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by Steven Novella, May 10 2010

Language is a powerful but tricky thing – it not only is a tool for expressing our thoughts, to a large degree it shapes and frames our thoughts. This is true in every area of intellectual enterprise – where expanding one’s vocabulary literally expands the palette of ideas and concepts available, and technical or specialized language typically develops to precisely capture the necessary concepts.

This is true in my own field of medicine. I often caution students, for example, to use the proper terminology – not out of convention, but because sloppy language leads to (equals, in fact) sloppy thinking. The legs are not “below” the arms, they are “caudal” to the arms – further along the neuraxis away from the brain. Not only is it important to use terms that are precise, it is important (and a more subtle problem) to use words that are not prematurely precise. Disease taxonomy is often hierarchical, and if you commit yourself too early to a narrow branch, you will prematurely narrow your thinking as well. The patient did not present with “seizures”, they presented with “episodes” – and it is for us to determine if these episodes are seizures or something else.

Politicians and marketers use language differently from scientists and philosophers. The latter is concerned with precision and accuracy, while the former with emotion, deliberate vagueness, and false implication.

The specific example I am getting to today is a particular peeve of mine – the gross overuse of the term “therapy.” It seems you can throw the term “therapy” at the end of any activity and thereby imply that it has a specific medical application, or some benefit beyond the obvious pleasure or benefits of engaging in that activity. So now we have aromatherapy, massage therapy, music therapy, and dance therapy. “Therapy” has become a marketing term, like “natural” – rendered devoid of precise meaning and used to create vague implications.

I was once interviewed about music therapy. Now – I have nothing against the use of music in therapy. Music can affect our mood and attention and can be quite useful in a therapy setting. There is also evidence that listening to music is better for our mental health than doing nothing,  but I file that under – doing stuff is generally better than not doing stuff. Our brains and bodies function better when they are used, and suffer from the neglect of disuse. For example, if you studied the effects of playing soccer on health you would find that people who play soccer are stronger, in better shape, have more endurance, probably weigh less, and have a host of better health outcomes than people who spend an equivalent amount of time sitting on the couch. Should we call this “soccer therapy?” I would consider this false precision. Better to just say that exercise is better than being sedentary for specific health outcomes. Likewise, engaging the mind and interacting socially is better than being bored and lonely. At best music is a tool of therapy, it is not therapy itself.

I am not just being picky. Attaching the word “therapy” to the back end of an activity is an attempt to give it a status it may not deserve – and that status is subsequently used to garner insurance coverage, hospital resources, consumer patronage, and research dollars. It is also used to constrain how we think about an intervention – implying that perhaps there is some specific mechanism as work, when none need exist.

Massage, for example, is a useful technique for muscle relaxation. There are likely to be non-specific benefits also from the tactile experience which may be pleasant (depending on the techniques used). But by calling it “massage therapy” there is the implication that something more is going on – that it is a medical intervention, and that there are further mysterious biological mechanisms at work.

Aromatherapy is perhaps the most bizarre manifestation of this language abuse. Aromatherapy involves the use of pleasant scents with the implication of medical benefit. This is a brilliant marketing strategy – people like to surround themselves with pleasant scents, and there is already a vast market for scented candles, air fresheners, and all sorts of other products that essentially make the air smell pleasant. Now add “therapy” to these products, and you add the implication of a medical benefit to an already desired product. Cover it with a patina of pseudoscience and  you’re done.

A PubMed search for research into aromatherapy found the predicted assortment of studies. There isn’t much, actually, but there is a smattering of small and poorly controlled studies with the typical results you see from uncontrolled studies (such as a 100% response rate) – which is a good indicator of bias and nothing else. There are plenty of studies that are not even testing efficacy, and so are useless in this context.  I could find one controlled study of lavender and anxiety that found:

“Although this study did not show aromatherapy to be effective based on statistical analysis, patients did generally report the lavender scent to be pleasant.”

And there is aromatherapy in a nutshell – it may not do any actual therapy, but it smells nice. Seriously – why even study that. If you want people to have a pleasant smelling pre-operative experience, then knock yourself out.

