Elaine Harkness

The Efficacy of “Distant Healing”: A Systematic Review of Randomized Trials

The widespread use of complementary and alternative medicine (CAM), commonly defined as therapies that are neither taught widely in U.S. medical schools nor generally available in U.S. hospitals (1), is now well documented. Results of several national surveys in the United States and elsewhere suggest that up to 40% of the adult population has in the preceding year used some form of CAM to treat health-related problems (1-5). In part because of the increasing use of CAM by the public, there has been a greater sense of urgency and motivation on the part of the scientific community to study the safety and efficacy of these therapies. A belief in the role of mental and spiritual factors in health is an important predictor of CAM use (2). In a recent study of CAM in the United States (1), 7% of persons surveyed reported having tried some form of spiritual healing. This was the fifth most frequently used treatment among all CAM therapies assessed. In the same study, 35% of persons surveyed reported that they had used prayer to address their health-related problems. A national survey conducted in the United States in 1996 found that 82% of Americans believed in the healing power of prayer and 64% felt that physicians should pray with patients who request it (6). Although not without its critics (7), a growing body of evidence suggests an association between religious involvement and spirituality and positive health outcomes (8-11). Spiritual healing is a broad classification of approaches involving the intentional influence of one or more persons upon another living system without utilizing known physical means of intervention (12). Following the example of Sicher and colleagues (13), we use the term distant healing in our review. Although it does not necessarily imply any particular belief in or referral to a deity or higher power, distant (or distance) healing encompasses spiritual healing, prayer, and their various derivatives and has been defined as a conscious, dedicated act of mentation attempting to benefit another persons physical or emotional well being at a distance (13). As we define it here, distant healing includes strategies that purport to heal through some exchange or channeling of supraphysical energy. Such approaches include Therapeutic Touch, Reiki healing, and external qigong. Although they do not necessitate actual physical contact, these healing techniques usually involve close physical proximity between practitioner and patient. Distant healing also includes approaches commonly referred to as prayer. Prayer, whether directed toward health-related matters or other areas of life, includes several variants: intercessory prayer (asking God, the universe, or some higher power to intervene on behalf of an individual or patient); supplication, in which one asks for a particular outcome; and nondirected prayer, in which one does not request any specific outcome (for example, Thy will be done ). All forms of distant healing are highly controversial. Despite several positive reviews examining the research on these techniques (12-14), there continue to be conflicting claims in the literature regarding their clinical efficacy (7, 15, 16). In the absence of any plausible mechanism, skeptics are convinced that the benefits being reported are due to placebo effects at best or fraud at worst. Notwithstanding this ongoing controversy, distant healing techniques are increasing in popularity. For example, in the United Kingdom today, there are more distant healers (about 14 000) than there are therapists from any other branch of CAM. This level of popularity makes examination of the available evidence relevant. The objective of our systematic review was to summarize all available randomized clinical trials testing the efficacy of all forms of distant healing as a treatment for any medical condition. Methods A comprehensive literature search was conducted to identify studies of distant healing (spiritual healing, mental healing, faith healing, prayer, Therapeutic Touch, Reiki, distant healing, psychic healing, and external qigong). The MEDLINE, PsychLIT, EMBASE, CISCOM, and Cochrane Library databases were searched from their inception to the end of 1999. The search terms used were the above-named forms of treatment plus clinical trials, controlled clinical trials, and randomized, controlled trials. In addition, we contacted leading researchers in the fields of distant and spiritual healing to further identify studies. We also searched our own files and the reference sections of articles on distant healing that we identified. Numerous studies have been carried out in these areasfor example, in a review of spiritual healing, Benor (12) identified 130 controlled investigations, and Rosa and colleagues [15] identified 74 quantitative studies of Therapeutic Touch. However, we included only studies that met the following criteria: 1) random assignment of study participants; 