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 " Linda Rosa, BSN, RN; Emily Rosa; Larry Sarner; Stephen Barrett, MD JAMA. 1998;279(13):1005-1010. doi:10.1001/jama.279.13.1005

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was published and since I offered my first critique of it the next day, the sad truth is that JAMA still has not rescinded the article.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JAMA hasn't rescinded the article for one very good reason.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readers, and apparently the TT community, still do not understand what is wrong with the article and why it ought to be rescinded.

The article should have been rescinded because it made no sense.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 , Nursing Philosophy, 5: 75-78. and Cox, T. (2003). A nurse-statistician reanalyzes data from the Rosa therapeutic touch study , Journal of Alternative Therapies in Health and Medicine, 9(1): 58-64.) and my work on Professional Caregiver Insurance Risk, and my book: Standard Errors: Our Failing Health Care (Finance) Systems And How To Fix Them" (http://www.standarderrors.org ) describe exactly the same flaw in reasoning that is destroying the nursing profession and our health care (finance) systems.

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"."