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Testimonials abound for this practice, and TTPs eagerly discuss anecdotal evidence supporting the efficacy of their treatment. Published TT literature already claims remarkable success. Indeed its promoters describe it as virtually a universal cure; from the mundane “comforting the dying” and “increased relaxation,” to the highly speculative “remedies thyroid imbalances,” “breaks fevers,” “relieves acute pain,” and even “brings some dead back to life.” 6
The Roots of Therapeutic Touch
“They shall lay hands on the sick, and they shall recover.” - Mark 16:18
Even though Krieger had published her views previously in Human Dimensions (1972) and Psychoenergetic Systems (1974), it was the article in the American Journal of Nursing (AJN) that catapulted her to fame and fortune. While some Christians saw biblical roots to Krieger’s approach, and considered her study’s publication in the American Journal of Nursing official permission to bring their religious faith openly into patient care, others recognized and embraced the practice’s Eastern mystical roots. The concept of prana is taken from Hinduism, and Krieger admitted that prana was “at the base of the human energy transfer in the healing act.” 7
Skeptics remarked on similarities to the teachings of Anton Mesmer, the 18th century hypnotist and theorizer of “animal magnetism.” Mesmer believed that a “subtle magnetic fluid” exists in the body and needs to be controlled or expelled in order for healing to occur. He and his followers believed that obstacles to the free flow of this fluid caused illness, and that skilled healers or “sensitives” could remove these obstructions by making passes over the patient’s body with their hands. Dora Kunz, TT’s co-founder and President of the religious Theosophical Society of America, claimed to be just such a “fifth-generation sensitive.”
Of course, some professional nurses did object to Krieger’s article. In a letter to the editor in a subsequent issue of the AJN, nursing instructors from the University of Washington noted numerous flaws in Krieger’s study. They complained that Krieger gave no indication of how patients were assigned to her groups, and they wondered why there was such an uneven distribution of patients in the therapy group (19) and the control group (9), and whether other treatments or conditions might have influenced the results, such as medication use, dietary changes, menstrual cycles, transfusions, etc. They criticized AJN for publishing such a study without a critique, charging the article was dangerously misleading, and reminded readers that the energy field Krieger was postulating had never been shown to exist. 8
Noting that much of the critical response to her studies centered around the vaguely religious concept of prana, Krieger switched to a seemingly more scientific concept pioneered by nursing theorist Martha Rogers - that of the Human Energy Field. Rogers postulated that humans not only have an energy field, but that they are an energy field, and that this energy field is constantly interacting with the energy of its environment. From this she derived theories about the non-linearity of time, how clairvoyance and telepathy occur, and how physical contact is unnecessary for the transfer of energies. This led to a doctoral dissertation by Janet Quinn in 1982, which “proved” that therapeutic touch need not use physical contact in order to produce results. 3b The non-touch version has been the standard ever since.
Individuals in high places
Some explanations for the phenomenal growth of TT have been less than favorable. Dr. William Jarvis, president of the National Council Against Health Fraud, stated: “I see therapeutic touch as a form of faith healing that has captured the imagination of a few nurses who happen to be in pretty powerful positions of influence within the nursing profession.” 9
Jarvis has a point. The fact that respected nursing professors and nursing journals were endorsing TT gave it an instant legitimacy it did not deserve. Krieger was a Professor Emeritus at New York University’s Division of Nursing. Martha Rogers was a well respected nursing theorist and Dean of Nursing at NYU. Janet Quinn, who studied at NYU, would go on to become Associate Professor of Nursing at the University of Colorado. Jean Watson, Distinguished Professor of Nursing at Colorado, also a supporter of TT, would go on to head the National League for Nursing, the board that accredits nursing schools.
