• Placebos and Complementary & Alternative Medicine

    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.

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    Placebos and Complementary & Alternative Medicine  by Alisa Huskey

    Sarah Parkinson & husband Paul Merton

    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.

    Category: HealthMedicinePseudoscienceScienceTeaching

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    Article by: Caleb Lack

    Caleb Lack is the author of "Great Plains Skeptic" on SIN, as well as a clinical psychologist, professor, and researcher. His website contains many more exciting details, visit it at www.caleblack.com

    2 Pingbacks/Trackbacks

    • intuitiveacuity

      The placebo effect seems to only be really effective when whats wrong with you isn’t all that serious. Anything else that gets chalked up to the placebo effect (such as spontaneous remission of cancer) is likely not due to some placebo effect, but rather due to an unknown environmental or internal stimulus. Novel interactions between cancer and variants of the herpes virus, for example, can result in the reduction of tumor size or provoke outright remission of cancer growth. Events like this are neither miraculous nor explained by the placebo effect (which can, in this context, be seen as the power of positive thought), but the absence of an observed causal mechanism requires us to simply refer to it as the placebo effect. In short, the power of positive thinking is probably helpful in fighting off medical issues (at least it can’t hurt) but almost without exception the power of positive thinking is no cure.

      • Smenotti

        Yes. All the things you just said.

    • psychodawn93

      The placebo effect of alternative medicine does shoe the power of the human mind over some aspects of our health and well being. A positive attitude does help a person to feel better faster, but it won’t cure things like cancer. Usually alternative medicines are used in connection with traditional medicine, but in some instances like Sarah in the article, they are used in place of traditional medicine which can have catastrophic results. Should the government regulate these types of therapies or should adults be allowed to do what they please? Maybe adults should be allowed to do what they want if proper disclosure is made by the people providing these services, but there are instances where children are denied traditional medical procedures that could save their lives because of parents who chose alternative medicine. These are the instances where the government should (and usually do) step in. Sometimes we humans have to be saved from ourselves and educating the general public about these types of pseudosciences is one of the best methods of doing just that.

      • Thomas Taylor

        The cases of children being denied medical treatment by their parents should be handled as neglect charges. It is common in the legal system for children to have a lawyer assigned to represent their best interest in custody hearings and child support cases so why is it seen as a negative to intervene on medical neglect? As far as the treatments go, maybe we should have a federally managed, easily accessible, free database that all treatments are required to submit to? Seems that this would fix many issues that plague society today as parents would be able to look up the treatment and see the science linked to it. They could even make an app to search it on your cell phone.

    • CathlinaSmith

      I had an aunt that was diagnosed with cancer. As the family sat around the table, I was shocked to find out how many of my family members suggested treating it with acupuncture. If she had done that, she would have been dead. When it comes to healthcare, sometimes the placebo effect does work but those are not serious cases. Even then, real medicine has real results. Good post.

    • narges30

      I think when someone give up, they may try for other things (placebo) rather than real things. If Sarah Parkinson thought her body should heal itself, why she did not think her body damaged itself, and she should do something about it.

    • Ryan Danger McCall

      The placebo effect can be very effective. However, we must be careful when distinguishing the placebo effect from an actually effect. I read a book that was recommended by a professor that included a chapter on acupuncture and the great healing powers it has. The teacher was in support of this book and acupuncture. I have know doubt that practices such as meditation and relaxation can have great effects on the body, but it is a placebo effect. Perhaps a person can enter a meditation like state with acupuncture to help them relax. That seems plausible. But to heal cancer or other illnesses, I think I’ll just stick to medicine.

    • Alexa Riffe

      Here lately i have been extrememly curious about the placebo effect. It is quite puzzeling how the different variables align to make the placebo effect so effective. I actually have heard a testimony from a woman I see at my gym and she too had breast cancer. The testimonies are very intriguing and do make the alternative medicines seem highly effective in treating illness although they have never been proven to treat illness.

    • vivianjingjing

      The psychosomatic disease is different from physical disease, emphasis on the part of mental. Many people begin to pay attention to mental healthy and believe that it could regulate the situation of our body. So the placebo effect of alternative medicine is indeed effective for some person.

    • Adam Braly

      It always breaks my heart to hear that individuals suffer through mortal illness by taking advantage of the wide variety of alternative treatments rather than conventional medicine. Often, people around me address “medical” techniques like acupuncture and chiropractic medicine as if they are a sufficient means to alleviate physical pain. Even after explaining how placebo effects work, the probability of them working, and the fact that methods such as these should not be taken seriously, they still seem to favor the notion that they got better regardless. It seems even in the face of placebo effects we are still wary to toss aside bullshit medicine.

      “60 percent of the time, it works every time!”

    • JazzySmall

      In a scene from the movie “This Is 40”, the couple’s youngest daughter gets sick with an ear infection. The wife decides that the young girl should see an “alternative” specialist, but the husband decides to take their daughter to a quote, “real doctor” and not a “witch doctor.” The need to have a positive outlook during sickness is vital, and it’s true that excessive worrying can make a person sick. However, the placebo effect should be used in addition to scientifically proven medicine, not as a replacement.

    • dandymandyl

      I think its sad how many people have been sucked into things like this and have either had their lives cut short, or have suffered more than they needed to because of believing in things like alternative medicine.

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    • Grace Armstrong

      very informative

    • Grace Armstrong

      I’ve been using alternative medicine since I a friend of mine introduce it. Since 2013 of using it, it relieves my severe migraine and you know how painful it could be. I couldn’t be more thankful being introduced to this.

      • I think it’s incredibly important for people to understand how we can know if something does or does not work.