Rosa L, Rosa E, Sarner L, Barrett S. a Close Look at Therapeutic Touch
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A Close Look at Therapeutic Touch Linda Rosa; Emily Rosa; Larry Sarner; et al. JAMA. 1998;279(13):1005-1010 (doi:10.1001/jama.279.13.1005) Online article and related content current as of December 29, 2008. http://jama.ama-assn.org/cgi/content/full/279/13/1005 Correction Contact me if this article is corrected. Citations This article has been cited 90 times. Contact me when this article is cited. Topic collections Nursing Care Contact me when new articles are published in these topic areas. Subscribe Email Alerts http://jama.com/subscribe http://jamaarchives.com/alerts Permissions Reprints/E-prints [email protected] [email protected] http://pubs.ama-assn.org/misc/permissions.dtl Downloaded from www.jama.com by guest on December 29, 2008 A Close Look at Therapeutic Touch Linda Rosa, BSN, RN; Emily Rosa; Larry Sarner; Stephen Barrett, MD Context.—Therapeutic Touch (TT) is a widely used nursing practice rooted in and that about half of those trained ac- mysticism but alleged to have a scientific basis. Practitioners of TT claim to treat tually practice it.39 Therapeutic Touch is many medical conditions by using their hands to manipulate a “human energy field” taught in more than 100 colleges and uni- 5 perceptible above the patient’s skin. versities in 75 countries. It is said to be the most recognized technique used by Objective.—To investigate whether TT practitioners can actually perceive a 40 “human energy field.” practitioners of holistic nursing. Con- sidered a nursing intervention, it is used Design.—Twenty-one practitioners with TT experience from 1 to 27 years were bynursesinatleast80hospitalsinNorth tested under blinded conditions to determine whether they could correctly identify America,33 often without the permission which of their hands was closest to the investigator’s hand. Placement of the inves- or even knowledge of attending physi- tigator’s hand was determined by flipping a coin. Fourteen practitioners were tested cians.41-43 The policies and procedures 10 times each, and 7 practitioners were tested 20 times each. books of some institutions recognize Main Outcome Measure.—Practitioners of TT were asked to state whether the TT,44 and it is the only treatment for the investigator’s unseen hand hovered above their right hand or their left hand. To “energy-field disturbance” diagnosis show the validity of TT theory, the practitioners should have been able to locate the recognized by the North American investigator’s hand 100% of the time. A score of 50% would be expected through Nursing Diagnosis Association.45 RN, chance alone. one of the nursing profession’s largest Results.—Practitioners of TT identified the correct hand in only 123 (44%) of 280 periodicals, has published many articles favorable to TT.46-52 trials, which is close to what would be expected for random chance. There was no Many professional nursing organiza- significant correlation between the practitioner’s score and length of experience tions promote TT. In 1987, the 50 000- (r=0.23). The statistical power of this experiment was sufficient to conclude that if member Order of Nurses of Quebec en- TT practitioners could reliably detect a human energy field, the study would have dorsed TT as a “bona fide” nursing skill.32 demonstrated this. The National League for Nursing, the Conclusions.—Twenty-one experienced TT practitioners were unable to detect credentialing agency for nursing schools the investigator’s “energy field.” Their failure to substantiate TT’s most fundamen- in the United States, denies having an tal claim is unrefuted evidence that the claims of TT are groundless and that further official stand on TT but has promoted it 3,53,54 professional use is unjustified. through books and videotapes, and JAMA. 1998;279:1005-1010 the league’s executive director and a re- cent president are prominent advo- cates.55 The American Nurses’ Associa- THERAPEUTIC TOUCH (TT) is a titionerfocusesonhisorherintenttohelp tion holds TT workshops at its national widely used nursing practice rooted in the patient. This step resembles medita- conventions.Itsofficialjournalpublished mysticism but alleged to have a scientific tion and is claimed to benefit the practi- the premier articles on TT56-59 as well as a basis. Its practitioners claim to heal or tioner as well. The second step is assess- recent article designated for continuing improve many medical problems by ment, in which the practitioner’s hands, education credits.60 The association’s im- manual manipulation of a “human energy from a distance of 5 to 10 cm, sweep over mediate past president has written edi- field” (HEF) perceptible above the pa- the patient’s body from head to feet, “at- torials defending TT against criticism.61 tient’s skin. They also claim to detect ill- tuning” to the patient’s condition by be- The American Holistic Nursing Associa- nesses and stimulate recuperative pow- coming aware of “changes in sensory tionofferscertificationin“healingtouch,” ersthroughtheirintentiontoheal.Thera- cues” in