this page is available from http://www.phact.org/e/tt/wound.htm
 

On April 8, Donal O'Mathuna called our attention to an article by
Barbara Daley in Journal of Advanced Nursing (25, 1123-1132 (1997)),
entitled "Therapeutic touch, nursing practice and contemporary cutaneous
wound healing research."  I have now read this article and wish to share
some of its pseudoscientific aspects, including its rationalization of
failures in some of the clinical studies by D.P. Wirth and coworkers.

(Daley (MA, RN) is Director, Center for Music and Touch Therapy, New
York.)

  From background material on therapeutic touch (TT) we are told that "The
theoretical foundation of TT is based on the Rogerian conceptual model
of Integrality which views the person and environment as complementary
multi-dimensional energy fields engaged in mutual and simultaneous
interactions (Malinski 1986).  Martha Rogers' 'Science of Unitary Human
Beings' set forth the principle of Integrality as a holistic framework
for nursing (Rogers 1986).  This perspective holds that the human energy
field is fundamental to the person's survival and is in fact a field
which continuously interacts and repatterns itself in response to the
environmental energy field around it..."

  In reference to the Wirth studies: "Although the implications of these
studies for nursing science are profound, due to the general scorn and
misunderstanding of the TT process especially outside the bounds of the
nursing profession, the studies have remained in relative obscurity.
Perhaps Einstein's observation that a truly innovative and effective
idea or approach often requires at least one generation to evolve into
general acceptance may unfortunately be applied to the five experiments
under consideration and, by extension, to the field of TT in general
(Pais 1994)."

  The studies dealt with "the rate of re-epithelialization of small
surgically biopsied full thickness dermal wounds.  In the first study of
the series, subjects placed their biopsied shoulder through a circular
occlusive opening in a shielded door, whereupon a TT practitioner
situated on the other side conducted a 5 minute NCTT healing treatment."
(NCTT= non-contact TT)  "The treatment subjects demonstrated a
statistically significant increased rate of re-epithelialization
compared to the control group - in fact, 57% of the treated group
exhibited fully healed wounds at the end of the experiment, whereas none
of the control group wounds were fully healed."

  However, Daley noted that heat transfer from the healer could have
improved the healing.  So in other studies there was a one-way mirror
between the subject and healer (presumably this still allows human
energy fields to penetrate!).  In the second study, "the treated group
once again showed a highly significant rate of wound
re-epithelialization when compared to the control group."

  The third and fourth studies "incorporated complex, randomized,
double-blind, within subject, crossover methodological design
protocols...The experimental approach used in these two studies greatly
reduced the variability between treatment and control groups because the
individual subjects acted as their own controls."  (From this I conclude
that the first two studies did not have one or more of these features;
they are not described as being double-blind, for example.)

  The third study included a number of interesting features: "a
specifically designed biofeedback, guided imagery, visualization and
relaxation component were included along with in person NCTT treatment
sessions and a simultaneous distant Intercessory Prayer and LeShan
healing protocol...section one of the study included two TT healers who
simultaneously administered a five minute treatment via the one-way
mirror and real time video image of the subject.  The control condition
for this section of the study was the same as the treatment condition
except that a clear plastic sheet was added to the patient's side of the
one-way mirror without the practitioner's knowledge.  The plastic sheet
was included in the design in order to experimentally examine the
clinical reports of many nurses and TT practitioners who have indicated
over the years that plastic, often in the form of prostheses or other
medically constructed components, seems to act as an inhibitor or
impediment to the flow of energy..."  We are not told the outcome of
this study.  I assume it was negative - which could suggest either that
TT doesn't work, or that human energy fields can penetrate plastic after
all.

  In the second part of study 3 (designed to test the effect of distance
and belief), TT was administered at a distance using a video monitor
image of the subject, who was on a different floor from the
practitioner.  However, in the test condition, the practitioner was told
that the patient was on the opposite side of a partition, whereas in the
controls the practitioner knew that the patient was on another floor.
Here we are told that "the results were inconclusive."  Again, because
of the design (which, at least from Daley's description, had no real
controls), this could be because TT doesn't work, or doesn't work at a
distance; or maybe it does work at a distance, but it doesn't matter
whether the practitioner knows whether the patient is nearby or not!
(It is usually stated that the practitioner detects and manipulates the
energy fields.  Wouldn't the practitioner have noticeably more trouble
detecting the field if the patient were on another floor?)

  Daley seems more excited by the possibilities suggested by the
experiments than by the lack of results: "...the experiment raises
fascinating implications for TT intervention and nursing practice in
general.  For example, the possibility that a nurse could actually
transmit a distant, compassionate, loving intention to heal over a
digital medium such as real time video could potentially have far
reaching effects for any patient undergoing digital monitoring or
diagnostic procedures.

  "The fact that a single nurse could be in constant therapeutic
interaction with several patients at once even at a distance may be
difficult to conceptualize from a strictly scientific physical
perspective, yet many nurses whole-heartedly believe that this is
exactly what happens in their daily practice.  In this regard, it is
interesting to note that patients on the ward, who previously were
restless or agitated, have often suddenly become calm, peaceful and
relaxed when they remember that a particular nurse is coming on duty
soon.  Or, the reverse situation, where a particular nurse or team of
nurses seem to dispense consistently more pain medication, receive more
patient complaints, and have more sick time than other nursing teams.
Most experienced nurse practitioners know that they personally can
affect a positive therapeutic change for their patients through
compassion, intention, and even sometimes with only a loving thought.
In fact, what nursing professional has not prayed for a patient, or
begun a shift thinking about how to make a particularly ill patient feel
better?  Many clinicians intuitively know that every little positive
thought, every heartfelt prayer, every moment of sincere compassion, can
potentially have a measurable therapeutic physiological effect (Fanslow
1989)..."

