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Further Notes on Therapeutic Touch

Kevin Courcey, R.N.

The woman lying in the bed is in pain. She is just back from major abdominal surgery, and her nurse is working to make her more comfortable. Just then, another staff member comes in the room and announces that she will use Therapeutic Touch to relieve the patient's pain. She waits a moment, then begins moving her hands in the air above the patient's body. She makes numerous passes over the patient, and the patient finally reports that she is feeling more comfortable.

Distracted by the dramatic, sweeping gestures going on over her body, the patient did not notice that her nurse had just increased the rate of her IV pain medication; she assumes the arm waving staff member must be responsible for the relief she now feels. And another believer in the power of Therapeutic Touch has just been created.

A similar scenario may be happening now in a hospital near you. More than 100,000 people have been taught Therapeutic Touch (TT) in the past 20 years, including nearly 50,000 nurses and health care professionals [1]. Practitioners have been aggressively demanding respect for their "art." They have formed TT associations, pushed for insurance coverage, established training centers in more than 100 colleges and universities, and have even convinced the North American Nursing Diagnosis Association to include "Energy Field Disturbance" as an official nursing diagnosis, for which TT is the primary intervention [2]. This article examines some of the reasons TT has become entrenched within the nursing profession.

What Is TT?

Therapeutic Touch was developed in the early 1970s by Dolores Krieger RN, a professor of nursing. Krieger and co-founder Dora Kunz stated that the human body is kept alive and vital by a force called prana (a Sanskrit term meaning "vital force") and that this energy flows around and through the body and is channeled by chakras, a series of non-physical energy centers in the body. Whereas the original protocol was based on actual physical touch [3], subsequent research claimed that similar results could be obtained without touching the patient [4]. Current practice is based on the assumption that the physical body is surrounded by an energy field that trained practitioners can detect, assess, and manipulate, and that imbalances in this energy field result in illness or pain, which TT can treat [5,6]. Imbalances are "felt" using the hands, and are described variously as a sensation of tingling, pressure, pulling, temperature variations, energy "spikes," or the like.

A TT session begins with a centering exercise by the practitioner. This initial step is considered to be similar to a brief period of meditation, where the Therapeutic Touch Practitioner (TTP) focuses "internally" and concentrates on their intent to heal. The second phase is assessment, where the TTP sweeps her hands 2-4 inches over the patient's entire body in an attempt to detect energy imbalances in the patient's Human Energy Field (HEF). The third phase is called unruffling. During this phase the TTP uses circular sweeping motions with the intent to "decongest" accumulated energy and either redistribute it to areas of lower energy, or rid the HEF of the excess energy by sweeping it down the body and off at the feet, shaking the excess off their hands (a motion similar to shaking water off the fingers) at the foot of the bed or table. It is rumored that at least one disgruntled individual is considering suing a Midwestern hospital because he was hit with what he called the "excess negative energy" from a careless TTP working on a patient in the next bed. The thought of hospital lawyers trying to prove it didn't happen is enough to brighten anyone's day.

Testimonials abound for this practice, and TTPs will eagerly discuss anecdotal evidence supporting the efficacy of their treatment. Indeed, published TT literature claims some remarkable results. It is promoted as being 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." [1]

The Roots of Therapeutic Touch

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. While some Christians saw biblical roots to Krieger's approach, and considered her study's publication in the AJN official permission to bring their religious faith more directly into patient care, others recognized and embraced the Eastern mystical roots to the practice. 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 what they saw as connections 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." [8]

Some professional nurses did object when Krieger's article came out. In a letter to the editor in a subsequent edition of AJN, nursing instructors from the University of Washington pointed to numerous flaws in Krieger's study. They complained that Krieger gave no indication of how patients were assigned to her groups, and wondered why there was such an uneven distribution of patients, with 19 in the therapy group and 9 in the control group. They questioned whether other treatments or conditions (such as medication use, dietary changes, menstrual cycles, transfusions, etc.) might have influenced the results. They also 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 [9].

