(First appeared in Rocky Mountain Skeptics, July/Aug 1993)
A year ago, we addressed this Board on a matter of great concern to us as taxpayers and consumers of health care. We had learned that the procedures and standards of this Board had become so lax that purveyors of unproven, ineffective, and unscientific pseudomedical techniques-some even identifiable as health-care fraud or quackery-could use your processes to gain legitimacy and access to the public which, by the charter granted your board by the State of Colorado should properly have been denied.
We petitioned you then to investigate one area subject to abuse, specifically, your continuing-education program for nurses in all categories. We believed then, and we now more strongly believe, that your credentialing process for Continuing Education Units (CEUs) was being abused, and required your immediate attention.
Subcommittee which you then appointed investigated in a most irregular manner. First, it did not meet in open session, and minutes of its proceedings were not kept. As complainants with potentially valuable evidence to contribute, we were never informed of meetings or otherwise afforded an opportunity to present our views or evidence. In fact, we were never informed about anything until after the group had met, adopted recommendations, and had them adopted in turn by this Board. Both the process and the staff work on this matter were conducted in secrecy in contravention of the regulations of the State of Colorado.
The subcommittee, in fact, addressed the awarding of Continuing Education Units to nurses for the study of THERAPEUTIC TOUCH and other "non-traditional and complementary healing modalities." While we welcome a genuine investigation by this Board into such matters, our original concerns remain unaddressed.
Since the subcommittee's recommendations are the only response to us thus far, we looked at them, perforce, as a separate concern. What we found as a result has greatly alarmed us and raised additional questions. Not only is continuing nursing education in question here as we first thought, but also basic and graduate nursing education as well.
Pseudoscientific practitioners have invaded the nursing profession at many levels and in many ways. Indeed, the profession has proved to be the weak flank on the medical and scientific front against shadowy practices, and this flank has been overrun. As a result, the nursing profession itself is at risk. More importantly, if these practices continue, the health, safety, and welfare of the public will be at great risk.
The stewardship by this Board of both the profession and of the public interest is being called into question thereby. That is why we are here before you today. We are asking that you discharge your responsibilities to the public by assuring them of a system of competent, effective nursing care.
The legislature of Colorado has declared, "...in order to safeguard the life, health, property, and public welfare of the people of this state and in order to protect the people of this state from the unauthorized, unqualified, and improper application of services by individuals in the practice of nursing, it is necessary that a proper regulatory authority be established." [CRS 12-38-102] This board is given powers and duties under the law to carry out the legislative mandate, including: "...To approve, pursuant to rules and regulations adopted by the board, educational programs in this state preparing individuals for licensure, including approving curricula...and establishing standards for such educational programs; to deny approval of or withdraw approval from such educational programs for failure to meet required standards as established by this article..." [CRS 12-38-108(1)(a)] The clear intent of the law is to establish a system that, through professional education, ensures that "unauthorized, unqualified, and improper application of services" is not a part of the practice of nursing in Colorado. The legislature - and the public - expects you to protect our "life, health, property, and public welfare."
The subcommittee recommended to this board, and you accepted, a definition of nursing that redefined the profession by stating:
Because Nursing is both a science and an art, nurses require access to and familiarity with many belief systems and knowledge bases, including, but not limited to, the traditional sciences.
That is not what the law says. In defining the "practice of professional nursing," the legislature declares it to be:
...the performance of both independent nursing functions and delegated medical ... functions...which [require] such specialized knowledge, judgment, and skill involving the application of principles of biological, physical, social, and behavioral sciences as are required for licensing as a professional nurse... [CRS 12-38-103(10)]
Thus we see that this board is charged with the duty to ensure that every professional nurse in Colorado is trained in and applies scientific principles while in practice upon the public. This does not preclude a humane application of these principles to individual patients, but it unquestionably imposes upon nurses an affirmative public duty to provide only those therapies which are demonstrably "supportive and restorative to life and well-being." This in turn requires that a treatment must be demonstrably "safe and effective" to be practiced. Colorado law specifically restricts nurses to this standard.
Since health care is a dynamic discipline, it is necessary for practicing nurses to rely upon their mentors and this Board for guidance as to what is considered "safe and effective" under this standard. You, in turn, must rely upon science and only upon science and the scientific method to provide you with the standards to judge proposed treatments and techniques. Most importantly, the modern scientific method is the only practical way to make such judgments and is the only fair way to judge applicants in their mastery and skill as nurses. Nursing as an art is unregulatable, since anything can be sanctioned or denied under the guise of artistic skill. If nursing is a science, as the law demands and the public expects, then you have a methodology for determining a set of practical standards by which you can measure both what content properly belongs in the practice of nursing and objectively whether applicants for licensure are qualified to practice it.
