October 1998
by Steven Novella, MD

The concept of an invisible, undetectable, spiritual life force which animates living creatures is an ancient superstition which has found a new home in modern alternative medical ideology.

In the early 1970’s, Dolores Krieger, Ph.D., R.N. developed and promoted the new discipline of therapeutic touch (TT). TT practitioners believe that the human body possesses a “human energy field” (HEF) which extends beyond the skin surface, and that illness is associated with (perhaps even caused by) blockages in the flow of the HEF, or knots of tense energy, or diminished strength of the HEF. Further, practitioners believe that they can sense the HEF, and by moving their hands over the body’s surface, they can smooth out the fields of energy, supporting its strength, and thereby promoting self-healing.

Although presented as a new healing modality, the concepts behind therapeutic touch were nothing new. It is really just a new packaging of very old concepts, combined with standard new age anti-scientific and mystical ideology. What makes TT unique, however, is its broad acceptance within a professional community, that of nursing, especially within Canada and the US. TT has penetrated deep within nursing education and practice, where it is valued more for its political value than its scientific legitimacy.

Vitalism

The concept of a human energy field is really just a new name to a several thousand year old concept. Most ancient cultures believed that there was some vital force, an animus which made living things alive, and distinguished them from non-living things. In ancient China this mysterious force was called Chi, in India it was chakra, in Greece animus, and in Rome spiritus. Today the concept still survives in traditional Chinese medicine and Indian ayurveda. Many modern alternative medicine disciplines have also adopted a vitalistic philosophy, such as the innate intelligence of chiropractic.

The concept of a vital life force was developed because ancient cultures lacked a scientific model of how living organisms work. They did not understand, for example, that sugars in food are transported to every cell in the body via the blood circulation where they are metabolized and combined with oxygen in order to produce energy (and a little carbon dioxide which is exhaled).

Today the depth of knowledge of physiology and biochemistry is vast. At no point in any biology laboratory has anyone detected a mysterious force which is responsible for any aspect of life. Nor is there any deep and pervasive mystery about how living organisms function that requires the hypothesis of a life force to keep things going. The concept of a life force is completely without empirical evidence or theoretical need for its existence, and is therefore best viewed as an ancient pre-scientific superstition.

The appeal of vitalism as a philosophy, however, is clear. To the ancients it explained the mystery of life – what makes living things different from non-living things. More important today, the existence of a single force which supports life allows so-called holistic healers to claim that they can cure any illness or disease simply by supporting this force. In contemporary alternative medicine philosophies, such simplistic approaches to health and disease are very common.

Philosophy Based Medicine

In order to understand this thinking, one must view such alternative modalities as taking a philosophy-based approach to medicine, as opposed to a science-based approach. What this means is that health and disease are viewed in terms of one all-encompassing philosophy, rather than the scientific approach where specific causes are sought to explain specific diseases. A philosophical basis was the approach taken throughout history until the modern era of scientific medicine, which is only about 150 years old.

An example of a philosophy of medicine which is no longer practiced is the humoral philosophy. This philosophy held that health was maintained by a balance of four bodily humors: blood, phlegm, green bile, and black bile. Illness resulted when the four humors were out of balance. Healing was therefore attempted by restoring balance, by either blood letting, or prescribing emetics or cathartics. This philosophy survived for over 2,000 years in western culture, until its practitioners started subjecting their ideas to scientific analysis. It is interesting to speculate what would have happened if scientific medicine first took root in the East. Would there now be a movement in China to import western traditional medicine, with proponents calling for more research into the benefits of blood letting?

Vitalistic approaches to healing adopt similar philosophies to those of medieval humoral practitioners. The concept of balance, for example, is widely used, probably because it is an easy concept to understand and visualize. For similar reasons, the concept of blockage of energy flow, and restoring flow is also widely used. Practitioners of traditional Chinese medicine, therefore, attempt to restore the balance of the Yin and Yang and improve the flow of Chi (usually through acupuncture). Straight chiropractors attempt to restore the flow of innate intelligence with spinal manipulation.

Connected to the concept of restoring balance and flow to the vital force is that of self-healing. Many alternative philosophies of medicine rely heavily upon the concept that the body has an unlimited, or nearly unlimited, capacity for self-healing. Therefore, as long as their is proper flow and balance, the body can maintain itself in perfect health. All disease, therefore, must result from a loss of this unlimited self-healing capacity, which can only be explained on the basis of blocked flow or disrupted balance.