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 being 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. She extrapolated from this to 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 showed that therapeutic touch need not use physical contact in order to produce results similar to the "touch" version. 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." [10]

Jarvis has a point. The fact that well respected nursing professors and nursing journals were endorsing TT gave it an instant legitimacy it perhaps 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 tended to be riveted on the (mostly male) MD's. TT gave nurses a way to feel they were participating more directly in the "healing" of the patient, rather than just passively carrying out doctor's orders. The nurse could now have secret mystical powers which the doctors did not possess-they could now be the shaman, the healers. Carla 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." [10]

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 multi-million dollar industry. According to the official "Energy Field Disturbance" nursing diagnosis, you should only perform TT if you have had a minimum of 12 hours of instruction and received a certificate. The protocol goes on to note that you 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 [2]. Such advanced training can cost thousands. With these criteria officially in place, the TT training mill should stay profitable for a long time.

In Colorado, however, a local skeptics group challenged the State Board of Nursing for its decision to issue continuing education credits for TT. They also challenged the University of Colorado to justify its nursing program's Healing Touch (HT) training. As a result of this pressure, Colorado State University established a blue-ribbon panel in 1994 to investigate TT, and its inclusion in the CU School of Nursing program. The panel consisted of 3 CU faculty members outside the School of Nursing, and two nursing professors from outside CU. It was chaired by Dr. Henry Claman, a distinguished professor and chairman of the department of immunology at CU. This was probably the first scientific jury to sit in judgement on the merits of TT. Despite considerable pressure from the entrenched TT interests in the nursing department, and the obvious financial gain of the TT classes for the school, the panel issued a blistering report critical of TT and the School of Nursing's misleading marketing of the courses. The panel concluded:

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. If an effect is observable, it can be measured. It is not adequate to state that TT involves mechanisms which exist beyond the five senses and which therefore cannot be proven by ordinary methods. Such comments are a disservice to science and the practice of healing and demonstrate a commitment to metaphysics and the mystical view of life rather than to a scientific or rational view of lifeÖAlthough TT practitioners state that the existence and nature of the [human] energy field is an hypothesis which has not been confirmed in over 20 years, in practice they behave as if the energy field were a perceptible reality. There is virtually no acceptable scientific evidence concerning the existence or nature of these energy fields. [11]

Despite such a clearly negative finding, 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 videotapes featuring Quinn sells for $675. Healing Touch classes cost $225 each for the first three levels and $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 has 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 [10,13]. The study at UAB, to be conducted on burn patients, was billed as being the study that would finally settle the question as to the effectiveness of TT.

The Critics Grow Louder

Nursing theorist Myra Levine has noted:

The pretense of the healers that they perform scientific therapies is unconscionable. In our struggle to achieve academic recognition as a profession, we simply cannot afford to indulge in this kind of charlatanism. Therapeutic Touch challenges the validity of modern nursing research, teaching and practice. If its practitioners insist on their healing roles, let them honestly call themselves faith healers and stop claiming they are nurses who heal. [14]

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 that 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 Psychoenergetic 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." [10]

In 1994, 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 180-page Survey of Therapeutic Touch "Research," the report presents an abstract of virtually every study done on TT, along with an analysis of the results and the methodological critiques mentioned subsequently by other authors.

Rosa's report states, 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.

Dolores Krieger's early research studied a healer's powers applied to people. Assuming that plant chlorophyll and human hemoglobin were somehow similar, she decided to measure the subjects' 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 proponent, researcher, and former Krieger student Therese C. Meehan has admitted:

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. [15]

Yet another study that had a major impact on the nursing practice of TT was the 1984 study on premature newborns in the intensive care unit. The use of TT was evaluated as a stress-reduction intervention for these critically ill newborns. Stress was measured during the routine nursing procedure of taking vital signs by scores on an Infant Behavior Inventory and by measuring the amount of oxygen in their blood. The infants were treated with TT, mock TT (in which a nurse would simply wave their hands over the infant without the intention to "heal" or calm them), and No Touch. Interestingly, TT was declared to be an effective method for reducing the behavioral stress when measured by researchers' scores on the infant behavior rating inventory, but ineffective for reducing physiologic stress as measured by blood oxygen levels. Mock TT actually seemed to increase behavioral stress [16].

