MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.
The aim of this paper was to synthesize the most recent evidence investigating the effectiveness and safety of therapeutic touch as a complementary therapy in clinical health applications.
A rapid evidence assessment (REA) approach was used to review recent TT research adopting PRISMA 2009 guidelines. CINAHL, PubMed, MEDLINE, Cochrane databases, Web of Science, PsychINFO and Google Scholar were screened between January 2009–March 2020 for studies exploring TT therapies as an intervention. The main outcome measures were for pain, anxiety, sleep, nausea and functional improvement.
Twenty‐one studies covering a range of clinical issues were identified, including 15 randomized trials, four quasi‐experimental studies, one chart review study, and one mixed-methods study including 1,302 patients. Eighteen of the studies reported positive outcomes. Only four exhibited a low risk of bias. All others had serious methodological flaws, bias issues, were statistically underpowered, and scored as low‐quality studies. No high‐quality evidence was found for any of the benefits claimed.

 The authors offer the following conclusions:

After 45 years of study, scientific evidence of the value of TT as a complementary intervention in the management of any condition still remains immature and inconclusive:

  • Given the mixed result, lack of replication, overall research quality, and significant issues of bias identified, there currently exists no good-quality evidence that supports the implementation of TT as an evidence‐based clinical intervention in any context.
  • Research over the past decade exhibits the same issues as earlier work, with highly diverse poor quality unreplicated studies mainly published in alternative health media.
  • As the nature of human biofield energy remains undemonstrated, and that no quality scientific work has established any clinically significant effect, more plausible explanations of the reported benefits are from wishful thinking and use of an elaborate theatrical placebo.

These are clear and much-needed words addressed at nurses (the paper was published in a nursing journal). Nurses have been oddly fond of TT. Therefore, it seems important to send evidence-based information in their direction. In my recent book, I arrived at similar conclusions about TT:

  1. The assumptions that form the basis for TT are not biologically plausible.
  2. Several trials and reviews of TT have emerged. However, many of them are by ardent proponents of TT, seriously flawed, and thus less than reliable. e.g.[1],[2]
  3. One rigorous pre-clinical study, co-designed by a 9-year-old girl, found that experienced TT practitioners were unable to detect the investigator’s “energy field.” Their failure to substantiate TT’s most fundamental claim is unrefuted evidence that the claims of TT are groundless and that further professional use is unjustified. [3]
  4. There are no reasons to assume that TT causes direct harm. One could, however, argue that, like all forms of paranormal healing, it undermines rational thinking.

[1] https://www.ncbi.nlm.nih.gov/pubmed/19299529

[2] https://www.ncbi.nlm.nih.gov/pubmed/27194823

[3] https://www.ncbi.nlm.nih.gov/pubmed/?term=rosa+e%2C+therapeutic+touch%2C+jama

8 Responses to Therapeutic Touch: a theatrical placebo based on wishful thinking

  • Indeed, a good example of how a mass of poor-quality research can be used to justify a practice. This illustrates why educating health professionals to be able to critically appraise evidence effectively is essential. Overall in practical terms there is little to differentiate TT from witchcraft.

  • The best explanation I’ve found for why TT can seem so real is in the 2008 book by Sandra and Matthew Blakeslee, The Body Has a Mind of Its Own, chapter 7, “The Bubble Around the Body”. Perhaps if skeptics would more often present sympathetic alternative explanations like this, their criticisms would provoke less resistance in those who have had positive experiences with TT and find reductions of their experiences to “wishful thinking” and “theatrical placebo” insulting or at least unconvincing.

    • you seem to ignore that
      1) the term ‘theatrical placebo’ was used by the original authors of the paper;
      2) it does provide a plausible explanation for the experiences you refer to.

    • If you read the paper you will find why those ideas are untenable and have not been demonstrated. Its not an issue of skepticism, but simply of bad science, pseudoscience and deceptive practice. Being charged $150/hr for faith-healing that claims to do things it does not is unethical.

  • Just to be clear, I have no qualms with interpreting TT as theatrical placebo and wishful thinking. But I believe TT practitioners and patients could use some help understanding how their experiences can seem so real when there’s no plausible objective phenomenon. The science of body maps described in the book/chapter I mentioned is a compelling and detailed alternative explanation of such experiences, which has already helped persuade at least one former practitioner of alt-med bodywork/healing, Karla McLaren, who has written insightfully about bridging the cultural divide between skepticism and the world of CAM.

    • The problem with that is that remains a theoretical notion, and there are many other explanations of how the placebo and nocebo effects work (which I and Prof. Ernst have covered in our work). The best approach to demonstrating that a theory is sound is to undertake basic scientific studies to validate it. Otherwise is remains a theory and not a sound basis for advising patients or delivering health care.

      Additionally, none of the better quality studies in this review found that TT worked any different from the control, so there is actually no good evidence TT is beneficial. We all know testimonials are not a good source of evidence. Also, TT practitioners have been found guilty of misleading advertising on at least one occasion, and overall it is a practice that involves a high-risk of deception. If you would like another (and evidence-based) view of how deception in health care works, you could try my new book which covers the reasons why people engage with CAM (https://books.google.ca/books/about/The_New_Alchemists.html?id=0-MHzgEACAAJ&source=kp_book_description&redir_esc=y ) and Prof. Ernst has several excellent texts that address this subject.

      Lastly, for years I have openly invited TT practitioners to engage with us here at the University of British Columbia, as I have graduate students who would be happy to run well-designed experiments to test the claims these practitioners make of being able to detect and manipulate HEFs in fair-tests. None have agreed to do so, and used the argument “it only works if you believe in it,” which is of course, deceptive nonsense of the highest order.

      Overall, as we note in the paper, Given the mixed result, lack of replication, overall research quality, and significant issues of bias identified, there currently exists no good-quality evidence that supports the implementation of TT as an evidence‐based clinical intervention in any context. It is in effect another form of faith-healing.

      • Thank you Bernie, points well taken, and on more fully reading the original paper I find your approach more diplomatic and comprehensive than it had seemed from the excerpt. Among other things, I find the concept of faith healing or faith-based practice helpful for explaining the orientation of many TT practitioners, including their resistance to science and their tendency to (self-)deception.

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