The Witch in the Waiting Room: A Physician Investigates Paranormal Phenomena in Medicine

by Robert S. Bobrow M. D. M. D.

  So here's an irony. Each study, by itself, showed that prayer helps. And each study received a fair amount of press and accolades for confirming that prayer is effective. Taken together, however, the studies are not mutually corroborative. Scientific validity requires independent confirmation, which didn't happen here. Harris nevertheless felt that his findings "support Byrd's conclusion despite the fact that we could not document an effect of prayer using his scoring method." The power of prayer is, of course, a religious belief and may not lend itself all that easily to scientific scrutiny. For all we know, its "laboratory" effects could be influenced by factors like whether the intercessors all faced in one particular direction or what the earth's geomagnetic field was doing on those particular days.

  Harris cites other studies that show that regular church attendance is associated with better health. Mormon women in Utah, for instance, had much lower lung-cancer rates if their church activity level was higher. Breast and ovarian cancer were unaffected. He also made note of a study on anxiety and depression, and of one on alcoholism; these did not show a benefit of intercessory prayer.

  In one study done at an arthritis/pain treatment center in Florida published in Southern Medical Journal in 2000, patients with rheumatoid arthritis (a nasty affliction of joint inflammation) appeared to be helped by in-person intercessory prayer, but not by prayer from further away. In a more recent (2001) report from an outpatient facility in Miami, intercessory prayer was tried with kidney-dialysis patients. It did not make a difference, although patients who e.rpeeted to be prayed over did better than those without this expectation. (Optimism is usually a good thing.)

  Astin's review included an interesting study, which he classified as "other distant healing." It could easily have been included in the "prayer" section, as it did use an array of spiritual healers. These were chosen rather carefully, from schools and professional organizations all over the country, by word of mouth, and by reputation. For Byrd's San Francisco study, intercessors were only required to have an "active Christian life, daily devotional prayer, and active Christian fellowship with a local church." For Harris's Kansas City work, no particular religious affiliation was required, but those who would pray did need 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."

  But this 1998 endeavor, entitled "A Randomized DoubleBlind Study of the Effect of Distant Healing in a Population with Advanced AIDS," essentially assembled a dream team of professional healers, requiring a minimum of five years' experience, performance of at least ten attempts of healing at a distance, and experience working with two or more people with AIDS. The team included Christian, Jewish, Native American, Buddhist, and shamanic-tradition healers, as well as graduates of secular schools of bioenergetic and meditative healing.

  Psychologist Fred Sicher, the study's lead author, believed that healers do their best work when the need is greatest, so he decided to study AIDS patients who were advanced enough in the course of their disease to have had overt illness. Forty patients from the San Francisco Bay area were recruited through advertisements. Twenty would be "treated"; the other twenty would serve as controls. Neither patients, doctors, nor study personnel knew who was in the intervention group. The healers-also forty in all-were distant, all right: They were scattered all over the United States. Each was mailed photographs, first names, and current symptoms of the subjects.

  Using a rotating, random healing schedule, ten different practitioners treated each subject, working an hour per day for six consecutive days. The study ran for six months. The recipients of distant healing did better. They required fewer hospitalizations (three, against twelve in the control group) and fewer physician visits, were generally less sick (graded by an illness severity score), and developed fewer AIDS-related illnesses (two instances, against twelve among controls). And they showed general mood improvement as well.

  However, an indicator of prognosis-a blood count of the specific cell that the HIV virus targets, known as the CD4 lymphocyte-did not change. Six months is also not a very long time when following a prolonged, complex disease like AIDS. Nevertheless, Sicher and his colleagues were encouraged about the findings (as were Byrd and Harris about theirs) and concluded that their data "supported the possibility of' a distant healing effect in AIDS." Editorializing in The Western Journal oJ' elledic•ure, which published the research, editor Linda Hawes Clever was less enthusiastic, feeling that the study period was relatively short and the subjects relatively few, but still felt that publication of this "provocative study" was justified "to stimulate other studies of distant healing." Independent confirmation of Sicher's results would be necessary to validate these findings.

  An interesting sidenote: It's a good thing that Sicher's patients weren't being treated for warts, because "A Randomized Trial of Distant Healing for Skin Warts" in the April 2000 Amerieau Journal of zWedieiue using ten "experienced healers" Found no differences in the number or size of patients' warts.

  The Magic Touch

  Astin also reviewed eleven trials of a healing technique known as "noncontact therapeutic touch." Hands could hover nearby, but could not make direct contact with the patient. Astin only included work that included a control or placebo group that received "mock" therapeutic touch, or, in the case of two studies where treatment was administered from behind a one-way mirror, no treatment. All reviewed trials were published between 1984 and 1998. Running these down:

  • In 60 cardiovascular-unit patients where noncontact therapeutic touch was used for five minutes, there was a slight but measurable decrease in anxiety in treatment recipients.

  • For 60 tension-headache patients, noncontact therapeutic touch was used for five minutes, which resulted in some pain reduction in the treated group.

  • 153 patients awaiting open-heart surgery experienced the same regimen as above with no effect.