Many feel the psychological climate was also conducive to the spread of TT. Nurses, primarily women, have long felt under-appreciated in the medical profession - a profession whose focus of attention and adoration is riveted on the (mostly male) MDs. TT gave nurses a way to feel they were participating more directly in the “healing” of the patient, rather than just passively carrying out doctors’ orders. The nurse now has secret mystical powers which the doctors do not possess. They are now the shamans, the healers. Caria Selby, a member of the Rocky Mountain Skeptics who would later challenge the University of Colorado’s Healing Touch program, observed, “I’m all for nurses getting out from under the thumbs of doctors. But this is exactly the wrong thing to do.” 9b
Follow the money
Unfortunately, TT has meant big money for some, making it difficult to challenge. Over 100,000 people have been trained in TT. Considering that the cost of a basic TT certification training is frequently in the $250-300 range, this amounts to a multimillion-dollar industry. According to the official “Energy Field Disturbance” nursing diagnosis, one should only perform TT if one has had a minimum of 12 hours of instruction and been certified. The protocol goes on to note that TT trainees should be supervised by a nurse who has a master’s degree in nursing and has had 30 hours of instruction in TT theory, and 30 hours of supervised TT practice. 10 Bills for such advanced training can cost thousands of dollars. With these criteria officially in place, the TT training mill should remain profitable for a long time.
In Colorado, a local skeptics group challenged the University of Colorado to justify its nursing program’s Healing Touch (HT) training. Despite clearly negative findings (the report stated that “To date, there is not a sufficient body of data, both in quality and quantity, to establish TT as a unique and efficacious healing modality”) the review board voted to allow the school of nursing to continue its Healing Touch focus. The report itself gives us a clue as to the justification for this decision: “TT is potentially a source of considerable income. Training in TT is not complex and arduous and the practice of TT does not require a large investment in equipment or personnel.” 11 Indeed, Quinn’s Healing Touch training brings in a substantial amount of money for the nursing school. A set of three HT video tapes featuring Quinn sells for $675. Healing Touch classes cost $225 each for the first three levels, and then $325 each for the next two levels. 12
But training is not the only cash cow associated with TT. Recently, over half a million dollars of public tax money has been spent on Therapeutic Touch research. The National Institutes of Health has given $150,000 in grants, the Department of Health and Human Services granted $200,000, and most recently the Department of Defense granted $355,000 to the University of Alabama at Birmingham - all for studies of TT. The study at UAB, to be conducted on burn patients, was billed as being the study which would finally settle the question as to the effectiveness of TT.
The Critics Grow Louder
“One unerring mark of the love of truth is not entertaining any proposition with greater assurance than the proofs it is built upon will warrant”
-- John Locke, 1690
A growing chorus of dissent has, in the past four to five years, finally found its voice. In November 1994, TIME magazine featured an article which articulated the concerns of the skeptics. The author of the article scoffed at the research that had been done on TT, noting that, “As proof of TT’s efficacy, they cite ‘scientific’ reports in such obscure journals as Subtle Energies and Psycho-energetic Systems, as well as stories in popular magazines.” Vern Bullough, a retired professor of nursing at the State University of New York was quoted as saying, “None of the research demonstrated that there’s any effect, and many of the conclusions are subjective.” 13
It was also in 1994 that Linda Rosa, RN, Chair of the Questionable Nursing Practices Taskforce of the National Council Against Health Fraud, compiled a thorough review of the TT literature. Presented in her 18O-page Survey of Therapeutic Touch “Research,” the report presents virtually every study done on TT along with analyses of the results and the methodological flaws in the studies.
In the report we learn, for example, that when the original “healing” studies were done on plants, there were no controls for heat from the healer’s hands which naturally increased enzyme production in the plants, and caused them to grow faster. When appropriate controls were instituted, the healer’s effect vanished. Krieger’s early research studied a healer’s powers applied to people, and for some rather obtuse reason she decided to measure the subject’s hemoglobin levels before and after TT. She claimed to find increased hemoglobin following TT. Practitioners still excitedly talk about these studies as if they were a scientific breakthrough. But even TT researcher (and former Krieger student) Terese C. Meehan later admitted that “Methodological problems preclude scientific support for an increase in hemoglobin values. Subsequent studies have found no significant relationship between TT and increased hemoglobin values or transcutaneous oxygen blood gas pressure.” 14
Perhaps the most cited of the TT studies is one done by Wirth in 1990. Wirth inflicted volunteers with a full-thickness dermal wound (upper arm area) and then applied TT to half the group and no intervention to the other half. The interventions were done behind a screen so the subjects would not be able to tell which group they were in. The results were remarkable for TT. By day 16, all of the wounds treated with TT had completely healed, while none of the control group’s wounds had.
