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Sicher-Targ distant healing report

“My goal is simply to pave the way for free and fair scientific discourse on subjects that have previously been considered nonrational. It's our responsibility as scientists and physicians to speak based on fact, not opinion. If there's a benefit to distant healing, physicians and patients should consider it along with all the other proven treatments for disease.” --Elisabeth Targ

This very deceptive report is "widely acknowledged as the most scientifically rigorous attempt ever to discover if prayer can heal" (Bronson 2002). If that is true, rigor has become rigor mortis in this branch of scientific research. The study included only 40 subjects, so no matter how rigorous the design of the study, the likelihood that anything of major significance could be drawn from it would be remote. Furthermore, the study isn't specifically about prayer anyway. Both prayer and 'psychic healing' are mentioned in the abstract to the report, but prayer is not specified in the study as a method of healing they were testing. Since some of the healers were Christians and Jews, one might reasonably infer that some of the healers were using prayer in their efforts at healing someone from a distance. On the other hand, it seems rude to quibble over whether 'prayer' should be used to describe the various practices of the healers. If we define distant healing to include any effort to direct one's intentions toward the improved health and well being of others, then distant healing  might be considered a type of intercessory prayer.

The research took place from July 1996 through January 1997 and was published in The Western Journal of Medicine in December 1998 as “A Randomized Double-Blind Study of the Effect of Distant Healing in a Population With Advanced AIDS--Report of a Small Scale Study.” The main research scientists and authors were psychologist Fred Sicher, M.A., and psychiatrist Dr. Elisabeth Targ. The study was supposed to be a replication of an earlier "double-blind study of 10 treated and 10 control subjects conducted during July 1995 through January 1996."

What was the treatment? It's hard to say, since various people at various distances from the subjects engaged in various sorts of activities; they were instructed to "direct an intention for health and well-being" toward the subject. This is called "distant healing" or DH.

What were the patients being treated for? This is where it gets tricky. The first study looked at mortality: Would the prayers help AIDS patients live longer? In the first study, four patients died out of the ten in the control group, while none died in the DH group. Sicher and Targ bankrolled that into a grant from NIH to do a follow-up study, even though in the first study they hadn't controlled for age and the four who died were the four oldest in the study. Worse than that, the NIH acknowledges that the first thing most people do when they get really sick is start praying and asking others to pray for them. Prayer, according to the NIH, is the number one alternative therapy in America. The implication of this is that prayer can't be controlled for, making a controlled study on the effects of prayer and other DH techniques impossible. Clearly, the standards at NIH are not that high in the "alternative therapy" division.

Some critics might balk at such a study, believing that these scientists were testing some god. That seems to have been the idea in some other prayer studies, such as the Byrd study. But the Sicher-Targ report does not mention any god, nor do the authors imply that they have any idea how prayer or any other distant healing practice might work. One gets the feeling that they think it has something to do with energies, but it's all left very vague. Here is how the report describes the healers and the healing:

Healers

Forty DH practitioners, including 12 from the pilot study, were recruited via professional healing associations and schools of healing. Eligibility criteria were minimum 5 years regular ongoing healing practice, previous healing experience at a distance with at least l0 patients, and previous healing experience with AIDS. Healers had an average of 17 years of experience and had previously treated an average of 106 patients at a distance. Practitioners included healers from Christian, Jewish, Buddhist, Native American, and shamanic traditions as well as graduates of secular schools of bioenergetic and meditative healing. Practitioners were not paid and understood that the study could not evaluate the abilities of any individual practitioner. Healers were residing at various locations throughout the United States. The site from which they performed their healing was not restricted.

Healing treatment

A rotating healing schedule randomized healers to subjects on a weekly basis to minimize possible differences in healer effectiveness. Thus, each subject in the DH group was treated by a total of 10 different practitioners, while each practitioner worked every other week treating a total of 5 subjects. Each healer received five consecutively numbered subject information packets with instructions specifying the day to begin treatment on each subject. Healers were asked to work on the assigned subject for approximately 1 hour per day for 6 consecutive days with the instruction to "direct an intention for health and well-being" to the subject. Healers completed logs for each healing session, indicating period of healing, specific technique, and any impressions of the subject's illness. Subjects never met practitioners and did not know whether they were in the DH group, where the practitioners were located, nor at what time the DH might occur. Before the intervention, study personnel encouraged and motivated healers via letters and phone calls stressing the importance of the study and their individual efforts.

The 1998 Sicher-Targ study appears to be an extremely well-designed double-blind, controlled study. Even so, it is very unclear exactly what causal processes were to be measured. Worse, the researchers—at Targ’s urging—changed the goal of the study and had a statistician mine the data after it had been completed. As noted above, the original goal was to see if DH could lower the death rate for AIDS patients. Since only one of the patients in the study died, there was nothing to report on that count. The published study, however, claimed that the aim was to measure DH against a long list of AIDS-related symptoms. A biased researcher (Sicher) went through all the data after the study was completed to determine which patients had which symptoms. It was a bit of a fluke that Sicher and Targ’s deception was exposed by Po Bronson in Wired magazine four years after the study was published. By that time, Targ had bankrolled it into another big grant from NIH.

