Responses to Objections to the JAMA Paper
Proponents of therapeutic touch (TT) postulate that each person has a human energy field (HEF) that can be felt by other people, especially those who intend to do so and have been trained to recognize their perceptions as HEF-related. Emily Rosa's experiment found that 21 TT practitioners could not perceive her "energy field" under conditions where they should have been able to do so if TT theory were valid [Rosa L, Rosa E, Sarner L, Barrett S. A Close Look at Therapeutic Touch. JAMA 279:1005-1010, 1998]. Since our paper poses a direct threat to many with vested interests in TT, those interests have advanced specious arguments to discredit the paper and its conclusions. Here are our responses to the top ten objections made by TT apologists.
1. Emily's experiment was worthless because it wasn't double-blinded. The authors are biased against TT and any experimental results reported by them must be discounted. Emily's parents put her up to this so they could destroy TT.
Just how was this bias supposed to have its effect on the experimental outcomes? Yes, it is important to control for "experimenter bias," but not foolishly so. You don't do it just to be doing it, there must be a reason for doing so. Critics have yet to come up with any valid reasons for double-blinding, and some of the reasons put forward by critics are more bizarre than what was being tested. (For example, that Emily could stop the spinning of a coin by holding her hand several inches above it.) Double-blinding is compellingly important in clinical tests, but much less so in other types of experimentation. Emily's controls were sufficient for the experimental situation. It was a simple binary test. Either it was the right hand or the left. And the subject said either right or left. There were no shades of meaning or correctness to influence.
As for Emily's parents putting her up to this, Emily herself bristles at this, as it takes away credit she rightfully believes is hers. Her parents acted as teachers before and during the test, and helped her analyze and understand the results afterwards. They have raised her in an environment that puts a premium on the efficacy of the scientific method (as opposed to "other ways of knowing"), and they make no apologies for that. Emily's mother is a Registered Nurse (RN) with a professional (and legal) responsibility to report substandard practice to responsible authorities within her profession. This responsibility extended to the results of Emily's test: it would have been professionally irresponsible for her to suppress or fail to report it.
2. The statistics were flawed. In particular, the number of subjects was too few to warrant the conclusions reached by the authors. Practitioners were expected to get 100% right, which is unreasonable.
The study did no such thing. Logic "expected" practitioners to get 100% right, since they claim to be able to consistently manipulate the "human energy field" (HEF) for patient benefit, but the statistics analyzed the results only on the basis of getting 67% or 75% right. Yet subjects failed to do better than what would be expected from mere guessing. Indeed, the original protocol declared that a practitioner would have "passed" the test if she got 8 or more out of 10. Only one did that well, and in a retest got 6 out of 10. (The protocol also declared that anyone making 8 or more correct selections would be retested, but the retest results would not be included in the group analysis.)
Emily had more practitioners in her study than the vast majority of previous TT studies had patients for theirs. The study's statistics take into account the size of the sample. Thus, as reported in the paper, if TT practitioners had the ability to feel an energy field with their hands at least two out of every three times they try, the probability of missing it with Emily's test (even with only 21 practitioners) was less than 1 out of 20. If they had the ability to detect the field at least 3 times out of 4, then the chance of missing it with Emily's test was only 3 out 10,000.
3. The practitioners were not validly screened as being truly "representative" of TT In fact, one even reported being a practitioner for longer than TT has been around.
As to being unrepresentative, in what way? All claimed an ability beforehand, all reported at least one year of experience with TT, and one had even published on TT and appeared in a teaching video. There is no "certification" process for TT practitioners, so it is not possible in testing to do anything but take their statement about their abilities at face value. In fact, that was the reason why the allegedly anomalous "length of practice" was reported for one practitioner-it was the number of years stated by the practitioner herself. Assuming honesty on her part, it was likely she was reporting that she had been performing something like TT for that length time. One point is clear after Emily's test: from now on, reference to a "qualified TT practitioner" must be to one who can demonstrate and objectively detect a patient's human energy field. We know no one so qualified.
4. Emily's field was probably all wrong for this test. She either had (a) cold or bioenergetically dead hands; (b) a wild pubescent field; (c) too perfect a field (or too healthy); (d) a field with too short a range; (e) a field so large it encompassed both hands of a subject; or (f) suppressed or misdirected her field (either consciously or unconsciously) to fool her subjects.