Adopt any other standard than science, and you will lose your way as regulators. On the one hand, your duty is clearly to protect the public against quacks; if a nurse starts to behave as one, then it's your job to put a stop to it at once. On the other hand, it is undesirable to allow you an arbitrary power to prevent nurses from using truly efficacious techniques.
So how are you to choose when presented with a new, unproven technique or practice? You might follow your subcommittee's approach which is to allow any nurse to offer a "full range of caring and healing interventions" without any discrimination or judgment exercised on your part. The obvious problem with this approach is that your duty to us, the lay public, has consequently been ignored.
Or alternatively, you can conform to your own statutory directions and require scientific evidence of efficacy before permitting a technique into your canon of practice. The obvious advantage to the second approach is that you are making an objective decision; you run neither a risk of being taken in by charlatans, nor of being justly accused of stifling progress.
All of which brings us back to the original concerns we had with your regulation of nursing education. Initially, we were troubled by the appearance of certain pseudoscientific practices being offered to nurses for continuing education credit. Continuing education exists, in the words of your own regulations, "to promote the enrichment of knowledge and improvement of skills for enhancement of nursing practice." As we have seen, however, you are confined to regulating nursing only as a science. We are compelled, therefore, to notify you that more than one pseudoscientific technique is being offered for nursing CEUs, with this board's sanction.
Worse still, by adoption of your subcommittee's recommendations, you have added a state imprimatur to these practices, and given them a handy euphemistic nomenclature: "non-traditional and complementary healing modalities" recognized by the state, and we quote here from your document as "completely within the mainstream of modern nursing practice." This was an unconscionable act in betrayal of the public trust.
While we were appalled by your action last year, it was with complete dismay that we learned about the insinuation of pseudosciences into nursing education on a large scale, apparently with your prior acquiescence, and now with your sanction. Unproven, ineffective pseudoscientific techniques are being offered as part of the regular nursing curriculum in several schools recognized by you - including the University of Colorado School of Nursing - some of them for graduate credit! This state of affairs is a bunko artist's dream come true. The policeman on the beat is helping to close the scam on the mark.
Consider, for example, the testimony of one practitioner of Therapeutic Touch (TT). "I explain Therapeutic Touch to the parents [of a sick child]. I usually say that this technique is derived from an ancient practice of laying on of hands and that it is now being taught in some nursing schools." What is a parent to think? This is a licensed professional, with a caring demeanor, in a clinical setting, talking to uninformed lay people in one of the most vulnerable situations. She recommends a practice taught in real schools! Such an approach is irresistible under the circumstances - and repugnant to anyone with training in science and ethics. TT remains unproven to this day. Yet the same specious appeal-to-authority appeared in the subcommittee's report last year to justify TT's appearance in the CE curriculum. TT, as a nursing intervention, is being taught to nurses through many colleges and universities, and by the National League for Nursing through its continuing education videotape series on TT. In fact, it is indeed completely within the mainstream of modern nursing practice.
If the last sentence is true, it is a damning indictment of the entire profession of nursing and the laxity of its regulators... an indictment for which, at the very least, this board is an accomplice after the fact.
No one is denying that new discoveries may come from any quarter. No one is advocating a closed-mindedness in the investigation into techniques for "easing human suffering and the stimulation of healing." But there is only one reliable means known for making a determination about the validity of such claims - that is the scientific method.
When the subcommittee said that nurses also use the insights and experiences gained from studying peoples of other cultures and learning other perspectives to alleviate suffering and promote health and healing, which may lack modern scientific investigation, a chill went through those of us who are lay health-care consumers and taxpayers. Not because those "insights and experiences" come from elsewhere, but because they have not received "modern scientific investigation." There is no substitute for that. Nurses must not be practicing techniques that "lack modern scientific investigation." It violates the trust we the public have placed in them - and it violates the law under which the profession operates.
Certainly the subcommittee's report on which your decision was based was a hodge-podge of philosophical nonsense and several outright untruths, but it is uncertain whether its authors were the source of its improbity or were themselves duped. However, the report's conclusions were totally without scientific foundation, and we have found the supporting materials which you provided us to be completely lacking in scientific merit. They may have been deliberately deceptive.
My name is William Aldorfer. I am going to demonstrate the ceremony referred to as "therapeutic touch".
I have been trained to conduct this ceremony by a Registered Nurse. The course consists of 12 contact hours of exposure to the material. If I had been a registered or practical nurse, I would have been awarded 12 Continuing Education Units for my participation in this course. In other words, more than one-half of my biannual continuing education requirement would have been fulfilled by completing this course, and learning how to perform the rite of "therapeutic touch".
Before the rite begins, person performing the ceremony prepares himself or herself with a meditation intended, among other things, to draw energy from the ground. Having completed the meditation, the performer "scans" the subject with the hands, in an attempt to locate "differences" detected as "dips" and "bumps" in the so-called "energy field" surrounding the body.
