Nursing irrationality

Of all the offers of help pouring in for victims of the World Trade Center explosion last month, the one from the Nurse Healers professional association was surely the strangest.

The organisation, based in Salt Lake City, Utah, promotes a healing technique known as therapeutic touch (TT). The way it works, according to the organisation, is through an ‘energy exchange’ that takes place when the TT practitioner passes her hands over the patient’s body without ever actually touching the patient.

However, the organisation’s website (1) now suggests that the dubious no-touch therapy can be performed long-distance on people who died at the World Trade Center. The week after the New York City tragedy, the website posted this advice to its members from Dolores Krieger, a former New York University professor of nursing and founder of the TT technique within the nursing profession:

‘I suggest the following.…I am doing healing at a distance, which I do by visualising myself at [a dead victim’s] side and see/feel/think of myself doing therapeutic touch to that person. In this I am calling upon the help of the angels of compassion.…My first thought is to help the person through the terror of dying so suddenly and so horribly….I project that wondrous blue that is connected with the Mother of the World in all belief systems….’

If this were simply one of many independently operating New Age cults, it would be of little interest to the general public. But TT has been endorsed at the highest levels of the nursing profession. The National League for Nursing, the agency that accredits nursing schools in the USA, has promoted the technique through books and videos. The technique is used by nurses in scores of hospitals in the USA and Canada. Proponents have claimed that at least 43,000 healthcare professionals have been trained in the technique (2).

The North American Nursing Diagnosis Association calls TT the only appropriate treatment for a diagnosis it dubs ‘energy-field disturbance’. There is no scientific evidence that such an energy-field exists, and experts consider it implausible. The technique was publicly discredited in 1998, when the Journal of the American Medical Association published a study showing that TT healers did no better than random chance when asked to ‘sense an energy field’ in another person (3). No well-designed study before or since has demonstrated any health benefit from TT.

Yet TT continues to be practised in hospitals and taught in nursing schools, and PhD nurses continue to defend the method in nursing journals (4). If there has been any backing off, it seems to be in the claims for what TT can heal. Only a few years ago, adherents were claiming it could heal broken bones, arthritis and wounds and even boost the immune system (5). The ‘official’ website now claims only ‘reduction of pain and anxiety’ and ‘promotion of relaxation’.

What’s the harm?

Proponents have sometimes argued that even if TT hasn’t been proven to heal any better than a placebo, at least it won’t do any harm. One proponent has argued that nurses should go ahead and use TT anyway because the placebo effect is so powerful (6).

Nurse critics say this would be an unethical use of their position. ‘Doing TT automatically entails telling the client a lie’, Kevin Courcey, a registered nurse at Humboldt County Mental Health in Eureka, California, said in an email. ‘There is absolutely no evidence that such a thing exists, that it is subject to manipulation or that this individual practitioner has such a skill. This is not nursing. It is medical fraud and malpractice.’

Moreover, a recent review of clinical trials suggests the placebo effect is not as powerful a clinical tool as has long been supposed. A placebo was no more effective than ‘no treatment’ in most clinical studies, suggesting that many patients just get better naturally as the course of their disease improves (7).

For some patients the practice of such voodoo methods can be both physically harmful, because they are getting it in place of standard medical treatment, and emotionally distressing. Colorado registered nurse Linda A Rosa, a leading critic of TT, describes one malpractice case settled out of court.

A patient who entered the hospital for a liver biopsy complained of severe pain. Instead of calling a doctor, the nurse’s response was to call a practitioner of ‘healing touch’, a variation of TT. When the patient saw the practitioner waving her hands above him, he thought he was dying and was receiving the Last Rites. Three days later the patient returned to the hospital with an infected bladder, which had to be surgically removed.

Irrational fads invading nursing

As holistic techniques adopted by nurses go, TT is being joined and possibly overtaken by other New Age fads, including aromatherapy, Reiki and herbalism, a multimillion dollar, unregulated business in the USA. ‘It’s a sham’, says nurse practitioner Linda Pearson, talking about the current marketing of herbal supplements for every imaginable ailment.

Pearson is editor-in-chief of the Nurse Practitioner Journal, the premier journal for nurse practitioners in the USA. Nurse practitioners are registered nurses who have at least two years of graduate-level education in nursing. Because the US government does not regulate herbal medicines, the herbal industry can freely market its products with outlandish, unsubstantiated claims, Pearson points out. It is impossible to know the real contents of any bottle, because the ingredients do not have to be listed or tested. Few scientific studies have been conducted on the safety of most herbal medicines on the market. As for what dose would be safe, that is also unregulated and often unknown, even though some supplements can be quite dangerous.