In the second go-around, subjects were allowed to first "feel" the energy field around their hands and pick a hand for her to use in the subsequent test. If they couldn't feel anything at all at that point, why I didn't they say something? Nothing in the previous literature on TT suggests significant obstacles or limitations to the practice of TT. With this notion, the "TT Self-Assessment" procedure (where nurses familiarize themselves by feeling the energy field between their own hands) could never work. Also, in TT originator Dolores Krieger's book, she talks about her own "Emperor's Clothes" test where you can tell the difference when a shoulder is covered with plastic and when it is not; no warning is given that this test is invalid if the shoulder is healthy (not to mention the state of the practitioner). Also, Krieger claims to feel the energy fields of apparently normal seeds, rivers, rocks, etc., and to tell the difference between them.
As for redirecting her energy, it should be remembered that Emily was performing the role of a patient in this experiment. It has long been maintained that the beliefs and attitudes of patients (i.e., the people whose fields practitioners feel) have no bearing on the effectiveness of TT practice. This argument also belies the need for double-blinding. Regardless of who was holding out the "target" hand, this argument could always be used to call the target into question. With such obviously contradictory explanations or rationalizations, the point is made for the necessity for fundamental testing, such as Emily's. It should be noted that each of these reasons, if accepted, would lead to a fundamental untestability of the HEF premise. A failure could always be explained away.
5. This was not a test of TT, but a parlor game. What the practitioners were required to do during the experiment invalidated its applicability to TT, especially since TT is a holistic process and can't be validly analyzed in parts.
Emily's test was not of efficacy or technique (or "healing"), but I of raw ability. It's very much like testing a surgeon to see if he can l tell, without looking, in which hand the scalpel is being held. In any event, there was some movement. Emily presented her hand after each coin flip, which required relative movement between her hands and the subject's. Both subjects and Emily had at least small I movements of their hands during the trials, and some practitioners even wiggled their fingers or hands. Previous descriptions of the sensations of feeling an HEF state that the field itself is constantly in motion, and the literature states that such motion can be easily felt. Significantly, all of Emily's subjects agreed to the protocol and none voiced any concern that the test setup would pose a problem in demonstrating their ability.
The argument about TT being "holistic" is a thinly disguised attempt to get back to "outcome" (i.e., clinical) testing, where it is easier to obfuscate, ignore negative results, or explain away nonconforming data. There have been numerous clinical trials on outcomes using TT. The results are highly mixed. Some tests do not have statistically significant results, others revealed slight positive effects (though statistically significant), and several actually reported statistically significant effects, but negative (i.e., the control group did better than the TT group). Holistic practitioners' prejudice against what they call "reductionism" (analyzing things in parts) is not shared by others in scientific medicine.
6. The conclusions reached by the authors were illogical and outrageous. Nobody ever said that feeling a human energy field was necessary to practice TT, and in fact one doesn't need to.
TT theorists have said so-consistently. Some "energy workers" now say they do not have to feel the field to be effective, but for 25 years TT practitioners undeniably have claimed to feel the HEF and to assess and manipulate it. It is the raison d'être of TT (as applied energy work). A quarter-century of conducting clinical studies and book-writing by TT advocates makes it clear that (until this experiment came along) detecting the energy field was an indispensable part of TT practice.
7. It doesn't matter how TT works. Even if it's only a placebo, what's the harm? TT is too valuable not to be used.
How do they know it works or is truly valuable? By anecdotal evidence and "other ways of knowing" (e.g., wishful thinking, whim, insights through meditation, "grounded theory," magic, etc)? Sorry, science requires much more. But for the sake of argument, suppose that TT works only as placebo. How could it be ethically practiced nonexperimentally on real patients? The practitioner needs to deceive the patient as to the efficacy as well as the mechanism of the treatment. Deceit is never ethical, even with good intentions. Perhaps TT practitioners and others who argue this point believe that the ends justify the means. Fortunately for the rest of us, responsible medical practitioners believe otherwise. Science requires much more.
But for the sake of argument, suppose that TT works only as placebo. How would it be practiced nonexperimentally on real patients? The practitioner would need to deceive the patient as to the efficacy and the manner of treatment (knowing full well it is only placebo). Is it proper for a practitioner to mislead a patient about a treatment in order to get it to work? Must the practitioner "come clean" afterwards? Are there any limits to this type of professional behavior? Most important, how real is "patient empowerment" (a big point with alternative-medicine types) when the patient is deliberately deceived on the efficacy of a proffered treatment?
