This post is part of a series of guest posts on GPS by the undergraduate and graduate students in my Science vs. Pseudoscience course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Pseudoscience.” To that end, each student has to prepare two 1,000ish word posts on a particular pseudoscience topic, as well as run a booth on-campus to help reach people physically about the topic.
Placebos and Complementary & Alternative Medicine by Alisa Huskey
Sarah, a successful writer, producer, and actress, developed breast cancer at just 39 years old. She chose not to seek attention from conventional medicine, but instead turned to various alternative remedies, including homeopathy, yoga, acupuncture, and Johrei (a Japanese spiritual therapy). According to her husband, Paul, “she refused chemotherapy because she knew it would finish her off.” After having many negative experiences with conventional health providers, she decided to try and allow her body to “heal itself.” In addition to the alternative approaches, Sarah and Paul incorporated nutritional therapy, meditation, and positive thinking into their everyday lives. Sarah reported that she and her husband were “healthier than [they had] been for years.”
Sarah Parkinson decided she wanted to let her body heal itself, and her general health showed an improvement (at least according to her). Does the body actually have the capacity to heal itself, or did she simply see what she expected to see? The various alternative remedies Sarah used in an attempt to rid her body of cancer – specifically, homeopathy, acupuncture, and Johrei – have never been shown to cure cancer, or any other major illness for that matter. However, there have been many positive outcomes from these remedies for various ailments. In fact, various alternative remedies have been linked with some significant health improvements. That must mean they work, right?
The answer, as it so often is in life, is it depends. The placebo effect results from a number of variables including the people using them, prescribing them, selling them, and often, the relationship between these variables. Simply because a remedy is linked with improved symptoms does not mean it is the cause of the improvement. To assume so would be a logical error known as the correlation-causation fallacy. The question as to how these remedies continue to have positive effects seems to boil down to one thing: the placebo effect. The Skeptic’s Dictionary defines the placebo effect as “the measurable, observable, or felt improvement in health or behavior not attributable to a medication or invasive treatment that has been administered.” This definition aligns in some ways with the outcome of alternative treatments, such as the ones Sarah used. Alternative remedies are a form of pseudoscience, meaning they can look very similar to real science, but continue to fail or avoid the scientific scrutiny to which conventional medicine is subjected.
Because these types of treatment fall outside of the regulatory administration (e.g. the FDA in the United States) they are able to practice under the misleading guise of complementary and alternative medicine (CAM). Interestingly, acupuncture is somewhat of an exception, having undergone a number of scientific investigations. However, the mechanisms actually causing the improvement remain unclear, and often fail to outperform placebo treatments. Thus, acupuncture is still classified as CAM. Acupuncture is an ancient Chinese therapy used to realign the body’s “Qi” by placing very small needles into specific areas of the skin. It is based upon a philosophy that purports the bodies’ energy (Qi) alignment, or lack thereof, is the source of health and wellness. The systematic placements of the acupuncture needles in the meridians of the body supposedly realign the energy, thus alleviating ailments. Subjecting ancient beliefs and philosophies to scientific investigation is not exactly feasible. However, examination of the practice of acupuncture is.
Meta-analyses investigating the efficacy of acupuncture therapy in comparison with a placebo group have shown small to moderate differences in amelioration of symptoms between control and treatment groups. A placebo acupuncture treatment can be administered either by placing the needles unsystematically (not according to the tradition protocol) or by using apparati that look and feel like the actual needles. Researchers in this area are attempting to examine the mechanisms involved in the positive outcomes, not establish the legitimacy of an ancient philosphy. Because acupuncture therapy is often used as an analgesic, the gate control theory of pain is implicated as a possible mechanism in pain relief due to this treatment. The gate control theory describes the sensation of pain as a function of large and small nerve fibers in an opponent process that ultimately determines whether or not pain is felt. Essentially, the pain gate is opened when the number of small fibers (activators) is greater than large fibers (inhibitors). This phenomenon describes why rubbing your head after hitting it on a sharp corner helps relieve the pain; it provides stimulation that “distracts” from the sharper pain by creating competing signals trying to communicate to the brain. Likewise, researchers suggest that acupuncture may provide this same kind of distraction from various types of pain, even chronic.
Research on acupuncture illuminates the fact that there are many alternative explanations for how and why the placebo effect can be so powerful. Placebo groups in acupuncture research have effectively established that the treatment does not help by realigning the body’s Qi through energy points (meridians). In fact, it may be no more effective than a plain old massage for symptoms of pain. There are various ways in which placebos relieve pain, depression, anxiety, and countless other symptoms. The doctor-patient relationship has been shown to be a large contributor to the effectiveness of treatment in general, not just with placebos. In a conventional doctor’s office or health clinic, the average time a patient gets to spend with their doctor is only 8 minutes per visit. Many of the alternative medicines are not harnessed with the burdens of insurance and an overcrowded appointment book. The more time spent with a patient typically equals a stronger, more trusting relationship. Thus, if a doctor exemplifies a hopeful prognosis for a patient based upon a particular treatment, the expectations of the patient will also be hopeful. One article addressing how and why placebos work states “when someone believes that they are going to get better no matter what the treatment is, they have a higher probability in doing so.” Sarah’s story can attest the importance of the doctor-patient relationship. After several bad experiences with her health practitioners, she completely turned her back on conventional medicine, and she began to see improvement in her health when her treatment related expectations changed positively.
Along with the benefits that come with placebo treatments, come a host of ethical issues for practitioners. Sarah Parkinson sought out alternative practitioners to aid in her recovery from cancer. As an adult, one has the right to seek their own preferred type of healthcare. However, the ethical responsibility lies on the shoulders of the practitioners. Offering (and billing for) remedies and treatments that have either been shown to be ineffective, no better than placebo, or that have not been scientifically examined provides an ethical dilemma. The most common question that arises in response to pseudoscientific treatments based upon the placebo effect is what’s the harm? If they are working, then why not use them? There are a number of harms, in fact.
Returning back to the opening story, Sarah Parkinson, chose not to use conventional medicine for her breast cancer. The alternative treatments, including acupuncture, provided her with relief from some of her symptoms and a healthier lifestyle. However, it did not save her life. The conventional medicine may have provided her with a few more years. The American Cancer Society reports a 5 year survival rate of 93% of individuals who are diagnosed with breast cancer at stage 2, and 72% at stage3. Based on these statistics, she probably had a better chance if she actually sought treatment. Although many alternative medicine practitioners do not have malicious intentions towards their patients, their remedies and philosophies behind them can be damaging. Embracing placebo (alternative/complementary) and rejecting conventional medicine (backed by years of science) entirely should never be a viable option. After all, alternative medicine that becomes scientifically supported is no longer alternative medicine; it’s just medicine.