We continue to stand by what we feel is a reasonably cautious and conservative interpretation of the findings. Because 57% of the trials we examined did show a significant effect on at least one outcome (and the overall pooled effect size was significant), we do feel that, at a minimum, additional research should be carried out in these areas. While it is true that the results were not uniformly positive, the mathematical odds (based on a simple binomial test) that 13 of 23 studies would show a significant treatment effect (P < 0.05) are greater than 1 in a million. It is therefore unlikely that these results are due to chance alone. However, as we noted, it is true that the single-blind designs used in the Therapeutic Touch studies cannot entirely rule out a placebo effect (although the designs in the other trials did theoretically rule out such an explanation because patients had no presumable way to know whether they were receiving distant healing). As we note in our paper, several studies had some methodologic problems. However, overall the trials we reviewed were judged to be of fairly high methodologic quality (1). With regard to the specific issues concerning two of the prayer studies, we refer readers to a recent exchange (2, 3) about these matters.

If we understand Dr. Kaptchuk correctly, he is right in stating that in many cases no amount of empirical evidence is sufficient to change one's prior beliefs, particularly if such beliefs are held to strongly. This appears to be the case whether such evidence refutes a layperson's belief based, say, on faith (for example, "my religion is true") or a scientist's skepticism that something (such as distant healing or homeopathy) is not possible. (Ironically, although scientists frequently argue that their lack of belief in certain phenomena is based on reason and rationality, such skepticism shares much in common with religious dogma in that it is based largely on a set of untested assumptions and is not easily refuted by contradictory evidence.) Understanding the complex reasons underlying people's unwillingness to alter their perspectives even in the face of evidence is of paramount importance because oftentimes (whether in medical science or in our personal lives), only by letting go of previously held beliefs can new learning and discovery ever take place.