This study provided TT proponents with the data they needed to claim near miraculous healing power for TT. But true science is not built on one study, and Wirth continued what would be a series of five trials on this experiment. After the fifth attempt to replicate his original results, Wirth noted:
“The results of the experiments indicated significance for the treatment group in the initial 2 studies in the series, and non- and reverse-significant results for the control group in the remaining 3 experiments... Although the 5 studies represent a seminal research effort within the field of complementary healing, the overall results of the series are inconclusive in establishing the efficacy of the treatment interventions examined.” 15
Proponents of TT often only quote the first study, which seemed quite promising. Critics have noted that in that first study, subjects in the treatment group were wounded and treated on a different day than the control group, introducing the possibility of non-uniform wound depth between the groups.
When another pro-TT article appeared in the AJN in April 1995, claiming supportive evidence from a recent study, the author of the study wrote to the journal in protest. “The effects of TT on pain are unclear and replication studies are needed before any conclusions can be drawn,” she stated. “There is no convincing evidence that TT promotes relaxation and decreases anxiety beyond a placebo effect,” she continued. “Other claims about outcomes are, in fact, speculation.” 16
By 1996, nurses began calling the bluff of practitioners of TT. Reading one glowing article after another on TT in their professional journals, one group of Emergency and Operating Room nurses in Philadelphia invited a TTP into their ER for a demonstration. The practitioner, who had studied with Dolores Krieger, explained how she could feel a person’s energy through clothes, a chair, or even a cast. She stated she could tell the difference between the energy of animate vs. inanimate objects, or between a child and an adult.
The nurses then suggested a demonstration of this claimed ability. They would have the healer assess the energy patterns of several individuals, including an elderly man with heart disease and two healthy girls. From these, she would pick the individual she felt most sure of being able to identify. The nurses would then cover up one of the test subjects with blankets, and the healer would have to identify whether it was the subject she had chosen. She declined. She did recommend that they all take her introductory course ($125) so they could learn to do it themselves. They declined. 17
| “The infection rate, one of the most serious problems of burn treatment, was found to be three times higher in the TT group than in the mock TT group. Oddly, this fact was left out of the final official report. |
The UAB Burn Study
Crashes and Burns
The Department of Defense grant of $355,000 to the University of Alabama at Birmingham for the study of TT on burn patients was to be “the first real scientific evidence there is for Therapeutic Touch,” according to the primary researcher Joan Turner. Aside from illustrating a potentially problematic researcher bias, this is an accurate assessment of the TT research to date. Despite over 20 years of research, this would have been the first real evidence.
The study was designed to show the effectiveness of TT on pain relief and the prevention of infections for hospitalized burn patients, with the secondary goal of arriving at a working TT protocol for use in the army. The study tested TT against mock TT in which nurses mimicked the movements of “real” TT.
The results, as usual, were mixed. When using one pain measurement scale, the TT group seemed to have less pain; however another scale showed no statistical difference between the groups. Turner reported that when pain was measured on day three, subjects in the TT group showed a slightly better outcome. Contrary to this assertion, and possibly a better indicator of relative pain relief, the TT group actually used slightly more pain medication than the sham control group. And the infection rate, one of the most serious problems of burn treatment, was found to be three times higher in the TT group than in the mock TT group. Oddly, this fact was left out of the final official report.
