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Fighting TT Quackery in Oregon:
A Front-Line Report

Kevin Courcey, R.N.

On April 1, 1998, my local paper carried a front-page story of an 11-year-old girl who had "debunked" Therapeutic Touch (TT) for her fourth-grade science fair project. The results of her experiment were published in the prestigious Journal of the American Medical Association (JAMA) that same day. This was a day for scientists and skeptics alike to rejoice! Finally someone had figured out how to call the bluff of TT practitioners and force them to confront the fact that the "energy fields" they claim to feel are imaginary.

During the next week, a nurse who worked at the Sacred Heart Medical Center in Eugene, Oregon, told me about an interaction that had occurred a few days previously. She had been attending a fresh postoperative patient, trying to get her settled in bed and making her less painful. She left briefly to get some pain medication, and when she returned to the room, another hospital staff member was at the bedside, announcing that she would "help take away the patient's pain" with therapeutic touch. This staff member proceeded to wave her hands over the patient as though capturing the pain with her hands and shaking it off at the foot of the bed. During the next few minutes, the patient noticed that her pain receded. She did not notice, until her nurse pointed it out, that she had just been given IV pain medication. The nurse was concerned that if she hadn't informed about the pain medication, the patient would have attributed her relief to the magical arm-waving ceremony. The nurse felt this would have constituted fraudulent medical practice.

I Protest

That same week, I noticed that our hospital was offering courses in TT for staff nurses; one for beginners, and one for those with at least six months of "regular practice" who "feel ready to deepen their sensitivities and awareness with their practice." That pushed me into action. Why were we, a modern Level-2 medical facility, not only allowing this practice to occur in the hospital, but training more nurses to do it! I knew there were influential nurses in the hospital that supported TT, so I decided to write to the medical Chief of Staff with my concerns. My letter stated:

A study published in the latest Journal of the American Medical Association concludes that Therapeutic Touch is little more than quackery. It is a system based on metaphysics rather than science. The authors of the JAMA article noted that even after an extensive literature search, "no well-designed study demonstrates any health benefit from Therapeutic Touch. These facts, together with our experimental findings, suggest that Therapeutic Touch claims are groundless and that further use of TT by health professionals is unjustified." [1]

It is important to convey a professional and competent attitude to the general public when they seek care at our facility. . . . In light of this study, and the subsequent media attention to the issue, people might well worry about their level of care if they are confronted with staff who, rather than discussing breathing techniques or relaxation exercises, are flapping their arms about, claiming they are "smoothing the patient's energy fields." . . . .

I urge you to call for a cessation of this practice in the hospital. Let us insist in using proven interventions, ordered by an MD, for your patients.

Several days later, the doctor phoned to tell me he was interested in what I had to say and that he had also received a complaint from one of the medical staff. He said he would discuss the issue at the next Medical Executive Committee meeting. I offered to do some research on the subject for him, and he gladly accepted my offer.

A TT Advocate Responds

Unknown to me, a friend with whom I had shared the letter was a TT supporter and gave a copy to a nurse-clinician who was one of the foremost TT practitioners in the hospital. She quickly replied, chastising me for not doing a thorough review of the literature myself, relying instead on a study "done by the child of parents who have the most anti-therapeutic touch website on the Internet." The fact that the study had survived the peer-review process of the professional journal apparently did not impress her. "I am disappointed that you decided to not hold yourself to a professional standard that you appear to have espoused in your letter" she continued. She ended by offering to send me a "comprehensive body of literature" and her personal bibliography on the subject. I accepted.

I knew that in order to accurately brief the medical executive committee, I had to become somewhat of an expert on TT in a very short time. I asked Linda Rosa, RN, the primary author of the JAMA study, for any material she could send me. She was extremely helpful, despite being swamped with calls from reporters after the huge press coverage that followed the study's publication. Along with some hard-to-locate studies, she sent me her 180-page survey of the literature, covering virtually every research study ever done on TT. I did further literature and Internet searches, requesting documents from libraries around the country, and ended up with about 50 articles and research papers. The more I read, the more outraged I was that this practice is being allowed to continue. I condensed Linda's survey and my documents into an 11-page summary of the research and presented it to the Chief of Staff.

