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mesmerized by hypnotherapy

December 28, 2007. I was pleased to read my letter to the editor about chiropractic published in the Sacramento Bee today. My letter was in response to an article by the leader of the California Chiropractic Association. In case you don't read the Bee, here's what I wrote:

The president of the California Chiropractic Association says his group is “outraged” that the Bee would support a boycott of chiropractors until the state Board of Chiropractic Examiners cleans up its act. I’m outraged that the Bee doesn’t support an all-out boycott of chiropractors because the profession has been riding on the coattails of anecdotes and the placebo effect ever since the grocer and “magnetic healer” D. D. Palmer announced that “95% of all diseases are caused by displaced vertebrae.” Palmer is the “father” of chiropractic and none of his ideas about disease have been verified by scientific evidence. He claimed to cure deafness by a spinal adjustment even though the ear isn’t connected to the spine!  Many chiropractors today don’t even accept the germ theory of disease.

We’re in the 21st century folks! We know most ailments heal themselves on their own. We know about regression toward the mean and chronic pain. We understand the power of suggestion. We’ve learned a lot about self-deception and communal reinforcement. Yet, many of us still believe in magic and self-promoting stories told by interested parties.

I find it outrageous that chiropractors are “licensed primary care doctors.”

My joy was quickly erased when I saw that one of the features in today's Bee was a panegyric to hypnotherapy. If you've read R. Barker Bausell's Snake Oil Science or my review of this excellent book, you know that hypnotherapy is nearly impossible to distinguish from a placebo. If hypnotherapy is a perfect example of the placebo effect, Bee writer Alison apRoberts's account of the subject is a perfect example of media coverage of medical issues. Her claim that "there is growing evidence from clinical trials that [hypnotherapy] can be effective" is the perfect misleading lead-in for such stories. It deceives not just because of the weasel word 'can,' but because most readers are ignorant of what constitutes a clinical trial. In this case, the claim borders on the absurd. As Bausell notes: both hypnosis and the placebo effect are "so heavily reliant upon the effects of suggestion and belief that it would be hard to imagine how a credible placebo control could ever be devised for a hypnotism study." I was not surprised, however, that apRoberts didn't identify or discuss any of this "growing evidence from clinical trials" and relied exclusively on anecdotes to demonstrate the effectiveness of hypnotherapy.

The article did, however, provide a "sidebar" with the claim: Studies published in mainstream medical journals have found hypnosis to provide relief for those suffering from irritable bowel syndrome, fibromyalgia and cancer. The sidebar also cited as sources the American Society of Clinical Hypnosis and something called the Hypnotist Examining Council. A quick google of the WWW produced one systematic study on the effectiveness of hypnotherapy for the treatment of irritable bowel syndrome. The effectiveness "is uncertain." On the other hand, a search of PubMed found a systematic review of studies on hypnosis and cancer patients. Six randomized control studies were evaluated for the effectiveness of hypnosis in treating chemotherapy-induced nausea and vomiting. In five of these studies the participants were children. "Meta-analysis revealed a large effect size of hypnotic treatment when compared with treatment as usual, and the effect was at least as large as that of cognitive-behavioural therapy." This is what one would expect if the hypnosis were accompanied by elements of cognitive-behavioral therapy or if both were no more effective than a placebo.

Ms. apRoberts provides anecdotes from hypnotherapists and their clients that seem to support the idea that hypnotherapy helps people quit smoking. She may not be aware of the Cochrane systematic review of studies on hypnosis as an aid to quitting smoking. The fact is that there is not enough good evidence to show whether hypnotherapy can help people trying to quit smoking.

The anecdotes provided by apRoberts were vague regarding the details of the treatment, but from what I could gather some therapists are combining elements of cognitive-behavioral therapy (CBT) with hocus pocus hypnosis to help people with behavioral problems like phobias or bad habits. It would be a difficult task to weed out the superfluous baggage of hypnosis from the combined effectiveness of suggestion, cognitive-behavioral therapy, and highly motivated clients who trust their therapists and believe in the therapy. But it shouldn't be too difficult to recognize the difference between anecdotes and good scientific evidence. Nor should it be beyond the ken of a reporter to understand what a clinical trial is, what a placebo is, and why good trials about effective techniques for breaking habits or overcoming phobias should involve controls, be double-blinded and randomized, should note the rate of attrition, should be independently replicated, and should publish their findings in first rate, peer reviewed journals.

