What can we learn from the placebo effect?
An article in The Economist this week - "Think yourself better" - examined the effectiveness of alternative medical treatments such as acupuncture, crystal healing, Reiki channelling, and herbal remedies. Alternative medicine a booming business. Survey results released by the US National Institutes of Health found that in 2002 62.1% of adults in the country had used some form of alternative treatment in the past 12 months and 75% across lifespan. Alternative treatments are typically not proven effective using scientific methods, and according to Dr. Edzard Ernst, one of the few to run clinical trials on these treatments, around 95% of these treatments are statistically indistinguishable from placebo treatments. If these treatments are no more effective than a placebo and the high usage rates are increasing, are we looking at a serious public health problem? Maybe. There are certainly cases of alternative treatments that harm the patient, either directly, or more commonly- by replacing more conventional treatments that have been proven effective. However, we should pay attention to what's going on with this placebo effect. There are many examples of this strange phenomena- one example is that telling someone that you are giving him morphine provides more pain relief than saying you are giving him aspirin, even when both are just sugar pills. What's going on here? If we can figure it out, it has great potential to positively impact the medical field. We may be starting to...
In the morphine example, neuroimaging shows that the deception stimulates the production of naturally occurring painkilling chemicals in the brain. Research in other areas has found that placebo treatments are able to affect the autonomic nervous system, which controls heartbeat, blood pressure, and digestion. Wow.
And here's where anyone interacting with patients should especially pay attention- the more positive a doctor is when telling a patient about a placebo, the more likely it is to do that patient good. Practitioners giving alternative treatments tend to do a great job of this. They will often spend a long time consulting with their patient and believe passionately in their treatments. Is this enough in some cases?
I could be convinced. In full disclosure, as much as I hail to evidence-based practices, I've dabbled in the alternative. I spend a lot of time on my yoga mat (though the evidence base for yoga is growing, I'll save that for another post). But my curiosity has led me to go to such extremes as getting a Reiki massage, in which the masseuse transfers healing energy in through her palms. I feel pretty confident in saying that Reiki will never be on the list of EBTs, but I did walk away feeling much more relaxed and positive than my last visit to the doctor's office. Perhaps all clinicians should start taking a few lessons from their alternative counterparts to harness that apparently effective placebo effect.