Therapeutic Touch Debate

From: george pace <surfgeorge@yahoo.com>

Because of the length and unwieldy appearance of adding my comments to
the Sunday, June 7 post of Mr. Hallman (commenting on my comments
about his comments...) I have excerpted from his post, hoping to not
alter meaning by removing from context.
 

Mr. Hallman wrote:  So far, i don't think the "skeptics"
and the TTers are even trying to measure the same thing.

Pace:  Well, as is said, the burden of proof is on those making the
claim.  What some “skeptics” have done is read the tt literature and
talked to therapeutic touch practitioners (ttps), gotten a clear
picture of what ttps claim they can do, asked them if they can
specifically do something very particular under very clearly defined
conditions,  and heard them say something equivalent to, “Yes, I can
do that.  It is a part of what I do every day when I practice tt.”
With full disclosure of the experimental conditions to the ttps, and
their agreement to said conditions and confidence of success before
(and sometimes after) experimental testing, the results are tabulated
and it consistently turns out that they cannot do what they claimed
they could do (and often believed they did do, having stated with
confidence after being tested that they were certain of their
success).  Now if the ttps want to measure something else, such as
“efficacy”, then they are going to have to construct a much more
complex and difficult experiment, due to so many confounding factors.
And that is precisely the crux of the critiques of tt experiments
showing “success” at “healing efficacy.”  There are huge
methodological flaws.  That does not mean that tt may not be able to
do what its proponents claim, only that THAT experiment does not show
it.  This leaves the question of selectivity aside, which Mr. Courcey
addressed briefly in his original letter posted by Mr. Krieg.  Ttps
can do an experiment to measure whatever they want, but they cannot
say that a flawed experiment has measured anything at all.

Mr. Hallman wrote:  It reminds me of the arguments physicists used to
have about whether light is waves or
particles. Each camp designed more and better experiments to prove that
their side was right and the other wrong, while light just kept on
doing its thing. Now we know that light (and for that matter
particles) both exhibit wavelike and particle-like properties. The
argument hasn't been so much _settled_ as transcended by a deeper
understanding of the phenomenon.

Pace:  I believe this is a false analogy.  The case you cite (whether
light behavior is better explained by particle or wave theories) is
not analogous because the “argument” was about the theoretical
explanation for an agreed upon phenomenon.  None of the physicists
questioned the existence of “light.”, only what theory best explained
the variety of observed phenomena involving light.  In the case of tt,
clearly not everyone agrees that there is such a phenomenon.  Skeptics
are not (yet) concerned with a theoretical explanation of tt, but
whether such a phenomenon exists beyond the physical behavior of the
practitioners.  Everyone agrees that people pass their hands near
other people’s bodies while thinking/imaging certain ways, etc., but
that has nothing to do with what any experiment would measure: does
that behavior have any effect beyond the exact same behavior done by a
non-ttp?  Such experiments are difficult to design and execute, and
thus far, it appears that the tighter the design and control of
confounding factors, the more the effects of tt fail to manifest.
What is needed is not “a deeper understanding”, but some concrete
experimental evidence as to whether there is anything needing
understanding.  By your analogy, some of us think it is really dark
around here, and wish there was some light.

Mr. Hallman wrote:  But similarly it is unreasonable to
dismiss thousands of positive experiences of TT clients as "merely"
anecdotal. This is essentially saying that the experience of pepl in
white lab coats is somehow more authoritative than other pepl's.

Pace:  But I believe that to be precisely true in areas regarding
objective and quantitatively measurable phenomena.  If it weren’t,
there wouldn’t be any people in white lab coats, or if there were, no
one would value anything they had to say, since we would all be our
own authorities based upon our own (or some other individual's)
experiences.  I have no doubt that people report all kinds of things
(including those that can be measured quantitatively) following any
kind of “treatment”, including tt.  The question is whether what they
report is CAUSED specifically by the purported treatment in itself, or
by some other combination of factors (someone paying
attention/listening to them, demonstrating concern, assuring them of
successful recovery, etc. etc.).  It’s the old post hoc, ergo propter
hoc (it happened after, therefore it happened because of) fallacy.  It
is possible that all of the people can be wrong some of the time.  See
How We Know What Isn’t So by Thomas Gilovich.