The results must have seemed impressive to the folks at NIH and to believers in distant healing everywhere. The abstract for the Sicher-Targ report notes that controls were done for age, number of AIDS-defining illnesses, and T cell count. Patients were randomly assigned to the control or DH groups. The study followed the patients for six months. "At 6 months, a blind medical chart review found that treatment subjects acquired significantly fewer new AIDS-defining illnesses (0.1 versus 0.6 per patient, P = 0.04), had lower illness severity (severity score 0.8 versus 2.65, P = 0.03), and required significantly fewer doctor visits (9.2 versus 13.0, P = 0.01), fewer hospitalizations (0.15 versus 0.6, P = 0.04), and fewer days of hospitalization (0.5 versus 3.4, P = 0.04)."

These numbers are very impressive. They indicate that the measured differences were not likely due to chance. Whether they were due to healing prayer (HP) is another matter, but the scientists concluded their abstract with the claim: "These data support the possibility of a DH effect in AIDS and suggest the value of further research."

Po Bronson put it this way:

The research results showed that the subjects who were not prayed for spent 600 percent more days in the hospital. They contracted 300 percent as many AIDS-related illnesses. That's a pretty sensationalistic way of saying those who were prayed for were a lot less sick. Here's the somewhat less-sensational way of framing the results: The control group spent a total of 68 days in the hospital receiving treatment for 35 AIDS-related illnesses. The treatment group spent only 10 days in the hospital for a mere 13 illnesses.

Two years after the publication of these sensational sounding results, Elisabeth Targ was granted $1.5 million from the National Institutes of Health Center for Complementary and Alternative Medicine to do two further studies on the healing effects of prayer. Both studies would involve 150 subjects. One was going to involve AIDS patients and the other was going to involve patients with brain cancer. Ironically, Targ died of a brain tumor in 2003, despite being one of the most prayed-for persons on the planet. Rather than take this as a sign that maybe this prayer therapy isn't so effective, her husband Mark Comings—they married shortly before her death—now gives presentations where he discusses communications he has been receiving from Elisabeth since she died (Solstice). This shouldn't be surprising. Comings is "a theoretical physicist. He felt that an eight-dimensional universe could explain how a healer in Santa Fe could influence a patient in San Francisco: In our ordinary three-dimensional world, healer and patient appear far apart, but in one of the as-yet-unmeasurable extra dimensions, they'd be in the same place" (Bronson).

What the Sicher-Targ report didn't reveal was that the original study had not been designed to do any of these measurements they report as significant. Of course, any researcher who didn't report significant findings just because the original study hadn't set out to investigate them would be remiss. The standard format of a scientific report allows such findings to be noted in the abstract or in the discussion section of the report. Thus, it would have been appropriate for the Sicher-Targ report to have noted in the discussion section that since only one patient died during their study, it appears that the new drugs being given AIDS patients as part of their standard therapy (triple-drug anti-retroviral therapy) were having a significant effect on longevity. They might even have suggested that their finding warranted further research into the effectiveness of the new drug therapy.

However, in the introductory remarks, the Sicher-Targ report gives the impression that the researchers already knew the new drug therapy would work (making them clairvoyant!) and that is why they changed the design from the earlier pilot study. They now claim they never intended to replicate that study. Instead, they write:

an important intervening medical factor changed the endpoint in the study design. The pilot study was conducted before the introduction of "triple-drug therapy" (simultaneous use of a protease inhibitor and at least two antiretroviral drugs), which has been shown to have a significant effect on mortality. [Here, they cite a study published in September of 1997, which is nine months after their study was supposedly completed! Again, proof of their clairvoyance!] For the replication study (July 1996 through January 1997, shortly after widespread introduction of triple-drug therapy in San Francisco), differences in mortality were not expected and different endpoints were used in the study design.

The above description of why they changed the endpoint is grossly misleading. It was only after they mined the data once the study was completed that they came up with the suggestive and impressive statistics that they present in their published report. Under certain conditions, mining the data would be perfectly acceptable. For example, if the original study was designed to study the effectiveness of a drug on blood pressure but found that the experimental group had no significant decrease in blood pressure but did have a significant increase in HDL (the so-called "good" cholesterol), you would be remiss not to mention this. You would be guilty of deception, however, if you wrote your paper as if your original design was to study the effects of the drug on cholesterol and made no mention of blood pressure.