8. Publication of this was a travesty. It was an insult to qualified, hard-working, grownup nurse researchers.
Why? Because it was done by a kid? What is the minimum age for thinking scientifically? A panel of 15 JAMA editors passed this on for publication. They were highly mindful that if this particular study didn't pass muster, the journal's reputation would suffer. Had they suppressed it for nonscientific reasons, they would have been guilty of ignoring facts. JAMA editor George Lundberg put it well: "Age doesn't matter. All we care about is good science. This was good science."
Some of these "qualified, hard-working grownups" are not without reason for feeling threatened. Publication of Emily's experiment is embarrassing to those with PhD's or DNS's doing "research" in this area, many of whom actually owe their degrees to TT. It is also embarrassing to all of nursing for letting them get away with it for so long. If their research was so good, so undeniable, so revolutionary, why weren't their theories recognized by other scientific fields long before Emily was even born?
9. JAMA published this because simple, inexpensive remedies like TT threaten the economic interests of doctors and pharmaceutical companies. They won't publish research on things that will save consumers money.
In truth, most papers on alternative medicine received by major (mainstream) journals are hopelessly poor in quality. Reading those papers that are published in the lesser journals confirms this. And, of course, there is the question of whether there is anything scientifically valid to report favorably about any alternative practice.
To accept the conspiratorial premise on which this argument is based, one needs to accept also that the conspiracy is not only vast, but is ubiquitous. One has to accept that there is absolutely no one of integrity at the top of the medical professions. And one must accept also that the practicing professionals are so completely impotent, ignorant, or uncaring that they are all unable even to detect the conspiracy, much less fight it to get what is right for their patients.
10. TT works, Emily or no Emily. Let's talk about something else.
And supposedly open minds slam shut. Next time the statement is made that "skeptics are closed-minded," remember the Emily Event and consider whose minds were actually closed to evidence.
Time to Put up or Shut up
When we published Emily's experiments in JAMA, along with some analysis of TT literature, we generalized Emily's question and answer to the following carefully worded (and quite conservative) conclusion:
To our knowledge, no other objective, quantitative study involving more than a few TT practitioners has been published, and no well-designed study demonstrates any health benefit from TT. These facts, together with our experimental findings, suggest that TT claims are groundless and that further use of TT by health professionals is unjustified.
Despite more than 15 months of controversy, two rounds of letters in JAMA, and many ex cathedra pronouncements by Dolores Krieger et al., the above conclusion has held up. Krieger and other TT apologists can blather all they want about the alleged "parlor-game" inadequacies of Emily's protocol. But at the moment, it, and the conclusion derived in part from it, stand unrefuted in the scientific literature. They will remain so until someone can produce persuasive evidence that supports the practice of TT as a "unique and effective modality."
Nothing else will do. Poorly designed clinical experiments won't do it. Testimonials from TT practitioners or their "patients" won't do it either. Rudolf Steiner-like ravings against the evils of reductionism, materialism, and determinism aren't going to make TT any more plausible. Pretending that TT is too noble an undertaking to muck after Randi's million-dollar prize definitely doesn't wash. Many people now understand that TT is a form of nurse quackery. We are seeing signs that TT is withering on the vine, yet its practitioners won't even try to refute the simple challenge posed to by a nine- (now twelve-) year-old child. They are displaying themselves as close-minded to evidence, objective reality, and the scientific method.
A proper scientific test requires going for broke and letting reality demonstrate when something is wrong. That usually means conducting a scientific experiment on a falsifiable hypothesis. That means that if you believe x causes y, you come up with an experimental condition where you believe x must cause y, then find out if it does. If it doesn't, you're wrong. Real scientists think this way all the time. Emily figured this out for herself at age 9.
That's the kind of test TT advocates should be trying to come up with. So let me cut to the quick. I challenge anyone who thinks TT is effective to do the following:
Please publicly describe, in clear and unambiguous terms, an objectively measurable test that would conclusively determine whether Therapeutic Touch is or is not a real phenomenon. (In other words, state what scientific evidence would convince you that TT does not work.) Then you, I, Emily, mutually acceptable outside scientists, and perhaps even James Randi, will devise and—within the limits of our financial resources —conduct such a test.
Any takers? Or do we get bragging rights that no one is confident enough in their beliefs about the reality of TT or its practice to test it or even state how it should be tested. Or that TT advocates are so closed-minded that they can think of anything that can think of any circumstance that could change their minds?
The first portion of this article was published in slightly different format in the September 1998 issue of Skeptic Magazine, which contains additional information about the experiences of the Rosa/Sarner family after the JAMA article was published.
This article was revised on Novermber 11, 1999.