by Kevin Courcey RN

The head TT practitioner in the hospital got wind of it, and
wrote a letter chastizing me for relying on the JAMA article, rather than
doing my own survey of the literature.  She offered to send me a
bibliography of the "comprehensive body of literature" available which
supports TT.  I accepted her offer.  After about a month, she finally sent
me the bibliography and copies of several articles.  The following is my
response to her packet of information. (The name has been changed)

Claudette-

   Thanks for sending the bibliography and the accompanying articles. I had
actually said just the day before that I needed to get the Clark and Clark
literature review after reading about it in another journal. I was somewhat
surprised that you sent it, however, since it roundly criticizes the TT
research done to date. After noting numerous fatal methodological flaws in
the works of Grad, Smith, Krieger, Heidt, and Randolph, the authors end with
the summary that "In the final analysis, the current research base
supporting continued nursing practice of therapeutic touch is, at best,
weak." They continued by noting that "it may be presumptuous to teach the
art or to seriously discuss the use of this practice in the treatment of
illness." Hardly a glowing endorsement.

   On your bibliography, I noticed several studies I am already familiar with,
and, once again, I am surprised that you cite them as support for TT. The
Fedoruk NICU study has been universally criticized for its numerous flaws.
Not only were the researchers proponents of TT, they were the sole data
collectors and raters of infant behavior. To make things worse, they knew
which infants were treated with TT and which were treated with "mock" TT
before rating their behaviors! The proof of their bias is shown by the fact
that the one physiologic indicator that was measured mechanically, oxygen
saturation levels, remained the same in the TT and mock TT groups. Yet this
one incredibly flawed study has nurses all over the country waving their
hands over premature infants, probably subjecting them to increased stress
levels by their bizarre and threatening behavior.

The next study you flagged was the 1990 Kramer study on kids. On this one,
I'll let TT researcher MTC Meehan do the damage: "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." Ouch!

You also starred the Quinn studies on your bibliography. One problem with
all the Quinn studies is the procedure she uses for the "mock" TT (Quinn had
them count backwards from 100 by serial 7's). As you can well imagine, the
client's experience of someone who is anxiously internally preoccupied with
a series of math problems would be drastically different than their
experience of someone who was in a relaxed state, calmly focusing all their
attention on the patient. Yet this is how Quinn tests her hypothesis. And
hey, what do you know, the TT group showed more relaxation than the group
that had the strangers who seemed internally preoccupied waving their hands
inches from their faces.

This critique of Quinn's 1984 study is moot, however, because Quinn could
not duplicate her results in her 1989 study. In an attempt to finally prove
that there was an actual energy transfer taking place, not just some placebo
attention response, Quinn eliminated eye contact during TT. In her own
words, "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. The theorem was
not supported." To the unbiased observer, this would seem to show that TT is
completely dependent upon the focused attention given the patient by the
nurse. Perhaps if more advanced practice RN's would put as much "energy"
into pushing for better staffing levels on the floors as they do into
pushing the practice of TT, all nurses would be able to give their
patients the 15 minutes of undivided attention that seems to be responsible
for the results seen for TT. (A little editorial comment there.)

I was appalled by the AJN article for CEU credit. Since when is a first
person, completely anecdotal essay worthy of continuing education credits?
The author makes flat statements about the healings, analgesia, etc. that TT
is purported to deliver, but does not cite studies to support her claims.
The studies that are described in a sidebar to the article are not cited and
misrepresent the research to which they refer.

The post-op study mentioned is obviously Meehan's 1993 study -Meehan
herself says this study did not support the hypothesis that TT would
significantly decrease post-op pain compared to a placebo.

The second uncited study in the sidebar is Wirth's dermal regeneration
study. The author claims this demonstrates the amazing healing powers of
TT. However, by 1995, the year this CEU article came out, Wirth had
acknowledged that "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." In other words, overall, the control group fared as well or
better than the TT group. His first study is always cited by proponents,
while his own assessment of his series of 5 trials is never mentioned. Why
is that? Could it be because the studies show a randomness of results that
should be ascribed to chance rather than TT?

