Facilitated Communication with Coma Patient Is a Sham

Facilitated Communication with
Coma Patient Is a Sham

Prof. Dr. Willem Betz

Tests by the Belgian skeptical organization SKEPP have confirmed that the "facilitated communication" with Rom Houben—a Belgian man who allegedly was trapped in his body for 23 years—was wishful thinking. Neurologist Dr. Steven Laureys and his team, who presented Houben’s case in the international press in November 2009, seem to have rushed to premature conclusions.

According to his doctors, Houben has been in a persistent vegetative state (PVS) for over 20 years. In November 2009, however, Dr. Laureys declared that three years ago Houben's PET-scans had shown signs of consciousness in his brain and that he was now able to communicate. All over the world, video footage showed Houben fluently typing complex messages with one finger with the help of a "facilitator." This trained assistant guided Houben's hand over a keyboard, supposedly feeling and amplifying the patient’s tiny intentional movements. In interviews, Dr. Laureys claimed that his scans have shown that up to 40% of patients, previously diagnosed with PVS, were trapped in a paralyzed body and could be “released."

Many commentators expressed disbelief, and so did SKEPP, for several reasons, medical and others. Facilitated communication (FC) has long been discredited. Controlled experiments have consistently demonstrated that the facilitator always directs the "conversation." In The Times and Der Spiegel, Dr. Laureys claimed that he had performed controlled experiments, which had convinced him of the reliability of FC. Later he expressed doubts and planned new tests, but by then the news of the miraculous rebirth after 23 years had already circulated the globe.

Testing FC is actually quite simple. On February 4, 2010, at the request of the medical institution where Houben is cared for, SKEPP was present as advisor for a planned test, and we also conducted our own tests. From the institute's staff, we learned that during two years, all attempts to establish any form of communication with the patient by detecting and coding tiny movements of the eyes or any other body part had failed, but with FC he seemed to produce correct words and elaborate sentences. Indeed, his answers to our simple test questions were intelligible and sometimes elaborate, but when the facilitator was prevented from hearing the questions, Houben's answers were completely wrong; and when the keyboard was shielded from the facilitator’s view, the typing produced gibberish and halted. There clearly was no communication with the patient, only with the facilitator.

Our intent was to not to test Houben, but to test FC—and once more we demonstrated that the method is a sham. This is not to deny that he may have some limited consciousness. After our test we had a long conversation with Dr. Laureys. He insisted that we test more facilitators before drawing conclusions. We declined and advised him to clearly distance himself from the FC scam. Out of respect and to allow them time to discuss the results with the family and the dedicated staff, we agreed on a 2-week embargo before making the results of our test public. Of course, not everyone is convinced yet. In a phone conversation, Houben’s mother told us that she still believes in FC, because “sometimes it had produced answers that only her son could have known.” She is convinced that Dr. Laureys will ultimately find a method to communicate with her son. His team is experimenting with other methods. Let's hope her wish comes true.

The international news coverage of this case has given many relatives of coma patients false hope, and the advocates of the illusionary facilitated communication got an undeserved publicity boost. The emotional impact on patients’ families can't be underestimated. To say the least, the decision to present this case before the international media was premature.

Note from Dr Stephen Barrett

Although simple tests would have revealed the hoax, reporters failed to request them. The The Skeptic's Dictionary has posted an excellent article about FC and the tests that could have been done.

CNN's sensational report—Trapped 'coma' man: How was he misdiagnosed?—remains posted in its health section and on the "Anderson Cooper 360" blog. On February 25, I sent the following message through the Cooper blog with the link to Dr. Betz's report:≠

How about telling CNN viewers that the "coma man" communication was a hoax? Proper testing two weeks ago demonstrated that when the facilitator didn't know what questions Rom Houben was asked or when she couldn't see the keyboard, his "facilitated" typing was gibberish. You should have suspected this but, instead, you headlined the story repeatedly.

It will be interesting to see whether CNN is willing to admit that it goofed.

Dr. Betz is professor emeritus and former head of the department of family medicine at Brussels University. He also chairs SKEPP, the Belgian Flemish skeptics organization.

This page was posted on February 25, 2010.