is there science in reflexology?

I subscribe to the Tertiary Insight newsletter (a great way to keep up with news of what's happening in the tertiary sector). Yesterday's edition  included a statement (& a link) about the NZQA's decision to cancel the registration of the Aromaflex Academy. It seems that this Private Training Establishment (PTE) was placed under strict conditions in January 2018, & has presumably failed to meet them. 

Now, if you go to the Academy's webpage, you'll see that it offers courses about "The Science of Aromatherapy, Reflexology, Holistic Massage, Anatomy & Physiology". Personally, I struggle to see how one could offer a course in the science of either aromatherapy or rellexology (of which, more at the end of this post), so my first thought was that the NZQA's decision was – from a scientific perspective – a Good Thing. However, the list of compliance requirements shows that they are regulatory in nature, and in fact this is how the NZQA processes are intended to work.

And so they should: we absolutely need to ensure that providers comply with the various regulations that ensure the quality of the learning experiences for students and the quality of the outcomes that they attain. But surely we should also be asking questions about whether the nature of what's taught in programs describing themselves as science-focused – the actual content side of the curriculum – is evidence-based as well?

In this particular case, the Academy's website lists a number of offerings. From a science perspective the anatomy & physiology certificate sounds OK (although without access to the study materials it's hard to say more than that). As currently described on the website

The Anatomy & Physiology award is the 'foundation' upon which all other Complementary, Beauty and Sports Therapy awards are based. It is comprised of 12 units encompassing all systems of the body: The Chemistry of Life & Pathology, Cells, Tissues and the Skin, Skeletal System, Muscular System, Nervous System, Human Senses, Endocrine System, Circulatory System, Lymphatic and Immune System, the Respiratory System, the Digestive System and the Urinary & Reproductive Systems.

However, I'm puzzled about how someone with an even an introductory understanding of those body systems and their functioning (it's described as a level 4 Certificate) could then go on to accept the idea of reflexology. Again from the website: 

The Diploma in Reflexology qualification is a study of the reflexes of the feet that relates to the various parts of the body. Hand Reflexology and Auricular Therapy (reflexes of the ears) are also taught over the various block week courses.  Students also learn about Zone Therapy and the Meridians relating back to the feet and hands.  

This statement appears to be using the word 'reflexes' in a rather non-scientific way; here's a definition that someone who's learned about the nervous system should be familiar with. In addition, since the 'meridians' relating to feet, ears & hands seem to be totally invisible to science (ie non-existent), it's hard to see how a course could reasonably claim to teach the science underlying them. Which leads to the next question: is that aspect of delivery something that NZQA considers in approving programs & papers? And if not, should that change?

The scientists & doctors at Science-Based Medicine have written quite a lot about reflexology and the fairly specific specific health claims made by some providers, They note that a 2011 systematic review found that there is no convincing evidence that relexology is effective against any medical condition. (The massage aspect of it may well make you feel better, in a general sense, but that's a different issue.)

It's the same for aromatherapy: nice fragrances can be relaxing, but as Steven Novella comments, "high quality studies are almost completely lacking in the published literature regarding essential oils." He goes on to explain that any studies demonstrating efficacy need 

to be properly blinded and adequate controls are essential. You can use pseudo-objective measures, like the need for additional pain medication, functional ratings, and other markers of their health outcome as appropriate. And of course, studies need to be large enough and carried out for long enough to get adequate data, and executed to prevent p-hacking.

Especially when dealing with a treatment for a subjective symptom like pain, one that we know to be highly modifiable by non-specific interventions (like distraction, mood, the introduction of a novel treatment, physical contact, the environment, interaction with the practitioner, and other variables), adequate controls are essential (pun intended).

Now, I understand that people believe in these modalities, regardless of whether or not there's empirical evidence that they work, and that the NZQA

approves training schemes if they are genuinely needed by learners and stakeholders,

but is that sufficient grounds for accrediting courses that claim to teach 'the science of…' but from a scientific perspective appear to be a combination of massage and magical thinking?


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