Elizabeth Targ, MD
Can one person's thoughts influence the experience or the health of another
-- far away? While there are many complex and meaningful aspects to the practice
of prayer or hands-on healing, a sixty-four million-dollar question remains: Is
there an effect at a distance?
In December 1998, forty scientists from universities and research laboratories around the United States gathered at the Swedenborg Chapel at Harvard University for a three-day conference jointly sponsored by the Institute of Noetic Sciences and the Harvard University School of Medicine. Their focus: to examine and evaluate data on a remarkable phenomenon baffling to modern medical science. The attendance list was confidential, and the proceedings closed. Preliminary data presented at this conference suggested that we are on the verge of an explosion of evidence to support the efficacy of distant healing.
The term "distant healing" and the more precise but cumbersome "distant mental influence on biologic systems" (now adopted by the National Institutes of Health) -- is an attempt to find a way to objectively describe the outcome of what others call psychic healing, energy healing, or prayer.
While distant healing has historically received little attention from mainstream medical institutions and laboratories, a substantial body of published data supports the possibility of a significant effect. Over the last forty years, more than 150 formal, controlled studies of distant healing have been published more -- than two-thirds of them showing significant effects (a less than one-in-twenty likelihood of the effect having occurred by chance; in scientific terminology, p <.05)².
The most exciting and the most controversial studies in the area of distant healing have involved human beings as subjects. These studies are challenging to design because of uncontrollable factors such as hope, expectation, and the role of the relationship between the healer and the patient.
A seminal paper presented at the 1998 conference was "A Study of Distant Healing as an Adjunctive Intervention for People with Advanced AIDS," initiated by IONS member Fred Sicher. This project, recently published in the Western Journal of Medicine, represents five years work by a research team at California Pacific Medical Center (CPMC). While many studies of distant healing have focused on more benign conditions -- such as headache, high blood pressure, or recovery from minor surgery -- after interviewing numerous healers, Sicher had observed that many healers feel they do their best work when the need is greatest.
The healers suggested that if we want to see a significant effect on someone's health, there has to be a significant motivation -- the patient should be in extremis. Continuing his survey, Sicher also found that, unlike in many healing studies, distant healing is not usually performed as a one-time effort. Most of his interviewees stated that they tend to work with patients over a period of time, often many weeks. In an effort to bring the scientific approach in line with this "community standard," Sicher then proposed that a study of distant healing should involve people with an incurable disease such as AIDS, that the treatment should occur over at least two months, and that many healers be involved.
THE CPMC RESEARCH TRIALS OF DISTANT HEALING FOR AIDS
In 1994 Sicher joined our team at the California Pacific Medical Center to design a methodologically airtight collaborative research project. The CPMC trial of distant healing for people with AIDS was a "proof of principle" trial. It made no effort to investigate any mechanisms. The sole purpose of the study was to determine whether or not there is an effect of healing intentions over distance. Because of the controversial nature of this area of investigation, the research protocol was discussed and reviewed by numerous scientists, by AIDS specialists, and by self-identified healers before the first patient was enrolled.
Two studies were eventually completed, a pilot of twenty patients, followed by a confirmatory study of another forty patients. The pilot, considered exploratory, produced the surprising finding of 40 percent mortality in the control group, but no deaths in the treatment group. This striking result occurred despite the fact that patients and researchers did not know who was in the treatment group, and that the two groups were balanced for CD4 count. Both of these studies are reported in the December 1998 issue of the Western Journal of Medicine.
In each study, patients were recruited from around the San Francisco Bay Area, using flyers, physician contacts, and newspaper advertisements. In the first study only men were included; the second study included women. Because of the variable course of HIV at different stages it was important to choose a group of patients at a similar stage of illness. The study inclusion criteria required all patients to have T-cell counts less than 200 and a history of at least one AIDS-defining illness (such as pneumocystis pneumonia, Kaposi's sarcoma, or cytomegalovirus).
The patients were randomly divided into two groups using a formula that equalized both groups on factors relevant to disease course (CD4 count, age, number of previous AIDS-defining diseases). Patients in the study had an average age of forty-three years, and had been HIV-positive for an average of eight years. Baseline illness severity was calculated by summing severity scores for previous and current AIDS-defining illnesses. No significant differences were found on any of twenty-seven baseline variables. The study was triple blind: None of the patients, physicians, or researchers knew which patients were in the treatment group and which were in the control group.
Healers for the study were recruited by word of mouth and from schools and professional organizations all over the country. Because the study itself was a test of the efficacy of distant healing, there was no objective test that could be used to determine which healer might be "the best." Healers were therefore selected using the same type of criteria that might be used in selecting any healthcare practitioner. Researchers collected names based on healer reputation among colleagues and patients. Healers were required to have had at least five years of experience as professional healers, to have performed at least ten healing attempts at a distance, and to have worked with at least two people with AIDS. The healers selected significantly surpassed these criteria, averaging more than seventeen years of experience performing healing-at-a-distance on an average of 106 people. In addition, just as one would select only a physician who believed one could get better from an illness, for the study, we selected only healers who believed the study would succeed.