The third study mentioned in the AJN sidebar was Quinn's 1993 "pilot"
study. Even Quinn admits that "no definitive conclusions can be reached
based on these pilot data." Yet they are presented as documented, scientific
support for TT. The fact that the author had to resort to such flimsy
studies after 30 years of research seems to me a clear reflection of the
paucity of evidence TT proponents have at their disposal.

The information you copied for me on the electromagnetic field generated by
the hands was interesting, but was completely hypothetical. The diagram of
a "vortex" of energy in the palm of the hand caused by the arteriovenous
system has no physical counterpart. The veins and arteries in the hand do
not "vortex" in the middle of the palm. The arterial system and the venous
system extend completely through the entire hand and out into the fingers.
The article also seamlessly floats between the concepts of "heat" and
"energy." We can all agree that the hands generate heat. What we cannot
agree on, and that which has never been shown empirically, is that the hands
throw off/direct/detect energy other than heat such as that claimed by TT
practitioners. An imbalance of heat does not make one ill. Practitioners
claim that an imbalance of energy does create illness, so we are clearly
talking about two different energies.

The Gagne and Toye study- comparing TT with relaxation therapy was
interesting in that relaxation therapy was shown to be more effective than
TT at achieving a relaxed state. Also interesting was the fact that the TT
intervention was done in street clothes, while the mock TT was delivered by
a nurse in traditional nursing garb, and the relaxation therapy done by a
priest in his robes! Considering this was a group of psych patients, the
dynamics of having the target treatment done by a casually dressed nurse,
and the mock by a nurse in her clothes of authority-the same clothes worn
when they are given their meds, or their time-outs-strikes me as
exceptionally poor design. Plus having a theologian deliver one of the
target treatments in garb...the confounding variables are virtually endless.
This was also yet another study polluted by Quinn's mock protocol of having
the therapist perform complex mathematical calculations in their head while
mimicking the gestures of TT.

Krieger's 1988 historical overview had little of interest except that she
misreported her 1973 findings' level of confidence. She also now claims to
have controlled for meditation in that study, however this is not reflected
in her original report, and other researchers have stated that all but one
of the participants in that study chose to meditate. Her hemoglobin studies
have been dismissed even by such hard core TT advocates as Quinn and Meehan,
so I see little reason to dwell on them. (Quinn: "...it is clear that no
causal connection between the TT treatment and the apparent change in
hemoglobin could be made"(1988) and Meehan: "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."(1992))

The article from Today's OR Nurse was interesting on a number of levels.
The fact that the author assumes that she can just go ahead and use this
technique on people in various states of anesthesia seems unethical. Many
fundamentalist Christians feel that healing can only take place through a
personal relationship with Jesus Christ, and that such healing is a
manifestation of the holy spirit. They are quite sure that TT is, in fact, a
Satanic rite, since it invokes an unknown, impersonal "universal energy"
rather than the personal healing power of Christ. Using this technique on an
anesthetized patient without a complete informed consent filled out, could
subject the nurse and the hospital to a huge lawsuit.

Curiously, this was the very article that prompted the OR and ER nurses in
Philadelphia to call a TTP to come in and do a demonstration for them.
During the demonstration, she claimed she could tell the difference between
children and adults, between illness and balanced energy, even through
chairs or casts. So they suggested a demonstration. They would have her
assess five people of varying ages and illnesses and find an individual
whose energy field she felt she could identify. They would then place a
person under a blanket and she would have to determine if it was the person
she picked. She declined. Of course, she suggested they all take her course
for $125 so they could learn to do it. They declined.