This was a dismal failure for the TT proponents. On most measures, no significant differences were found between the group receiving “real” TT and the group receiving “mock” TT. In the researcher’s own words:
“The greatest lesson learned from this process is that the inclusion of a true control group in addition to a sham and treatment group is required because a strong placebo effect occurs from the special attention given to patients in the ‘sham’ treatment.” 18 [emphasis mine]
But the truly astounding aspect of this study is that it was approved at all. One would assume that the Department of Defense has actual scientists working for them who would have reviewed the literature prior to approving this study. If they had, they would have found Janet Quinn’s 1989 study, which attempted to prove that TT was not merely a placebo or relaxation effect caused by the relationship of focused attention between the client and the TTP, but an actual physical energy transfer process, independent of the more superficial aspects of the interaction. To prove this, Quinn eliminated eye contact with the patients given TT. In her own tersely worded conclusion, Quinn states
“The theorem that eye and facial contact between TT practitioners and subjects should not be necessary to produce the effect of anxiety reduction was deduced from the Rogerian conceptual system and tested. This theorem was not supported.” 19
If TT alone wouldn’t even work with simple anxiety, how could DOD scientists have thought this would work on the severe intractable pain of burn patients? Hadn’t they reviewed Wirth’s studies on dermal regeneration, noting that TT had shown positive results in only two of the five trials, and in others the control group actually did better than the TT group? Was this really an appropriate use of tax dollars?
The Final Straw
It was also in 1996 that Linda Rosa’s daughter, Emily, was preparing her fourth grade science fair entry. She was working on an exhibit with M&Ms that would illustrate the probability of picking out a certain color when one reached blindly into a bowl and plucked one. While she was working out the details, she noticed her mom watching a video on Therapeutic Touch. Emily said, “I wonder if they can really do that?” Suddenly her science fair project took a different form. After discussing several different possibilities with her mom, Emily decided that instead of having volunteers reach in and grab an M&M, she would invite Therapeutic Touch “healers” to reach through her screen and see if they could detect which of their hands Emily was holding her hand over. She designed and constructed the screen herself, tested it out on a few school buddies, and then made further modifications to ensure the screen would insulate her from her subjects. She was ready.
James Randi, the famous magician and skeptic, has a standing offer of over ten thousand dollars to anyone who can reliably detect an energy field. Despite publicly offering the challenge to Delores Krieger and the other 100,000 people who claim to have this ability, Randi has only had one person make the attempt - and she failed. Unlike Randi, however, Emily was able to recruit 21 experienced TT practitioners for her experiment!
The TTPs were allowed to “feel” Emily’s hands prior to the test, and choose which one they felt the strongest energy radiating from. With the TTP seated behind the screen, Emily then placed her hand over one of the TTP’s hands. After 20 trials, these experienced TTPs - some of whom had even published articles on TT - could only sense Emily’s hand correctly 44% of the time. By chance alone, they should have guessed correctly 50% of the time. Clearly, they were not sensing any energy field except in their minds.
The results of this study were published this year in the prestigious Journal of the American Medical Association (JAMA). Anticipating criticism about the author’s age, JAMA editor George Lundberg stated for the record: “Age doesn’t matter. All we care about is good science. This was good science.” With that, Emily became the youngest author to be published in the journal.
The Response from TT Practitioners
“I do hope it’s an April fool’s joke,” stated Delores Krieger when informed that the official report of Emily Rosa’s research was to be published in JAMA on April 1st. She attacked Emily, saying she “completely misunderstood what the nature of basic research is.” Big talk coming from someone who has never been published in a peer-reviewed journal of the stature of JAMA. Editor George Lundberg said the journal’s statisticians thought the study was well done. “They were amazed by its simplicity and by the clarity of its results,” he said. 20
Janet Quinn’s Healing Touch program in Colorado had an immediate response also. Researcher Cynthia Poznanski Hutchison admitted that for the first several years of her practice of TT touch, she could not sense anyone’s energy field. But she kept on practicing anyway. She attempted to justify what would otherwise be called medical fraud by saying that “Being able to sense another person’s energy is an aid in guiding one’s treatment, but it is not an essential ingredient.” 21
TT practitioner and instructor Marilee Tolin agrees, and expands the definition even further. Tolin says that practitioners rely on more than just touch to sense the human energy field. They also use “the sense of intuition and even a sense of sight.” 20b Suddenly, the world of
Therapeutic Touch has shifted gears.
