The Misuse of Placebos

Originally published in The Ottawa Citizen August 28, 2001

Attending a conference entitled The Scientific Review of Alternative Medicine, a number of physicians noted that the placebo effect was a very powerful force and motivator with respect to the success of alternative medicine practices such as therapeutic touch, chiropractic, herbal remedies and the like. It was further implied that physicians underutilize the placebo effect in our medical practices. In fact, some vociferously contested that we should use the placebo effect as do Alternative Medicine Practitioners (AltMedists) regardless of the therapies’ efficacy so long as it will help our patients.

For a group of scientifically literate people, I was surprised by this attitude. On the surface this argument sounds reasonable. What are the implications of implementing these treatments into our practice? I have reservations regarding the use of the placebo effect in this manner to bolster claims that a particular therapy is valid.

If we accept every claim at face value and give others the benefit of the doubt, despite the good intentions inherent in the action, we condone a slippery slope towards anarchic feel-good approaches to scientific problems. In that light, several people mentioned that some practices have existed for centuries and therefore had to be considered on an equal footing with scientific medicine. The length of time something is practiced does not justify that it is valid. For example witch hunts, slavery, blood-letting and cupping were commonly practiced and accepted in their time.

I think it is more reasonable to say to our patients that we do not have all the answers at this time but we will work hard to figure things out. We should not substantiate beliefs in extraordinary claims or miracle cures without the requisite proof. Extraordinary claims require extraordinary proof.

Scientific medicine is consistently challenged and responds by rethinking the way things work. It tests new hypotheses and discards old accepted notions when the evidence demands it. Scientific Medicine grows and develops with time.

Alternative Medicine is stagnant. It resists challenges because it is based on dogma or on the ideas of a few who were/are convinced they were/are right using unsubstantiated or unproven claims. Yet alternative medicine ridicules us for being dogmatic and unyielding because we dare ask questions and evidence of proof! We tend to fall into the trap of relativism, giving equal consideration to claims no matter how outrageous.

I do not want to be duped or fooled by anyone. If I am to provide consistent reliable information to my patients, my skepticism respects their integrity. My ability to separate out the proven from the unproven gives me the opportunity to evaluate potential benefit or harm to my patients. No one wants to be placed in a position of having provided or recommended a therapy to a patient that can be harmful. I disagree with the idea that boosting or augmenting the placebo effect is not harmful to our patients. One of the most important tenets of the doctor-patient relationship is the contract for trust. We do not lie to our patients. If we do not disclose to our patients what we are doing and why a therapy may or may not work (based on the evidence at hand) we nullify their right to self-determination and we show great disrespect. If we talk about therapeutic benefits placebo or otherwise, I do not know anything more disruptive to this effect then this destruction of trust

As physicians and scientists we need not apologize to others under the guise of relativism for insisting that therapeutic practices or modalities require concise thorough scientifically based evidence before subjecting them to a priori practices. It is a standard that insures the best possible measure of safety for our patients. In this manner, we can provide evidence-based information to our patients. It is then up to the patient to make up their minds and select the best possible alternatives and therapies for themselves.

If we state that there is not enough data to suggest, for example, therapeutic touch is of unlikely benefit to patients, by what standard and measurement does one use to prove validity? A common standard must exist to effectively compare therapeutic modalities. If some other method of measurement is needed, then propose it. However it must conform to known physical laws unless there are some new ones that have yet to be elucidated. It must be consistent and provide reliable data every time it is used and not devised as a superset of laws for each branch of alternative medicine.

AltMedists invariably use pseudoscientific jargon to “prove” their therapies work. They accuse critics of being stodgy Western thinking conservatives. Ad hominem attacks are irrelevant when trying to prove or disprove a point. Does not their use of jargon illustrate the language of science is indeed important when making claims?

© Dr. Barry Dworkin 2001

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