A study out of Iran titled “Therapeutic touch for nausea in breast cancer patients receiving chemotherapy: Composing a treatment” was recently published in the journal Complementary Therapies in Clinical Practice. It is a great example of the Tooth Fairy science that permeates much of the research in complementary and alternative medicine. In Tooth Fairy science, researchers attempt to study a phenomenon without first determining whether it exists.
What is therapeutic touch?
Therapeutic touch (TT) is a type of energy medicine; practitioners claim to be able to:
- sense a patient’s “human energy field” with their hands,
- manipulate the energy field by moving their hands near (but not touching) a patient’s skin surface, and
- thereby improve the patient’s health.
TT was the delusional invention of a nurse and a theosophist, and it has no scientific basis. Scientists can detect and measure minute energies down to the subatomic level, but they have never detected a “human energy field.” And when TT practitioners were tested on their ability to detect such a field, they failed miserably.
“Therapeutic touch is pure vitalism, the belief in a soul or animating force,” writes Paul Ingraham, “exactly like the Force in Star Wars, and just as fanciful. Auras and life energy do not exist and cannot be felt, let alone manipulated therapeutically.”
Despite the combination of extreme implausibility and a total lack of evidence, TT is taught to nurses in many otherwise reputable institutions, and there are more than 90,000 practitioners worldwide. There is even a Therapeutic Touch International Association that claims TT is evidence-based. It is not.
TT practitioners believe they are helping patients. That belief is reinforced by seeing patients improve due to the natural course of illness, suggestion, and the “placebo” or nonspecific contextual effects of the provider/patient encounter. They allow confirmation bias to overcome scientific reality, and they do poorly-conceived research seeking further confirmation. Since the studies are designed to show that TT works rather than to ask if it works, they find evidence that is convincing to believers but not to the scientific community as a whole.
Study of TT for chemotherapy-induced nausea
Assumptions. The authors start with several questionable assumptions:
- Humans are complex systems of patterned energy in continual process with the energy of their environments.
- A person’s energy is a vital life force that permeates the individual and interpenetrates the energy of the universe.
- In illness, there are imbalances in the patient’s energy field.
- TT practitioners modulate the energy field through hand movements and mental imaging.
- Nausea and vomiting are due to the disruption in energy balance in one of the body orbits.
Methods. They studied 108 breast cancer patients undergoing chemotherapy. All patients were on the same chemotherapy regimen (Cyclophosphamide and Epirubicin) and the same antiemetic drugs (Dexametasone, Plasil, Kitril and Emend). They were randomly divided into three groups of 36 patients each. The test group got a standardized TT intervention “touching of first energy layer” (described in detail in Box 1 in the paper), the placebo group got the exact same intervention except that “the practitioner’s hands-to-patient’s body distance was different (more than 20 cm.) and in fact there was no energy transfer.” The control group got no intervention. A single practitioner performed all the treatments.
Findings. They report that the duration, frequency and intensity of nausea were significantly lower in the test group. They provide data for the mean duration of nausea in hours: Experiment 5.36, Placebo 10.81, and Control 10.01. They provide data on the frequency of nausea: Experiment 50.29, Placebo 31.44, Control 81.76. It’s interesting that nausea was less frequent with the placebo TT than with the “real” TT; they don’t comment on that. Although their abstract says the intensity of nausea was also significantly lower in the test group, they don’t provide any data for that. They mention that in 69.4% of women there was a need for re-intervention after reassessment phase, so if there was an effect it didn’t last very long.
Discussion. They comment on what they see as the strengths and weaknesses of their study. They mention a variety of other uses for TT: stress, anxiety, pain, positive effects on the cardiovascular and immune systems, wound healing, broken bones, joint mobility in arthritis, etc. They say their results can be extrapolated to the treatment of nausea in other diseases. They throw in some irrelevant comments about the alleged effectiveness of acupressure and foot massage in treating chemotherapy-induced nausea.
Their conclusions. Unsurprisingly, they believe their study establishes the efficacy of TT for treating nausea and vomiting. They recommend TT technique be taught as one of the main courses (!) in nursing schools and suggest that their research processes should be used to design education programs and standards of practice for TT practitioners.
Problems with this study
Since there is no evidence that the alleged energy field exists, there can be no evidence that a distance of greater or less than 20 cm makes a difference. Their claim that “in fact there was no energy transfer” in the placebo group is undoubtedly true, but it is presumably just as true in the TT group. The alleged energy can’t be measured, so they can’t show any evidence that there was energy transfer with TT; they can only imagine it. Since there was a single practitioner, one wonders whether she might have inadvertently given the patients some signal that the placebo intervention was not the standard one. One wonders about the patients’ beliefs and whether they could tell whether they were in the TT or the placebo group.
In studies like this, doing anything always works better than doing nothing, so of course the no-treatment control group did not fare as well. A competent peer reviewer should have insisted the authors present data for their claim about the intensity of nausea, and should have questioned a number of other things. A rigorously science-based editor would not have published it. There are many things that can go wrong in clinical research to lead to incorrect conclusions; we know that half of all studies are wrong, and we can assume that Tooth Fairy studies on nonexistent phenomena are even more likely to be wrong.
The skeptical conclusion about this therapeutic touch study
Nausea has always been a problem with chemotherapy. The anti-emetic medications in current use have proven very helpful, but they are costly and have side effects. It would be great if alternative treatments like TT or acupressure or foot massage could reduce or eliminate the need for medications. But there’s no credible evidence that they can. Some might argue for using them as placebos, but medical ethicists universally condemn that practice.
Therapeutic touch is a fantasy. Even doing well-designed clinical studies of it would be silly. The results of a poor quality trial like this can be disregarded as meaningless. The only useful study of TT would be to investigate the psychology of how the practitioners are able to fool themselves and their patients.
This article was originally published in the Science-Based Medicine Blog.