But the term “aromatherapy” has granted pleasant odors a healing mystique that appeals to certain individuals – even in the military. A few dedicated believers are trying to inflict pseudoscience on our soldiers, first with battlefield acupuncture, now with aromatherapy. I think our men and women in uniform deserve better.

Perhaps a solution to all of this madness is a heavy dose of skeptical therapy.

29 Responses to “Aroma”therapy””

  1. Robo Sapien says:

    Steven, can you form the institution that will certify us as Skeptopractors? Another way that science terms get misused is by calling them “Applied” sciences, i.e. Applied Kinesiology. It has nothing to do with the actual science of kinesiology, it only applies certain techniques of the science with little study. by comparison, walking could be considered “applied physics”.

  2. WScott says:

    In the case of massage therapy, I think the name is more an attempt to distance themselves from “massage parlor” connotations. It’s basically a way of saying “no funny business here.” Personally, I have a bad back, so for me regular massage borders on physical therapy. But your point about therapy as a marketing term is valid – it’s basically become the equivalent of “supplement.”

  3. Scott – I think it is more accurate to say that massage is a tool or treatment used by physical therapists and others.

    The term “therapeutic” in medicine implies disease modifying, and is specifically distinguished from “symptomatic” interventions.

    Again – this gets to the difference between how science uses language and marketers use language. Scientists want clarity, marketers want to blur the lines so that they can imply a claim.

    • Max says:

      Are cold medicines and allergy medicines therapeutic? If not, what’s a better term for them?

  4. WScott says:

    That makes sense. But then…by that definition, is physical therapy theraputic or symptomatic? Or both?

  5. Majority of One says:

    I went to a party this weekend and a lady was there who was selling magnetic bracelets. She was making her pitch to several people around the table and I heard her say she was selling “magnet therapy.” The look I gave her must have said enough because she didn’t approach me. When she got a victim, she’d make them stand up, she’d place a bracelet around one of their arms and then she’d have them do several yoga like poses while she pushed them or pulled on them. Of course she told them they were performing better than they would if they didn’t have the bracelet on. What a load!

    I think she knew it was a load, and I think most of these people do know what they’re doing. I don’t believe that most people really believe in their own crap, but I guess some do.

    Language is becoming misused in a lot of areas. You have to be really careful not to be scammed.

    • Robo Sapien says:

      I don’t think that is the case, most people wouldn’t deliberately sell crap if they knew it was crap, it is much easier to sell something useful. My dad has been a “distributor” for countless MLM companies, and he fully believed in every product he sold.

      People get suckered into selling these things because they were sold on it by someone else, they are led to believe that this fabulous new Product X is such a phenomenal new discovery (or abandoned ancient discovery) that it will easily sell itself, so the up front investment should be no problem.

      Even if people do realize it is crap, they may still find themselves stuck with a bulk of crap to get rid of or else never see their money again.

  6. MadScientist says:

    I love my unnatural inorganic foods – there’s nothing like a Technetium pancake. It’s even better than that natural Uranium yellowcake.

    I think my brother needs some aroma therapy; his buccal orifice exudes the aromas of the Cloaca Maior.

  7. Max says:

    Listening to my music reduces my dental anxiety.
    Turns out there’s a lot published on the subject.
    According to the following RCT, music distraction (MD) “reduced dental anxiety significantly,” and brief relaxation (BR) was even better. They let patients choose the music style, but not fully customize their playlist as I do. They also concede, “Because of the obvious characteristics of MD and BR, blinding of participants was not possible.”

    • tmac57 says:

      You think thats good,you should try N2O! Sounds like you need some ‘floss therapy’… err treatment…I mean preventative? Dammit Novella,you got me all edgy about usage now!

      • Max says:

        Or try blinding the participants… with blindfolds. I’m sure that would reduce anxiety.

      • MadScientist says:

        My usual technique of blinding with a hot poker is proven to increase anxiety, so I guess my expertise wouldn’t be needed.

  8. Xplodyncow says:

    I believe the correct term would be “skeptitherapy.”

    • MadScientist says:

      Naah; it sounds too muck like “Skippy therapy”, and I’m not sure if that constitutes massage by a kangaroo or watching old Australian kid’s TV programs.

  9. Brian says:

    We need to come up with a way to market this new “skeptical therapy”.