[scanning demonstrated]
Supposedly, the "parameter" of the "energy field" can be detected in this way, as can a so-called "pain ridge", which can then be swept away with the hand. In this manner, I was taught, the hands of the ritualist "direct and create energy flow" in the subject by manipulating the subjects so-called "energy field". "Tuning and balancing" the "vibrations" of this so-called "field" is accomplished through opening of "Chakras".
[chakras demonstrated]
The ceremony of therapeutic touch therefore is dependent upon belief in what is being currently marketed as "Vibrational Medicine".
I was instructed that I could not use my own so-called "energy" as an agent in the ritual, because I would become exhausted. Rather, I would have to draw "energy" from the ground. I was told that, in the process of detecting the so-called "pain ridge" and sweeping it away, that the process would feel as if the performer was pulling taffy.
I was taught several methods for relieving pain, of which I will demonstrate two. The first employs a bundle of cotton. In the belief system of the TT advocates, cotton stores energy from the hands of the performer in the way that a nicad battery stores energy from its charging unit. A performer goes through the charging ritual in this manner, then places the cotton over the injured area as if it were a poultice. You, the State Nursing Board, claim that this is mainstream nursing. The second method that I demonstrate involves raising one hand towards the sky and, in the way that a radio antenna traps radio waves, I can trap "sky energy". By holding my other hand on the afflicted area of a subject, I can direct "sky energy" into the injury and heal it. You, the State Nursing Board, claim that this is mainstream nursing.
As I mentioned earlier, I was instructed in the ritual by a Registered Nurse. This nurse informed me that she was "conservative" in her approach to TT in that she did not employ either crystals or pendulums in her ceremony. This leads me to wonder if conservative nursing schools are the schools that don't use pendulums or crystals in their curriculum.
TT depends upon belief in doctrines that have no scientific basis. No advocate of the ceremony has yet demonstrated the existence of this so-called "human energy field". I was taught that no particular system of belief was needed in order to conduct the ceremony. This is not correct. Belief in "vibrating and rotating chakras" is required or assumed. Belief in radiant human "energy fields" that have the consistency of taffy is required or assumed. Anyone who tells you that belief is not a component of TT is deceiving you. Indeed, deceit lies at the very heart of this issue.
Contrary to what you have been told, therapeutic touch is founded upon mysticism. Therapeutic touch is only one of the latest manifestations of the "feel-good" that lies on the very fringe. It has no scientific basis. The studies referred to by the advocates of the TT ceremony employed sample sizes too small to be reliable indicators of any cause-and-effect relationship claimed for this ritual. The studies are, at best, at the very best, unreliable.
It seems that the TT ceremony is only effective upon people who do not, or can not, differentiate between symptomatic relief and truly effective remedies. The RN who instructed me said that small children and the mentally retarded are the easiest to train in TT, as they lack the skepticism of adults.
In my view, the ritual of TT holds two distinct attractions for its advocates: 1) Advocates claim that "no harm" can be caused by performing the ritual of TT; and 2) Advocates must, as a condition for performing the ritual, be willing to divorce themselves from the outcome and accept any result.
What could be more attractive to an advocate of this ceremony, this belief system? After all, in this belief system that this Board promotes, no harm comes to the subject and no accountability accrues to the person performing the ritual. No accountability. None. Ever. The "no harm" claim is highly suspect. That claim is as suspect as the claim that each of us swims around in a magical, mystical "energy field."
The Board is obligated to document its support of the "no-harm" claim with valid, replicated, unequivocal clinical data. The Board is likewise obligated to document its support of the "energy field" claim with valid, replicated, unequivocal clinical data. To date, no valid, replicated, unequivocal clinical data have been produced by any advocate of the TT ceremony.
The Board must know that the most damning indictment of all came from the Registered Nurse who trained me in the ceremony of therapeutic touch. She advised me that it could take time for me to "feel" the "energy field" of a subject, and told me that it was entirely appropriate to fake the manipulation. The registered nurse told me that, while she was rehearsing her technique, she lettered a sign and attached it to her refrigerator door. The sign said: "FAKE IT 'TIL YOU MAKE IT".
You, the State Nursing Board, claim that this is mainstream nursing. You, the Board, have been deceived by the advocates of this ceremony. The Board has not been told the truth about the content and meaning of their ceremony, nor of their underlying belief system. You, the Board, have been deceived.
The Board has not shown us any meaningful evidence that demonstrates the presence of any effect besides the placebo effect. It is doubtful that the Board has seen any meaningful evidence. The Board has not shown us any meaningful evidence. None. Not one shred. NO MEANINGFUL EVIDENCE.
To this we say, let the Board demand that the proponents of this ceremony, this belief system, now bring forth their best evidence for consideration.
The State Board of Nursing has credentialed the teaching, training, and instruction of a ceremony, a system of belief. In so doing, the State Board of Nursing has proactively advocated, promoted, legitimized and underwritten the introduction of ceremony, ritual, and fakery into the honorable profession of nursing.
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