But as Linda Rosa's survey points out, virtually every cardinal sin of research was committed in this severely flawed study. The investigator and her assistant knew which infants were treated with TT and which were treated with mock TT, yet they served as the sole data collectors and the raters of infant behavior! Notably, the unbiased physiologic indicator, the oxygen level in the blood, seemed curiously unimpressed by the TT intervention when compared to the human researchers. Despite its obvious flaws, this study has nurses all over the country waving their hands over critically ill newborns, possibly increasing the infants' stress levels by their bizarre and threatening behavior.

Perhaps the most cited of the TT studies was 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, half 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 from the use of TT. But true science is not built on one study, and Wirth laboriously continued what would be a series of five trials of 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. [17]

In other words, overall, the control group fared as well or better than the group treated with TT.

TT proponents often only quote Wirth's 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 that non-uniform wound depths between the two groups might have caused the dramatic difference seen in the first study.

When another pro-TT article appeared in the AJN in April 1995, claiming supportive evidence from a recent study, the primary researcher for 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." [18]

By 1996, staff 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 [19].

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 [20]. 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, remarkably, this would have been the first real evidence. The study was designed to show the effectiveness of TT on both 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 simply mimicked the movements of "real" TT.

The results, as usual, were mixed. When using a verbal pain measurement scale, the TT group seemed to have less pain, however on a visual pain measurement scale there no statistical difference between the groups. Turner reported that when pain was measured on day 3, subjects in the TT group showed a slightly better outcome. Contrary to this assertion, however, and possibly a better indicator of relative pain relief, the TT group actually used slightly more pain medication than the sham control group [21]. And the infection rate, arguably the most serious problem in burn treatment, was found to be three times higher in the TT group than in the mock TT group. [22] Oddly, this fact was left out of the final official report to the Department of Defense.

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. [22]

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 show that TT was not merely a placebo or relaxation effect caused by the relationship of focused attention between the client and the practitioner, but an actual physical energy transfer process, independent of the more superficial aspects of the interaction. To prove this, Quinn eliminated eye contact when administering 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. [23]

If TT alone couldn't even decrease simple anxiety in this study, how could DOD scientists have thought it would be effective on the severe intractable pain of burn patients? Was this really an appropriate use of tax dollars?

More importantly, what Quinn's study (and indirectly, the UAB burn study) had inadvertently shown was simply that patients respond positively to extended, caring, interpersonal contact with their nurse. This is very likely the key element responsible for producing whatever positive results have been observed during TT research. If TTP's would devote half as much energy to lobbying for increased nurse/patient ratios as they do cheerleading for TT, perhaps every staff nurse could spend the time needed to positively influence their patients' outcomes.

The Final Straw

It was 1996 when 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. She 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 whether 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 $1 million dollars to anyone who can prove they can accurately detect an energy field. Despite publicly offering the challenge to Dolores 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 TTP's 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 TTP's, 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 [1]. Clearly, except in their own mind, they were not sensing an energy field.

In 1998, the results of Emily'd study were published in JAMA, the prestigious Journal of the American Medical Association. Anticipating criticism about the author's age, JAMA editor George Lundberg stated, "Age doesn't matter. All we care about is good science. This was good science." [24] 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 Dolores 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." [25] That's quite an accusation coming from someone who has never been published in a peer-reviewed journal of the stature of JAMA. Editor George Lundberg said JAMA's statisticians "were amazed by its simplicity and by the clarity of its results." [25]

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 attempts to justify what might otherwise be called medical fraud by claiming that "Being able to sense another person's energy is an aid in guiding one's treatment, but it is not an essential ingredient." [26]

Fellow 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." [25]

What's missing from all of this, of course, is any statement by Krieger and her disciples about how the existence of their energy field can be demonstrated by scientifically accepted methods.

Conclusion

Some 2400 years ago, in The Sacred Disease, Hippocrates observed:

They who first referred [epilepsy] to the gods appear to me to have been just such persons as the conjurors and charlatans now are, who give themselves out for being excessively religious, and as knowing more than other people. By such sayings and doings, they deceive mankind by [performing] lustrations and purifications upon them, while their discourse turns upon the divinity and the godhead.

