Science or Pseudoscience? Pentagon Grant Funds Alternative Health Study
Carla Selby and Bela Scheiber
$355,225 was awarded for a ‘laying over of hands,’ Therapeutic Touch study at the University of Alabama at Birmingham.
Consider the following: A major public university’s burn center requests a grant for $317,725 from the Uniformed Services University of the Health Sciences (USUHS) (a department of the Pentagon) in order to study the “laying over of hands,” or “The Effect of Therapeutic Touch on Pain and Infection in Burn Patients.” One might be skeptical about the topic to be investigated and therefore not surprised that the grant was rejected. Now assume that this same university resubmitted the grant proposal revised in accordance with the suggestions of USUHS and two months later was awarded a grant of $355,225.
And, in fact, that’s what happened: $355,225 was awarded September 20, 1994, to the University of Alabama at Birmingham (UAB) Burn Center for a “single blinded randomized clinical trial- to “quantify the effect of therapeutic touch (TT) on pain and infection in burn patients, and to develop a research-based protocol for practice. A comparison will be made between the control group which will receive placebo intervention (mimic TT) along with the standard treatment regimen, and the experimental group will receive TT in addition to usual burn center management.”1
During the experiment, a group of burn patients — suffering from first-, second-, and third-degree burns on anywhere from 5 percent to 70 percent of their bodies — will have a nurse’s hands waved over them without touching (which should relieve any anxiety about exacerbation of pain on the part of burn patients) to see if the patient is helped. This group of patients will be compared with a control group of burn patients — selected by a coin toss — who are denied the benefit of a trained practitioner’s TT, but who instead get a wave of the hands from a nurse who has been trained in how to fake therapeutic touch.
Of course, a skeptic might ask, “What’s the difference between waving your hands over a patient’s body hoping to help heal him or her and pretending to wave your hands over a patient’s body hoping to help heal him or her?” Another question might be, “What if the mimic TT practitioner feels compassion for the burn patient and accidentally performs actual TT?” How would that affect the results of the study? Granted, the UAB Burn Center deals with burn victims, but if the USUHS was going to reject the first proposal and make suggestions, why didn’t they suggest that the practitioners start with a group of subjects suffering from less trauma? For example, people with mild sunburn?
The proposal “is designed to investigate the effects of a complementary therapy.”2
The “specific objectives” of the project are to:
- Recruit 150 subjects aged 15 to 65 and randomly assign them to either the treatment or control group.
- Compare the effects of TT on the outcomes of pain perception and nosocomial infection.
- Develop and test a TT protocol for use as an adjunct to narcotic analgesia in lowering pain levels and the incidence of infection in burn patients.3
- Therapeutic touch is a contemporary interpretation of several ancient healing practices.
- The technique . . . is based on the assumption of a human energy field which extends beyond the skin. The idea behind TT is that the human energy field is abundant and flows in balanced patterns in health but is depleted and/or unbalanced in illness or injury.
- This action is believed to place the person in an optimal position for his/her own resources to be used in self-healing.
- In this view, the therapist acts as a human energy support system until the person’s own immunological system is robust enough to take over.
- Central to the practice is the assumption of a human energy field and an environment filled with ‘life energy’ which is also present in all living organisms.
- Support for this view is based entirely on a field world view.
- Quantum theory states that all of reality is made up of energy fields and that over 99% of the universe is simply space.
- Our present technology does not allow the measurement of the human energy field, but to a trained sense, primarily touch, the human energy field can be perceived and assessed.4
Perhaps the people at USUHS were impressed by the diagram of the Conceptual Model of Study that accompanied the proposal. The diagram (reproduced on the next page) shows that burn injury causes “pain,” “stress,” and “risk of infection.” TT, on the other hand, leads to “activation of endogenous opioid system,” “reduced stress,” and “decreased T-suppresor (sic) lymphocytes,” which in turn lead to “pain relief” and “decreased risk of infection,” which together lead to “enhanced healing.”6 Of course, the existence of a human energy field as well as the benefits of TT are all hypothetical. Their efficacy is the purpose of the study, after all. Unfortunately, the continued assumption of the validity of the theoretical basis of TT is to be found throughout the proposal without any comment about this logical fallacy on the part of the proposal’s reviewers.
Among other criteria for selecting the subjects are the necessity of speaking English and the ability to communicate verbally. The subjects must also be able to see and hear. One might wonder if the patients need to be able to see and hear so that they will be aware when either TT or mimic TT is being administered. However, this requirement is putatively added in order to determine if the TT was effective and if the mimic TT was not effective. Why? Because the results are measured by asking the patients if they feel better!