2) placebo, sham, or otherwise patient-blindable or adequate control interventions; 3) publication in peer-reviewed journals [excluding published abstracts, theses, and unpublished articles]; 4) clinical [rather than experimental] investigations; and 5) study of humans with any medical condition. We did not apply restrictions on the language of publication. The methodologic quality of studies was assessed by using the criteria outlined by Jadad and colleagues (17). In addition, we examined the extent to which studies were adequately powered, randomization was successful (that is, it resulted in homogenous study groups), baseline differences were statistically controlled for, and patients were lost to follow-up. Other predefined assessment criteria were study design, sample size, type of intervention, type of control, direction of effect (supporting or refuting the hypothesis), and type of result. Extracted data were entered into a custom-made spreadsheet. Differences between two independent assessors were settled by consensus. A meta-analytic approach was considered but was abandoned when the heterogeneity of the trials became apparent. Nevertheless, effect sizes averaged across each category of distant healing were included in an effort to provide some quantitative measure of the magnitude of clinical effects. Effect sizes were calculated by using Cohens d (18), weighted for sample size. The Hedges correction was applied to all effect sizes [19]. In studies that reported multiple outcomes, a single outcome was chosen to calculate effect size if 1) a significant change after treatment was shown for that outcome or 2) that outcome was the primary outcome measure in studies that found several or no significant treatment effects. In the few cases in which the authors did not provide sufficient information with which to calculate Cohens d, the study was not included in the overall effect size. The funding sources were not involved in the design of the study and had no role in the collection, analysis, or interpretation of the data or in the decision to submit the manuscript for publication. Data Synthesis Using our search methods, we found more than 100 clinical trials of distant healing. The principal reasons for excluding trials from our review were lack of randomization, no adequate placebo condition, use of nonhuman experimental subjects or nonclinical populations, and not being published in peer-reviewed journals. Twenty-three studies met our inclusion criteria (13, 20-41). These trials included 2774 patients, of whom 1295 received the experimental interventions being tested. Methodologic details and results of these trials are summarized in Tables 1, 2, and 3. The studies are categorized as three types: prayer, Therapeutic Touch, and other distant healing. However, these classifications are not mutually exclusive. For example, the study of distant healing by Sicher and colleagues (13) included 40 healers, some of whom would describe what they did as prayer, and the study by Miller (22) described the intervention as both prayer and remote mental healing. Table 1. Randomized, Placebo-Controlled Trials of Prayer Table 2. Randomized, Placebo-Controlled Trials of Therapeutic Touch Table 3. Randomized, Placebo-Controlled Trials of Other Distant Healing Methods Prayer Of studies that met our inclusion criteria, five specifically examined prayer as the distant healing intervention (Table 1). In all five studies, the intervention involved some version of intercessory prayer, in which a group of persons was instructed to pray for the patients (there was no way to control for whether patients prayed for themselves during the study). Qualifications for being an intercessor varied from study to study. For example, in the trial by Byrd (23), intercessors were required to have an active Christian life, daily devotional prayer, and active Christian fellowship with a local church. In the study by Harris and colleagues (39), those praying were not required to have any particular denominational affiliation, but they needed to agree with the statement I believe in God. I believe that He is personal and is concerned with individual lives. I further believe that He is responsive to prayers for healing made on behalf of the sick. In each of these studies, the intercessors did not have any physical or face-to-face contact with the persons for whom they were praying. Instructions on how the intercessors should pray were fairly open-ended in most instances. For example, in the trial by Harris and colleagues (39), intercessors were asked to pray for a speedy recovery with no complications and anything else that seemed appropriate to them (39). Two trials showed a significant treatment effect on at least one outcome in patients being prayed for (23, 39), and three showed no effect (20, 21, 24) (Table 1). The average effect size, computed for four of these studies, was 0.25 (P =0.009). Therapeutic Touch Eleven trials examined the healing technique known as noncontact Ther