This article cites as fact many of the flawed studies I have already
discussed above, including Krieger's hemoglobin studies, Meehan's post-op
study, Fedoruk's NICU study, and Wirth's subsequently 'wirthless' studies.
It is almost as if they believe that by sheer repetition, they can create a
scientific basis for this practice. As Therese Meehan commented in Research
in Nursing and Health, most TT practitioners are clueless when it comes to
reading scientific research critically.
Amazingly, this author even cited the Randolph Byrd distant healing cardiac
study in defense of her statement that TT treatment can be done at a
distance during surgery! The Byrd study is often cited by people who would
like to believe in the healing power of "intercessory prayer." What Byrd
doesn't tell you in his conclusions is that his control group had more admit
diagnoses of acute MI's, more unstable angina, more cardiomyopathy, more
cardiac arrhythmias, more heart valve disease; even 50% more admit diagnoses
of cardiac arrest! Gee, we weren't trying to stack the deck in favor of the
desired outcome, were we? Even so, the "prayed-over" group required more
medication for angina pain, had more unstable angina, had a higher
percentage of re-admissions to the Coronary Care Unit, needed 4 times the
number of temporary pace makers and three times the number of permanent pace
makers as the control group.
But our esteemed operating room Therapeutic
Touch practitioner uses this bogus study to justify distracting herself from
her surgical duties to "send out thoughts or images to the patient during
the procedure." She should have her license pulled.

The Rogerian Science article was a hoot. Somehow I don't think describing
Therapeutic Touch as "occurring in a universe that is totally open,
unbounded and infinite within the context of energy fields, human and
environment, that are characterized by patterning and in a pandimensional
domain where time and space have no meaning and therefore, place no
constraints on the process" is going to improve the standing of the practice
in the scientific community. The entire paper is dedicated to a discussion
of whether to frame the model of TT as one of intentionally channeling
energy or as simply a "knowing participation" in the patterning process.
Excuse me, but considering no one has ever demonstrated the existence of
such an energy field, or that it can be either channeled or "participated
in," and repeated attempts to allow practitioners to demonstrate their
ability to even detect this energy have been futile, this all sounds like
just so much high-falutin' hogwash. Who do they think they are kidding?
"Diversity accelerates with higher frequency phenomena." "Helicy identifies
the nature of change as innovative and unpredictable increasing diversity."
Are they seriously unaware that this is pseudo-scientific-sounding
gibberish? This is such ridiculous babble they have a hard time even
constructing English sentences with these concepts. I admit I am astounded
that otherwise intelligent people could be so brainwashed by their own
dogma.
I hate to end on such a down note, but I assumed you would want to hear what
I really thought about the information you sent. I realize I have gone on at
some length- but then, you previously criticized me for not doing a thorough
literature review. As I hope you can now see, I have become quite familiar
with the research. I remain thoroughly unconvinced that there is anything
other than a placebo/relaxation response going on with TT, and still feel it
degrades the profession and encourages an anti-science, anti-medicine
mindset that will not serve us well now or in the future.

Sincerely,

Kevin Courcey RN

additional notes from Kevin:
Eric-
You might want to add that the TTP's response to my letter was simply to
state that we apparently "disagree on the foundational support for TT," and
that she would be most comfortable ending the discussion.  No response to
the criticisms, no attempt to justify the practice scientifically, no
rationale for continued investigation.  She will undoubtedly continue to
practice and teach that TT speeds healing, reduces pain, and quiets anxiety
by smoothing wrinkled energy fields through the intentionality of the
healer.  She will cite the research as if it is valid, and make claims based
upon the research that are contrary, in many cases, to the statements of the
researchers themselves.  And they wonder why we get upset with them, and
accuse them of fraud.  They refuse to be held accountable scientifically,
saying their practice exists in a realm outside science, and have thereby
created not another nursing modality, but a religion-based on uncritical
belief, wishful thinking, and the occasional positive placebo or relaxation
response.
 

This page is posted by Eric Krieg and found from
The Therapeutic Touch page at http://www.phact.org/e/tt