  • 108 post-operative patients went through the same regimen; the treated group showed reduced need for pain medication.

  • For 105 institutionalized elderly patients, noncontact touch was combined with a back rub, which the control group also received. Lower anxiety levels were noted in the treated group.

  • 24 participants with experimentally inflicted puncture wounds were treated with noncontact touch from behind a one-way mirror, five minutes a day for ten days. There was more rapid healing in the treatment group. (The wounds were made by a technique known as a punch biopsy, performed after the skin is numbed. A 4millimeter-wide plug of skin is removed, and the punch process ensures that the full thickness of skin is taken.)

  • 38 participants with experimentally inflicted puncture wounds were again given therapy from behind a one-way mirror. This time the non-treated (control) group healed faster.

  • 31 patients with osteoarthritis of the knee (this is a degenerative, wear-and-tear arthritis) were treated with noncontact therapeutic touch in one session per week for six weeks. No change was noted.

  • 99 severe burn patients had five days' noncontact therapeutic touch for five to twenty minutes each time. The treatment group experienced less pain and anxiety, although there was no difference in pain medication usage.

  • 25 participants with experimentally inflicted puncture wounds were treated with noncontact therapeutic touch. Both the treatment and control groups were treated with visualization and relaxation. There was no effect noted on either group.

  • For 44 men with experimentally inflicted puncture wounds, noncontact therapeutic touch from a healer not visible to the patient was given for five minutes a day for ten days. Accelerated wound healing was noted in the intervention group.

  The scorecard: Seven of the studies showed a "positive treatment effect" on at least one outcome, while three showed no effect, and one actually showed a negative effect. This is all interesting, but the hodgepodge of data so far precludes definitive conclusion
s.

  A more recent (2001) work, "Therapeutic Touch in the Treatment of Carpal Tunnel Syndrome," was published in the Journal n` the Anteri'cau Boary) o` Funnily Practice. Carpal tunnel syndrome results from the pinching of a large nerve, known as the median nerve, at the wrist, causing numbness and pain. It can be diagnosed electrically by using tiny needles to measure the speed of nerve impulses across the wrist, which are slower when the nerve is squeezed. Eleven patients received "real" therapeutic touch from trained and experienced practitioners, while ten controls got a "sham" version - mimicry of the movements by untrained personnel. There was no demonstrable difference in results between the groups, but there was a surprise: Both groups improved, by the subjective measure of pain, which decreased, and by the objective measure of nerve conduction, which increased toward normal. Both groups also reported improved relaxation. In fact, for pain and nerve velocity, the "sham" patients' improvement was more significant, statistically speaking.

  Why did this happen? Coincidence is possible. The authors wonder if' the control patients could have inadvertently received therapeutic touch, even though the study was set up only to make it appear to patients that they might be receiving it so they would remain unbiased. Could simply going through the motions of therapeutic touch be effective? Studies like these often tend to generate more questions than answers.

  A well-publicized study in the Journal of the American Medical Aeeociatton (JAMA) in 1998 tested whether practitioners of therapeutic touch could detect, with their hand, the presence of another person's hand three to four inches away. This was based on the belief, central to therapeutic touch, that a "human energy field" exists which can theoretically be manipulated. Practitioners' palms faced the palms of the subjects, whom they could not see (behind a tall, opaque screen with cutouts at the base) and, as it turned out, could not reliably detect either.

  Shortly after the article was published, I had occasion to try it myself. One of the nurses I worked with in a local clinic considered herself a practitioner of therapeutic touch. Her sister, also a practitioner, happened to be visiting one day, so I simulated the test conditions of the JAMA report, albeit crudely, and the sisters were kind enough to indulge my curiosity. Maybe my hands have been washed too many times, but they were not detectable with any consistency.

  The bottom line with any treatment, of course, is whether or not it helps the patient. Thus, one can extrapolate only so much from the JAMA study, which did not look at disease outcomes. Astin's review of twenty-three trials of distant healing showed some positive effect for thirteen (57 percent). He notes that in the United Kingdom, there are more distant healers (about fourteen thousand) than there are practitioners of any other branch of alternative and complementary medicine.

  Qi Gong

  A form of traditional Chinese medicine, Qi Gong is used for distant healing through manipulation of a purported life energy known as "Qi." Garret Yount, who has a Ph.I). in molecular neurobiology, and colleagues at the California Pacific Medical Center in San Francisco recently studied the effects of external Qi Gong on the growth of human brain cells in culture plates in a laboratory. This target has the advantage of being objectiveyou can count cells, as opposed to asking patients if they feel better. "External" means that the Qi is directed outside the practitioner's own body: in this case, toward the growing cells.

  The paper, in B1WC Cnmplenu'ntarv and Alternatii'e illedieiae, reports on three similar experiments. The first, a "pilot" study (to see if it's worth doing a larger one), used eight trials of Qi Gong, administered toward the cells from four or more inches away, for twenty minutes. Treated cells multiplied faster than non-treated cells handled the same way. This work was done in San Francisco. Encouraged, a more formal study was set up with the same design, done in Beijing, China. This time, twentyeight trials came up with the same result: Qi Gong made cells divide a little faster. So a third, confirmatory study was done, this time with sixty trials, also in Beijing. This time there was no difference.