There is no evidence, however, for the concept of unlimited capacity for self healing. The body can, of course, heal itself to some degree. Our immune systems can fight off infections, our tissues are self-regenerating to a degree, our bodies can heal wounds, and compensate for disease. For these reasons, most of the day-to-day minor symptoms and illnesses we develop do get better on their own. This capacity for self-healing, however, has definite limits. Sometimes, the infecting organisms win the battle against our immune systems resulting in death or significant permanent damage. Some diseases are caused by genetic or biochemical problems that cannot fix themselves. And, as we all know, our bodies progressively wear out under the strain of time. Eventually, we will all die of something.

Therapeutic Touch

TT has its philosophical roots deeply imbedded in the ancient and common concepts described above. The HEF is just a modern name for the old superstition of a vital life force. Some TT practitioners even liken the HEF to the “animal magnetism” of the 18th century quack, Anton Mesmer (Barrett, 1998).
In a 1994 TT grant proposal to study the effects of TT on burn victims, the grant authors described TT as “based on the assumption of a human energy field which extends beyond the skin. The idea behind TT is that the human energy field is abundant and flows in balanced patterns in health but is depleted and/or unbalanced in illness or injury.” They also state that, “This action is believed to place the person in an optimal position for his/her own resources to be used in self-healing,” and “Our present technology does not allow the measurement of the human energy field, but to a trained sense, primarily touch, the human energy field can be perceived and assessed by practitioners.” (Turner) Is all this beginning to sound familiar?

Typical TT sessions involve moving the hands about 6-12 inches above the body. Practitioners claim that they can feel the HEF in this way, and it is often described as being rubbery or electric in feel. The sessions begin with the practitioner “centering” which is necessary to align the healer’s energy with the patient’s. Next is “assessment” where the practitioner senses the patient’s HEF. Third is “unruffling the field,” which is designed to smooth out knots or blockages in the patient’s HEF. And finally there is “energy transfer” whereby the practitioner transfers energy from their own field to support that of the patient, who is depleted due to their illness.

Most TT is practiced by nurses who have undergone special training, which involves learning to sense the HEF. TT is taught in some nursing schools, and any nurse can get continuing education credits for taking classes or seminars in TT. In this way TT has been accepted and legitimized by the nursing profession.

The Rocky Mountain Skeptics have waged an ongoing war to remove TT from the curriculum of Colorado nursing schools. Their scientific and rational arguments, however, have been countered by the powerful political clout of TT, which was introduced into nursing at a time when the profession was searching for a new level of respect and independence, one which they rightly deserve as health care professionals. Ironically, however, some nurses have chosen as an icon of their profession’s power and independence a discipline which seriously diminishes their professionalism and respectability.

The Evidence

There has been some research testing the claims of TT, but not much. Most research has focused on comparing the outcomes of patients treated with TT compared to those either untreated or given sham TT. Studies have been done on post-operative pain, burn victims, and in other conditions. The difficulty with these trials is that they mostly are based upon subjective measurement, such as the patient’s report of pain severity or comfort. Such measurements are legitimate if done properly, but they are very soft findings upon which to rest an entire theory of health and disease.

Another problem is the difficulty with properly controlling the experiments. Control groups are typically given sham TT, which is done by people who do not have training in TT and who are shown simply how to move their hands in a way which mimics TT. The difficulty arises from the possibility, according to TT proponents, that such sham TT might accidentally work. Some sham practitioners have stated that they “felt something” when giving the control therapy. This can therefore be used to explain any lack of apparent effect by TT when compared to the control group.

In 1996, Linda Rosa, an RN, published a review of all clinical TT research published in the nursing literature (Rosa, 1996). She found that, “The more rigorous the research design, the more detailed the statistical analysis, the less evidence that there is any observed – or observable – phenomenon.” This pattern is familiar to those skeptical of other AM modalities. Clinical research on homeopathy and acupuncture, for example, follow the same pattern of an inverse relationship between the quality of research, and the observed effect of treatment.