  10. Susan says:

    It’s interesting that the medical community has a ‘PRACTICE’ instead of a business. Is that because they’re just practicing, trying to get it right? It’s interesting that a third of Americans are turning to alternative therapies because of dissatisfaction with the medical PRACTITIOINERS, who only treat the symptoms with drugs and surgery. When was the last time a physician really listened to you? Can they really diagnose in the five minutes they are allowed before they turn the case over to the insurance company to decide how to proceed?

    Our sense of smell is directly linked to the limbic system of the brain. What we smell has an immediate impact, but not all are willing or able to verbalize what they ‘feel’. Nonetheless, our sense of smell is how babies recognize their mothers; how we have used our sense of smell for eons of time for survival.

    Closing your mind to the possibilities of aromatherapy is like judging the book without having read it. And not all aromatherapy is the same. There are significant quality differences between commercial quality (soaps, candles, cosmetics, cleaning products) and the essential oils used for well-being. But if you don’t know what you’re talking about, you wouldn’t know that.

    A closed mind – what a waste.

  11. tmac57 says:

    Psychotherapy,always sounds a little fuzzy to me. No offense to people that genuinely help others with psychological problems,but I get the feeling that there is also a lot of woo under that rubric as well.

  12. kiwinerd says:

    If you think massage therapy is not a medical treatment, you need to go back to school to acquire modern medical knowledge, or brush up on modern medical literature, or both.

    • Carl says:

      If you think massage therapy is not a medical treatment, you need to go back to school to acquire modern medical knowledge

      Just FTR, kiwinerd, you do realize that Dr. Novella teaches at a medical school, right?

      To be convincing you would instead post some EVIDENCE that massage has actual therapeutic value, instead of just anger and assumptions.

  13. Susan – nice boilerplate propaganda.

    Riffing on the “practice” of medicine – that’s old school. While this is just a play on words, it is true that practicing medicine is a constant learning experience. If you think you have the final correct answer – you are a guru and a charlatan, not a science-based practitioner.

    The 1/3 figure is bogus – the numbers are that high only if you include things like exercise and dieting. For hard core CAM modalities the numbers are in the single digits, and not increasing.

    And – several surveys have shown that when people do use CAM it is mostly NOT because they are not satisfied with their doctors – but rather because it is in line with their ideology. But don’t let the actual facts get in your way.

    My new patient visits are 1 hour, not 5 minutes. Even in private practice new visits are 30-40 minutes. And we spend our time fighting with insurance companies, not deferring to them.

    The “closed mind” gambit. How lame.

    My mind is more open than yours. You appear closed to rational criticism. While I am open to the evidence. Do you have any? Care to cite some references? I did a thorough PubMed search before writing my analysis – how about you?

    • Max says:

      Hehe, practice. And waiters make you wait, and brokers make you broke, and therapists…

  14. Mike says:

    While I don’t put much faith in aromatherapy – at least what its proponents fully claim – I did spend about 12 years as an analytical chemist in fragrance-related industries. There were certain chemicals that could very predictably cause a specific effect when evaluated for odor – such as headaches, feelings of increased alertness, etc. There is no question in my mind that certain odors can elicit a physiological effect on the body; but to what degree this does any good – other than mild mood alteration, I can’t say…


  15. Retired Prof says:

    My female relatives who enjoy shopping call it “retail therapy.” If they could suppress their sense of irony, they might profitably offer guided Retail Therapy Tours.

    • tmac57 says:

      Too late, see:
      ‘Divas On A Dime Retail Therapy Tour’
      “Treat yourself to a full day of retail therapy on this colorful shopping excursion around Toronto. From boutique shops to department stores, this tour is sure to be just your style.”


      See these books from Google search:
      Books for retail therapy
      Retail Therapy: Life Lessons Learned While … – Amanda Ford – 2002 – 224 pages
      Retail Therapy – Roz Bailey – 2006 – 351 pages
      Retail therapy: store design today – Andrea Boekel – 2007 – 224 pages

      Its’ really hard to have an original idea these days.

  16. Donna Gore says:

    One of my kooky nurse friends once gave me a Reflexology massage. She and I argued frequently about new age woo, so she knew that I didn’t believe there was any science behind it. But it was the best damn foot massage EVER!

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