Therapeutic Touch practitioners would like to keep us in similar ignorance about the nature of TT by maintaining its "divine" metaphysical nature. They are attempting to shift their practice into a realm where we can no longer test it. They had been content up until now to base their practice on their presumed ability to detect and manipulate the otherwise undetectable "human energy field." This was supposed to be a simple technique that anyone could learn, one that 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, and they found that the practitioners tested were unable to feel the energy field they had previously claimed to be detecting, assessing, manipulating, and correcting. Practitioners are now shifting the TT paradigm into an area they hope we cannot test: the healer's "intentionality," or the use of "intuition" as a diagnostic tool.

In their attempt to create a non-disproveable theory of TT, they have instead created a religion; and they expect nurses to believe on faith that this method works despite its lack of scientific credibility. Their fundamentalist stance encourages disdain for science and rationalism, and betrays the basic tenets of modern nursing. 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 as a post-modern feminist cause, rather than a treatment intervention whose effectiveness can be determined scientifically. Early in the Colorado State University investigation, the panel heard testimony from the school of nursing that a negative finding on TT would be viewed as male-dominated medical imperialism against female-dominated nursing. They warned the committee that nurses would not sit still for one more instance of men attempting to keep women in their place, this time denying women the all-important opportunity to be "healers." [27] The goal is to keep the discussion out of the realm of science, where a measure of validity and proof of efficacy could be determined, and plant it firmly in the realm of politics and belief. We should not accept this subterfuge.

Most RNs have taken TT classes because they sincerely desire to help their patients and wish to add another nursing tool to their patient-intervention strategies. They were no doubt led to believe that there was scientific proof of the efficacy of this treatment. But they have been misled. After 25 years of research, there is virtually no evidence for an effect beyond that of a placebo or relaxation response. And as Linda Rosa stated, "We owe our patients more than simply the suggestion that they will improve." [28]

In an editorial titled "Our Naked Emperor" published in Research in Nursing and Health, editor Marilyn Oberst criticized the skeptical majority in the nursing research field for not speaking out against TT. Referring to the paucity of valid research supporting TT, Oberst noted, "Like the citizens in the fairy tale, we seem curiously unwilling to go on record about the emperor's obvious nakedness." While supportive of alternative and complementary medicine, Oberst urged nursing researchers "to carefully consider the scientific and practical limits of diversity, and to set some standards for acceptable practice. 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." [29] We can no longer afford to placidly allow those in positions of authority to redirect the field of nursing away from the scientific method and reliable research.

Like the snake-oil salesmen of the last century who, after listening to their customers' stories of miraculous cures, began to believe in the product themselves, modern TT proponents may have become overly influenced by anecdotal evidence. Such case histories are valuable in terms of pointing out a direction for research, but are virtually meaningless for determining the real efficacy of an intervention. Proof of efficacy, according to the principles of the scientific method, requires well designed research that can be independently verified by other researchers. The literature for TT is filled with poorly designed, and non-replicable studies. In responding to Oberst's "Naked Emperor" editorial, Therese C. Meehan, perhaps the most thorough of the TT researchers, noted that, "It appears that many proponents of TT are both clothesless and clueless when it comes to reading research critically." Noting that letter writers had cited studies as evidence for TT that were of notoriously poor quality, Meehan frankly admitted: "The Kramer (1990) study [on TT with children], while no doubt conducted with sincere intent, contains so many flaws in its design and analysis that it would be soundly trounced by a class of undergraduates engaged in their first research critique." [30]

As nurses, we are held responsible by our state Nurse Practice Acts to protect our patients' best interests and report medical malpractice. When "healers" make claims, when questionable treatments are offered as reliable, or when our hospital administrators decide to make major changes in the way we deliver care, we should insist on a scientific evaluation. If the claims do not hold up, or if the plan jeopardizes patient care, we should speak out and make our data available to the public. The public trusts nurses to protect them, but unless we continue to speak out, we may lose that trust.

It is estimated that over a billion dollars a year is spent on cancer quackery alone. When a cancer patient is faced with the difficult decision of choosing chemotherapy or surgery to treat their cancer, they might think back to their last hospital stay when an RN performed TT on them, explaining that this non-invasive technique balances their energy fields, allowing the body to heal itself. Might this encourage them to seek out a "healer" rather than treatment that is known to be effective, possibly with fatal results? The National Council Against Health Fraud recently received a report of a case in which signs of appendicitis were ignored, TT was substituted for proper care, and the patient died. If we continue to allow TT to be practiced in our hospitals, should administrators of those hospitals be held accountable for such fatalities?

