The following letter was written in the summer and fall of 2000 to the editor of the Annals of Internal Medicine in response to the “distant healing” review published in June 2000. A greatly truncated version was subsequently printed in the Annals (June 19, 2001). Although we have previously published an analysis of that review (Sci Rev Alt Med. 2000; 4(2): 12–16), it is useful to present other perspectives. —Eds.
To the Editor:
The “Distant Healing” article in the June 6 Annals1 is misleading. Its formal conclusion is couched in a seemingly conservative tone: “Given that approximately 57% of trials showed a positive treatment effect, the evidence thus far merits further study.” This is neither what the first author says in a more public forum, however, nor is even such a modest statement justified. This is from WebRN News:
“I tried to go into [this review] without any prejudgments of what we’d find,” says lead author John Astin, PhD, assistant professor in the complementary medicine program at the University of Maryland School of Medicine in Baltimore. “Given the rigor of the research and the fact that we reviewed 23 studies that, overall, came up with what appeared to be compelling positive effectiveness of these interventions, [I find] that somewhat of a surprising finding.” [italics added]2
That Dr Astin proceeded “without any prejudgments” is questionable, given his title. What about the “rigor of the research” and the conclusion itself?
The review contains several fatal flaws, some of which are mentioned by the authors but not understood to be as damning as they are. These include, but are not limited to:
- Overstating the rigor and conclusions of the studies in question. The well-known Byrd study on intercessory prayer, said to show a “significant treatment effect” by Astin and colleagues, is a case in point.3 The study refers to itself as “doubleblind” but also states, “pertinent updates in [the patients’] condition were given to the intercessors.” Well, which is it? Second, the multiple post hoc outcome events are presented as independent, although they obviously are not, thus giving the appearance of more “effect” than is really there. Indeed, all of the events that appeared to favor the prayer group—“congestive heart failure,” “cardiopulmonary arrest,” “diuretics,” “intubation/ventilation,” “pneumonia,” and “antibiotics”—are likely to be related. Finally, it is revealing to compare the instructions given to the intercessors with the outcomes: “. . . each intercessor was asked to pray daily for a rapid recovery and for prevention of complications and death. . . .” The study and control groups showed no difference in duration of CCU stay, duration of total hospitalization, or number of discharge medications (the preordained “study variables”), and no difference in mortality. The only reasonable conclusion, as other critics have pointed out,4–7 is that there was no real difference in outcome.
- The mixing of Therapeutic Touch (TT) study outcomes with “distant healing” methods such as to suggest that there is something to be said for the latter, although no real effect was found. TT is not “distant healing,” but “healing” in the presence of the subject. Apparent positive effects are thus not surprising, since the practitioner interacts with the patient.
- The inclusion of several “single-blinded” studies of TT. The authors’ citation of a study purporting to show that “blinded observers have been unable to differentiate actual noncontact TT from the mock or placebo version of this therapy” is irrelevant here; the crucial point, as the authors themselves mentioned but failed to heed, is that the practitioners may have given cues to the patients.
- The statement that a “fail-safe N” of 63 for TT makes the “file-drawer” effect less likely. The “fail-safe” number wouldn’t be nearly so large if only acceptable studies had been included (see objections 1 and 3).
- Various other methodologic problems pointed out by the authors themselves (see “methodologic issues”) but not appreciated by them to be as ruinous as they are to claims of “distant healing” and TT.
- The authors’ finding, even while overlooking these objections, that the combined positive treatment effect for “distant healing” and TT was still quite modest. All of this, and there is no delicate way put it, suggests nothing.
The point here, as always pertains to questionable claims based on fantastic theories, is that “extraordinary claims demand extraordinary evidence.”8,9 There either is or is not a human “energy field” that can be detected by TT practitioners but not by the most sensitive scientific instrument. If there is not, then any apparent effect of the technique must have a prosaic explanation, such as the placebo effect, a general sense of well-being due to attention paid by a concerned practitioner, or error—the very sort of phenomena that Astin and colleagues were trying to exclude. If the “energy field” exists, on the other hand, it would constitute a heretofore unknown force in the universe, the discovery of which would be comparable in import to that of electricity and magnetism (and utterly surprising, since there are no obvious clues to its existence). In the scientific world this would be huge, with equally huge implications for technological applications.
Basic principles alone make such a force vanishingly unlikely.* Even if that were not the case there would be plenty of room for doubt: all known manifestations of “energy,” from light to electricity to heat to gravity to earthquakes to venous pressure to uterine contractions and all the rest, are either obvious or, when subtle, can be more precisely detected (and measured) by the appropriate instrument than by a human observer. On the other hand, there is a rich tradition of wishful thinking in our species, with many more examples left in the dustbin of history than are in vogue during any particular epoch. Which is the more likely explanation here?