Conclusions
There is a theory that says that the concept of a god started out as an explanation of a wide variety of otherwise inexplicable natural phenomena. Known as the “God of the Gaps” theory, it posits that we use the concept of a god almost as a place holder to explain that which we currently cannot explain. At one time, for example, thunder and lightning were thought to be the activities of a god, but we now know that they are the result of differing electrical charges coming in contact with each other. As our knowledge increases, and we are better able to understand the world around us, the conceptual territory inhabited by “god” shrinks, or shifts to another arena where we are still “in the dark.”
Therapeutic Touch practitioners would like to keep us in the dark when it comes to TT. They are attempting to shift their god into a new realm where we cannot test it. They had been content up until now to base their practice on the ability to detect and manipulate the “human energy field.” This was supposed to be a simple technique that anyone could learn, and involved the transfer and balancing of actual physical energy. But then James Randi and Emily Rosa came by and showed us that we can test this claim about their practice. The practitioners tested were unable to detect that which they had formerly claimed not only to be detecting, but also assessing, manipulating, and correcting. So they are now shifting the paradigm into an area they hope we cannot test: the healer’s intentionality, and the use of intuition as a diagnostic tool. In their attempt to create a non-disprovable theory of TT, they have instead created a religion. They have used their positions of power in the nursing profession to spread their religion, and have craftily used the political dynamics of the late 20th century to stage their holy war in a post-modernist feminist arena rather than in the verifiable arena of science. Like a fundamentalist religion, they have created a disdain for science and rationalism, and have betrayed the basic tenets of nursing.
In a speech heralding the formation of Colorado’s Center for Human Caring, soon to be a hotbed of Therapeutic Touch training, former Dean of Nursing Jean Watson, now the director of the center, waxed philosophic, stating that this was “part of the universe turning, ushering in one of the seasonal ancient calendar revolutions... appeasing the gods and goddesses of the universe... this leave-taking from the Age of Pisces, after 2,000 years of the Mayan calendar, takes us away from the destruction, the violence, the technological, industrialized war, and power into spirit-filled cosmology... commercial and machine entropy are being scattered to the universe and being replaced by guardians, angels in fact, of esthetic mystic and spiritual unification, of human and planetary evolution.” 22
Shockingly, the speaker of this cosmic religious drivel was promptly elected President of the National League of Nursing.
When “healers” make claims, when questionable treatments are offered as reliable, we should investigate. And if the claims do not hold up, we should make our data available to the public. This is especially true in the medical arena.
It is estimated that over a billion dollars a year is spent on cancer quackery alone. I don’t particularly care if Jean Watson believes the absurd statements she made above; but I do care that she is re-directing the field of nursing away from science, and away from reliable research. When cancer patients are faced with the difficult decision of choosing chemotherapy or surgery to treat their cancers, I worry that they may think back to their last hospital stay when a Watson/Quinn/Krieger acolyte performed TT on them, explaining that it is a noninvasive technique that has been shown to cure a variety of ills. Might they not then seek out a “healer” rather than a treatment which is known to be effective? Might this not prove fatal?
Carl Sagan worried that “especially as the Millennium edges nearer, pseudoscience and superstition will seem year by year more tempting, the siren song of unreason more sonorous and attractive.” 23 I agree wholeheartedly. We must be a voice for reason. We must shine the light of science into the darkness of superstition. We must expose pseudo science for the con that it is. As Marilyn Oberst accurately noted in an editorial on TT in Research in Nursing and Health, “At the moment we seem to have at least one naked emperor, and I think it’s time for the reputable scientists among [us] to say so - loudly, repeatedly, and in public.” 24
At the core of Atheism is skepticism. We do not accept beliefs simply because they are widely held, but prefer evidence and a rational examination of the facts over blind faith. As skeptics, we must continue to confront the absurd on all fronts. This is a positive aspect of Atheism that is often overlooked. We can occasionally get bogged down in esoteric religious criticism or debate that seems to make very little difference to the vast majority of our fellow citizens. But by applying our skepticism, a little rational thinking, and the scientific method to real-world issues, we can be models of the positive aspects of Atheism. We can make a difference in our communities.