Another TT literature review conducted by Kevin Courcey, also a nurse, came to a similar conclusion (Courcey, 1998). Courcey also noted that TT researchers themselves have had to admit the poor study design of most TT research. One researcher, for example, noted, “In the final analysis, the current research base supporting continued nursing practice of therapeutic touch is, at best, weak . . . It may be presumptuous to teach the art or to seriously discuss the use of this practice in the treatment of illness.” (Clark, 1984) Another TT researcher, Therese Meehan, criticized in a letter to Research in Nursing and Health a major study done by TT researcher, Kramer, by saying “While no doubt conducted with sincere intent, this study 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.” So far, TT researchers have failed to produce a single well designed clinical study which establishes the effectiveness of TT and stands up to peer review.

Due to the difficulty of establishing rigor in clinical research, it seems more straightforward to test the underlying premises of TT. For example, TT is based upon the existence of a HEF, and the fact that practitioners can sense it. The HEF, however, remains elusive. No one has ever been able to demonstrate that it exists. Defenders of TT claim this is because the HEF cannot be measured by any instrumentation or device, only the practitioner’s hand can sense it. This, however, is the classic unfalsifiable hypothesis. If the HEF cannot be measured, then there is no way to prove that it does not exist. This renders the theory non-scientific.

What about the other primary claim, that TT practitioner’s can sense the HEF? This, certainly, must be testable. TT practitioners, however, have never subjected this very basic premise of their art to any scientific testing. They have also been uncooperative in other’s attempts to do so. In 1997 the James Randi Educational Foundation offered an award of $742,000 to anyone who could pass a simple test of their ability to sense a HEF. Despite aggressive recruiting, only one TT practitioner took the test, and they failed. The award now stands at over $1 million, but no TT practitioner seems interested in putting their ability to the test even for such potential financial gain. (Randi, 1997)

In 1998 one person was able to enlist the cooperation of TT practitioners to perform such a study. Emily Rosa was 9 years old when she conducted the only formal study testing the claim that TT practitioners can sense the HEF (Rosa 1998). The study report speculates that TT practitioners were willing to cooperate in the study because they were not threatened by a child who espoused no skepticism. Emily was supported by her mother, Linda Rosa, a nurse who rejects TT as an unproven treatment. The test was very simple. The TT practitioners sat behind a cardboard curtain and placed both of their arms through two holes. Emily would then place either her right or left hand (chosen by the subject) just above either the right or left hand of the subject, determined by a coin flip. The subject would then announce whether they felt the presence of the hand, via the HEF, over their right or left hand.

In this simple and elegant manner, Emily conducted 150 trials (10 trials per practitioner) with 70 (47%) correct responses. A follow up test resulted in 53 (41%) correct of 130 tries. The combined results are 280 trials and 123 correct (44%), which is not significantly different from random guessing, which is predicted to produce 50% correct. Of the 25 subjects there was also no difference between TT practitioners with one year or 20 years experience.

The Rosa study was originally designed as a grade school science project. It therefore lacks strict scientific rigor, for example control data was not published along with the study data. The study design, however, as presented, was adequate to detect the practitioners’ ability to sense the HEF. If they possessed such an ability, there is every reason to believe that they would have been able to demonstrate this, whether to James Randi for a million dollar prize, or for a 9 year old’s science project.

The most devastating implications of these admittedly limited studies is that practitioners may believe they sense an energy field when in fact they cannot. The alternative hypothesis that TT practitioners are victims of self-deception is supported by the existing data, and has not been contradicted by any study. TT practitioners may reject this conclusion, but they have yet to conduct a study which is designed to disprove this hypothesis. If TT practitioners’ subjective sensations are not reliable – nothing more than wishful thinking and a little imagination – then the only source of evidence for the HEF is gone.

Conclusion

Therapeutic touch is a modern incarnation of the vitalistic philosophy, an ancient and mystical concept that does not comfortably coexist with modern scientific medicine. Despite its anti-scientific roots, lack of credible evidence, and rejection by mainstream medicine, therapeutic touch has found a home in the nursing profession, where it has put down deep roots. The scientific backlash is well underway, however, and the efforts of scientists, skeptical organizations, professional journals, and defenders of scientific medicine will continue. Like all pseudosciences, TT will likely not disappear completely, but it is a reasonable limited goal to remove the imprimatur of a professional organization from this superstition and the stain of pseudoscience from a noble profession.