While it is true that some hypnotherapists can help some people lose weight, quit smoking, or overcome their fear of flying, it is also true that cognitive-behavioral therapists can do the same without any mumbo-jumbo about trance states or brain waves. There have been many scientific studies on the effectiveness of CBT. For example, one  systematic study found that CBT improves weight loss in people who are overweight or obese. Another systematic study found that CBT appears to be an effective and acceptable treatment for adult out-patients with chronic fatigue syndrome.

One of the people mentioned in a sidebar for apRoberts's article is an important figure in the history of scientific tests involving hypnosis. Here is how the sidebar reads:

One of the more modern pioneers of hypnosis was an 18th century Viennese doctor, Franz Anton Mesmer, who used relaxation and soothing words in a therapy which he called Mesmerism ("mesmerizing" comes from his name, as well).

What the article fails to mention is that Mesmer stumbled upon the power of suggestion by a charismatic character over believing clients. In the beginning he used magnets and magnetized objects to do what today's hypnotists do in the showroom and the clinic, and what faith healers do in tents and churches. With Louis XVIs and Marie Antoinette's help, Mesmer set up a Magnetic Institute where he had his patients do such things as sit with their feet in a fountain of magnetized water while holding cables attached to magnetized trees. He quickly learned that he got the same results without the magnetic props. King Louis was not as fond of Mesmer as was his wife. He set up a scientific commission to investigate his claims, one of which was that he could channel "animal magnetism" (his term for the "energy" he claimed he was directing to bring about his cures) into objects like trees, which would then have curative powers. He was later denounced as a fraud by the French medical establishment and by a commission that included Benjamin Franklin that had performed a rather simple but revealing test involving a "magnetized tree" and a blindfolded 12-year-old boy who was overcome by the force of the energy the farther away from it he traveled.*

Something similar seems to happen with techniques like hypnotherapy: the farther one gets from the science, the more powerful the effect of the therapy.

Finally, we have to remind ourselves that no therapist tells anecdotes about her failures and few reporters seek out people for their testimonials on how they didn't lose weight, quit smoking, or overcome their fear of flying. Who wants to read about failures and losers?

postscript

January 4th is World Hypnotism Day. A press release for the 2008 event claims that it will be a celebration of the Healing Benefits of Hypnosis.

Michael Ellner, who considers himself "an internationally prominent Certified Hypnosis Practitioner and Pain Relief Educator," claims that there is considerable scientific evidence that hypnosis can help reduce, even eliminate pain. He doesn't tell us where this evidence may be found, however. Nor does he give us any clues as to why we should think that hypnotherapy is not just another placebo therapy like acupuncture or homeopathy.

"With the recent spate of bad news about pain killers," he says, "one would think that hypnosis, acupuncture, chiropractic medicine, and other healing arts would take their rightful place in the anthology of pain treatment." Again, he doesn't mention what bad news he's referring to. In any case, I think that the rightful place of the CAM therapies he mentions might be in a museum of questionable therapies. We could put it in the Science Museum of Minnesota down the hall from the Questionable Medical Devices room.

According to Ellner, "There is an urgent need for World Hypnotism Day because there are tens of millions of people who could be helped to feel better, heal faster and be more effective who are not utilizing this safe, effective and affordable approach to relieving both psychic and physical pain." I think the Scientologists are saying the same thing about Scientology, the EMDR therapists are saying the same thing about their work, the anthroposophic folks feel likewise, as do the naturopaths and supplement pushers. All these helpers and so little time to help all these desperate clients!

One of the favored hooks used by hypnotherapists is to complain that the media and the "medical establishment" have been spreading lies about hypnosis. As a result, says Ellner, "many people believe that being hypnotized means losing control when, in fact, hypnosis is about helping people take control."

Yes, and as one hypnotherapist put it: "It is extremely successful when people are willing to change."*

No comment necessary.

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Mesmerized by hypnotherapy - hypnosis, placebos, & pig ignorant about science (CAM) (JS)

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