Mr. Hallman wrote:  Sure, research is worthwhile, and sure, it
has its limitations (cold fusion? thalidomide? we're only human).

Pace:  Interesting example.  The cold fusion case was one where one
experiment in one lab (without independent replication) was shown to
be invalid/nonexistent (due to various confounding factors) when other
researchers failed attempts to replicate the results of the
experiment.  This reminds me of the claims for tt (and a variety of
other “alternative” modalities)... tighten up the controls on the
experiment, the phenomenon disappears.  (When thalidomide was approved
as a sedative, human teratogenic testing was not required, but the
animal experiments showed no teratogenicity.)  If you are just saying
"mistakes are made," I hope you are not suggesting that they would
necessarily be made exclusively by one side of a scientific
controversy.

Mr. Hallman wrote: I guess what i'd like to see in the whole "TT or
not TT" discourse is a higher level of "quibbling". For example, an
experiment that measures efficacy, rather than "HEF detection", and
that has some basis for accepting input about how the client feels.

Pace:  Already mentioned the great problems with existing tt research
measuring “efficacy.”  As for “input about how the client feels,”
again, that is begging the question.  No matter how the client feels,
or what they “report”, that does not demonstrate causation, only that
something is being reported as “changed”.  The “cause” of that change
could even be “randomness.”  (As is possible in the Wirth, et. al. tt
wound healing studies with positive, negative, and neutral results
over the course of five separate studies using the same protocols.)
Even if the patients subjectively report “improvement”, that does not
mean that the “improvement” is attributable to the purported cause (tt
or whatever) unless confounding factors have been scrupulously
factored into the analysis.  In the federally-funded burn patient pain
perception study at the U. of Alabama Birmingham, patients “reported”
“significant differences” in pain and anxiety in 3 of 7 subjective
measurements, BUT there was no difference in the amount of pain
medication requested.  It would appear that what they “reported” about
their pain did not coincide with what they actually DID to cope with
their “actual” pain.  Having worked with clients as a hypnotherapist,
and having read some of the literature regarding what people will say
or “perceive” in various contexts, it is quite possible that what you
measure when you measure a subjective report may or may not have
anything to do with a quantitatively measurable change.  Thus the need
for blinded and controlled data.

If you want to argue that if someone says they feel better after a
particular treatment, then that treatment ought to be used...you can
make that argument, but it has nothing to do with whether the
treatment per se is the cause of the reported effect.  Perhaps some
other “treatment” is equally or more efficacious, whether as placebo
or not.  The only way to reliably find out is with a very tightly
controlled study that is independently replicated.

Mr. Hallman wrote:  If the TTP and the client are
both happy with the transaction, and remain so over time and over a
large number of clients, then that seems to me no different than clients
going for something else that someone might think wasteful, like
Freudian
analysis or a manicure - it's a contract between informed, or at least
experienced adults that is their own affair. What business is it to a
disapproving 3rd party?

Pace:  Mr. Courcey’s letter was with regard to the practice of tt
being sanctioned by a hospital as a legimate practice within that
setting.  Neither he nor I have ever (to my knowledge) asserted anyone
(consenting adults) not have the right to engage in any behaviour that
does not harm anyone else.  If someone wants to give their money to,
or depend upon, a psychic, psychic surgeon, ttp, leeches, Ramtha or
Zeus, that is certainly their prerogative.  However, if someone wants
to introduce that procedure/person into a hospital setting, or have
insurance pay for it, or have a study published in a peer reviewed
journal, then certain criteria must be met.  And that is where
legitimate questions are asked.  It all depends on what the
practitioners are claiming.  Know any manicurists who claim human
energy field remodulation?  I bet a lot of people report “feeling
better” after a manicure, and I wouldn’t be surprised to see their
hemoglobin levels have risen.