References:
1) Barrett S. Therapeutic Touch. 1998, www.Quackwatch.com
2) Grant No. MDA 905-94-Z-0080. Uniformed Services University of the Health Sciences. Project Title: The Effect of Therapeutic Touch on Pain and Infection in Burn Patients (N94-020A1), p. 35. Awarded to: University of Alabama at Birmingham. Principal Investigator: Joan G. Turner.
3) Selby C, Scheiber B. “Science or Pseudoscience?” Pentagon Grant Funds Alternative Health Study. Skeptical Inquirer, 1996
4) Rosa L. Survey of Therapeutic Touch “Research.” Loveland, Colorado: Front Range Skeptics, 1996.
5) Courcey K. Fighting TT Quackery in Oregon: A Front-Line Report. 1998, www.quackwatch.com
6) Clark PE, Clark MJ. Therapeutic Touch: Is there a scientific basis for the practice? Nursing Research 33(1):38­41, 1984.
7) James Randi Educational Foundation. http://www.randi.org
8) Rosa L. A Close Look at Therapeutic Touch. JAMA. 1998;279:1005-1010

The following are Letters To The Editor concerning this article

Dear Editor,

In response to Dr. Steve Novella’s fine article about Therapeutic Touch (“The Touch of Life”), allow me to offer up comments on my pet subject.

1.) Dr. Novella writes that: “Typical TT sessions involve moving the hands about 6-12 inches above the body.”
Well, you know pseudoscience — nothing is precisely determined by actual studies, so anything goes. (You can even see TT being done over the phone these days — advertised as “healing on the cellular level.”) Anyway, 2-6 inches is what you typically find in the bulk of nursing literature. This point is important in developing test protocols. If one were to believe some TT nurses that the “human energy field” (HEF) is a quantum field, then according to one physicist I know, the HEF would extend less than 10 to the minus 20 centimeters from the body. This is much smaller than the size of a single atom.

2.) A discussion of the origins of TT should include a mention of “Theosophy” — Krieger’s and Kunz’s occult religious beliefs that they are trying to get the nursing profession tacitly to accept through TT. Krieger still holds forth on TT at Pumpkin Hollow, a Theosophical retreat just across the Mass. state line in New York. Her sessions are billed (with a straight face) as: “The Hollow Experience.”

3.) There are, alas, even more problems with TT clinical studies than those recounted by Dr. Novella. Add to the list small numbers of subjects and (except for *perhaps* one study) no attempts at independent replication.

4.) Dr. Novella states of Emily Rosa’s study: “Of the 25 subjects there was also no difference between TT practitioners with one year or 20 years experience.” That should be 21 subjects. This is, by the way, more subjects than in most TT *clinical* studies.

5.) Dr. Novella states: “The Rosa study was originally designed as a grade school science project. It therefore lacks strict scientific rigor, for example control data was not published along with the study data.”
Emily did, indeed, design her protocol as a science fair experiment, but that doesn’t necessarily mean it lacked rigor. Emily’s experiment was sufficiently controlled (which is all that is required) to provide meaningful results and to be seriously published in a refereed journal. JAMA’s editors put her co-authors through six months of repeated reviews and revisions until we had satisfactorily supported (by evidence) our article’s conclusions. Those conclusions, by the way, were based not just on Emily’s experiment but our exhaustive (and exhausting) analysis of existing TT literature.

6.) Dr. Novella appears to characterize Emily’s experiment as “limited.” As far as I can tell, Emily’s study is limited only in that there will never be, alas, a successful attempt to recruit subjects for independent replication. Those who have tried so far have either had doors slammed in their face, their project shut down, or gotten mired in endless, fruitless negotiations with TT nurses about experimental design.

It may be too soon to tell, but it appears James Randi’s prediction is correct — TT will continue largely unabated in nursing schools and hospitals, despite devastating and widely-publicized evidence TT nurses can’t do what they claim they can. (Mass General still allows it, for example.) I think there’s a big lesson here for skeptics. We typically counter a pseudoscience by providing evidence that it doesn’t work. Perhaps there are other more effective ways of fighting nonsense. I’m not sure what they would be. Legal means, theater, politics, advertising? Mass suicide with homeopathic preparations has already been tried…

Linda Rosa, RN
Front Range Skeptics
Loveland, CO

Filed under: Science and Medicine