Spinal Manipulation: A Systematic Review of Sham-Controlled, Double-Blind, Randomized Clinical Trials

For many years, spinal manipulation has been a popular form of treatment. Yet the debate about its clinical efficacy continues. The research question remains: Does spinal manipulation convey more than a placebo effect? To summarize the evidence from sham-controlled clinical trials of spinal manipulation as a treatment of various conditions, and to assess the methodological quality of these studies, a comprehensive search strategy was designed to locate all sham-controlled, double-blind, randomized trials of spinal manipulation as a treatment of any medical condition. Data were extracted from these trials and validated by two independent reviewers in a standardized fashion. All trials were critically analyzed and their methodological quality evaluated. Eight studies fulfilled the pre-defined inclusion/exclusion criteria. Three trials (two on back pain and one on enuresis) were judged to be burdened with serious methodological flaws. The results of the three most rigorous studies (two on asthma and one on primary dysmenorrhea) do not suggest that spinal manipulation leads to therapeutic responses which differ from an inactive sham-treatment. This analysis demonstrates that sham-controlled trials of spinal manipulation are sparse but feasible. The most rigorous of these studies suggest that spinal manipulation is not associated with clinically-relevant specific therapeutic effects.

Spiritual healing as a therapy for chronic pain : a randomized, clinical trial

&NA; Spiritual healing is a popular complementary and alternative therapy; in the UK almost 13 000 members are registered in nine separate healing organisations. The present randomized clinical trial was designed to investigate the efficacy of healing in the treatment of chronic pain. One hundred and twenty patients suffering from chronic pain, predominantly of neuropathic and nociceptive origin resistant to conventional treatments, were recruited from a Pain Management Clinic. The trial had two parts: face‐to‐face healing or simulated face‐to‐face healing for 30 min per week for 8 weeks (part I); and distant healing or no healing for 30 min per week for 8 weeks (part II). The McGill Pain Questionnaire was pre‐defined as the primary outcome measure, and sample size was calculated to detect a difference of 8 units on the total pain rating index of this instrument after 8 weeks of healing. VASs for pain, SF36, HAD scale, MYMOP and patient subjective experiences at week 8 were employed as secondary outcome measures. Data from all patients who reached the pre‐defined mid‐point of 4 weeks (50 subjects in part I and 55 subjects in part II) were included in the analysis. Two baseline measurements of outcome measures were made, 3 weeks apart, and no significant differences were observed between them. After eight sessions there were significant decreases from baseline in McGill Pain Questionnaire total pain rating index score for both groups in part I and for the control group in part II. However, there were no statistically significant differences between healing and control groups in either part. In part I the primary outcome measure decreased from 32.8 (95% CI 28.5–37.0) to 23.3 (16.8–29.7) in the healing group and from 33.1 (27.2–38.9) to 26.1 (19.3–32.9) in the simulated healing group. In part II it changed from 29.6 (24.8–34.4) to 24.0 (18.7–29.4) in the distant healing group and from 31.0 (25.8–36.2) to 21.0 (15.7–26.2) in the no healing group. Subjects in healing groups in both parts I and II reported significantly more ‘unusual experiences’ during the sessions, but the clinical relevance of this is unclear. It was concluded that a specific effect of face‐to‐face or distant healing on chronic pain could not be demonstrated over eight treatment sessions in these patients.

Spirituele healing als therapie voor chronische pijn: een willekeurige, klinische test

Spiritual healing as a therapy for chronic pain: a randomized, clinical trial [Pain 2001;91:79-89]

Spiritual healing as a therapy for chronic pain: a randomized, clinical trial (Abbot et al., PAIN 2001;91:79–89)

know, because the study was not powered to detect an effect of that magnitude. However, in patients with chronic pain even small effects are sizeable and worth the effort. The authors have not shown a specific effect of the size anticipated. But it was unreasonable in the first place, we contend, to anticipate a specific effect of d 1⁄4 0:8. They have shown strong non-specific effects, and we hold that also these are therapeutically valuable with chronic pain patients. And they have found a small but rather interesting specific effect. Alas, the study was not powered to detect it. The question is still open, whether spiritual healing has a specific effect. What is increasingly emerging is the fact that the non-specific effects are sizeable. We are wondering whether it is not time for the scientific community to pose the question, how these non-specific effects are produced and how they can be harnessed for effective treatment. Healing seems to be one method to do this.