The journal access question
THE FEBRUARY 2004 article "Debating access to scientific data" presented both sides of an important controversy, but in a skewed fashion. I judged only nine paragraphs supported, while 27 paragraphs opposed, open and free access. Letting the market decide the fate of science's product was presented as the likely outcome in a consensus of opinion from both critics and advocates, but the market is a poor arbiter for such a crucial issue. As scientific fields face information overload accompanied by its increasingly restricted access, I am reminded of similar dynamics in which managed care has staked restrictive claims based on so-called market forces.
Just as most psychologists would likely agree that adequate mental health care should be available to all who need it without profit-driven constraints, similarly scientific information should be made openly available, not just to privileged consumers with elitist access (e.g., to restricted databases).
APA, as a major player in the knowledge business, has vested economic interests here, and this article's slant unfortunately seems biased in this direction. I note that it is important to recognize that communication is a two-way process involving both sender and receiver. Though the current system may offer benefits to some producers and disseminators of knowledge, it greatly disadvantages many potential recipients--and both are equally necessary for successful scientific communication.
Just as most psychologists think managed care is a bad deal for mental health consumers and providers, I think most psychologists should conclude that managed information, like managed care, is best avoided.
HARRIS FRIEDMAN, PHD
Saybrook Graduate School
More on obesity
WE WERE PLEASED BY Charlotte Huff's attention to the Trevose Behavior Modification Program ("Teaming up to drop pounds," January Monitor). It is necessary, however, to correct a serious error in the unfavorable comparison of the results from an examination of the Trevose program (Latner et al., 2000) with the results from a recent study of Weight Watchers (Heshka et al., 2003). Ms. Huff claimed that the retention rate in treatment after two years in the Weight Watchers study was "nearly three fourths," far higher than the "just under half" in the Trevose program.
In fact, the Weight Watchers "retention" rate was not for retention or participation in treatment but for university clinic visits, for which participants received generous financial compensation. Treatment attendance was assessed only through self-report, despite the notorious unreliability of self-report data.
Doubts about the retention rates in Weight Watchers programs are heightened by the two studies that have measured actual retention in Weight Watchers. One found that attrition was 50 percent at six weeks and 70 percent at 12 weeks (Volkmar et al., 1981) while the other found that 33 percent of enrollees dropped out between the first and second meetings (Lowe at al., 1999).
Attendance and weight data in the Trevose program were collected at weekly weigh-ins as part of the program's routine operating procedure. This retention rate (47 percent at two years) is as high as any in the literature, and the mean weight loss of 40 pounds is the highest.
JANET D. LATNER, PHD
University of Canterbury
ALBERT J. STUNKARD, MD
University of Pennsylvania
WE AGREE ON THE TIMELINESS and importance of discussing psychological treatment for weight loss, but were disappointed that the article by Leigh E. Rich ("Bringing more effective tools to the weight-loss table," January Monitor), while mentioning the benefits of cognitive behavioral therapy (CBT) and specific techniques like meditation, did not make any reference to the use of hypnosis as an adjunct to CBT and other therapies. Meta-analyses by Irving Kirsch and his collaborators have unequivocally shown the advantages of including hypnotic techniques for weight loss--unparalleled by any other adjunctive technique. For instance, Irving Kirsch, PhD, in 1996 in the Journal of Consulting and Clinical Psychology (Vol. 64, No. 3) found that across studies mean weight loss at the last assessment was 6.03 pounds without hypnosis and 14.88 pounds with hypnosis, and that the benefits of adding hypnosis significantly increased over time.
Following the Surgeon General's plea at the APA Convention in Toronto, we should offer every tool and intervention we can muster to combat this serious epidemic.
ETZEL CARDEÑA, PHD
FRANK DEPIANO, PHD
JOSEPH GREEN, PHD
DAVID HERL, PHD
IRVING KIRSCH, PHD
SHIRLEY McNEIL, PHD
Div. 30 (Society of Psychological Hypnosis)