the hands. The third step is in- 62 1-6 a TT variant. The Nurse Healers and peutic Touch practice guides describe 3 tervention, in which the practitioner’s Professional Associates Cooperative, basic steps, none of which actually re- hands “repattern” the patient’s “energy which was formed to promote TT, claims quires touching the patient’s body. The field” by removing “congestion,” replen- about 1200 members.39 first step is centering, in which the prac- ishing depleted areas, and smoothing out ill-flowing areas. The resultant “energy balance” purportedly stems disease and The TT Hypothesis allows the patient’s body to heal itself.7 Therapeutic Touch was conceived in From the Questionable Nurse Practices Task Force, Proponents of TT state that they have theearly1970sbyDoloresKrieger,PhD, National Council Against Health Fraud Inc (Ms L. Rosa), 8 and the National Therapeutic Touch Study Group (Mr “seen it work.” In a 1995 interview, TT’s RN, a faculty member at New York Uni- Sarner), Loveland, Colo; and Quackwatch Inc, Allen- founder said, “In theory, there should be versity’s Division of Nursing. Although town, Pa (Dr Barrett). Ms E. Rosa is a sixth-grade no limitation on what healing can be ac- often presented as a scientific adapta- student at Loveland, Colo. 9 63-68 Ms E. Rosa designed and conducted the tests and complished.” Table 1 lists some claims tion of “laying-on of hands,” TT is im- tabulated her findings. Mr Sarner did the statistical made for TT in published reports. bued with metaphysical ideas. analysis. He and Ms L. Rosa recruited the test subjects, Krieger initially identified TT’s active performed the literature analysis, and drafted this re- port. Dr Barrett added background material and edited BACKGROUND agent as prana, an ayurvedic, or tradi- the report for publication. Professional Recognition tional Indian, concept of “life force.” She Corresponding author: Stephen Barrett, MD, PO Box stated, 1747, Allentown, PA 18105 (e-mail: sbinfo@quackwatch Proponents state that more than .com). 100 000 people worldwide have been Health is considered a harmonious relation- Reprints: Larry Sarner, National Therapeutic Touch 38 Study Group, 711 W Ninth St, Loveland, CO 80537 trained in TT technique, including at ship between the individual and his total envi- (e-mail: [email protected]). least 43 000 health care professionals,2 ronment. There is postulated a continuing in- JAMA, April 1, 1998—Vol 279, No. 13 A Close Look at Therapeutic Touch—Rosa et al 1005 ©1998 American Medical Association. All rights reserved. Downloaded from www.jama.com by guest on December 29, 2008 Table 1.—Claims Made for Therapeutic Touch on Rogers’ concepts, although Eastern “curriculum committees and other insti- 2,70 66 Calms colicky infants,9 hospitalized infants,10 women metaphysical terms such as chakra tutional bulwarks of today’s society.” The 71 in childbirth,11 trauma patients,12 and hospitalized and yin-yang are still used. mysticism has been downplayed, and vari- cardiovascular patients13,14 The HEF postulated by TT theorists ous scientific-sounding mechanisms have Promotes bonding between parents and infants15 been proposed. These include the thera- Increases milk let down in breast-feeding mothers16 resemblesthe“magneticfluid”or“animal Helps children make sense of the world17 magnetism” postulated during the 18th peutic value of skin-to-skin contact, elec- Protects nurses from burnout18 and effects changes century by Anton Mesmer and his follow- tron transfer resonance, oxygen uptake in their lifestyle19 ers. Mesmerism held that illnesses are by hemoglobin, stereochemical similari- Helps to evaluate situations where diagnosis is elusive9 caused by obstacles to the free flow of this ties of hemoglobin and chlorophyll, elec- Relieves acute pain,20 especially from burns21 fluid and that skilled healers (“sensi- trostatic potentials influenced by healer Relieves nausea,22,23 diarrhea,5 tension headaches,24 brain activity, and unspecified concepts 21 tives”) could remove these obstacles by migraine headaches, and swelling in edematous 66,67 legs and arthritic joints7 making passes with their hands. Some from quantum theory. Decreases inflammation25 aspectsofmesmerismwererevivedinthe Therapeutic Touch is said to be in the Breaks fever21 vanguard of treatments that allow 5 19th century by Theosophy, an occult re- Remedies thyroid imbalances “healing” to take place, as opposed to the Helps skin grafts to seed9 ligion that incorporated Eastern meta- Promotes healing of decubitus ulcers7 physical concepts and underlies many “curing” pejoratively ascribed to main- Alleviates psychosomatic illnesses5 currentNewAgeideas.72 DoraKunz,who stream medical practice. Therapeutic Increases the rate of healing for wounds, bone and Touch supposedly requires little train- muscle injuries, and infections26 is considered TT’s codeveloper, was Relieves symptoms of Alzheimer disease,27 acquired president of the Theosophical Society of ing beyond refining an innate ability to immunodeficiency syndrome,5 menstruation,28 and America from 1975 to 1987.