The "comprehensive body of literature" and bibliography from the TT nurse clinician cited supportive research by Fedoruk, Krieger, Kramer, and Quinn, and included copies of seven articles by various authors. Curiously, one of the articles had concluded: "In the final analysis, the current research base supporting continued nursing practice of therapeutic touch is, at best, weak . . . . It may be presumptuous to teach the art or to seriously discuss the use of this practice in the treatment of illness." [2] This was hardly a glowing endorsement.

After nearly a month of study on the subject, critiquing the remaining TT research and articles proved fairly easy. At one point or another, the major TT researchers have admitted the flaws of previous studies. So, for example, when our nurse-clinician quoted the Kramer study as supporting the use of TT on children, I simply allowed staunch TT proponent and researcher Therese Meehan to voice the critique for me. Meehan commented on the Kramer study in a letter to the editor of Research in Nursing and Health, saying "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!

My response to the TT nurse-clinician was a three-page, single-spaced critique covering each of the articles and the research she had sent me. Whenever possible, I used the researcher's own words, or other TT proponents ' critiques of the research. I was intent on showing her that this wasn't just some cranky group of skeptics questioning this modality, it was the primary TT researchers themselves! I concluded by asking how she would ethically incorporate these negative findings and critiques into her practice and teaching of TT.

Her reply came quickly and was brief: "I am most comfortable with leaving this discussion where it stands, that you and I disagree on the foundational support for therapeutic touch." So after telling me that I had no business discussing this practice until I had personally reviewed the literature, she now said that further discussion would be pointless anyway.

It appears to me that no research could be strong enough to disillusion its adherents. From what I have seen, its practitioners seem to feel no need to justify their practice scientifically. Especially since the JAMA article, practitioners have attempted to recast TT theory into something untestable that cannot be scientifically disproved. One practitioner at the Colorado school for Healing Touch has now admitted that it was years before she could actually feel energy fields in her TT work. She justifies this past practice by stating that detecting energy fields is not essential to TT, but only an aid in treatment, and that other senses, such as intuition, and even "a sense of sight" play an equally important role. Critics who demand verification for the claims of enhanced wound healing, pain relief, and anxiety reduction are simply dismissed with "Let's just agree to disagree, shall we?" TT's uncritical acceptance by its advocates is characteristic not of science, but of religion. I do not think that hospitals should knowingly permit their staff members to administer pseudoscientific treatment.

While awaiting a reply from the hospital chief of staff, I donated a copy of my 11-page summary of the literature to our hospital library, to be placed in the TT information folder. This enables clinicians who are interested enough to look at the literature to access information that they would not get from TT proponents. For too long, only one side of this story has been accessible.

TT is Banned!

In May 1999, during a workshop about patient care in the maternal services complex, I learned that the hospital had quietly changed its policy on TT. While discussing techniques to make the delivering mothers more comfortable, the presenters discussed massage, but repeated several times that they were not talking about TT! Apparently, at a recent meeting of the medical staff (the same group I lobbied to ban TT last year), concerns were expressed about a rumor that a component of the new program would be the use of TT on laboring patients. It was then decided that TT would not be offered to any patient in the hospital, and if a patient spontaneously requested TT, it would be performed by one of the Catholic nuns rather than by a staff nurse. As I stated in Further Notes on Therapeutic Touch, TT is more like a religious ceremony than a medical or nursing intervention. Having a religious figure deliver the "treatment" maintains this distinction in an appropriate manner.

I am certainly pleased with this decision and respect the doctors for speaking up for their patients. If you work at a hospital where TT is practiced, please protest and let me know what happens.

References

1. Rosa L, Rosa E, Sarner L, Barrett S. A Close Look at Therapeutic Touch. JAMA 279:1005-1010, 1998. To obtain a reprint of this article, send a self-addressed stamped envelope to the National Therapeutic Touch Study Group, 711 W. 9th St., Loveland, CO 80537.
2. Clark PE, Clark MJ. Therapeutic Touch: Is there a scientific basis for the practice? Nursing Research 33(1):38­41, 1984.

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Mr. Courcey has been a nurse for 22 years, spending 15 years as a psychiatric nurse, and 6 years in phone triage answering questions about medical problems ranging from lacerations to fevers to chest pain. He has also chaired an 800-nurse bargaining unit and been a board member of the Oregon Nurses Association.

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