Mr. Hallman wrote: I use TT several times a week, not as
a living. I have accumulated 14 years' experience giving treatments in a
variety of situations and with a variety of clients' conditions. In
about 80% of the treatments, i receive immediate, positive to very
positive feedback, from clients saying that they have benefitted. No
one has ever reported harm. My question is, how long do i have to
experience this before i /am/ entitled to say that i _know_ it works?
Something beneficial usually happens, i'd hafta be deaf and blind not
to notice.

Pace:  Beating the dead horse:  What you are entitled to say is
precisely what you have said, “I do this. They say this.”  If you want
to say that means you “know” A (and only A) causes B, then you simply
have very different epistemological standards than I do.  (Whenever
the thought happens “It will rain today,” it does rain, does not
warrant me to (correctly) say that when the thought “It will rain
today” happens, I KNOW it will rain, even if it DOES always rain [and
it does rain nearly every day if one lives on the windward side of
certain tropical islands]). You can SAY whatever you want.  Whether or
not doing “nearly” the same thing (A minus any intention, etc.) would
have similar results (B) might raise the question as to what is the
true causal factor.  It might turn out to be tt
training/intention/etc.  But so far there is no clean replicated study
to demonstrate that.

Mr. Hallman wrote:  Why should this be acceptable in medicine, yet
something as clinically harmless as TT be held to some higher standard
of proof? We don't know how it works, but neither does medical science
know how a good deal of its toolkit works either.

Pace:  I don’t believe it’s a question at all of “how it works.”  But
rather IF it works.  I don’t beleive the evidence shows that it does.
I believe that the higher quality evidence shows the effects (quite
real in some cases) attributed to tt are actually due to other factors
(or nonfactors in the case of randomness).  Certainly ANY
procedure/practice under scrutiny for hospital application needs to
meet whatever standards that hospital sets.

Mr. Hallman wrote: This is a serious, not rhetorical question: How do
u suppose that placebo effect works? It's common enuf that it can
hardly be denied. One can see it may be unethical to give an inactive
"placebo" pill to a cancer patient who thinks they're getting
medication, that's deception. But if i tell a client that pepl often
feel relaxation, well-being, comfort as an effect of treatment, i'm
not holding out a "cure", i'm just stating what other clients have
reported.

Pace: I DON’T deny it. How does the placebo effect work?  Might as
well ask me how does the brain/body do what it does.  I’m kinda
stumped.  Though I am amazed, continually.  The human biocomputer has
complex capabilities.  If one has ever done a “visualization” exercise
where one “imagines” the details of biting into a lemon, one knows
that there is a “real” physical reaction to a purely “cerebral” event.
 Or one can imagine someone naked...no, we won’t go there!  I believe
there is evidence that the vast majority of cerebral electro-chemical
events do not result in “conscious awareness.”  In that vast territory
of “unconscious” (not the Freudian or Jungian kind) activity there are
no doubt many things (perhaps literally tens of thousands of
simultaneously running “parallel programs”) having an effect on
various parts of the remainder of the body... in fact, right now i am
feeling very relaxed and peaceful as I imagine the manicurist holding
my hand...  And remember, the placebo effect can produce “negative”
effects as well as positive... we just had an example of “school
sickness hysteria” here.

Mr. Hallman wrote:  Are u actually claiming that scientific
methodology is some defence against atrocities? Must i point out that
Nazi (and other) horrors were well endowed with "scientific" support?

Pace:  I used the Nazi eugenics example precisely because it was an
example of “junk science.”  The studies used to bolster the Nazi
political agenda were not independently replicated tightly controlled
studies, they were methodologically faulty and could not have been
(were not) replicated by any independent researcher under blind
conditions.  My belief is that, thus far, the majority of studies
supportive of the claims of tt fall into the “junk science” category.

Mr. Hallman wrote:  Do u actually believe that the scientific
method is immune to politics, prejudice, or systematic error?

Pace: No.  See the eugenics example above, as well as much of the
“work” regarding  “the human effect on global warming.”  But I believe
that the scientific method is less immune to the influence of
politics, prejudice or systematic error than “whatever clients [or
practitioners] say works.”  



 Is Therapeutic Touch valid?
t