April Fool's Day was marked by two noteworthy events centered around the Journal of the American Medical Association, one of which received a tremendous amount of publicity. The April 1 issue of the Journal featured a media-hyped article debunking therapeutic touch based on the fourth grade science fair project of an 11-year-old girl. The April 1 event that went unnoticed, but was likely more significant, was the passing of the deadline for the Journal's general call for scientific papers on alternative medicine to be published in a special theme issue this fall.

Therapeutic touch is a widely practiced but controversial nursing technique that is a medicalized version of "laying on of hands." This approach to healing through the "energy field" around the body has been taught to thousands of nurses including many at the Medical Center. Much research demonstrating a variety of beneficial effects has been done, however skeptics criticize that these studies were not scientifically rigorous enough to validate the claims.

The recent study was a randomized single blind trial that tested the ability of 21 therapeutic touch practitioners to detect the presence of the energy field of the young experimenter's hand from a distance of eight to 10 cm. The subjects, who were asked to place both arms through a screen, were expected to be able to tell which of their hand the girl placed her own hand above as determined by a random toss of dice. The practitioners were correct only 44 percent of the time, which is less than chance, seeming to invalidate one of the central claims of therapeutic touch, the ability to reliably detect a human energy field.

The study, however, has several methodological limitations including the lack of a comparison control group. It is also possible that the effects of intentionality flawed the study-a point which was probably not even considered by the Journal's reviewers. The above approach may be fine for Newtonian science experiments typical of modern biomedicine, but may not be appropriate for experiments regarding postmodern concepts of consciousness and energy which underlie many of the claims of alternative medicine techniques. The intent of the experimenter, an impressionable young girl whose mother and research collaborator is a member of a national organization of skeptics, may have been a factor.

Such an "experimenter effect" is well illustrated in a recent study involving a balanced collaboration between a skeptic and a non-skeptic. Marilyn Schlitz, the director of research at the Institute of Noetic Sciences, designed a rigorous randomized trial evaluating whether blinded subjects could detect another person staring at them from a distance, a test which yielded statistically significant positive results. When her skeptical colleague, British psychologist Richard Wiseman, failed to replicate the results, he invited her to England to repeat the experiment along with him in two separate but equal trials using the same subjects and the same equipment, and once again she got positive results and he got negative ones.

Ironically, the Journal may have unwittingly published an article which provides supporting evidence for the experimenter effect. When the experimental data is reevaluated with this possibility in mind, the subjects' performance was below chance by a statistically significant amount, p = 0.04. Unless some undiscovered systematic error was involved, the two most likely explanations would be that either the girl unconsciously cheated to satisfy the expectations of her mother or that her skeptical bias had some other negative influence on the results.

The exact mechanism by which conscious intent might affect experimental results in this fashion remains unexplained, but the collaborative approach of Schlitz and Wiseman may provide a model for future research in this field. In fact, similar therapeutic touch research of a more balanced and rigorous nature will soon be completed at Duke by nurse clinician Jon Seskevich and psychophysiologist Jim Lane. Perhaps their research will also be published in the Journal, for despite the debunking nature of the April Fool's Day article, the recent call for papers is evidence of a shift in attitude of the Journal's senior staff.

For 1998, the editorial board ranked alternative medicine among the top three of 68 subjects to be addressed in the coming year, compared to 68 of 73 in the previous year. The fact that a recent survey of the Journal's physician readers ranked alternative medicine the seventh most important topic out of 73 might have something to do with this shift in editorial policy. Another factor could be that Jim Dalen, the editor of one of the AMA's other journals, the Archives of Internal Medicine, is the Dean of the University of Arizona School of Medicine where popular medical author Andy Weil has established his Fellowship Program in Integrative Medicine.

The actual intent of the Journal's senior staff remains to be seen. Hopefully, the importance of the experimenter effect will be taken into account in evaluating future research. In "Nature and Purpose," scientist/priest Pierre Teilhard de Chardin notes that "nothing less imposing than the significance of our lives is bound up with the quest for a union of mind and nature established on solid grounds compatible with reason, common sense and science."

Dr. Larry Burk is an associate professor in the Department of Radiology.