I stumbled upon a very interesting programme on BBC Radio 4, entitled "Is Surgery Scientific?". It posed a question about the nature of surgery and the ways in which it has been and could be researched that was very pertinent to those looking to undertake research in many fields of complementary medicine, especially hypnotherapy.
The point being made was that surgery is more an art/craft than it is a science and that, as such, each operation is different. This is because each surgeon will have their own particular way of performing even the most routine of procedures and because each patient is unique. Furthermore, throughout a surgeon's career, he/she will be continually refining their techniques; sometimes making minor modifications and sometimes making changes large enough for them to publish as an alternative approach to current routines. Consequently, it is virtually impossible to undertake comparative trials of techniques (across time for an individual surgeon or between surgeons) and each surgeon will make his/her choice based on the individual client in front of them, and on their own experience with a particular operation. Most surgeons argue that such, individually-made decisions are essential in order to maximise success. They argue, therefore, that randomised trials are unethical because they do not involve making treatment decisions on the basis of what they believe is best for the patient. Consequently, randomised trials are uncommon in surgery. Furthermore, modifications to surgical procedures can be made and implemented by individual surgeons without trialling and testing, unlike modifications made to drugs which can take 6-7 years to be allowed to be available to patients.
It struck me that the difficulty in making surgery subject to scientific study had parallels with my own field of hypnotherapy. Hypnotherapists also modify standard methods, according to their own skillset and experience and any experienced hypnotherapist acknowledges that no two clients are alike. Whether seeking therapy to stop smoking, lose weight or to deal with anxiety, each client will have some aspect of their issue that is unique to them. What's more, the relationship between client and therapist is critical to the way hypnotherapy goes and will differ with each client and with each therapist.
The programme suggested that the current approach in surgery of publishing series of individual case studies for a procedure was bad science as such case series have no hypnothesis to test and are always retrospective. One conclusion of the radio programme was that it might need to be accepted that the randomised trial approach, developed largely for the testing of pharmaceutical treatments, was not the be-all-and-end-all, and should not be assumed to apply to all areas of medicine, certainly not to surgery. A different approach of setting up registries was suggested in which all approaches and outcomes are recorded and accessible for broader analysis through a registry database.
It struck me that we are in a very similar position in hypnotherapy. An approach which attempts to copy the randomised trials used in drug trials ignores the art/craft angle of hypnotherapy. It is not a true test of hypnotherapy if exactly the same script is used in exactly the same way to a group of people labelled with a particular issue, because that's not how it 's done (at least not by well-trained, experienced hypnotherapists). Each client needs to receive a 'script' which takes into account aspects such as their language patterns, their drivers, their world view, etc. If this isn't done, successful outcomes are unlikely for the majority of them. This is not to say we do not need good, solid research in our field; far from it. However, as a profession we need to accept that the randomised trial approach may not be appropriate and so should not feel obliged to be shoe-horned into going down a model of trialling which was never intended for areas of treatment which have to be individually based. We are clearly in good company and could learn much from the approaches being developed by surgeons -- let's broaden our search for research methods and watch their development.
"Is Surgery Scientific?" is available on BBC iPlayer at http://www.bbc.co.uk/iplayer/episode/b00zshp3/Is_Surgery_Scientific/