  The fourth study used the same subjects as the second; these were
"individuals who were regular practitioners of visualization/relaxation
and meditation techniques."  It included "a design feature where the
subjects concentrated on a specific intent to relax or a specific intent
to heal their wounds."  It is not clear from Daley's summary what the
control and treatment groups were, but apparently the outcome was not
favorable to TT: "the results did indicate significance for the control
condition and not for the treatment condition."  However, she noted,
"these results may be explained by a carryover treatment effect from the
prior complementary healing sessions.  Previous clinical reports have
indicated that it can take a period of several days to weeks for a
positive therapeutic TT effect to manifest (Dossey 1993, Krieger
1993)."  (But why should subjects who had previously received TT but now
were in the controls do better than treatment subjects getting new TT,
unless the latter had not had the previous treatment, i.e., were not
matched?)

  "The fifth and final study in the series was an exact methodological
replication of the second experiment even to the extent that the same TT
practitioner was utilized (wirth et al. 1996).  The results, however,
demonstrated statistical significance for the control group.  An
interesting observation was made during the study which has startling
implications for clinical nursing practice.  It was suggested that the
reverse significance noted in the experiment was due to a transference
effect that somehow occurred between the practitioner and subjects.
That is, during the study, it became apparent that the practitioner was
ill, suffering from flu-like symptoms such as nausea, dizziness and
fever.  Interestingly enough, the treatment group subjects, who were
physically healthy prior to the study, began to exhibit similar symptoms
as the healer following their treatment sessions."  She goes on to note
that "the very founders of the TT technique repeatedly emphasize in
their training classes that if the practitioner is not centered and
balanced - for example, if they are ill - they could potentially take on
their patients' energy, become physically drained or, even worse,
further disturb or imbalance the energy field of the patient (Krieger
1979)."

  This section further notes that "the experiment has also lent credence
to a consciousness-based interpretation or theory of the TT healing
encounter.  The conceptualization of TT as essentially a consciousness
oriented process wherein the practitioner is not only IN the environment
along with the patient, but actually IS the environment, has begun to
gain significant ground in recent years.  This holistic framework is
supported by the works of Bohm, Grof, Watson and others (Quinn 1992).
In fact, the notion of an interconnectedness of all life is now widely
discussed in such diverse fields as quantum physics and Ayurveda,
psychoneuroimmunology and spirituality, theology and nursing.
Consciousness within this paradigm is considered to be non-local, not
bound by physical laws, and the essence which connects all individuals
with each other."

  So the review encompassed five studies: two were favorable to TT, three
others (apparently better controlled) gave either no difference or even
better results for controls - yet the latter are interpreted not so much
as evidence against TT but as possible indications of its delayed effect
and of negative interactions in the human energy field!  However, Daley
continued, "Despite the fact that the 5 studies reviewed did not
demonstrate a consistent, replicative TT effect, Wirth and colleagues
should be commended for their seminal research efforts.  The design
features utilized in these experiments are considered by many, both
within orthodox and complementary healing circles, to be some of the
most scientifically rigorous, methodologically sophisticated
experimental protocols ever utilized in the field of healing research."

  It is then noted that while the authors conceded that their overall
results were inconclusive, "It must be pointed out, however, that this
conclusion is not an assessment of the clinical value of TT but, rather,
a scientific evaluation of the experimental data obtained...Given the
clinical nature of TT, the non-significant and reverse significant
results obtained in three of the studies may indicate that there are
inherent drawbacks in attempting to demonstrate experimentally what is
essentially a clinical phenomena.  That is, there may be a distinct
difference between the TT administered in the laboratory setting and TT
employed in clinical practice."  Nevertheless, "the highly significant
results of the initial two studies can be seen as indicators of the
power of TT even under extreme experimental conditions."  (Then why
couldn't it be seen in the other three studies?  Favorable results
count, but unfavorable ones don't because TT is too hard to study in the
lab!)

  In the "Conclusion" section, Daley writes, "The issue here tends to be
one of medicine's blind adherence to age-old philosophies and well
established protocols.  A fundamental tenet of nursing practice,
however, has always been to put the needs of the patients ahead of
unreasonable administrative procedures and guidelines.  Since the
unofficial birth of modern-day nursing began with Florence
Nightingale...the profession has evolved from underneath the shadow of
the physician, to a place where the nurse's education and research are
now second to none."

  It then notes that "Even if TT is relegated to a position where it is
considered to be wholly dependent upon the placebo effect, the five
studies reviewed indicate that TT appears to be effective ~ 40% of the
time..."  (This was apparently determined by counting two positive
studies, but not offsetting them by the studies which showed TT to be
worse than nothing!)  Daley confuses the issues here.  If TT helps
patients merely by placebo effects, there would be more appropriate
techniques of mind-body medicine to employ rather than to pretend that
the mystical hand-waving of TT practitioners is doing something.  More
importantly, to the promoters and practitioners of TT, it is not just
placebo.  Whether the human energy field exists and can be manipulated
to benefit health is what is being disputed.

  Returning to the abstract, it is stated that "While the results of the
studies were inconsistent overall, the series of experiments nonetheless
significantly expanded the theoretical boundaries and understanding of
the TT process..."  While Wirth and coworkers may have contributed to
the "theory" of TT, I do not see how this series of negative and
inconclusive experiments contribute anything to the "understanding of
the TT process," which has not even been shown to exist.

Tom Wheeler