Positive Health Online

At a recent colloquium organised by the National Federation of Spiritual Healers regarding research into spiritual healing, I was asked to summarise the themes emerging through the day. Initially, it seemed impossible to bring together the keynote presentations, because although the three speakers spoke the same language, they had three quite different ways of thinking about and researching Healing.

The problem reflected some important issues about research into complementary therapies which I wanted to share.

The three classic medical research questions are: 'Can we understand how it works?' 'Does it work in practice?' 'Is it worth it?' The first is about basic processes; in this case, the search for a scientifically acceptable theory for the Healing effect, possibly in terms of an electro-magnetic phenomenon. This is laboratory science and the question could apply equally well to using a bio-physics approach to making sense of homoeopathy or acupuncture meridians.

The gold standard for answering the second question is the clinical trial; randomisation and controls trials are intended to ensure clinical objectivity, whereas comparative cost-effectiveness studies, which simply compare two populations treated differently, provide a method for the third sort of inquiry. These are important questions, but there are many other kinds of fascinating and useful questions that could be asked about Healing. For instance: what is 'good healing' like and what do patients say about their experience and the outcome of having Healing? Questions like these require a different approach: qualitative research. On the other hand, if we want to ask 'what sort of problem is being treated' or 'what is the best way of organising the delivery of a Healing service?' then we would need to use an audit approach.

As I listened to the speakers, it seemed clear that to paint a true picture of Healing a whole palate of research methods would be essential. But is research actually wanted? Many of us remember the Chilvers report into The Bristol Cancer Help Centre's work; how it almost destroyed the Centre and how for a while it made complementary practitioners distrust researchers and suspect their hidden agendas, (justifiably so, since as it transpired, the study was untruthful due to its poor design). However, I think that in the long run this experience has made practitioners all the more keen to understand research methods so that they would not get fooled again.

The benefits of research are three-fold. First, it can add to a practitioner's integrity and the integrity of a therapy, because reflectiveness is part and parcel of professional and personal development. Second, it secures an evidence base about whether a practice truly makes a difference and how it does this. Third, research makes us curious about the human condition, by telling us something about what we are and what we might be. These are statements about the spiritual nature of research: a striving for insight, honesty and inner development.

Are we researching to answer only our own questions, or those of our colleagues, or our patients? Is research done for me, for us or for them? Or, can it, for example, help to define a profession's boundaries and identity (research for us). Do we want research that influences them: doctors, managers, policy makers? In a very real sense research is part of a process whereby we persuade attitudes and even policy to change. At the colloquium, there was a definite feeling that research could help to persuade those who control the way in which health care resources are allocated to recognise the potential of Healing.

And though there is no reason to suppose any immediate threat, there was a feeling too, that Healing will need research-power as a necessary defence from Euro-diktat.

By looking at the personal, professional and political considerations in the light of our three questions ('can it work?', 'does it work in practice?', 'is it worth it?'), we can begin to think about the priorities for research into Healing (and other complementary therapies). So, should the search for basic processes be a priority? Only, I suggest, if it would make the mainstream more likely to take Healing seriously. Cost benefit then? This question puts to one side how or even whether Healing 'works', but simply asks if there is significant health gain and a better use of resources among people given Healing.

It seems that our colloquium had two intertwined themes: on the one hand, it asked which research questions are currently most relevant; on the other, how to be sure that the research done can persuade and protect. Until Healer effectiveness is better understood and the delivery of Healing can be quality assured (I make no apology for this language), it is hard to see how reliable and replicable, generalisable clinical trials can proceed. Answers to some simpler questions are needed first, before we dive into randomised effectiveness research. Understanding best practice, the reasons why people turn to Healing and what they get from it would encourage practitioner development. Moreover, it would add weight to the case for access to Healing and also reassure those concerned that Healers are aiming to raise standards. My feeling is that our priority questions should be what makes a safe and effective practitioner? and equally important why do people use Healing; what is their experience of its impact? Pragmatic action-research involving many practitioners would send out a strong message about reflective practice, competence and professional development. An inquiry into best practice and whether needs are met could involve hundreds of Healers, devolved into small groups, and could even use the Internet to gather and share the information.

Together, these programmes would help to define the professional boundaries of Healing and develop an argument for its relevance to the mainstream. In the current climate, this would, I believe, be more persuasive a defence of Healing's place in healthcare practice than for instance bio-physical research into basic mechanisms or even randomised trials.