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REFERENCES
1. Rosa, Linda et al. “A Close Look at Therapeutic Touch.” Journal of the American Medical Association, April 1, 1998 via website at http://www.ama-assn.org/public/journals/jama
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2. Krieger, Delores. “Therapeutic Touch.” American Journal of Nursing, May 1975.
3. Quinn, Janet. An Investigation of the Effects of Therapeutic Touch Done Without Physical Contact on State Anxiety of Hospitalized Cardiovascular Patients [dissertation]. New York: New York University; 1982.
3b. Quinn, Janet. An Investigation of the Effects of Therapeutic Touch Done Without Physical Contact on State Anxiety of Hospitalized Cardiovascular Patients [dissertation]. New York: New York University; 1982.
4. Krieger, D. “The relationship of touch, with intent to help or to heal, to subjects’ in-vivo hemoglobin values: a study in personalized interaction.” In: Proceedings of the Ninth ANA Nurses Research Conference, 1973.
5. Karagulla S., and Kunz, D. The Chakras and the Human Energy Field: Correlations between Medical Science and Clairvoyant Observation. Theosophical Publishing House; 1989.
6. Rosa, Linda et al. “A Close Look at Therapeutic Touch, Table 1. Claims made for Therapeutic Touch.” JAMA as above.
7. Krieger, D. The Therapeutic Touch. Prentice-Hall, 1979.
8. Various authors. Letters section, American Journal of Nursing, August 1975
9. Jaroff, Leon. “A No-Touch Therapy.” TIME, November 21,1994.
9b. Jaroff, Leon. “A No-Touch Therapy.” TIME, November 21,1994.
10. Kelley, Helen and Ludwig, Gail. “Energy Field Disturbance.” The Nursing Diagnosis Handbook, a Guide to planning Care, 1995.
11. Claman, Henry N., Chair, Committee on Therapeutic Touch. University of Colorado Report on Touch Therapy. University of Colorado Health Sciences Center, Department of Medicine, 1994.
12. Healing Touch Registration form. From the website at http://www.healingtouch.net/
13. Jaroff. As above.
14. Meehan, M.T.C. “Therapeutic Touch.” In: Bulechek & McCloskey, eds. Nursing Interventions: Essential Nursing treatments. 1992. Pp 201-212.
15. Wirth, D.P. “Complementary healing intervention and dermal wound re-epithelialization: An overview.” International Journal of Psychosomatics, 42:48-53.1995.
16. Meehan, Therese C. Letters, American Journal of Nursing, July 1995.
17. Glickman, Robert, and Janet Burns. “If therapeutic touch works, prove it!” RN Magazine, December 1996.
18. Turner, JG. Therapeutic Touch Study Final Progress Report. 1996.
19. Quinn, J. “Therapeutic Touch as energy exchange: Replication and extension” [abstract]. 1989.
20. Kolata, Gina. “Research: Her simple test discredits a common alternative treatment.” New York Times. April 1,1998.
20b. Kolata, Gina. “Research: Her simple test discredits a common alternative treatment.” New York Times. April 1,1998.
21. Poznanski Hutchison, Cynthia. Official Response from Healing Touch International as posted on their web site.
22. Watson, Jean. As quoted in Rosa, Linda: “Hand to Hand Combat: What happens when a skeptical nurse takes on pseudo-nursing.” Skeptic, 1994.
23. Sagan, Carl. The Demon-Haunted World: Science as a Candle in the Dark. Ballantine. 1996.
24. Oberst, Marilyn T. “Our Naked Emperor” (editorial). Research in Nursing and Health, February 1995.
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