The proposal says the following “instruments” will be used in this study to collect data relative to outcome variables:
- McGill Pain Questionnaire (which consists primarily of three major classes of word descriptors: sensory, affective and evaluative, and is used to specify the subjective pain experience);
- Visual Analogue Pain Estimation Scale (which is used by having the patient mark or indicate a point on a straight line that reflects the amount of sensation the patient is experiencing at the time);
- Visual Analogue Anxiety Estimation Scale (which is used by having the patient mark or indicate a point on a similar straight line that reflects the amount of anxiety the patient is experiencing);
- Credibility of Therapy Form (which is used after an explanation of TT to record the patient’s opinion as to how logical TT seems, how confident the patient is that TT will be successful, and if the patient would be willing to pay for TT as an optional part of hospital treatment).7
The names of patients who answer “yes” to that last question ought to be valuable information to somebody!
The grant proposal isn’t afraid to reveal the secrets of TT by describing how it works: “The TT practitioner will begin by centering” which “consists of a quieting and focusing of consciousness with the intent to help. Next, an assessment of the subject’s energy field will be done to search out all areas of imbalance, blocked energy flow, congestion, or deficit in energy flow. Then TT treatment will begin, starting at the subject’s crown and moving downward to the feet . . . through stimulation and augmentation, clearing of congestion or blocks in flow, or quieting the energy flow to achieve a balanced, abundant, symmetrical energy flow. The TT practitioner’s hands, held about four inches above the subject, will move in a rhythmical way directing energy from central areas of the subject’s energy field to peripheral ones or touching the subject lightly for short periods where additional energy is needed.”8 Contrast this precision methodology with TT’s exceedingly imprecise origin in Martha Rogers’s “. . . nursing theory . . . based entirely on a field world view . . .”9 which has far more in common with revealed wisdom than with a scientific hypothesis.
An ongoing assessment by the practitioner will indicate when the treatment is completed. At the conclusion of this process, the subject will be allowed to rest quietly for about 10 minutes. It is implied therefore that the subject needs this time of quiet rest at the end of TT treatment in order to recover from all the agitation caused by the practitioner’s waving hands.
On the other hand, the placebo intervention of the mimic TT administered to the control group will be completely different:
Mimic treatments will be provided to all control group subjects by the non-nurse research assistant, who does not know what Therapeutic Touch is. This research assistant will be trained to perform the same movements that will be used by the Therapeutic Touch practitioners. However, instead of centering and holding the intent to help the subject as the Therapeutic Touch practitioners will do, the research assistant will simply begin the treatment and will count back from 100 by serial sevens during the mimic treatment. To assure that the sessions are all comparable, three uninvolved lay persons will be asked to observe the research assistants and the Therapeutic Touch practitioners and identify which treatments are real. The research will not be started until observers cannot tell the real from the mimic treatments. Mimic treatments will be given in the patients’ rooms approximately one hour before the daily dressing change. As in the Therapeutic Touch treatment, the patients will lie on their backs on the hospital beds. Lighting will be dim, and soft, relaxing instrumental music will be playing. Prior to the first treatment, the subject will be instructed to relax as fully as possible and a brief explanation of what will be done during the treatment will be given. The research assistant may randomly spend between five and twenty minutes doing the mimic treatment. At the end of the mimic treatment, the subject will be allowed to rest quietly for about 10 minutes. Thus, with this single, blind placebo intervention, all subjects and unit personnel will perceive that subjects are receiving the same intervention. The identity of the mimic TT vs. TT intervention subjects will be known only to the researchers.10
The proposal attempts to address some “limitations” of its study: “A frequent criticism when TT administration is used as an intervention relates to the ‘placebo effect.’ However, administration of a mimic intervention to control subjects helps control for placebo effect.”11 In other words, a placebo treatment for a possible placebo treatment will take care of that problem!
In considering the success that the UAB Burn Center had in acquiring $355,225 to study TT, we ask whether public money is best spent on such highly speculative “alternative therapies.” What is the difference, after all, in TT and “remote healing” where practitioners will patients to get better from across the room, or perhaps, over the phone. (What about E-mail?)
Further, should questions not be asked about the ethics of trying a completely speculative technique on burn patients whose pain is most severe and intractable and whose infection rate is very high? First and most important, practitioners of TT must demonstrate some basis in reality for their theory. Then, and only then, can they move to the next step — proving its efficacy.
- Grant No. MDA 905-94-Z-0080. Uniformed Services University of the Health Sciences. Project Title: The Effect of Therapeutic Touch on Pain and Infection in Burn Patients (N94-020A1), p. 35. Awarded to: University of Alabama at Birmingham. Principal Investigator: Joan G. Turner. Award amount: $355,225. Period of Award: 9/15/94 through 9/30/95. (Due to the unwillingness of UAB to provide us a copy of this grant proposal, we obtained it through a Freedom of Information Act request.)
- Ibid., p. 40.
- Ibid., p. 42.
- Ibid., p. 45.
- Ibid., p. 47.
- Ibid., p. 49.
- Ibid., p. 40.
- Ibid., p. 52.
- Ibid., p. 52.
Grateful acknowledgement to Mary Folsom and Dan Culberson.