Therapeutic Touch

Today we're going to point the skeptical eye at a healing modality that's non-invasive, requires no drugs, produces no unpleasant side effects, and is taught in nursing schools everywhere: therapeutic touch. As it does not actually involve any touching, it's also called distance healing, or non-contact therapeutic touch. The method is premised on the presumed existence of an "energy field" which practitioners believe extends around the human body, and which they believe they can see or touch, many claiming it's tactile and they can actually feel it. This "energy field" is then manipulated by waving the hands over the patient's body. Based on a number of varying explanations, this action is said to promote faster healing of wounds, reduce pain or anxiety, or promote wellness in some other way.

Therapeutic touch was developed in 1972, a collaboration between a self-described clairvoyant and a nursing professor. Dora Kunz was a member of the Theosophy Society in America, and soon to become its president. Theosophy is a form of religious mysticism which Kunz had studied under the Hungarian psychic healer Oskar Estabany. Dolores Krieger, who taught nursing at New York University, became engaged with Kunz's metaphysical approach to healing, and codified therapeutic touch into the system that it is today.

What sets therapeutic touch apart from most other alternative treatments is its level of acceptance within the medical community. Although it's made no inroads in medical schools or with doctors, it is taught in a surprising number of nursing schools and in continuing education for nurses. This apparent rubber stamp of legitimacy has convinced many that there's something to it. The University of Maryland Medical Center is one hospital that offers therapeutic touch, and on its website, attempts to explain how they believe it works [They've since removed this web page, so the link goes to an archived version. —BD]. They offer two explanations, erroneously describing them as theories:

One theory is that the actual pain associated with a physically or emotionally painful experience (such as infection, injury, or a difficult relationship) remains in the body's cells. The pain stored in the cells is disruptive, and prevents some cells from working properly with other cells in the body. This results in disease. Practitioners believe therapeutic touch promotes health by restoring communication between cells.

I read this five times and still couldn't make any sense of it. Pain remains in the cells? Pain is transmitted by nerves, and does not exist in the body outside of nerves, so right off the bat this makes no medical sense in even a rudimentary way. Then they say this is the cause of disease. No, not exactly. We have very good theories of various diseases and almost all are well understood, and nowhere in the medical texts do we find "the pain of difficult relationships remaining the body's cells". Finally, wrapping this up with the assertion that "therapeutic touch promotes health by restoring communication between cells" is not, in fact, an explanation of how anything works. It is a non-specific claim loosely bolstered by a few vaguely medical-sounding words.

The other theory is based on the principles of quantum physics. As blood, which contains iron, circulates in our bodies an electromagnetic field is produced. According to this theory, at one time we could all easily see this field (called an aura), but now only certain individuals, such as those who practice therapeutic touch, develop this ability.

Ah yes, the tired old "appeal to quantum physics". Mention that phrase, and immediately you sound smart. Well, not so much in this case: circulating iron in the blood creating a magnetic field is not an example of quantum physics. It's also known to be untrue: the tiny amount of iron in our hemoglobin, each molecule of which has a jumbled pole pointing in a different direction, neither creates a magnetic field, nor is there any electromagnetic theory which predicts that it might. And, there has never been a sound theory that all humans could at one time see magnetic fields, and no example of anyone ever seeing one. If anyone could, they would be essentially blinded all day by the overwhelming influence of the Earth's magnetic field which is much stronger than the tiny ones we encounter all day long.

Dolores Krieger, one of the co-founders of therapeutic touch, offers yet another completely different explanation for how it works. In 1975, she wrote in the American Journal of Nursing that this manipulation of the body's magnetic field raises the body's hemoglobin levels. This statement packs about as many implausible falsehoods into one sentence as I've ever seen. Placing a hand into a magnetic field does not alter that magnetic field. A magnetic field strong enough to extend several inches out from the human body would have to be immensely strong, and we wouldn't be able to wear metal jewelry or get out of our car, and we'd be sticking to each other all day. There is no explanation for how or why any magnetic effects would create hemoglobin, and no report of such a thing ever happening from magnetic resonance imaging or other applications of real magnetic fields to the human body. Finally, raising hemoglobin levels may be an effective therapy for some conditions, but not for pain, which is the primary use of therapeutic touch. One has to marvel at how Krieger, an experienced medical professional, could have strung together such an outlandish chain of nonsense and promoted it as sound science.

