Jul 28 2009
Alternative medicine by definition is medicine that has not been shown to work any better than placebo. Patients think they are helped by alternative medicine. Placebos, by definition, do “please” patients. We would all like to please our patients, but we don’t want to lie to them. Is there a compromise? Is there a way we can ethically elicit the same placebo response that alternative theorists elicit by telling their patients fairy tales about qi, subluxations, or the memory of water?
Psychiatrist Morgan Levy has written a book entitled Placebo Medicine. It’s available free online. In it, he makes an intriguing case for incorporating the best alternative medicine placebo treatments into mainstream medicine.
In a light, entertaining style, he covers the placebo effect, suggestibility, and the foibles of the human thought processes that allow us to believe a treatment works when it doesn’t.
“Thinking like a human” is not a logical way to think but it is not a stupid way to think either. You could say that our thinking is intelligently illogical. Millions of years of evolution did not result in humans that think like a computer. It is precisely because we think in an intelligently illogical way that our predecessors were able to survive… [by acting on quick assumptions rather than waiting for comprehensive, definitive data]… We have evolved to survive, not to play chess.
He offers evidence from scientific studies indicating that belief in a treatment and the power of suggestion can have actual physiologic consequences such as production of endorphins or changes on brain imaging studies. He spices his narrative with colorful stories, including anecdotes from his own sex life and an impassioned plea (tongue in cheek?) for everyone to drink coffee for its proven benefits.
He gives examples (10 each) of three groups of treatments that elicit the placebo effect:
• Herbs and spices, (Bach’s flower remedies, Gingko, Echinacea, etc.)
• Misused therapies (chelation, colonic irrigation, fish oil, etc.)
• Totally fake treatments (acupuncture, homeopathy, ear candles, etc.)
He explains that some of these treatments do have real therapeutic effects, but they are being marketed for claims that are not the same as those real effects, or the real effects are too mild to support the claims.
“Placebo” is commonly thought of as a synonym for “ineffective” but it actually describes a therapeutic phenomenon that is very real and can be quite effective.
The mechanism of action involves the way we think about therapy rather than any actual effect of the therapy.
What if we told a patient:
I’m sending you to a Placebo Medicine specialist who will administer magnetic therapy. This therapy will have no real physiologic effect. However, if you carefully follow the direction of the magno-therapist and fully buy into what he or she is saying, then your brain will produce endorphins that will relieve the pain in your elbow.
This might work even better if we used Levy’s suggested term “Non-Pharmacological Intervention” or NPI instead of using the word “placebo.”
We could select patients by testing with suggestibility and psychosomatic instruments. We could tell the patient that he is fortunate because “Considering your scores on these scales you have a high probability of responding well to NPI treatments.”
What if scientific medicine were to co-opt the CAM movement? We could take these treatments out of the hands of the less ethical practitioners and outright scam artists and place it in the hands of those who are more likely to be altruistic. The truly altruistic practitioners could work within official guidelines. The charlatans would no longer be able to paint conventional medicine as the enemy. Family doctors would get to use placebos again. It would be a win-win situation.
If an acupuncturist is willing to use sham acupuncture and they don’t mind the patient being fully informed and they don’t cost too much, then I would gladly make referrals… I think that I could select an appropriate patient, perhaps one of my more somatic individuals, and educate them about the placebo effect. I would tell them how it can facilitate the brain to produce naturally occurring endorphins. I would refer patients for chronic idiopathic pain or for nausea and I would encourage them to fully buy into the story that the acupuncturist tells. I would say that the more they are able to do this the better it will work. Finally, I would follow the patient up afterwards.
I’m not entirely convinced, but I wonder if Dr. Levy might just be on to something. What do you think?
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