Yet, according to Pearson, almost every nursing conference – as well as physician conferences – these days includes a seminar on herbal medicine. ‘The universities that offer these conferences know there’s money to be made because everybody’s taking herbal supplements. You’ve got nurse practitioners saying, “I’ve got a large percentage of my patients taking this stuff. I have to know about it”.’

She adds, ‘It’s a snake oil era. The public’s scientific sophistication is being eroded by the false advertising of the herbal and diet supplement industry that is making billions [of dollars] off gullible consumers. While some nurse practitioners and physicians endorse the taking of herbs for treatment, most attend the conferences to help them understand what their patients are taking’.

In spring 2001, respected Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, offered a nine-week course on ‘The Art and Science of Herbalism’ for continuing education credit to nurses. The course was taught by Rosemary Gladstar, author of the popular book Herbal Healing for Women. The book proudly pronounces that ‘Alchemy and magic are integral parts of herbalism and healing’.

Gladstar’s book encourages the use of herbs like comfrey, and dismisses health concerns that comfrey has compounds known to be toxic to the liver and carcinogenic. A small number of case reports have documented liver toxicity after people ingested these herbs. Because of these health concerns, the US Food and Drug Administration has urged firms to remove any product containing comfrey from the market and to alert their customers to stop using the product immediately.

Rosemary Jacobs is a resident of the Dartmouth area who was disfigured by argyria – a permanently grey skin discoloration – as a result of taking silver, which is now sold as a ‘dietary supplement’ in the United States. Jacobs was given nose drops containing silver as a child. She was shocked to learn that Dartmouth was training nurses in Gladstar’s technique. ‘It is without a bit of exaggeration that I say that I’m horrified at the thought of myself or a loved one being incapacitated and alone at night in a hospital under the care of one of the many nurses in my area who believes in magic medicine-the kind Gladstar practices’, or that is practised by local nurses who believe in aromatherapy, Jacobs said in an email.

A small but growing number of nurses are practising Reiki, a Japanese practice in which the practitioner ‘channels’ energy to various parts of a patient’s body in need of healing. One website promoting Reiki claims it can heal any mental or physical disease. The practitioner does not even have to be in the same location as the recipient for it to work, according to the site, because ‘the healing energies are not bound by space and time’ (8).

‘I’ve read half a dozen case reports from hospitals saying patients love Reiki and it works wonders. And so the hospitals are offering it’, says Donal P O’Mathuna, a professor of biochemistry and ethics at Mount Carmel College of Nursing in Columbus, Ohio and a critic of New Age fads. ‘I see Reiki as going the next step towards spiritual practices, compared to TT, which was more covert about its spiritual side’, O’Mathuna says. ‘I think it needs to be made clear to a patient if you’re moving out of the realm of the physical and into the spiritual.’

Sarah Glazer is a journalist in Larchmont, New York, who writes on health and social policy issues. Her articles on therapeutic touch and nursing have appeared in The Public Interest, The Washington Post Health Section, and in the book Research in Science and Technology Studies: Gender and Work (From the series Knowledge and Society, Vol 12, JAI Press, 2000).

Read on:

Put alternative medicine back in its box, by Dr Michael Fitzpatrick

Touching a nerve, by Sarah Glazer

The rise and rise of CAM, by Bríd Hehir

Watered-down science, by Howard Fienberg

Head cases, by Bríd Hehir

(1) Nurse Healers – Professional Associates International

(2) A Close Look at Therapeutic Touch, Rosa L, Rosa E, Sarner L, Barrett S, JAMA 279:1005-1010, 1998

(3) A Close Look at Therapeutic Touch, Rosa L, Rosa E, Sarner L, Barrett S, JAMA 279:1005-1010, 1998

(4) Postmodern Nursing, Glazer, Sarah, The Public Interest, Summer 2000, p3-35

(5) The Mystery of Therapeutic Touch, Glazer, Sarah, Washington Post health section, 19 December 1995

(6) ‘Therapeutic touch and postmodernism in nursing’, Glazer, Sarah, in Research in Science and Technology Studies: Gender and Work (from the series Knowledge and Society, Vol 12, JAI press, 2000)

(7) Is the Placebo Powerless? An Analysis of Clinical Trials Comparing Placebo with No Treatment, Hrobjartsson A, Gotzche PC, New England Journal of Medicine, May 24, 2001, vol 344 (21), p1594-602

(8) See a Reiki Treatments website