  It is said that research is one percent inspiration and ninetynine percent perspiration. Add a measure of exasperation, and there you have it.

  Distant healing has been around for a long, long time, and only recently have scientifically designed studies tried to evaluate it. Results are inconsistent, but worth a good look.

  wive

  Auditory Hallucinations: The Voices that

  Knew What They Were Talking About

  Many people have heard a voice that sounded real -perhaps in a dream, or even while awake-but they could not explain where it was coming from. These are auditory hallucinations; some are fleeting and happen once in a while, while others are chronic and disrupt the normal experience of life. Some are explained by illness, injury, emotion, or disease. Others, like the case below, seem to be beyond medical explanation.

  Warning Voices

  In 1997, a consultant psychiatrist in London, Dr. 1. O. Azuonye, reported the following case, entitled "Diagnosis Made by Hallucinatory Voices," to the Briheb iiledieal Jour,zal.

  A full-time housewife and mother, identified by her initials, A. B., had always enjoyed good health. She had never been hospitalized and rarely sought medical attention. Born in continental Europe during the mid-1940s, she came to Britain in the late 1960s, where these events unfolded about twenty years later.

  While reading quietly one evening, A. B. heard a distinct voice inside her head. The voice politely said: "Please don't be afraid. I know it must be shocking foryou to hear me speaking to you like this, but this is the easiest way I could think of. My friend and I used to work at the Children's Hospital, Great Ormond Street, and we would like to help you." While A. B. knew of this hospital, she had never been there and didn't know where it was.

  The voices assured her of their sincerity, even supplying some factual tidbits for A. B. to confirm (she did). But by now, the woman assumed she had gone crazy, and ran to her doctor, who of course referred her to a psychiatrist (Dr. Azuonye), which is how this all came to publication. He diagnosed a "functional hallucinatory psychosis" and offered supportive counseling and an anti-psychotic medication. Within a few weeks, the voices stopped and A. B., relieved, went on a vacation.

  Although she was still taking the prescribed drug, the voices returned. This time, they told her that she needed immediate medical care, and should return to England right away. She returned, and the voices gave her an address to go to; her husband was good enough to humor her, and actually took her to the address just for reassurance. It may not have been that reassuring when it turned out to be the CAT-scanning department of a large London hospital, and that as she arrived, the voices told her to go in and have a brain CAT scan. Previously, these voices had been correct about things; this time they informed A. B. that she had a brain tumor.

  She instead returned to her psychiatrist, Dr. Azuonye, who decided that the best way to reassure her was to obtain the scan. So although physical examination found absolutely no signs to suggest a tumor, the doctor ordered the test. Britain's National Health Service-their version of managed caredenied the procedure, noting the apparent absence of' medical necessity. I)r. Azuonye persevered, however, and eventually the scan was allowed. The result? A brain tumor, which doctors thought to be a meningioma.

  Meningiomas are neither the rarest nor the most common of' cranial growths. Their cells, which arise from the brain's coverings, generally grow slowly without eating through the brain and only rarely float off to start new colonies elsewhere in the body (called metastasizing). But the space they take up squashes good brain. Removal, as soon as possible, is usually recommended. So while there were no headaches or specific neurologic abnormalities, A. 13.'s neurosurgeons opted for immediate surgery. The voices told her they agreed.

  Surgeons found and removed a meningioma that measured two and a halfby one and a half'inches-about the size of'an egg. When A. B. awoke from anesthesia, the voices spoke once more: "We are pleased to have helped you. Goodbye." They never returned.

/>   Hearing Voices

  Hallucinations-of all types-are not rare. One study, done on over thirteen thousand non-institutionalized Europeans, found almost 39 percent to have experienced some sort of hallucination or imagined sensation, mostly visual, often occurring at the transition between sleep and wakefulness, and more likely when drugs, anxiety, or a history of psychiatric illness were involved.

  Auditory hallucinations, the doctors' terminology for voices inside one's head, are an even more common occurrence. When a spouse dies, for instance, up to half of the surviving partners report hearing the voice, or feeling the presence, of the deceased. I once had a patient who was a minister; when I asked him how he had decided upon his career, he told me that one evening he heard the Voice of God, plain as the conversation we were having, advising him to do just that (he had had strong religious convictions to begin with). Psychiatrists consider these types of perceptions normal.

  Auditory hallucinations can be amazingly real, and may take the form of music, noise, or, most often, conversation. A hospitalized fifty-seven-year-old man without mental illness, recovering from a brain abscess, was surprised to find that the folk songs he heard a boys' choir singing were not, in fact, coming from an adjacent schoolyard, nor could they be heard by anyone else. A thirty-four-year-old man with seizures arising from one of the brain's temporal lobes (the lobes closest to the temples) began to hear seemingly ordinary voices from outside his head instructing and insulting him. He attempted to taperecord them, and was shocked to find they were not on the tape. He then sought further medical attention, realizing that he had a problem.