therapy. Tarpening had become overly self-confident about her
abilities as a healer. This led her to expand her services into areas
way beyond her expertise. This led to conflict with the law, and further
alienated her from consumer protection agencies and the tenets of
science-based health care. In 1989, Tarpening was found guilty of
second-degree murder in the still birth of a baby. According to trial
testimony, after a prolonged labor the mother begged to be taken to the
hospital, but Tarpening talked her out of it saying that "it was the
most natural thing for a baby to be born." [7] Her failure to recognize
the seriousness of the situation caused a needless death, and a lifetime of regret on the part of those who lost a precious baby.
NCAHF Recommendations
NCAHF advises practitioners and consumers of reflexology to be
skeptical of therapeutic claims beyond the ability of foot massage for
relaxation. Health professionals should be cautious about recommending
practitioners who make, or encourage patients to believe in, unproved claims that reflexology is a valid method for assessing health status or for the treatment of diseases.
References
1. Downing G. "Zone Therapy," in The Massage Book. Random House.
2. Raso J. "Alternative" Healthcare: A Comprehensive Guide. Prometheus Books, 1994, p.126.
3. Eunice D. Ingham and the development of foot reflexology in the U.S. (Benjamin) Massage Therap J, Winter, 1989.
4. Helping Yourself With Foot Reflexology. Parker, 1969; Body Reflexology: Healing At Your Fingertips. Parker, 1983.
5. Oleson T, Flocco W. Randomized controlled study of
premenstrual symptoms treated with ear, hand and foot reflexology.
Obstetrics and Gynecology 82:906-911, 1993.
6. Clinical Psychology Review, 1993;13:375-91.
7. Cohen MR, Nagel E, "Logic and Science," chapter 5 in Introductory Readings in Philosophy, New York: Charles Scribner´s Sons, 1974.
8. Seligman K. "Midwife´s trial worries practitioners," San Francisco Examiner, May 21, 1989, p.B-1.
Recommended Reading
– Barrett S. Reflexology: A close look. Quackwatch Web site.
– Butler K. A Consumer´s Guide to "Alternative Medicine." Prometheus, 1992.
– Raso J. "Alternative" Healthcare: A Comprehensive Guide. Prometheus, 1994.
– Zwicky, Hafner, Barrett, Jarvis. Reader´s Guide to "Alternative" Health Methods. American Medical Assoc., 1993.
[National Council Against Health Fraud, 1996 (http://www.ncahf.org/articles/o-r/reflexology.html)]
(Source: imglyfadas.gr)
