In my blog posting, titled Alternative Medicine – Important Questions, I commented on how alternative therapies are becoming increasingly common. All therapies can be divided into three groups, those that are beneficial, those that really do nothing, other than costing time and money, and those that cause harm. With respect to seeking out advice on alternative therapies I ask the questions, “Is the advice good?” and “How do we decide?” Then in my blog posting, titled Alternative Medicine – Testimonials Natural History and Secondary Gain, recognizing many seek out evidence a therapy may work before embracing it, I looked at testimonials. Testimonials are kind of evidence commonly used to lend support to many alternative therapies. I addressed the fact testimonials do not prove that a therapy really works. One of the reasons for this is that many problems tend to get better, or at least improve, over time no matter what therapy is applied. This is due to the natural history of many medical problems, which is to improve over time. Next, we need to consider what kind of evidence provides some proof a therapy really does something useful. Before continuing, we need to consider the placebo effect.
The placebo effect is when a therapy is associated with improvement even when there is no physical basis for the therapy to bring about improvement. The placebo effect improvement is over and above improvement expected based on the natural history of the condition being treated.
The placebo effect was recognized a number of years ago. A review of evidence in the Journal of the American Medical Association in 1955 says,
It is evident that placebos have a high degree of therapeutic effectiveness in treating subjective responses, decided improvement, interpreted under the unknowns technique as a real therapeutic effect, being produced in 35.2 +/- 2.2% of cases. This is shown in over 1000 patients in 15 studies covering a wide variety of areas: wound pain, the pain of angina pectoris, headache, nausea, phenomena related to cough and to drug-induced mood changes, anxiety and tension, and finally to common cold, a wide spread of human ailments where subjective factors enter.[1]
It is also pointed out that placebos have the greatest positive effect when the stress is the greatest. The review also says,
When subjective responses, symptoms, are under study, it is apparent that the high order of effectiveness of placebos must be recognized.
People taking placebos may also report significant side effects, even though there is no physical basis to explain their experience.
At least part of the effect experienced with using a placebo (a therapy were there is no physical basis to explain the results) is associated with the belief that a therapy is likely to help. What may be even more important, in the area of health related therapies, is the experience that the person applying or offering the therapy really cares and is willing to do what it takes to help.
In light of the placebo effect, in order to know if a therapy causes benefit the size of the benefit observed needs to be greater than the size of the effect of a placebo used to treat the same condition.
The placebo effect can be used by a therapist for financial gain or to gain notoriety. If the therapist deals with problems that have significant subjective symptoms[2] and is able to demonstrate a caring attitude, then a therapy does not need to have any direct way to cause any real physical change. Based on presenting the therapy with a caring attitude, alone with the patients belief that it will work, the therapy has a 33% likelihood of results that will be satisfying to the patient. Whatever the therapy, as long as it is placebo like and has no direct way of causing harm, the therapist will likely to get positive results in at least one third of those treated. This third is likely to come back to the therapist for more treatment. Those who get worse are not likely to return. Due to those with positive results returning and those with negative results staying away, the therapist is likely to end up with a following of patients where more than 50% will have positive results. Those with positive results will tent to promote the therapist and therapy to other people. So, it is possible for a therapist, with a caring attitude and a belief in what they are doing, to do very well even if the therapies they promote have no more physical basis to bring about change than that of a placebo.
There are some things to consider from a Christian point of view. Biblicallv, mankind is more than just physical. We are body and soul. To what extent is the placebo effect due to the the non-physical part of us? Before answering this question, we need to consider something of the supernatural. Hopefully, I can consider alternative medicine and the supernatural in a blog posting in the near future.
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-this blog posting is part of a series – the next in the series, Alternative Medicine – and the Supernatural
-for more on Alternative Medicine and the placebo effect read posting titled, Alternative Medicine – Placebo, What’s Wrong With That?
-the first posting in this series – Alternative Medicine – Important Questions
-For all postings on Alternative Medicine – Alternative Medicine Postings Page
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[1] Henry Beecher, The Powerful Placebo, JAMA, Dec 24, 1995, Vol 159, No. 17. p 1606. (The Powerful Placebo)
[2] Subjective symptoms are symptoms that are, in some way, based on reporting by the patient, as compared to “objective symptoms” that are those that can be measured totally independent of what the patient reports.