218 Barrett, Implausible research: How much is enough?
Editorial
Wien Klin Wochenschr (2003) 115/7–8: 218–219
© Springer-Verlag 2003
Implausible research: How much is enough?
“Distant healing” encompasses prayer, therapeutic
touch, and other methods whose practitioners claim to
heal through what amounts to wishful thinking. Although
no relevant healing forces have been objectively mea-
sured, researchers have looked for clinical effects that
would imply that such forces exist.
About three years ago, Ernst and colleagues conclud-
ed that methodological limitations made it difficult to
draw definitive conclusions about whether 23 randomized
trials of distant healing showed a statistically significant
treatment effect [1]. In this issue of Wiener klinische
Wochenschrift, Dr. Ernst notes that one of the studies may
have been rated too highly and that subsequent studies
have “decisively weakened” the evidence that distant heal-
ing is associated with specific effects [2]. He then con-
cludes that “the question of whether distant healing is
more than a placebo is unanswered” and expresses hope
that a large ongoing trial will “clarify the issue”. I don’t
share his hope. In fact, there are many reasons why further
research into “distant healing” is pointless:
1. No scientifically plausible mechanism has been pos-
tulated. Proponents would like us to believe that they
can manipulate a nonmaterial form of energy that can
travel through air but cannot be detected by current
scientific instrumentation.
2. Any force involved in distant healing would probably
be related to the force postulated for psychokinesis.
No measurable force or effect of this type has been
found despite many decades of research.
3. Extraordinary claims require extraordinary proof. So
far, there is not even a suggestion of proof, since
nearly all positive or suggestive studies are faulty or
erroneous [3–5].
4. Therapeutic touch, which allegedly involves manipu-
lating an “energy field” that practitioners claim to
feel, has been decisively debunked by a simple study
showing that practitioners cannot even locate the pa-
tient’s body without visual contact [5].
5. Research does not take place in a vacuum. The avail-
able resources are finite. Doing more studies in one
area means doing fewer studies in others. Simple
logic suggests that the most plausible and potentially
beneficial methods should receive priority.
6. Research into distant healing has little or no practical
value because very few people are likely to accept
results that contradict what they already believe.
7. Prayer may help some people feel reassured when
they are worried. But, for most people, it makes more
sense to spend one’s time and energy on more con-
wiener klinische
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structive health-promoting activities. Although luck is
still a significant factor, it is more sensible to believe
that health is more likely to be influenced by prudent
living than by magical thinking.
8. When a faith-based treatment fails, some people
blame themselves and get depressed. Thus it should
not be assumed that supernatural approaches are
harmless.
In addition to these, researcher bias makes evaluating
studies of pseudoscientific methods much trickier than it
might appear. Ernst mentions that that his previous review
may have been overly optimistic because one of the “pos-
itive” studies may have involved “data dredging”. This
study concerned 40 patients with advanced AIDS who
were randomly selected for either “distant healing” or a
control group. The “healers”, many of whom were located
thousands of miles away, performed various prayer-based
ministrations after receiving photographs of the patients.
After six months, the researchers concluded that the sub-
jects who were not prayed for had spent 6 times as many
days in the hospital and contracted 3 times as many AIDS-
related illnesses [6].
The study was designed to measure death rates. When
the data showed no difference between the prayer and
control groups, the researchers conducted a chart review
that was not properly blinded, looked for other differenc-
es, and reported that several were statistically significant.
Such analysis is improper because when many endpoints
are examined, the odds of finding a few that appear signif-
icant are much higher than the odds of a single endpoint
selected in advance proving significant. The impropriety
was discovered – somewhat by chance – by an investiga-
tive reporter assigned to write a biography of the lead
researcher, Elizabeth Targ, M.D., who had succumbed to a
brain tumor despite widespread efforts to pray for her. The
reporter recognized the situation as an example of the
“sharpshooter’s fallacy” – spraying bullets randomly, then
drawing a target circle around a cluster and calling it
significant [7]. Pre-publication review rarely can detect
fraud due to researcher bias.
Dr. Ernst, for whom I have great respect, deserves
credit for acknowledging that his previous review may
have been overly optimistic. But I believe that the Targ
study was not the only one he overscored. The 1988 Byrd
study, which involved patients in a coronary care unit,
compared patients who were prayed for by Christians
located outside the hospital with patients who served as
controls [8]. Byrd’s report stated that the prayed-for group
had fewer complications. However, his tabulation was not
 Barrett, Implausible research: How much is enough?
valid because he scored interrelated complications sepa-
rately and therefore gave them too much weight. The
average length of hospital stay, which was not subject to
this type of scoring error, was identical for the treatment
and control groups. In addition, Byrd himself acknowl-
edged that other sources of prayer could have contaminat-
ed his data [9]. Yet Ernst’s previous review gave the Byrd
study a Jadad score of “5”, which is the highest possible
rating.
The Harris study [10] of coronary patents also re-
ceived a “5”, even though Ernst stated that “no differences
were observed when the summed scoring system devel-
oped in Byrd’s study was used”. I find it puzzling that
both studies were counted as “positive” even though one
negated the other.
Astronomer Carl Sagan has noted that, “At the heart
of science is an essential tension between two seemingly
contradictory attitudes – an openness to new ideas, no
matter how bizarre and counterintuitive they may be, and
the most ruthless skeptical scrutiny of all ideas, old and
new” [11]. While open-mindedness is an essential part of
scientific inquiry, it is equally important to recognize
when implausible ideas should be abandoned. Studies of
methods that are unlikely to yield useful findings deserve
low or no priority.
Stephen Barrett
References
1. Astin JA, Harkness E, Ernst E (2000) The efficacy of
“distant healing”: a systematic review of randomized tri-
als. Ann Intern Med 132: 903–910
2. Ernst E (2003) Distant healing – an update of a systematic
review. Wien Klin Wochenschr 115: 241–245
219
3. Rosa L, Rosa E, Sarner L, Barrett S (1998) A close look at
therapeutic touch. JAMA 279: 1005–1010
4. Atwood KC (2002) A critique of the ‘Annals of Alternative
Medicine’ distant healing review. Sci Rev Alt 6: 99–101
5. Sampson W (2000) Are systematic reviews and meta-
analyses sufficient as well as necessary for assessing the
medical effectiveness of prayer? Sci Rev Alt Med 4: 12–
16
6. Sicher F, Targ E, Moore D, Smith S (1998) A randomized
double-blind study of the effect of distant healing in a
population with advanced AIDS. Report of a small scale
study. West J Med 169: 356–363
7. Bronson P (2002) A prayer before dying. Wired Magazine;
December
8. Byrd RC (1988) Positive therapeutic effects of intercesso-
ry prayer in a coronary care unit population. Southern
Medical Journal 81: 826–829
9. Posner G (1990) God in the CCU? A critique of the San
Francisco Hospital study on intercessory prayer and heal-
ing. Free Inquiry 10: 44–45
10. Harris WS, Gowda M, Kolb JW, Strychasz, et al (1999) A
randomized, controlled trial of the effects of remote, inter-
cessory prayer on outcomes in patients admitted to the
coronary care unit. Arch Intern Med 159: 2273–2278
11. Sagan C (1987) The fine art of baloney detection. Parade
Magazine Feb 1: 12–13
Key words: Distant healing, therapeutic touch, alternative
medicine, randomized controlled trials, research design.
Correspondence: Stephen Barrett, M.D., Board Chairman,
Quackwatch, Inc., NCAHF Vice President and Director of In-
ternet Operations, P.O. Box 1747, Allentown, PA 18105,
U.S.A., E-mail: sbinfo@quackwatch.org