The most famous example of therapeutic touch's basic premise being put to the test was in 1996, when a 9-year-old girl, Emily Rosa, ran an experiment for her fourth grade science fair. Her parents, who were both critical of therapeutic touch, helped her devise a simple protocol. She visited 15 practitioners who claimed to be able to detect the presence of a "human energy field", and had them stick both hands through a screen. She then held her own hand directly above one of the practitioner's hands, selected randomly, and the practitioner stated each time which hand detected her field. They failed to guess better than random chance, indicating that practitioners cannot, in fact, do what they claim. The following year, the TV show Scientific American Frontiers filmed her repeating the test, with the same results. The year after that, Dr. Stephen Barrett contacted the Rosas and helped them write it up and had the study published in the Journal of the American Medical Association. This gave young Emily, then 11, the world record for the youngest person to have a scientific paper published in a peer-reviewed journal.

As you can imagine, the therapeutic touch community responded harshly. Healing Touch International, which was at the time the leading self-certification institute for practitioners, published an official response to the Journal's article with several key criticisms:

The published study does not test any critical variables related to therapeutic touch. The ability to sense the energy field of another is simply not a requirement of a TT practitioner.

This statement that "the ability to sense the energy field of another is simply not a requirement" is staggering. The entire practice is founded on manipulation of this energy field, which is described by practitioners as "tingling, pulling, throbbing, hot, cold, spongy, and tactile as taffy". They've now moved the goalposts. They've gone from sensing and manipulating this alleged energy field, to stating that it's not necessary to actually sense anything. How are you supposed to manipulate something you can't detect?

Healing Touch International's response to Rosa's study continues:

The study design was not representative of a therapeutic touch session. It was set up more as a parlor game. Therapeutic touch studies using people with health problems would most likely demonstrate positive effects.

They are correct that Rosa's study was not to test the efficacy of therapeutic touch on sick patients, it was about something else. It showed that therapeutic touch's fundamental concept is nonexistent. However, the studies they ask for do already exist. The authors of Rosa's paper included a literature analysis of 853 such studies. They concluded:

There is not a sufficient body of data, both in quality and quantity, to establish TT as a unique and efficacious healing modality... With little clinical or quantitative research to support the practice of TT, proponents have shifted to qualitative research, which merely compiles anecdotes.

Since the publication of Rosa's study, the healing touch industry now publishes only research that considers the improvement reported by patients, without regard to the method used. Most therapeutic touch websites cite a small number of studies where a small effect was shown, but ignore the much larger number of larger, better controlled studies that show no effect. This suggests deliberate deception on their part; it's impossible to do an honest search of the literature without happening to notice the saturation of large studies showing no results.

The next point in their response:

The child conducting the study was not neutral about therapeutic touch, and therefore could have affected the results. The studies of Dan O'Leary at SUNY-Stony Brook have shown the "experimenter bias" effect, in which the beliefs of the experimenter tend to be confirmed. Controlled experiments look like they cannot possibly be affected by the experimenter's beliefs, but O'Leary showed that in the real world, they are.

The only thing I can think of to say to this is "pot-kettle-black". Emily Rosa did employ good controls, of which the same cannot be said for the majority of the studies that find therapeutic touch to have a beneficial effect. It's fine to point out that she was a child, and it's fine to say that someone else once found that some studies are weakened by experimenter bias; but if you want to poke holes in Rosa's study, you have to actually find some. You can't merely insinuate that others have found holes in other studies, thus the child's results are automatically suspect. The editor of the Journal said "Age doesn't matter. All we care about is good science. This was good science."

We could go on all day like this, but it's pointless. The only thing that matters when we evaluate a new treatment is whether it works. The therapeutic touch proponents will quote studies that show that it does work, usually Wirth's 1990 study, "The Effect of Non-Contact Therapeutic Touch on the Healing Rate of Full Thickness Dermal Wounds". But they fail to note that an effect was found in only two of Wirth's five trials, and Wirth's own conclusion was "The overall results of the series are inconclusive in establishing the efficacy of the treatment interventions examined." The best state of our experimental knowledge is that therapeutic touch does not work. It certainly has no plausible foundation, and no physiological reason to suspect that the body's healing mechanisms are dependent upon some outside person waving their hands around. Really this is one for the kindergarten files, and responsible nurses should look instead to treatments that have credible hope of doing some good.

By Brian Dunning
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