The healers had an average age of forty-seven and represented a wide variety of educational backgrounds, including several medical doctors, nurses, and psychologists who also maintain a regular professional practice using nonlocal healing. Other healers included a Baptist minister, a cu-gong master, a Native American shaman, and a Philippine woman with no formal education who performed healing in the Christian tradition. Half of the healers in the study described their healing techniques as "energetic," 25 percent described their work as meditative or contemplative, 15 percent came from devotional or religious traditions, and 10 percent described their work as "shamanic." Many had received training or were now instructors at well-known schools of energetic or spiritual healing. A majority of healers reported working with chakra imagery for healings; other frequently reported modalities included prayer, visualization, and work with crystals.
THE HEALING INTERVENTION
The healing intervention consisted of each patient in the treatment group receiving healing efforts from one healer at a time, one hour per day, six days per week, for ten weeks. The healers worked on a rotating schedule so that each week, each patient was treated by a new healer. Thus, by the end of the study, each patient had received "healing effort" from a total often different healers. Each week, a head and shoulders photograph of one of the treatment patients was sent via overnight mail to a healer who was then instructed to "hold the intention for the health and well-being of the patient" for one hour a day during the time the patient was assigned to them. The healers were given the first name of the patient, the patients CD4 count, and two or three sentences describing active elements of their illness. Healing techniques were quite varied.
THE STUDY OUTCOME
Patients in the study were followed for six months. Three categories of outcome were assessed: progression of illness, medical utilization, and quality of life. Eleven specific outcome measures were used. Medical data were collected by blind chart review, and quality of life/psychosocial data were collected using standardized paper and pencil tests. At the end of six months, patients in the treatment group had acquired significantly fewer new AIDS-defining diseases than people in the control group, their overall illness severity scores were significantly lower, they had had significantly fewer hospitalizations, and those hospitalizations were significantly shorter. In addition, treatment patients showed significant improvement on psychological status, including decreased depression, decreased anxiety, decreased anger, and increased vigor, compared to controls. There were no significant differences between groups on CD4 counts, which went up slightly for both groups. The treatment group also showed more recoveries from AIDS-defining diseases (six versus two), but this result did not reach statistical significance.
Extensive statistical analyses were performed by the research team and were reviewed by several biostatisticians from outside institutions to determine whether some factor other than the distant healing intervention might have accounted for the differences between groups. Analysis did not reveal evidence that any baseline factor (such as medications, ethnicity, gender, age, religious orientation) could have accounted for any of the medical outcomes. By chance, the patients who were randomized to the treatment group were individuals who had initially higher scores on measures of psychological distress; this observation opens the possibility that their improvement on psychological outcomes may represent a regression to the mean. Interestingly, changes in psychological outcomes, for example becoming more depressed, did not correlate with medical outcomes, such as becoming more ill.
Historically, the usual scientific explanation for medical improvement in the context of distant healing or prayer is that the patients' hopes or expectations in the context of the treatment are what lead to any benefit. In the above studies, the main effect of hope or expectation is eliminated because the study was double blind. Neither group knew whether or not they were receiving the treatment, thus neither group should be differentially influenced by being in the study. This assertion relies on the assumption that the two groups had equal levels of expectation about the possibility of being treated.
The question arises: Did the group that received the treatment simply contain more patients who "guessed" or believed they were being treated? If that were the case, it would be possible that their increased level of expectation might have influenced the outcome. This question was addressed in two ways. First, the two groups were compared to see whether one group showed significantly greater likelihood of believing that they were in the treatment group. The answer to this question was -- no. Despite the fact that only one group was receiving the treatment, nearly half of the patients in the control group had (mistakenly) guessed they were in treatment. More important, despite the fact that they were doing significantly better than the control group, nearly half the patients in the treatment group guessed that they were not being treated.
The second approach to this issue was to ask whether those patients in either group who thought that they were being treated showed significantly better outcomes on any measure. It turned out that in the early stages of the study, patients who thought they were being treated were those whose T-cell counts had been rising (a fact that would have been known to them and may account for their guess). In the later part of the study, patients who were showing more recoveries from AIDS-defining illnesses were more likely to guess they were being treated. Significantly, believing one was being treated did not correlate with severity of illness, with development of new illness, with psychological outcomes, or with medical utilization. Thus it appears expectation does not account for the differential benefits seen in patients in the treatment group.
No single study can be decisive in demonstrating an effect. The two studies presented here represent only the latest work in a nearly forty-year process of developing, refining, and repeating studies to evaluate the effects of healing attempts at a distance. The two current studies, like the majority of other published studies, confirm such an effect. This work raises many more questions that will be the focus of future studies. What healing techniques or attitudes are the most helpful? Are certain individuals more likely to be able to develop healing abilities? Is distant healing more effective for some conditions than others? What is the role of the patient in the healing process? Is healing additive? Is it beneficial to have groups of people sending prayers or making healing efforts? Are there certain biological pathways that are specifically affected by healing efforts? And last, of course, how does it work?
The work described here is one piece in a puzzle that is bringing together medicine, philosophy, physics, and spiritual science to create a new picture of a highly connected and interactive universe. We look forward to seeing the results of the many other studies which are ongoing, and to exploring ways of introducing these interventions into mainstream medical settings.
Elisabeth Targ, MD, is director of the Complementary Medicine Research Institute at California Pacific Medical Center, assistant clinical professor in the Department of Psychiatry at the University of California, San Francisco, and a fellow of the Institute of Noetic Sciences. She was principal investigator of the studies of distant healing in AIDS described in this article.
Reproduced with permission from "Distant Healing," Noetic Sciences Review (August--November 1999 #49), p. 24.