The typical TT practitioner, apparently naive to these physical and historical truths, may need very little “proof ” to feel good about her imagined powers. That is why the literature of TT, which numbers more than 800 papers,10 includes so few that fulfill even the insufficient requirements of Astin and his colleagues. Science, however, demands much more; acceptance of this extraordinary claim would require not only virtually flawless, widely replicated studies, but also an obvious, marked effect, with no room for reasonable doubt. The only good experimental evidence, as the authors must know, found that TT practitioners failed to detect the “energy field” when visual cues were absent.10
“Distant healing” and the studies purporting to demonstrate it are reminiscent of its close relative, psi, or parapsychological effect, which includes extrasensory perception. Some advocates even suggest that the “mechanism” of “distant healing” is not the intervention of a benevolent deity, but psychokinesis—the manipulation of physical objects from a distance by sheer dint of will.11 After over 100 years of claims made for psi’s existence, including several “positive” (but ultimately nonreplicated) studies that would almost certainly pass muster with Astin and colleagues,12 there is still no real evidence that it is anything other than a figment of true believers’ imaginations.13,14 Few serious psychologists or physicists give it any credence,15 nor has it been of the slightest practical use, such as in police investigations.16,17 Nevertheless, it persists as a pseudoscience supported by a fringe group of advocates, some of whom are players in the “distant healing” game—surely Astin and colleagues must know this. Does the medical literature really need to prolong this tiresome exercise simply because the current “alternative” medicine fad has been joined by a cadre of benighted or unscrupulous physicians and nurses?
In summary, the only reasonable conclusions supported by the studies reviewed by Astin and colleagues are: (a) there is no evidence for a therapeutic effect of intercessory prayer or “other” forms of “distant healing,” and (b) any apparent effect of Therapeutic Touch, though slight, is entirely explicable by ordinary means.
* Based on the statements of Martha Rogers, widely credited with the “discovery” of the “human energy field.” She wrote: “The field projects into the future as well as the past” and suggested that its force doesn’t diminish with distance, but also claimed that it is an electrical field. Since the “field” hasn’t been objectively measured or characterized, we must assume that such descriptions are those that are under consideration. For these and other examples of Rogers’s incoherent and contradictory theories, see Raskin J. Rogerian nursing theory: a humbug in the halls of higher learning. Skeptical Inquirer. 2000; 24(5): 30–35.
- Astin JA, Harkness E, Ernst E. The efficacy of “distant healing”: a systematic review of randomized trials. Ann Int Med. 2000; 132(11): 903–910.
- Essig MG. “Distant healing” methods: factual or fraudulent? Authors urge open-mindedness, further study. WebRN News, June 6, 2000. Quoted by Courcey K. Available at: http://groups.yahoo.com/group/skepticrn/. Accessed June 2000.
- Byrd RC. Positive therapeutic effects of intercessory prayer in a coronary care unit population. South Med J. 1988; 81(7): 826–829.
- Posner G. God in the CCU? Free Inquiry. 1990; 10(2): 44–45.
- Witmer J, Zimmerman M. Intercessory prayer as medical treatment? An inquiry. Skeptical Inquirer. 1991; 15(2): 177–180.
- Sloan RP, Bagiella E, Powell T. Religion, spirituality, and medicine. Lancet. 1999; 353: 664–667.
- Tessman I, Tessman J. Efficacy of prayer: a critical evaluation of claims. Skeptical Inquirer. 2000; 24(2): 31–33.
- Lett J. A field guide to critical thinking. Skeptical Inquirer. 1990; 14(2): 153–160.
- Grey W. Philosophy and the paranormal, part 1: the problem of “psi.” Skeptical Inquirer. 1994; 18(2): 142–149.
- Rosa L, Rosa E, Sarner L, Barrett S. A close look at Therapeutic Touch. JAMA. 1998; 279: 1005–1010.
- Dossey L. Reinventing Medicine: Beyond Mind-Body to a New Era of Healing. San Francisco, Calif: Harper San Francisco/Harper Collins; 1999.
- Bem DJ, Honorton C. Does psi exist? Replicable evidence for an anomalous process of information transfer. Psych Bull. 1994; 115: 4–18. Available at: http://www.psych.cornell.edu/dbem/does_psi_exist.html. Accessed August 2000.
- Lilienfield SO. New analyses raise doubts about replicability of ESP findings. Skeptical Inquirer. 1999; 23(6): 9–12. Available at: http://www.csicop.org/si/9911/lilienfeld.html. Accessed August 2000.
- Hyman R. The evidence for psychic functioning: claims versus reality. Skeptical Inquirer. 1996. Available at: http://www.csicop.org/si/9603/claims.html. Accessed August 2000.
- Marks DF. Investigating the paranormal. Nature. 1986; 320: 119–124.
- Sweat JA, Durm MW. Psychics: do police departments really use them? Skeptical Inquirer. 1993; 17(2): 148–158.
- Rowe WF. Psychic detectives: a critical examination. Skeptical Inquirer. 1993; 17(2): 159–165.