Professional Caregiver Insurance Risk and Emily Rosa's article on Therapeutic Touch
I posted the following message to the Martha E. Rogers listserver today in commemoration of the 15th anniversary of the publishing of one of the worst articles to ever appear in the Journal of the American Medical Association...
"Today marks the 15th anniversary of the publication of Emily Rosa's JAMA article:
"A Close Look at Therapeutic Touch
It seems a fitting day to reflect on praxis in nursing.
Despite the fact that it has been 15 years since the article was
published and since I offered my first critique of it the next day, the
sad truth is that JAMA still has not rescinded the article.
The why behind that is, I think, pause for reflection.
JAMA hasn't rescinded the article for one very good reason. Most of its
readers, and apparently the TT community, still do not understand what
is wrong with the article and why it ought to be rescinded.
The article should have been rescinded because it made no sense. The
authors claimed that the Therapeutic Touch Practitioners failed to
perform well in what they thought of as a simple matter of guessing
whether or not a hand was present when the probability of a correct
answer was 0.5000.
But random guessing, when the probability of a success is 0.5000 does
not produce low scores - it produces scores close to 50% correct. The
JAMA group were so intent on discrediting their test subjects' skills
that they fudged the data to so great a degree that the subjects'
combined test scores were inconsistent with random guessing.
In addition, as I described in my articles, the authors presented two
different numbers for the number of correct responses in 280 trials.
That, from a purely logical and mathematical perspective, is known as
self-contradiction.
Between the fact that their two reported count of correct answers were
inconsistent and their own statistical tests produced answers
inconsistent with their conclusions, those who should be most invested
in compelling JAMA to rescind the article and take it out of circulation
have failed to do so.
Why is that?
As it turns out, and certainly not what I was thinking back on April 2,
1998, the answer to that question is critically important. The
Therapeutic Touch article, my two major articles about it [Cox, T.
2004). Transgressing the boundaries of science: Glazer, scepticism, and
Emily's experiment
The core problem with the Rosa article was that the average number of
correct responses was lower than one would expect to see when random
guessers simply guess between two equally likely answers.
The problem with our health care finance system is that people confuse
the advantage insurers have - that their average claim size (or loss
ratio) is close to the average claim size (or loss ratio) for the
population from which their policyholders were selected - with the
advantage that a competing business has when it can reduce the costs of
the products/services it markets.
A perfectly efficient, infinitely large insurer has an average claim
size (or loss ratio) that is exactly equal to the the average claim size
(or loss ratio) for the population from which their policyholders were
selected. No insurer can consistently pay all the legitimate claims of
its policyholders AND consistently produce loss ratios lower than
average.
Despite this, the ongoing dialogue on health care (finance) system
reform assumes that capitation can achieve exactly this goal: Reducing
costs and maintaining service quality and quantity. Well known advocates
of this thinking include Sen. John McCain and Rep. Paul Ryan but there
are tons of others of both major political parties.
Despite the same absurdity involved in the failure to compel JAMA to
rescind approval for "A Close Look at Therapeutic Touch" nurses continue
to labor in health care facilities that are trying to do the impossible:
Manage the health insurance risks of their patients and maintain the
quality of nursing care.
Which brings to mind the question: If the largest professional group in
the health care sector does not understand the impossibility of what we
are being asked to accomplish on a daily basis, are we doing enough to
understand the true context of contemporary nursing care?
I think not, but then I am just a "Bear"."
posted by Thomas Cox PhD, RN @ 1:29 PM
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