In his book Demon-Haunted World, 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." [31] Nurses must continue to be a voice for reason. We must shine the light of science into the darkness of of nursing practices based on wishful thinking or fraud. We must expose pseudo-science, and we must do so "loudly, repeatedly, and in public."

About the Author

Mr. Courcey has been a nurse for 22 years, spending 15 years as a psychiatric nurse, and 6 years in phone triage answering questions about medical problems ranging from lacerations to fevers to chest pain. He has also chaired an 800-nurse bargaining unit and been a board member of the Oregon Nurses Association.

For Additional Information

References

1. Rosa L, Rosa E, Sarner L, Barrett S. A Close Look at Therapeutic Touch. JAMA 279:1005-1010, 1998. To obtain a reprint of this article, send a self-addressed stamped envelope to the National Therapeutic Touch Study Group, 711 W. 9th St., Loveland, CO 80537.
2. Kelley H, Ludwig G. Energy Field Disturbance. Nursing Diagnosis Handbook: A Guide to Planning Care. St. Louis: Mosby, 1995.
3. Krieger D. Therapeutic Touch: The imprimatur of nursing. American Journal of Nursing 75:784­787, 1975.
4. Quinn J. 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.
5. 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.
6. Karagulla S, Kunz D. The Chakras and the Human Energy Field: Correlations between Medical Science and Clairvoyant Observation. Theosophical Publishing House, 1989.
7. Krieger D. The Therapeutic Touch. Prentice-Hall; 1979.
8. Boguslawski M. Therapeutic Touch: A facilitator of pain relief. Topics in Clinical Nursing 2(1):27-37, 1980.
9. Various authors. Letters section, American Journal of Nursing, Aug 1975.
10. Jaroff L. A no-touch therapy. TIME, Nov 21, 1994.
11. Claman HN, Chair, Committee on Therapeutic Touch. University of Colorado Report on Touch Therapy. University of Colorado Health Sciences Center, Department of Medicine, 1994.
12. Registration form. Healing Touch International. Accessed, April 10, 1999.
13. Maxwell J. Nursing's New Age? Christianity Today, Feb 1996.
14. Levine M. Quoted in Rosa, Linda: Survey of Therapeutic Touch "Research." National Therapeutic Touch Study Group, 1997.
15. Meehan MTC. Therapeutic Touch. Inn Bulechek & McCloskey (editors). Nursing Interventions: Essential Nursing Treatments, 1992, pp 201-212.
16. Fedoruk RB. Transfer of the relaxation response: Therapeutic Touch as a method for reduction of stress in premature neonates. PhD dissertation, Univ. of Maryland, 1984.
17. Wirth DP. Complementary healing intervention and dermal wound re-epithelialization: An overview. International Journal of Psychosomatics; 42:48-53, 1995.
18. Meehan, TC. Letters, American Journal of Nursing; July 1995.
19. Glickman R, Burns J. If therapeutic touch works, prove it! RN Magazine, Dec 1996.
20. Turner JG. Quoted in The Birmingham News; Nov 17, 1994.
21. Turner JG. The effect of Therapeutic Touch on pain and anxiety in burn patients [grant final report], Nov 1996.
22. Turner JG. Therapeutic Touch sudy final progress report, 1996.
23. Quinn JF. Therapeutic Touch as energy exchange: Replication and extension. Nursing Science Quarterly 2(2):79­87, 1989.
24. Lundberg GM. As quoted by Linda Rosa RN in a private email to the author, April 1998.
25. Kolata G. Research: Her simple test discredits a common alternative treatment. New York Times, April 1, 1998.
26. Hutchison CP. Official response from Healing Touch International. 1998.
27. Rosa L. Hand to hand combat: What happens when a skeptical nurse takes on pseudo-nursing. Skeptic, 1994.
28. Rosa L. Phone conversation with author, April 1998.
29. Oberst MT. Our naked emperor (editorial). Research in Nursing and Health, Feb 1995.
30. Meehan, TC. Letters to the editor, Research in Nursing and Health, July 1995.
31. Sagan C. The Demon-Haunted World: Science as a Candle in the Dark. New York: Ballantine Books, 1996.
 
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