Thus, it would have been entirely appropriate for Sicher and Targ to have noted in the discussion section of their report that they had discovered something interesting that they hadn't set out to examine: Hospital stays and doctor visits were lower for the DH group. It was inappropriate to write the report as if that was one of the effects the study was designed to measure when this effect was neither looked for nor discovered until Moore, the statistician for the study, began crunching numbers looking for something of statistical significance after the study was completed. Again, crunching numbers and data mining after a study is completed isn't always inappropriate; not mentioning that you rewrote your paper to make it look like it had been designed to crunch those numbers is always wrong. If you engage in such behavior it would be appropriate to ask people who pray to pray for you.

Also, it would have been appropriate in the discussion section of their report to have speculated as to the reason for the statistically significant differences in hospitalizations and days of hospitalization. Sicher and Targ could have speculated that DH made all the difference but, if they were competent, they would have also noted that insurance coverage could make all the difference as well. "Patients with health insurance tend to stay in hospitals longer than uninsured ones" (Bronson 2002). The researchers should have checked this out and reported their findings. Had they been competent researchers and had hospital visits been one of their original data points, they should have pair matched the control and experimental groups for insurance coverage. With such a small study, randomly assigning the patients to their groups isn't sufficient to protect against biasing the sample.

What Sicher did was to take a list of 23 illnesses associated with AIDS and go back over each patient's medical chart to collect data for the 23 illnesses as best he could. This was done after the unblinding of the study, so it was known to Sicher which group each patient had been randomly assigned to, prayer or control. The fact that the names were blacked out, so that he could not immediately tell whose record he was reading, does not seem sufficient to justify allowing him to review the data and still call the study double-blind. There were only 40 patients in the study and he was familiar with each of them. Just looking at their charts could have clued him as to whose chart he was reading. If there was to be data mining, the one who was to go over the medical charts should have been an independent party, someone not involved in the study. Sicher is "an ardent believer in distant healing" and he had put up $7,500 for the pilot study on prayer and mortality (Bronson). His impartiality was clearly compromised. So was the double-blind quality of the study.

Why did they do this? Bronson describes it this way:

Moore brought Targ and Sicher into his office and showed him the data on his computer. Moore thought this new triple-drug therapy was nothing short of a medical miracle, the triumph of science. It was saving lives! But Targ and Sicher didn't want to see it that way. Targ asked him to crunch the numbers on the secondary scores - one a measure of HIV physical symptoms, the other a measure of quality of life. These came out inconclusive; the treatment group didn't score better than the control. Not what they wanted to find. In dismay, Targ called her father [physicist and parapsychologist Russell Targ]. He calmed her down, told her to keep looking. She had Moore run the mood state scores. These came out worse - the treatment group was in more psychological stress than the control group. Same for CD4+ [T cell] counts. Targ flew down to Santa Fe to attend a conference at a Buddhist retreat run by her godmother. When she called back to Moore's office, Sicher answered. Moore was crunching the last data they had, hospital stays and doctor visits. "Looks like we have statistical significance!" Moore announced. Sicher told Targ, who turned and yelled out to her friends at the conference.

Even so, true believers continue to praise the Sicher-Targ report. Some are still promoting Targ's deceptive self-assessment of her work, published in the Noetic Sciences Review (August--November 1999). Here are just a few websites still [as of 4/9/06] promoting the notion that the Sicher-Targ report found evidence for the effects of distant healing:

The Journal of Western Medicine stood by the Sicher-Targ report until it ceased publication in September 2002.*

See also alternative health practice, faith healing, and selection bias.

further reading

A Prayer Before Dying” by Po Bronson (Wired Dec. 2002)

Energy Healing: Looking in All the Wrong Places by Robert Todd Carroll

Distant Healing and Elisabeth Targ by Martin Gardner, Skeptical Inquirer March/April 2001.

Can Prayers Heal? Critics Say Studies Go Past Science's Reach by Benedict Carey, New York Times, October 10, 2004

A Magical Death? by Phillips Stevens, Jr. Skeptical Briefs. Sept. 2003.

Bunk: my comments on a Parade magazine article on the healing power of prayer

Some Thoughts about Faith Healing Stephen Barrett, M.D.

Gary Posner's review of Larry Dossey's Healing Words: The Power of Prayer and the Practice of Medicine (Harper, 1993)

God in the CCU? A critique of the San Francisco hospital study on intercessory prayer and healing Gary P. Posner, M.D.

The Power of Prayer Nicholas Humphrey

If Looks Could Kill and Words Could Heal by Robert Baker (review of Larry Dossey's Healing Words: The Power of Prayer and the Practice of Medicine (Harper, 1993))

Reality Check The Science of Prayer by Victor J. Stenger

"Is there scientific evidence that intercessory prayer speeds medical recovery?" A Debate Transcript of the March 13th, 2001, Debate Between William Harris, PhD, Saint Luke's Hospital, Kansas City, MO, and Irwin Tessman, PhD, Purdue University, West Lafayette, IN

Another Controversial Effort to Establish the Medical Efficacy of Intercessory Prayer by Gary Posner, MD

Studies on Prayer and Healing Flawed - Infidels.org

Last updated 15-Nov-2012

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